Monday, May 23, 2022

 NEW YORK TIMES

‘I Had to Go Back’: Over 55, and Not Retired After All

After leaving the labor force in unusual numbers early in the pandemic, Americans approaching retirement age are back on the job at previous levels.

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Kim Williams, 62, lost her job early in the pandemic but has recently gone back to work. “I’m too young to retire, so I had to go back,” she said.Credit...Desiree Rios for The New York Times

By Ben Casselman

May 19, 2022

When Kim Williams and millions of other older Americans lost their jobs early in the coronavirus pandemic, economists wondered how many would ever work again — and how that loss would weigh on the economy for years to come.

Ms. Williams, now 62, wondered, too, especially when she struggled for months to find work. But in January, she started a new job at an AAA office near her home in Waterbury, Conn.

“I’m too young to retire, so I had to go back,” she said.

Whether by choice or financial necessity, millions of older Americans have made the same move in recent months. Nearly 64 percent of adults between the ages of 55 and 64 were working in April, essentially the same rate as in February 2020. That’s a more complete recovery than among most younger age groups.

The rapid rebound has surprised many economists, who thought that fear of the virus — which is far deadlier for older people — would contribute to a wave of early retirements, especially because many people’s savings had been fattened by years of market gains. But there is increasing evidence that the early-retirement narrative was overblown.

“The bottom line is that older workers have gone back to work,” said Alicia Munnell, director of the Center for Retirement Research at Boston College.

For many people, retiring early was never an option. Ms. Williams spent more than 25 years in manufacturing, working for a Hershey’s plant making Almond Joy and Mounds bars. The job paid reasonably well, and offered a retirement plan and other benefits. But in 2007, Hershey’s closed the factory, moving production partly to Mexico.

The State of Jobs in the United States

The U.S. economy has regained more than 90 percent of the 22 million jobs lost at the height of pandemic in the spring of 2020.

·   Higher Interest Rates: Spurred by red-hot inflation, the Federal Reserve has begun raising interest rates. What does that mean for the job market?

·   April Jobs ReportU.S. employers added 428,000 jobs and the unemployment rate remained steady at 3.6 percent ​​in the fourth month of 2022.

·   Trends: New government data showed record numbers of job openings and “quits” — a measurement of the amount of workers voluntarily leaving jobs — in March.

·   Job Market and Stocks: This year’s decline in stock prices follows a historical pattern: Hot labor markets and stocks often don’t mix well.

·   Unionization Efforts: Since the Great Recession, the college-educated have taken more frontline jobs at companies like Starbucks and Amazon. Now, they’re helping to unionize them.

Ms. Williams, then in her 40s, went back to school, earning an associate degree in hospitality and eventually finding a job as a supervisor at a local hotel. But the position paid significantly less than her factory job, and she drew down her retirement savings to cover medical expenses and other bills. When she was laid off again in June 2020, just a few weeks after her 60th birthday, Ms. Williams had little in savings.

Ms. Williams tried to change careers again, this time going back to school to train as a medical secretary. But she has been unable to find work in her new field. In January, with her savings gone, she took a job at AAA for $16.50 an hour, $2 an hour less than she earned at the factory in 2007, before accounting for inflation. She says she will have to work at least until she can start drawing her full Social Security benefits at age 67.

“If I could’ve left at 62, I would’ve left at 62, but I can’t,” she said. “Not all of us made that money where I could move down to Florida and get a $400,000 house.”

The fastest inflation in decades has added to the pressure on people of all ages to return to work. More recently, so has the turmoil in financial markets, which has taken a bite out of retirement savings.

But even some people who could retire are choosing to return to work as the pandemic ebbs.

When the Long Island fitness studio where she worked as a spinning instructor shut down early in the pandemic, Jackie Anscher lost both a job and a part of her identity. In an interview with The New York Times that summer, she described what seemed at the time like an abrupt end to her career as “a forced retirement.”

But after spending the beginning of the pandemic reorganizing her life and re-evaluating her priorities, Ms. Anscher, 60, has begun teaching spin classes again as a substitute instructor at a local gym, and she is looking for a more regular gig. Her husband is already retired — “he’s been waiting for me to go fishing,” she said — and the couple could afford for her to stop working. But she isn’t ready to hang up her cycling shoes.

“I liked what I had. I loved who I was in front of the room,” she said. “It’s about my mental health. For me, it’s about preserving me.”

