CHANGE ISN’T COMING IT’S HERE!

Don’t Buy the
Entitlement Crisis
By Steve Gorin, Ph.D., MSW
In recent years, numerous commentators, pundits and politicians have argued that the US faces a looming fiscal crisis, driven to a large extent by entitlements, particularly Social Security and Medicare. The solution to this crisis, so the argument goes, is to slow the rate of growth in Social Security and Medicare (http://tiny.cc/VuaPJ). While there is a grain of truth in the entitlement crisis argument, it is only a grain, and a small one at that.
Proposals to cut Social Security benefits are misguided for at least two reasons. First, the program is not in crisis. According to the Congressional Budget Office, the Social Security Trust Fund will not run out of money until 2049; at this point it will still take in enough in taxes to meet 84 percent of its obligations (http://tiny.cc/N6Qy9). This is an issue but hardly an imminent or insurmountable one. (For a sensible approach to addressing the problem, see the proposal by Robert Ball and Nancy Altman (http://tiny.cc/NSDsz). Second, cutting benefits, or even the threat of doing so, would likely deter consumer spending at a time when the economy desperately needs it and prolong the current recession
The grain of truth in the entitlement crisis argument is that Medicare costs have increased rapidly in recent years and, in the absence of change, will continue to accelerate (http://tiny.cc/z7ITZ). However, it is important to put this into perspective. Since 1983, when Medicare’s prospective payment system was introduced, it has had a better record controlling average annual per-enrollee spending growth than private plans (http://tiny.cc/qaRVy). The real crisis is not with Medicare but our health care system generally (http://tiny.cc/5dKqg).
How should we address this? My first choice would be through a single-payer system, such as Medicare. However, I have reluctantly concluded that this is not possible politically.
During the campaign, President Obama proposed an approach that would force regulated competition between private plans and a new public option, like Medicare, which would be open to anyone (http://tiny.cc/KkD7A).
I believe this offers our best hope for reforming our system and reducing costs and perhaps eventually leading to a single-payer system.
Stephen Gorin, a social worker and professor of social work at Plymouth State University. He is a co-founder and incorporator of EngAGING NH. Any views expressed are his own.






Home Heating Fuel Update
Oil, credit: $2.177/gal
Propane, credit: $2.750/gal
Kerosene, credit: $2.872/gal
Electricity: $0.16441/kwh
Natural Gas, first tier:
$1.4098/therm
Natural Gas, second tier:
$1.2692/therm
Gasoline, self-serve regular:
$1.864/gal
Diesel: $2.319/gal
Source: OEP 3/9/09
There is an expectation that despite the global economic situation, demand will continue to drive the cost of home heating fuel up. It may therefore be wise to consider joining a purchasing cooperative, using pre-buy options and to consider ways to make your home more energy efficient.
Home Energy Audits generally cost between $200 and $500. Your local utility provider can assist with a home audit. Other resources include:
Information on audits, weatherization, tax credits including Renewable Energy, solar, geothermo and wind projects. www.energystar.gov
For information on weatherization including eligibility for assistance, check the Office of Energy and Planning www.nh.gov/oep
The New Hampshire Residential Energy Performance Association (REPA) is an organization made up of individual Residential Energy Auditors and Weatherization Professionals providing Energy Efficiency Services in NH. Its objective is to improve/expand understanding of residential energy efficiency technology, skills, and delivery of the "House as a System". www.repa-nh.org
Tax Credits: You may qualify for federal tax credits if you replace windows, doors, roofs or insulation. And audit can help you decide which improvements will provide the greatest advantage.



This is a busy time of year in the Concord. The biggest issue, the state budget, is still playing out. The Governor’s budget was relatively kind to senior services, but not all programs were protected. Projected cuts include eliminating several senior volunteer programs, including the foster grandparent and the retired senior volunteer programs.
Here are a few highlights from this year’s legislative activities to date:

Bills Ought to Pass
HB 279 establishes an alert program for missing adults with cognitive or developmental issues.
SB 42 establishes a committee to study the cost and feasibility of implementing a hospice benefit under Medicaid.
SB 62 establishing a commission to study creating a statewide plan for addressing Alzheimer’s disease in NH/
Bills Retained
HB 380 As we go to press, we understand that the bill to create a Long Term Care Commission will be retained by the Health, Human Services and Elderly Affairs Committee. Expressing concerns about the cost of a Commission in this time of government frugality, study committee members express interest in establishing a legislator caucus as an alternative to address issues identified in this bill.
HB 626 requires that a voter present a valid photo identification to vote in person. Voters without photo identification may vote by provisional ballot. This bill also eliminates the fee for nondriver’s picture identification cards.
Bills Failed
HB 121 to establish a board of residential building and remodeling contractors to register and regulate contractors, subcontractors, and residential contracting contracts
HB 397 to establish a property tax relief program based on taxpayer income.
HB 400 increasing the reimbursement rate for personal care attendants and personal care services providers.



