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Author: WatchingTheHerd Big red star, 1000 posts Feste Award Nominee! Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: of 465323  
Subject: Unfunded Liabilities and Macro Forecasts Date: 12/29/2011 9:09 PM
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A common theme of posts over the past 2-3 weeks involves the changing tax based to support current government programs and the macro impact of continued crushing debt loads imposed by continuing those programs.

It really is worthwile to step back and carefully review the differences between the mental shorthand we use in our head for terms like "unfunded liabilities" and what the law and politics (lower case "p" -- no partisan point being made here) actually require.

Are the "unfunded future liabilities of Social Security" a threat to financial growth? They are if one assumes that the fact your parents may have retired at age X and collected Y years of payments based upon Z years of "contributions" creates an actual LEGAL obligation for future generations to do the same when YOU retire.

It doesn't.

If people wake up and realize any one of the following changes could be made to drastically alter the funding / drain balance of the program,

* eliminate yearly SS tax cap on income above $106,800
* limit payment eligibility to whatever yearly tax cap is used (if you aren't taxed for income above $106,800 then your benefits should be calculated with yearly incomes no higher than $106,800)
* means testing payments for wealthy elderly

then the future burden on the overall economy as the demographics shift wuld look NOTHING like it does from extrapolating current behavior. If one assumes elderly voting blocks would never allow such changes at the polls, one has to hope that the 18-35 generation doesn't suddenly realize they better get their butts to the polls to represent THEIR generational interests. That might not happen in a booming economy where every 20-something has enough money to hit the clubs every night instead of paying attention to politics and economic trends. It DEFINITELY might happen when an entire generation of 20-somethings is living in their parent's home working at minimum wage and realize their primary political choice is to alter social security eligibility rules so money can go directly to their generation or continue having it flow through their parents while they live in the basement.

Will spiraling Medicare costs pose an equally existential risk to future economic growth and prosperity? They certainly will if millions of families learn NOTHING from watching "heroic" medical efforts burn through a lifetime of savings in a few short months while adding nothing to the quality of life.

Is that likely?

I'm not sure but I would lean towards many people learning the difference between quantity and quality of life and updating their own directives to avoid some of the more extreme scenarios that cost so much money.

Will spiraling healthcare costs for the rest of us continue to weigh down the economy? They could if one assumes healthcare and pharmaceutical companies have our government in a headlock to prevent changes to the insurance models in place and the actual delivery practices in place for healthcare. It certainly SEEMS like they do have our government in a headlock but there's a catch.

That headlock can only last as those firms stay in business. They're a business just like anyone else and their primary customers are businesses -- our employers. If our employers are crippled by higher healthcare costs and cut staff or go out of business entirely, guess what? Those insurance companies, pharma companies and hospitals lose customers as well. Lose enough and they're no longer enough of a lobbying threat to a politician to block changes that tip the balance back towards individuals.

There ARE such things as points of economic discontinuity -- points where one or two inputs to a larger set of macro decisions reach values that trigger huge changes in MANY other decision variables, not just incremental changes in one or two. We may be very near one or more of those points right now. Extrapolating beyond those points using current behavior is almost pointless to the point of comedy.


WTH
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Author: tjscott0 Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 382942 of 465323
Subject: Re: Unfunded Liabilities and Macro Forecasts Date: 12/29/2011 9:54 PM
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Will spiraling Medicare costs pose an equally existential risk to future economic growth and prosperity? They certainly will if millions of families learn NOTHING from watching "heroic" medical efforts burn through a lifetime of savings in a few short months while adding nothing to the quality of life.

Is that likely?

I'm not sure but I would lean towards many people learning the difference between quantity and quality of life and updating their own directives to avoid some of the more extreme scenarios that cost so much money.


As long as families have no immediate economic stake/cost in the provision of "heroic" medical measures paid for by medicare; i think it unlikely family behavior will change. Most families [and my gut tells me it is 75+%]do not have an end of life discussion with those likely to make the decision of medical treatment. So the family must make the decision in emotional turmoil. My personal experience that doctors are loath to make declarative statements about a patient's condition. Its like pulling teeth or reading tea leaves.

So the solution is 1)making an economic cost to medicare beneficiarie 2)having an outside board ration health care. 3)require medicare beneficiaries make end of life decisions prior to signing up for the entitlement.

I don't any of solutions palatable to the body politic.Perhaps you have a better solution.*

In any case, I see little appetite amongst our leaders of either party willing cross seniors. Nor do I see seniors willing to forgo benefits that were provided their elders.

