Everyone is going to die. This is generally underappreciated. The issue is always how and when each individual gets there.
Keys are preventing very early deaths (everything with pregnancy, newborns, kids), preventing traumatic death (cars and guns broadly), delaying mid life deaths (trauma and chronic disease including cancer, depression) and focusing on quality of life for everyone (mental health, disability, excellent end of life care).
Discouraging vaccines, encouraging dirty air and water, letting guns rule, shutting access to health care but for ERs and reducing the viability of a health care career are meant to meet which health goal?
I think there is a more sinister aspect of the failure to address these issues. Reduce the population of seniors. Let’s look at long term care, adding better care extends the quality and quantity of life for these people….thus costing more… longer….reminds me of the senator from Iowa who said you are going to die anyway…
No, they DON'T get free health care. Haven't for decades (if they ever did). Health insurance for both houses is through the Washington DC ACA exchange (DC Health Link). They pay for it, just like everyone else. It's not free. This is one difference from civil service employees who get their health benefits from FEHB – which is also where Congress people bought their health insurance before passage of the ACA.
All members, like all civil servants, pay into Social Security and Medicare, and go on Medicare after age 65 if they are retired. I assume, like civil servants, they can pay for medical insurance after retirement and keep paying for that additional medical insurance after they go on Medicare.
For pay and benefit purposes, members of congress are just civil servant employees.
For Senate Majority & Minority Leaders, President Pro Tem of the Senate: $193,400
For the Delegates (DC, other territories) and Resident Commissioner of Puerto Rico: $174,000
Both houses have passed legislation denying Congress a pay raise on 1 Jan 2026.
From that CRS report, on retirement: “Importantly, former Congress members do not receive full congressional salaries for life, but they become eligible for a pension after five years of service. Members can start collecting pensions at age 62 if they have served for at least five years.”
Note this is the same retirement system (FERS) as all other civil servants are on. Again, for pay and benefits, they are just civil servants.
There’s a lot we can criticize Congress for, but at least criticize them for real issues, not mythsl
one other benefit to nationalized health care - I mentioned to my doctor that I'd just figured some symptoms (fatigue, shortness of breath, hand numbness) were 'just' old age - she said they check other possibilities and treat before coming to that conclusion. So at age 90 I'm getting "free" Vit K shots and wrist surgery. What's government FOR but to do for citizens what they can't do themselves and what is best for the population as a whole?!
Joni Ernst, the senator from Iowa who said that made it clear that she was lost both morally and ethically. That is the condition of virtually every Republican politician today and the vast majority of Republican voters. They had traded decency and the law for the ability to impose their own beliefs on everyone. That means they have abandoned democracy. It is now more important for Republicans to get their way than it is for the country to follow the wishes and needs of the majority. The Electoral College has long made that an occasional reality, as well.
The sad truth is that we have two major failures with regard to the elderly.
1. We need some to die sooner, not later. Before anyone freaks out, finish reading this. What I mean is that we are now keeping people breathing and preventing their inevitable deaths by using extraoridinary measures that accomplish nothing positive once their loved ones have had an opportunity to visit and say "Goodbye." A number of years ago, Frontline on PBS had a program ("Facing Death," November 23, 2010, 53 minutes) on which they followed several people who were very ill and hospitalized. At the end of the program, one of the doctors involved said that there was no doubt that she had done harm. Why? Because the individuals involved were beyond real help. They could be kept breathing, but only at the cost of suffering and huge expenditures. Much of the suffering may be felt, not by the patient, but by her or his loved ones, who don't want the person to die and refuse to let go. Even when there was no genuine hope, for the patient, family members might insist on continuing treatments that were not going to save the patient and simply prolonged suffering. While that may be understandable, does it make any sense? One serious question is, "If death is inevitable, is it better to allow the patient to die, so that those left behind can move on with their lives? The patients on the Frontline program did not improve, if they left the hospital, they came back very soon, and none of them were living a life that is likely to appeal to any mentally healthy person. Using extraordinary measures just to allow someone to still be breathing the next day when there is no realistic chance of improvement is both cruel and wasteful, even when that is what people are choosing. Miracles don't happen, although occasionally extremely improbable events do occur. Should people put their hope on an extremely improbable event and, if so, for how long? My answer would be "No" and only as long as it takes for close family members (and possibly dear friends) to visit briefly and say farewell. In many cases, the patient won't even know anyone is there.
As Anne H. pointed out, we are all going to die. Perhaps, every American could after a certain age, attend classes concerned with preparing to die and accepting death. It need not be morbid or depressing. None of us are going live forever. Physician assisted death laws are often called "Death with Dignity." But for the patients I'm discussing how dignified is it to spend one's final months, weeks, or days on the planet with lines and probes and sensors attached or inserted all over one's body despite the fact that they are not going to change to outcome, only the timing? Show a picture of that to a 25-year-old and I expect the universal response would be? "Not me." Add 53 years to that person and the response is often very different. But should it be? Money spent on hopeless patients is not available for those with better prospects. (Or the result is simply more debt, which may result in bankruptcy and subsequent unnecessary hardship.)
2. The other failure is far simpler. Too many people die for lack of adequate care. That, in my mind, is definitely more important that #1. When those deaths are the result of failings in coverage and/or the system, it is unforgivable. Or should be. Yet, we accept it.
My sense is that Americans are generally quite poor at confronting death. Those who are deeply religious may hold out hope that "God" will intervene, but that is not a good bet. Alternatively, for those who are deeply religious and believe in heaven, delaying death and reuniting with "God" seems more selfish than religious.
I'm old and I am facing these questions now in my own life. I don't want to die, but I don't want to be alive regardless of my circumstances. In the past, I have read several books about dying -- nothing religious, I am not a believer -- in part, to understand the inevitable better and to help myself prepare for it when the time comes. The final act of one's life may include issues that are spiritual, personal, familial, medical, financial, and practical. My own mother was fortunate. She had a massive stroke on a Friday. She was hospitalized and soon after tests revealed no significant brain activity. She was allowed to die with minimal time in the hospital, minimal cost, and minimal fuss. Undoubtedly, they could have kept her breathing indefinitely, but to what purpose? My father died of metastatic prostate cancer, which metastasized to his bones and caused him considerable pain. The upside to his death was the possibility of closure. I returned home when my mother asked me to come and help her. I sat up with my father at night, not sleeping unless he did. Our relationship was complete. All that needed to be said was said. His death was not sad or tragic, but a relief, for him and for me. There was no closure with my mother. I had not spoken with her recently and fortunately my sister was visiting her when she had a stroke. I spoke with my sister and there was no reason for me to cross the entire country to "say goodbye," because there were no longer goodbyes to say. I had no desire to see my mother either on life support or dead. Our relationship ended prior to her death. Which is better? My father's death was better for me, but my mother's death was better for her. She didn't suffer. She was talking to my sister one minute and gone the next.
We normally don't get to choose the time or manner of our own deaths. Suicide is a complicated issue, but for elderly people without mental illness the government should not only not try to prevent suicide it should make humane means easily available. I recoil at the idea of my spending a long time in the hospital or a nursing home before dying and if I can prevent that I will.
