The Silent Killer That No One Likes To Talk About

It is the second leading cause of preventable deaths.  An estimated 300,000 people die annually from diseases related to this condition. Yet the issue lurks in the shadows because of unhealthy anguish about social stigma. By not shining a light on the subject, America is inviting a catastrophic health crisis.

Obesity is a health risk the nation can no longer ignore.  Obesity is linked to chronic medical conditions, including Type 2 diabetes, heart attack, stroke, kidney failure, nerve damage, gum diseases and some forms of cancer.  And there are a host of lesser disorders, such as sleep apnea.     

Statistics document that obesity is one of the most serious public health challenges of the 21st century:

• Data shows that 41.9% of adults are obese according to data from the Centers for Disease Control and Prevention (CDC).  In 1995, obesity affected 15.3% of adults.  Adult obesity rates have increased 37% since 2008.

• More than 80% of obese people develop Type 2 diabetes, according to research from the National Institutes of Health (NIH). Obesity related cardiovascular disease deaths tripled between 1999 and 2020, reports the American Heart Association. 

• The American Cancer Society data found excess body weight is responsible for about 7% of all cancer deaths in the country, including 11% in women and 5% in men.  

• The rate of childhood obesity is increasing at a faster rate than adult obesity. As of 2023, one in five children in the country is obese. Youth obesity rates have increased 42% since 2008. 

• A recent report by the Milken Institute estimates the annual medical and economic impact of obesity exceeds $1.3 trillion. The direct medical costs to treat obesity related diseases ranges from $147 billion to $260 billion annually, reports the CDC. 

Who is considered obese?  Answering that question would appear simple.  The process involves a calculation based on a person's weight in pounds, divided by the height in inches squared, multiplied by 703, to determine a Body Mass Index (BMI).  The number is adjusted for age and gender.  

For the average American, it sounds like voodoo medicine.  A study reported by the NIH found only 22% of obese women and 6.7% of obese men correctly classified themselves as obese. Complexity is the enemy of dealing with preventable health issues.

Improbably, the American Medical Association has been at the forefront of quashing honest discussions about obesity and its impact on health. A report in the AMA Journal of Ethics stated that focus on BMI and weight has "yielded few health benefits and contributed to weight related discrimination."

How can the country tackle obesity if the leading medical group hushes information about unhealthy weight gain?  Apparently, the medical profession prefers to treat obesity related diseases rather than target prevention. No wonder U.S. medical costs are soaring, reaching $4.5 trillion in 2022.

Another impediment is the country's obsession with race.  Since African-Americans are disproportionately impacted by obesity, many academics and medical groups blame systemic racism for the rise of obesity.  Even pointing out the statistics is considered racist.  What does that solve?

Lifestyle choices play a large role in obesity.  Unhealthy diets and Americans addiction to screen time --cell phones, computers, video games and television--contribute to sedentary lifestyles. Only 28% of adults and 22% of adolescents meet the CDC's physical activity guidelines.

Prevention can be as simple as a healthy diet and exercise, such as walking 20 minutes a few times a week.  But let's acknowledge that for some, hormones and genetics make some people predisposed to obesity or excessive weight gain.  Unhealthy stress can also be a contributing factor. 

But why eat healthy and exercise when a drug can do the heavy lifting? It's the American way, and pharmaceutical companies are eager to profit from the solution.  The Food and Drug Administration has approved two Type 2 diabetes drugs, administered with an epipen, for weight loss.  

Diabetes medications Mounjaro from Eli Lilly and Ozempic from Novo Nordisk are soon expected to be rebranded and marketed for weight loss. Currently, the drugs cost about $1,000 to $1,200 for a month's supply. No prices have been announced for the weight loss versions.

Today most insurance companies do not cover weight loss drugs.  A 2003 law prohibits Medicare from doing so.  However, given the size of the obesity cohort, expect growing political pressure for insurance companies to cover the drugs, which will raise the cost of health premiums for everyone.

The sensible solution is for the medical profession and public health organizations to launch campaigns to increase education about the causes of obesity, while describing its harmful effects.  The campaign should include information on unhealthy foods and the benefits of physical activity. 

Unfortunately, many medical organizations and health advocates want the government to step in and legislate health.  Zealots want Washington to pass laws mandating better food labeling, healthier fast food, organic vegetables while outlawing red meat.

Onerous federal edicts are not the answer.  Arresting obesity rates requires individuals and families to take responsibility for their health. Prevention starts in the home with healthy food and physical activity. That means arming Americans with facts, not silencing discussion of obesity.  

