Health-insurance customers in a growing number of mostly rural regions will have just one insurer’s plans to choose from on the Affordable Care Act’s exchanges next year. Reported by Wall Street Journal 22 hours ago.

Residents at Village at Proprietors Green Senior and Assisted Living Community in Marshfield, MA are participating in a new, complimentary program designed to decrease the risk of falls, build confidence in mobility, and improve overall safety and quality of life.

Marshfield MA (PRWEB) May 16, 2016

Residents at Village at Proprietors Green in Marshfield, MA are participating in a new, complimentary program designed to decrease the risk of falls, build confidence in mobility, and improve overall safety and quality of life. Exercise Your Right Not to Fall is a collaborative initiative of Village at Proprietors Green and CAREtenders Home Health Care and Rehabilitation. Through this program, CAREtenders professionals visit interested residents to:· Evaluate the safety of the residents' apartment and identify potential hazards such as loose scatter rugs, cords, and other items known to increase falls risk.
· Conduct individualized balance testing in the comfort and privacy of the resident’s own apartment.
· Recommend next steps to improve balance and safety.

If recommendations include additional intervention to reduce falls risk, Village at Proprietors Green and CAREtenders professionals coordinate services such as physical or occupational therapy with the resident, his or her family, and his or her personal physician. Residents may choose CAREtenders or the home health agency of their choice to provide these services and have them billed to their health insurance carriers or Medicare.

Falls and fall-related injuries are common among older adults. In fact, an estimated one in three adults over the age of 65 falls each year, leading to more than 2.5 million emergency room visits. Village at Proprietors Green staff, including the community’s wellness director, fitness center physical therapist, and the entire nursing staff encourage all residents to participate in Exercise Your Right Not to Fall as a simple and effective way to avoid falls, gain confidence, and live life to the fullest.

Village at Proprietors Green in Marshfield, MA is managed by Welch Healthcare & Retirement Group. The senior living community with a continuum of care offers independent living that focuses on hospitality and amenities; assisted living that emphasizes personal care; and assisted living memory care that creates more joyful moments. To learn more visit: http://www.ProprietorsGreen.com Reported by PRWeb 17 hours ago.

This article is a preview of the Summer 2016 issue. Subscribe here. 

There are two types of businesses in America today: those that pay their workers a living wage—the real economy—and those that don’t—the parasite economy. And all of us who live and work in the real economy should be royally pissed at the way the parasite economy is sucking us dry.

Here in the real economy, we solve the problems, build the things, and pay the wages that make America great. When politicians of both parties promise to attract “good jobs” to their districts or states, they’re talking about the kind of real-economy jobs that pay a decent middle-class wage—jobs that provide the income, benefits, and security necessary to participate robustly in the economy as a consumer and taxpayer. It is the real economy that drives both production and demand, and that fills our tax coffers with the money needed to educate our children, maintain our infrastructure, invest in research and development, fund our social safety net, and provide for the national defense.

But in the parasite economy—where companies large and small cling to low-wage business models out of ignorance or habit or simple greed—“good jobs,” and the economic dynamism they produce, are in short supply. This is the economy in which tens of millions of Americans work for poverty wages with few if any benefits, often in the face of abusive scheduling practices that make it impossible to plan their life from day to day, let alone month to month.

The difference between these two economies is stark. The real economy pays the wages that drive consumer demand, while the parasite economy erodes it. The real economy generates about $5 trillion a year in local, state, and federal tax revenue, while the parasite economy is subsidized by taxes. The real economy provides our children the education and opportunity necessary to grow into the next generation of innovators, entrepreneurs, and civic leaders, while the parasite economy traps them in a cycle of intergenerational poverty.

The real economy delivers on the promise of capitalism.

The parasite economy relentlessly undermines it.

AP Photo/Jae C. Hong, File

In this May 9, 2013 file photo, a worker pushes shopping carts in front of a Walmart store in La Habra, California. 

If, as many on the right are wont to do, we divide our nation into one of “makers” and “takers,” it’s not the working poor who deserve our derision, but the low-wage businesses that exploit them. These are the real deadbeats of the parasite economy: companies with a business model predicated on a cheap supply of taxpayer-subsidized labor, growing fat on the vast wealth of consumer demand generated by the middle-class wages of the real economy, while leaving employees with little if any discretionary income of their own.

To be clear, I am not making a moral argument for the real economy (though there is surely a moral argument to be made), but rather a cold and calculated economic appeal based on self-interest properly understood. You see, I am an entrepreneur and venture capitalist invested mostly in technology companies that pay the sort of middle-class wages that enable our workers to fully participate in the economy as consumers of other companies’ products. That’s the way a market economy is supposed to work. We buy your products. You buy ours. But low-wage workers at parasite companies—mostly giant and profitable corporations like Walmart and McDonald’s—cannot afford to robustly consume our products, or most anybody else’s, in return. The parasite economy is simply bad for business.

At best, a worker earning the federal minimum wage of $7.25 an hour can barely manage to the pay the rent, buy some groceries, and maybe a bus pass, leaving little disposable income for anything else. No restaurants. No hair salons. No health club or yoga studio memberships, let alone the latest tech gadget or service from one of my companies. In business, the first, second, and third most important thing is demand. If demand is high, almost any other obstacle can be overcome. Workers earning $7 or $8 an hour cannot demand most products and services. They can barely subsist.

As an entrepreneur and investor, I have founded or financed 35 companies across a wide range of industries: manufacturing, retailing, software, e-commerce, robotics, health care, financial services, and banking. I know a thing or two about sales and customers. And I have never been in a business that considered minimum-wage workers earning $10,000 to $20,000 per year as our target customer. Except for pawnshops or payday lenders, a typical business’s core customers very likely earn more than minimum wage. It is demand from middle-income workers that supports the small local businesses that create 64 percent of new private-sector jobs and 49 percent of all jobs in America. So a fair question to ask is: If no business wants customers who make $7.25 an hour, why in the world would we tolerate—or even worse, subsidize—businesses that pay their workers so little?

A leading advocate of the parasite economy is the National Restaurant Association (the other NRA), which has worked assiduously to keep wages low. The federal minimum wage for tipped workers, unchanged since 1991, is a shocking $2.13 an hour. Lest you think all those workers are raking in tips, as a small elite of servers in high-end urban restaurants do, the median hourly wage for restaurant servers, including tips, is just $9.25 per hour. Tipped workers are more than twice as likely as the average worker to fall under the federal poverty line, and restaurant servers nearly three times as likely, according to a 2011 study by the Economic Policy Institute. Ironically, in its 2014 edition of “Consumer Spending in Restaurants,” the NRA notes that “[t]he primary influencer on consumer spending in restaurants is disposable income.” American households earning less than $30,000 a year—about a third of all households—make up only 15 percent of all restaurant spending, the NRA reports. Can you imagine how much more profitable the restaurant industry would be if one out of three Americans had more disposable income to spend at restaurants? The NRA appears to want every American to eat in restaurants—except restaurant workers.

AP Photo/Manuel Balce Ceneta

The National Restaurant Association building in Washington, Monday, November 7, 2011. 

 

And it’s not just the rise of the service sector that’s to blame for falling wages. America has lost millions of manufacturing jobs since 2000, but those that remain are no longer the golden ticket into the middle class they once were. According to a new study from the UC Berkeley Labor Center, the families of one in three manufacturing production workers now rely on public assistance at a cost of $10.2 billion a year to state and federal taxpayers. Blue-collar manufacturing workers didn’t earn solid middle-class incomes because they were better trained, better educated, or more productive than their service-sector counterparts, or because their employers were larger or more profitable than the giant service companies of today. Manufacturing workers earned middle-class wages because they were unionized, and as their bargaining power declined, so did their incomes.

I used to take parasitic business practices for granted, believing that they were an inherent and unavoidable feature of capitalism. But the more I examined the evidence, the more I realized that this just isn’t true. Some companies just choose to pay their workers as little as possible, and others don’t—while some companies have simply never bothered to imagine that there might be any other way. And yes, some companies reluctantly keep wages low in the face of market pressure from more willfully parasitic competitors. But in the end, all of us—workers and business owners alike—pay the price in the form of decreased demand, higher taxes, and slower economic growth.

And yes, these low-wage business models are a choice. While there are parasite companies and parasite jobs, there are no parasite industries or occupations, and there is no line of work worth doing that cannot command a living wage. For every Walmart, there’s a Costco. For every McDonald’s, there’s an In-N-Out Burger. For every single mom waiting tables at the local diner for $2.13 an hour, there’s a healthier, wealthier counterpart earning $13 an hour or more (soon to be $15!) in Seattle or San Francisco or in the thousands of real-economy businesses nationwide where management understands that the “minimum wage” is meant to be a minimum, not a maximum.

