Not "too old": Presidential candidates help transform aged, old argument

Ness White wrote this article for Viet Tide (published Dec. 18, 2015) with support from the Journalists in Aging Fellows Program, a project of The Gerontological Society of America and New America Media, supported by the Silver Century Foundation. It has since been updated and edited accordingly, last posted on the New America Media website on Jan. 5 as "Too Old to Be President? Ageism a Political Undercurrent in U.S."


ORLANDO, Fla.-- Ageist comments have been made against three leading 2016 presidential contenders so far -- both of whom are older than what is considered to be the middle-aged bracket.

Former Secretary of State Hillary Clinton, 68, a Democrat, has been called “too old to run” for president, in the mainstream media. And political independent U. S. Sen. Bernie Sanders, 74, of Vermont, has been called an “unlikely white-haired rock star.”  

While Republican frontrunner, and business mogul Donald Trump, 69, has mostly managed to avoid questions based on his age to date, largely because he is so controversial, he has not completely escaped the negative perception of him based on his age.

Trevor Noah on The Daily Show (Jan. 5) mocked his New Year’s Eve appearance on Fox stating, “Donald Trump is the human embodiment of Times Square: Their both old, loud, flashy and full of garbage.” Why “old”?

Negativity Persist

How Americans view aging was brought up throughout the five-day 68th Annual Scientific Meeting of the Gerontological Society of America (GSA) in Orlando, Fla., in November. The event attracted over 4,000 researchers in aging from around the world.

During one press presentation, for example, The FrameWorks Institute shared a video of street interviews with people being asked to describe aging. For the most part, people highlighted the negative aspects of aging, focusing on illness and disability.

GSA’s opening keynote speaker, Ezekiel Emanuel, MD, brother of Democratic Chicago Mayor Rahm Emanuel, was key in shaping Obamacare policies. He had shared similar -- though perhaps extreme -- views about aging, particularly the end years. 

In October 2014, The Atlantic published his article, “Why I Hope to Die at 75,” in which he focused on some of the horrors of care at the end of life and the difficulties he expects might await him as he ages.

“Doubtless, death is a loss,” he wrote. “Living too long is also a loss. It renders many of us, if not disabled, then faltering and declining, a state that may not be worse than death but is nonetheless deprived. It robs us of our creativity and ability to contribute to work, society, the world.”

Emanuel went on in the article, “We are no longer remembered as vibrant and engaged but as feeble, ineffectual, even pathetic.”

Interestingly, his view might be challenged by the vast amounts of energy emitted by most of the leading presidential contenders during debates and on the campaign trail. More directly, however, various health journalists, experts and academics have criticized Emanuel’s stance, pointing to the larger issue of how Americans view aging.

A Different View

Even though Emanuel avoided mentioning his provocative ideas in his keynote speech, a panel of experts on aging zeroed in on his negative views of living beyond age 75 and how his ideas reflect U.S. culture, as well as ways in which to transform such narratives.

Author Wendy Lustbader, a lecturer at the University of Washington’s School of Social Work, said that some of the most important opportunities for growth occur when people are vulnerable, as they age. Further, she added, illness, frailty, disability and the approach of death can be “vehicles for change,” allowing people the opportunity to make sense of the past and make peace with their loved ones as they urgently desire to become complete.

Emmanuel’s article, Lustbader said, “[gave] us a catalogue of fear.” She countered his view by adding that the deprivation some people feel when aging can lead for some to creativity, which “brings up the needs of the soul.”

Jennifer Sasser, who chairs the Department of Human Sciences at Marylhurst University in Portland, Ore., said what Emanuel described in his piece could really apply to people of any age, as all people are subject to frailty and pain. 

“We need to shift consciousness,” said Sasser, who directs Maryhurst’s Gerontology Program. “This is about being a human being.” 

Expanding on the Positives

Members of the audience contributed their views, some alluding to a fear and anxiety around death that is pervasive in U.S. culture. One woman mentioned that in dictionaries, the word “geriatric” is defined in negative terms, suggesting nothing about health in older years. 

For example, the online Merriam Webster Dictionary defines “geriatrics” as “the process of growing old and the medical care of old people” and adds the metaphorical definition, “being old and outmoded (geriatric airplanes).”