34 Trillion Reasons To Cut Federal Spending

Every hour the U.S. debt jumps $218 million. That's $5.2 billion each day.  Current total government debt stands at a staggering $34.228 trillion. As scary as those figures are, the debt is expected to skyrocket to $50 trillion by 2033, less than a decade away.

For perspective, the nation's debt was $5.67 trillion at the beginning of 2000.  In just over two decades, the current debt is nearly seven times higher.  Since 2018, Congress has shoveled on another $12.7 trillion to the debt mountain. 

Today there is no limit on how high the federal debt can rise.  Congress passed a bill in June of last year suspending the nation's debt limit through January 1, 2025.  It is the equivalent of handing a credit card for Congress to continue to rack up more debt without any restraints.   

The debt balloon is the result of Congress's insatiable appetite for spending more than the tax dollars the government collects. In the most recent fiscal year 2023, the federal government collected $4.44 trillion in taxes, but spent $6.13 trillion, creating a $1.7 trillion deficit hole. 

Deficits matter because the feds issue debt to fund the yawning canyon between revenues and spending.  Beginning with fiscal year 2020 through 2023, the government accumulated deficits totaling $9 trillion. Even drunken sailors are spendthrifts by comparison.   

Don't expect a baptism of fiscal responsibility to convert the current Congress. The Congressional Budget Office (CBO) forecasts a $1.6 trillion deficit by the end of fiscal year 2024 on September 30. Deficits are expected to top $2 trillion annually after 2031, reaching $2.6 trillion in 2034.

Revenues are not the problem.  Tax collections and fees rose 8% from 2022 to 2023.  Individual taxpayers forked over $2.18 trillion, accounting for 49% of the revenue collected by the feds. Fiscal accountability is a fleeting idea that has been drowned by a gusher of spending.

Paying for the debt created by deficit spending is getting more expensive.  Interest costs have nearly doubled the past three years from $345 billion in 2020 to $659 billion in 2023.  Interest is now the fourth largest spending category, behind only Social Security, Medicare and defense.

Those eye watering figures are projected to get worse.  Based on trends, the CBO forecasts that interest on federal debt will reach $1.4 trillion in fiscal year 2033, creating a budget nightmare.  This is fiscally unsustainable without Draconian tax increases or budget cuts or both.   

Balancing the budget, a feat performed by millions of American households, is apparently beyond the mental acuity of Congress.  Only twice in the last half-century has Congress found the political will to reach financial equilibrium--in 1969 and from 1998-2001 under President Bill Clinton,

Before even tackling a balanced budget, Congress must first reign in deficits.  Although it's easy to blame COVID spending for the spike in the size of deficits, Congress has been spending more than government revenues for the last 22 years.  Lawmakers have a spending dependency. 

Since 1997, senators and representatives of both parties have ignored the regular budget process of approving a budget that fully funds the government.  Congress seems to prefer chaos, failing to pass more than five of its 12 regular appropriation bills by the deadline in the last 26 years. 

In 11 of the past 13 fiscal years, lawmakers have not passed a single spending bill by October 1, which marks the beginning of a new federal budget year.  Instead, Congress employs a shell game, approving what's called continuing resolutions to partially fund the government over several months. 

Continuing resolutions maintain government funding at current levels, but often supplemental appropriations are shoehorned into a CR.  These stopgap gimmicks allow lawmakers to spend while obfuscating the full impact on deficits. This lack of transparency would not be tolerated in any business.

For all the brouhaha over CR's, these appropriation measures only cover discretionary spending. The hefty money is federal outlays for Social Security, Medicare, Medicaid, unemployment compensation and other entitlement programs. Funding is mandated by statues.  

These programs accounted for $4.6 trillion in spending in 2023, about 73% of the federal budget. Unless Congress tackles mandatory appropriations, spending will reach the stratosphere.  Lawmakers of both parties are deathly afraid of the political blowback of even suggesting a reduction in programs. 

Representatives and Senators are easily spooked.  Mention "government shutdown," defaulting on the national debt," or "reducing food stamps" and lawmakers capitulate. They prefer political theatre and gamesmanship to tackling the unpalatable but essential choices to restore fiscal integrity. 

What will it take to restore financial sanity?  Most likely an economic meltdown.  Short of a financial Armageddon, the solution is for voters to quit electing the same people to Congress and expecting a different outcome.  If voters make balancing the budget their top priority, there is hope for change. 

