Working Longer: The Solution to the Retirement Income Challenge
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Contents:
Annuitization yields the highest income for life, yet people dislike it. Tapping housing equity efficiently is another challenge. For many people, their house is their major asset; leaving it to heirs is a luxury that very few can afford. There needs to be some financial innovation so that people can access their housing equity.
In terms of the three legs of the existing retirement income stool, the situation is particularly acute for those who depend on Social Security. Can benefits be cut? If the population is divided into income terciles, Social Security payments are crucial at the bottom, really important in the middle, and significant even for the top.
Thus to suggest that shortfalls in the Social Security system be fixed partly by tax increases and partly by benefit cuts is not realistic. Even if people work longer and Social Security benefits are not diminished, private retirement plans will be inadequate.
Working Longer: The Solution to the Retirement Income Challenge | Pension Rights Center
When k plans were first devised, they were intended to be supplementary to Social Security and defined benefit plans. A whole new tier of savings for retirement is necessary. For people with or without a k plan, it would provide 15 or 20 percent of replacement income. It would be contributory by either employee or employer, and it should be mandatory, with no access until retirement.
This new tier of savings would be invested in something very low cost, and the portfolio would change as people age. It would be paid out as an annuity.
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Munnell acknowledged that although she has many ideas, she does not have a plan. Nevertheless, she asserted that the imperative is to increase savings by whatever means.
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The solution to income insecurity for an aging population, then, is threefold: work longer, use assets more effectively, and save more. With that agenda, Munnell proposed the following key questions:. There are three basic questions regarding health care financing for an aging population: 1 What is happening to the prevalence and onset of disability? Langa reviewed the areas of consensus, controversy, and ignorance regarding these questions.
Disability is measured in terms of the capacity to perform activities of daily living ADLs and instrumental activities of daily living IADLs independently. The risk of disability increases with age, and the United States has an aging population. What are the trends in disability prevalence?
There is a general consensus that the prevalence in disability among the aged has declined over the past 20 years. There is also some evidence of significant declines in cognitive impairment, although longitudinal data are more limited. These declines are probably the result of increases in education, through multiple direct and indirect causal pathways.
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Decreases in cardiovascular disease have also contributed to decreases in disability prevalence, as have improvements in health care such as cataract surgery, joint replacement, and treatment for hypertension and cholesterol. Healthy behaviors are also helping to compress disability, so that onset of disability is later when it does occur. Disability rates will be higher for those in the bottom income quartile. This may be due, in part, to differences in early education, which has long-term consequences including influence on the choice of jobs, ways of using the brain, environments, and social interactions.
Better education earlier in life for those in the bottom quartile could be an important component of addressing disparities in health and disability later in life. A final factor regarding trends in disability is the impact of rising obesity and diabetes, including among children. The large increase in the prevalence of obesity and diabetes may reverse some of the disability declines that have occurred over the past 20 years.
Trends in disability are important to study, because they have large implications for both costs of long-term care and for the ability of older workers to remain in the labor force.
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Tracking trends in disability also helps to identify healthy behaviors and other risks and protective factors in the environment. Regarding the right amount of care for older people and those at the end of life, there is particular evidence of regional variations in Medicare expenditures. Per capita Medicare expenditures vary widely across regions. Growth in Medicare expenditures has also exhibited striking differences.
In Miami, for example, Medicare expenditures are far higher and growing faster than in Oregon. The data are properly adjusted for characteristics of the population, and thus the results reflect actual differences in utilization rates, not differences in the people or the burden of disease in these regions. The patients in the high-use regions are not sicker, nor do they prefer more intensive care in general or at the end of life.
Furthermore, they do not have better health outcomes in many ways that can be measured.
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Physicians in high Medicare expenditure regions make more referrals to subspecialists, more frequently hospitalize older patients at the end of life, more frequently use intensive care units for older patients, and less frequently discuss palliative care with patients and families. Why is determining the right amount of care for older adults important? Second, the so-called gray areas of decision making—determining whether and how much to intervene—is where health care money goes.
The tremendous regional variation in Medicare expenditures suggests that the decisions made in these discretionary gray areas vary widely and that further refinement is needed, for example, in the guidelines for appropriate care for frail adults with multiple coexisting chronic diseases.
The guidelines for treating a year-old in this situation might be very different from those for an year-old.
Corporate Governance in the European Insurance Industry. Corporate Governance and Corporate Finance. The pattern of those ratios reflects the presence of the boomer generation: the worker-to-beneficiary ratio is fairly stable in years the boomers are in the workforce — but is substantially lower when the boomers are in their retirement years — We also collect and use personal data for our legitimate business needs. Sass estimate that people who retire at age 65 today can expect Social Security to provide the equivalent of only 39 percent of their incomes after deductions for basic Medicare contributions. To qualify, a federal employee must have worked full-time for at least three years and be eligible for retirement. Others working for and with Us.
Further attention should also be given to determining the appropriate goals of chronic disease care in terms of independence or length of life, for example. More work is needed to define and measure outcomes. Another essential challenge is to figure out how to organize and pay for services in a way that will reward more conservative practice.
The current system of compensation for procedures performed rather than for actual health outcomes generates perverse incentives.
Working Longer: The Solution to the Retirement Income Challenge [Alicia H. Munnell, Steven A. Sass] on giuliettasprint.konfer.eu *FREE* shipping on qualifying offers. Daily headlines warn American workers that their retirement years may be far from golden. The main components of the retirement income system -Social.
Finally, better tools for prognosis and for encouraging communication between doctors and patients and their families are essential. This is true not just at end of life. End-of-life care and costs should be thought about from an earlier age, prior to crisis or any kind of impairment. The next question is who will provide the care for an aging population. The pool of informal nonprofessional caregivers in the United States is shrinking.
The population over age 65 is increasing, and the population of to year-olds—the potential caregivers—remains essentially flat. Looking at informal caregiving costs for various chronic diseases, the largest costs were for dementia, amounting to 29 percent of costs in When other aspects of brain ill health, such as depression and strokes, are added, this accounts for 54 percent of informal caregiving costs.
In informal settings, caring for someone with dementia can be literally a full-time job. Thus, brain health will be key in terms of the costs and hours involved in informal caregiving. In the formal sector, there are coming shortages in geriatricians and direct care workers. The United States currently has 7, geriatricians, and trends suggest that number will decline by , when projected need will rise to 30, geriatricians. Current shortages in direct care workers for home care services and nursing home care are also significant and expected to grow.
Background and Introduction
Considering the future supply of informal and formal care is important because it focuses attention on potential interventions to increase supply. It also highlights the importance of making the most of what is available, particularly improving the performance of geriatricians and other care providers in the gray areas of decision making regarding care for older patients.
Improved training, clearer guidelines, and different pay incentives could both improve outcomes and lower costs. There is also a great potential to coordinate the formal and informal care systems, especially through such technology as telemedicine and e-consultations. This would extend the caregiving network and could improve outcomes while decreasing costs.
Research is also now being conducted to understand the determinants of the well-being of informal caregivers and ways to intervene to maintain it. Supporting informal caregivers with new technologies could make them more effective and efficient.
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