In any industry there are many different strategies for running a profitable business—some of which honor the contributions of their workers and some that don’t. And if these businesses that choose to follow a low-wage model represented isolated incidents, I would shower them with moral opprobrium and leave it at that. But there’s nothing isolated about it: It’s a pervasive pattern that warps the entire economy. Economists have a name for this sort of strategy; they call it “free riding.” And make no mistake—free riding doesn’t come free.

According to data compiled by the Brookings Institution, 73 million Americans—nearly one-quarter of our population—live in households eligible for the Earned Income Tax Credit (EITC), a benefit exclusively available to the working poor. I want to underscore this point. Nearly a quarter of our fellow citizens are poor—not because they don’t have jobs, but because they or their family members do—mostly working for giant profitable corporations. These are people who labor long hours preparing our food, stocking our shelves, cleaning our offices, caring for our children, and performing the many other tasks and services that define our modern way of life.

AP Photo/Mary Altaffer

McDonald's employees serve a meal containing a large soda, Tuesday, June 12, 2012, in New York. 

Today, a majority of the money we collectively spend on anti-poverty programs doesn’t go to the jobless, it goes to the working poor. According to a recent analysis by the Economic Policy Institute, 69.2 percent of all public benefits go to non-elderly households with at least one working member, nearly half of whom work at least full-time. In 2014, the EITC alone cost U.S. taxpayers $67 billion, directly supplementing the incomes of the working poor and, thus indirectly, the payrolls of their parasite employers. The Child Tax Credit (CTC) cost the federal government another $58 billion; food stamps, $80 billion; housing vouchers and rental assistance, $38 billion—again, all programs that largely benefit families of the working poor.

These numbers keep growing; the most recent 10-K filings of food manufacturer Mead Johnson reported that “approximately 47% of all infants born in the United States during the 12-month period [that] ended December 31, 2015 benefited from the WIC [Women, Infants, and Children] program,” which provides food assistance to “those considered to be at nutritional risk, including low-income pregnant, postpartum and breastfeeding women and infants and children up to age five.” It is a national disgrace that the parents of nearly one in two infants born in America require government aid just to meet the daily nutritional needs of their children.

And then there’s Medicaid. According to the Kaiser Family Foundation, total state and federal Medicaid spending cost U.S. taxpayers $475 billion in 2014. Conservatives disparage Medicaid as a costly “entitlement,” but an entitlement to whom? Workers can’t work when they’re sick or dead; that’s why real-economy companies provide their workers with health insurance and paid sick leave. But parasite economy companies pass that cost off to taxpayers.

This is a ridiculously inefficient way to run an economy. Complex bureaucracies like food stamps, Medicaid, and housing assistance are expensive to administer, while the relentless task of applying, qualifying, and maintaining eligibility for the various state and federal programs can be a time-consuming and humiliating process for those compelled to use them. Being poor is hard work in and of itself. So why spend billions on a bureaucratic redistribution system when employers could simply pay workers enough to afford food, medical care, and housing on their own?

I am not making an argument against anti-poverty programs; the EITC alone lifted 6.2 million Americans out of poverty in 2013 (more than half of them children), while reducing the severity of poverty for another 21.6 million working Americans and their families. But while the EITC has done an admirable job incentivizing low-wage work, it also has the unintended consequence of incentivizing employers to keep wages low—indeed, a 2010 study by Andrew Leigh in The B.E. Journal of Economic Analysis & Policy finds that “a 10 percent increase in the generosity of the EITC is associated with a 5 percent fall in the wages of high school dropouts and a 2 percent fall in the wages of those with only a high school diploma.” Why in the world would you pay your workers enough to clothe, house, and feed themselves, a growing number of my fellow CEOs apparently figure, when taxpayers are willing to do it for you?

In the fast-food industry, more than half of all families—52 percent—are enrolled in at least one public assistance program, at a combined cost of $7 billion a year. (Until 2013, McDonald’s even provided a “McResources” hotline to help its impoverished workers apply for government aid.) And Walmart alone, according to a 2014 report from Americans for Tax Fairness, costs U.S. taxpayers an estimated $6.2 billion a year in public assistance to its 1.4 million mostly low-wage workers—coincidentally, an amount roughly equal to the $6.5 billion a year the company lavished on stock buybacks over the previous decade. Quite simply, McDonald’s and Walmart and other businesses in the parasite economy have grown to rely on the tax dollars of other companies and other workers to indirectly subsidize their payroll—and their immense profits. In effect, many real-economy companies end up subsidizing their parasite-economy competitors.

Compare Walmart’s Sam’s Club chain of warehouse discount stores with its rival Costco—perhaps the most elegant (and studied) head-to-head comparison of low-wage versus living-wage business models in America today. In an effort to reverse high turnover costs, a reputation for poor customer service, and stagnant same-store sales, notoriously low-wage Walmart recently made news by raising starting wages at all its stores, including Sam’s Club, to $9 an hour in April 2015, and to $10 an hour 2016. “Bottom line—it’s working,” Walmart CEO Douglas McMillon reassured nervous investors in a recent a blog post. But don’t mistake this minor course correction for a change in business models; Sam’s Club wages remain substantially lower than those at rival Costco.

AP Photo/Seth Wenig

A supermarket displays stickers indicating they accept food stamps in West New York, New Jersey, Monday, January 12, 2015. 

To the casual observer, the two chains look virtually identical: cavernous warehouses stacked high with pallets of heavily discounted goods, from groceries to apparel, electronics to major appliances, and everything in between. Both chains earn a substantial portion of their profits from annual membership fees ($45 a year at Sam’s Club, $55 at Costco), and both chains offer myriad other discounted services to their members, from insurance to travel to banking. Together, the two chains dominate the warehouse retail category: Sam’s Club claims the largest geographic footprint, with 652 stores located throughout the U.S. and Puerto Rico, compared with Costco’s 492 stores. But Costco is the perennial market leader in paid members (currently 84 million, while Sam’s Club had 47 million in 2012), gross revenue ($113 billion in 2014 versus $57 billion), and pre-tax earnings ($3.2 billion versus $2 billion).

But the biggest difference? Costco offers its average worker the opportunity to earn a living wage, while Sam’s Club does not.

Neither company publishes its wage scale, so exact numbers are hard to pin down, but Costco is famous for its generous compensation policies. Walmart is infamous for the opposite. Glassdoor.com, which relies on worker-reported data, lists an average wage for a Sam’s Club cashier at less than $10 an hour, while a Costco cashier earns nearly $15. Costco’s wages may start only a couple bucks an hour higher than at Sam’s Club, but Costco quickly rewards workers for their loyalty and experience. A 2008 article in Slate reported that a Costco cashier with five years’ experience earns $40,000 a year plus benefits—enough for a two-cashier Costco family to find themselves firmly ensconced in the American middle class, enough to pay into the federal treasury rather than draw out of it.

Which brings us to the cruelest irony of these dueling business models: High-wage Costco and its workers are essentially subsidizing through their taxes their competition from low-wage Sam’s Club. But it isn’t just the tax subsidies that are so maddening. Costco employees can afford to shop at Sam’s Club, while impoverished Sam’s Club employees cannot afford to shop at Costco.

This irony is repeated throughout the nexus between the real and parasite economies: Low-wage McDonald’s (just over $8 an hour) is subsidized by higher-wage In-N-Out Burger (about $11.50 an hour). Low-wage Macy’s (about $9 an hour) is subsidized by higher-wage Nordstrom (nearly $12 an hour). Low-wage Kroger (just over $8 an hour) is subsidized by higher-wage Safeway (more than $11 an hour). In industry after industry, direct competitors are paying employees vastly different wages to perform the exact same job. But there is little difference between a Sam’s Club cashier and a Costco cashier other than the fact that one qualifies for government assistance while the other helps pay for it.

Both models can be highly profitable—both Costco and Sam’s Club have returned billions of dollars to shareholders. But only one model lifts workers into the Great American Middle Class that is the primary engine of economic growth. So why should we subsidize a low-wage parasite economy when the high-wage real economy offers so much more?

Of course, some will argue that the question is moot—that the labor market efficiently determines wages, not well-meaning CEOs or self-serving policymakers (or meddling know-it-alls like me), and that if a Sam’s Club cashier is worth $15 an hour, then that is what the labor market would force Sam’s Club to pay. “Supply and demand,” and all that.