Scientists seek genes for growing new teeth
Tooth loss from gum disease is a major problem in the US and abroad. Dentures or dental implants, while helpful, can have their own problems. Study of animals that have more than one row of teeth (like sharks) has lead scientists to investigate related genes. Research reveals that a single gene bred into mice caused additional teeth to grow. If scientist can learn how to trigger growth of a single tooth, they may eventually be able to use the knowledge to stimulate regeneration in adults. The gene, Osr2, may also lead to a break through for treating cleft palates.
Unraveling the secrets of Alzheimer’s
“Alzheimer’s disease is probably a very complex disease with many things happening simultaneously,” said Kishore Kuchibhotlas of Harvard. But one indicator that appears to be a major contributing factor is the build up of plaque. A team at Massachusetts General Hospital and Harvard Medical reported that they have discovered a certain plaque, amyloid, agitates a brain cell needed for normal brain functioning. The studies of how the amyloid plaques become toxic may lead to a better understanding of how the disease works and drugs that can better treat symptoms.
Arthritis and heart disease patients may fear exercise
The US Centers for Disease Control and Prevention report that patients suffering from arthritis and heart disease may be afraid to get the exercise they need to improve their health. Yet studies show that even a little exercise may help to relief symptoms of both conditions. Two national studies find that 57% of adults with heart disease also have arthritis. 29% of this group admits that they rarely or never exercise, primarily because they are unsure of which activities are not harmful to their conditions. Regular exercise can help relieve joint pain, which in turn leads to beneficial activity to manage heart problems. Consider adding a discussion about exercise to your next health care provider visit.

Margaret looked forward to her retirement years, filled with things she enjoyed, such as reading, watching TV, exercising, keeping in touch with family, and traveling. It was great as first, but she soon recognized that she needed more. “Everyone needs to feel needed and to have a purpose in life, especially retirees.”
While she was working and bringing up her children, it was not difficult to know she was needed. While she was working she did volunteer work on a limited basis and always thought about devoting more time to it when she retired. However, she did not realize how important such activities would become to her.
Margaret became politically active, working on recent elections and participating in issue related activities. She still considers herself a strong advocate for the elderly. Today she willing serves on a number of non-profit boards of directors. Her life experience not only makes her an asset to the Boards; it also reinforces her self-confidence and worth.
This sense of making a meaningful contribution in turn enhances her family relationships. She has been a strong source of support for both her mother and her daughters. “Having had the opportunity to spend more time with my mother in her final years is still a source of comfort to me “.
Time spent with her grandson is important and mutually beneficial. “Because children grow up so quickly if we don't spend time with them when they are young, that opportunity does not come around again,” she stresses. Margaret feels that the quality of her grandchildren's lives is enriched from learning from their grandparents. And there is of course, the enjoyment of the time spent together.

When people gather around the desire to affect social change they often fail because all their energy goes into dealing with immediate crisis rather than planning for mid and long term. The ENH Board has developed a long term strategy and will continue to refine the steps we take to achieve our goals. That being said, most of the January meeting discussion was around budgets, the economy and the decisions being made that impact NH’s long term care delivery systems. In other words, we cannot escape the immediate needs our seniors face.
We have a growing demand for services to be provided in the community, and we have a shrinking work force. Yet, we do not have the funds to continue service delivery in the manner to which we have been accustomed. These facts can not be disputed.
We are pleased to be at the table with the Department of Health and Human Services in discussions on how to realign the way the Department serves its clients, including older adults. Likewise, we welcomed the opportunity to serve on the study committee for establishing a Long Term Care Commission.
Many of these discussions shift to a very limited focus of “can we afford to pay for a specific service”, rather than a broad view. Our frustration continues to be the lack of a significant consumer voice. Elders have more to contribute besides wearing organizational tee-shirts at public hearings.

Dealing with the immediate can be an opportunity, if senior advocates give focus to certain outcomes:
• Older Adults need to be seen as a valuable asset in dealing with a work shortage, and as knowledgeable contributors to planning;
• We need a comprehensive plan as NH ages, that looks to incentivize efficient uses of limited resources;
• We need to consider which services or practices create greater savings through prevention; and
• We need to have public involvement to create changes that support the greater good.
There are many opportunities for you to hear budget proposals and to weigh in. We strongly encourage you to do so.
A system will emerge either by default or by design. It’s up to us.

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