Medicare on life support: will it survive?

This Issue Brief discusses Medicare reform. The Balanced Budget Act of 1997 reduces spending in the Medicare program by $115 billion between 1998 and 2002. Most of the reduction in spending comes from reducing payments to providers, and most of the savings (36 percent) occur in 2002. By 2007, the Part A trust fund is expected to be insolvent, four years before the baby-boom generation reaches the current Medicare eligibility age of 65. Congress is likely to revisit Medicare reform in the near future. A number of reforms received a significant amount of attention during the Medicare reform debate, but were not included in the final legislation. The Senate-passed legislation would have increased the Medicare eligibility age from 65 to 67, imposed means testing on Medicare Part B, and imposed a Part B home health copayment of $5. While these provisions were not included in the Balanced Budget Act of 1997, they may be the focal point of future Medicare reform. Many changes to the Medicare program are likely to significantly affect employment-based health plans for both active and retired workers. Raising the Medicare eligibility age would undoubtedly affect both workers and retirees. Unless workers are willing to work until age 67, their likelihood of becoming uninsured would increase. In 1995, 15.8 percent of retirees ages 55-64 were uninsured, compared with 11.5 percent of workers in the same age group. Early retirees might also find themselves unable to afford health insurance in the private market. An Employee Benefit Research Institute/Gallup poll indicates a direct link between the availability of retiree health benefits and a worker's decision to retire early. In 1993, 61 percent of workers reported that they would not retire before becoming eligible for Medicare if their employer did not provide retiree health benefits. If workers responded to an increase in the retirement age by working longer, employment-based health plans would probably experience an increase in costs, because older workers are the most costly to cover. Some employers might respond to an increase in the Medicare eligibility age by dropping coverage altogether. The message for future beneficiaries is becoming very clear: expect less from Medicare at later ages and higher premiums. As was true prior to the enactment of Medicare in 1965, workers will increasingly need to include retiree health insurance as an expected expense as they plan and save for retirement.     

Is DNA cut out for a long life?

Much attention has been focused on the DNA repair hypothesis of aging. Studies in mammals that seek to test the validity of this model are complicated by both the functional redundancy and the essential nature of genes involved in the repair process. Compared to mammals, the study of DNA repair and aging in yeast has considerably fewer complicating factors. In this Perspective, I discuss results presented in this month's issue of Aging Cell that address whether the types of DNA damage repaired by the base excision repair pathway cause aging in yeast.     

Jokes and routines make everyday life a good life—on ‘doing family’ for young people in foster care in Sweden

The aim of this article is to identify inclusion practices in foster families by studying the everyday life of young people entering various types of foster family. Structure and warmth in the family stand out as important dimensions of everyday life. What is not so evident in previous research is the way emotional ‘warmth’ is created. In particular, joking, gentle teasing and laughing, which in this paper stand out as important inclusion practices, seem to be rather unknown aspects in foster care, as is the importance of doing things together in everyday life. The young people's contributions in creating a good family atmosphere are visible in the study, as is their capacity to adapt to a new family. Daily routines normalise the adolescents' everyday life. Negotiations make them part of important decisions, and may strengthen them as social agents. Foster parents' positive attitude towards birth family facilitates birth parents' support to their children. In this case study, mixed qualitative methods are used: interviews, network maps, ‘beepers’ and video recordings in the foster home.     

Does past life matter? Social workers' views on biographical approaches

The article discusses the application of biographical approaches in social work practice and aims to identify issues that may need to be taken into account when implementing these approaches. The essays of 16 Finnish social workers, working in psychiatry, addiction treatment, rehabilitation, gerontology, pre-adoption counselling and vocational education, were analyzed regarding the respondents’ views on the benefits of biographical approaches, especially biographical interviewing (BI). Qualitative content analysis was used. The results indicate that biographical approaches can create a space for user reflection and social worker listening as well as provide a better understanding of service users’ situation. However, concerns regarding limitations of the approach, ethics and necessary professional competencies were raised. The conclusions drawn are that social work practice can benefit from BI done with awareness and ethical sensitivity and that ‘biographical lenses’ as a metaphor for a general attitude can be applied in most practice situations. The paper draws on a wider literature on biographical approaches in the social sciences.     