Organized Theft Buffeting Retail Industry

An epidemic of theft, fraud and robberies are forcing the shuttering of retail stores across many cities.  Walmart is closing stores in Chicago and New York City. Target shut down nine stores in four cities, including Portland and Seattle. Big box chains are abandoning downtown San Francisco.  

A CVS Pharmacy, located in Washington, D.C., has been ransacked so many times by mobs of teenagers that the firm announced it is abandoning the store next month.  A spokesman said groups of as many 45 teenagers regularly clean out the store, leaving rows of empty shelves.  

The crime wave is a burgeoning threat to the $1.3 trillion retail industry, according to a report by the National Retail Federation (NRF). Longstanding risks such as robbery and in-store theft are not the only problems. The industry also has been battered by return fraud, gift card fraud and payment fraud.

Petty theft and shoplifting are overshadowed by the emergence of gangs of organized criminals operating in major cities.  Teams of thieves smash stolen cars into stores and haul away hundreds of goods.  The criminals resell the merchandise on the black market to make a profit.  

NRF research found 70% of retailers reported an increase in organized crime incidents over the last five years.  The data shows 38% of organized crime occurred in-store, while 45% transpires en route from the distribution center to the retailer's store. 

The survey of retailers found that 48% of stores reduced operating hours because of crime. Another 29.7% trimmed product selection and 28.1% reported closing specific store locations.  Scores of Mom and Pop stores have been the hardest hit by criminal activity.

"Retailers are seeing unprecedented levels of theft coupled with rampant crime in their stores, and the situation is only becoming more dire," said NRF, VP David Johnson. "Far beyond the financial impact of these crimes, the violence and concerns for employee and customer safety are our priority."

Leaders from the retail industry testified before a Congressional Committee in December, detailing the scope of the problem.  Increased violence involving theft is causing injury to employees and consumers, the death of some retail associates and a fear of working or shopping in high-crime locations, they said. 

The NRF is lobbying Congress to pass a Combating Organized Retail Crime Act, to crack down on organized retail crime.  The bipartisan legislation, if approved, would create an intra-agency group within Homeland Security to coordinate with other federal law enforcement agencies to rein in crime.

Financial losses are soaring for retailers. Retailers were hit with $112.1 billion in retail theft in 2022, the latest annual data available.   Shoplifting losses grew 19.4% over 2021. Retailers lost an additional $84.9 billion in fraudulent sales returns, which represent a mushrooming concern for the industry. 

In the absence of 2023 numbers, William Blair Investment Banking analyzed NRF data and estimated that retailers absorbed $142 billion in inventory shrinkage and theft losses, a jump of 25% from 2022. Shrinkage is a retail industry term for the difference between inventory and actual physical goods.  

Large organizations of professional shoplifters are taking advantage of soft-on-crime policies in big cities to steal store goods and resell the merchandise openly on the streets, sometimes not far from the scene of the crime. The lucrative nature of the theft is encouraging more individuals to turn to crime. 

In California, home to the largest increase in organized theft, the state passed a law that stipulates stealing merchandise worth $950 or less is a misdemeanor.  It often means that law enforcement likely won't bother to investigate and prosecutors will let offenders off, even if police arrest someone.

Transnational criminal organizations crossing the southern border are contributing to the rising tide of theft in both urban and rural areas, Texas Rep. August Pfluger told a Congressional hearing.  Lenient crime legislation, no cash bail laws, reduced police presence and weak-kneed district attorneys are all to blame for the explosion of retail theft.

Many legacy news outlets and social justice advocates blame retailers, accusing them of manipulating theft data to camouflage a decline in profits.  Since most retailers are regulated by the Securities & Exchange Commission, auditors would have ferreted out these irregularities. 

There are liberals in Congress, such as Alexandria Ocasio-Cortez, who has repeatedly claimed that the spike in retail theft is evidence that desperate families are shoplifting food because of rampant hunger. The data undermines her attempt to raise sympathy for thieves.

Retail industry statistics show that among the most stolen items are athletic clothes, mobile devices, denim, cosmetics, handbags, jackets, sneakers, mechanic tools, beauty aids, alcohol, candy, gum and energy drinks.  Hunger may be a real issue in New York, but these items won't feed a family. 

The real victims are consumers--you and me--who end up paying for the thievery.  Retailers losses are passed on to consumers in the form of higher prices.  Without a sea change, stores will be forced to hire more armed guards and lock up merchandise to protect inventory, souring the shopping experience.

