Unsilent Generation

Entries categorized as ‘disability rights’

Quadriplegics and Geezers Deemed Too Dangerous to Release from Prison

April 8, 2010 · Leave a Comment

A quadriplegic could be a threat to public safety if release from prison. At least, that’s what the California Board of Parole Hearings (BPH) concluded when a prisoner requested compassionate release.

Steven Martinez, convicted of several violent felonies, had served three years of a 157-year sentence when he was stabbed by another inmate. His spinal cord was severed, and he was permanently paralyzed from the neck down. Despite his physical condition, the Parole Board denied his request– citing his violent past and verbal threats he had made since he was rendered quadriplegic–and said that he must remain incarcerated indefinitely.

According to the blog Lowering the Bar (which specializes in reporting on legal absurdities) this week a California state Court of Appeals more or less agreed with the Parole Board. In Martinez v. Board of Parole Hearings, the Appeals Court decided that the case should be “returned to BPH because it did not explicitly articulate” the facts on which the Board had based its decision. Yet the Court found that such a threat was “conceivable.”

On Legal Blog Watch, Bruce Carton writes about the Court’s opinion, in which a dissenting judge faces off against the majority over what Carton dubs “the ‘dangerous quadriplegic’ doctrine.”

The majority opinion cited four cases to show that “quadriplegics can commit violent crimes.” Among these  was one case where “a quadriplegic confined to a wheelchair thought his bride of two weeks was cheating on him and killed her by firing a pistol using a string in his mouth.”

The dissenting judge responded that “with the help of a good Internet search engine, you can prove anything, including that pigs can fly.” He then proceeded to cite several stories in which they did just that (with the help of a trampoline or an airplane–but still). The judge concluded:

[T]he majority’s citation of these quadriplegic crime stories actually supports my argument. Thus the majority’s four accounts are drawn from the entire country and span a period of 38 years–from 1972 to the present. I am sure that if there were more stories of this ilk, the majority would have found them.

Four stories in the country in 38 years is darn few. Indeed, the stories are written and reported because the commission of serious crimes by quadriplegics is so rare and bizarre that they are newsworthy. Thus I am willing to take the risk that petitioner Martinez will fire a pistol with a string in his mouth. Indeed, given the hundreds of thousands of dollars that Martinez is costing the State each year, it is a risk that we all must take.

California’s compassionate release program was in large part designed to save money, in a cash-strapped state that has the nation’s largest population of prisoners, and spends $8 billion a year to incarcerate them. But the Parole Board’s response–and the Court’s–show why even crippling state budget crises do not necessarily lead to more sensible corrections policies.

The same is true when it comes to the growing numbers of old inmates languishing in U.S. prisons due to longer sentences and harsher parole policies. Jonathan Turley, who founded the Project for Older Prisoners, has written that in assessing risk factors for parole or early release, “the most reliable is age. As a general rule, people become less dangerous as they age. In males, the greatest drop in recidivism occurs around age 30 and tends to continue to fall.” At the same time, “because of maintenance and medical costs, the average cost of an older prisoner is two to three times that of a younger prisoner.”

A report on the subject released earlier this week by the Vera Institute of Justice recommends more use of early release for older prisoners who present a low risk to public safety. But if a quadriplegic is deemed dangerous, can anyone ever be “low risk”? According to an article about the Vera study on The Crime Report:

At the end of 2009, 15 states and the District of Columbia had provisions for geriatric release, but jurisdictions rarely use them. Four factors help explain the difference between the stated intent and the actual impact of geriatric release laws: political considerations and public opinion; narrow eligibility criteria; procedures that discourage inmates from applying for release; and complicated and lengthy referral and review processes.

Last year, I wrote a two-part article for The Crime Report about the “Graying of America’s Prisons,” citing many cases in which states denied early release to elderly prisoners–even ones who showed ample evidence of rehabilitation. (You can read it here and here.) In many cases, these same inmates would have been out long ago had their crimes preceded the draconian sentencing boom of the last 30 years.

The fact that so many states refuse to seriously consider releasing prisoners who are rendered virtually harmless by age, sickness, or disability suggests that our prison policies have less to do with protecting public safety, and more to do with the politics of punishment and the psychology of retribution.

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Categories: Aging Behind Bars · disability rights · financial crisis / recession · health care · legal issues · prisons / criminal justice · public safety
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War Wounds: VA Ignores an “Epidemic” of Veteran Suicides

November 11, 2009 · 1 Comment

This Veterans Day, tributes continue for the 13 soldiers killed last week at Ford Hood, gunned down by one of their own. It was a shocking and terrible event, which warranted the outpouring of sorrow it inspired. Yet every single day, on average, more current and past members of the U.S. armed services die by their own hands than were killed on November 5 at Fort Hood.

According to the Department of Veterans Affairs’ own calculations (which it tried to conceal from a CBS News probe, and from the public), there are “about 18 suicides per day among America’s 25 million veterans.” That’s well over 6,000 a year. In addition, the VA admits that “suicide prevention coordinators are identifying about 1,000 suicide attempts per month among veterans we see in our medical facilities.” Rates are highest among young men in their twenties, veterans of our current wars. And these numbers do not include suicides by active duty members of the military. In 2008, these numbered nearly 250 (Army 128, Navy 41, Marines 41, Air Force 38)–five every week.

There are no public outpourings of grief for these servicemen and women, whose deaths must often have followed prolonged suffering from PTSD, traumatic brain injury, depression, or plain old despair. There are no weeks of nonstop media coverage, no tributes at Veterans Day parades, and no memorial services with eulogies by the president. In fact, it has been a longstanding policy that the families of soldiers who commit suicide do not even recieve a letter of condolence from the president.