*There is the Monty Python solution.<g>
http://www.youtube.com/watch?v=Sh8mNjeuyV4

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Author: WatchingTheHerd Big red star, 1000 posts Feste Award Nominee! Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 382944 of 465323
Subject: Re: Unfunded Liabilities and Macro Forecasts Date: 12/29/2011 10:03 PM
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As long as families have no immediate economic stake/cost in the provision of "heroic" medical measures paid for by medicare; i think it unlikely family behavior will change. Most families [and my gut tells me it is 75+%]do not have an end of life discussion with those likely to make the decision of medical treatment. So the family must make the decision in emotional turmoil.

========================

My point is that one doesn't even have to know or care about the pure financial cost of many end-of-life scenarios. You just have to be in the room watching the result. It's not "life" as most of us would expect or want it -- even if it were free. Many more of this generation will get that experience with their parents and may be much more inclined to state their preferences to their families going forward.


WTH

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Author: Hawkwin Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 382974 of 465323
Subject: Re: Unfunded Liabilities and Macro Forecasts Date: 12/30/2011 10:12 AM
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eliminate yearly SS tax cap on income above $106,800
* limit payment eligibility to whatever yearly tax cap is used (if you aren't taxed for income above $106,800 then your benefits should be calculated with yearly incomes no higher than $106,800)
* means testing payments for wealthy elderly



Unfortunately, that will not be nearly enough:

http://www.nationalreview.com/corner/262338/means-testing-so...

Snip:
The reason, as the CEPR analysis shows, is that there aren’t enough rich retirees — and they don’t collect enough in Social Security — to make much of a difference. Only 2 percent of Social Security benefits go to retirees with other (non-Social Security) income of $100,000 or more each year. (See chart.) Only about 10 percent of benefits go to people with outside income of $40,000 or more a year — a figure that most of us would regard as middle class.

Also:
Means-testing would also penalize people who planned prudently for their senior years. Income security during retirement is often likened to a three-legged stool — consisting of Social Security benefits, employer pensions, and personal savings — sometimes supplemented by part-time employment. Reducing Social Security for people whose non-Social Security income is higher because they built up savings during their working years or take a part-time job would sap incentives to work and save.

--------

Even from the DailyKos:

http://www.dailykos.com/story/2011/02/20/947639/-The-case-ag...

Snip:
That includes the idea of means testing, or reducing or eliminating benefits for wealthy individuals. On the face of it, it sounds almost progressive. Why should the well-off get the same benefits as everyone else? They don't need them, why shouldn't that money be redistributed to those who need it more?

The simplest answer is that it's their money, too. They paid into the system and, in doing so, bought into the same promise as the rest of us. Which gives them the same incentive to support the program as the rest of us.

...

The justification for denying benefits to people who have paid taxes into the system is also questionable. We do not deny interest payments to wealthy owners of U.S. Treasury bonds, for example, and it is difficult to see how the payment of Social Security benefits to rich senior citizens is any less appropriate. Indeed, why single out senior citizens as a group for special treatment in this regard? If we think that the rich are getting too much of the economic pie, then they should be taxed more--not just the ones who happen to be over 65.

(much more at the link)

-----------

In my opinion, further means testing of SS will be one of the fastest ways to kill it forever.

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Author: PolymerMom Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 382983 of 465323
Subject: Re: Unfunded Liabilities and Macro Forecasts Date: 12/30/2011 11:12 AM
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WTH,

You are absolutely correct.

My Mother experienced kidney failure at the ripe old age of 91. It took us a while to catch on to what was happening. She made three trips to the emergency room and a week-long hospital stay to get her blood chemistry back in balance. She was pretty good for a couple of weeks, but always went downhill.

The major symptoms we noticed was that she would first lose her coordination and then her mental acuity. She kept asking, "What is happening to me?" About all we could say is, "You're getting old." She'd reply, "Older than dirt."

My brother and I talked to the doctor after the third episode. Mom had told us several times that she didn't want any extraordinary measures taken to stay alive. We came to the conclusion that hospice care was in order. Keeping her alive the way it had been happening seemed like torturing her. Within a day, she slipped into a coma, never to re-awaken.

PM

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Author: WendyBG Big gold star, 5000 posts Top Favorite Fools Top Recommended Fools Feste Award Winner! Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 383003 of 465323
Subject: Re: Unfunded Liabilities and Macro Forecasts Date: 12/30/2011 2:06 PM
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<Means-testing would also penalize people who planned prudently for their senior years....

In my opinion, further means testing of SS will be one of the fastest ways to kill it forever. >

Current Federal Reserve policies penalize people who saved and planned prudently for their senior years.

I think means testing of SS is inevitable because relatively few people would be affected (depending on the limit) and the politicians need the votes of the many, not the few.