It's time to quit coddling criminals and declare war on organized theft. Since 2022, nine states have passed laws to impose harsher penalties for organized retail crime.  Inexplicably, states hardest hit, such as California and New York as well as the District of Columbia, continue their ineffective approaches.

Communities need to demand more police presence, stronger prosecutors and tougher laws.  Hard working Americans should not have to pay for the criminal spree sweeping the retail industry.  

Top 12 Predictions For 2024

Stock in prognosticators plunged in 2023.  Almost no one forecast last year would be a boon for the stock market.  Wall Street experts predicted doom and gloom, including the likelihood of an economic recession.  Despite bank failures and accelerated interest rate hikes, bulls trampled market angst. 

Many forecasters might be in hibernation after last year's experience, especially those who suffer from Atelophobia (the fear of being wrong). Against the current backdrop of wars, political chaos and global disorder, it will be challenging for prognosticators to divine a vision in a world of dense fog.    

Your writer has many flaws but doesn't suffer from failure anxiety nor does he shy from predictions.  My confidence is bolstered by picking the S&P would increase 20% in 2023.  The index finished with a gain of 24%.  With 2023 gone and forgotten, here are the Top 12 forecasts for 2024:

1. The economy defied predictions of a recession last year, but the Gross Domestic Product (GDP) will grow a modest 1.9% for 2024.  Consumer spending was the driver for economic growth last year, however, signs point to a retreat.  Consumer debt is at a historic level of $1.3 trillion and credit card rates are near 20% APR.  After a robust 2023 and the usual Christmas splurge, consumer spending will taper off, but will not crater. Consumer spending accounts for about 70% of GDP.

2. The stock market rocketed higher in the final months of 2023, driven by the Magnificent Seven: Apple, Meta, Microsoft, Amazon, Nividia, Tesla and Alphabet while the rest of the stocks were stuck in limbo.  Adoption of generative Artificial Intelligence (AI)  juiced average gains of 100% for the seven as PE ratios reached the stratosphere. This year Wall Street will be looking closer at AI revenues not just shiny forecasts.  Overall, the seven and a few big tech stocks will outperform the overall market, but the growth will be pale in comparison to last year. Presidential elections are usually good for markets, but the three major indices will give back much of last year's supersized gains, finishing with mixed results.  The NASDAQ will eke out a single digit gain.    

3. The Federal Reserve will lower rates twice in 2024, with reductions in the second and fourth quarters, surprising Wall Street and roiling the markets. After teasing three rate reductions, beginning in the first quarter, the Fed turns cautious as stubborn inflation remains above the preferred target of 2% throughout the year.  The nation's fiscal deficit will nudge $1.9  trillion, worrying Fed governors enough to temper major reductions in interest rates. Each rate cut will be a tepid 25 basis points with more promised in 2025. There is one caveat: If the economy weakens in an election year, the Fed may bow to political pressure and vote to cut rates four times. 

4. Major union contracts will help stoke inflationary pressure. Unions won big increases at UPS, the Big Three automakers and Hollywood studios last year but a full-year of costs will hit corporate bottom lines this year, leading to price increases.  There are several big contracts to be negotiated this year, including at AT&T, Boeing, American Airlines flight attendants, postal workers and Anheuser-Busch.  Wage hikes and offsetting price increases are a major risk to inflation.    

5. Momentum in the job market wanes from 2022-2023 levels because the economy has fully absorbed the labor displacement caused by the pandemic. While some industries cannot find enough workers, other sectors are beginning to layoff employees in the face of softer demand and rising expenses. Job growth in December was driven by payroll gains in state and local governments and healthcare. The job quitting surge will gradually return to normal levels. As a result of these issues, unemployment will drift higher throughout the year, reaching 4.1% in the fourth quarter.

6. With housing affordability metrics already at a 40-year low, sales of residential property will flatline. More Americans will choose renting because home values in many markets continue to rise amid tight supply.  About 75% of Americans have mortgage rates locked in at 4% or lower, presenting another headwind for a rebound in the housing sector.  One optimistic scenario: Soft sales may actually lower home prices, triggering a fourth quarter uptick.

7. Geopolitical risks are increasingly creating global economic shudders.  Wars in Ukraine and the Middle East coupled with saber rattling by North Korea are a powder keg waiting to explode. The widening of conflict in the Middle East will disrupt shipping of goods, trigger supply chain bottlenecks and destabilize global oil supply.  An unintended incident may spark an increased military escalation. Meanwhile, Russia will make significant progress in its ongoing war against Ukraine, dashing hopes for a peace agreement.