At best, there are sporadic news reports noting the high rates of suicide, and the occassional Congressional hearing. And while increasing lip service has been paid to improving mental health care for veterans, in reality, the VA has set up multiple obstacles to such care.  As The Nation reported last year, the VA has delayed or denied disability and medical benefits to thousands of Iraq and Afghanistan veterans because they couldn’t “prove” that their conditions were “service-related.” In addition, ”a recent Inspector General report found that 70 percent of VA facilities don’t have a system to track suicidal veterans. Only a handful of VA hospitals have rehab programs that include families. And soldiers injured today face a benefits waiting list more than 650,000 veterans long.” One doctor in the VA’s leadership who publicly criticized these shortcomings was summarily fired.

Even the true statistics on veteran suicides would never have come out were it not for a class action lawsuit by Veterans for Common Sense (VCS) and Veterans United for Truth, who sued the VA in federal court. According to the veterans’ groups:

Many veterans who have fought in Iraq and/or Afghanistan, as well as those who served in earlier conflicts, are not being given the disability compensation, medical services and care they need. A much higher percentage of these veterans suffer with Post Traumatic Stress Disorder (“PTSD”) than veterans of any previous war, due to the multiple tours many are serving, the unrelenting vigilance required by the circumstances, the greater prevalence of brain injuries caused by the types of weaponry in use, among other reasons. Despite this, the Department of Veterans’ Affairs (“DVA”) is failing to provide adequate and timely benefits and medical care.

The judge who heard the case in federal district court in San Francisco–himself an 86-year-old veteran of World War II–said he was sympathetic to the plaintiffs’ cause, but he found against them. According to VCS, “In his decision, Judge Conti held that although it is clear to the Court that the VA may need ‘a complete overhaul’ the the power to remedy this crisis lies with the other branches of government.” In other words, if the VA can’t or won’t fix itself, it’s time for Congress and the White House to step up and do something about this travesty.

Categories: Congress · disability rights · health care · legal issues · media · mental health care · veterans
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The Secret World of Deaf Prisoners

October 2, 2009 · 1 Comment

The following is a special report written for The Crime Report, a publication that comes out of the Center on Media, Crime, and Justice at John Jay College for Criminal Justice, City University of New York.

In the 1970s, an antiwar demonstrator found himself at New York City’s Rikers Island jail facility for a couple of months on a disorderly conduct charge. The demonstrator, who happened to be a friend of mine, met a handful of young men from the Bronx in his unit who were deaf.

They were having trouble communicating with anyone but themselves. My friend knew a little sign language and, after a few conversations, discovered they were illiterate. With the idea of helping them improve their communication skills, he asked prison authorities for permission to order books on sign language from the publisher. The wardens refused, saying that they did not want anyone in that prison using a “language” they could not understand.

Things may have changed a little for the better since then. But not by much.

I first wrote about the deaf in the late 1960s in the New Republic and so I know something of the background which is what really informs this article. While researching stories about solitary confinement at Angola Prison for Mother Jones, I came upon an article in Prison Legal News about widespread violations against deaf prisoners. Remembering the people and culture I had caught a glimpse of in the 60s, I got in touch with the article’s author, McCay Vernon. Luckily he remembered my earlier writing, and promptly agreed to help me.

The letters quoted below are from deaf prisoners to different people in the “free world,” who are seeking to help them, to advocate their cause. I have disguised the advocates, prisoners and prisons to keep the inmates from getting reprisals—reprisals which they fear on a daily basis. You have to remember a deaf person can’t hear the chatter among other inmates, can’t hear the person sneaking up behind, is unintelligible in his cries for help during a rape.

The deaf face a nightmare when they fall into the criminal justice system. They live in a world apart to begin with; but in prison they are thrown into a dread new environment where they literally can’t understand the language of either their jailers or the other prisoners. When people who have never heard a spoken word try to speak, the sounds often come out jumbled and weird—leading ill-informed jailers to think they are obstreperous or crazy. As a consequence, some deaf prisoners can end up in solitary.

I discovered numerous examples of abuses and violations of the rights of deaf prisoners as part of an ongoing investigative reporting project. But the most troubling discovery I made was how little has been done about the problem in the criminal justice system—and how little is known about it outside prison walls.

No one knows exactly how many deaf prisoners there are in the U.S. Efforts by psychologists and other experts to find out have been largely unsuccessful. With few exceptions—the state of Texas apparently being one—no one counts the deaf or hard of hearing in most of the prison population.

But according to two researchers, as many as one-third of the entire U.S. prison population of 1.7 million have difficulty hearing—with some of them being profoundly deaf. The researchers, Prof. Katrina Miller of Emporia State University in Kansas, herself a former corrections officer, and McCay Vernon, a psychologist whose late wife was deaf and who has worked within the prison community for years, believe it is long past time to seek help for this ignored segment of prisoners. Almost two-thirds of deaf prisoners, according to some studies, are in jail for violent and often sexual offenses committed against children. (The deaf are themselves at increased risk for abuse as children, the researchers point out.)

A person is hard of hearing if he/she has a 50 percent loss of hearing in one ear. Prisoners who are illiterate as well as deaf are especially deprived when they find themselves in the criminal justice system. The average person who is deaf and enters
prison has an educational achievement level of second grade, fourth month, As a consequence, they have  trouble reading and writing. Because they are deaf and without competent interpreters, they can’t go to AA meetings or drug counseling or make it through educational programs.