Older workers weren’t any more likely than younger workers to leave the labor force early in the pandemic. But economists had reason to think they might be slower to return. Unemployed workers in their 50s and 60s typically have a harder time finding jobs than their younger counterparts, because of ageism and other factors. And unlike after the 2008-9 recession, when depressed housing prices and high debt levels left many people with little choice but to keep working, in this crisis prices of both homes and financial assets kept rising, providing a financial cushion to some people nearing retirement age.

The share of Americans reporting that they were retired did rise sharply in the spring of 2020. But retirement is not an irreversible decision. And research from the Federal Reserve Bank of Kansas City has found that at the pandemic’s onset, there was a steep drop in the number of people leaving retirement to return to work, attributable at least partly to fear of the virus and a lack of job opportunities, swelling the ranks of the retired.

 

As the economy has reopened and the public health situation has improved, these “unretirements” have rebounded and have recently returned roughly to their prepandemic rate, according to an analysis of government data by Nick Bunker of the Indeed Hiring Lab.

The return of older workers has been concentrated among those in their late 50s and early 60s, people who were still several years or more away from retirement when the pandemic began. The employment rate among those 65 and older fell more sharply and has been much slower to recover. That suggests that the pandemic might have led some people who were already closer to retirement to accelerate those plans, and that the greater health risks they faced may have made them less likely to return to work while the virus continues to circulate.

Still, the return of early retirees to the labor force is a reminder that rising wages and abundant job opportunities can draw in workers who might otherwise remain on the sidelines, Mr. Bunker said. The labor force shrank during the last recession, too, and some economists were quick to declare that workers were gone for good. But many people eventually came back during the strong job market that preceded the pandemic: It provided opportunities to people with disabilities and criminal records, to people with little formal education and to people who had taken time away from work to raise children or to care for ailing parents.

That pattern may be repeating itself, but on a much more compressed timeline.

“Don’t underestimate labor supply,” Mr. Bunker said. “Don’t count out the possibility that people want and need work. It has happened much more quickly than what we saw after the global financial crisis, but the broad principle is the same.”

When Tad Greener lost his job managing utilities for a Utah university in late 2019, he wasn’t worried at first about finding a new one — the unemployment rate, after all, was near a 50-year low. But Mr. Greener had hardly begun his search when the pandemic hit and the bottom fell out of the economy. Suddenly, he was 60 years old, unemployed and facing the worst labor market in nearly a century.

Mr. Greener eased up on his job search during the first phase of the pandemic, in part because of some health issues unrelated to the coronavirus. By spring of 2021, he was ready to work again, but he had little luck applying for jobs. He thinks many prospective employers were turned off by the combination of his age and his time out of the work force.

“It’s a daunting task to be 62 years old, to be unemployed for over a year and to try and find work,” Mr. Greener said. “There were times where I didn’t think I was ever going to be able to go back to work.”

As the economy reopened, however, many businesses struggled to hire enough workers to meet the surge in demand. That prompted employers to consider candidates they might otherwise have dismissed, or to look for ways to attract people who could work but weren’t looking.

In Mr. Greener’s case, he learned about a new “returnship” program from the State of Utah that was meant to help people who had been out of the labor force get back to work. Last fall, he was accepted into the program, landing a part-time job in the state Office of Energy Development, which quickly turned into a permanent, full-time job. Now that he is back at work, Mr. Greener says he plans to stay until he is 67, or perhaps longer if he stays healthy.

“Every day I hear about how there aren’t enough workers available,” Mr. Greener said. “There are a lot of older workers that are being written off, or at least finding it much more difficult to get back into the workplace, who have a lot of years and things to offer.”


 NEW YORK TIMES

She Was Told Surgery Would Cost About $1,300. Then the Bill Came: $229,000.

The Colorado Supreme Court ruled that Lisa French had never agreed to pay the full price when she signed service agreements with a hospital.

“I was glad not just for me, but for other people,” Lisa French said about her court victory. “I think most people don’t get, like I didn’t get, how insurance and hospitals work.”Credit...Helen H. Richardson/The Denver Post, via Associated Press

By Michael Levenson

May 21, 2022

When Lisa Melody French needed back surgery after a car accident, she went to a hospital near her home outside Denver, which reviewed her insurance information and told her she would be personally responsible for paying about $1,337.