Even though we might not be able to change those negative terms, Sasser added, we can expand on the positives of aging.

When it comes to the leading presidential candidates, none are showing signs of decline from old age. Despite what voters might think of their views, these candidates are challenging and maybe even changing some stereotypes about aging.
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California’s Motor Voter Program creates auto(matic) voter registration

This article originally appeared in the Viet Tide on Jan. 15, 2016. It was written by Ness white and has been updated, edited accordingly.

A new law that has taken effect in California this month could have interesting implications for this year’s local and state elections. It could even impact federal elections if similar or identical laws spread to other states.

The result of Gov. Jerry Brown’s signing of the California State Legislature’s Assembly Bill (A.B.)  1461 in October, the California New Motor Voter Program went into effect on Jan. 1 and is expected to be fully implemented in time for the state’s June primaries. In short, under the program people are automatically registered to vote when they visit the DMV to apply for, renew or change their address on their driver’s licenses. Prior to the law’s implementation, drivers had to opt-in to be registered to vote.

California is the second state to have implemented such a law, following Oregon, and advocates say it will help give more Californians easier access to the voting process. Critics, however, say the law will contribute to voter fraud as people who are not eligible to vote but are eligible to drive could easily slip into the state’s voter rolls.

For example, critics -- including organizations like the conservative-leaning True the Vote and liberal-leaning American Civil Liberties Union  -- have said that non-naturalized immigrants eligible to receive driver’s licenses in California could accidentally be automatically registered to vote, which they are not legally allowed to do. While AB 1461’s language reflects that the California Secretary of State’s Office and DMV will be collaborating to ensure that only people eligible to vote will be registered and state officials will be held responsible for anyone participating in illegal voting, critics do not believe the state has the capabilities to avoid making a mistake.

Additionally, critics believe that the Democratic-controlled state legislature and Democratic governor have pushed the law forward in efforts to further lessen the influence Republicans have in the state. As a result, some critics believe citizens will give up on voting because the process will be corrupted by an influx of ineligible voters.

“[AB 1461] will effectively change the form of governance in California from a Republic whose elected officials are determined by United States citizens and will guarantee that non-citizens will participate in all California elections going forward,” Election Integrity Project of California President Linda Paine has said.

Critics’ fears are not completely unfounded. During the summer of 2014, we reported on the changing political demographics of Orange County, Calif. -- a longtime Republican stronghold and home to largely immigrant communities. For example, in the Viet Tide's July 11 article, “Orange County stands on the cusp of social, political change,” we reported on the Republican Party losing its influence in the county as the ethnic minority population has been increasing in the OC. More specifically, we reported on the OC Vietnamese-American community’s support for Democratic policies lauded by President Barack Obama and Gov. Brown.

In contrast, advocates of the law -- like Democratic state lawmakers -- have said it will help more people have access to voting. It seems to be something of a counteraction against various Republican-backed voter-related laws throughout the country that Democrats have said restrict voter rights for millions of people, particularly racial, ethnic and language minorities, women, younger and elderly individuals, people who are considered disabled and people who have little to no income. These individuals are considered to have less time to register to vote and fewer locations available for them to do so.

“In a free society, the right to vote is fundamental,” California Secretary of State Alex Padilla has said. “Citizens should not be required to opt in to their fundamental right to vote.

“The New Motor Voter Act will make our democracy stronger by removing a key barrier to voting for millions of California citizens.”

When it comes to voters, it seems the law has support as a Public Policy Institute of California poll conducted last year shows two thirds of Californians surveyed were in favor of automatic voter registration at the DMV.

But what do readers feel, think and believe? Can California’s Motor Voter law increase voter turnout in a state the Pew Charitable Trust Elections Performance Index rated the third-lowest in electoral performance in 2014? Or is the law a setup to give non-citizens an opportunity to participate in the voting process?

Could it be both -- and how might that possibility change conversations about voting and immigration?

We, (some of) the people: Supreme Court case raises questions on electoral representation

This article was originally published in the Viet Tide on Jan. 1, 2016. It was written by Ness white and has been updated, edited accordingly.