The abuses begin as soon as a deaf prisoner enters the criminal justice system and faces accusers in court. Often the hard of hearing and deaf can’t hear the charges against them, don’t know what the trial is all about. Later in prison they won’t understand why the guards are screaming at them. Nor will they hear the commands or orders, warnings,
announcements, etc. that come over the prison public address
system. If they are close enough to the judge and look hard at him, they can try to read his lips. But, as McCay Vernon points out, only 50 percent of spoken sounds can be translated into sign language.

On occasion, deaf persons will be given a court interpreter who knows sign language. But this can be a doubly frustrating experience: sign language can’t convey the special, often arcane lingo used by defense lawyers, prosecutors and judges. Most deaf people don’t read lips. The idea they can hear normally, or at least hear enough to act as if they can hear normally, is a myth of the hearing world, Vernon points out, noting that  ”fifty percent of the sounds of the English language  look just like some other sound on the lips, making  lipreading a tenuous task at best.”

 In prisons and jails around the country, there are few interpreters who are trained well enough in sign language.. Often other deaf or hard-of-hearing prisoners are recruited to help, but just as usually deaf prisoners are left with few resources when they are confronted with pitfalls and crises that are tragically common in today’s prison system.

One deaf prisoner wrote, for example, that when he sought help after a prison rape, the guards laughed at him. A hard-of-hearing inmate who requested a pair of headphones to listen to the radio was turned down by the warden, who said he had not filled out the papers correctly. A request for a vibrating alarm clock got a similar rejection.

When deaf inmates want to make a phone call using TTY—a method of typing out messages—the prison insists two guards must be in the room. To make matters worse, the deaf are restricted to the same amount of phone time as hearing prisoners, though it takes twice the time to type out the messages.

Such anecdotes illustrate that deaf prisoners are faced daily with violations of the Americans with Disabilities Act, which mandates equal treatment for deaf and other disabled persons. There is even a provision under the Act to pay attorneys additional sums to bring cases to correct inequities suffered by deaf inmates—a provision which, like other parts of the act, is honored mostly in the breach.

A twitter for these people isn’t just a vehicle for social networking, but a lifesaving device to communicate with the hearing world.

Complicating this situation, is the fact that the deaf community in general rarely goes to bat for peers who are in prison. As the mother of one deaf son, told me, “it makes them look bad.” Thus deaf prisoners are subject to a double isolation—from the prison community and from the larger community of their peers.

In a letter to a friend, one deaf prisoner wrote the following:

I have been lowered to nothing more than a beggar in order to stand up for something. I believe the deaf have a right too. But I tell you this…there is no help for us here…I am almost at the end of my rope and believe that before I submit this body to any form of sexual act in order to get legal work done, I will take my own life. There is no help for us here…Many nights I have stayed awake contemplating the end and only my fear in the Lord Jesus in not accepting me in heaven has kept me from that act.

Many many times deaf people raped and beat and no help from the officers. Hearing people steal our things…when we try to talk to officers, they just laugh. So hard for us. Many, many times I just want to die but have Jesus in [my] heart…Now one day at a time. Pray every day to help other deaf.

This letter is signed with the drawing of a small, round smiling face and the words, “Deaf and proud.”

Categories: disability rights · legal issues · prisons / criminal justice
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Prisons Becoming Warehouses for the Old

July 25, 2009 · 4 Comments

AGING BEHIND BARS SERIES

I have written hefore about the aging population in American prisons and jails, due in large part to the draconian sentencing policies of the courts, federal, state, and local. As a result these places seem destined to become nursing homes surrounded by razor wire.  

Angola prison in Louisiana, for instance, boasts that some 90 percent of its population will die there. The prison has managed to equip itself with a hospice, and trained inmates to attend to a convict’s last days. Burl Cain, the warden, is backed up by a phalanx of Christian fundamentalist preachers who freely roam the 18,000 acre former slave plantation recruiting inmates to be preachers. The clergy instruct  prisoners their only way out is through redemption made possible by the  acceptance of Jesus Christ. When an elderly inmate, knowing his end was near, sought to be win release so as to die in the so-called “free world,” the parole board refused. The procedure is to go to your death in the Christian way–from cell to hospice to a prison cemetery where your grave will be dug by the inmates who will mark your bruial with gospel hymns

 The travesty at Angola is held up as a model  for the nation and Cain celebrated by the media  as a new corrections messiah. Elsewhere,old,sick people,piled into these living tombs by the courts, stand in line for hours to get an aspirin; arthritic old women  are made to climb into upper bunk beds.Parapalegic men are denied canes, which are ruled to be weapons, and instead must crawl to the toilets.People are locked in solitary for years. Mentally ill convicts who act out in the general population are put into solitary because they howl and scream in public.  Locked down, they go truly mad. Old sex offenders can be released into the hands of friends or family. but often noone wants them, so they are released to the county jail, reindicted, and sent back to prison.

The American public is  up in arms about  CIA jails in far away places. But it  could care less about American prisons. Now a new report by the Sentencing Project in Washington adds to the growing body of information about  prisons here at home. No Exit: The Expanding Use of Life Sentences in America contains, among other things, the first nationwide collection of life sentence data documenting race, ethnicity and gender, and reveals “overwhelming racial and ethnic disparities in the allocation of life sentences”: 66% of all persons sentenced to life are non-white, and 77% of juveniles serving  life sentences are non-white.

