I commented on someone else’s blog a few weeks back that my personal concern for the future was not so much survival, as end-of-life. I remarked that I see elder care getting infinitely worse as the US empire slowly declines; when my turn comes ’round, I’ll probably have to take my ending into my own hands.
I got this response from a fellow in Finland.
I often feel astonished when reading these comments. You are so lonely over there in America. It is same as with our own overeducated, liberal burghers here. Themon mentioned “taking matters to his own hands” considering his old age, because your governmental pension system is collapsing. What has government to do with this? I understand from his comment that he has many sons. Is it not responsibility of his children to take care of him, when he is old?
Of course it is. And of course it isn’t.
We’ve recently had to say good-bye to an elderly friend. I used to take her to the movies every couple of weeks, and we’d discuss the acting and plot at length on the way home. My wife had been her daily phone contact, medical power of attorney, and general-purpose guardian angel. Our friend has no children, and her three sisters are scattered throughout the southwestern US, all at least a thousand miles distant.
The old dear is moving rapidly now into full senile dementia. Call it Alzheimer’s. She has trouble remembering the names of her sisters. In a few days, or weeks, or months, she will forget about us. She will gradually lose control of her bladder, and her bowels. She will be unable to walk without falling, and falls will result in life-threatening gashes, broken bones, and internal bleeding, so she will be confined to a wheelchair. If she lives long enough, she will forget her own name.
She’s at one of the difficult stages right now: belligerent, obstinate, argumentative, and paranoid. It’s understandable. It seems to her that we are all conspiring against her, because she cannot remember the discussions held in her presence, and remembers with crystal clarity conversations that never occurred. These memories change constantly. Her self-awareness and judgement are compromised. She thinks she is perfectly capable of taking care of herself, just as she always has, yet has no idea where the bloody gash on her arm came from, or the bandage — and she’s likely as not to just rip it off and invite sepsis.
It is appropriate that her sisters take over her care. So we’ve relinquished powers-of-attorney. Traded phone numbers. Briefed and debriefed.
Shed tears and said good-bye.
We recognize the patterns, because we went through it with my father from 2004 to early 2009. He was once a professional surveyor — he laid in highway tunnels bored blindly through solid rock from both sides of the mountain, to meet in the middle, and climbed those mountains to set up his theodolite. He was one of the first computer programmers in the State of Wyoming. When I was young, he taught me elementary cryptanalysis, morse code, woodworking, bookbinding, a bit about electronics and ham radio. He gave me my love for classical music.
Toward the end, changing the batteries in his television remote control was too complicated for him. He began to introduce me to the staff as his brother. He forgot his wife of forty-five years — she passed in 2000 — and would often scowl in a puzzled way and ask me if he’d been married.
The needs of an elder in such a decline eventually exceed the capabilities of the most devoted children. My wife and I took my father to lunch and the grocery store until he could no longer manage the trip. Soon after that, any kind of outing — a drive to the mountains, or a lake — confused and terrified him. Loss of bowel control made any trip a potential for unpleasant humiliation. When he got out of bed in the middle of the night and fell and broke a hip during his last year, it took two strong men to lift him from the floor: my wife and I together could not have managed it, nor should we have tried. He needed substantially more care — different care — than the two of us could give.
Such care costs money. At the very end, we were paying over seven thousand dollars per month for his room and board.  Over eighty-four thousand dollars per year. We managed the costs by selling his house, the house he’d raised my sister and me in. Had that money run out — had he lived another year — we would have had no choice but to let him fall back on government assistance as an indigent.
We could not care for him, and could not afford to pay others to care for him.
People who have not been through this, who speak glibly about children caring for their elders, have no idea what they are talking about.
There are limited solutions to the problem of old people who are past their years of usefulness. Let me list them, just for the record:
- Bring Out ‘Cher Daid — from the skit in Monty Python and the Holy Grail. Adult children simply look the other way while someone clubs their useless parents and throws them on a cart. Or the children do the clubbing themselves, if they’ve the stomach for it.
- The Kevorkian Plan — we cultivate a national attitude, and perhaps even a new religion, that glorifies suicide. We make lethal drugs and suicide assistance readily available to the old, cross our fingers, and hope that enough of them will do the right thing when the time comes. Otherwise, we have to club them.