Readers are probably aware that Republicans and Democrats have been historically and ideologically divided on a number of issues. What readers might not know is that a recently heard Supreme Court case could not only prove to keep that divide in tact, but it could pit the two parties more strongly against each other just in time for the scheduled 2022 mid-terms elections.

On Dec. 8, the U.S. Supreme Court heard arguments in the Evenwel vs. Abbott case regarding redistricting in Texas. Redistricting is done after the U.S. Census is taken every 10 years and is meant to ensure that local, state and federal voting districts are created for all Americans to be fairly represented as populations increase, decrease, shift and change. The plaintiffs -- Sue Evenwel and Edward Pfenninger -- are arguing that only registered voters should be considered when redistricting lines are redrawn, not the currently used total populations. They argue against the State of Texas that considering the total population when redrawing districts makes districts with large populations of non-voters more electorally powerful than districts with smaller populations of more eligible voters.

The case could impact urban cities, where Democrats tend to be localized, critics have said, as these areas tend to have higher populations of non-voters. If these districts were redrawn to reflect eligible voters rather than total population, could Republicans see some gains?

Who are the eligible voters? Are there ineligible ones?

Evenwel and Pfenninger argue that non-residents, undocumented immigrants and children are among those who should not be counted in redistricting tallies, as they are not eligible to vote. All others who are eligible to vote should be counted.

However, as media outlets have sporadically reported over the past few years, there are obstacles that can keep people from registering to vote -- which is required for anyone to become an eligible voter -- and obstacles that can keep people from remaining recognized as eligible voters. For example, registered voters in Indiana who are considered to be inactive are stripped from voter rolls; and in Tennessee, voters who have been deemed potential non-citizens by a database check are required to prove they are citizens in order to register to vote.

Obtaining the required documents for such proof can be costly, time-consuming and inconvenient --

similar to what critics have said about voter ID laws, which require voters to present state-issued, photo ID in order to vote. Several states, including Texas, have implemented such laws, which have been considered to disproportionately impact lower-income individuals who depend on public services and transportation -- namely people of color, language minorities, women, young people, the elderly and those considered disabled. These people also tend to be located collectively in larger, urban cities and vote Democrat.

Is the Evenwel vs. Abbott case currently awaiting decision in the Supreme Court an extension of the voter ID push that the Republican Party has been a part of since at least 2011? While Republicans -- including 2016 presidential candidates -- supporting the IDs have argued they decrease voter fraud, Democrats have argued they keep people who would otherwise be considered eligible from voting.

In other words, such laws could be considered to make certain voters ineligible -- therefore keeping them from being part of the eligible voter pool that would be counted if the plaintiffs in the Evenwel vs. Abbott case win.

But, do the plaintiffs have a case? Should marginalized groups of eligible voters have their voices silenced or not well heard because their representatives are working on behalf of a larger population that did not even vote for them?

The high court is not expected to decide the case for months, though the court of public opinion could begin ruling at any time.

Presidential presence: Are 2016 presidential candidates present?

This article originally appeared in the Viet Tide on Dec. 4, 2015. It was written by Ness white and has since been updated, edited accordingly.

It's become something of a catch phrase: being present.

Often the phrase is mentioned in spiritual circles that are focused on enlightenment, or even among people who are interested in health and wellness -- it usually means something along the lines of directing one's attention to whatever is happening in the moment. Rarely, if ever, is the phrase applied to conversations about politics and U.S. presidential candidates. Instead, mainstream news reports mention candidates' stage presence, pointing out which of them is commanding enough for voters to rally behind.

For example, Wisconsin Gov. Scott Walker and former Texas gov. Rick Perry, who have dropped out of the Republican presidential race with low poll numbers, were reported to have weaker stage presence when compared to former business mogul Donald Trump and former Hewlett-Packard CEO Carly Fiorina following the September presidential primary debate. Similarly, Democratic candidates U.S. Sen. Bernie Sanders and former secretary of state Hillary Clinton have both been credited with having tremendous stage presence and have experienced the gap closing between them in public opinion polls.