  The the report’s key findings:

140,610 individuals are serving life sentences, representing one of every 11 people (9.5%) in prison. Twenty-nine percent (41,095) of the individuals serving life sentences have no possibility of parole.

The number of individuals serving life without parole sentences increased by22% from 33,633 to 41,095 between 2003 and 2008. This is nearly four times the rate of growth of the parole-eligible life sentenced population.

In five states—Alabama, California, Massachusetts, Nevada, and New York—at least 1 in 6 people in prison are serving a life sentence.

The highest proportion of life sentences relative to the prison population is in California, where 20% of the prison population is serving a life sentence, up from 18.1% in 2003. Among these 34,164 life sentences, 10.8% are life without parole.

Racial and ethnic minorities serve a disproportionate share of life sentences. Two-thirds of people with life sentences (66.4%) are nonwhite, reaching as high as 83.7% of the life sentenced population in the state of New York.

 There are 6,807 juveniles serving life sentences; 1,755, or 25.8%, of whom are serving sentences of life without parole.

Seventy-seven percent of juveniles sentenced to life are youth of color.

There are 4,694 women and girls serving life sentences, 28.4% of females sentenced to life do not have the possibility of parole.

Categories: Aging Behind Bars · death / end of life care and choices · disability rights · health care · legal issues · mental health care · prisons / criminal justice
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Old Prisoners Denied Their Social Security

July 21, 2009 · 4 Comments

AGING BEHIND BARS SERIES

From time to time, I’ve written about the growing numbers of older prisoners now filling up the country’s prisons and jails, in a series of posts called Aging Behind Bars. Many of these prisoners receive inadquate health care and are subject to special forms of cruel and inhuman punishment that have to do with age–i.e. requiring people with bad arthritis to climb to the upper bunk to sleep, or making it next to impossible for inmates in wheelchairs to access parts of prisons available to younger people, even including something as simple as handicapped showers. Among the worst incidents described to me by a medical consultant were ill women forced to get out of bed at 3 am,then stand in lines to obtain medicine in one Alabama women’s prison.

Older prisoners are also often denied the Social Security they earned for years before being convicted of a crime. Lois Ahrens, who runs the indispenable Real Cost of Prisons Project, alerted me to the situation of David Hinman, a prisoner in Iowa. Now 65, he contributed to Social Security for years while he was in the “free-world.” He is not eligible for parole for a number years. Hinman writes:

Currently the government will not pay people in prison social security. I am speaking about paying social security to those who paid into the fund. Payment is based on what they paid in. Even though I am now 65 and paid into the fund, since I am in prison I am not allowed to collect unless I am released from prison. By not paying inmates the social security to which they are entitled, I believe this is in some manner, theft.

My question to readers is: should prison inmates who paid into social security and reached 65 be allowed to collected social security while incarcerated or not.

(You can write to David Hinman, #25374, Anamosa State Penitentiary, 406 North High Street, P.O. Box 10, Anamosa, IA 52205-0010.)

Asked about this situation, Paul Wright, editor of Prison Legal News, the excellent magazine which tracks prison issues, wrote me:

Part of the problem I have with this is that someone can work their whole life, pay into Social Security, commit a crime at a later age, and go to prison for the rest of their life and never see a penny of the money they paid into SS. The lie used to justify this is prisoners have no need for money but that is not true. I think it is a backdoor way to trim the SS rolls. I think this is the exception. To put it into context, retirees can get their pensions in prison, veterans can get their VA benefits in prison. It follows that if you earn something you are entitled to it. It is not a freebie the government can take away because it doesn’t like you and that is exactly what they do here.

Wright attached an article from a 1998 isssue of Prison Legal News, describing a federal court decision on the subject, that sets the situation into the bleakest of terms.

The court of appeals for the Ninth circuit held that a statute denying Social Security benefits to prisoners is constitutional. Robert Butler is a 77 year old Nevada state prisoner. Butler was granted social security retirement benefits in 1983. He was later incarcerated and the Social Security Administration (SSA) determined he was not entitled to benefits while he was incarcerated pursuant to 42 U.S.C. § 402(X). An administrative law judge affirmed the SSA’s decision. Butler filed suit in federal court and it was dismissed for failing to state a claim upon which relief could be granted. The court of appeals affirmed. The appeals court noted that every court to consider the constitutionality of 42 U.S.C. § 402(X), this includes the Second, Fourth, Eighth, Tenth and Eleventh circuits, had upheld the law. Congress has wide discretion in administering welfare resources. The court held that § 402(X)’s ban on social security benefits to prisoners does not violate constitutional guarantees to due process, equal protection and protection against ex post facto laws and bills of attainder. The court also held that Butler was provided with ample due process before his benefits were terminated because he participated in the SSA hearing by telephone. Since the statute leaves no room for agency discretion and the only fact issue was whether or not Butler was a felon doing time in prison, the telephone hearing was sufficient to safeguard Butler’s due process interest in his social security benefits. See: Butler v. Apfel , 144 F.3d 622 (9th Cir. 1998).

Categories: Aging Behind Bars · Congress · Social Security · age discrimination · disability rights · health care · legal issues · pensions / retirement funds · prisons / criminal justice
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Ted Kennedy and Peter Singer on Health Care

July 20, 2009 · Leave a Comment

Conservatives are now moving to block Obama’s modest health reform (miniscule to many of us) by charging his socialist government is out to ration health care, deciding who is to live and who is to die through bureaucratic decision-making.