- The Natural Plan — we bring back smallpox and plague, and let God take the elderly and the weak the way He apparently intended. Or, as a variant, we could cut off all medical aid to anyone over the age of, say, eighty. Maybe seventy-five, to be safe. Or we could simply let the elderly and the handicapped die of neglect if they can’t take care of themselves. Survival of the fit, and all that.
- The Capitalist Plan — “let the market take care of it.” That’s exactly how things are done in Colombia, where my wife’s father lives and is now tipping into senile dementia. Options for an elder in Colombia are personal wealth, followed by family, followed by the street. Personal wealth (unless it is vast) will run out if you live too long, so this places many families in the dilemma I described above: unable to provide care, and unable to afford to pay others for the care. This was also the norm in the London of Charles Dickens’ time.
- The Socialist Plan — we recognize this as a community problem and deal with it as a community, specifically by contributing our means to help care for other people’s elders.
Unless one is a psychopath, the first three options are intolerable, and they are morally justifiable — if at all — only in the most brutal sorts of raw survival scenarios.
The fourth option is empty talk. In a society where wealth is plentiful and broadly distributed, it could perhaps be reasonably argued by reasonable people. In our society as it exists right now, this is merely whitewash for one of the first three options. Far less than one percent of our population has the kind of personal or family wealth that allows them to drop eighty-four thousand dollars a year on end-of-life care. The marketplace mandates the murder of those who live too long, and destroys their families in the process. In the words of Dickens’ Ebenezer Scrooge, “They’d rather die than go to the workhouses and prisons? Then let them be quick about it, and rid the earth of excess population.”
The fifth option is the one that all all pre-modern societies adopted and lived by. The elders are a community resource, and a community problem, and everyone contributes to their care. It is the model that this country accepted until very recently.
For examples of the fifth option, we can go all the way back to the tradesmen’s confréries, or brotherhoods, in the fourteenth century at the dawn of modern capitalism; scarcely a time of any imaginable kind of nanny state. Or we can look at the “mutual aid societies” of the nineteenth century, such as the Odd Fellows or the Benevolent Protective Order of Elks. We can even look at modern auto, home, life, or health insurance. They all run on the same basic principles:
- Everyone contributes, irrespective of need.
- Everyone (once vested) benefits, irrespective of contributions.
Another way of putting this is:
- From each, according to ability.
- To each, according to need.
Some people may recognize this as the (stated) foundational principle of the old Soviet Worker’s Paradise, but it predates the Soviets by thousands of years. It’s an example of what is more generally called a “hedge,” which is — as the word implies — a kind of fence or barrier against ill-fortune. One of the earliest examples I can think of is in the Bible, where the captive Joseph, son of Jacob, son of Isaac, son of Abraham of Ur interprets Pharaoh’s dream of the starving cattle to mean that a famine is coming, and advises him to build granaries to store seven years of grain for the lean years. The granaries are a hedge, and Joseph is serving as an actuary — the person who figures the odds and determines how much to store, and for how long.
The United States has a perfectly functional way of doing this at the national level: it’s called Social Security.
Social Security is nothing new, and nothing unusal. It is the Pharaoh’s granaries, the weavers’ confrérie, or the Odd Fellows Society on a national scale. It is a hedge against the infirmities of old age. It has worked extremely well, not for merely seventy-some years, but in varying forms for many centuries.
As a national hedge, Social Security has some significant advantages over the older (and smaller) aid societies and brotherhoods.
First, membership is — with a few exceptions — mandatory, and dues are scaled to income. This makes its risk pool — a technical term for the group of people covered — stable and vast, and size alone reduces overall risk. A local Odd Fellows’ chapter with one hundred members might be able to support one centennarian in a nursing home, but not two. A larger Odd Fellows’ chapter with 1000 members would probably never face the issue of having twenty centennarians at the same time. Social Security, with over a hundred million members, will never face the problem two million centennarians — at least, not with the current state of medicine.