And I’ve heard some Republicans say it’s mainly old women, so what’s the loss? They can’t bear children anymore so they are no longer useful.
BTW, Gruber says the nation was willing to close down to save seniors during peak Covid, but that was just blue states. Red states opened after 6 weeks, with 70 year old Texas politicians declaring they would be willing to risk their lives to keep the economy going. Covid revealed their true intentions about seniors.
I just browsed your posts for a brief two minutes. You are about as far from useless as it gets. There is a ton of knowledge in that brain, the rest of us could use some of that.
It wasn't just Republicans. Cuomo in New York infamously used elderly care homes as Covid clinics, increasing the fatality rate amongst the inhabitants.
I lost count of how many maga politicians and candidates died of covid. I could be as callous as they are and say “nothing lost” but I won’t. I fear the stupidity becoming normal.
We are the only industrialized country without some form of single payer healthcare. Rugged capitalism and healthcare don't mesh.
There are different permutations but everybody is in the pool. If you're wealthy in Britain you can go to a Harley Street doctor but you're still paying into the pool.
We pay more for healthcare than any other country but always rank way down the list in quality of care. There is a bump in taxes to fund the system, instead of what we pay now in ridiculous insurance premiums. We can do better but not under Trump and his Big Pharma & Big Healthcare benefactor$
I don't think a bump in taxes is necessary, just turn over all single payer health administration to CMS and eliminate insurance company profits. Tax corporations to pay for the added costs to CMS as employers will no longer have health coverage burden. And CMS will have great leverage to bring health costs down. It could be an economic and overall health win.
"Every system is perfectly designed to produce the results it's now getting."
Rational government and health care systems improve health and years of useful life.
The US system sends 5% of 18% of GDP to insurance company profits and thus to their rich owners.
"A recent study by political scientists Martin Gilens of Princeton and Benjamin Page of Northwestern concludes, basically, that the US is a corrupt oligarchy where ordinary voters barely matter. Or as they put it, "economic elites and organized interest groups play a substantial part in affecting public policy, but the general public has little or no independent influence.""
Revoking haitian tps is beyond stupid. Someone should just run ads in Florida all day long and ask the white republicans how many of their parents and grandparents they want to kill. That state would go blue next year.
Ask them if they want to care for their family members themselves at home. Because that is what will happen. Every form of assistance with the activities of daily living.
Then perhaps we need a pathway from TPS to permanent resident status. Or perhaps we simply need to rename TPS.
I'm not harmed in any way by having Haitians living here, temporarily or not, and having them here means fewer citizens are dying. Sounds like a win to me.
What we're doing now is taking away TPS status...just because. "Just because" isn't sound policy here; it's not sound policy on any topic.
You hit in the cruelty of Trump and MAGA deportation. Where do these folks live and support themselves when they are pushed out of a living they have developed over many years, especially cruel for families.
Another pristine example of assuming way too much about a definition and in this specific case assuming temporary labels an individual. Riffs on an isolated word based on a definition in Webster Annotated Dictionary sound convincing but founder once checked against how the word is used in the law. For this case and in all probability "temporary" was chosen arbitrarily as expedient and close enough.
Temporary designates the staus of a country not the status of citizens from a TPS designated country who reside in the United States. Moreover,
'The law does not define the term “temporary” or otherwise limit the amount of time for which a country can have a TPS designation. '
"I understand immigration is a fraught issue, and clearly we might have gone too far in the Biden years."
I would have like to see Krugman push back a bit on this statement by Gruber. Who is the "we" who "might have gone too far" in the 2021-24 years? The Biden administration? The Democratic Party? The "general public"?
What exactly went "too far" during those years?
And which groups of people, in which parts of the country, felt that "we" might have "gone too far" in those years?
I do not ask these questions to vilify Gruber. I ask them because:
* I live in a city that historically has functioned as an assimilator of millions of immigrants over centuries. So in this city we don't have the strong underlying fear of immigrants people in other parts of the country may have.
* I have little exposure to broadcast or cable news, so I was not buffeted by televised images of "chaos at the border" during the Biden years. (My hunch is that now the images are of "chaos in [Democratic-run] cities.")
* When I interact with the health care system -- five hospitalizations since the age of 62 -- I assume that more than two-thirds of the M.D.s and more than nine-tenths of all other staff will be immigrants. These proportions are roughly the same as those I found in ten years of working in the lowest-paid segment of the health-care business: state-run, long-term psychiatric hospitals. Moreover, these are the same proportions I found in the health care system in a much smaller, low-immigration metropolitan area where my parents lived their entire lives and spent the years between 2006 and 2021 interacting with the health care system.
So I concede that I cannot understand the panic about immigration that the Felon-in-Chief's political base apparently feels.
I think a lot of it was just lies spread by the Republicans - not based on fact or reality. They are very good at repeating their lies, and at one point, people start believing it.
One of the first steps in establishing an authoritarian government is to create a group or groups of people for "good citizens" to hate. In 1930s Germany, these were the Communists, the gypsies (Romani), union workers, and the Jews. Here, it's immigrants, transgender people, homosexuals, and, in some areas, any non-white person.
I’ve heard this same comment from others recently without explaining why. I’ve believed the immigration issues Biden inheritance, came from years of the Republican party’s desire to keep the system dysfunctional so they could run on the issue. Going back to the Clinton days, wasn’t it he who changed the entry quotas to be more balanced between Europe and the Americas, where it previously leaned towards europeans.
I agree that the Republican Party delighted in keeping the immigration system dysfunctional so that they could run on the issue. However, that would mean that "we" -- really, the White House and Congress -- didn't *do enough* to restore the system to (some definition of) workability.
What I don't understand is Gruber's statement that "we" might have gone *too far* during the Biden administration. I suspect that Gruber is not the only person who thinks this way -- but I don't think that the only thing leading them to think this way is Republicans repeating the Big Lie.
Agree, good point, thank you. I’m no expert on immigration. I followed the Biden administration as best I could and never remember hearing anything about them going to far till recently.
I definitely think Biden went too far in allowing so much immigration. If he had kept the border crossings down to Obama and Trump1 levels then Trump would not be president now - we would have better healthcare, less debt, no wars, no ICE agents or national guard in our cities, lower tariffs, UKraine would be free, etc etc While compassion wins hearts, realism wins elections, progressive (not moderate) Dems have to remember the oft repeated wisdom that "Perfection is the enemy of good"
Frau, can you connect the dots for me please. Was the spike due to the Biden immigration policies? Or is it that since it happened while he was in office he is automatically responsible for the spike? Thanks
I’m hardly an expert but my understanding is that Biden changed Trump’s earlier draconian immigration restrictions. But his administration appeared unprepared for the post Covid spike and didn’t move quickly enough to close the border.
Towards the end of his term he tried to push through a comprehensive immigration reform bill but by then Trump realized it was a winning campaign issue and ordered the Republicans to vote against it.