William Kristol in a Weekly Standard blog post yesterday seizes upon a paragraph in Ted Kennedy’s powerful, emotional plea for health care reform–including a modest public option–in the current Newsweek to claim he’s into rationing. Here is a key excerpt from Kennedy:

We will bring health-care reform to the Senate and House floors soon, and there will be a vote. A century-long struggle will reach its climax. We’re almost there. In the meantime, I will continue what I’ve been doing—making calls, urging progress. I’ve had dinner twice recently at my home in Hyannis Port with Senator Dodd, and when President Obama called me during his Rome trip after meeting with the Pope, much of our discussion was about health care. I believe the bill will pass, and we will end the disgrace of America as the only major industrialized nation in the world that doesn’t guarantee health care for all of its people. … In the last year, I’ve often relied on that Congressional insurance. My wife, Vicki, and I have worried about many things, but not whether we could afford my care and treatment. Each time I’ve made a phone call or held a meeting about the health bill—or even when I’ve had the opportunity to get out for a sail along the Massachusetts coast—I’ve thought in an even more powerful way than before about what this will mean to others. And I am resolved to see to it this year that we create a system to ensure that someday, when there is a cure for the disease I now have, no American who needs it will be denied.

Kennedy’s piece is worth reading in full. I can’t find an argument for rationing health care anywhere in it, but if you can, please drop me a line and tell me where.

We all know the U.S. already rations health care, by denying insurance coverage to the poor and lower middle classes, by forcing people without insurance to wait hours in emergency rooms, limiting treatment for anyone who doesn’t have the kind of Cadillac insurance that comes mostly with high-paying jobs, allowing pharmaceutical companies to charge exorbitant prices for drugs—so high in many cases people just stop taking them. And in the current debate, politicians want to add to that rationing by cutting back Medicare, which the only thing close to a fair, classless, single-payer system the United States has ever seen.

The subject of rationing is a tricky one, but if you want to get into it, you might start with Peter Singer’s article in Sunday’s New York Times Magazine. I know Singer from his work on animal rights. As I’ve written before, as an old person I’m not keen on the implications of things like QALYs–which stands for “Quality Adjusted Life Years”–might have in the wrong hands.  (Advacates for the disabled have criticized Singer on the same grounds.) But Singer’s piece is valuable for pointing out that even the most bureaucratic and “socialistic” government-run system manages better, fairer delivery of health care than we do. His ideas also bring the plain fact of income-based health care rationing out of the shadows, which is where opponents of reform would like to keep them. Here is an excerpt from Singer’s conclusion:

Rationing public health care limits free choice if private health insurance is prohibited. But many countries combine free national health insurance with optional private insurance. Australia, where I’ve spent most of my life and raised a family, is one. The U.S. could do something similar. This would mean extending Medicare to the entire population, irrespective of age, but without Medicare’s current policy that allows doctors wide latitude in prescribing treatments for eligible patients. Instead, Medicare for All, as we might call it, should refuse to pay where the cost per QALY [a method of assessing cost benefit] is extremely high. (On the other hand, Medicare for All would not require more than a token copayment for drugs that are cost-effective.) The extension of Medicare could be financed by a small income-tax levy, for those who pay income tax — in Australia the levy is 1.5 percent of taxable income. (There’s an extra 1 percent surcharge for those with high incomes and no private insurance. Those who earn too little to pay income tax would be carried at no cost to themselves.) Those who want to be sure of receiving every treatment that their own privately chosen physicians recommend, regardless of cost, would be free to opt out of Medicare for All as long as they can demonstrate that they have sufficient private health insurance to avoid becoming a burden on the community if they fall ill. Alternatively, they might remain in Medicare for All but take out supplementary insurance for health care that Medicare for All does not cover. Every American will have a right to a good standard of health care, but no one will have a right to unrationed health care. Those who opt for unrationed health care will know exactly how much it costs them.

It is common for opponents of health care rationing to point to Canada and Britain as examples of where we might end up if we get “socialized medicine.” On a blog on Fox News earlier this year, the conservative writer John Lott wrote, “Americans should ask Canadians and Brits — people who have long suffered from rationing — how happy they are with central government decisions on eliminating ‘unnecessary’ health care.” There is no particular reason that the United States should copy the British or Canadian forms of universal coverage, rather than one of the different arrangements that have developed in other industrialized nations, some of which may be better. But as it happens, last year the Gallup organization did ask Canadians and Brits, and people in many different countries, if they have confidence in “health care or medical systems” in their country. In Canada, 73 percent answered this question affirmatively. Coincidentally, an identical percentage of Britons gave the same answer. In the United States, despite spending much more, per person, on health care, the figure was only 56 percent.

Categories: Congress · age discrimination · death / end of life care and choices · disability rights · health care · health insurance industry
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Credit Card Companies Snatch Social Security Payments

April 28, 2009 · 16 Comments

Holes are appearing every day in our so-called safety net, as state and local governments, in particular, are forced to cut back on public programs. But even amidst all the budget cutting, most elders and disabled people probably feel that their monthly Social Security checks are something they can count on. Having escaped attempts at privatization under Bush, Social Security might appear secure, at least in the short term.

Maybe not. As New America Media* reports, debt collectors for credit card companies and other creditors are  now going after Social Security payments, which are supposed to be exempt from garnishment in such situations. Their tactics include freezing the bank accounts into which a beneficiary’s Social Security checks are direct-deposited. When this happens, often without warning, old and disabled people find themselverobber_011 suddenly without the resources to buy food and medicine, which can trigger a desperate medical crisis.

