Making the Most of Your Money NOW

For insight into our frequent frustration with medical care, I urge you to read the graduation speech that surgeon and writer Atul Gawande gave to Harvard students last week. He talked about patient-care issues I hadn’t fully understood, and for which even today’s generation of doctors are apparently not prepared. It will greatly enlarge your thinking about what’s  needed for medical reform.

Docs are still being taught to be cowboys — demanding that they be in charge — even though medicine today is far too complex for a single person to master. They need to think like members of pit stops — the teams that keep race cars on the track. Hospitals and practices that operate as teams have better outcomes and lower costs, not to mention fewer fatal infections and better diagnoses. But the incentives in the system continue to favor cowboy care, and so do the attitudes in medical schools.

Anyone who has tried to coordinate hospital care for a patient who’s seriously ill knows about these issues all too well, yet we’re helpless to do anything except pester and shout. The medical establishment doesn’t hear us.  Congress isn’t close to understanding what needs to change.

I sat in on a meeting last year where a hospital safety expert explained how his institution had reduced post-surgical infections by 90 percent, by using checklists and empowering everyone (not only nurses but also various aides) to raise safety issues without fearing reprisal by docs. His audience was comprised of people sitting on hospital boards of directors. To my amazement, they rejected his program, saying it would be too controversial and difficult to implement. “It won’t work. The doctors won’t cooperate,” was the general response.

Save lives? Cut costs? Help patients by listening to advice? Move into the modern, connected world? Not at these hospitals. I learned from Gawande that the medical schools apparently don’t get it, either. So please read what he has to say. You’ll be glad you did. He’s a wonderful writer, too.

Dear Friends –

Spam is the bane of online life. I have a pretty good spam-blocker and for more than a year it has collected hundreds messages a week that were trying to sell you everything from yoga manuals (doubtful) to stock-picking services (ugh) to obvious porn (yikes). Lately, however, the little robot buggers have been worming through.

I mediate all the comments on this site, meaning that nothing goes up unless I click “approve.” I send bots to “trash.” Even with my lightening mouse, however, cleaning up comments is starting to take too long.  So I’ve thrown up another wall.

When you have something to add to a post, you’ll now see a box with a wavy word in it. It’s called a Captcha. You have to type in that word before your comment can be sent. Someday, a spammer will teach bots to read but so far, they’re still illiterate. Captchas stop them at the door.

I like this Captcha because it’s legible. (How many have you seen with lines so blurred that they might as well have been written in another script?) I hope it’s not a bar to you. Thanks for taking the extra step, to let me know what you think. I love hearing from all of you.

Jane

What’s high on the hit list in Washington DC today? The new Consumer Financial Protection Bureau, which was created to defend you from lying and predatory lenders. The financial industry hates the bureau and wants it gone. Their lobbyists and legislators couldn’t stop it from being enacted into law. Now, they’re trying to cripple it so that it can’t do you any good.

The first shot, in March, came from the House of Representatives, which passed a resolution to starve the CFPB of funds. The Senate fired the second shot a week ago. Forty-four Republican Senators signed a letter to President Obama, telling him that they wouldn’t confirm anyone he nominated as director of consumer protection – not even a Republican – unless the bureau was restructured to their liking. It takes just 41 votes to kill a nomination (in the Senate, minorities – not majorities – rule), so the GOP has the upper hand.

At first blush, that might sound like a bureaucratic battle that won’t matter much to consumers one way or the other. Not so. The outcome is crucial to the CFBP’s success. The bureau was set up to operate independently, so that a hostile Congress (and banking lobbyists) couldn’t cripple its work. If the GOP undermines that independence, you can kiss pro-consumer rulemaking goodbye…. more

What should you do to guarantee yourself access to future medical care? If you’re under 55, talk to your parents or your grandparents. They hold the votes that will decide whether your options will be as good as theirs.

The Republicans, in a recent House budget resolution, offered seniors and Boomers a breathtaking deal. The GOP will promise not to include Medicare in their massive cost-cutting program, for people who are currently 55 and up. In return, they have to agree to throw the next generation under the bus.

The GOP plan ends Medicare as we know it for people under 55 today. Starting in 2021, new beneficiaries would have to buy private, individual coverage. The insurance companies would offer different plans, at different prices, with different types of benefits. The government would provide vouchers to help cover the cost. But the vouchers wouldn’t buy as much insurance as Medicare provides today. To get the same level of coverage, you’d have to pay more yourself, with your out-of-pocket amount increasing every year. The government saves money, while you pay more of your rising health expenses in older age.

Will seniors and Boomers take the deal? So far, they’ve shown themselves willing to vote their interests and forget the young. For example, more than half of the population 65 and up opposes the health reform law, known as the Affordable Care Act…. more

What if pre-retirement savers have been doing things all wrong? Instead of focusing on stocks, to grow money for your later years, advisors are looking, increasing, at current income guarantees. They’re asking how you’re going to pay your bills when your paycheck stops.

Traditionally, you’re supposed to keep 50 or 60 percent of your money in stocks (or stock mutual funds). That’s because, at 65, healthy people are likely to live for another 20 or 30 years. Over that long period of time, stocks will almost certainly go up (we assume from U.S. history). You’ll be well provided with assets for your later years.

But what about your earlier years? Twice in a decade, savage bear markets have wrecked the retirement plans of aggressive stock owners in their 50s and 60s, and crushed the standard of living of those who had already left their jobs. They were positioned for higher market prices in the distant future but not for income to pay their bills today…. more