That is nonsense. Take it from someone who has created dozens of businesses—people don’t get paid what they are “worth.” They get paid what they negotiate. We can all point to examples of CEOs who negotiated far more than they are worth, but there are many, many more people in our country who are worth far more than they negotiated.

That’s because more than any other market, the labor market is distorted by a profound imbalance of power between buyers and sellers; in fact, other than the small share of workers who have a collective-bargaining agreement, the vast majority of workers enjoy little bargaining power at all. Most workers have limited resources and immediate needs—to eat, to pay rent, to provide for their children—while most employers could leave any particular position unfilled indefinitely without suffering any personal hardship at all. As Adam Smith noted in The Wealth of Nations: “In the long run the workman may be as necessary to his master as his master is to him; but the necessity is not so immediate.”

So why do parasite employers keep wages low? Because they can. And in recent decades, employers have relentlessly exploited this power imbalance, eroding labor’s share of the economy from an average of 50 percent of GDP between 1950 and 1980 to a ten-year-average of only 43 percent today, while profits’ share of GDP has risen by a similar amount. That’s about a trillion dollars a year that used to go to wages that now goes to profits. But that trillion dollars isn’t profit because it needs to be, or has to be, or should be. It’s profit because powerful people like me prefer it to be, and workers no longer have enough power to negotiate a fairer and more economically sensible split.

AP Photo/Rogelio V. Solis

Grocery bags loaded with food from the Special Supplemental Nutrition Program for Women, Infants and Children, better known as WIC, sit in a cart before being loaded into a vehicle in Jackson, Mississippi, Thursday, October 3, 2013.

Clearly, wages are low in the parasite economy because many employers choose to keep them low and workers lack the power to affect that choice. And in highly price-competitive markets, even the most noble and generous CEOs are limited by the dynamics of competition.

This brings me to an uncomfortable confession, and the part of this essay that is least fun to write: I’m a parasite, too. And I hate it.

I worked my way up through the family business, Pacific Coast Feather Company, one of the largest domestic manufacturers of textile products in the nation. We employ roughly 750 workers in factories across the United States, making pillows, comforters, and mattress pads. And I’ll admit it: I am not proud of the wages we pay many of our workers. We do pay more than 90 percent of our employees above the state minimum wage—and the majority of those minimum wage workers are in California, where the wage floor was recently raised to $10 an hour (and will go to $15 over the next five years)—but at any given time, between 20 and 30 percent of our workforce (around 250 people, give or take) come from temporary labor firms, which very likely do not pay those employees enough to sustain anything close to a middle-class life.

Today, I co-chair the board with my brother; a non-family CEO manages the day-to-day operations. But like many other business owners in the parasite economy, I feel trapped by the low standards and competitive dynamics of our highly price-sensitive industry. The retailers we sell our product through are viciously price-competitive; if our prices inch higher than our competitors’ on pillows and comforters of comparable quality, we’d lose the bulk of our market share in a New York minute. I desperately want to pay our workers a living wage, but while labor only accounts for a fraction of our costs, we just couldn’t compete against manufacturers paying at parasitic wage levels. No doubt our better-paid workers would be more productive, happy, and loyal, but I fear the labor cost differential might be too great and our margins too small for us to survive.

And yet.

If every company paid a reasonable wage, everybody would benefit as a result. Every worker would benefit from higher wages. Every company would benefit from higher worker productivity, lower turnover, and from increased demand for goods and services, without being squeezed by low-wage competitors. Every community would benefit from the jobs created by that extra demand. Every taxpayer would benefit from decreased need for poverty programs. Imagine an economy in which every worker could afford to treat themselves daily to a fancy espresso drink—how great would this be for Starbucks, even if Starbucks had to pay its own workers a little bit more, too?

If you give the poorest Americans a raise, they will spend that money within their community. We have plenty of data to back this up. When San Jose increased its minimum wage by $2 in 2013, the organization Puget Sound Sage reports, registered businesses in San Jose increased by 3 percent in the year after the raise, and small-retailer registration increased by 19 percent. Furthermore, unemployment decreased by a full percent, and more than 4,000 jobs were added in the restaurant and hospitality sector alone.

Which brings me to my main point. We could collectively solve the problem of the parasite economy quickly and fairly, simply by raising the federal minimum wage back to a reasonable level—say $12 to $15 an hour. And the ironic part is that everyone would benefit—even the companies that currently pay low wages.

Markets are defined by rules; indeed, no high-functioning market economy is possible without the effective rule of law. Some of these rules are necessary to prevent companies from cheating—for example, the enforcement of standard weights and measures. Some of these rules are necessary to protect the health and safety of consumers, such as food and drug standards. And some of these rules are necessary to prevent companies from gaining an unfair advantage by externalizing their costs—such as dumping toxic chemicals rather than paying the cost of safe disposal. In a very real sense, that is exactly what parasite companies are doing: externalizing their costs. They pay their workers so little that that they are forcing the rest of us to pick up part of the cost. And in the process, these parasite companies gain an unfair labor cost advantage over their higher-wage competitors, setting off a downward spiral of lower wages and lower consumer demand.

A race to the bottom isn’t how you build an economy; it’s how you take advantage of it. So let’s stop conflating collectivism—which is bad—with collective action—which is indispensable to the success of every social human endeavor. Collective action can enable individuals to take actions they know are beneficial—for themselves and others—but that they feel constrained from doing by themselves. Throughout the 1970s, most National Hockey League players refused to wear helmets, despite the known risk of serious head injuries. Some players went helmetless out of vanity, or fear of being ridiculed, while others believed that wearing a helmet imposed a slight competitive disadvantage. In 1969, one player admitted to Newsweek: “It’s foolish not to wear a helmet. But I don’t—because the other guys don’t. I know that’s silly, but most of the players feel the same way. If the league made us do it, though, we’d all wear them and nobody would mind.” A decade later, the NHL began requiring helmets, and now every player—and the league as whole—is better off as a result. Both the NHL’s helmet rule and the minimum wage are forms of collective action; they solve collective problems that no individual could solve on his or her own. Collective action is not anti-capitalist or anti-market; in fact, a functional market would not be possible without it.

Yes, the parasite economy is a choice. But while there are some individual bad players, it is largely a choice that we as a nation have collectively made. In Washington, D.C., and in state capitols nationwide, we have chosen to erode the minimum wage and the overtime threshold and the bargaining power of labor. We have chosen to sit quietly by as corporate America has stripped workers of the benefits that define what it means to be middle class. We have chosen not just to tolerate the parasite economy, but also to subsidize it.

But the great news is: Collectively, we can make a different choice.

AP Photo/Damian Dovarganes

Employees move merchandise at Costco Wholesale Los Feliz store on Wednesday, October 7, 2009 in Glendale, California. 

Stagnant wages are a collective-action problem that Pacific Coast Feather Company cannot solve on its own; but if Congress were to solve it for us by gradually raising the minimum wage for all American workers—including those of our competitors—it would be no problem for us at all. In fact, it would be fantastic—not just for workers, but also for my family business. Obviously, the three million hourly workers currently scraping by at or below the $7.25 federal minimum wage aren’t buying many new pillows—and neither are the tens of millions of Americans earning just a few bucks more. Nineteen percent of American workers currently earn under $12.50 an hour; 42 percent earn under $15. Every dollar an hour amounts to another $2,080 in annual income. In 2010, Americans spent $740 million on pillows. How many more would be sold if half of America could afford one more pillow per year? Sure, the price of a new pillow might rise a few pennies to cover the higher labor costs. But what a trade-off! What a difference! What a great nation in which to sell pillows!

Given a choice between a high-wage America and a low-wage America, I’d happily choose higher wages. But I can’t make this choice on my own. I need you to make me do it. I need you to level the playing field by forcing me and my competitors to raise our wages, so that one low-wage employer can no longer drag the rest of us down with him. I need you to raise the minimum wage.

Many readers will claim this is all a pipe dream, that it could never work in practice. But in fact, it is working—right where I live, in Washington state. Washington has long recognized the fundamental law of capitalism—that when workers have more money, businesses have more customers and hire more workers. That is the model that we have been following here, and our economy has been booming as a result. At $9.47 an hour (indexed to inflation), Washington state’s minimum wage had long been the highest in the nation, and as one of a handful of states with no tip penalty, our tipped workers already earn four and a half times the $2.13-an-hour tipped minimum wage in much of the rest of the country.

And yet according to Bloomberg, high-wage Seattle supports the second-highest concentration of eateries per capita in the nation—trailing only even-higher-wage San Francisco. And according to the Paychex IHS Small Business Jobs Index, Washington also enjoyed the highest rate of small-business job growth in the nation, while even higher-wage Seattle ranks second by major metropolitan areas.

