Why older people work: For money

Being old enough to collect a Social Security check doesn't necessarily mean being able to afford living expenses without a job.At 76, Robert Scheidly gets up at 2 a.m. for his daily four-hour newspaper route. His wife, Anna, 72, coordinates operations at a warehouse one day a week and applies for jobs the rest. "I was hoping that by this age we would be able to maybe enjoy going to visit his or my brothers or sisters," said Anna, a former receptionist and bookkeeper. "But we both really need to work in order to make ends meet."

The Scheidlys' story is increasingly common. As those older than 65 become the nation's fastest-growing workforce demographic -- increasing at five times the pace of younger workers -- the primary reason cited for continuing to punch the clock is money. Surveys consistently reveal this to be the case, even though seniors often find work to be fulfilling and may forget that money was their primary motivation.

"The reasons can change as people experience going to work," said Caitrin Lynch, an associate professor of anthropology at Olin College and the author of "Retirement on the Line: Age, Work and Value in an American Factory." A lot of people can't disentangle that," she said, "even if their initial motivation may have been that, 'I need to pay for heat in the winter.'"

The statistics are sobering:

• More than half the nation's workers are at risk of being unable to maintain their standard of living in retirement, according to research from the Center for Retirement Research at Boston College. Nearly two-thirds of low-income households are at risk.
• For most families with members over 65, Social Security constitutes the bulk of household income, even though Social Security was never meant to do such heavy lifting. For those in the middle third of the income scale, it provides 71% of income; for those in the bottom third, 88%.
• According to the Social Security Administration, 34% of the workforce has no savings set aside for retirement.
• Social Security income averages just under $16,000 per year for those ages 65 to 74, less for those past 75.
• In 2020, nearly a quarter of Americans over the age of 65, or 22.6%, are projected to be in the workforce, according to the Bureau of Labor Statistics, compared with 11.8% who worked in 1990.
• Like millions of Americans, the Scheidlys had always been frugal, and they had always worked. Robert was a welder until his factory shut down in 1987, then a minister."We lived hoping that we could retire, but we didn't set anything aside because we used what we got, mainly to raise a family," Anna Scheidly said. "Some people would say that it was our fault because we didn't plan right, but you do the best that you can in the situation you are in."According to the Employee Benefit Research Institute, two-fifths of families with seniors are like the Scheidlys, with expenditures outweighing income in retirement. And the recent economic turmoil isn't to blame -- at least not fully.

• Yes, the stock market crash depleted individual retirement plans. The housing crash sucked the value from many people's greatest asset. And for some, the recession added the financial burden of supporting younger relatives.
• But these factors merely exacerbated trends that have been in the making for 20 to 30 years, say experts. The typical working lifetime has expanded as wages have fallen, and a great share of jobs available are less demanding physically. Meanwhile the shift away from company pension plans has put the onus on workers to save for retirement.
• In just one generation, the shift away from pensions has been dramatic. In 1983, 88% of workers were enrolled in a private or public employer pension plan. In 2010, only 31% were, according
•  to the Center for Retirement Research.
  

The Doctor Won't See You Now. He's Clocked Out...

ObamaCare is pushing physicians into becoming hospital employees. The results aren't encouraging.

Big government likes big providers. That's why ObamaCare is gradually making the local doctor-owned medical practice a relic. In the not too distant future, most physicians will be hourly wage earners, likely employed by a hospital chain.

Why? Because when doctors practice in small offices, it is hard for Washington to regulate what they do. There are too many of them, and the government is too remote. It is far easier for federal agencies to regulate physicians if they work for big hospitals. So ObamaCare shifts money to favor the delivery of outpatient care through hospital-owned networks.