There was a lot of TV footage showing immigrants just flooding through holes in fences at the border. Biden felt that he had to honor the international amnesty law which said that if you set foot in a country illegally you could ask for and get amnesty. Trump has simply ignored that law, and nobody has mentioned it again. Also, Repubs wouldn't give Biden the money to fix the border. At least Trump has sealed the border. That needed to be done, and Biden couldn't or wouldn't do it. As for the deportations, we would be better off giving all the illegals amnesty as Reagan did while saying "we'll never do that again." Well, it's time to do it again.
I recommend you read "America for Americans" by Lee. It's probably banned in Florida schools because it doesn't cast the US in favorable terms. We are a still a very racist society; the more I study TRump and MAGA it's hard to come to any other conclusion,
Having had very good, expensive health insurance in the US and then moving to France. I can tell you France does it better. The US government pays more out for US health insurance than France but does a worse job. I had cancer in the US and my insurance paid for most things but at the end, dropped me! So if I'd stayed in the US, who would have covered me. Luckily I had planned to move to France . 5 years later I had a recurrence due to the bad operation in the states lwhere they had said I was cured! and Frane took care of everything. I wouldn't be alive today if I hadn't moved to France. I didn't move to France for its health insurance but for its quality of life but a bonus was its healthcare. Universal healthcare is not only humane but it saves money. Also we all pay into the French healthcare system with a progressive tax - very fair.
Per capita healthcare costs in the U.S. are about twice as high as they are for first world countries with universal healthcare. But don't worry - U.S. healthcare outcomes are among the worst, so we get what we pay for.
It really is amazing not just how bad it all is but that we as a nation actually tolerate it.
So many of us do not know about this. We are Exceptional (USA! USA! USA!) and do not WANT to know that our healthcare system is exceptional, in its high costs and mediocre results for those who are not financially well off.
Every penny wasted in bureaucratic overhead gives its 5% to insurance profit.
And of course, insurance company procedures can increase waste, prices, and costs.
(For many years, the way prices for PROCEDURES (surgery, hospital, imaging, labs) were set was to take the 75%ile of the charges submitted as the NEW PRICE for the next year. ) Just think about what that would do to prices.
Many providers, who don't know what the ins will pay, each want to submit at least that much...and if the ins pays the full amount, they might have gotten more if they submitted higher charges...
Thank you for this topic, Paul. I recently had an operation in NYC and actually wrote in my Substack about the wonderful carers from all over the world. I was treated with such hands-on compassion by them all. Aging ain't for sissies as the saying goes, but so far 80 has been a good year.
I would retire right now if not for needing health insurance. My decent corporate job would probably be filled by a younger person if I left, and I would love more time with my dear second husband while we’re both healthy, but we’re terrified of taking this risk. I represent the tail end of the baby boom, and this conundrum obviously contributes to our national economic stagnation.
yes this is the reason for a universal single payer healthcare system but as we know the gop and some dems will never allow it since they are whores to the lobbyists, wall street and other entities sucking americans dry with this for-profit broken system
Don't retire until you are both eligible for Medicare. If he's older, then he should go on Medicare if eligible. You can reduce your costs by removing him from your corporate policy. Retire at 65; then you get your medicare too. Sorry, but right now, that's the only road.
Yes, he’s older and yes he’s on medicare. I agree that there’s really no choice in the matter but to keep working. I don’t rule out a rude awakening on Wall Street either, in which case it could happen anyway.
I skimmed the article, I have two thoughts: the waste that Trump has spent together with the graft that could have been addressed to healthcare would have funded the cost for the Trump term.
The ICE killing of one nurse in Minnasota reduced the healthcare potential, how many CNAs have also been put on the plane at $1 m/person removed from Healthcare potential
As a single parent working my way through a state university in the late 70/early 80s, I was able to afford non-profit health insurance until reagan/congress came in and killed the non-profit laws covering health insurance. So, we had none, daughter broke her arm at a non-profit day care. It was hell getting their insurance to cover it. I can’t tell you have stressful it was having the hospital calling me at my part-time job demanding payment. There was no extra money. Decades later, the person who cuts my hair told me their insurance went from a few hundred per month to $3200 a month - more than these people bring home a month as small business owners. He’s a mechanic and she does hair (same building). They ended up with a private policy that will cover nothing if either one of them gets injured or ill. All of this so Musk, Thiel, Bezos pay less.
Taxes are lower the more you make. Health care is big, big business. If fact I read today that it is healthcare/social services propping up job numbers.
When you add up the so-called lower taxes plus health insurance costs and of course the costs denied by insurance companies or costs for non-covered services (dental work), we pay far more for healthcare.
This is a great conversation and very enlightening. It is obscene that the current regime in DC is willing to hundreds of billions of dollars into creating for profit concentration camps in which to imprison undocumented people. I guess their next move would be to force them into unpaid labor since the Constitution does not make slave labor illegal in the case of prisoners. So maybe the Confederate enslavers will yet win the long war 150 or so years after they supposedly lost. I also can't help but think that for the Epstein class the high numbers of additional senior deaths caused by mass deportation is actually an added bonus to their plan. I cared for my own beloved husband for more than 10 years at the end of his life. The last 9 months he was in a nursing home at around 14,000 dollars a month. The kindest, gentlest, and most respectful carers he had there were all immigrants from Africa and central America. The did impossibly awful work cheerfully and without ever making him feel bad or ashamed. I hope the Stephen Millers of this world get demonic robots as their end of life carers. They don't deserve the human touch.
In my province (British Columbia), long term care is 80% of your income, with no obligation to spend down assets. It’s publicly run (expensive private care is also available).
Sorry about your husband. I’m glad you had good workers, though.
Yes, in fact, partly in response to you (Frau Katze) stating that to me earlier, I put the difference in financing, Canada (which varies by province but is uniformly much better than the U.S.) to U.S. on my own little substack post:
but the contents are actually mainly in this thing from the Canadian Government,
and from there, I pull, for British Columbia:
"Income-based, up to 80% after tax, $1,417 to $3,974.10/month (2024)",
showing your veracity!
--
I also note that, by coincidence, I stuck a post on the Canadian financing, with the same info as this comment, and it appears to be chronologically right before the comment you are answering.
Separately, I recall you, Frau Katze, indicated your name on the posts was just a pen name. (I had prior somehow thought you were in Germany, and it was just your real name.)
So, I ask, if you don't mind telling me. Does it stand for "cat lady"?
MRI may not answer #1, and usually doesn't change #2.
So rational systems don't jump to MRI but instead Rx rest, ice, NSAIDs if tolerated and Physical Therapy which is usually #2.
IF you had an ACUTE knee, you would get an MRI and treatment sooner.
Long ago (before MRI was widely available) I saw a patient in the ER with an acute locked knee. The Ortho's verbal report to me was "Yup. It's locked." He was admitted that day for surgery to fix the problem. Today he'd get an urgent MRI to help direct the surgery, but MRI is still mostly a 'help in planning surgery/is surgery needed?' tool.