While having stage presence is considered a valuable resource, especially to voters, various writers and experts have revealed how invaluable being present is. For example, in a recent Huff Post blog, Karen Trepte, international businesses coach, wrote that being present has significant benefits -- among them is managing stress. After citing a few spiritual teachers, including Thich Nhat Hahn, she shared that it is wise to live in the present moment, as that is all we truly have.

"Getting carried away with thoughts of the past or the future only serves to stir up our emotions," Trepte shares. "Regardless of the nature of the emotion, thoughts like this remove us from the present moment and what is truly going on for us.

"When a negative emotion is triggered by them, these thoughts take us out of what is emotionally true for us in that moment, too.

Trepte's words might remind our readers of what we reported in a recent article, "A breath of fresh air? None of the presidential candidates are even close," where we explained that presidential candidates might not be relieving voters' stresses, but might instead be creating more stress for them by using fear-mongering tactics. When watching the presidential debates, our readers might notice that the candidates speak heavily about what they will do to tackle issues in the future and what they have done to solve problems in the past, usually mentioning the present moment only to discuss what is wrong with it -- again, something that will be fixed when they are elected … in the future

We have also made a connection between the importance of breathing -- particularly when it comes to easing stress -- and the fact that none of the mainstream presidential candidates discuss this necessary aspect of daily life on the campaign trail. It is interesting to note that Trepte relates being present with stress relief and breathing.

"So much of the time, especially when we are feeling stressed and overwhelmed, we are wracked with worry or thinking ahead, which can create emotions that feed the stress," Trepte says. "If we would only pause, take a breath, and look out the window, we'd see we were actually feeling fine before those thoughts rolled in."

Our readers who have watched the debates, or who might have interacted with the candidates firsthand, can answer for themselves whether they believe the candidates are fully present on stage or in person. Further, do the candidates' words take us out of the present moment?

It might behoove us to be present ourselves as we witness the candidates talk and gesticulate during debates, rallies and news interviews. Then, we might determine for ourselves which ones are present, on stage or not.

We might also have a better understanding of whose presence matches our own.

A breath of fresh air? None of the presidential candidates are even close

This article originally appeared in the Viet Tide on Nov. 20, 2015. It was written by Ness White and has since been updated accordingly.

Along the campaign trail over the past few months, some of the mainstream presidential candidates from either side of the aisle have been called a “breath of fresh air.” Let’s take a look at that word “breath” for a moment.

Recent mainstream news articles have looked at the importance of breathing in our everyday lives, particularly highlighting how we breathe. For example, a Yahoo health article published in November detailed how breathing is one of the most important things we can do, yet most of us do it wrong — when stressed we tend to breathe quickly and shallowly from our chest, which actually increases the stress, rather than taking slow breaths through our abdomens and calming ourselves down — and don’t focus much of our attention on it during our day-to-day activities. Another article published on AOL news takes a different approach on breathing, focusing more on the fact that people who work in stuffy office settings aren’t breathing enough oxygen and are therefore not able to use their brains to capacity.

What does any of this have to do with the presidential election? Well, if breathing — particularly the way we breathe in what has often been called a “high-stress” American culture — is as important as it is, why are none of the candidates talking about it? Shouldn’t such an important topic be a campaign platform? If breathing correctly can make such an impact in our lives, shouldn’t our candidates be helping us figure out how to do it? Are they even able to do it themselves?

And what about the candidates’ campaign staffs that help the candidates make critical decisions — like which platforms the candidates should focus on? Are they stuck in offices most of the day unable to get adequate air and thus not thinking as effectively as they could? And what about the stress the staffs and their candidates might be under during campaign season? Are the staffs and their candidates able to regulate their breathing as to remain calm and not perpetuate the stress they encounter?

Going even further than the candidates and their campaign staffs, what about the stress candidates cause among voters? A Truth Media article published earlier this month details how candidates tend to focus on issues that arouse fear and anger in voters. Studies have shown that fear can trigger the fight, flight or freeze stress responses that can have detrimental effects on our health if prolonged. These responses are characterized by quick and shallow breathing, among other effects. While fear is one of the triggers of stress, it is also considered one of the ingredients to get people to the voting booth where they will vote for the candidate who promises to alleviate their fears and, therefore, their stresses — helping voters to breathe a bit easier, we might say.