But after the surgery, the hospital claimed that it had “misread” her insurance card and that she was, in fact, an out-of-network patient, court papers said. As a result, Centura Health, which operated the hospital, billed her $229,112.13. When she didn’t pay, Centura sued her.

“I was scared about it,” said Ms. French, 60, a clerk at a trucking company, who eventually filed for bankruptcy. “I didn’t understand because I kind of relied on the hospital and my insurance company to work out what I needed to pay.”

This week, after a yearslong legal battle, the Colorado Supreme Court ruled that Ms. French did not have to pay nearly $230,000 for the spinal fusion surgery she underwent at St. Anthony North Hospital in Westminster, Colo., in 2014.

It said she would have to pay only $766.74, apparently reflecting the remainder of her balance, as previously determined by a jury.

“I was very happy,” Ms. French said on Friday. “I was glad not just for me, but for other people. I think most people don’t get, like I didn’t get, how insurance and hospitals work.”

Centura Health did not immediately respond to requests for comment.

The unanimous ruling capped what Ms. French described as a stressful ordeal that began when her doctor referred her to St. Anthony North, telling her she needed back surgery or she could be paralyzed in a fall.

“Personally, it was really hard because I had never had surgery before,” she said. “I was already scared about that.”

Before her surgery, Ms. French signed two service agreements promising to pay “all charges of the hospital.”

 

Centura asserted that, because Ms. French was an out-of-network patient, those service agreements required her to pay the full rates, listed in a giant health system database known as a chargemaster — a catalog of the cost of every procedure and medical supply Centura provided.

In Centura’s view, the service agreements “were unambiguous and French’s agreement to pay ‘all charges’ ‘could only mean’ the predetermined rates set by Centura’s chargemaster,” the court said.

But the court found that Ms. French wasn’t responsible for paying those rates because she didn’t know the chargemaster even existed and hadn’t agreed to its terms.

The court said that the chargemaster wasn’t mentioned “even obliquely” in any of the service agreements or Patient Bill of Rights forms that Ms. French signed.

“Indeed, Centura representatives testified that the chargemaster was not provided to patients, and in this very litigation, Centura refused to produce its chargemaster to French, contending that it was proprietary and a trade secret,” Justice Richard L. Gabriel wrote.

Justice Gabriel pointed out that courts and commentators have noted that hospital chargemasters have become “increasingly arbitrary and, over time, have lost any direct connection to hospitals’ actual cost, reflecting, instead, inflated rates set to produce a targeted amount of profit for the hospitals after factoring in discounts negotiated with private and governmental insurers.”

Chargemasters, which are used by hospitals across the country, have long been a source of confusion for patients trying to decipher what they may pay for a given procedure, despite efforts to require more transparency.

“They have no basis in reality,” said Gerard F. Anderson, a professor of health policy and management and a professor of international health at Johns Hopkins University Bloomberg School of Public Health.

“The hospital cannot explain to anyone why they charge the prices they charge,” he said. “They are not based on costs. They are not based on accounting principles. They are fictitious instruments created by somebody in the hospitals.”

In 2019, the Trump administration ordered hospitals to begin listing prices for all their services, theoretically offering consumers greater clarity and choice and forcing health care providers into price competition.

But the data, posted online in spreadsheets for thousands of procedures, have often been incomprehensible and unusable by patients — a thicket of numbers and technical medical terms, displayed in formats that vary from hospital to hospital.

“Essentially, the patient has no ability to do comparison shopping for the majority of hospital services,” Professor Anderson said. “There are just too many moving parts. There are too many different services you would need.”

Ms. French called the chargemaster “a mystery” and said she had no idea she was agreeing to its rates when she signed the hospital’s service agreements.

“I'm just glad it’s over,” she said. “And I hope it benefits people who have gone though the same thing I have and might go through in the future.”


Saturday, May 7, 2022

 

8 Surprising Things That Can Raise Your Blood Pressure

It’s not just salt and stress — foods, drinks, drugs and other factors can affect your numbers

woman having her blood pressure checked

FATCAMERA / GETTY

En español

People who watch their blood pressure are generally familiar with the more common factors that can cause their numbers to spike — salt and stress, for example.

But a handful of unsuspected foods, habits and health issues can play a role, too, and sabotage well-intentioned efforts to lower high blood pressure, or hypertension, a condition that affects nearly half of U.S. adults.

Here are eight surprising things that can send your numbers soaring.