Wendy

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Author: Hawkwin Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 383005 of 465323
Subject: Re: Unfunded Liabilities and Macro Forecasts Date: 12/30/2011 2:22 PM
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Wendy, in order the means testing to have any significant impact, it would have to affect more than just a few people, as the study suggested. Only 2% make more than $100,000 a year. Once we get below that level of income, you will very quickly hit pensioners (public school and other public union retirees, for example) and other individuals that have historically supported SS and the politicians that would protect it.

Can you imagine the uproar over the 70+ yr old double pension couple (let's say they get $40,000 each in pension income) that now has to take their RMD from their IRAs and be taxed on it, only to turn around and lose more of their SS due to a higher tax rate for having saved well all their life? Talk about an increasing disincentive to save in your own retirement account. Why would anyone do that if they believed their pension would come close to making the SS be taxed higher. Think about the additional risk we would create by encouraging even more not to save their own money.

Lastly, what percentage of retirees do you think ANY politician would be willing to give up? 2%? 5%? How many states are decided by less? It is the few that usually decide elections.

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Author: PeterRabit Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 383014 of 465323
Subject: Re: Unfunded Liabilities and Macro Forecasts Date: 12/30/2011 3:38 PM
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I've been making the same point about "unfunded liabilities" for quite a while.

I don't know why you guys are forever harping on unfunded liabilities which are simply promises by the federal government. If the money is not there, the promises will not be met. Whether the promises are met or not will have no effect on foreign creditors or debt ratings.

Compare to US Treasuries in which case if the money is not there, all hell breaks loose.

http://boards.fool.com/i-dont-know-why-you-guys-are-forever-...

http://boards.fool.com/td1-as-a-nation-we-have-2-sets-of-cre...

Peter

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Author: PeterRabit Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 383015 of 465323
Subject: Re: Unfunded Liabilities and Macro Forecasts Date: 12/30/2011 3:42 PM
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Hawkwin, I'm really not worried about a retired couple who have no children to support and ONLY $80,000 of income per year.

Peter

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Author: tim443 Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 383016 of 465323
Subject: Re: Unfunded Liabilities and Macro Forecasts Date: 12/30/2011 3:44 PM
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I think means testing of SS is inevitable because relatively few people would be affected (depending on the limit) and the politicians need the votes of the many, not the few.

Wendy



Take it to PA or I'll ask Wendy to have your post FA'd (Fool Alert) METaR is non-politi..... oh it's you!!! }};-D


Doesn't a progressive tax system act as a form of "means testing" anyway?


Anymouse (cause I don't know how to spell anonymous and I have little idea why we are discussion this subject on METaR)


Since we are in the weeds anyway there was a discussion this morning that the "occupy" crowd had a valid point in the US but not in Ka Nada.

... oh "Friday Prince" just started it again... oh well I'll try to post it later. Oh is he ever ranting about the Congress guys getting to use inside information.

...

I may not be able to in good faith post it... it's getting worse...

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Author: tjscott0 Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 383041 of 465323
Subject: Re: Unfunded Liabilities and Macro Forecasts Date: 12/30/2011 6:39 PM
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medicare is already means tested. Its a small for SS bennies to be means tested.

https://questions.medicare.gov/app/answers/detail/a_id/2310/...

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Author: tjscott0 Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 383043 of 465323
Subject: Re: Unfunded Liabilities and Macro Forecasts Date: 12/30/2011 7:31 PM
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I previously stated " My personal experience that doctors are loath to make declarative statements about a patient's condition. Its like pulling teeth or reading tea leaves."

A supportive link:
http://newoldage.blogs.nytimes.com/2011/12/29/the-unspoken-d...

It has taken physicians a very long time to accept the need to level with patients and their families when they have terminal illnesses and death is near — and we know that many times those kinds of honest, exploratory conversations still don’t take place.

Now Dr. Smith, a palliative care specialist at the University of California, San Francisco, who also practices at the San Francisco Veterans Affairs Medical Center, and two co-authors are urging another change, one they acknowledge would “radically alter” the way health care professionals communicate with their very old patients.

In a recent article in The New England Journal of Medicine, they suggested offering to discuss “overall prognosis,” doctorspeak for probable life expectancy and the likelihood of death, with patients who don’t have terminal illnesses. The researchers favor broaching the subject with anyone who has a life expectancy of less than 10 years or has reached age 85.

“Advanced age itself is the greatest predictor of poor prognosis,” Dr. Smith told me in an interview.

By age 85, the article points out, the average remaining life expectancy for Americans is six years. An 85-year-old has a 75 percent chance of living another three years, but only a one in four chance of surviving for 10. Which category a particular old person falls into has much to do with the medical problems he or she has, or doesn’t have, and with his or her ability to function.

When the odds are that they have only a few remaining years, should doctors discuss that with them?