That’s right. The meager amounts deposited into our accounts by the Social Security Administration, which many older people now must rely on more than ever before because of layoffs, the real estate crash, and the 401k collapse, are being illegally siezed, often by the very same companies that brought on the crisis in the first place–the big banks and other financial institutions that issue loans and credit cards. After taking in billions in public stimulus funds, they are wringing out every last dime by going after these public pensions, which are supposed to be protected. When you read stories about how Wall Street is relaxing with the comeback of high pay and big bonuses, think about this:

Margot Saunders of the National Consumer Law Center estimates that “tens of thousands of people every month,” who are elderly or disabled, are being forced into dire financial circumstances. Bank account freezes and illegal garnishments of exempt funds, including veterans’ benefits, are shredding safety nets. In her 2008 testimony before a House Ways and Means Subcommittee on Social Security, Saunders included a long list of stories…..

According to SSA, its payments provide baseline financial solvency for 13 million Americans, who would otherwise be in poverty. However, a 2008 report by SSA’s inspector general, estimated that direct-deposit beneficiaries across the United States have incurred $177.7 million in total garnishments. The report did not attempt to estimate the near incalculable damage of bank account freezes.

Bank account freezes are designed to prevent account holders from withdrawing funds before creditors can collect on legal claims. Debt collectors, though, often file claims on exempt accounts.

“The freeze creates a hostage-like situation where the creditor can wait out the debtor by demanding payment,” said attorney Johnson Tyler, director of the Social Security/Consumer Rights Unit at South Brooklyn Legal Services.

Tyler explained that often consumers don’t know SSA funds are exempt and agree to make payments to have the freeze lifted, so they can access their accounts. He suggested the problem might be worse in communities where limited proficiency in English is common.

The story includes the account of one 60-year-old disabled man, recovering from open heart surgery and dependent upon his monthly Social Security, who went to fill his prescriptions one day, only to find that his Washington Mutual bank account had been frozen because he owed money on an old credit card bill. (Think about it: You know that without the medicine you’ll probably die. What would you do? Would you beg on the streets? Or maybe go for some poetic justice, and rob a bank?)

While these illegal efforts to steal exempt funds (which also include SSI, veteran’s benefits, and unemployment insurance) have been going on for some time, they are bound to be increasing with the recession: While more and more people find themselves hard pressed to pay their bills, a couple of trillion in taxpayer funds doesn’t seem to have bought any mercy from the bailed-out banks.

*This story reflects the new “Ethnic Elders” and “Elders News Roundup” initiatives being run by Paul Kleyman at New American Media, a unique news organization that both aggregates material from the nation’s thousands of ethnic media outlets, and produces original content.  In its own words, NAM is “dedicated to bringing the voices of the marginalized–ethnic minorities, immigrants, young people, elderly–into the national discourse.”

Categories: Social Security · Wall Street / financial industry · disability rights · financial crisis / recession · health care · legal issues · pensions / retirement funds · poverty
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Reducing the Handouts to Privatized Medicare: A First Step

April 7, 2009 · 3 Comments

The Obama administation has taken an important first step toward cutting back what are basically a set of handouts to private insurers, embedded in the Medicare system. These government subsidies to private industry enrich insurance companies at the expense of taxpayers and beneficiaries.

The particular handouts in question come in the form of subsidies to so-called Medicare Advantage plans. As the Wall Street Journal reported on Monday:

The federal government made good on its plan to cut 2010 payments for private Medicare plans, whittling the subsidies to health insurers sooner than the industry originally expected.

The cuts, announced late Monday by the Centers for Medicare and Medicaid Services, are slightly less severe than the 5% reduction the federal agency signaled in February, but still raise concerns about what has been a critical source of profit growth for many health insurers. Reimbursements to private insurers that administer so-called Medicare Advantage plans would fall by as much as 4% to 4.5% next year.

Even the WSJ acknowledges that “Republicans during the Bush administration pushed the plans’ extra benefits for seniors and subsidies to insurers to promote more private-sector involvement in Medicare.” I described the genesis of Medicare Advantage plans in more detail in a post back in January:

Medicare Advantage (MA) plans–-which offer managed care run through private insurers, paid for by the federal government–-are the point of the stake that conservatives have long been trying to drive into the heart of traditional Medicare (which, for all its shortcomings, is the closest thing to a single-payer program that this country has ever seen). Columnist Saul Friedman recently wrote about the history of  of this effort, recalling a 1995 press briefing in which Dick Armey, Newt Gingrich’s collaborator on the “Contract With America,” announced their intent to “wean our old people away from Medicare.”  The first step was to introduce private Medicare HMOs–-what later evolved into Medicare Advantage plans, with a big boost from the Republicans’ 2003 Medicare bill.

MA plans have come under increasing fire for their hard-sell tactics to elderly Medicare recipients, shoddy coverage, and rip-offs of the public purse. “Competition” from the private plans was supposed to reduce growth in Medicare spending–but in fact, they cost the government more. A September report from the Commonwealth Fund calculated that “payments to MA plans in 2008 will be 12.4 percent greater than the corresponding costs in traditional Medicare–-an average increase of $986 per MA plan enrollee, for a total of more than $8.5 billion. Over the five-year period 2004-2008, extra payments to MA plans are estimated to have totaled nearly $33 billion.”

