Tom Friedman Declares War

A bum rap for the elderly

Tom Friedman was his usual glib self in Sunday’s New York Times, arguing that the two political parties “would rather focus on winning the next election and blaming the other guy than making hard choices” about energy, climate, and the deficit. The metaphors he used made all this sound soooo scary. If we manage to avoid atmospheric and financial calamity until 2013, we’ll be able to address these problems “in our time, in our way, with minimum collateral damage. It will be like having a rotten tooth removed by a dentist using lots of Novocain. It will hurt a little, but we’ll easily recover.” But if the market or Mother Nature strike before then, oh my! It will be like having a rotten tooth removed by a caveman using stone tools. Who needs that?

When you get past the cutesy metaphors, you learn that Friedman thinks the president has been too timid and has not shown the courage of his convictions on energy, climate, and fiscal predicaments. Obama has opted for the inside game, letting Congress lead. “I fear this time he will not have the votes for the kind of serious, sensible, Simpson-Bowles-like budget cuts and tax increases we need—without his leading and enlisting the public in a much more aggressive way,” writes Friedman. That’s the same argument many other media opinion types are making in order to convince Obama to step up and promise to make Social Security cuts.

Friedman slapped the GOP because they have called for cuts in things we need to invest more in, such as education and infrastructure, “while leaving largely untouched things we need to reduce, like entitlements and defense spending.” The subtext seems to be that he wants to cut Social Security benefits, but instead he attacked the almost 1.7 million elderly in nursing homes—some of the frailest, neediest people in America. Friedman argues:

A country that invests more in its elderly than its youth, more in nursing homes than schools, will neither invent the future nor own it.

That stopped me cold. For one thing, the U.S. spends more on elementary and secondary education than it does on nursing homes. A spokesman for the Department of Education told me the amount spent on elementary and secondary education for the 2007-2008 school year was $495 billion; for nursing homes, national expenditures in 2008 totaled $138 billion, according to a document called “Health United States, 2010” from the CDC. That’s not even close.

Here’s a more important question the press and the public should ask: What will happen to the elderly if we reduce spending on nursing homes, as Friedman hints is necessary? About half the care is paid by Medicaid, which is jointly funded by the states and the feds. We have no national program to pay for nursing home care except requiring families to spend down to the poverty level—in other words, make themselves poor enough so a family member qualifies for Medicaid assistance.

Nursing home care across the country is also problematic. For decades press exposés have documented poor care. It never seems to improve. If Medicaid is cut or transformed into block grants, as Republicans have proposed, it’s fair to ask if care will get worse, and if family members will have to produce the cash to keep their loved ones in nursing facilities.

That brings up yet another related problem: Where will the children of tomorrow’s nursing home residents get the money to pay the nursing home bills? Imagine a jobless sixty-nine-year-old waiting for a full Social Security benefit at age seventy while digging into his pocket to pay for his ninety-two-year-old mother in a nursing home—plus a large share of his own medical expenses if Medicare morphs into a voucher plan.

And while we’re asking questions, still another comes up: What are seniors good for? One answer comes from Seattle Times reporter Michael Berens, who just won a $20,000 Nieman prize for his series “Seniors for Sale,” to which we awarded a laurel to last October. Berens documented how owners of adult homes exploited the elderly to make gobs of money while providing poor care.

Nearly fifty years ago, President John F. Kennedy sent a message to Congress, quoting the historian Arnold Toynbee: “A Society’s quality and durability can best be measured ‘by the respect and care given its elderly citizens.’” Tom Friedman seems to argue otherwise.

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Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR's healthcare desk, which is part of our United States Project on the coverage of politics and policy. She also blogs for Health News Review. Follow her on Twitter @Trudy_Lieberman. Tags: , , , , ,