Why is High Blood Pressure Dangerous?

High blood pressure — also known as hypertension and called the “silent killer” because it often comes with no symptoms — can wreak havoc on the body, causing damage to the blood vessels, heart, brain, kidneys, eyes and more. If left undetected or uncontrolled it can lead to:

  • Heart attack
  • Stroke
  • Heart failure
  • Kidney disease
  • Vision loss
  • Sexual dysfunction
  • Angina
  • Peripheral artery disease

It’s estimated that nearly half of U.S. adults have high blood pressure; only about 1 in 4 adults with hypertension have it under control.

Source: American Heart Association, Centers for Disease Control and Prevention

1. Sleep apnea

Sleep apnea, a sleep disorder in which a person stops and restarts breathing several times throughout the night, can cause a bump in blood pressure. And it’s becoming increasingly common in the U.S. as more Americans struggle with being overweight, says Donald Lloyd-Jones, M.D., president of the American Heart Association and chair of the department of preventive medicine at Northwestern University Feinberg School of Medicine. Excess weight is one of the foremost risk factors for developing sleep apnea; age is another big one.

When a person with sleep apnea stops breathing, the brain steps in and wakes the body up to take a breath; this can happen up to 30 times an hour. “And when we don’t get good quality sleep — and particularly if we’re not getting good quality sleep because our airway gets closed and our brain and our body have to maintain enough awareness to try to open up the airway — that is very, very hard on the vascular system,” Lloyd-Jones says.

All the stress and strain drives up blood pressure — “and not just when we’re asleep, but also when we’re awake for the rest of the day,” Lloyd-Jones says. It can cause a whole host of other health issues, too, including an increased risk for heart attack, type 2 diabetes and liver problems. Researchers at Johns Hopkins Medicine found that severe sleep apnea in middle or old age can increase risk of premature death by up to 46 percent.

A common warning sign of sleep apnea is snoring, so if someone tells you that you snore loudly or gasp often during sleep, it may warrant a discussion with your health care provider. A number of devices and therapies can help to treat sleep apnea, and studies suggest that treatment with one of the more common options — a continuous positive airway pressure (CPAP) machine — may even improve blood pressure numbers.

2. Air pollution

Research reveals that exposure to both “fine particulate matter” air pollution (what you’d find from car exhaust and fuel burning, for example) and coarse particulate matter air pollution (like dust from roads and construction sites) can boost blood pressure in adults. The link has also been established in children.

One study led by researchers at the University of Michigan found that even short-term exposure to high levels of air pollution can impact the blood pressure of healthy adults. The change was typical of what a person might see if his weight increased by about 5 or 10 pounds, the researchers noted in a news release.

Another, also led by University of Michigan researchers, demonstrated that filtering the air can lower a person’s blood pressure, study coauthor and assistant professor of internal medicine J. Brian Byrd, M.D., told AARP. Exercise can also lower high blood pressure, even in places where pollution levels are high, a 2020 study found. In 2019, 99 percent of the global population lived in places where air quality did not meet World Health Organization guidelines.

In addition to the pollution from cars, traffic noise has been linked to an increased risk for high blood pressure.

3. Black licorice

No trick on this treat: Black licorice — we’re talking the real deal, not just licorice-flavored candy — can be a health hazard, and not just because of its sugar content. The candy contains the compound glycyrrhizin, derived from the licorice root, which can cause the body to hold on to lots of salt and water, thereby driving blood pressure up.

Consuming black licorice can also lead to low potassium levels and abnormal heart rhythms. In fact, the Food and Drug Administration (FDA) cautions against eating large amounts of black licorice at one time. Eating just 2 ounces a day for at least two weeks could land adults age 40 and older in the hospital, the agency says.

4. Alcohol

Although it’s often repeated that wine is good for the heart, alcohol can send blood pressure soaring, both in the short and long term. Lloyd-Jones explains that while alcohol initially relaxes the blood vessels, those vessels start to constrict once the liver metabolizes it. Blood pressure can remain at higher-than-normal levels the day after imbibing. And if drinking too much becomes a pattern, so will higher blood pressure numbers.

Heavy drinkers (more than three drinks a day for women, four for men) who cut back to moderate drinking (up to one drink a day for women, two for men) can lower the top number in their blood pressure reading by about 5.5 mm Hg (millimeters of mercury, a measurement for pressure) and their bottom number by about 4 mm Hg, according to the Mayo Clinic.