If the Commonwealth Fund’s figures hold true for this year as well, then by my calculations the Medicare Advantage plans are still getting a subsidy of some 8 percent over traditional Medicare, even after a 4 percent cut. (In fact, the baseline payments to private plans will still go up slightly in 2010, but they’ll be offset by adjustments in other areas—so the 4 percent is just an estimate.) Nonetheless, the insurance companies are already whining about (and lobbying against) the cuts, claiming that they will harm the 10 million Medicare beneficiaries who’ve been convinced to switch to private plans. According to Reuters:

Analysts say the new rates will force insurers to cut benefits for elderly and disabled patients enrolled in Medicare Advantage plans or increase premiums in order to maintain profit margins.

That last phrase, of course, is key: It’s the profit margin that matters to these companies, which is why they shouldn’t be in the Medicare business in the first place—especially if they require extra government subsidies just to make enough money to satisfy their greed. The insurers know that in order to maintain their high profits, they’ll now be “forced” to cut the benefits on their private plans, and more and more Medicare patients will just switch back to conventional, government-run Medicare.

That can’t happen soon enough, as far as I’m concerned. The government’s next step should be to boot the insurance companies out of the Medicare Part D prescription drug program, which would likewise save the taxpayers a bundle while improving benefits to the old and disabled. I’d love to see this done before I fall into the coverage gap, which usually happens around August. But to accomplish this change, Congress will need to act—and they’ll have to battle Big Pharma as well as the insurance giants. So I’m not holding my breath.

Categories: Bush Administration · Congress · Medicare · Obama Administration · disability rights · drug industry · health care · health insurance industry
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How Much Is a Year of Your Life Worth?

March 25, 2009 · 5 Comments

If they know what’s good for them, older folks will be especially attentive to one undercurrent in our present health care debates: an increasingly widespread view that the allocation of medical treatments—and indeed, the worthiness of human life—should be subject to a cost-benefit analysis.

Obama’s stimulus plan, for example, includes substantial funding for what’s called “comparative effectiveness research,” to test various treatments for the same illnesses and report their findings to the president and Congress, which will presumably use it in their policymaking decisions. As the New York Times reports, “Supporters of the research hope it will eventually save money by discouraging the use of costly, ineffective treatments.”

On one level, this is only sensible. And thusfar, the main opponents of comparative effectiveness research seem to be conservatives, who fear any kind of government intervention into the current–and highly unequal–private system of health care dispensation. But what worries me about this approach is how the data it acquires might be used—or misused. 

On its Economix blog, the Times has been running a series of posts by Princeton economics professor Uwe E. Reinhardt, the latest of which discusses the concept of ”QALYs”–”quality adjusted life-years”—which could be used to help determine how the government spends its health care dollars. 

QALYs are a metric widely used now in cost-effectiveness research. They are meant to adjust for the fact that not all years added to people’s lives are equal. A medical intervention yielding a given number of additional life-years in perfect health makes a greater contribution to human well-being than an intervention that yields the same number of life-years in less-than-perfect health. QALYs are used to adjust for that difference in a patient’s quality of life. 

Who, I wonder, is going to determine the quality of our life-years—especially as we get older? I’m 72, and I know it’s been a long time since I had a year in “perfect health.” It seems to me a very short leap from calculating QALYs to instituting age-based health care rationing, an increasingly popular proposition under which the elderly are told they should sacrifice some of their ”less than perfect” life-years for the good of all by forgoing costly medical treatments.

As I’ve written before, arguments for age-based health care rationing are in turn based upon the idea that if we don’t do something like this, health care costs—and especially Medicare—will soon bankrupt what’s left of the American economy. But this idea rests upon a major fallacy:  that there’s nothing else we can do to lower costs other than withhold care from the greedy geezers who want a new hip or a heart bypass when they haven’t got long to live, anyway.

In fact, there are plenty of other things we can do to cut costs—for a start, kicking the insurance companies out of the mix, reining in the drug companies, and instituting a single-payer system, which could lower our national health care  bill by as much as 40 percent while providing improved care to Americans of all ages. This fact is supported by numerous studies comparing health care in the United States and other industrialized countries, conducted by the World Health Organization, Congressional Research Service, Kaiser Family Foundation, and Commonwealth Fund, among others. 

So I’ll say it again: As a public-spirited old person, I might be willing to give up some costly, life-sustaining treatment if the future of humanity depended upon it. But I’m not going to sacrifice a single life-minute to preserve our system of medicine for profit.

Categories: Congress · Medicare · Obama Administration · age discrimination · budget / tax policy · disability rights · drug industry · financial crisis / recession · generations / intergenerational issues · health care · health insurance industry · media
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I Want My DTV: Old Folks Get Shafted by the Switch to Digital Television

February 5, 2009 · 2 Comments

I wrote today on the Mother Jones blog about the latest developments in the digital TV disaster: After a week of peevish wrangling–and with just two weeks left until the deadline–Congress finally did the right thing and postponed the switchover from analog to digital-only television from February 17 to June 12.

I also wrote about the winners and losers in the so-called transition. Old people, of course, were (and still are) the ones most likely to be left in the dark. Others wil l suffer as well: According to a January report from the Congressional Research Service, the changeover will be hardest on “low-income, elderly, disabled, non-English speaking, minority, and rural populations”–all the people who have no cable and no spiffy new digital TV set, and to lack the resources to make the switch–as this very funny but sadly accurate video portrays.

I’ve been researching the whole mess for several weeks, and I’m posting here some of what I couldn’t fit on Mother Jones–including my own experiences with cable guys and fritzed-out toasters.