Sadly, it takes guts to propose this when mention of the D word to patients still raises alarms. The Obama administration had to cancel plans for Medicare to reimburse doctors when they discuss end-of-life care with their patients. Death panels! Rationing!


If the professional in the room with medical knowledge refuses or is evasive in addressing the issue of death & quality of living; I think it highly unlikely that families will be able to make a correct decision & thus allow more suffering & expense.

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Author: steve203 Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 383044 of 465323
Subject: Re: Unfunded Liabilities and Macro Forecasts Date: 12/30/2011 7:40 PM
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medicare is already means tested. Its a small for SS bennies to be means tested.

And, this is probably a guidpost for *how* SS would be means tested: by income, not net worth. So you could have millions in assets, but you could get the lowest premium rate if you manage your income to keep it under the threashold.

Steve

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Author: WatchingTheHerd Big red star, 1000 posts Feste Award Nominee! Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 383046 of 465323
Subject: Re: Unfunded Liabilities and Macro Forecasts Date: 12/30/2011 8:58 PM
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If the professional in the room with medical knowledge refuses or is evasive in addressing the issue of death & quality of living; I think it highly unlikely that families will be able to make a correct decision & thus allow more suffering & expense.

============================

In my view, this is a direct outcome of what might be called the "over-specialization" of medical care. The percentage of people who die in hospitals is MUCH higher than it was 20, 30 or 40 years ago because there are more technologies and treatments available to GET one further along the curve of life and more technology to apply once you get there. At that point, especially in the last 5-10 years of change in the administration of hospitals and insurance plans, patients are virutally NEVER in a "family health care" setting with their primary physician involved. Instead, a "hospitalist" is "coordinating" treatments in a hospital setting or the patient is in a hospice setting that offers no re-imbursement for a family doctor to remain involved. The patient is a stranger in a sea of highly trained, very expensive strangers bent primarily on the avoidance of any proximate act that could be DIRECTLY tied to a death (a fall out of bed, slip in the bathroom, wrong med...) and trigger a lawsuit even though the patient is very clearly going to die of SOMETHING and could have died from any one of those accidents with 10x the likelihood on their own or in a family member's home.

Candidly, as complex as modern medicine has become, I don't expect the doctor in the room to be the moralist, theologeon, or emotional guide for a patient they have never seen before in their life. In some sense, I think doctors and nurses act as they do because psychologically, there is no other way to survive a career getting that involved with each patient and still be able to focus on the skill we're really paying for when they ARE in a position to do something.

It's up to us future patients to recognize that the odds of us being put in that situation are VERY real. If we don't like what we see, and many of us claim we don't, then it is VERY important for us to develop a plan and philosophy for dealing with those choices and communicate it to our families and friends.


WTH

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Author: Goofyhoofy Big funky green star, 20000 posts Top Favorite Fools Top Recommended Fools Feste Award Nominee! Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 383051 of 465323
Subject: Re: Unfunded Liabilities and Macro Forecasts Date: 12/30/2011 9:57 PM
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A common theme of posts over the past 2-3 weeks involves the changing tax based to support current government programs and the macro impact of continued crushing debt loads imposed by continuing those programs.

Yes, there's been an awful lot of talk about "unfunded mandates" over the past few years, and some of it got me to thinking.

Why, for instance, is it only Social Security and Medicare which get all the carping? Don't we have lots and lots of "unfunded mandates" lying around?

Haven't we promised Veterans a certain measure of benefits, both monetary and medical? Is there a big pot of money somewhere at the Pentagon with all the cash that's going to pay for that? Or are those "unfunded mandates"?

And how about agriculture price supports or other such nonsense? Don't we have laws which "mandate" payments based on certain criteria? Does the DoA have a bunch of greenbacks lying around to pay for those in the future? I'm pretty sure the answer is "no." Can the laws be changed? Sure. Then they're not "mandates" anymore, right? Will the farm states like it? No. Will their representatives continue to complain about Social Security? Yes.

And here's one: pensions for federal workers. Don't we have tens of thousands of ex-federal employees who have been promised a pension? Is there a bank account somewhere, already funded with those dollars? And if Federal is a question, how about State and Local employees, who presumably also have some sort of pension coming after a lifetime at the County Clerk office. (State unfunded pension liabilities alone: over $1 trillion.)

Those are all "unfunded mandates" so far as I can tell, but nobody thinks about them - or at least those who keep stirring the "unfunded mandate" pot don't bother bringing those up, even though they amount to trillions of dollars. Why is that? Could it be because Social Security and Medicare are big fat political targets?

Oh, it's not just those things, heck, in the private sector, 92% of pension funds are underfunded. 92%! Why isn't there a hue and cry about those "unfunded liabilities"? Heck, the largest corporation on the planet, and the most profitable, also happens to own the most underfunded pension fund going. (They could fully fund it with four months' profits, but they choose not to because, according to a spokesperson, "We have chosen not to." I am not making this up.)

