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By Sabrina Tavernise and Abby Goodnough

The New York Times

Jan. 30, 2020

WASHINGTON — Life expectancy increased for the first time in four years in 2018, the federal government said, raising hopes that a benchmark of the nation’s health may finally be stabilizing after a rare and troubling decline that was driven by a surge in drug overdoses.

Life expectancy is the most basic measure of the health of a society, and declines in developed countries are extremely unusual. But the United States experienced one from 2015 to 2017 as the opioid epidemic took its toll, worrying demographers who had not seen an outright decline since 1993, during the AIDS epidemic.  An uptick in what have become known as “deaths of despair” (younger people dying from overdoses, suicide and alcoholism) has drawn considerable attention from politicians and policymakers.

The 2018 data, released in a recent report, confirmed the first decline in drug deaths in 28 years, an important improvement after decades of rises.  The increase in life expectancy it helped produce was small, just over a month, and demographers cautioned that it was too early to tell if the country had turned the corner with opioid overdoses, which have claimed nearly 500,000 lives since the late 1990s.

“It’s good news, but we don’t know yet if it’s the beginning of a new trend,” said Elizabeth Arias, a demographer at the National Center for Health Statistics, which released the report.  Still, the rise was welcome news in states like Ohio, which in 2018 had the biggest decline in overdose deaths in the country.

The last time life expectancy in the United States flat-lined for several years was in the 1960s, when the mass habit of smoking, particularly among men, began showing up in the mortality statistics, said Dr. Samuel Preston, a demographer at the University of Pennsylvania. But from 1968 to 2010, life expectancy went up by an average of about two years a decade, he said, a substantially slower rate than in European countries, but twice as fast as the increase in 2018.  Life expectancy at birth rose to 78.7 years in 2018 from 78.6 the previous year. It peaked at 78.9 in 2014, but has fallen or been flat since then.

Dr. Preston pointed out that the small rise in 2018 merely put the country back where it was in 2010, amounting to nearly a decade of stagnation, rare for a wealthy country.  Improvements in cancer mortality rates represented the single largest share of the life expectancy gain in 2018, about 30 percent. Next came the decline in so-called unintentional injuries, which include deaths from car accidents and drug overdoses. That category accounted for about 25 percent of the gain, a change that was driven almost entirely by a decline in drug deaths, Dr. Arias said.

Recent widespread efforts to expand access to opioid addiction medications, clean needles and naloxone — the drug used to revive people overdosing on opioids — may be having an impact.  “Good things are happening that hadn’t before, like sheriffs, hospitals and others who now use naloxone telling me, ‘We saved a life,’” said Shane Hudson, president and chief executive of CKF Addiction Treatment in Salina, Kan. His clinic is treating 117 people with medication for opioid addiction, up from 35 two years ago.

Deaths from overdoses dropped by 4.1 percent in 2018, to 67,367 from 70,237 in 2017. The decrease was largely driven by a dip in deaths from prescription opioid painkillers, which set off the opioid epidemic in the late 1990s before heroin and, later, fentanyl moved in. Provisional data suggests those deaths continued to fall in 2019, likely in part because of restrictions on prescribing.

But the death rate from fentanyl rose by 10 percent in 2018, and early data suggests it kept rising last year, though not as sharply as before. There were more overdose deaths in 2018 than in any year on record except 2017, and nearly 70 percent involved opioids.

A separate federal report, also released Thursday, found that the rate of drug overdose deaths dropped in 14 states in 2018, climbed in five and stayed about the same in the rest. The five states whose rates climbed were California, Delaware, Missouri, New Jersey and South Carolina. Ohio saw the biggest drop, to 3,980 overdose deaths in 2018 from 5,111 in 2017.

Another bright spot in the data was cancer mortality. The overall cancer death rate dropped by 2.2 percent in 2018, a substantial decline. Rebecca Siegel, the scientific director of surveillance research at the American Cancer Society in Atlanta, said the new data appeared to extend gains from 2017, when the overall cancer mortality rate drop was the largest since record-keeping began around 1930.

These improvements were driven largely by a decline in the mortality rate for lung cancer, the leading cause of cancer death. Continued drops in the country’s smoking rate and advances in treatment, such as more precise tumor classification, better surgical techniques, and improved drug therapies, contributed to the progress, Ms. Siegel said.