8 Local TV stations, supported by the National Association of Broadcasters,  will increase lobbying of the Federal Communications Commission (FCC) to regulate streaming services as the agency does cable companies.  With cord cutting showing no signs of abating, there is an urgency to the effort. Streaming services currently have agreements with the major networks for carriage, but local TV outlets claim the deals are too low to support their operations. Streaming services are fighting back with their own powerhouse lobbying effort, which will quash the regulatory push. 

9.  Investments in data hubs skyrockets as global business demand soars for online content, cloud services and artificial intelligence.    Data centers are already experiencing a once-in-a-generation growth making it financially attractive to add more capacity.  Unless capacity increases, the rapid development of generative AI applications will be adversely effected. The big cloud companies--Amazon, Microsoft and Google--cannot expand fast enough to handle skyrocketing demand. 

10. China resorts to using political upheaval in Taiwan to bring the island nation closer to Beijing's rule, much as it did in Hong Kong.  The Communist regime will continue its hostile military provocations around Taiwan to spook democratic independence. Chairman Xi Jinping has vowed to bring Taiwan under Communist control. With the Chinese economy melting down, the leader needs a distraction to rally his country. There is no better time to act than 2024 with the U.S. military occupied with the Middle East.  

11. Small and regional banks with significant exposure to commercial real estate will be under increasing pressure, fueling a handful of bailouts.  With $550 billion of maturing commercial real estate debt this year, losses are forecast to mount for lenders and investors. Commercial real estate faces other turbulence, including the highest vacancy rate since 1979.  The national vacancy rate hit 19.6% in the fourth quarter.  Since the pandemic, remote work has become so ingrained at many companies which will hollow out office buildings.    

12.  There is at least a fifty-fifty chance that neither President Joe Biden nor former President Donald Trump will be on the general election ballot in November.  Biden's age, historically low poll numbers and his erosion with the Democratic Party base will prompt the donor class to back an alternative.  The most likely scenario: the president will bow out at the Democratic Party National Convention.  Trump and his Mount Everest of legal problems will deal a fatal blow to his candidacy.  The Department of Justice is determined to jail Trump by mid-year and major GOP donors are lining up to support Nikki Haley.  Predicting a winner in November is impossible without knowing the nominees. Republicans take back the Senate but lose the House by a handful of seats.

Persons Of The Year: U.S. Border Patrol Agents

That publication fossil--Time Magazine--selected singer Taylor Swift as its Person of the Year.  The pop diva narrowly beat out stuffy King Charles III and Barbie, a plastic doll.  Apparently, there is a dearth of humans who met the magazine's news-maker criteria. 

How hard can it be to select the person who shook up the world's news? In 1938, the magazine chose Germany's Adolf Hitler.  In view of the conceited editors' shallow standards, it's surprising Time overlooked the Hamas leader in Gaza Yahya Sinwar, who dominated worldwide news.  

Since Time bungled its selection, the Diatribe is offering a nominee that few appreciate. 

The top news makers arguably are the 16,878 Border Patrol Agents stationed along the 1,954-mile border between Mexico and the United States. These courageous men and women are on the frontlines of an ongoing war with Mexico's human and drug smuggling cartels.

Their bravery and service is ignored by most Americans who consume news from The Washington Post, New York Times, Associated Press, ABC, NBC and CBS News.  Cartels use social media to peddle fentanyl, so these disinformation platforms are blind to the role of border agents. 

The agents are the last line of defense against criminal syndicates that rake in billions of dollars annually by controlling the tide of drugs and migrants flowing from Mexico into the U.S. Their jobs are made harder by a lack of resources, technology, manpower and support from Homeland Security.

This year in particular has been the most challenging in the 20-year history of the U.S. Customers and Border Protection. Agents were swamped by 2.4 illegal immigrants who crossed the southern border from Mexico.  September saw the highest number of crossings, an 86% increase from June of this year.

Encounters, a sanitized word used by the government, increased 4% over 2022, but it represents a 40% hike since fiscal year 2021.  The numbers are staggering: 7.5 million encounters since January, 2021, at the southwest border.  The data does not include 1.7 million getaways.  

Just this year, agents arrested 35,433 immigrants with criminal convictions, 598 known gang members, including 178 were members of the notorious MS-13 gang, risking their lives to catch these law breakers.  Agents also apprehended 169 illegal immigrants on the terror watch list. 