No copay for MRI and $25/session copay for PT help raise health care costs, and thus the % of those costs that become insurance profit. (see my other comment)
I am still recovering from a three-level-resection in my neck. If I had been required to wait months for an MRI, I quite possibly would be dead by now. One of the problem areas controls breathing.
I've had direct experience with home health care through my mother-in-law, who was in an independent living facility at the same time that my husband was dying of kidney failure. She obviously needed to go into assisted living, but I could not take care of my husband and move her at the same time. Fortunately, her facility had a list of aides one could hire -- so one came in a couple of days a week for bathing, laundry, receiving groceries, and preparing meals for the rest of the week. They were lifesavers, and they were all immigrants. I believe many of them were not even CNAs, so another group of people who could earn more with education. They also provided peace of mind for me -- I hired them to be with her while my husband was in the hospital during his last days and afterwards when I had to arrange for his funeral. My mother-in-law only had a vague sense of what was going on, but she knew her son was dying, and she needed someone with her to alleviate the stress. Her insurance covered none of this, so I'm also fortunate to be able to pay out of pocket.
Thank you for this comment. I worked as a home health aid and CNA for several years before I retired. I was so impressed by the compassion and emotional intelligence of the women who trained me, and can only hope that I succeeded in emulating them. Krugman does not mention this aspect of the work; I’m not sure he understands that not any random person can do it well.
Thank you for your words and your work. It is indeed an extremely difficult job - few have the understanding, compassion, and toughness to do this work. Her caregivers, especially after I moved her into assisted living, were so compassionate. She didn't remember names, but when one entered the room, she would ask, "Are you my angel for the day?". And they were.
When my mother's health deteriorated to the point that she needed constant care, she refused to have in-home care because she was afraid that the carer would steal from her. She pressured my brother and me to move down and take care of her (so she could stay in her deteriorating house), but eventually wound up in a very nice care facility that my sister found for her. Fortunately, her pension was quite generous (much more than my salary) and Medicare paid the bulk of her prescription costs. That didn't prevent her from complaining about having to move out of her house, that the house sold for much less than she thought it was worth, and complaining about the cost of her facility.
I live in a largely hispanic town in NJ. So a factory town with older 2 family houses (and the fatories are gone). My doctor and I talk about health care and health insurance. She says the copays and deductibles discourage her patients from doing follow up visits. The lower cost policies actually don't work to provide reliable care (unless you are better off).
A very bad habit liberals have is using the word "we" to describe Republican sins. Paul Gruber who is otherwise a brilliant and wise advisor to us all says "So what we’re saying is we’ll spend ten times as much to make tax cuts for the rich as we are to make insurance affordable for the middle class." No Paul, Republicans did it all by themselves and definitely are not saying "we’ll spend ten times as much to make tax cuts for the rich as we are to make insurance affordable for the middle class." It's what Republicans think and don't say because they know they're harming the public to shovel huge piles of cash to the morbidly rich like Peter Thiel and Howard Lutnick. The GOP knows if the public clearly understood what the GOP was up to they wouldn't like it.
Aristotle defined political rhetoric as the assignment of praise and blame. Assign blame to Republicans for their cruelty plainly and directly . Don't confuse the argument by using the word "we". They are evil not "we".
Our country did NOT uniformly invest in caring for seniors during COVID. The Red States did not, the Blue States did. Consequently, the Red States had poorer results (and they also weren't interested in collecting data) and compared to other developed countries, we did less well. Now we're seeing it again with vaccine denialism, a direct offshoot of what happened with COVID.
(I am putting aside what happened in the early going with New York nursing homes, because the speed and intensity of the impact caught people by surprise. But once everyone knew what was happening, there should have been no more excuses.)
An important conversation, for sure. I hope that seniors are included in it. We tend to be invisible and unheard, which makes measuring QOL a challenge. For BIPOC and disabled seniors, it’s even worse.
The anti-immigration, anti-healthcare, anti-education, anti-everything positions of (R)ightWingNuts damages our society in many obvious - and subtle - ways.
A few years ago I was riding one of the excellent, slickrock mtn bike trails where I lived in the Glorious high desert of southern UT. I happened to meet, and rode with, a 50's-something couple from Denmark. I learned that they both had been employed in good mgmt jobs that they liked. They recognized a niche need that wasn't being addressed in their industry by existing companies. They decided to take the plunge, left their good jobs and started a company to fill the niche. Fifteen years later, they employed 20 people and were wealthy enough to take a 3 month biking vacation in the US. "Best decision we ever made", they said.
They noted that they NEVER would have taken the risk except that: 1) Denmark provides universal healhcare coverage for ALL citizens and 2) Denmark not only provides free college - they had two college-age kids - but also provides grants to cover rent and food expenses. Their kids would graduate with zero, nada, zip college loan debts!
They said, "Sure, our taxes are high, but the benefits from those taxes gives us the FREEDOM to live better lives without worrying about medical and education debt. High taxes support the small businesses and entrepeneurship that make societies vibrant and healthy.
PS: Paul says, "the system is cruel and dysfunctional and I think the only thing that allows it to persist is that most Americans don’t know that it doesn’t have to be this way."
I suggest that MAGAttes don't WANT to know it could be better. They REFUSE to make things better (even for them) if it might, in any way, help "THOSE PEOPLE" (whatever group-du-jour might be in the MAGAttes' gunsights). The myopic, parochial, brain-dead worldview of conservatives is damaging to our entire society (including THEM, for Goddess' sake!) and their stubborn close-mindedness makes them unteachable. Grrrrrr!
Everyone is going to die. This is generally underappreciated. The issue is always how and when each individual gets there.
Keys are preventing very early deaths (everything with pregnancy, newborns, kids), preventing traumatic death (cars and guns broadly), delaying mid life deaths (trauma and chronic disease including cancer, depression) and focusing on quality of life for everyone (mental health, disability, excellent end of life care).
Discouraging vaccines, encouraging dirty air and water, letting guns rule, shutting access to health care but for ERs and reducing the viability of a health care career are meant to meet which health goal?
I think there is a more sinister aspect of the failure to address these issues. Reduce the population of seniors. Let’s look at long term care, adding better care extends the quality and quantity of life for these people….thus costing more… longer….reminds me of the senator from Iowa who said you are going to die anyway…
and the senator gets free health insurance
No, they DON'T get free health care. Haven't for decades (if they ever did). Health insurance for both houses is through the Washington DC ACA exchange (DC Health Link). They pay for it, just like everyone else. It's not free. This is one difference from civil service employees who get their health benefits from FEHB – which is also where Congress people bought their health insurance before passage of the ACA.
All members, like all civil servants, pay into Social Security and Medicare, and go on Medicare after age 65 if they are retired. I assume, like civil servants, they can pay for medical insurance after retirement and keep paying for that additional medical insurance after they go on Medicare.
For pay and benefit purposes, members of congress are just civil servant employees.