The irony is that in the name of lowering costs, ObamaCare will almost certainly make the practice of medicine more expensive. It turns out that when doctors become salaried hospital employees, their overall productivity falls.

health system. A recent survey by the Medical Group Management Association shows a nearly 75% increase in the number of active doctors employed by hospitals or hospital systems since 2000, reflecting a trend that sharply accelerated around the time that ObamaCare was enacted. The biggest shifts are in specialties such as cardiology and oncology

Estimates by hospitals that acquire medical practices and institutions that track these trends such as the Medical Group Management Association show that physician productivity falls under these arrangements, sometimes by more than 25% (more on this below). The lost productivity isn't just a measure of the fewer back surgeries or cardiac catheterizations performed once physicians are no longer paid per procedure, as ObamaCare envisions. Rather, the lost productivity is a consequence of the more fragmented, less accountable care that results from these schemes.

Once they work for hospitals, physicians change their behavior in two principal ways. Often they see fewer patients and perform fewer timely procedures. Continuity of care also declines, since a physician's responsibilities end when his shift is over. This means reduced incentives for doctors to cover weekend calls, see patients in the ER, squeeze in an office visit, or take phone calls rather than turfing them to nurses. It also means physicians no longer take the time to give detailed sign-offs as they pass care of patients to other doctors who cover for them on nights, weekends and days off.

Most hospitals exacerbate these strains by measuring the productivity of the physician practices they purchase in "Relative Value Units." This is a formula that Medicare already uses to set doctor-payment rates. RVUs are supposed to measure how much time and physical effort a doctor requires to perform different clinical endeavors.

Medicare assigns each clinical procedure a different RVU and then multiplies this figure by a fixed amount of money to arrive at how much it will pay a doctor for a given task. A routine office visit has an RVU of about 1.68, while removing earwax has one of 1.26. Setting a finger fracture rates a 3.48.

This system misses all of the intangible factors that help gauge the quality and efficiency of the care being delivered. It focuses physicians on the wrong goals for promoting health, such as how well they code charts to capture higher-value "units."

Hospitals are beholden to the RVU system only because that is how they get paid by the government. Data from the Medical Group Management Association shows that physician productivity in these employed relationships, measured simply by RVUs, declines up to 25% compared with independent practices. The Advisory Board ABCO -0.47% Company, a health-care consulting firm, estimates that when hospitals last went on a physician-acquisition binge in the late 1990s, productivity fell by as much as 35%. Those arrangements mostly failed, and the hospitals divested the stakes they had in individual doctor practices. The physicians went back to practicing out of their own offices.

All of this reduced productivity translates into the loss of what should be a critical factor in the effort to offer more health care while containing costs. Yet hospitals aren't buying doctors' practices because they want to reform the delivery of medical care. They are making these purchases to gain local market share and develop monopolies. They are also exploiting an arbitrage opportunity presented by Medicare's billing schemes, which pay more for many services when they are delivered at a hospital instead of an outpatient doctor's office.

This billing structure exists because hospitals are politically favored in Washington. Their mostly unionized workforces give them political power, as does their status as big employers in congressional districts.

ObamaCare pushes this folly largely based on a naive assumption that models that worked well in one community can be made to work everywhere. President Obama has touted "staff models" like the Geisinger Health System in Pennsylvania and the Mayo Clinic in Minnesota that employ doctors and then succeed in reducing costs by closely managing what they do. When integrated delivery networks succeed, they are rarely led by a hospital. ObamaCare seeks to replicate these institutions nationwide, even though their successes had more to do with local traditions and superior management. That's hard to engineer through legislation.

:Note by the author.

Am I scared you damn straight I am scared. Not everyone in the public spectrum has very little knowledge of what is happening with health care. I hear people say with what I pay those doctors they are getting rich. But, I ask next time you get a bill from your insurance provider to please read it. Here is an example.

The doctor charges a certain amount, but never receives the amount the bill was for. The doctor must except what the insurance will pay them. But, then there is a write off, but who receives the write offs but the insurance company at the end of the year. This HMO insurance has been in effect since the Clinton Administration. Now with Obama care this will be putting doctors out of private practice and working in hospitals the way I do. Truth be known I was always going into practice with my pediatrician Dr. Steve when I became a fellow, but he is making cut backs at his office and couldn't afford me. 