Well, the short version is that Exxon says it's a healthy business, and there's no need to fully fund the pension fund right now, they'll get to it in time. And hopefully they will, since they are a going concern - with cash coming in each year, and expenses going out. And the government, having been pressured by corporations to allow this (thank the raiders of the 1980's who made hostile raids, declared the pension funds "over-funded", and gave themselves a nice cash payday while kicking out the old management) isn't chasing after them to bring the pension funds up to snuff. (If Exxon should somehow fold, their pension obligations devolve to the PBGC, now $40 billion in the hole thanks to, well, 2008 and company. This is where "unfunded liabilities" go to die, apparently.)

Some, of course, might think that all these pension funds are short now because of the economic collapse of 2008, but the story was the same in 2006, long before AIG, Bear Stearns, Countrywide, or other bad actors got so much publicity.

So what is it? Why are the "unfunded liabilities" of SS & Medicare so horrible, deserving of 100% of the dialogue, while others aren't even mentioned? Is the US Government going out of business? Is everybody going to retire tomorrow? Are people going to stop paying their taxes in April? What?

Note: I'm not saying there aren't funding problems, only that the man behind the curtain is pointing everyone at a convenient political target, ignoring the fact that an "unfunded liability" is, in most cases, matched by an "expected future income stream", and the whole thing smells of demagoguery.

Present company excepted, of course.
 


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Author: tjscott0 Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 383069 of 465323
Subject: Re: Unfunded Liabilities and Macro Forecasts Date: 12/31/2011 2:25 AM
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Why, for instance, is it only Social Security and Medicare which get all the carping?

It not ONLY SS & Medicare that receive the carping. It does receive the majority of the carping because vast majority of citizens that reaches age 65 has a stake that the promised benefit will be there.

The burden on the federal will be especially acute as baby boomer reach eligibility age. And with health care costs rising faster than the CPI it exasperates the situation even more. As Medicare continues to increase its share of the pie; other spending must be cut or taxes raised.

How has Medicare spending grown?
3.2% of 1970 federal budget
5.4% of 1980 " "
7.8% of 1990 " "
11.0% of 2000 " "
13.1% of 2010 " "
This graph sez it all:
http://www.heritage.org/static/reportimages/9AAF2DAFFCF42E0B...

Medicare is the largest promised entitlement that unsustainable. So it must be addressed first. Then Medicaid as vast numbers will be added to the program via Obamacare.

Ignoring the problem or saying lookee over there "their pension ain't funded either" does not solve the future funding of these largest entitlement programs. Because without solutions the future promises won't be fullfilled & families will have to take up the slack. And many family will be unable to do that. And that my friend will lead to massive unrest within the country that will make the inner city riots & college protests in the 1960's seem to be very minor affairs.


Should private corporations be required to fully fund their pensions. Absolutely. Especially as bankrupt corporate pension funds become the responsibility of the federal The Pension Benefit Guaranty Corporation. Yes sir, the taxpayers are on the hook though not for the full amount of the promised pension. So workers are screwed.

Farms subsidies are NOT an entitlement. They are pure corporate welfare that should be ended. "the majority of subsidies go to commercial farms with average incomes of $200,000 and net worths of nearly $2 million."*

*http://www.heritage.org/research/reports/2007/06/how-farm-su...

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Author: tjscott0 Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 383070 of 465323
Subject: Re: Unfunded Liabilities and Macro Forecasts Date: 12/31/2011 2:43 AM
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If the professional in the room with medical knowledge refuses or is evasive in addressing the issue of death & quality of living; I think it highly unlikely that families will be able to make a correct decision & thus allow more suffering & expense.

============================

In my view, this is a direct outcome of what might be called the "over-specialization" of medical care. The percentage of people who die in hospitals is MUCH higher than it was 20, 30 or 40 years ago because there are more technologies and treatments available to GET one further along the curve of life and more technology to apply once you get there. At that point, especially in the last 5-10 years of change in the administration of hospitals and insurance plans, patients are virutally NEVER in a "family health care" setting with their primary physician involved. Instead, a "hospitalist" is "coordinating" treatments in a hospital setting or the patient is in a hospice setting that offers no re-imbursement for a family doctor to remain involved. The patient is a stranger in a sea of highly trained, very expensive strangers bent primarily on the avoidance of any proximate act that could be DIRECTLY tied to a death (a fall out of bed, slip in the bathroom, wrong med...) and trigger a lawsuit even though the patient is very clearly going to die of SOMETHING and could have died from any one of those accidents with 10x the likelihood on their own or in a family member's home.