Agents and their partners in Air and Marine Operations seized 27,293 pounds of deadly fentanyl that was smuggled across the southwest border.  That's enough fentanyl to kill more than 6 billion people. A total of 73,654 Americans died of fentanyl overdoses in 2022, according to the most recent data.

Fentanyl wasn't the only dangerous drug exported into the country. Agents seized a total of 241,000 pounds of illicit drugs this fiscal year.  In a drug bust in Temecula, California, Border Patrol agents stopped a gray sedan, driving suspiciously.

When the agents inspected the cedar, they discovered 62 bundles of the blue fentanyl pills concealed inside its door panels and seats. The pills weighed 81.4 pounds with an estimated street value of $3.6 million. Often, seizures follow dangerous high-speed car chases as the drug mules flee from agents.

Agents are in harm's way every day on the job.  In two separate instances, Customs and Border Protection agents were shot at by cartel members on the Mexican side of the border.  In May agents tended to a four-year old child dropped from a border barrier by smugglers.  

As agents rushed to aid the injured boy, cartel members opened fire on the agents.  Fire and rescue first-responders on the scene were forced to take cover.  An Air and Marine Operations helicopter came to the rescue, providing cover for the agents transport the boy to the helicopter.

In another incident, agents patrolling the San Isidro Mountains at nightfall came under heavy fire.  Remote surveillance camera operators captured video of an individual, armed with a rifle.  The shooter was firing from the Mexico side of the border.

One border agent was killed in 2023.  Since January 2021, 43 Customs and Border Protection agents have died in the line of duty, according to Homeland Security.  Likely, this may be the first time you are reading about this tragic death toll.   

The media cabal only covers the border patrol if there is an activist group accusing an agent of abuse. The deaths of agents apparently don't warrant a mention on the national news.  Perhaps, it's because Homeland Security Secretary Alejandro Mayorkas keeps assuring Americans the border is secure.

The unprecedented flood of drugs and immigrants is overwhelming the agents, who protect Americans.   They are the unsung heroes of 2023. The women and men of the Border Patrol deserve to be recognized as the Persons of the Year, despite the lack of news coverage. 

Warehousing America's Elderly

More than 1.4 million Americans reside in nursing homes. A few go voluntarily.  Most are placed in facilities by spouses or family members no longer able to provide around the clock assistance, despite their heroic dedication.  Costs are steep, the quality of care varies and abuse can be a problem.  

There are more than 15,500 Medicare and Medicaid-certified nursing homes nationwide. The Centers for Disease Control and Prevention estimates there are 1.7 million beds in licensed nursing homes.  The majority are small facilities with 61 beds are fewer.  About 70% are for-profit operations.

Typically, nursing homes provide assistance with daily living, including preparing meals, bathing, dressing and assisting residents to the toilet, managing medications and feeding residents. Skilled nursing is often available on site.  

Costs are an added stress for families.  A 2021 study by Genworth Financial, the most recent data available, found the average nationwide cost of care in a private room at a nursing home costs $108,405 annually, versus $94,000 for a semi-private room.  Costs vary by state but prices are towering. 

An estimated 80% of aged adults lack the financial resources to pay for two years of nursing care, reports a study by the National Council on Aging. The data shatters the myth that most seniors, especially Baby Boomers, have the financial resources to pay for nursing care.    

Only 12.6% of seniors have long-term care insurance to cover the cost. Medicare pays for the first 20 days at a skilled nursing facility. Many seniors are forced to sell their homes, cash in insurance policies, drain savings and bank accounts.  Often the money runs out while they are in the nursing home.  

A report by the National Center for Health Statistics documented that 83% of nursing home residents are 65 or older.  However, 38% are 85 or older and 26% are between the ages of 75 and 84.  Nearly one-half (49.1%) have Alzheimers or another form of dementia. 

About 818,000 Americans reside in assisted living facilities, which offer less care than nursing homes because patients are usually mobile and able to perform general hygiene.  About 18% of assisted living facilities have a dementia unit and 11% serve only patients with dementia or Alzheimers.  

Research published by the National Institutes of Health (NIH) found patients in long-term care settings are at high risk for abuse and neglect.  Physical abuse may include hitting, slapping, pushing or striking patients with objects, according to the research. Incidents of theft too often occur at a facilities.

Oversight of facilities is spotty at best.  The Centers for Medicare and Medical Services (CMS) is tasked with broad oversight. State regulators, licenses and inspects skilled nursing homes. Significant  violations of standards, may result in a state rescinding a facility's license.