Second, Social Security is transparent, unlike private brotherhoods. The townhome I used to own had its entire capital fund stolen by its management company years before I moved in, after which the owner of the management company downed a fifth of whiskey and drove his car into the local reservoir. Most people are aware of how corporate retirement funds were pilfered by their corporate and union officers during the last decades of the last century. Do I even need to bring up Bernie Maddoff or Goldman Sachs? Social Security isn’t immune to pilfering, but the thief is Congress, and the theft is open for all to see.
Third, gaming Social Security is a federal crime against the government, and a portion of Social Security contributions goes to policing fraud. Gaming a private fund is merely being a clever fellow, assuming the fund managers even detect the fraud. In a small fund, like our townhouse association fund, there may not even be enough money for an annual audit, much less fraud prosecution for those who profit by gaming it.
Social Security does have some downsides, but they don’t include any of the bilge that comes out of the current so-called “national discussion” about Social Security. The wealthy do not now, and will never pay for Social Security, nor benefit significantly: it is entirely about working people bearing the costs of working people. Illegal aliens aren’t eligible for Social Security: it takes ten years of contributions to become vested in the program. The “welfare mother driving a Lexus” myth is something I addressed a long time ago in a different post. The “Congress has stolen the trust fund” myth is untrue. Calling Social Security a Ponzi scheme betrays complete ignorance of what a Ponzi scheme is, as well as how Social Security works. The “Social Security is going broke” myth is something I believed through my younger years, but only because I never bothered to look into the matter. It isn’t going broke, and never will. What it does need is a 2% course-correction now so that it doesn’t face a temporary and partial (but serious) problem twenty years from now.
The latest conceit to come out of Washington is the “we can’t afford it” bleat. Given the alternatives — such as clubbing our elders and throwing them in a mass grave — I have to ask, how can we not afford it? Right now, 15.3% of our total US working wage is going into maintaining our non-working elders, the disabled, and public health. This needs to rise to 17.3% to ensure stable benefits for the next seventy-five years. Can we not afford eighteen percent? Twenty percent? Twenty-five percent? Even fifty percent?
As an alternative to pushing our elders off the roof, of course we can afford this. Only a psychopath would claim otherwise.
Yet we are having this psychopathic national conversation that eighteen percent is “too much.” People in Washington are able to say with a straight face, over and over, that we have absolutely no choice but to make deep cuts in our entitlement programs.
This is bullshit.
Now, Social Security does have some big problems, but no one is talking about those problems because they are far too scary for people to even admit they exist.
The first real problem is the US economy — and the world economy — as a whole. You’ll hear two things from economists about the current economy. First, you’ll hear that it’s improving, right on schedule. On the heels of that, you’ll hear that it’s “puzzlingly sluggish.” Unpacking that could get complex, but I’m going to cut right to the chase: the real economy is flat or shrinking, and the only “economy” that is improving is the numbers game on Wall Street. That is, the only growth the US economy is actually experiencing is in financial bubbles.
That isn’t exactly true, but it’s a lot truer than most anything else you’ll hear.
This has two direct consequences for Social Security.
The first consequence is that Social Security contributions, which are based on wage income, which is based on real jobs in the real economy, are going flat or declining. All of the actuarial predictions for Social Security project growth in contributions based on a growing economy. Those predictions are flat-out wrong, and it will take a few more years for “puzzlingly sluggish” to become “alarmingly sluggish” and then “inexplicable.” In the meantime, they’ll continue to corrupt the economic indicators to prevent panic and try to make everything look rosy. I suspect that economic theory won’t change until the current crop of economists dies and is replaced. As one of the famous physicists of the last century quipped, “Science progresses one funeral at a time.” Until then, the ongoing economic reality will remain “inexplicable.”
The second consequence is inflation. It turns out that the CPI — Consumer Price Index — is so heavily manipulated, it may be as much as eight percent below the real inflation rate. This means that the COLA — Cost Of Living Adjustment –for Social Security is entirely inadequate. And that means that Social Security is gradually becoming irrelevant. Before it gets to Irrelevant, it will pass through the difficult stage of Intolerable, which will send seniors to Washington en masse with torches and pitchforks. Maybe that’s when the psychopaths in Congress are planning to club them all.
The other real problem Social Security faces is politics.
I’m not talking about the recent partisan gridlock, odious as it is. I’m talking about the fact that US Americans have lost control of their own government.