But after the voting is done, does our stress go away? Do the promises our candidates make actually come to fruition or do we still have the same fears — or more, worse ones — as before they took office?

During the upcoming presidential debates, let’s see if we can observe the candidates and how they’re breathing. Before talking, do they take quick, shallow breaths to respond to a question or do they appear to pause and become calm before responding? While responding, do they give themselves enough time to breathe in between words and phrases or are they talking too quickly for a breath to sneak by?

Further, let’s observe our own breaths as we listen to the candidates’ words. Are we becoming more stressed or are we calming down? Maybe this exercise can help give us a better idea about which candidate(s) can actually help us breathe a bit easier.

That is, if any of them can.

Abuse under health coverage plans amid upcoming high court decision

This article was originally published by the Viễn Đông on May 21, 2012. It was written by Vanessa White.

http://www.viendongdaily.com/nhung-vu-lam-dung-ke-hoach-bao-hiem-y-te-gay-ton-kem-cho-tieu-SP2TkqN7.html

WESTMINSTER, California—A patient might be given a year’s worth refill on medication and sent away, told it is unnecessary to return for another visit in a month.

The doctor, then, might go on a vacation.

Or, a doctor might have a sicker patient visit monthly, receiving more money than if the patient were healthy and visited less.

It all depends on the plan, Garden Grove’s Tran Pharmacy Pharmacist Thư-Hằng Trần told the Viễn Đông in a 12 May 2012 phone interview explaining some of the differences between increasingly pushed managed care health coverage plans and fee-for-service health coverage plans. Aside from having a doctor as a close family member, Pharmacist Trần said that her knowledge on health coverage plans was gained from her own research and experiences.

After a “very bad” accident that put her in the hospital ten years ago, she said, she had to wait for approval from her health maintenance organization (HMO) each time she needed to see a specialist for follow-up treatment. An HMO provides or arranges managed care health coverage plans.

Fortunately, she added, her HMO quickly approved the requests and referrals that her family doctor wrote. Though, not all patients are so fortunate, she continued, adding that there are times when HMOs will take too long to approve a referral or request, upon which she advises the patients to demand approval.

“For some patients, if you don’t fight you don’t get the service,” she said.

ACA, Managed care vs. fee-for-service

Under the Patient Protection and Affordable Care Act (ACA), awaiting a June or July 2012 U.S. Supreme Court decision on its constitutionality, Medicaid will expand coverage to uninsured Americans who will be required to have health insurance by 2014. Medi-Cal is California’s version of Medicaid, which covers lower-income families with children, seniors, foster children, pregnant women, and people with specific diseases including breast cancer and HIV/AIDS.

The Viễn Đông has learned that the upcoming court decision could extend managed care plans to more patients, as more states are reportedly moving towards these types of plans. Such managed care plans are private, with the state paying the private HMO a fixed monthly payment.

When doctors actually receive payment for their services, they get about $120-130 monthly, even if their patients do not visit the doctors, Pharmacist Trần told the Viễn Đông.

Pharmacist Trần said that she generally likes the idea of managed care plans because they can save the state money if a patient’s care is adequately managed. Though, she has a problem when the health care system is abused.

For example, Pharmacist Trần said that HMOs can take advantage of the system by denying certain patient referrals and requests for services or choosing the route that costs less, regardless of the patient’s need. For example, if a patient feels in need of a wheelchair, an HMO might approve a $500 manual wheelchair for the patient instead of a $5,000 electric powered wheelchair.

Pharmacist Trần added that under managed care plans, doctors also will sometimes withhold services from patients who really need them because the doctors will have to spend more time and energy providing the services, while feeling like they are losing out on money they might have made from fee-for-service payments. With fee-for-service health coverage plans, doctors are paid per service.

Under Medicaid fee-for-service health coverage plans, Pharmacist Trần continued, patients can abuse the system by claiming to need an earlier mentioned $5,000 electric powered wheelchair or other treatment and medication that stay at the patient’s home, unused.