Current compensation for Congress (https://www.congress.gov/crs_external_products/RL/PDF/RL30064/RL30064.44.pdf):
From that:
Salaries:
For most Senators & Congressmen: $174,000
For Speaker of the House: $223,500
For Senate Majority & Minority Leaders, President Pro Tem of the Senate: $193,400
For the Delegates (DC, other territories) and Resident Commissioner of Puerto Rico: $174,000
Both houses have passed legislation denying Congress a pay raise on 1 Jan 2026.
From that CRS report, on retirement: “Importantly, former Congress members do not receive full congressional salaries for life, but they become eligible for a pension after five years of service. Members can start collecting pensions at age 62 if they have served for at least five years.”
Note this is the same retirement system (FERS) as all other civil servants are on. Again, for pay and benefits, they are just civil servants.
There’s a lot we can criticize Congress for, but at least criticize them for real issues, not mythsl
one other benefit to nationalized health care - I mentioned to my doctor that I'd just figured some symptoms (fatigue, shortness of breath, hand numbness) were 'just' old age - she said they check other possibilities and treat before coming to that conclusion. So at age 90 I'm getting "free" Vit K shots and wrist surgery. What's government FOR but to do for citizens what they can't do themselves and what is best for the population as a whole?!
Joni Ernst, the senator from Iowa who said that made it clear that she was lost both morally and ethically. That is the condition of virtually every Republican politician today and the vast majority of Republican voters. They had traded decency and the law for the ability to impose their own beliefs on everyone. That means they have abandoned democracy. It is now more important for Republicans to get their way than it is for the country to follow the wishes and needs of the majority. The Electoral College has long made that an occasional reality, as well.
The sad truth is that we have two major failures with regard to the elderly.
1. We need some to die sooner, not later. Before anyone freaks out, finish reading this. What I mean is that we are now keeping people breathing and preventing their inevitable deaths by using extraoridinary measures that accomplish nothing positive once their loved ones have had an opportunity to visit and say "Goodbye." A number of years ago, Frontline on PBS had a program ("Facing Death," November 23, 2010, 53 minutes) on which they followed several people who were very ill and hospitalized. At the end of the program, one of the doctors involved said that there was no doubt that she had done harm. Why? Because the individuals involved were beyond real help. They could be kept breathing, but only at the cost of suffering and huge expenditures. Much of the suffering may be felt, not by the patient, but by her or his loved ones, who don't want the person to die and refuse to let go. Even when there was no genuine hope, for the patient, family members might insist on continuing treatments that were not going to save the patient and simply prolonged suffering. While that may be understandable, does it make any sense? One serious question is, "If death is inevitable, is it better to allow the patient to die, so that those left behind can move on with their lives? The patients on the Frontline program did not improve, if they left the hospital, they came back very soon, and none of them were living a life that is likely to appeal to any mentally healthy person. Using extraordinary measures just to allow someone to still be breathing the next day when there is no realistic chance of improvement is both cruel and wasteful, even when that is what people are choosing. Miracles don't happen, although occasionally extremely improbable events do occur. Should people put their hope on an extremely improbable event and, if so, for how long? My answer would be "No" and only as long as it takes for close family members (and possibly dear friends) to visit briefly and say farewell. In many cases, the patient won't even know anyone is there.
As Anne H. pointed out, we are all going to die. Perhaps, every American could after a certain age, attend classes concerned with preparing to die and accepting death. It need not be morbid or depressing. None of us are going live forever. Physician assisted death laws are often called "Death with Dignity." But for the patients I'm discussing how dignified is it to spend one's final months, weeks, or days on the planet with lines and probes and sensors attached or inserted all over one's body despite the fact that they are not going to change to outcome, only the timing? Show a picture of that to a 25-year-old and I expect the universal response would be? "Not me." Add 53 years to that person and the response is often very different. But should it be? Money spent on hopeless patients is not available for those with better prospects. (Or the result is simply more debt, which may result in bankruptcy and subsequent unnecessary hardship.)
2. The other failure is far simpler. Too many people die for lack of adequate care. That, in my mind, is definitely more important that #1. When those deaths are the result of failings in coverage and/or the system, it is unforgivable. Or should be. Yet, we accept it.
My sense is that Americans are generally quite poor at confronting death. Those who are deeply religious may hold out hope that "God" will intervene, but that is not a good bet. Alternatively, for those who are deeply religious and believe in heaven, delaying death and reuniting with "God" seems more selfish than religious.
I'm old and I am facing these questions now in my own life. I don't want to die, but I don't want to be alive regardless of my circumstances. In the past, I have read several books about dying -- nothing religious, I am not a believer -- in part, to understand the inevitable better and to help myself prepare for it when the time comes. The final act of one's life may include issues that are spiritual, personal, familial, medical, financial, and practical. My own mother was fortunate. She had a massive stroke on a Friday. She was hospitalized and soon after tests revealed no significant brain activity. She was allowed to die with minimal time in the hospital, minimal cost, and minimal fuss. Undoubtedly, they could have kept her breathing indefinitely, but to what purpose? My father died of metastatic prostate cancer, which metastasized to his bones and caused him considerable pain. The upside to his death was the possibility of closure. I returned home when my mother asked me to come and help her. I sat up with my father at night, not sleeping unless he did. Our relationship was complete. All that needed to be said was said. His death was not sad or tragic, but a relief, for him and for me. There was no closure with my mother. I had not spoken with her recently and fortunately my sister was visiting her when she had a stroke. I spoke with my sister and there was no reason for me to cross the entire country to "say goodbye," because there were no longer goodbyes to say. I had no desire to see my mother either on life support or dead. Our relationship ended prior to her death. Which is better? My father's death was better for me, but my mother's death was better for her. She didn't suffer. She was talking to my sister one minute and gone the next.
We normally don't get to choose the time or manner of our own deaths. Suicide is a complicated issue, but for elderly people without mental illness the government should not only not try to prevent suicide it should make humane means easily available. I recoil at the idea of my spending a long time in the hospital or a nursing home before dying and if I can prevent that I will.
Yes, This.
And I’ve heard some Republicans say it’s mainly old women, so what’s the loss? They can’t bear children anymore so they are no longer useful.
BTW, Gruber says the nation was willing to close down to save seniors during peak Covid, but that was just blue states. Red states opened after 6 weeks, with 70 year old Texas politicians declaring they would be willing to risk their lives to keep the economy going. Covid revealed their true intentions about seniors.
I am a 90 year old white male with an unbelievable level of uselessness.
I just browsed your posts for a brief two minutes. You are about as far from useless as it gets. There is a ton of knowledge in that brain, the rest of us could use some of that.
Thanks for your thought. I was always a physically active person so when you are in the "can't do that anymore" phase of life it feels very useless.
I can't bring myself to "like" your comment, but I understand and share the sentiment.
TrumpCare is you're on your own Care.
It wasn't just Republicans. Cuomo in New York infamously used elderly care homes as Covid clinics, increasing the fatality rate amongst the inhabitants.
Cuomo left the liquor stores open so the emergency rooms would not be crowded with alcoholics with DT.
I lost count of how many maga politicians and candidates died of covid. I could be as callous as they are and say “nothing lost” but I won’t. I fear the stupidity becoming normal.