Why are small businesses booming here despite our high minimum wage? Because that’s how capitalism works! Our minimum-wage workers spend so much more on the things that drive small businesses than they ever could while earning just $7.25 an hour. They eat at restaurants. They get haircuts and manicures. They send their mom flowers on Mother’s Day.

When workers have more money, businesses have more customers. And when businesses have more customers they create more jobs.

In 2014, Seattle took its high-wage model one step further, passing the first $15 minimum wage in the nation. Restaurateurs and right-wing think tanks warned of ruin. Businesses would close. Workers would lose their jobs. The invisible hand would punch us in the mouth. But it never happened.

As the Puget Sound Business Journal recently reported in a front page story titled “Apocalypse Not: $15 and the cuts that never came,” six months after the first wage increase went into effect, Seattle’s restaurant industry is growing faster than ever. Even celebrity chef Tom Douglas, who had warned that Seattle could lose a quarter of its downtown restaurants, has continued to add restaurants to his local empire. “Douglas has now changed his mind about the law,” the PSBJ reports, “saying he was ‘naïve’ to think that restaurants would raise pay on their own.” That he was. And then on February 15, 2016, The Seattle Times reported that ADP’s national survey of economic vitality ranked Washington state number one in the country for both wage and job growth. And you thought higher wages killed jobs. Not hardly.

It is appealing to believe that the parasite economy will eventually correct itself. Or that a few high-road employers will set an example that will eliminate it. But trust me when I tell you: This is wishful thinking. I know because I am one of those employers. People, like me, when faced with brutal competitive dynamics, will not pay workers a living wage unless all of our competitors do the same. And the only way that will happen is if citizens like you require employers like us to do it. Until then, corporate America will continue to build its record profits on the backs of cheap labor.

“I do not prize the word ‘cheap,’” President William McKinley once said. “[Cheap] is not a badge of honor. It is a symbol of despair. Cheap prices make for cheap goods; cheap goods make for cheap men; and cheap men make for a cheap country.”

In the absence of collective action, the parasite economy will continue to pay parasite wages, cheapening the real economy with it. But when we lift wages through reasonable increases in the minimum wage, everyone prospers—and more than just financially. Dezi Bonow, the head chef at Douglas’s new Carlile Room, told the PSBJ that $15 is a particular boon to kitchen employees, who don’t get tips. “It legitimizes cooking as a craft,” he said.

Imagine an economy where all work is honored as craft, and all craftsmen are compensated accordingly. Imagine a country where no labor is dismissed as “cheap.” Reported by The American Prospect 14 hours ago.

Three Medicaid managed care experts detail and assess the impact of many new requirements ahead for Medicaid managed care organizations, and suggest strategies to prepare, in a May 26 webinar sponsored by Atlantic Information Services.

Washington, DC (PRWEB) May 16, 2016

Atlantic Information Services, Inc. (AIS) is pleased to announce “CMS’s Final Medicaid Managed Care Rule: Sweeping Changes Ahead for MCOs,” a May 26 webinar on the new 1,425-page final rule issued by the Centers for Medicare & Medicaid Services (CMS) that will make a host of major changes to the program over the next few years. Three Medicaid managed care experts will offer expert analysis of the impact of these changes and suggest strategies on how to prepare.

In 60 minutes of presentations followed by 30 minutes of responses to individual questions, Bob Atlas, President of EBG Advisors, Jeff Myers, President and CEO of the Medicaid Health Plans of America, and Matt Salo, Executive Director of the National Association of Medicaid Directors, will offer answers to key questions such as:· How will CMS decide whether at least 85% of a Medicaid MCO’s revenue goes to furnishing medical services?
· How will states go about their new assigned responsibility of offsetting any MLR shortfalls by Medicaid insurers in future rate setting?
· In what ways did CMS change the proposed rule’s fraud-determination provisions? Why?
· What can Medicaid MCOs expect from the new quality ratings, and when? How should they prepare?
· How will states use the new responsibilities given to them to establish time and distance requirements for provider-network adequacy?
· Why did CMS back off its proposal regarding enforcement to ensure payments to Medicaid MCOs are actuarially sound? How might this issue be approached in the future?
· What does the new rule require on access by Medicaid MCO beneficiaries to behavioral care and long-term care? How will this impact the insurers?
· Why did CMS drop the proposed requirement that Medicaid MCOs give enrollees at least 14 days of fee-for-service coverage before they start managed care? Will this concept come back in another form?
· What steps should Medicaid MCOs and their partners take now to begin preparing for the many new requirements ahead?

Visit https://aishealth.com/marketplace/c6a14_052616 for more details and registration information.

About AIS
Atlantic Information Services, Inc. (AIS) is a publishing and information company that has been serving the health care industry for nearly 30 years. It develops highly targeted news, data and strategic information for managers in hospitals and health systems, health insurance companies, medical group practices, purchasers of health insurance, pharmaceutical companies and other health care organizations. AIS products include print and electronic newsletters, databases, websites, looseleafs, strategic reports, directories, webinars, virtual conferences and training programs. Reported by PRWeb 12 hours ago.

WASHINGTON (Reuters) - The U.S. Supreme Court on Monday ducked a major ruling on a challenge by Christian nonprofit employers to an Obamacare mandate to provide female workers health insurance covering birth control by sending the cases back to lower courts for further proceedings. Reported by Reuters 9 hours ago.

The U.S. Supreme Court on Monday ducked a major ruling on a challenge by Christian nonprofit employers to an Obamacare mandate to provide female workers health insurance covering birth control by sending the cases back to lower courts for further proceedings. The justices, who in previous decisions ... Reported by Raw Story 9 hours ago.

The U.S. Supreme Court on Monday ducked a major ruling on a challenge by Christian nonprofit employers to an Obamacare mandate to provide female workers health insurance covering birth control by sending the cases back to lower courts for further proceedings. Reported by Newsmax 8 hours ago.

Reported by Breaking News 9 hours ago.

The U.S. Supreme Court avoided a major ruling Monday on a challenge by Christian nonprofit employers to a mandate under the Affordable Care Act, also known as Obamacare, to provide female workers with health insurance covering birth control by sending the cases back to lower courts for further review. Ruling unanimously, the justices asked the lower courts to re-examine the issue. The High Court did not rule on the legal points of whether a 2013 accommodation determined by the Obama... Reported by VOA News 8 hours ago.

In Bernie Sanders' 2015 book, Outsider in the White House, the Senator from Vermont outlines his vision of democratic socialism. The vision that Sanders introduces is neither idealistic nor radical, but rather, a practical response to the problems that our current political and economic systems perpetuate. Here are 10 passages from that book that most clearly describe Sanders' brand of socialism:
*1.* "Honest people have differences of opinion as to what they believe are the most important problems facing this country. Let me tell you straight out the way I see it. Here they are: the unfair distribution of wealth, the decline of decent-paying jobs, the erosion of our democracy, the unchecked power of the corporate media, the insufficiency of our health care system, the inadequacies of American education... In my view, if we could address these problems forthrightly, our nation would become the great society it had always had the promise of becoming."*2.* "The gap between the rich and poor has extended beyond the breaking point of civil society and sound economics. Instead of addressing poverty, politicians of both parties have criminalized it and accepted incarceration rates that are obscene and racist; the devastating effects of climate change have been ignored; we have accepted a warped sense of priorities that says America can always find enough money for war but that there is never enough for infrastructure or education or nutrition programs. Our democracy has been rendered very nearly dysfunctional by Supreme Court rulings that make it easier for billionaires and corporations to buy elections and harder for people of color and students to vote in them. The United States is degenerating into a plutocracy as democracy is overwhelmed by money and negative ads and the collapse of serious journalism."*3.* "We live in the wealthiest nation in the history of the world, but that reality means little because almost all of that wealth is controlled by a tiny handful of individuals. There is something profoundly wrong when the top one-tenth of 1 percent owns almost as much as the bottom 90 percent, and when 99 percent of all new income goes to the top 1 percent. There is something profoundly wrong when one family owns more wealth than the bottom 130 million Americans. This type of immoral, unsustainable economy is not what America is supposed to be about. This has got to change, and together we will change it."*4.* "Time after time, I pointed out that such disparity in the distribution of wealth and decision-making power was not just unfair economically, but without economic democracy it was impossible to achieve genuine political democracy. The message could be reduced to a simple formula: wealth = power, lack of money = subservience. How could we change that? How could we create a truly democratic society?"*5.* "If you have no influence over your own working conditions, what kind of power can you have over the economics and politics of the entire country? Why bother to vote? Why bother to pay attention to politics? And millions don't. In Vermont and throughout the country, the rich ante up $500 or $5,000 at a fundraising event to support the candidate who will represent their interests. Meanwhile, the majority of the poor and working people don't even vote. No wonder the rich gets richer and everyone else gets poorer. Are we really living in a democracy?"*6.* "Believe me. The problem with Washington, and politics in the Untied States, is not that ordinary people have too much power and influence. It's not that too much attention is being paid to low-income children. It's not that the needs of the rich and large corporations are being ignored.