Cross-national work–life research: common misconceptions and pervasive challenges

ABSTRACT

While cross-national work-life research is a flourishing field of research, but a recent one, it is relatively recent as national context had been the missing ‘elephant in the room’ of work–life research for decades. Based on the keynote talk I gave at the 2015 Community, Work and Family conference in Malmö, Sweden, this research note highlights three pervasive challenges which I believe need to be discussed in our community of scholars, practitioners and policy-makers so that our research makes the strongest possible impact for individuals and organisations: (1) educating practitioners and policy-makers on the structuring impact that public and employer policies have on individual so-called private work–life decisions; (2) analyzing the inequalities of access to these policies within each country, which are often masked by simplified country-level comparisons and (3) finding innovative ways to combine ambitious etic research designs with in-depth emic understanding of local cultures.     

Good personal finances or a strong social capital—on different life conditions of importance for an active life when becoming alone in old age

Becoming alone in old age can be a decisive life event that brings major changes depending on various causes as health status, financial resources, family situation, and available welfare services. This article discusses the situation of older people in Sweden who have transitioned from a two-person to single-person household in recent years and what impact this might have on their everyday lives. Through in-depth interviews with 18 older people, age 67–90, their experiences about life conditions and opportunities were examined. Findings showed large differences between the men and women. They all tried to live as they always had done and they used the same personal life strategies that they always had. But the men could live as before on their own financial merits, while the women needed assistance from children, grandchildren and the welfare system. Transportation options were central and clearly related to both private economy and social services available. Shortcomings in the welfare state's way of caring for the elderly were clearly uncovered. The gap between social policy promises of opportunities for autonomy and independence to live an active life in old age and the everyday reality for older people still seems to be wide.     

Pet grief: when is non‐human life grievable?

This study explores how pet owners grieve their pets and view their pets' transience. Drawing on Butler's notion of the differential allocation of grievability, I have analysed interviews with eighteen pet owners. Butler argues that grievability is made possible by a normative framework which allows for some human or human‐like lives to be grieved, while other lives are rendered ‘lose‐able’. All the interviewed pet owners say that they are capable of grieving a non‐human animal, but analysis suggests that they make their pets grievable and ungrievable by turns. I argue that by maintaining this ambivalence, the interviewees negotiate pets' inclusion in a human moral community while simultaneously defending human exceptionalism. The article concludes with a discussion of pet grief as a potentially destabilizing emotion. I suggest that grieving beings on the border between grievable human and lose‐able animal – ‘werewolves’ according to Giorgio Agamben – may be a powerful way of challenging normative frameworks which arbitrarily render some human and non‐human lives lose‐able.     

Governing ‘emotional’ life: passions,moral sentiments and emotions

The seventeenth- and eighteenth-century statement that passions and not inactive reason are the motives that decisively influence the will and constitute the true drivers of human action promoted a new object of problematization and control on the part of the theoreticians of the art of government. Since then, a battle has waged over the general designations and definitions of what ‘emotional’ life is, and different dispositives of ‘emotional’ power (or pathospower) have been developed as central mechanisms for governing human beings. Analysing the British discourse on governmentality from the period, I recount the history of the emergence of the three main modern concepts of ‘emotional’ life and of its respective power strategies: passions in the discourse of utilitarian liberalism, moral sentiments in the discourse of conservatism, and emotions in biological and evolutionist psychology that underlies eugenic politics.     

Successful aging: how does physical activity influence engagement with life?

With the increasing number of individuals over the age of 65?years worldwide, it is critical for society to recognize the importance of helping seniors maintain their health, physical, and cognitive functioning as well as their engagement with life. These three dimensions provide the foundation for successful aging (SA). The positive role of engagement with life has been understated to date in the literature. This review highlights the components of SA with particular emphasis on engagement and how physical activity positively impacts engagement which in turn positively influences health and physical function.     

A life of one’s own: republican freedom and disability

This article outlines a republican perspective on disability. We argue that a commitment to ensuring the republican freedom of disabled citizens offers a promising account of what disabled citizens are owed as a matter of justice. A republican perspective offers a particular diagnosis of the injustice of disability disadvantage, both in relation to individuals (dominium) and the state (imperium), that is congenial to prominent concerns voiced by the disability rights movement. This article also offers a brief outline of three republican remedies: the right of social participation, the right of opportunities for civic contribution, and the right of democratic contestation. These remedies constitute key guidelines for the robust institutional protection of disabled citizens’ republican freedom.     