You seem to forget that dying cost a lot of money
But not for the ones who are dead.
yes, eliminate the republicans
The goal is death. They (Republicans) want the marginal folks to die.Sooner rather than later.
GOP healthcare plan (always two weeks away)-Hurry Up and DIE
We are the only industrialized country without some form of single payer healthcare. Rugged capitalism and healthcare don't mesh.
There are different permutations but everybody is in the pool. If you're wealthy in Britain you can go to a Harley Street doctor but you're still paying into the pool.
We pay more for healthcare than any other country but always rank way down the list in quality of care. There is a bump in taxes to fund the system, instead of what we pay now in ridiculous insurance premiums. We can do better but not under Trump and his Big Pharma & Big Healthcare benefactor$
I don't think a bump in taxes is necessary, just turn over all single payer health administration to CMS and eliminate insurance company profits. Tax corporations to pay for the added costs to CMS as employers will no longer have health coverage burden. And CMS will have great leverage to bring health costs down. It could be an economic and overall health win.
"Every system is perfectly designed to produce the results it's now getting."
Rational government and health care systems improve health and years of useful life.
The US system sends 5% of 18% of GDP to insurance company profits and thus to their rich owners.
"A recent study by political scientists Martin Gilens of Princeton and Benjamin Page of Northwestern concludes, basically, that the US is a corrupt oligarchy where ordinary voters barely matter. Or as they put it, "economic elites and organized interest groups play a substantial part in affecting public policy, but the general public has little or no independent influence.""
https://pnhp.org/news/gilens-and-page-average-citizens-have-little-impact-on-public-policy/
Revoking haitian tps is beyond stupid. Someone should just run ads in Florida all day long and ask the white republicans how many of their parents and grandparents they want to kill. That state would go blue next year.
Don't be so sure. After all, it's Florida we're talkin' about.
Ask them if they want to care for their family members themselves at home. Because that is what will happen. Every form of assistance with the activities of daily living.
Then perhaps we need a pathway from TPS to permanent resident status. Or perhaps we simply need to rename TPS.
I'm not harmed in any way by having Haitians living here, temporarily or not, and having them here means fewer citizens are dying. Sounds like a win to me.
What we're doing now is taking away TPS status...just because. "Just because" isn't sound policy here; it's not sound policy on any topic.
There was a way for a few years during Biden, for some people, however courts did not view it the same across the circuits.
Haiti is being run by gangs who kill and rape with impunity - hardly a place to send people to. Would you go there for a vaca?
You hit in the cruelty of Trump and MAGA deportation. Where do these folks live and support themselves when they are pushed out of a living they have developed over many years, especially cruel for families.
Another pristine example of assuming way too much about a definition and in this specific case assuming temporary labels an individual. Riffs on an isolated word based on a definition in Webster Annotated Dictionary sound convincing but founder once checked against how the word is used in the law. For this case and in all probability "temporary" was chosen arbitrarily as expedient and close enough.
Temporary designates the staus of a country not the status of citizens from a TPS designated country who reside in the United States. Moreover,
'The law does not define the term “temporary” or otherwise limit the amount of time for which a country can have a TPS designation. '
https://www.americanimmigrationcouncil.org/fact-sheet/temporary-protected-status-tps-overview/#:~:text=In%20order%20to%20gain%20permanent,for%20up%20to%2010%20years.
The current affairs in Haiti are probably as dangerous as the earthquake. The violence and lack of civil infrastructure equates to “unsafe to return.”
"Temporary" means "until it's safe to return."
You are missing some recent history in your analysis of that program
"I understand immigration is a fraught issue, and clearly we might have gone too far in the Biden years."
I would have like to see Krugman push back a bit on this statement by Gruber. Who is the "we" who "might have gone too far" in the 2021-24 years? The Biden administration? The Democratic Party? The "general public"?
What exactly went "too far" during those years?
And which groups of people, in which parts of the country, felt that "we" might have "gone too far" in those years?
I do not ask these questions to vilify Gruber. I ask them because:
* I live in a city that historically has functioned as an assimilator of millions of immigrants over centuries. So in this city we don't have the strong underlying fear of immigrants people in other parts of the country may have.
* I have little exposure to broadcast or cable news, so I was not buffeted by televised images of "chaos at the border" during the Biden years. (My hunch is that now the images are of "chaos in [Democratic-run] cities.")
* When I interact with the health care system -- five hospitalizations since the age of 62 -- I assume that more than two-thirds of the M.D.s and more than nine-tenths of all other staff will be immigrants. These proportions are roughly the same as those I found in ten years of working in the lowest-paid segment of the health-care business: state-run, long-term psychiatric hospitals. Moreover, these are the same proportions I found in the health care system in a much smaller, low-immigration metropolitan area where my parents lived their entire lives and spent the years between 2006 and 2021 interacting with the health care system.
So I concede that I cannot understand the panic about immigration that the Felon-in-Chief's political base apparently feels.
I think a lot of it was just lies spread by the Republicans - not based on fact or reality. They are very good at repeating their lies, and at one point, people start believing it.
One of the first steps in establishing an authoritarian government is to create a group or groups of people for "good citizens" to hate. In 1930s Germany, these were the Communists, the gypsies (Romani), union workers, and the Jews. Here, it's immigrants, transgender people, homosexuals, and, in some areas, any non-white person.
I’ve heard this same comment from others recently without explaining why. I’ve believed the immigration issues Biden inheritance, came from years of the Republican party’s desire to keep the system dysfunctional so they could run on the issue. Going back to the Clinton days, wasn’t it he who changed the entry quotas to be more balanced between Europe and the Americas, where it previously leaned towards europeans.
No, that rebalancing was part of the Immigration and Nationality Act of 1965, signed into law by Lyndon Baines Johnson. See: https://en.wikipedia.org/wiki/Immigration_and_Nationality_Act_of_1965.
Thank you
I agree that the Republican Party delighted in keeping the immigration system dysfunctional so that they could run on the issue. However, that would mean that "we" -- really, the White House and Congress -- didn't *do enough* to restore the system to (some definition of) workability.
What I don't understand is Gruber's statement that "we" might have gone *too far* during the Biden administration. I suspect that Gruber is not the only person who thinks this way -- but I don't think that the only thing leading them to think this way is Republicans repeating the Big Lie.
Agree, good point, thank you. I’m no expert on immigration. I followed the Biden administration as best I could and never remember hearing anything about them going to far till recently.
I definitely think Biden went too far in allowing so much immigration. If he had kept the border crossings down to Obama and Trump1 levels then Trump would not be president now - we would have better healthcare, less debt, no wars, no ICE agents or national guard in our cities, lower tariffs, UKraine would be free, etc etc While compassion wins hearts, realism wins elections, progressive (not moderate) Dems have to remember the oft repeated wisdom that "Perfection is the enemy of good"
There was a spike in migrant numbers after Covid crisis passed. There had been a dramatic falloff during Covid itself.