Despite this good news, the United States lags far behind most European countries in life expectancy. John Haaga, a demographer who retired from the National Institute on Aging in December, said that when he first started his job in 2004, life expectancy in the United States was about equal to that of Portugal, a much poorer country. Over his career, Portugal gained four years while the United States gained only one. He pointed out that life expectancy was longer in Costa Rica, Cuba and Slovenia.

The increase in life expectancy might have been greater if not for rising mortality due to influenza and pneumonia — the death rate grew by 4.2 percent — as well as suicide and nutritional deficiencies. But while there has been increased concern about suicide as a public health crisis, the growth in reported cases — to 48,344 in 2018 from 47,173 in 2017 — was relatively small. The suicide rate grew by 1.4 percent overall, with a larger rise for men than women.

Jill Harkavy-Friedman, a vice president at the American Foundation for Suicide Prevention, said the nation needed to invest far more in research to understand emerging patterns. “I’ve been a researcher in this area for 30 years and I can tell you the conversation and the funding has definitely changed,” she said, “but it’s still nowhere near the level of funding for any other public health problem of this scope.”

A federal report last fall found that the suicide rate among adolescents was at its highest level in 20 years, although the total number of teenagers who died by suicide in 2017 was fewer than 2,500. Jane Pearson, chairwoman of the Suicide Research Consortium at the National Institute of Mental Health, said there was no definitive explanation as of yet for the climbing suicide rate.

By Alessandra Malito

Nov 2, 2019

Retirement can be about relaxing, but make sure your money is in the right accounts first. A year into retirement, 55% of Fidelity participants haven’t touched their accounts. 

Millions of workers contribute to a 401(k) plan so they can have more money when they retire — and then sometimes, when they get to that point in their lives, they don’t touch those accounts for another few years.

More than half of workers, 55% are choosing to leave their assets in their former employer’s 401(k) plan a year into retirement, according to Fidelity data on its workplace retirement accounts. Four years ago, that figure was 45%. They may be leaving their accounts in place because their 401(k) plans have low fees or they want to stay with the same administrators and managers of the plan (in this case, Fidelity and their former employers), said Dave Gray, head of workplace retirement offerings and platforms.

Some retirees may also not be sure what to do with that money, such as rolling it over into another account or consolidating all of their 401(k) plans.

As with most financial planning, the decision on whether to keep 401(k) assets in a former employer’s plan or roll it over into an individual retirement plan or other investment vehicle is a personal one. Participants must consider fees tacked on to any account they choose, as well as investment options available in those plans. Not all 401(k) plans have the same fund choices, which may make one more favorable for your needs than another.

People shouldn’t roll over an account or consolidate just to do so, but after reviewing costs and features, it might make sense, said Patrick Beagle, owner and president of WealthCrest Financial Services in Springfield, Va. “I see clients all the time who have several plans,” he said. “If they intend to work past 70, I strongly urge them to stay in a 401(k), and consolidate all the old into the new so they can defer distribution on the whole lot.”

Retirees should review alternatives, such as individual retirement accounts, which offer more investment choices than 401(k) plans do, said Glenn Downing, founder and principal of Cameron-Downing in Miami. “401(k) plans are great accumulation vehicles, but can be cumbersome for distributions,” he said. It’s important to analyze not just the number of funds available but the quality of those funds.

Some retirees may not touch their 401(k) plans because they don’t need the money yet. Wealthier clients avoid withdrawing from 401(k) plans until they’re 70½ years old, which is around the time they must withdraw required minimum distributions or face a penalty of 50% of whatever amount they were supposed to withdraw.

Before rolling over a 401(k) into another type of account, participants should ask themselves if they can replace the same fund choices (or quality of fund choices) for the same price, and if they think they’ll ever need to borrow money from their retirement assets for current expenses, advises George Papadopoulos, a financial adviser at the Fee-Only Planner in Novi, Mich. Retirees should review not only fees but features of the plan, including loans and how much someone can withdraw without penalty.

There are times when they should keep their assets parked in a 401(k), too, such as if they intend to leave the workforce between 55 and 59½ years old, said Matthew Fatz, a financial adviser at Thrive Wealth in Wayne, Pa. Under the Internal Revenue Service’s “Rule of 55,” employers who have been laid off, fired or otherwise left their job after 55 can take money out of their current 401(k) plan without incurring the 10% penalty others would face for withdrawing from an account before they’re 59½ years old. “If you know you’ll need to use your 401(k) or 403(b) for living expenses prior to 59½, you might consider leaving the assets in the plan even if fees are higher or investment options are less than ideal.”