It’s clear to me that the mess that has been made of the digital transition was predictable from the start. According to the prevailing practices of the Bush administration, the program was designed to reward the entrepreneurial spirit of private companies by giving them government handouts, while leaving the public to figure things out more or less on their own. To this end, the agency in charge of the switch, the Commerce Department’s National Telecommunications and Information Administration (NTIA) developed a plan to help poor, cable-less people get the converter boxes they needed by means of government-subsidized coupons redeemable at private retailers. Each household was allowed to send in a request to the NTIA for one or two free coupons, each worth $40 toward the converter box of their choice.

bkgd1Then the chaos began. The public education efforts about the changeover, according to both the Congressional Research Service and the Government Accountability Office (GAO) were too little and too late. They were also confusing and incomplete, and focused on steering consumers toward information on web sites. It didn’t seem to occur to anyone that the people most likely to need converter boxes were the same people least likely to have computers, or know how to use them. (Even nursing home residents were advised to apply for coupons using “the paper application available downloadable [sic] at www.DTV2009.gov.”)

A Consumers Union survey conducted in December 2007, as the coupon program began, found “a staggering lack of awareness and confusion among consumers about the DTV transition.” More than a third of all Americans were “entirely unaware of the government-mandated transition to digital broadcasting,” and “74 percent of respondents who said they were aware of the upcoming transition had serious misconceptions of its impact.” Among those completely unaffected by the transition, 33 percent planned to get converter boxes they didn’t need, while 31 percent planned to purchase a new digital TV. Even six months later, according to a June 2008 report from the GAO, “45 percent of those households who are at risk plan inadequate or no action to prepare for the transition. Conversely, amongst those unaffected by the transition, 30 percent indicated they have plans to ready themselves for the transition–despite the fact that no action will be required to maintain television service.”

Even if people managed to order and receive coupons, they then had to get themselves to a retailer and buy themselves a converter box-no small challenge for an elderly, disabled, or non-English-speaking person. While a few stores, including Wal Mart and Best Buy, had boxes selling for around $40, many other boxes sold for $50 to $80, requiring an additional investment by consumers.

btn_wherecoupon1Then, on January 4, with just six weeks to go until the transition, the coupons ran out. The NTIA had reached the $1.34 billion limit set by Congress, and even though only about half the coupons had been redeemed, it could issue no more. People were told to add their names to a waiting list; when unredeemed coupons expired, they might or might not get one. The waiting list was soon more than a million names long, while millions of others held unused, expired coupons they might have needed-and they aren’t allowed to re-apply.

Those who managed to get converter boxes had problems of their own. To begin with, they were far from easy to hook up. And they weren’t enough to ensure digital reception: In many cases, consumers also need a new indoor or outdoor antenna, which can cost anywhere from $20 to $150, and presents additional challenges as well. “Winter in Vermont is not when you want to be installing a rooftop antenna,” Senator Bernie Sanders ( I-VT) told the Associated Press. “Television is a connection to the outside world for many people. But if you’re 80 years old and living on Social Security, you may not be able to buy an antenna or hire someone to install it.”

Finally, while people with cable have been told they have nothing to worry about, this isn’t always true. Some will need to add or upgrade their cable boxes to get clear pictures and access to all channels.

I discovered this myself a few weeks ago, and called RCN, the cable provider in Washington, D.C., and after half an hour on hold was told the cable signal had been upgraded as per the new government program, and I would need a cable box. RCN would supply one complementary box, and I could purchase others at their online store, or rent them for a monthly charge of $3 each. A company technician would install them free of charge.

On the appointed day, the technician arrived and set to work. Soon he had a clear picture, and was ready to show me how to use the new system. First he handed me my old remote and told me to point it at the newly equipped set, then push the power button. Once the light on the set turned green, I was to drop the old remote, grasp the new remote, point it at the set, and push a button labeled “all devices.” I’d need to use two remotes to turn it off, too. If I had any problems, he said, brandishing a booklet, I could follow the instructional bulletin. He ran his finger over a set of intricate disagrams and labels, then bade me good bye.

Everything worked splendidly until the toaster, attached to the same plug as the TV, suddenly stopped working. I pulled the toaster plug out and got it restarted, but when I went to turn on the TV-I was back to square one. The technician had left a card with his direct number on it, but there was no answer. After calling several times, I finally resorted to RCN’s regular tech service number, which usually went through, after some waiting, to a helpful person in an unknown overseas city. As I sat on hold, randomly clicking the two remotes, I finally found the right combination to get the television working.

I may be old, but I’m a lot younger than some people, and I’m physically able, computer saavy, and able to afford cable-and I still had problems. In fact, about 40 percent of those affected by the changeover are senior citizens, and many will clearly be unable to manage the transition on their own.

As early as the fall of 2007, the Senate Special Committee on Aging, among others, was warning of the impending disaster the switch represents for old people. A year later, Congress finally allocated $20 million for additional education and outreach efforts. Just over $1.3 million went for advertising in AARP publications. Another $355,000 was used to sponsor a NASCAR car–which crashed and burned in its second race.) It took until January 6, 2009 (just after the coupons ran out) for the FCC to give $8.4 million in contracts to educational and community groups to provide hands-on outreach and help to a fraction of the vulnerable populations who would soon be cut off. Another $2.7 million of this money went to AARP, to expand its call centers and talk seniors through the changeover process. The contract for call centers to handle the panic once the transition sets in has gone to IBM, to the tune of $12 million-which, based on the current situation, may well prove to be not enough.

Categories: Bush Administration · Congress · Congressional Democrats · Congressional Republicans · Obama Administration · age discrimination · disability rights · poverty
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