Frau, can you connect the dots for me please. Was the spike due to the Biden immigration policies? Or is it that since it happened while he was in office he is automatically responsible for the spike? Thanks
I’m hardly an expert but my understanding is that Biden changed Trump’s earlier draconian immigration restrictions. But his administration appeared unprepared for the post Covid spike and didn’t move quickly enough to close the border.
The figures are in this NYT piece.
https://www.nytimes.com/2024/12/11/briefing/us-immigration-surge.html
Towards the end of his term he tried to push through a comprehensive immigration reform bill but by then Trump realized it was a winning campaign issue and ordered the Republicans to vote against it.
There was a lot of TV footage showing immigrants just flooding through holes in fences at the border. Biden felt that he had to honor the international amnesty law which said that if you set foot in a country illegally you could ask for and get amnesty. Trump has simply ignored that law, and nobody has mentioned it again. Also, Repubs wouldn't give Biden the money to fix the border. At least Trump has sealed the border. That needed to be done, and Biden couldn't or wouldn't do it. As for the deportations, we would be better off giving all the illegals amnesty as Reagan did while saying "we'll never do that again." Well, it's time to do it again.
I recommend you read "America for Americans" by Lee. It's probably banned in Florida schools because it doesn't cast the US in favorable terms. We are a still a very racist society; the more I study TRump and MAGA it's hard to come to any other conclusion,
Having had very good, expensive health insurance in the US and then moving to France. I can tell you France does it better. The US government pays more out for US health insurance than France but does a worse job. I had cancer in the US and my insurance paid for most things but at the end, dropped me! So if I'd stayed in the US, who would have covered me. Luckily I had planned to move to France . 5 years later I had a recurrence due to the bad operation in the states lwhere they had said I was cured! and Frane took care of everything. I wouldn't be alive today if I hadn't moved to France. I didn't move to France for its health insurance but for its quality of life but a bonus was its healthcare. Universal healthcare is not only humane but it saves money. Also we all pay into the French healthcare system with a progressive tax - very fair.
Per capita healthcare costs in the U.S. are about twice as high as they are for first world countries with universal healthcare. But don't worry - U.S. healthcare outcomes are among the worst, so we get what we pay for.
It really is amazing not just how bad it all is but that we as a nation actually tolerate it.
So many of us do not know about this. We are Exceptional (USA! USA! USA!) and do not WANT to know that our healthcare system is exceptional, in its high costs and mediocre results for those who are not financially well off.
You don’t notice it when you’re young and healthy.
There's a reason:
https://pnhp.org/news/gilens-and-page-average-citizens-have-little-impact-on-public-policy/
Every penny wasted in bureaucratic overhead gives its 5% to insurance profit.
And of course, insurance company procedures can increase waste, prices, and costs.
(For many years, the way prices for PROCEDURES (surgery, hospital, imaging, labs) were set was to take the 75%ile of the charges submitted as the NEW PRICE for the next year. ) Just think about what that would do to prices.
Many providers, who don't know what the ins will pay, each want to submit at least that much...and if the ins pays the full amount, they might have gotten more if they submitted higher charges...
I know it's shocking and sad. I hope it will change.
Thank you for this topic, Paul. I recently had an operation in NYC and actually wrote in my Substack about the wonderful carers from all over the world. I was treated with such hands-on compassion by them all. Aging ain't for sissies as the saying goes, but so far 80 has been a good year.
I would retire right now if not for needing health insurance. My decent corporate job would probably be filled by a younger person if I left, and I would love more time with my dear second husband while we’re both healthy, but we’re terrified of taking this risk. I represent the tail end of the baby boom, and this conundrum obviously contributes to our national economic stagnation.
yes this is the reason for a universal single payer healthcare system but as we know the gop and some dems will never allow it since they are whores to the lobbyists, wall street and other entities sucking americans dry with this for-profit broken system
Don't retire until you are both eligible for Medicare. If he's older, then he should go on Medicare if eligible. You can reduce your costs by removing him from your corporate policy. Retire at 65; then you get your medicare too. Sorry, but right now, that's the only road.
Yes, he’s older and yes he’s on medicare. I agree that there’s really no choice in the matter but to keep working. I don’t rule out a rude awakening on Wall Street either, in which case it could happen anyway.
I skimmed the article, I have two thoughts: the waste that Trump has spent together with the graft that could have been addressed to healthcare would have funded the cost for the Trump term.
The ICE killing of one nurse in Minnasota reduced the healthcare potential, how many CNAs have also been put on the plane at $1 m/person removed from Healthcare potential
As a single parent working my way through a state university in the late 70/early 80s, I was able to afford non-profit health insurance until reagan/congress came in and killed the non-profit laws covering health insurance. So, we had none, daughter broke her arm at a non-profit day care. It was hell getting their insurance to cover it. I can’t tell you have stressful it was having the hospital calling me at my part-time job demanding payment. There was no extra money. Decades later, the person who cuts my hair told me their insurance went from a few hundred per month to $3200 a month - more than these people bring home a month as small business owners. He’s a mechanic and she does hair (same building). They ended up with a private policy that will cover nothing if either one of them gets injured or ill. All of this so Musk, Thiel, Bezos pay less.
The US is obsessed with low taxes (I’ve noticed this as a Canadian. I think it’s why you don’t have universal healthcare.)
Taxes are lower the more you make. Health care is big, big business. If fact I read today that it is healthcare/social services propping up job numbers.
Quite likely. My mother (a Depression era child) was certainly very obsessed with taxes.
When you add up the so-called lower taxes plus health insurance costs and of course the costs denied by insurance companies or costs for non-covered services (dental work), we pay far more for healthcare.
Fortunately for me, in the '70s and '80s, the university I attended had a free clinic and health insurance.
This is a great conversation and very enlightening. It is obscene that the current regime in DC is willing to hundreds of billions of dollars into creating for profit concentration camps in which to imprison undocumented people. I guess their next move would be to force them into unpaid labor since the Constitution does not make slave labor illegal in the case of prisoners. So maybe the Confederate enslavers will yet win the long war 150 or so years after they supposedly lost. I also can't help but think that for the Epstein class the high numbers of additional senior deaths caused by mass deportation is actually an added bonus to their plan. I cared for my own beloved husband for more than 10 years at the end of his life. The last 9 months he was in a nursing home at around 14,000 dollars a month. The kindest, gentlest, and most respectful carers he had there were all immigrants from Africa and central America. The did impossibly awful work cheerfully and without ever making him feel bad or ashamed. I hope the Stephen Millers of this world get demonic robots as their end of life carers. They don't deserve the human touch.
In my province (British Columbia), long term care is 80% of your income, with no obligation to spend down assets. It’s publicly run (expensive private care is also available).
Sorry about your husband. I’m glad you had good workers, though.
Yes, in fact, partly in response to you (Frau Katze) stating that to me earlier, I put the difference in financing, Canada (which varies by province but is uniformly much better than the U.S.) to U.S. on my own little substack post:
https://normspier828307.substack.com/p/paying-for-nursing-homes-in-the-us
but the contents are actually mainly in this thing from the Canadian Government,
and from there, I pull, for British Columbia:
"Income-based, up to 80% after tax, $1,417 to $3,974.10/month (2024)",
showing your veracity!