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There are many variables to consider when deciding what to do with your 401(k) assets which is why Greg Says recommends consulting with a licensed certified financial planner (CFP).

Medical staff walks through a corridor inside Royal London Hospital.

Nearly a quarter of a million British patients have been waiting more than six months to receive planned medical treatment from the National Health Service, according to a recent report from the Royal College of Surgeons. More than 36,000 have been in treatment queues for nine months or more.  Long waits for care are endemic to government-run, single-payer systems like the NHS. Yet some U.S. lawmakers want to import that model from across the pond. That would be a massive blunder.

Consider how long it takes to get care at the emergency room in Britain. Government data show that hospitals in England only saw 84.2% of patients within four hours in February. That’s well below the country’s goal of treating 95% of patients within four hours – a target the NHS hasn’t hit since 2015. Now, instead of cutting wait times, the NHS is looking to scrap the goal.

Wait times for cancer treatment – where timeliness can be a matter of life and death – are also far too lengthy.  According to January NHS England data, almost 25% of cancer patients didn’t start treatment on time despite an urgent referral by their primary care doctor. That’s the worst performance since records began in 2009.  And keep in mind that “on time” for the NHS is already 62 days after referral.

Unsurprisingly, British cancer patients fare worse than those in the United States. Only 81% of breast cancer patients in the United Kingdom live at least five years after diagnosis, compared to 89% in the United States. Just 83% of patients in the United Kingdom live five years after a prostate cancer diagnosis, versus 97% here in America.

The NHS also routinely denies patients access to treatment. More than half of NHS Clinical Commissioning Groups, which plan and commission health services within their local regions, are rationing cataract surgery. They call it a procedure of “limited clinical value.”

It’s hard to see how a surgery that can prevent blindness is of limited clinical value. Delaying surgery can cause patients’ vision to worsen – and thus put them at risk of falls or being unable to conduct basic daily activities.

“It’s shocking that access to this life-changing surgery is being unnecessarily restricted,” said Helen Lee, a health policy manager at the Royal National Institute of Blind People.

Many Clinical Commissioning Groups are also rationing hip and knee replacements, glucose monitors for diabetes patients, and hernia surgery by placing the same “limited clinical value” label on them.

Patients face long wait times and rationing of care in part because the NHS can’t attract nearly enough medical professionals to meet demand. At the end of 2018, more than 39,000 nursing spots were unfilled. That’s a vacancy rate of more than 10%. Among medical staff, nearly 9,000 posts were unoccupied.

These shortages could explode in the years to come. In 2018, the Royal College of General Practitioners found that more than 750 practices could close within the next five years, largely because heavy workloads are pushing older doctors to retire early.

The NHS recently announced that, in a desperate attempt to shore up its doctor workforce, it would pay British general practitioners working abroad more than $24,000 in “relocation support” to come back to the country. The Service is also trying to encourage doctors to come out of retirement.  Great Britain’s health crisis is the inevitable outcome of a system where government edicts, not supply and demand, determine where scarce resources are allocated.

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We at ‘Greg Says’ share the concerns of many healthcare professionals that a “Medicare for All” approach to healthcare in the USA poses several risks borne out by the results experienced in Canada and Great Britain.

The Cleveland Clinic

Jan. 18, 2019

Have you resolved to slim down in 2019? Chances are you already know the health and beauty benefits of losing weight, but there is one more area that stands to gain when you lose: your brain. Losing belly fat, in particular, is linked to better brain health.

Researchers weigh-in: body shape and the brain

A recent research study of more than 5,000 adults age 60 and older showed that a large waist-to-hip ratio (“apple shape”) was more often aligned with poor scores on memory and thinking tests than was overall weight or body mass index.

Another group of researchers took a look at body mass index (BMI), waist-to-hip ratio and brain size of 9,600 people around the age of 55. By comparing brain scans (MRIs), they linked both high BMI and bigger belly size to smaller brain size.

What does belly fat have to do with your brain?

A big, bulging belly, or more affectionately called a “beer belly” or “spare tire”, is made of visceral fat. This troublesome fat develops from consuming too many calories and is located inside organs and between the organs of your stomach. It can produce harmful hormones and inflammation in the body leading to an increased risk of many health problems including heart disease, type 2 diabetes, high blood pressure, high cholesterol and possibly dementia.

