Families and Elder Care in the 21st Century

Marie Ellsworth                                                          Five Key Points for Chapter 13

1. One of the important points I found was the criteria by which policies vary and the cost of such programs.  Eligibility criteria are usually based on age or the degree of need. Programs that play very important roles in maintaining wellness and providing access to health care in the lives of elders are Social Security and Medicare.  Federal expenditures for these programs are growing as the aging population grows.  Based on the Center on Budget and Policy Priorities in 2013 showed that the combined usage of tax dollars towards Social Security and Medicare rounded to about 43 percent.  I thought it was important to note that although some people complain that the budget for these programs is becoming a burden, that funding for defense is growing much faster in comparison.  The benefits of these programs are vital to the lives of most elders and are vital to wellness.  Older people receive these benefits based on their lifetime contributions as worker into these public insurance systems.  Contrary to what the media may imply, such programs as SSI or Medicare are not a “free ride.”  (Page 359)
2.  Another important point debate on the role of government versus individual responsibility and how values affect social policy.  In the United States, two contrasting core values regarding responsibility are reflected in many current debates.  First, individual welfare is essentially the person’s responsibility, based on self-determination and personal choice.  Second, individual welfare is the responsibility of both the person and the community.  In Scandinavian countries, public policies benefit citizens from “cradle to grave”, including free health care and benefits that help people throughout the lifespan.  Indeed there is much debate in the U.S. political climate about the role of government versus individual responsibility in promoting health.  (Page 359-361)
3. Another point that is important is the proposed changes paying for the costs of social security, by privatization or by other means.  Privatization is a fundamental shift from universal government protection to individual responsibility.  However, privatization would not ensure coverage for younger groups of children whose parents die or adults who become disabled.  This method would also disproportionately negatively impact low income workers, including women and minorities.  Privatization would however benefits higher income, unmarried workers.  There are other proposed strategies include raising the cap on the amount of wages and salaries subject to payroll taxes and expanding the number of workers paying social security taxes, such as government employees.  It is important to look at the pros and cons of the methods being considered to extend full solvency of the Trust Fund beyond 2033 while maintaining adequate benefits to those in need.  (Page 367, 368)
4. Another key point I noted was about some of the info provided about Medicare and the extent of coverage.  Medicare, or Title XVII of the Social Security Act of 1965, is a social insurance system based on the age available to all adults age 65 and older.  Beneficiaries earn access by virtue of paying payroll taxes throughout the years of employment, similar to social security.  Prior to its passage, only about 50 percent of elders had health insurance.  It is intended to provide financial protection for the costs of acute care by hospitals and physician visits.  Medicare does not provide full coverage for medical care; only 80 percent of the cost of the care provided is covered, while the person is required to pay the difference.  To make up for the difference, there is supplemental Medigap insurance that covers some of the cost of intensive care, dental care and eye exams, while not covering some the services elders want most- home care and skilled nursing home care.  Making long term care more affordable in the future is an important area that needs to be addressed, especially as the elder population becomes older and larger in numbers.  (Page 372, 373)
5. The last important point to discuss was the benefits of the recent health care reform for older adults.  While the ACA focused on providing coverage to younger populations, the aca benefited older adults as well.  Most of the act’s benefits for older adults are orientated to using incentives to reduce hospital admissions, emergency room visits and admission to skilled nursing facilities.  Essentially, in preventing hospitalization and improving coordination of acute care providers with some provisions of home and community based services. The ACA will now require these insurance companies to spend more on patient care rather than profits or overhead.  There were many misrepresentations by politicians in the media about the ACA reducing Medicare.  The only cuts to Medicare are eliminating the federal subsidy per enrollee in Medicare Advantage. (Page 384, 385)

Name of Peer Reviewed Article: “Families and Elder Care in the 21st Century.”

Author(s): A. Bookman, D. Kimbrel