____________________________________________________________________
_______________________________________________________________________

Rather than specializatiion; I'd say its a sales job to the client that the salesman[doctor] doesn't believe in hisself.

http://zocalopublicsquare.org/thepublicsquare/2011/11/30/how...

How Doctors Die

Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. He had a surgeon explore the area, and the diagnosis was pancreatic cancer. This surgeon was one of the best in the country. He had even invented a new procedure for this exact cancer that could triple a patient’s five-year-survival odds—from 5 percent to 15 percent—albeit with a poor quality of life. Charlie was uninterested. He went home the next day, closed his practice, and never set foot in a hospital again. He focused on spending time with family and feeling as good as possible. Several months later, he died at home. He got no chemotherapy, radiation, or surgical treatment. Medicare didn’t spend much on him.


http://newoldage.blogs.nytimes.com/2011/12/30/when-doctors-f...

“How Doctors Die” was the third of three posts Dr. Murray had agreed to write for Zocalo. His first received one comment and the second two – all from people he knew. When I last checked, the third had drawn nearly 400 and has by now surely reached hundreds of thousands of readers. “I am in shock,” said Dr. Murray, who’s 59. “This was a nerve that was ready to be hit.”

Dr. Murray contends in his post that doctors know too much about the futility of aggressive end-of-life treatment to subject themselves to it. His argument is anecdotal, based on people he has known but lacking statistical underpinnings. “It’s a fair criticism,” he said.

But recently an alert reader e-mailed him a study, published in 2008 in The Archives of Internal Medicine, of more than 800 physicians who graduated from Johns Hopkins University between 1948 and 1964. Most had reached their late 60s and 70s, so questions about end-of-life treatment were not purely hypothetical.

Asked what treatment they would accept if they’d suffered irreversible brain damage that left them unable to speak or recognize people but was not terminal, the doctors overwhelmingly said they’d decline CPR, feeding tubes and a host of other common interventions. “So there is actual evidence about this,” Dr. Murray said, pleased.


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Author: tim443 Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 383077 of 465323
Subject: Re: Unfunded Liabilities and Macro Forecasts Date: 12/31/2011 8:16 AM
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Torch was no doctor, but he knew he wanted a life of quality, not just quantity. Don’t most of us? If there is a state of the art of end-of-life care, it is this: death with dignity.


tjscott0

What a great article, Dr. Murray says what I suspect many docs would like to say but must be careful for fear of upsetting some patients and the "morality nuts" in our society. My own doc drops hints of the subject especially after recently being "forced" to revive a 104 year old only to have him die anyway two days later.

After watching my dad die (fairly quickly after an operation) of pancreatic cancer, my younger brother over a period of 20 years from the effects of MS and having my mom in a nursing home with lights on but nobody home I can't help but think about the subject.

My last remaining brother (who incidentally made the decisions for the other two) is now struggling with colon cancer (he is 65 the same age I will be in August) and from a recent report by diplomat lady who took him and his wife out to lunch a few weeks back in Ottawa not doing all that well in spite of rather aggressive efforts by his docs.

I’m currently in great health and looking forward to a couple of Caribbean trips but can’t imagine fighting it all that much when the time comes. We live in an odd world when we give our dogs and cats the dignity than we often deny our family members?


Tim <volunteers for "NONE" of that> 443

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Author: rinjr715 Big funky green star, 20000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 383084 of 465323
Subject: Re: Unfunded Liabilities and Macro Forecasts Date: 12/31/2011 9:52 AM
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Goofy, you're right that we shouldn't ignore other underfunded liabilities while focusing on SS & Medicare. Those other liabilities add up to a hell of a lot of jack. But the trouble, not only with SS & Medicare but with government pensions and health care and all the other underfunded liabilities, is that the "expected future income streams" just ain't gonna be enough and anybody with a properly functioning brain knows it. What to do about it might be a better subject for a political board or for Free For All, but it's gonna be a hell of a problem and we all know it, and especially people expecting to be owed these underfunded liabilities better plan on what they'll do to protect themselves from getting shorted.

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Subject: Re: Unfunded Liabilities and Macro Forecasts Date: 12/31/2011 11:07 AM
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tjscott0

What a great article, Dr. Murray says what I suspect many docs would like to say but must be careful for fear of upsetting some patients and the "morality nuts" in our society. My own doc drops hints of the subject especially after recently being "forced" to revive a 104 year old only to have him die anyway two days later.

After watching my dad die (fairly quickly after an operation) of pancreatic cancer, my younger brother over a period of 20 years from the effects of MS and having my mom in a nursing home with lights on but nobody home I can't help but think about the subject.

