Medicare Advantage Sticker Shock

Wow.

I just received my Presbyterian Senior Care (Medicare Advantage) Notice of Changes for 2014.

Ee-yikes!

My co-pays are going wayyyyy up. Many have doubled, others are up 50%-70%. These are huge increases for people on limited incomes, though Presbyterian claims that the maximum out of pocket expense for patients on this plan will only go up by $400 -- which still isn't chicken feed for a lot of folks.

I assume this is happening because some of the excessive payments and reimbursements for Medicare Advantage providers are being reduced, and so the providers seek to recover from their patients. I don't know though.

We had no warning, no hint at all that co-pays were going up so steeply.

Of course even with these increases, out of pocket expenses are still a good deal less than with Medicare alone, there's no additional charge for drug coverage (though the co-pays are much higher than they were), and all in all, except for some higher rates for the first three days of hospitalization, patient co-pays are similar to or lower than the Kaiser coverage we had in California -- that cost $800 a month.

We're lucky enough to be able to pay these higher costs, but what of old folks who are just able to handle the out-of-pocket costs imposed by Presbyterian now but do not have -- and won't have -- an additional $400 for medical care? They're not poor enough for Medicaid, but don't have any additional flexibility in  their budgets, either. What are they supposed to do?

(I can hear it now: "Do you really need a dog? What you pay in dog food alone, not to mention the vet and stuff, would easily pay for the higher medical co-pays. Priorities. You know?")

It's gonna be a tough year for a lot of folks come January.

Here We Go

Noises out of the White House and Congress, funneled through their ever reliable water-boy Ezra Klein (as well as many others), tell us that a Fiscal Cliff Deal is nigh, and one of its components is the adoption of the so-called "chained CPI" for calculating Social Security benefits (and possibly other Federal benefits) going forward.

In other words, a cut in future benefits.

It's not a trivial cut, either, as Social Security recipients have already felt the economic blow of low or no COLAs since the advent of the Permanent Recession (for you), while prices of goods and services used by seniors have continued to rise at a smart clip and profits to providers have never been higher.

The chained CPI assumes seniors can just substitute lower priced goods and services, and will do so, when their accustomed goods and services become more expensive, as they will. Ergo, the cost of living index need not reflect the full cost increases faced by older people. It can be jiggered in such a way that COLAs are diminished year by year, cumulatively, such that old folks will receive an ever lower monthly benefit than they would under the current, let alone an appropriate, cost of living index -- which is itself wholly inadequate.

Of course the tragedy in Newtown has consumed most of the attention lately, and with Christmas coming up shortly, there will be little opportunity for the public to consider and digest, let alone oppose, this move to put even more of the forever economic burden on the old, the sick, the halt, the lame and most especially the poor.

Oh, and supposedly, the White House is prepared to agree to the expiration of the payroll tax cut on workers come January. Now, the payroll tax cut was not a very good idea to begin with, but once it was instituted, the the $60-100 a month it provided to households for immediate spending rather than for future retirement became the difference between getting by for the moment and falling off the household fiscal cliff. Millions of households are being forced into poverty every year as it is; the moves to cut benefits and raise taxes for those least able to absorb further economic blows simply ensures more poverty and suffering in America in the future.

Of course, the correct approach is to raise benefits -- substantially at the lower end, not so much at the higher end -- lower the retirement age (55 or lower), provide Medicare for All (eliminating private profit health insurance companies), and establishing a full employment policy, putting everyone who can work to work in peacetime endeavors to repair and rebuild America's crumbling infrastructure while transforming America's energy regime.

All of this and more is doable, should have been started years ago, and as time passes is farther away than ever. Our Ruling Class simply has no intention of allowing any such thing in the near future, either.

We are locked in a political prison with no apparent escape...

But at least we're not Greece! Yay!

Driving Across the West on a Holiday Weekend

As I was driving west on the I-40 this past weekend, I was playing the radio as I tend to do when I'm driving, and I heard this song, called "Cost of Livin'" come up on one of the Country Top 40 programs. It's Ronnie Dunn's new single, follow up to his solo hit, "Bleed Red," and I have to confess, I was stunned almost speechless by it.

You're seeing him do it live in the video above, and it's quite rough -- which may be even more effective given the subject matter -- but the version released as a single is very polished... and completely heartbreaking.