All my life I heard if you want a job that will never down size and one that you will always have a future pick the medical profession. I have to tell you if you have picked medicine as a get rich profession you have picked the wrong career. You are going to have to be here practicing medicine because you love it and  for the money. It is a shame you go to school all your life and when it is almost your turn to make the money it's not there. It is a crying shame when banks, car dealerships and brokers on Wall Street can get bail outs to keep there plush salaries and the doctor who save your lives have to squabble with a insurance over treatment or a surgery for there patient.  

Please Tell me what you see wrong with this situation? 

SUPER SIMPLE GRAIN-FREE, FLOUR-FREE PEANUT BUTTER COOKIE RECIPE

I have a bad sweet tooth. The fact that these cookies are so easy to make doesn't help matters either (3 ingredients, 15 minutes to prepare from start to finish).

What You Need
1 cup peanut butter (or your favorite nut butter - I like almond butter)
1 egg
1 cup sugar (I like sucanat because it is basically unrefined ground sugar cane)

What You Do
Combine all ingredients in a bowl and mix thoroughly. Drop mixture onto cookie sheet by the heaping teaspoon. Bake in oven at 350 for 10-12 minutes, or until the edges of the cookies have slightly browned. Cookies may not look completely cooked in the center. That's okay. The residual heat from the cookie sheet will continue to cook them a few more minutes after you remove them from the oven. After about 5 minutes of cooling you can transfer the cookies to a wire rack for cooling.

Best enjoyed warm, with a nice cold glass of milk. Makes one dozen cookies.

GLUTEN-FREE ZUCCHINI BREAD/MUFFIN MIX

What You Need
3 cups gluten-free flour (I like Better Batter)
1 tsp salt
1 tsp baking soda
1 tsp baking powder
3 tsp ground cinnamon
3 eggs
1 cup olive oil
2 1/4 cups sugar
3 tsp vanilla extract
2 cups grated zucchini
1 cup chopped walnuts or 1 cup semi-sweet chocolate chips (optional)
What You Do
Grease 2 loaf pans or muffin tins. Preheat oven to 325.
Sift together flour, salt, baking powder, baking soda, and cinnamon together in a bowl.
In a large bowl beat together eggs, oil, vanilla and sugar until well combined.
Add sifted ingredients to the creamed mixture. Mix well.
Stir in zucchini and add nuts/chips (optional). Pour into pans or muffin tins.
Bake 40-60 minutes until tester comes out clean. Cool in pan for 20 minutes before cooling on wire rack.

GLUTEN-FREE SANDWICH BREAD

Within 24 hours of making a loaf of this bread, there were only crumbs remaining. The celiacs in our house had to quickly learn to pace themselves. This is an excellent, moist and tasty bread ... great for sandwiches (hence the name).

What You Need

dry ingredients

1 1/4 c brown rice flour

1/2 c almond flour

1/2 c amaranth flour

1/2 c quinoa flour

1/3 potato starch

1/4 c tapioca starch

1 T xanthan gum

1 1/4 t bread machine or instant yeast

1 1/4 t salt

wet ingredients

1 1/2 c water (110-115 degrees Fahrenheit)

2 T olive oil

2 T liquid honey

1 t cider vinegar

2 eggs, lightly beaten

2 egg whites, lightly beaten 

** I used a Bread machine to make my bread.

What You Do

1. Pour wet ingredients into bread machine baking pan.
2. Add dry ingredients.
3. Select the gluten-free cycle, select your crust darkness and press start.
4. One to two minutes into mixing use a rubber spatula to scrape flour from sides so that it can be incorporated into the dough. Close lid.
5. Once the loaf has baked promptly remove it and allow it cool completely on a wire rack before slicing.
   