Statistics are a sterile view of the nursing home industry.  Your reporter has seen first-hand the level of care at facilities where family members were housed.  These observations are admittedly unscientific, but most have been collaborated by others with loved ones in nursing homes.

A heartbreaking issue for patients being warehoused: About 7 in 10 receive no visitors. Ever. These poor souls are lonely, frail and virtually shackled to their beds.  They stare vacantly at a small television.  It is an existence in name only.  

It is gut-wrenching to watch patients waiting to be fed, their heads slumped down on tables.  Staff is too busy with other patients, which means some residents wait an hour or more for a meal.  Even those who can feed themselves, are not served in a timely manner in the dining area.  

The meals may include the minimum daily calories and dietary proteins but at the expense of appetizing food. Patient complaints about meals are disregarded as the ramblings of a grumpy old people. If staff were forced to eat the same meals, it would make a difference in quality and variety.

Patient rooms, even the private ones, are spartan and void of color. Wafer thin mattresses on the beds and lumpy pillows are standard. Some patients have televisions, but in many facilities the TVs are provided by the family.  The smell wafting from some rooms testifies to the lack of constant cleaning.

These conditions exist, despite dedicated, trained staff. Facilities are nearly always understaffed.  COVID dealt a devastating blow to nursing homes, killing more than 200,000 residents and staff, according to the Kaiser Family Foundation. 

Isolation protocols forced staff to work excessive long hours, which caused burnout, triggering a worker exodus at many facilities.  As of the fourth quarter of 2022, the annual turnover rate at a nursing home was 53%. One-quarter of facilities reported turnover rates greater than 64%. 

Industry experts estimates there is a shortage of 200,000 nurses at long term care facilities. Recruiting firms forecast it may take five years or longer to reach pre-2020 staff levels.  The workforce problem must be addressed to improve care at nursing facilities.

Another issue is economic.  Although Medicaid pays for most patients' care, the government program reimburses facilities only 86% of the costs for a patient.  Nearly half of nursing homes are losing money, according to the American Health Care Association (AHCA).

As a result, the number of nursing homes is dwindling. An estimated 300 closed in 2020 and a combined 400 went out of business from 2021 to 2022.  This year already 135 facilities shuttered their doors.  These statistics were culled from reports by the Centers for Medicare and Medicaid.   

Understaffing and economics aren't the only problems. With so many aged adults unable to afford more than two years of nursing care, Medicare and Medicaid are ill equipped to provide the safety net for the elderly. Both programs face financial shortfalls and prospects are dim for a short term fix. 

Nothing short of an overhaul of the nursing home model is required for America to meet the needs of a population living longer.  By 2030 more than 73 million Baby Boomers will be 65 or older. In 2035, the number of Americans 65 and older will outnumber those 18 years old and younger. 

Congress can help, but often Washington's heavy hand leads to regulations that add costs and disincentivize the adoption of technology and innovation. Throwing money at a problem without a coordinated plan leads to wasteful spending, fraud and misapplication of funds. See COVID spending. 

This issue requires an all hands of deck approach.

Solutions must involve the long term care industry, state governments, Medicare, Medicaid, nursing schools and organizations that represent seniors.  The technology industry has a role to play also. One solution to the staffing shortage is to use wearable devices to monitor patients. 

Alarm bells are sounding. Urgent action is required to prevent long term care from erupting into a national crisis. Up to now, the siren call is being ignored, putting in peril millions of elderly Americans.   

Unimaginable Savagery of Hamas Terrorists

Hamas terrorists unleashed a barbaric attack on Israel, murdering 1,300 ordinary civilians, including 30 Americans.  The sheer scale of the horror shocked most of the civilized world. Babies decapitated. Elderly gunned down in their beds. Families burned alive in their houses. Women raped and kidnapped. 

Young concert goers were senselessly slaughtered after killers floated from the skies on paragliders.  Two Holocaust survivors were shot in cold blood. Terrorists on motorcycles sprayed cars with bullets and then kidnapped the occupants.  More than 4,500 Hamas rockets exploded in a quiet residential area.

For perspective, the massacre of 1,300 people in Israel is the equivalent to more than 35,000 civilians casualties in the U.S. That's ten, 9/11 attacks.  After 9/11, Americans united in support of military action against the terrorists. The same national resolve is fueling Israel's strategic preparations for war.   