Or, she added, a patient might go to one doctor that prescribes a medication or treatment the patient does not want, so the patient will go to a different doctor. That doctor might prescribe another medication the patient does not want and the cycle continues, all the while costing the state money.

Both programs have their weaknesses and strengths, Pharmacist Trần suggested, with managed care plans being good for helping patients decide what care they need and fee-for-service plans allowing the patients a different level of flexibility in choosing services.

There are problems, she said, when the systems are abused.

Electronic prescriptions not federally mandated, local pharmacist says

This article was originally published by the Viễn Đông on May 19, 2012. It was written by Vanessa White.

http://www.viendongdaily.com/phone/chinh-phu-hoa-ky-khong-bat-buoc-bac-si-ke-toa-thuoc-dien-tu-h8xYnS8I.html

WESTMINSTER, California—A newer form of prescribing medication has been touted as helping reduce errors and speed up delivery time, though the Viễn Đông has learned that the process might be slower.

E-prescribe is a system that allows doctors to “electronically send an accurate, error-free and understandable prescription directly to a pharmacy from the point-of-care,” according to the Centers for Medicare and Medicaid Services (CMS) website. Included in the 2003 federal Medicare Modernization Act, e-prescribing has become considerably popular and aligned with the government’s plans to make medical records electronic.

Garden Grove’s Tran Pharmacy Pharmacist Thư-Hằng Trần told the Viễn Đông in a May 12, 2012 phone interview that the e-prescribe process involves a doctor inputting prescriptions into a laptop instead of using a notepad.

To some extent, the e-prescribe system does reduce error, Pharmacist Trần said. For example, if done correctly, the pharmacy will receive the prescription right away and the patient can pick it up sooner than if the patient had brought in the prescription.

Also, if a doctor has poor handwriting, Pharmacist Trần added, electronically submitting the prescription can ensure that the pharmacist reads the prescription correctly and does not make a mistake with the order. Though, aside from ensuring patients receive their prescriptions in a timely and accurate manner, Medicare gives doctors bonuses for using e-prescribe.

Doctors who do not use e-prescribe, Pharmacist Trần continued, experience a 1-2 percent reduction in payments, even though the program is not federally mandated.

E-prescribe myths

Pharmacist Trần told the Viễn Đông that some doctors who use e-prescribe will tell their patients that they can only send prescriptions to certain pharmacies that accept e-prescribe.

A common trick, she said, is for doctors to say that the patient must pick up a prescription from one particular pharmacy and nowhere else. Though in reality, the doctor might have a wife or brother-in-law operating that pharmacy and the doctor is helping to benefit others in the business, she added.

Pharmacist Trần suggested to the Viễn Đông that she is not one of those pharmacists with connections, as some doctors do not send her prescriptions right away. When the patient shows up looking for their prescription and she has not yet received it, she said that she calls the doctors and they tell her that there must be a problem with her receiver.

Some doctors even tell their patients not to go to her pharmacy, she continued, adding that she shares with her patients that some doctors offer misleading information.

Another e-prescribe trick involves pharmacists who do not give their patients the entire prescriptions, she said. For example, if a patient is to pick up 10 medications, some pharmacists will give the patients eight or nine, because the pharmacists might be short on medication or even because they might want to keep it for themselves.

Though, one of the most upsetting tricks or  “lies,” Pharmacist Trần said, is for doctors to tell their patients that because they are using e-prescribe, the federal government has mandated that they cannot write out a prescription for the patient. Not only is it misleading the patient regarding their prescription, she added, but it leads to a dislike toward the federal government.

“Many doctors take advantage,” she said.

Fight for the prescription

Pharmacist Trần told the Viễn Đông that patients have the right to ask their doctors for hand-written prescriptions. In fact, they should do so before leaving the doctor’s office, even if the doctor uses e-prescribe, she added.

With a handwritten copy of their prescriptions, she continued, the patient will know if the pharmacist is withholding medication or if the doctor has failed to electronically send the prescription to the pharmacy.

Some patients will have to fight for their prescriptions, she said, adding that this has been the case with some of her patients and she feels sorry for them having to fight for their right.

Medicare does not mandate that doctors and pharmacists use e-prescribe, she reiterated.