The problem, for those who have just crawled out from under a rock, is that groups representing the wealthiest people in this country are able to decisively influence the legislative process so that public policy reflects the interests of the privileged few and not the needs of the general population. And if you don't understand this simple fact, you haven't a clue as to what politics in America is all about."*7.* Democratic Socialism can be described as: "A vision which says that in this richest if all nations all of our people, and not just the wealthy, should enjoy the fruits of their labor with decent jobs and benefits that allow them to live in dignity. That we cannot continue to have the highest rate of childhood poverty in the world, while the number of millionaires and billionaires continues to increase. A vision which says that every man, woman, and child in this country is entitled to healthcare as a right of citizenship, and that the United States must join the rest of the industrialized world by enacting a national health care system, a single-payer health care system. A vision which says that lifelong quality education is the essence of what being alive is about, and that all of our citizens, no matter what their incomes, should be able to receive a higher education.

A vision which says that we respect the struggles that women have been waging for so many years, and that the very personal decision of abortion must be decided by the woman herself--and not Newt Gingrich or the United States government. A vision which says that we judge people not by their color, their gender, their sexual orientation, their nation of birth--but by the quality of their character, and that we will never accept sexism, racism, or homophobia.

A vision which says there is no conflict between respect for the environment and job growth, and that, in fact, our economy improves when we stop environmental degradation. A vision which says that a society is ultimately judged by how we treat the weakest and most vulnerable among us--the children, the elderly, the sick, the disabled. And that we do not cut back on programs which help the weak and powerless, in order to give tax breaks to the rich and the powerful."*8.* "For as far back as I can remember, I have always been a proponent of a national health care system. It just seemed eminently fair and right. How can we call this a civilized society when some Americans have access to the best medical care in the world and others are unable to walk into a doctor's office because they lack money? How can we tolerate a situation where the children or parents of the rich get the medical attention they need in order to stay alive, while members of the working-class families, who lack health insurance, have to die or needlessly suffer--or go hopelessly into debt to get the care they need? This is an outrageous injustice and it cannot be rationally defended."*9.* "I am convinced that if we can muster the courage to work together, we can do what needs to be done. Building a progressive future requires building a progressive movement. And that means that in every community of America citizens must stand up and say, 'We believe in economic justice for all. We will no longer accept a situation in which the wealthy and powerful have undue influence. We are going to change this nation, and we are going to start by doing what needs to be done from the grassroots on up.'

It is time, in other words, for you to begin doing in your community what many of us have begun doing in Vermont: take a stand, organize, and use the political process to build democracy all over again...

As we move toward a progressive and democratic future, I am sustained by the hope that one day, when millions of Americans are actively involved in the political process and are standing up for their rights and those of their children, a majority of the members of Congress will then represent the interests of ordinary people, and not the rich. When that day comes, we will no longer be outsiders in the House.

That House, and this country, will then belong to all of us. And that's the way it should be."*10.* "What could happen, what would happen, in this country if progressives were allowed to have four or five nights of prime-time television and front-page newspaper coverage? What would happen if we could present a point of view that most Americans are unfamiliar with? Would we suddenly be the dominant political force in America? No. Would millions of Americans develop a much more sympathetic attitude toward democratic socialism? Yes."-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 8 hours ago.

Whether attributed to Nelson Mandela, George Schultz or simply an old adage, the quote "Where you stand depends on where you sit" has powerful meaning when it comes to the Affordable Care Act (ACA) and the affordability of health care.

This sentiment was brought home in a recent survey of health care opinion leaders and health care providers conducted by APCO Insight.

*Support for the Affordable Care Act*

It is well known that public support for the ACA is split, particularly among Republicans and Democrats. As a recent survey pointed out, this same split holds when you ask health care policymakers and providers about their thoughts on the ACA.

While mean support for the law is just above average on a scale of 0-10 (5.6), where 10 indicates the highest level, ACA support among opinion leaders reflects public sentiment when party affiliation is taken into account. Democrats (7.9) and Independents (6.1) express levels of support above the mean and Republicans (4.1) are well below.

Interestingly, in the category of strongly support (8-10), Democrats express a level of 67%, while Republicans who strongly oppose (0-2) are only 51% of the sample. Perhaps, at least among opinion leaders, this indicates Democrats more strongly support the law than Republicans oppose it.

Besides party affiliation, age, gender and profession indicates level of support or opposition to the law. Of those who gave the highest level (8-10) of support to the law, women outpaced men 44% to 31%; and among age, those 18-34 led with 62%, well ahead of all other age categories (35-49: 46%, 50-64: 35%, 65+: 44%).

And when looking at professions, nurses have a higher level of support (6.5) versus doctors (4.7) and pharmacists (4.4). There is also a distinct difference among practice - those in general practice are much more supportive (5.9) than those in specialty fields (4.3).

While this study was done on only a small sample of the population, these results point to a simple hypothesis that because nurses and general practitioners come in contact more often with under and uninsured, their level of support can be understood, as they have the best understanding of the value of insurance in gaining access to health care.

The gender differential is also interesting based on a similar hypothesis; women make most of the health decisions in a family. Therefore, their higher support than men is understood - women have much more practical interactions with the health care system and thus a greater appreciation of the ability to access care that the ACA provides.

And thinking about accessing care, support differs little among those with private insurance (6.5) versus those with government insurance (6.2). This also supports the hypothesis that interaction with a health care system is better than no interaction at all.

The gender and age gap is also a strong determinant of support for the law. When asked how they would like to change the law, 88% of men said repeal the law while only 41% of women answered as such. Among age groups, results show older Americans are much more in favor of repealing the law than their younger counterparts. With lower premiums, low out-of-pocket costs, low prescription costs and good health, it is no surprise that the younger generation is the only group not to support repeal, especially compared to those over 50, who have the highest premiums and out-of-pockets, and have the most health issues.

*Affordability
*
Questions surrounding affordability are also important to the current public discussion about our health insurance system. While affordability is a priority among all respondents, there is no specific cost identified as most important to address to make insurance more affordable. When asked what affordability means to them, they responded fairly evenly. Sixty-seven percent (67%) responded that lower out-of-pocket health care costs were important, while 70% responded lower prescription costs were and 73% said lower insurance premiums.

This sentiment was relatively unchanged across stakeholders. Seventy-four percent (74%) of health care providers (HCPs) responded that lower out-of-pocket health care costs were important to affordability while 60% of opinion leaders (OLs) also identified lower out-of-pocket health care costs (this differential may be due to provider's closer proximity to billing issues). On the question of lower prescription drug costs 70% of HCPs responded they were important while nearly the identical percentage of opinion leaders agreed at 71%. On the importance of insurance premiums to affordability the percentage of health care providers who agreed was 76% while 70% of opinion leaders also identified lower insurance premiums.

However, when you break down respondents according to age, a significant gap is revealed. The younger the group the less lower out-of-pocket costs are a priority. Among those 18-34 it was 38%; among the 35-49 age group it was 54%, and then it jumps considerably among older age groups. For those 50-64 it is 85% and for those Medicare eligible (65+) it is 80%.

However, when it comes to lower prescription costs and lower premiums, the 18-34 age group has similar responses as the other groups. For those 18 to 34, 72% thought lower prescription costs was a key to affordability. Sixty-eight percent also thought lower premiums were important. The numbers were nearly identical for the other age groups: 35-49; 67% and 70%; 50-64; 88% and 81% and 64 plus the numbers were 64% and 67%.

Again, a simple observation may explain this: younger people, while they do pay premiums and get the occasional prescription, they are less likely to face serious out-of-pocket costs like hospital stays, tests etc. All of these costs increase as you age, but when you hit 65, Medicare kicks in and your worry over them drops as these issues are less of a problem (though if you have traditional Medicare, your out-of-pockets can still be high, which may explain why they also score high on lower out-of-pocket costs).

*Conclusion*

When describing their opposition to the Affordable Care Act, Republican politicians make fuzzy and unproven claims about its impact on the economy. But they are very clear that their ideas will lower costs - though they do resort to vagueness in describing details over exactly how they would accomplish this goal. In fact, Republicans have yet to produce legislation or even a detailed plan given the challenge of matching their rhetoric to reality. So at first glance, given the result of this survey, this strategy makes sense.