   
   
   
   

Holistic Granola Bites

Looking for a simple, nutritious snack made from whole food ingredients? Give these Granola Bites a try. They are a favorite in our house, and easily adaptable for a number of food allergies.

What You Need
1 cup rolled oats (no quick oats)
1 cup coconut flakes
1/2 cup nut butter (I use organic peanut butter)
1/2 cup ground flax seed
1/3 cup honey, raw preferred
1 tsp vanilla extract

What You Do
Combine all ingredients in large mixing bowl, and mix until well combined.

Chill in refrigerator for 30 minutes.

Remove from refrigerator, and roll into 1/2" balls.

Store in an airtight container in the refrigerator for up to one week (but they won't last that long).

Obamacare Doctors Abandon Private Practice for the Safety of the Hospital Staff.

Obamacare – – the Patient Protection and Affordable Care Act. It will be yet another reminder that government seizure of free-market medicine provides neither patient protection nor affordable care.

Only a year short of full implementation of Obamacare, we now know that almost nothing that the president promised from his signature piece of legislation is true.

Repeatedly the president said that his health care scheme would reduce the cost of annual premiums. He said the plan would not add to the deficit. He claimed that patients could keep their doctor and insurance plans. These claims were all false.

In addition, we now see thousands of pages of Obamacare regulations, a host of new taxes, and a reversal of protection against the use of federal funds for abortion.

The most alarming side effect of Obamacare is the impact on doctors themselves. Doctors nationwide are retiring early. They are refusing to accept new Medicare and Medicaid patients. Now we witness the demise of the private practice and the increasing trend that sees doctors signing on as salaried employees with big hospitals.

Only last year, a survey among doctors conducted by the Doctor Patient Medical Association Foundation found that 83% of respondents believed that changes in the medical system made them think about quitting medicine altogether. By a margin of 85%, survey respondents said the doctor-patient relationship was declining. An alarming 61% flatly said that it was getting more difficult to adhere to the Hippocratic ethic of medicine.

The survey also reported that respondents believed corporate medicine (including hospitals and insurance companies) is intentionally trying to destroy private practice.

Dr. Scott Gottlieb, a physician and resident fellow at the American Enterprise Institute, recently focused on the problem in an article in the Wall Street Journal under the headline: The Doctor Won’t See You Now. He’s Clocked Out.

Gottlieb explains that Obamacare is making the local doctor- owned medical practice a relic as more and more doctors become hourly wage earners in hospitals. Why has this happened? Gottlieb provides the answer in the first sentence of his article: “Big government likes big providers.”

He goes on to write that Washington doesn’t like doctors in private practice in small offices because it’s harder to regulate them. It is easier to regulate them if they work for big hospitals, he writes, so Obamacare “shifts money to favor the delivery of outpatient care through hospital-owned networks.”

Gottlieb writes that by next year about 50% of U.S. doctors will be working for a hospital or hospital-owned health system. He cites a recent survey by the Medical Group Management Association that showed a nearly 75% increase in the number of active doctors employed by hospitals or hospital system since 2000, “reflecting a trend that sharply accelerated around the time that Obamacare was enacted.”

When doctors become salaried hospital employees, Gottlieb explains, their productivity falls. This loss of productivity reflects a lack of physician accountability as well as a drop in the performance of medical procedures.

Gottlieb concludes that hospitals are not buying doctors’ practices because they want to reform healthcare delivery.

“They are making these purchases to gain local market share and development monopolies,” Gottlieb writes. “They are also exploiting an arbitrage opportunity presented by Medicare’s billing schemes, which pay more for many services when they are delivered at a hospital instead of an outpatient doctor’s office.”

Prepare for the day when your once personal physician is now punching the clock at a corporate- owned hospital. When you call the hospital to reach your doctor you will be put on hold, only to learn that the doctor is out. Try again on Monday.