There once was a time when country music had lots of Outlaw song and Outlaw performers as part of the culture being celebrated. But that's no longer the case, and it hasn't been for quite a while. Instead, the genre is dominated by "I know my place, and I HAPPY with my place! HAPPY!" songs that are kind of stomach turning when you think about it. The whole point of these songs is to make sure the underclass, specifically the redneck Stars 'n' Bars underclass, stays tame in the midst of so much suffering for the masses.

And this song, "Cost of Livin'," fits into that category nicely.

Until you listen to it.

And then if you don't feel the need to do something about the horror that people are being put through -- or slit your wrists in despair -- I would wonder if you really have any sense of another's pain, lack of dignity, and reduction to abject submission.

The lyrics:

Everything to know about me
Is written on this page
The number you can reach me
My social and my age
Yes I served in the army
It’s where I learned to shoot
Eighteen months in the desert
Pourin’ sand out of my boots
No I’ve never been convicted of a crime
I could start this job at any time.

I got a strong back
Steel toes
I rarely call in sick
A good truck
What I don’t know
I catch on real quick
I work weekends
If I have to
Nights and holidays
Give you 40
And then some
Whatever it takes
Three dollars and change at the pump
Cost of livin’s high and goin’ up.

I put Robert down as a reference
He's known me all my life
We attend the same church
He introduced me to my wife
Gave my last job everything
Before it headed south
Took the shoes off of my children's feet
The food out of their mouths
Yesterday my folks offered to help
But they’re barely getting by themselves

I got a strong back
Steel toes
I rarely call in sick
A good truck
What I don’t know
I catch on real quick
I work weekends
If I have to
Nights and holidays
Give you 40
And then some
Whatever it takes
Three dollars and change at the pump
Cost of livin’s high and goin’ up.

I'm sure a hundred others have applied
Rumor has it you're only takin' five

I got a strong back
Steel toes
I'm handy with a wrench
There's nothing I can't drive
Nothing I can't fix
I work sun-up to sun-down
Ain't too proud to sweep the floors
Bank has started calling
And the wolves are at my door
Three dollars and change at the pump
Cost of livin’s high and goin’ up.

Before I left New Mexico this time, I was yakking with neighbors who were having a yard sale -- trying to sell off practically all the remaining contents of their house before they sell the house too. They've been having yard sales every few weeks for a year. They put the property on the market a few months ago and they just reduced the price to what the bank has said they will accept, which is considerably less than they owe. They say they have not had an offer yet, but they are hoping that an older couple from further out of town will buy their house so as to live close in. It will be a little less expensive for them, too. It may seem like these are small things, selling off your stuff, your house, your spare car -- what really got to me was that Walter was selling off his Gibson guitar, a beautiful Les Paul Signature, something he's treasured for years, and something you just don't sell lightly. Nor is it that they are poor, nor have they fallen completely out of the middle class... yet. No, they've been maintaining two households, one in town (ie: Albuquerque) where the jobs are -- such as they are, and I'll get to that in a moment -- and one out in the country where the kids have been going to school. But the oldest daughter just graduated from high school, and the cost of the commute back and forth, together with the cost of maintaining two households was just too much. (Believe me, I understand!) Something's got to give. So, they're... liquidating their assets in the country. To say they've been somewhat disappointed with results is to be kind.

Meanwhile, before I left New Mexico this time, I was yakking on the phone with a former neighbor who moved into Albuquerque a couple of years ago when she was offered a free-rent house-sitting gig for a University couple who were going on sabbatical overseas. She still comes out to our place in the country from time to time to feed the feral cats she was taking care of before she moved. But it's getting harder and harder what with the cost of living and the fact that she has to pay rent now, and so many other things have gone wrong -- she was in a terrible accident on the freeway, injured and her truck was totaled, among so many other incidents -- and now she was telling me that her employer is cutting back, letting go 7 people last week, more likely soon, and everyone else has had their work cut by one day a week for the last two months. Naturally she's scared.

We were talking about all the news of "good times" coming back to New Mexico, but for whom exactly would that be? Not for the masses, not a bit of it, not at all. Things are getting worse. She said her son just found a job, at half the salary he was making before. He'd been out of work for two years before landing this position, and he feels lucky to have a job at all.

There is no economic recovery for the many; and in New Mexico, the difference between the many and the few is stark and very visible.

Ronnie Dunn has a house up in Santa Fe, up off of Hyde Park Rd, a beautiful spread with a expansive view of the city lights below and the Jemez (burning) to the west. Down below, the working people, if they can find a job at all, look up to the houses of the High and the Mighty dotting the hillsides all around the town and think, "Gee, it must be nice."

Yeah, well. I'm sure it must. Happy Fourth.