However, when you get beyond the surface, the survey results paint more nuanced and complicated feelings about the law; feelings that the GOP positioning may run into if they find themselves in a position to make major changes to or even repeal the ACA. With support among young people and women higher than the average and the GOP's existing issues with losing younger and minority voters from the electorate, repealing the ACA may prove at best a short-term victory but a long-term loss. For Democrats the takeaway points to a stronger hand in the future as the results suggest a strategy of taking steps to "fix" the law. Now all we have to do is wait to see who's in charge come this November.
###This piece originally was published in The Morning Consult on May 12, 2016.

-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 6 hours ago.

In a deep dark recess of the Federal Register, large corporations just quietly received permission to "play doctor" with their employees. They can now impose even more draconian and counterproductive wellness schemes on their workers than they already do. Their hope is to claw back a big chunk of the insurance premiums paid on behalf of employees who refuse to submit to these programs, or who can't lose weight.

*A Bit of Background on Wellness*

The Affordable Care Act (ACA) allowed employers to force employees to submit to wellness under threat of fines. Specifically, the ACA's "Safeway Amendment" -- named after the supermarket chain whose wellness program was highlighted as a shining example of how corporations could help employees become healthier -- encouraged corporations to tie 30 percent to 50 percent of the total health insurance premium to employee health behaviors and outcomes. (As was revealed while ACA was being debated, Safeway didn't have a wellness program. The fictional Safeway success was a smokescreen for corporate lobbyists to shoehorn this withhold into the ACA.)

Once this 30 percent to 50 percent windfall became apparent, many corporations figured out what this vendor (Bravo Wellness) advertised: there is much more money to be made in clawing back large sums of money from employees who refuse to submit to these programs than in improving the health of employees enough to allegedly reduce spending many years from now. "Allegedly" because -- unlike simply collecting fines or withholding incentive payments -- improving employee health turns out to be remarkably hard and ridiculously expensive to do, so hard and expensive that:
· The entire wellness industry has not avoided even a single heart attack or case of diabetes, statistically speaking, according to data compiled by a wellness consulting firm for the federal government;· The only wellness company willing to release results of its own wellness program on its own employees, admits the program failed;· Even the employers whose wellness programs have won awards as the best in the field have made only trivial improvements in employee health.
Most importantly, the complete lack of regulation has allowed the wellness industry and health plans to expose employees to significant potential harms, in order to maximize revenues.

*The Federal Government Green-Lights "Wellness-or-Else" Programs*

There are no regulations, licensure requirements or oversight boards constraining the conduct of wellness vendors, and only one agency -- the Equal Employment Opportunity Commission (EEOC) -- providing any employee recourse. The Business Roundtable has taken on the latter at every opportunity. First they threatened President Obama that it would withdraw its support for ACA unless he declawed the EEOC. Then they held sham Senate hearings entitled: "Employer Wellness Programs: Better Health Outcomes and Lower Costs." Finally, they threatened to push the "Preserving Employee Wellness Programs Act" to eviscerate the EEOC's protections legislatively.

But it turns out the legislative end-around wasn't necessary. The EEOC has now caved in. These programs are defined as "voluntary," and yet as of now, employees can be forced to hand over genetic and family history information, or pay penalties. So, as in 1984, where "war" means "peace," employees can be required to voluntarily hand over this information.

Let's be clear. This isn't about employee wellness programs, which don't work. It's all about the penalties. Genetic information is worthless in the prevention of heart disease and diabetes, as Aetna just showed in a failed experiment on its own employees.

Knowing family history does have some predictive value, but it is unclear how employees are going to benefit from employers collecting it. Self-insured employers could either fire the employee or do nothing. Neither is useful for the employee. If the employer is fully insured, this information is akin to a "pre-existing condition" in the old days. The employer's premiums will increase as long as employees with bad family histories remain on their payroll.

*The Good News, Part 1*

The Business Roundtable, and their friends at the US Chamber of Commerce, might want to connect their computers to the internet. It turns out that many companies are finally realizing that compelling employees to submit to medical screens just to claw back some insurance money isn't worth the morale hit.

Increasingly, employers are learning that what the national data shows is also true for themselves: these programs simply do not work. For example:
· The prestigious journal Health Affairs confirmed previous analysis that fining or bribing employees to lose weight is a waste of time and money;· The state of Connecticut, also in Health Affairs, admitted that their program has caused costs to increase;· The Health Enhancement Research Organization (HERO), the wellness industry's trade association, admitted wellness causes such massive cost increases that it loses money -- even when HERO acknowledges fabricating data to try to show savings.

And the morale hit? A formerly obscure faculty member who led the successful employee revolt against the Penn State wellness program just got elected president of the Penn State Faculty Senate -- largely because employees were so grateful to him for his leadership in that revolt.*The Good News, Part 2*

As a result, many companies are deciding that clawing back some insurance money isn't worth the damage done to the their workforces. They are replacing "wellness done to employees" with "wellness done for employees." These companies are improving the built environment, upgrading their foodservice, encouraging fitness, or simply adding features to the health benefit like paternal leave or financial counseling. They might still hold a "health fair" every now and then, but their medical tests are conducted infrequently -- according to actual clinical guidelines -- instead of allowing vendors to screen the stuffing out of their employees to find diseases that don't exist.Or they are actually focusing efforts where they can make a difference, like steering employees to safer hospitals or educating employees on how to purchase healthcare services wisely. (Disclosure: my own company, Quizzify, is in the business of teaching employees how to do the latter.)

Notwithstanding this disruption and regardless of the harms it has caused, the $7-billion wellness industry has excelled in perpetuating its own existence. Industry "thought leaders" recently proposed a scheme to encourage companies to disclose how fat their employees are -- and have even managed to get a few large employers to sign on to it.

The sheer audacity of that scheme and complete disregard for its consequences on overweight employees means the war on "voluntary" wellness-or-else programs is by no means over. Like every other industry threatened by reality but supported by deep-pocketed allies like the Business Roundtable, the wellness industry can rely on the government to delay the inevitable. Consequently, it might be quite some time before the inevitable course of reality overcomes this pox on the healthcare system.

-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 5 hours ago.

Voters age 50 and older are expected to turn out in force in this, the mother of all presidential elections. We offer this guide on what the three presidential candidates still in the race have had to say about the issues of key importance to this voting bloc:

*Social Security: The gift that we hope keeps on giving.*

There are around 40 million people collecting Social Security benefits. Over half of workers between the ages of 55 and 64 have no retirement savings, according to the GAO. More than a third of senior citizens depend on Social Security for virtually all of their income. Yes, Social Security is a vital concern.

The problem is that the Social Security system is on track to run out of money. That, by most estimates, won't happen until 2033, at which point -- assuming nothing else is done -- it plans on reducing benefits by 25 percent. 

Everyone wants to fix Social Security so that the fund doesn't go broke; they just don't agree on how to do it. There are at least a dozen ways and plans that have been proposed to "save" Social Security. Here's how the leading candidates say they will do it, according to their websites:

*Hillary Clinton's website says, *"Hillary understands that there is no way to accomplish that goal without asking the highest-income Americans to pay more, including options to tax some of their income above the current Social Security cap, and taxing some of their income not currently taken into account by the Social Security system."

She would also fight privatization, oppose any reduction of the annual cost-of-living adjustment, and not raise the retirement age -- an idea she has called "unfair;" the GAO says that raising the retirement age disproportionately hurts the poor.  

She would also expand Social Security benefits for widows and those who took time out of the paid workforce to care for a child or sick family member.

*Donald Trump's *website focuses on seven key positions and mentions about a dozen other issues. Social Security isn't among them. Trump believes that strengthening the economy and creating more jobs would, in turn, generate more payroll-tax support for Social Security. At the South Carolina GOP debate on Feb 13, 2016, Trump also said there is waste, fraud and abuse in the program. He said, "We have in Social Security thousands of people over 106 years old. You know they don't exist. There's tremendous waste, fraud and abuse, and we're going to get it. But we're not going to hurt the people who have been paying into Social Security their whole life and then all of a sudden they're supposed to get less. We're bringing jobs back."

*Bernie Sanders'* website notes the senator has already introduced legislation to lift the payroll cap so that those who earn more than $250,000 a year pay the same percentage of their income into Social Security as do middle class and working families.

He says, "This would not only extend the solvency of Social Security for the next 50 years, but also bring in enough revenue to expand benefits by an average of $65 a month; increase cost-of-living-adjustments; and lift more seniors out of poverty by increasing the minimum benefits paid to low-income seniors." 