--
I also note that, by coincidence, I stuck a post on the Canadian financing, with the same info as this comment, and it appears to be chronologically right before the comment you are answering.
Here: https://paulkrugman.substack.com/p/talking-again-with-jon-gruber/comment/214420146
---
Separately, I recall you, Frau Katze, indicated your name on the posts was just a pen name. (I had prior somehow thought you were in Germany, and it was just your real name.)
So, I ask, if you don't mind telling me. Does it stand for "cat lady"?
Yes, it’s cat lady. Just a pseudonym I picked while I was still working.
As a Canadian, if I hurt my knee, I would have to wait months for an MRI.
But
A homeless and a university professor have the same access to medical care.
And it’s free.
I don’t know what moral standards America is based on, but it’s not Christianity.
re "wait months for an MRI."
Patients want to know
1 what's wrong and
2 what to do about it.
MRI may not answer #1, and usually doesn't change #2.
So rational systems don't jump to MRI but instead Rx rest, ice, NSAIDs if tolerated and Physical Therapy which is usually #2.
IF you had an ACUTE knee, you would get an MRI and treatment sooner.
Long ago (before MRI was widely available) I saw a patient in the ER with an acute locked knee. The Ortho's verbal report to me was "Yup. It's locked." He was admitted that day for surgery to fix the problem. Today he'd get an urgent MRI to help direct the surgery, but MRI is still mostly a 'help in planning surgery/is surgery needed?' tool.
No copay for MRI and $25/session copay for PT help raise health care costs, and thus the % of those costs that become insurance profit. (see my other comment)
I am still recovering from a three-level-resection in my neck. If I had been required to wait months for an MRI, I quite possibly would be dead by now. One of the problem areas controls breathing.
I've had direct experience with home health care through my mother-in-law, who was in an independent living facility at the same time that my husband was dying of kidney failure. She obviously needed to go into assisted living, but I could not take care of my husband and move her at the same time. Fortunately, her facility had a list of aides one could hire -- so one came in a couple of days a week for bathing, laundry, receiving groceries, and preparing meals for the rest of the week. They were lifesavers, and they were all immigrants. I believe many of them were not even CNAs, so another group of people who could earn more with education. They also provided peace of mind for me -- I hired them to be with her while my husband was in the hospital during his last days and afterwards when I had to arrange for his funeral. My mother-in-law only had a vague sense of what was going on, but she knew her son was dying, and she needed someone with her to alleviate the stress. Her insurance covered none of this, so I'm also fortunate to be able to pay out of pocket.
Thank you for this comment. I worked as a home health aid and CNA for several years before I retired. I was so impressed by the compassion and emotional intelligence of the women who trained me, and can only hope that I succeeded in emulating them. Krugman does not mention this aspect of the work; I’m not sure he understands that not any random person can do it well.
Thank you for your words and your work. It is indeed an extremely difficult job - few have the understanding, compassion, and toughness to do this work. Her caregivers, especially after I moved her into assisted living, were so compassionate. She didn't remember names, but when one entered the room, she would ask, "Are you my angel for the day?". And they were.
Exactly so. Thank you.
When my mother's health deteriorated to the point that she needed constant care, she refused to have in-home care because she was afraid that the carer would steal from her. She pressured my brother and me to move down and take care of her (so she could stay in her deteriorating house), but eventually wound up in a very nice care facility that my sister found for her. Fortunately, her pension was quite generous (much more than my salary) and Medicare paid the bulk of her prescription costs. That didn't prevent her from complaining about having to move out of her house, that the house sold for much less than she thought it was worth, and complaining about the cost of her facility.
I live in a largely hispanic town in NJ. So a factory town with older 2 family houses (and the fatories are gone). My doctor and I talk about health care and health insurance. She says the copays and deductibles discourage her patients from doing follow up visits. The lower cost policies actually don't work to provide reliable care (unless you are better off).
A very bad habit liberals have is using the word "we" to describe Republican sins. Paul Gruber who is otherwise a brilliant and wise advisor to us all says "So what we’re saying is we’ll spend ten times as much to make tax cuts for the rich as we are to make insurance affordable for the middle class." No Paul, Republicans did it all by themselves and definitely are not saying "we’ll spend ten times as much to make tax cuts for the rich as we are to make insurance affordable for the middle class." It's what Republicans think and don't say because they know they're harming the public to shovel huge piles of cash to the morbidly rich like Peter Thiel and Howard Lutnick. The GOP knows if the public clearly understood what the GOP was up to they wouldn't like it.
Aristotle defined political rhetoric as the assignment of praise and blame. Assign blame to Republicans for their cruelty plainly and directly . Don't confuse the argument by using the word "we". They are evil not "we".
Excellent point.
Our country did NOT uniformly invest in caring for seniors during COVID. The Red States did not, the Blue States did. Consequently, the Red States had poorer results (and they also weren't interested in collecting data) and compared to other developed countries, we did less well. Now we're seeing it again with vaccine denialism, a direct offshoot of what happened with COVID.
(I am putting aside what happened in the early going with New York nursing homes, because the speed and intensity of the impact caught people by surprise. But once everyone knew what was happening, there should have been no more excuses.)
An important conversation, for sure. I hope that seniors are included in it. We tend to be invisible and unheard, which makes measuring QOL a challenge. For BIPOC and disabled seniors, it’s even worse.
The anti-immigration, anti-healthcare, anti-education, anti-everything positions of (R)ightWingNuts damages our society in many obvious - and subtle - ways.
A few years ago I was riding one of the excellent, slickrock mtn bike trails where I lived in the Glorious high desert of southern UT. I happened to meet, and rode with, a 50's-something couple from Denmark. I learned that they both had been employed in good mgmt jobs that they liked. They recognized a niche need that wasn't being addressed in their industry by existing companies. They decided to take the plunge, left their good jobs and started a company to fill the niche. Fifteen years later, they employed 20 people and were wealthy enough to take a 3 month biking vacation in the US. "Best decision we ever made", they said.
They noted that they NEVER would have taken the risk except that: 1) Denmark provides universal healhcare coverage for ALL citizens and 2) Denmark not only provides free college - they had two college-age kids - but also provides grants to cover rent and food expenses. Their kids would graduate with zero, nada, zip college loan debts!
They said, "Sure, our taxes are high, but the benefits from those taxes gives us the FREEDOM to live better lives without worrying about medical and education debt. High taxes support the small businesses and entrepeneurship that make societies vibrant and healthy.
PS: Paul says, "the system is cruel and dysfunctional and I think the only thing that allows it to persist is that most Americans don’t know that it doesn’t have to be this way."
I suggest that MAGAttes don't WANT to know it could be better. They REFUSE to make things better (even for them) if it might, in any way, help "THOSE PEOPLE" (whatever group-du-jour might be in the MAGAttes' gunsights). The myopic, parochial, brain-dead worldview of conservatives is damaging to our entire society (including THEM, for Goddess' sake!) and their stubborn close-mindedness makes them unteachable. Grrrrrr!