The discussion taking place in Washington about “entitlements” is as clear an indication as anyone could need that the government is entirely decoupled from the needs of people, just as Wall Street is decoupled from the needs of business. Social Security is subject to Congress, and we cannot trust our own Congress because it no longer represents our needs. Congress is currently torn between its own petty court intrigues, and the ill-conceived, short-sighted whims of the class that purchases members of Congress through campaign funding. We, the people, are as irrelevant to Congress as dandelion fuzz.
Perhaps this loss of our Congress merely reflects that, at a deeper level, we’ve lost any sense of national unity — or any sense of communal identity at all.
After all, what do you do with a world-class military superpower when the Great Enemy that defined it — the Soviet Union — up and vanishes? All tanked up and no place to party. Or maybe the big breaking point was the national catastrophe of Vietnam. Or perhaps it goes back to Truman dropping the atomic bomb on Japan. I don’t really know when we stopped being Americans and started being so damned selfish.
You know, we could take great national pride in the way our Social Security program keeps an old black woman in downtown Los Angeles from starving to death. Do we take such pride?
Not to hear people talk. Some sniff and say she should have worked harder and built up an adequate 401K fund for herself; that she’s a leech and worthless drain on society. Others say her kids ought to take better care of her: they fault her as a bad parent if none of them turned out rich. Some fault her for living too long. Some fault her because she’s a single woman. Some fault her because she’s black. Whatever the excuse, it seems that no one wants to put 15.3% of their money in her tin cup. That’s confiscatory taxation. It’s morally wrong.
I can understand people who are confused about Social Security. A lot of lies have been told, professionally designed to promote hysteria. You have to do some research to realize that Social Security is a brilliant legacy of a past when it seems people were smarter and better human beings than they are now, and that the program is — apart from the general decay of our whole culture — still fiscally sound: certainly more so than anything Wall Street has to offer. I understand that people simply don’t know this, because they’ve been lied to for so long.
I even understand half of the people who originate the lies: the Wall Street sociopaths, who simply want to suck the Trust Fund — some two and a half trillion dollars — into their three-card Monte game, where most of it will magically vanish into their pockets. I hold them in contempt, but I understand them. They are just commonplace thieves with bottomless appetites who grow fat on the wealth of others. It’s all they know how to do, and they’re good at it.
But there’s this other crowd, this “moral” crowd, that I don’t understand at all: the group of people who think sharing is simply bad. It cannot be tolerated. It must be stopped at all costs. Social Security must be destroyed.
It baffles me.
So what do we do with the old people? Solutions are limited, after all. Do we start clubbing them? Do we hand them Kevorkian kits? Do we just look the other way as they begin to starve or freeze in the bedbug-infested one-room cold-water flats they can afford on their frugal benefits? Do we squeeze the $7000/month nursing care facilities until their staff quits, their facilities degrade, and they become 18th-century asylums where the old sit in their own filth for days on end?
I’m personally proud to be contributing 15.3% of my wages to keeping that old black woman in Los Angeles alive. And some old Jewish man in Brooklyn. And the crazy lady at my Dad’s old care facility who sat at the dinner table and shouted someone’s name every two minutes. And our friend living near her sister in Phoenix who has perhaps already forgotten us. And my mother-in-law who has moved back to Colombia where her pittance of a benefit can actually support her. I’m proud of living in a nation that used to think this kind of thing was important.
I’m deeply ashamed, however, of the current nest of sociopaths on Wall Street and in Congress who are leading this “national discussion” on “entitlements.” As Congresscritters, they should be stripped of their wealth — it could be held in trust for their grandchildren — and forced to live out the remainder of their lives on Social Security. My, wouldn’t that change the discussion!
 Nursing care can be had for less than $7000/month. The best prices we found around here were about $6000/month, and it would have been covered by Medicare. We gave that a try. The problem was that the nickel-pinchers in our sociopathic Congress mandated that residents be stacked two to a room, which is cruel and unworkable for many who are in late-stage senile dementia, including (unfortunately) Dad. Because Dad had the house to sell, we opted to upgrade to a single room and spend down his house, giving up the entire Medicare benefit — so we had to pay the full $7000/month out-of-pocket: our inheritance, had we wanted to look at it through the same lens of selfishness that some people do.