*Medicare: The plan we love to hate.*

Medicare pays for hospital care for those age 65 and over, and heavily subsidizes their doctors’ visits, medical tests and drugs. But it is far from free. Almost all seniors pay monthly premiums for some parts of Medicare, and many also enroll in a supplemental insurance plan, Medigap, to help cover out-of-pocket costs.

TheWeek reports that in 2010, the nation's Medicare bill was about $524 billion, or 15.2 percent of all government spending. Only Social Security and the defense budget cost taxpayers more. 

One of the most frustrating parts of Medicare is not knowing what is covered. Eye glasses, hearing aids and dentures are not (no dental care at all) -- three things that seniors regularly need. Low-income seniors sometimes must choose between filling their expensive prescriptions and buying groceries. According to Hunger in America, 30 percent of its client households with seniors said they have had to choose between paying for food and paying for medical care.

*Clinton's* plan is to push down drug costs by allowing Medicare to negotiate for lower prices with drug manufacturers. She would allow Americans to import lower-cost drugs from foreign countries and reward drug companies that invest in the development of "life-saving treatments rather than jacking up prices without innovation." Her changes will save Medicare more than $100 billion in program spending, her campaign claims.

Again, nary a mention of Medicare on *Trump's* website. But he has promised that "On day one of the Trump Administration, we will ask Congress to immediately deliver a full repeal of Obamacare." And then this happened, as per the Wall Street Journal: “After the administration has been in place, then we will start to take a look at all of the programs, including entitlement programs like Social Security and Medicare,” said chief Trump policy adviser Sam Clovis, during an event in Washington. “We’ll start taking a hard look at those to start seeing what we can do in a bipartisan way.” Did he just call them entitlement programs? 

*Sanders* wants to build on the success of the Affordable Care Act and has lobbied for "Medicare for all" -- meaning universal health coverage for everyone. He would separate health insurance from employment. How will he pay for it? His website says through a combination of a 6.2 percent income-based health premium paid for by employers, a 2.2 percent income-based premium per household, progressive income tax rates and taxing capital gains and dividends the same as income derived from work. He would also limit tax deductions for the wealthy.

*College: Affording it without incurring a lifetime of student debt.*

People who are post 50 know first-hand how crippling student debt has become. It's why they have adult kids still living at home and why they are looking toward community colleges for their kids who are now graduating high school. According to the Federal Reserve Bank of New York, outstanding student loan debt in the U.S. is between $902 billion and $1 trillion with about $864 billion of it owed to the federal government who loans students money. College has just become unaffordable. According to the College Board, the average cost of tuition and fees for the 2015 - 2016 school year was $32,405 at private colleges, $9,410 for state residents at public colleges, and $23,893 for out-of-state residents attending public universities. The call to "find a better way" needs to be answered.

*Clinton's* plan is called the New College Compact. She says students should never have to borrow to pay for tuition, books, and fees to attend a four-year public college in their state. Colleges and universities will be held accountable for improving outcomes and controlling costs. Students will do their part by contributing their earnings from working 10 hours a week. Families will be asked to make "an affordable and realistic family contribution." And the federal government will provide grants to states that commit to these goals and cut interest rates on loans. Students at community college will receive free tuition.

*Trump's* website doesn't cite a plan to address student debt or the skyrocketing costs of higher education. In a campaign rally in New Hampshire, he was reported saying "Just trust me."

*Sanders* says he would make all public colleges and universities tuition-free to qualified students. He also would stop the federal government from profiting off student loans. It's been estimated that the U.S. government will make more than $110 billion over the next 10 years from student loans. Sanders would drop interest rates on undergraduate loans from 4.29 percent to 2.37 percent and allow people to refinance their existing loans to those rates. The cost of his $75 billion a year plan would be paid for by imposing a tax on the "Wall Street speculators who nearly destroyed the economy seven years ago," said his website.

*Caregiving is in crisis mode.*

Families and friends have become our nation's go-to plan for caring for the nation's elderly. The price tag for this kind of informal caregiving in the United States comes to $522 billion a year, according to a RAND Corporation study.

Replacing that care with unskilled paid care at minimum wage would cost $221 billion, while replacing it with skilled nursing care would cost $642 billion annually. The personal toll on the caregiver is also mighty. If they leave their own paid employment to stay home and meet the needs of an elderly parent or ailing spouse, their Social Security, pension and 401k benefits all shrink. And re-entering the jobs market at a later point is often difficult, if not outright impossible.

On the campaign trail,* Clinton *regularly mentions giving caregivers relief. She has proposed a $6,000 tax credit to offset caregiving expenses and would allow earnings credit toward Social Security for family caregiving.

“No one should face meager Social Security checks because they took on the vital role of caregiver for part of their career,” said a summary of her plan.

*Trump's* website remains silent on the subject and it does not appear he has said much about it while campaigning.  

*Sanders' *website doesn't specifically address caregiving but does speak broadly about improving the country's sick leave, vacation and family leave policies.  

*Age discrimination is real.*

People over 50 regularly report that they can't find jobs because of their age. Ageism has been described as the last unaddressed prejudice in America. Age discrimination is blatant, but very little is being done about it by the EEOC. While sex is a protected class in employment under Title VII of the Civil Rights Act of 1964, age is covered by the Age Discrimination in Employment Act of 1967. That leaves the EEOC somewhat toothless in demanding that companies track the age of their work forces. What will the candidates do?

Radio silence on all fronts for the most part. Disappointing.

*Alzheimer's is our boogey man in the closet.*

One in nine people age 65 and older has Alzheimer's disease. Nobody really likes those odds. Losing our memories, the ability to live independently, to even recognize our loved ones -- we want no part of it.

*Clinton* says that by 2025, we can prevent, effectively treat, and make an Alzheimer’s cure by investing $2 billion a year in research.

*Trump* has called Alzheimer’s a “total top priority for me.” His father had Alzheimer’s. 

When asked about Alzheimer’s in New Hampshire town hall meeting, *Sanders* shifted the conversation to blaming Republicans for cutting back on funding for scientific research overall.

Editor’s note: Donald Trump regularly incites political violence and is a serial liar,rampant xenophobe, racist, misogynist and birther who has repeatedly pledged to ban all Muslims — 1.6 billion members of an entire religion — from entering the U.S. 

-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 5 hours ago.

After the Supreme Court’s decision to send the case on contraception access back to the lower courts, the White House press secretary explained that the ruling did not mean that the health insurance of female employees was in danger. Reported by NYTimes.com 4 hours ago.

The Court avoided a major ruling on a Christian nonprofit employer's challenge to an Obamacare mandate to provide female workers with health insurance covering birth control. Reported by Christian Science Monitor 3 hours ago.

High country residents who pay high prices for health insurance are seeing a glimmer of hope for relief. Reported by Denver Post 3 hours ago.

The U.S. health insurance industry has lost a few billion dollars selling policies on Affordable Care Act exchanges. It’s why many carriers are seeking large premium increases next year and why at least one major carrier is dropping policies in most states.

But some insurance companies are making money and looking to expand. A new report helps explain why their strategies are working -- and why the health care law as a whole is not in danger of collapse, as some of its critics frequently suggest.

The report, from the consulting firm McKinsey and Company, focuses on the exchanges that approximately 12.7 million people used to sign up for insurance before the end of this year’s open enrollment. Based on public filings, McKinsey’s researchers determined that losses on those policies totaled more than $2.7 billion in 2014 and were probably even bigger last year.

Those figures are just one more sign that the exchanges, which have helped bring the proportion of uninsured Americans to an all-time low, remain works in progress. On the same day as the McKinsey report, for example, The Arizona Republic reported that Humana and UnitedHealth Group were dropping their plans for Arizona, which means that eight of the state’s rural counties will have just one provider. And in Florida, according to state officials, insurers are seeking average rate increases of more than 17 percent in order to cover losses from their newly insured populations, although those requests are subject to review by regulators.

“The individual market faces continued challenges,” the report says, noting that many insurers had expected or at least hoped the exchanges would be more stable by now.

But volatile markets with large rate increases were, if anything, more common before Obamacare. An adjustment period to the new law was inevitable. And McKinsey’s findings echo what a broad, if not quite unanimous, chorus of insurance industry officials and experts have been saying for a while -- that while premiums are likely to keep bouncing around, with carriers entering and exiting the market, the new system is likely to endure in the long run.

