We were especially struck by Krugman’s comments about the modern Medicaid program. We will guess that many people don’t know the nature of that program. But this program serves an important purpose—and the program is very humane:
KRUGMAN (5/13/11): The great bulk of federal spending that isn't either defense-related or interest on the debt goes to Social Security, Medicare and Medicaid. The first two programs specifically serve seniors. And while Medicaid is often thought of as a poverty program, these days it's largely about providing nursing care, with about two-thirds of its spending now going to the elderly and/or disabled. By my rough count, in 2007, seniors accounted, one way or another, for about half of federal spending.
And in case you hadn't noticed, there will soon be a lot more seniors around because the baby boomers have started reaching retirement age.
According to Krugman’s column, about two-thirds of Medicaid spending now goes to senior citizens; this largely involves nursing care. And Medicaid isn’t a “poverty program,” although it does serve poverty-level families. Much of its spending goes to middle-class seniors, much as Krugman noted.
Coincidence: On the day that column appeared, we journeyed several hundred miles to visit an 84-year-old friend who has been having severe physical challenges in the past six weeks. Our friend is staying in the “residential and rehabilitative care” wing of a non-profit hospital near the exurban New York county where he lives. Over that weekend, we saw a group of health care workers ministering to our friend, and to other senior patients.
Many of those patients were being funded by Medicare or Medicaid. What we saw made us think of the two different cultures which have been growing in this country over the past fifty years.
A point of reference: In the late 1950s, our father spent the last several years of his life in a nursing home. (He died in 1959; we had just turned twelve. He was 65 when we were born, which helps make sense of the numbers.)
Visiting our friend this past weekend, we were hugely impressed, and inspired, by the quality of the facility he was in—a facility which (we assume) is largely funded by payments from Medicare and Medicaid.
We couldn’t help recalling the nursing home in which our father, a person of substantial means, spent the last years of his life at a time when there was no Medicare or Medicaid. We were young, and our memory is imperfect; nor are we experts on this history of American nursing care for seniors. But the place was deeply depressing. We would guess that it represented the state of the art at that time.
The cheerful facility we visited last week wasn’t depressing (though you of course wouldn’t want to be there). As we said, this wasn’t a spa for the rich. But the facility had large, cheerful sitting rooms and friendly, cheerful, upbeat staff. Our friend’s wife, who is also a long-time friend, is a native New Yorker and nobody’s pushover. She wouldn’t be afraid to complain about indifferent care. But she said the staff there truly were cheerful. When another patient praised one staff member as “a real sweetheart,” our friend said she had to concur.
This facility’s employee of the year had just been named. In the lobby, a citation listed the reasons for her selection. According to the citation, this employee routinely treats this facility’s patients with “compassion, dignity, respect, understanding.” But then, from the very upbeat director on down, that seemed to be the actual tone of the place.
Presumably, not every facility is like the one we observed. But this facility, and others we’ve visited, are like the Taj Mahal compared to the place where our father died. Making the obvious comparison, we couldn’t help thinking of the change in American culture over the past fifty years.
More specifically, we thought about two different cultures which have grown during that period.
One culture has grown from the top on down. This is a culture of acquisition, consumption and sometimes greed; this culture has grown quite dramatically. (In the years when our father was dying, CEOs were willing to be paid just forty times the average salary!) Within the frameworks of this growing culture, the senior citizens in the facility we just visited are no longer productive citizens; they will no longer work at jobs, or fashion careers, or raise the society’s children. The Ryan plan would slash the spending which has let such people spend their last years in more humane surroundings. Presumably, if the Ryan plan passed, many seniors would end up spending their final years in much less humane settings.
(Note: Medicaid spending is affected right away under Ryan’s plan. Yesterday, David Gregory didn’t try to figure out how nursing care would be affected.)
That is one of our growing cultures. But a second culture was on display in that facility’s cheerful sitting rooms and in the attitudes of its upbeat staff. That second culture has grown from below in the past fifty years—and from the imperfect but humane impulses of the War on Poverty and the Great Society. (Lyndon Johnson could feel people’s pain.)
Thanks to this second culture, a lot of decent people are working with seniors around the country. They aren’t getting rich, and they aren’t getting famous; you won’t see them on TV during cable panel discussions. But we were very impressed by, and grateful for, the work we saw them doing last weekend. Seeing their cheerful demeanors in that cheerful facility made our thoughts range back fifty years.
(“He was manager of the Bowdoin Square Theater, and booking agent for the Old Howard, at the age of 18,” our father’s Boston Globe obituary said. “Mr. Somerby in interviews recalled that Fred Allen had appeared or him for 50 cents a night, and that Fred and Adele Astaire once played in his theatre for $60 a week.”)
One culture has grown from the top during the past fifty years; a different culture has grown from below. We see the millionaire tribunes of one of these cultures on our TV machines every night; they drive the talking-points of this culture in tightly scripted ways. For us, it was impressive, and very moving, to see the tribunes of that second culture respecting those seniors last week.
The liberal world does a very poor job calling attention to such decent people. By the way: Conservatives grow old and become sick too. But alas! We liberals rarely consider fashioning outreach to “those people.”
CUMMINGS (1925): Humanity i love you
Humanity i love youbecause you would rather black the boots ofsuccess than enquire whose soul dangles from hiswatch-chain which would be embarrassing for both
parties and because youunflinchingly applaud allsongs containing the words country home andmother when sung at the old howard
That said, our current friend may be the only person we know with three editions of Joyce’s Ulysseson his shelf (old, older, oldest), each annotated with copious notes. But then, who isn’t entitled to final years in a place of compassion, respect?
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