While scientists continue to explore the belly-brain connection, it’s a good idea to keep your weight, blood sugar and heart-related medical conditions in check to support brain health.

How do you whittle your waist?

The good news is that visceral fat breaks down more easily than other fat, so it will most likely be the first to go when you start to lose weight. According to experts sit-ups alone won’t cut-it. Eating a healthy diet with reasonable portion sizes and getting regular exercise, especially cardio and strength training, is the best way to lose belly fat.

Nearly one-quarter of Americans say they never plan to retire, according to a poll that suggests a disconnection between individuals’ retirement plans and the realities of aging in the workforce.

Experts say illness, injury, layoffs and caregiving responsibilities often force older workers to leave their jobs sooner than they’d like. According to the poll from The Associated Press-NORC Center for Public Affairs Research, 23% of workers, including nearly 2 in 10 of those over 50, don’t expect to stop working. Roughly another quarter of Americans say they will continue working beyond their 65th birthday.

According to government data, about 1 person in 5 age 65 and older was working or actively looking for a job in June.  For many, money has a lot to do with the decision to keep working.

“The average retirement age that we see in the data has gone up a little bit, but it hasn’t gone up that much,” says Anqi Chen, assistant director of savings research at the Center for Retirement Research at Boston College. “So people have to live in retirement much longer, and they may not have enough assets to support themselves in retirement.”

When asked how financially comfortable they feel about retirement, 14% of Americans under the age of 50 and 29% over 50 say they feel extremely or very prepared, according to the poll. About another 4 in 10 older adults say they do feel somewhat prepared, while just about one-third feel unprepared. By comparison, 56% of younger adults say they don’t feel prepared for retirement.

Among those who are fully retired, 38% said they felt very or extremely prepared when they retired, while 25% said they felt not very or not at all prepared.

“One of the things about thinking about never retiring is that you didn’t save a whole lot of money,” says Ronni Bennett, 78, who was pushed out of her job as a New York City-based website editor at 63.

She searched for work in the immediate aftermath of her layoff, a process she describes as akin to “banging my head against a wall.” Finding Manhattan too expensive without a steady stream of income, she eventually moved to Portland, Maine. A few years later, she moved again, to Lake Oswego, Oregon.

“Sometimes I fantasize that if I win the lottery, I’d go back to New York,” says Bennett, who has a blog called Time Goes By that chronicles her experiences aging, relocating and, during the past two years, living with a pancreatic cancer diagnosis.

Meanwhile, Americans have mixed assessments of how the aging workforce affects workers: 39% think people staying in the workforce longer is mostly a good thing for American workers, while 29% think it’s more a bad thing and 30% say it makes no difference.  A somewhat higher share, 45%, thinks it has a positive effect on the U.S. economy.

Working Americans who are 50 and older think the trend is more positive than negative for their own careers — 42% to 15%. Those younger than 50 are about as likely to say it’s good for their careers as to say it’s bad. Just 6% of fully retired AP-NORC poll respondents said they left the labor market before turning 50.

But remaining in the workforce may be unrealistic for people dealing with unexpected illness or injuries. For them, high medical bills and a lack of savings loom large over day-to-day expenditures.

“People like me, who are average, everyday working people, can have something catastrophic happen, and we lose everything because of medical bills,” says Larry Zarzecki, a former Maryland police officer who stopped working in his 40s after developing a resting tremor in his right hand and a series of cognitive and physical symptoms he at times found difficult to articulate.

At 47, he was diagnosed with Parkinson’s disease. Now 57 and living in Baltimore, Zarzecki says he has learned “to take from Peter and give to Paul, per se, to help make ends meet.”

Zarzecki has since helped found Movement Disorder Education and Exercise, a nonprofit organization that offers support and treatment programs to those with similar diseases and certain traumatic brain injuries. He has also helped lobby state and national lawmakers to address rising prescription drug prices. He receives a pension and health insurance through the state, but he spends more than $3,000 each year out of pocket on medications.

“I can’t afford, nor will my insurance cover, the most modern medication there is for Parkinson’s,” he says. “Eat, heat or treat. These are decisions that people in my position have to make. When it’s cold out, or if it’s real hot out, do you eat, heat (your home) or treat (your ailment)?”