The main reason for this confidence is the law’s tax credits, which discount premiums by hundreds or sometimes thousands of dollars a year. They insulate the majority of consumers from rising premiums and are likely to keep enrollment from dwindling to the point where insurers must constantly raise premiums to cover their losses.

“The individual market has little risk of entering a classic insurance ‘death spiral’ as long as the federal government continues to offer subsidies,” the report concludes.

The McKinsey report also offers insights into what kinds of insurance plans are already succeeding in the new marketplaces, potentially offering a roadmap to carriers looking to avoid the kinds of losses they experienced in the first two years.

Generally speaking, the carriers that do the most aggressive managing of care -- either by emphasizing prevention and coordination, or simply limiting beneficiaries to very small sets of providers -- are the ones most likely to be making profits, the report finds. Meanwhile, the carriers that have historically thrived in other markets, like administering employer plans or offering private insurance to Medicare beneficiaries, are the ones struggling to adapt -- and, in a handful of cases, leaving the business altogether.

It isn’t a huge shock that some insurers are facing these problems. The health care law’s most dramatic impact has been on the nongroup market -- that is, on insurance for people who don’t have access to coverage through employers or government programs like Medicare. Previously, insurers could deny coverage or charge higher premiums to these people when they had pre-existing conditions. Insurers could also sell plans without maternity care, mental health treatment and other services that employer policies typically cover. The law prohibits these practices.

But insurers in most states had little experience selling coverage under these conditions. They had to make a bunch of guesses about the kinds of people who would buy their policies and the prices they'd be willing to pay, and many simply guessed wrong. These insurers ended up with sicker-than-expected enrollees who incurred bigger-than-expected medical bills, producing the losses that McKinsey’s analysts document in the new report. It’s why these many of these firms say they need bigger premium increases next year.

“Once insurance became accessible to people with pre-existing health conditions, no one, including insurers, really knew how many sick people and how many healthy people would sign up,” said Larry Levitt, senior vice president at the Henry J. Kaiser Family Foundation.

“It’s only now that insurers are catching up to some of the bad guesses they made," he added. "Big premium increases are bad news in the short term, but they should help to make the marketplaces financially profitable and sustainable for insurers.”

Some insurers made more accurate predictions, though. Overall, 30 percent of the carriers representing 40 percent of the market made money in 2014. And looking over the data, McKinsey researchers detected a few patterns.

Plans like Centene that had experience running managed care policies for Medicaid, the government-run program for the poor, have done well overall -- perhaps because those carriers are accustomed to running plans that have smaller networks of doctors and hospitals who are willing to accept much lower reimbursement for services.

Doctors and hospitals that run their own insurance plans by offering care within their systems also seemed to perform well -- although mostly because of one specific plan, Kaiser Permanente of California, which dominates the state's market. (The insurer has no relationship to the Kaiser Family Foundation.)

How consumers feel about these plans is another matter entirely. Kaiser Permanente is extremely popular, and experts consider its style of care a model of high-quality efficiency -- but narrow networks in the Medicaid-style plans have become an increasing source of frustration, particularly for people who have long-standing relationships with doctors who won’t accept the payments in their new plans. In some cases, people have gotten care at hospitals in their networks, only to receive huge bills because the doctors working in the hospitals were out of network.

Some states have responded by imposing regulations that protect consumers from such surprise bills, while some of the law's supporters have called for additional steps, like requiring insurers to maintain bigger networks. Of course, in competitive markets of private insurers, bigger networks can also mean higher premiums -- or extra out-of-pocket costs. That’s one reason even many the law’s supporters, like Democratic presidential front-runner Hillary Clinton, have also proposed providing enrollees with more financial assistance. 

Whether any of these specific proposals become reality remains to be seen. Regardless, the process of identifying the Affordable Care Act's shortcomings and trying to fix them is likely to continue for a long time.

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Slightly more than 20,000 people in Colorado will be affected by the decision of UnitedHealth and Humana to exit the individual market and the state's health insurance exchange. Reported by Denver Post 9 minutes ago.

The Court avoided a major ruling on a Christian nonprofit employer's challenge to an Obamacare mandate to provide female workers with health insurance covering birth control. Reported by Christian Science Monitor 22 hours ago.

For 200 years, there have been two schools of thought about what determines the distribution of income -- and how the economy functions. One, emanating from Adam Smith and nineteenth-century liberal economists, focuses on competitive markets. The other, cognizant of how Smith's brand of liberalism leads to rapid concentration of wealth and income, takes as its starting point unfettered markets' tendency toward monopoly. It is important to understand both, because our views about government policies and existing inequalities are shaped by which of the two schools of thought one believes provides a better description of reality.

For the nineteenth-century liberals and their latter-day acolytes, because markets are competitive, individuals' returns are related to their social contributions -- their "marginal product," in the language of economists. Capitalists are rewarded for saving rather than consuming -- for their abstinence, in the words of Nassau Senior, one of my predecessors in the Drummond Professorship of Political Economy at Oxford. Differences in income were then related to their ownership of "assets" -- human and financial capital. Scholars of inequality thus focused on the determinants of the distribution of assets, including how they are passed on across generations.

The second school of thought takes as its starting point "power," including the ability to exercise monopoly control or, in labor markets, to assert authority over workers. Scholars in this area have focused on what gives rise to power, how it is maintained and strengthened, and other features that may prevent markets from being competitive. Work on exploitation arising from asymmetries of information is an important example.


As inequality has widened and concerns about it have grown, the competitive school, viewing individual returns in terms of marginal product, has become increasingly unable to explain how the economy works.


In the West in the post-World War II era, the liberal school of thought has dominated. Yet, as inequality has widened and concerns about it have grown, the competitive school, viewing individual returns in terms of marginal product, has become increasingly unable to explain how the economy works. So, today, the second school of thought is ascendant.

After all, the large bonuses paid to banks' CEOs as they led their firms to ruin and the economy to the brink of collapse are hard to reconcile with the belief that individuals' pay has anything to do with their social contributions. Of course, historically, the oppression of large groups -- slaves, women and minorities of various types -- are obvious instances where inequalities are the result of power relationships, not marginal returns.

In today's economy, many sectors -- telecoms, cable TV, digital branches from social media to Internet search, health insurance, pharmaceuticals, agro-business and many more -- cannot be understood through the lens of competition. In these sectors, what competition exists is oligopolistic, not the "pure" competition depicted in textbooks. A few sectors can be defined as "price taking"; firms are so small that they have no effect on market price. Agriculture is the clearest example, but government intervention in the sector is massive, and prices are not set primarily by market forces.


Today's markets are characterized by the persistence of high monopoly profits.


U.S. President Barack Obama's Council of Economic Advisers, led by Jason Furman, has attempted to tally the extent of the increase in market concentration and some of its implications. In most industries, according to the CEA, standard metrics show large -- and in some cases, dramatic -- increases in market concentration. The top ten banks' share of the deposit market, for example, increased from about 20 percent to 50 percent in just 30 years, from 1980 to 2010.

Some of the increase in market power is the result of changes in technology and economic structure: consider network economies and the growth of locally provided service-sector industries. Some is because firms -- Microsoft and drug companies are good examples -- have learned better how to erect and maintain entry barriers, often assisted by conservative political forces that justify lax anti-trust enforcement and the failure to limit market power on the grounds that markets are "naturally" competitive. And some of it reflects the naked abuse and leveraging of market power through the political process: Large banks, for example, lobbied the U.S. Congress to amend or repeal legislation separating commercial banking from other areas of finance.

The consequences are evident in the data, with inequality rising at every level, not only across individuals, but also across firms. The CEA report noted that the "90th percentile firm sees returns on investments in capital that are more than five times the median. This ratio was closer to two just a quarter of a century ago."

The battle against entrenched power is not only a battle for democracy; it is also a battle for efficiency and shared prosperity


Joseph Schumpeter, one of the great economists of the twentieth century, argued that one shouldn't be worried by monopoly power: monopolies would only be temporary. There would be fierce competition for the market and this would replace competition in the market and ensure that prices remained competitive.

My own theoretical work long ago showed the flaws in Schumpeter's analysis, and now empirical results provide strong confirmation. Today's markets are characterized by the persistence of high monopoly profits.

The implications of this are profound. Many of the assumptions about market economies are based on acceptance of the competitive model, with marginal returns commensurate with social contributions. This view has led to hesitancy about official intervention: If markets are fundamentally efficient and fair, there is little that even the best of governments could do to improve matters. But if markets are based on exploitation, the rationale for laissez-faire disappears. Indeed, in that case, the battle against entrenched power is not only a battle for democracy; it is also a battle for efficiency and shared prosperity.

*Also on WorldPost: *-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 22 hours ago.