My last remaining brother (who incidentally made the decisions for the other two) is now struggling with colon cancer (he is 65 the same age I will be in August) and from a recent report by diplomat lady who took him and his wife out to lunch a few weeks back in Ottawa not doing all that well in spite of rather aggressive efforts by his docs.

I’m currently in great health and looking forward to a couple of Caribbean trips but can’t imagine fighting it all that much when the time comes. We live in an odd world when we give our dogs and cats the dignity than we often deny our family members?


This is why I submit that the older we get, the more life and limb risks we should take. There is less loot on the table then. In a perfect world, only people eligible for Social Security would be allowed to go to war. Ride sport bikes, and snort crack cocaine, and engage in unprotected promiscuity. Maybe all at the same time.

Cheers
Qazulight

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Author: brucedoe Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 383092 of 465323
Subject: Re: Unfunded Liabilities and Macro Forecasts Date: 12/31/2011 11:20 AM
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Means testing involves money coming in to SS. You can also do things with money going out to save on expenses. As I've said before that at the very least the early SS rate should be advanced to age 64 as the full rate is age 67. The current gap between early and full is 5 yrs. I think one is silly not to take the early SS for 5 yrs of benefits. If you don't need it, invest it. Who knows what may happen in 5 yrs time?

brucedoe

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Author: tjscott0 Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 383096 of 465323
Subject: Re: Unfunded Liabilities and Macro Forecasts Date: 12/31/2011 11:39 AM
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tjscott0

What a great article, Dr. Murray says what I suspect many docs would like to say but must be careful for fear of upsetting some patients and the "morality nuts" in our society. My own doc drops hints of the subject especially after recently being "forced" to revive a 104 year old only to have him die anyway two days later.


Every person need to have an end of life discussion with family members so that mistakes are not made. My mother sat her children down & stressed that no extraordinary measures be made to save her life. That she didn't want to be hooked up to any machines. She had this discussion with my father. But she knew that he not follow her wishes & have the medical profession pull out all the stops to keep her alive...but not really living. It took her children to convince their father to let her go.

I have formal end of life instructions & discussed my wishes with family members likely to make decision if I am unable. In my case no measures are to be made to extend my life.

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Author: brucedoe Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 383097 of 465323
Subject: Re: Unfunded Liabilities and Macro Forecasts Date: 12/31/2011 11:54 AM
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Goofy

While I agree with your post, there is one place where you might like to know more: And here's one: pensions for federal workers. Don't we have tens of thousands of ex-federal employees who have been promised a pension? Is there a bank account somewhere, already funded with those dollars?

Actually Federal employees paid 7% of their salary into a retirement fund in the days when I worked for them. Now there is a different plan with a Savings Program (with a small Federal match), Social Security, and a small pension. So far as I know, Federal employees account is still in the black. Toward the end of my career, I was also able to get involved in the Federal Savings Plan, but without a match. Please note that Federal employees hired since 1983 are in Social Security along with the rest of the people, so what happens to Social Security will happen to them.

One thing that does happen on occasion is that the Federal Government "barrows" the Federal Savings Plan when they get into short term trouble. This helped delay the Federal bankruptcy date this last summer. So far they have always paid it back, unlike Social Security.

brucedoe

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Author: Goofyhoofy Big funky green star, 20000 posts Top Favorite Fools Top Recommended Fools Feste Award Nominee! Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 383105 of 465323
Subject: Re: Unfunded Liabilities and Macro Forecasts Date: 12/31/2011 1:05 PM
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Actually Federal employees paid 7% of their salary into a retirement fund in the days when I worked for them. Now there is a different plan with a Savings Program (with a small Federal match), Social Security, and a small pension. So far as I know, Federal employees account is still in the black.

The FERS takes money out of paychecks (7%) just like Social Security does. (OK, the numbers are a bit different). And what do they do with them? They issue "special issue treasury securities" to their trust fund. There is no basement full of gold, and there are obligations which must be met in the future by redeeming these "securities."

What's happening now? Cash flow problem:

FERS has a trust fund. Currently there is $775b of Special Issue
Treasury securities in the fund. This is equivalent to 6% of our total
debt and is therefore a very big deal. FERS holds as much of our paper
as do the Chinese and the Federal Reserve.

-FERS is running a cash flow deficit. This is a new phenomenon. FERS is
converting itself into a defined contribution plan that will address
some of the problems. However the cash drain experienced in 2010 will
not be reversed in the foreseeable future. It will increase. Some
numbers from OMB:

[table omitted because of formatting]
The benefits paid in 2010 will come to $70b. Therefore total revenue
exceeds expenses by a tidy $28b. This is the conclusion presented to the
public. Clearly there is no problem with FERS. They are running a
surplus! I look at it exactly the other way around.