What is high blood pressure?

CategorySystolic Blood PressureDiastolic Blood Pressure
Normal <120 mm Hg <80 mm Hg
Elevated 120-129 mm Hg <80 mm Hg
Stage 1 Hypertension130-139 mm Hg80-89 mm Hg
Stage 2 Hypertension≥140 mm Hg ≥90 mm Hg

Source: CDC


5. Common medications

Headache? Joint pain? Be mindful what you reach for when you head to the medicine cabinet. Nonsteroidal anti-inflammatory drugs like ibuprofen (Advil) and naproxen (Aleve) can raise blood pressure. And so can regular use of acetaminophen (Tylenol), according to a new study published in Circulation, the journal of the American Heart Association.

“Any time people are using those types of medications for pain control, if they’re using them continuously, they need to get with their doctor,” Lloyd-Jones says.

Other over-the-counter products to be aware of: decongestants, which relieve stuffiness by narrowing blood vessels to reduce swelling in the nose. This can also raise blood pressure. “So you don’t want to use them consistently or routinely,” Lloyd-Jones says.

Even supplements like ginseng and ephedra are associated with increased blood pressure.

6. Added sugar

When we eat sugar, our bodies release insulin to help clear the sugar from the blood and get it into the cells where it can be used for energy.

“But insulin, itself, tends to drive up blood pressure in many people,” Lloyd-Jones says. “So if you’re eating a lot of added sugar or simple starches, you’re having these more intense and longer bursts of insulin, which will raise blood pressure.”

Added sugar is common in soft drinks, cakes and cookies. Some yogurts and breakfast cereals can also be high in added sugar.

7. Smoking

Yet another reason to kick the habit: Smoking, a proven risk factor for heart attack and stroke, can also mess with your blood pressure. According to the American Academy of Family Physicians, nicotine is to blame. It causes the blood vessels to narrow and the heart to beat faster, which makes your blood pressure get higher.

“If you look at the monitoring, it’s clear that the blood pressure [of smokers] over a 24-hour period is higher than non-smokers’,” Byrd says.

8. Another health condition

The overproduction of a hormone called aldosterone can cause high blood pressure and even make it difficult to control with medication. Byrd says people who haven’t had any luck lowering their high blood pressure with multiple medications should talk to their doctor because “there’s a reasonably good chance that they have a condition called primary aldosteronism.” The condition often is missed, Byrd says, but medications can treat it.

High blood pressure could also point to an issue with the kidneys or the thyroid gland. It can even signal low levels of potassium. Increasing the amount of potassium in your diet (fruits and vegetables are great sources) can lower blood pressure, Lloyd-Jones says.

Don’t forget about the usual suspects

It’s important not to overlook the biggest drivers of high blood pressure in the U.S., chief of which is weight. If you’re overweight, losing even a few pounds can have a big impact on blood pressure — you can reduce your numbers by 1 mm Hg for every 2.2 pounds you lose, according to the Mayo Clinic.

And don’t discount your diet. Americans consume, on average, about 3,400 milligrams (mg) of sodium each day, the majority coming from packaged foods and restaurant meals. That number should be closer to 1,500 mg, the American Heart Association says.

“There is too much sodium in our food supply, we are not getting enough physical activity, we are gaining too much weight, and we are drinking too much alcohol, and every single one of those things contributes to increasing blood pressure levels,” Lloyd-Jones says.

To stay on top of your blood pressure, take your measurements often and “understand where you are on the spectrum,” Lloyd-Jones says. You can do this at home with a cuff-style biceps monitor. If you notice your blood pressure is starting to increase or if it’s already elevated (a systolic, or top, number that’s less than 120 and a diastolic, bottom, number less than 80 is considered normal), it’s important to be careful around the foods and habits that can make it worse, Lloyd-Jones adds. It’s also important to work with a doctor to find the best way to control it, be it with medications, lifestyle changes or both.

“Home blood pressure monitoring is a really important and empowering way for patients to take control of this,” Lloyd-Jones says.

Rachel Nania writes about health care and health policy for AARP. Previously, she was a reporter and editor for WTOP Radio in Washington, D.C. A recipient of a Gracie Award and a regional Edward R. Murrow Award, she also participated in a dementia fellowship with the National Press Foundation.​

How to Lower Blood Pressure