The photo‐survey research method: capturing life in the city

Recent promotion of city centre living within UK policy has led to a commensurate interest in city centre conditions and the opinions and experiences of the people who live there. An apposite, straightforward method to capture city centre residents' experiences and views is described in this article. We successfully combined a novel, under‐utilized visual technique (self‐directed photography) with qualitative methods (log‐sheets and interviews) in the form of a ‘photo‐survey’. A background to visual methodologies is presented in this article, alongside a critique of using the photo‐survey with 84 city centre residents to investigate environmental conditions and perceptions within three of the UK's major cities. The method provided a rich, detailed set of data, but also brought a number of noticeable benefits to the data collection process. The photo‐survey not only effectively captured and documented life in the city but also acted as an ‘agent for change’, evoking thoughts and feelings which ultimately encouraged participants to reflect on their existing perceptions and urban experiences. The study also raises some important considerations for future work undertaken with this method and with using photographs as a set of data, and proposes techniques for minimising potential problems.     

Modernity’s dirt: carbon emissions and the technique of life

ABSTRACT

Under colonialism, the concept of dirt was frequently employed ideologically to make judgements about relative worth. In Africa, a particular European cultural idiom or “technique of life” was presented as superior because of its “cleanliness.” This paper is concerned with modernity’s “technique of life” at a particular historical moment when, as a result of environmental crisis, it is suddenly called upon to give an account of itself. I undercut modernity’s claim to cleanliness by suggesting that what it introduces alongside regimes of order and sanitation is a much more globally destructive form of dirt in the form of increasing carbon dioxide levels. The CAIT Climate Data Explorer is a website that compares carbon dioxide emissions across a range of categories. This paper reads three graphs generated by this website as incomplete figures for making visible modernity’s “technique of life.” Realist fiction, read as a supplement to the climate graph records, is able to reinvest some of the abstract categories employed by the climate data tool – transport, fugitive emissions and electricity use – with the details that characterise particular techniques of life and to reveal the way they continue to be defined, at this historical moment, by narratives of development and consumption.     

Volunteering and depression in later life: social benefit or selection processes?

Does volunteer participation reduce depressive symptoms among older people? Does depression influence whether older people will volunteer? Might nonrandom attrition in a longitudinal study bias the relationship between volunteering and depression? This research addresses these questions with three-wave data from theAmericans' Changing Lives study. Multigroup structural equation models for complete and incomplete data are used to estimate the joint causal relationship between volunteer work and depression. The results reveal a beneficial effect of formal volunteering on depression, but not for informal helping. Depression was shown to be associated with a subsequent increase in formal volunteering, suggesting voluntarism as a means of compensation. Functional health problems, not depression, emerged as the important barrier to volunteering. In addition, a sample selection effect--depressed persons and nonvolunteers were less likely to complete the panel study--was detected and accounted for in the analysis. The results are discussed in light of the legitimacy of formal social integration.     

Do private and public transfers received affect life satisfaction? Evidence from Romania

This paper uses Romanian survey data to investigate the determinants of individual life and financial satisfaction, with an emphasis on the role of public and private transfers received. A possible concern is that these transfers are unlikely to be exogenous to satisfaction. We use recursive simultaneous equations models to account both for this potential problem and for the fact that public transfers are themselves endogenous in the private transfer equation. We find that public transfers received have a positive influence on both life and financial satisfaction, while private transfers do not matter. People receive private transfers irrespective of their economic and demographic characteristics in Romania, which could be explained by some social norm motives.     

Elder self neglect: A geriatric syndrome or a life course story?

AimsTo explore the unique aspects of the elder self-neglect phenomenon and to achieve phenomenological understanding of self-neglect through the eyes of self-neglecting elders.MethodA qualitative study based on a sample of 16 self-neglecting elders. Data collection was performed through in-depth semi-structured interviews, followed by content analysis.FindingsFour major themes emerged from the older participants: “I was unlucky:” a life course of suffering; “That's the way it is:” self-neglect as a routine of life; “They tell me that I'm disabled:” old age as exposing situations of self-neglect; “My empire:” how do I perceive my old age.ConclusionsSelf-neglect is not necessarily an issue of old age, but is related to the person's life history. Self-neglect as a way of life accompanied the participants into old age, but it was not originated or created there. The overall message of the self-neglecting elders was to see them as human beings and not as old neglected people; not to label them as an “age syndrome” but to perceive them in a holistic and humanistic manner.