Cash out at FERS was $70b. Cash in was only $4.0b. The difference of
~$66b is the real measure of what is happening at FERS. They are sucking
down cash. A substantial portion of the deficit is funded with debt
creation.

http://www.zerohedge.com/article/your-face-entitlement-fers

Perhaps I have misunderstood, but I think there is a huge liability waiting, and it won't be covered by the current method of "income" from present workers and "redemption" of "securities.

Which is not to minimize the rest of it. There are unfunded liabilities all over the place. At some point it has to stop. (I question whether the middle of a recession cum liquidity trap is the time to do it; that would have better done when the economy was doing well, but no, we elected even more immediate gratification in the form of tax cuts.)

I think one is silly not to take the early SS for 5 yrs of benefits.

As somebody (I think Wendy) pointed out, by waiting your social security payment increases 8% per year. That's a pretty fabulous return, assuming you don't die before your breakeven point. I had planned on doing a Withdrawal of Application (payback and reapply at a higher rate) as I aged, but that option was taken away.

But the trouble, not only with SS & Medicare but with government pensions and health care and all the other underfunded liabilities, is that the "expected future income streams" just ain't gonna be enough and anybody with a properly functioning brain knows it.

Agreed. That's why anyone with a properly functioning brain knows that just yelling about SS and/or Medicare doesn't solve the problem. It's bigger than that - much, much bigger. (Ahem: Health Care Costs) Only by tackling the root problem do we stand a chance of ameliorating this, but politicians don't want to do that (or rather, won't let us do that.)

How has Medicare spending grown?
3.2% of 1970 federal budget
5.4% of 1980 " "
7.8% of 1990 " "
11.0% of 2000 " "
13.1% of 2010 " "
This graph sez it all:
http://www.heritage.org/static/reportimages/9AAF2DAFFCF42E0B......


The linked chart begins in 2005, not 1970. And, as usual, the Heritage Foundation presents a truthful lie. They start the chart in 2005, when military spending was at its height, and when social safety net programs were at a low. Why do they do that? (Because their target is Social Security and Medicare, of course.) The CBO apparently assumes there won't be any wars which need funding, or escalation of Pentagon spending at all! for the next 40 years! Does that seem likely?

Ignoring the problem or saying lookee over there "their pension ain't funded either" does not solve the future funding of these largest entitlement programs.

That's true. Neither will singling them out and not addressing the core problem, which, for instance, you intimate (and derisively call) Obamacare will exacerbate. Most other countries have some sort of national scheme which keeps medical costs down, we have one which only seems to shoot them skyward, yet we are not allowed to address it. Why is that?

Should private corporations be required to fully fund their pensions. Absolutely.

So why does the Heritage Foundation have 10 times the number of articles on Social Security as underfunded corporate pension funds (which, while smaller, are even more seriously underfunded, and still affect tens of millions of people?) Hint: it's political, and they know where their funding comes from.

Farms subsidies are NOT an entitlement. They are pure corporate welfare that should be ended.

Well, you say so, I say so, the only people who don't say so are the same people complaining about Social Security: i.e. legislators from farm states. Funny how they manage to overlook those "future liabilities". Heck, look at Iowa now. How many of the prospective candidates (and I include the Democrat back in 2008 in this blanket condemnation) are willing to talk the talk? About 3/4 of one guy who can't win. Not very impressive.

then it is VERY important for us to develop a plan and philosophy for dealing with those choices and communicate it to our families and friends.

Easier to say than do. My mother was one of those: many conversations with many people. Living will distributed to all children. Specific instructions abounded. Yet, with advanced COPD she ended up in the hospital several times each year, and though the charts all said "no special heroics" (or whatever the proper terminology is) and she had said to my father more times than I can count "I don't want to be strapped to machines", she was - and he went along, because it kept her alive for another 3 or 4 months until the next episode. Finally, at last, after one quite severe episode they were strapping an oxygen mask to her face and she was fighting it, and my father stood there watching until my brother-in-law (a medical professional) said "Dad, do you think Mom is uncomfortable with this?" and they took the mask off and she expired.

That could have happened months, or even years earlier, but her "wishes" kept getting violated, and even those who knew the exact instructions didn't stop it from happening. (And since they travelled, it happened in hospitals in South Carolina, Pennsylvania, Tennessee, and Boston - so this was not some isolated incident.)

It's a problem, for sure, and I have no answer (except, of course death panels, which is probably not a proper subject for discussion hereabouts.)
 


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Author: Hawkwin Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 383231 of 465323
Subject: Re: Unfunded Liabilities and Macro Forecasts Date: 1/3/2012 9:12 AM
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Hawkwin, I'm really not worried about a retired couple who have no children to support and ONLY $80,000 of income per year.

Peter


But that is who votes...

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