Unlike past Hamas incursions, this surprise invasion was meticulously planned and executed with military precision. Hamas killers breeched a virtually impenetrable concrete barrier separating Gaza and Israel. Some 1,500 heavily armed Hamas thugs invaded Israel, creating mass panic. That was their goal. 

Terrorists videotaped their heinous butchery and posted the images on social media.  The invaders also sent photos and videotapes to friends and families of victims. These sadistic killers are not "militants" or "soldiers" as portrayed by some media.  They are terrorists.  Period. 

News organizations self-censored the most gruesome images. Palestinian defenders and Hamas jihadists complained Jewish leaders were exaggerating the carnage.  An outraged Benjamin Netanyahu was compelled to release graphic photos and videos online to rebuke the deniers and propagandists.

The attack bears the fingerprints of Iran, although the State Department used parsed language to point out there was no "direct evidence" the Islamic Republic was involved.  Yet U.S. officials readily acknowledge that Iran is complicit in funding Hamas and providing it weapons and training. 

It strains credulity to suggest the Iran's ruling Islamic mullahs did not green light the attack. The Islamic Revolutionary Guard, the Islamic Republic's elite military arm, regularly trains state-sponsored terrorist groups, including Hamas and Hezbollah, according to intelligence sources.

Recent U.S. policy towards Iran has favored rapprochement and diplomacy in an effort to bring stability to the Middle East. The pursuit of peace is always preferable but Iran's malevolent words and its behavior make it clear the regime will never change under the current extremist leaders. 

The United States must course correct and implement every means possible to isolate Iran.  Deny the regime any funding.  Cut off its oil shipments, especially to China, the main buyers of Iran's crude. Launch a maximum campaign to pressure China to stop supporting the Iranian economy. 

Credit the Biden Administration for sending a flotilla of carriers and warships to the Mediterranean to deter a widening war against Israel. Hezbollah, which operates in Lebanon, is stepping up rocket attacks and shelling in the north of Israel.  Lebanon's military has missiles that can reach Tel Aviv. 

One of the first priorities must be the release of potentially 13 Americans held hostage in Gaza. Terrorists have threatened to murder hostages.  President Biden should announce America will hold Hamas responsible and will hunt down and kill any terrorist who harms a U.S. citizen.    

Even in these darkest of times, the ugly face of Antisemitism has been unmasked, both in the U.S. and abroad.  It is a reprehensible,  grim reminder of the Nazi's campaign to demonize Jews, paving the way for public acquiescence to the Holocaust.  Leaders must condemn those who applaud Hamas's attacks. 

Black Lives Matter chapters across America manufactured an image of a Hamas paraglider descending over Israel with the caption: "We stand with Palestine."  Not one corporate funder of BLM condemned the organization.  African-American leaders need to hold BLM accountable.

Four congresswomen criticized accusing the U.S.  of aiding and abetting "apartheid",while condemning Israel's response to Hamas violence.  Not one castigated Hamas for its inhuman brutality. The Hamas apologists are: Cori Bush, Ilhan Omar, Alexandria Ocascio-Cortez and Rashida Tlaib. 

College students at campuses across the country rallied behind Palestine, which amounts to veiled support for Hamas.  A student group at a Wisconsin college chanted, "Glory to the Murderers." Yes, their numbers were small, but college administrations were slow to denounce their actions.

Billionaire CEO Marc Rowan, a graduate of University of Pennsylvania's Wharton School of Business and a mega donor, demanded the college's leaders resign and rallied donors to shut their checkbooks. He was understandably upset after the UPenn president and provost failed to condemn the "hate filled" student protests at a Palestinian event. 

There were also demonstrations in many America cities, including in New York City, supporting Palestine and blaming Israel for the Hamas attacks. Simultaneous protests broke out in Atlanta, Chicao, Denver, San Diego, Washington, D.C. and other cities. 

New York City Mayor Eric Adams made a powerful speech declaring Israel had a right to defend itself after the unprovoked attacks and said "we are not right" with Pro-Palestinian protests celebrating Hamas  in the nation's largest city. He was a lone voice among mayors across the country.  

In Australia, a crowd of 1,000 rallied near the Sydney Opera House, screaming "Gas the Jews."  In London, thousands of pro-palestinian protestors congregated near the Israeli Embassy, chanting "Israel is a Terrorist State." 

There were scores of demonstrations supporting Israel too.  But inevitably counter demonstrators backing Palestine and decrying Israel showed up at some, spoiling for a confrontation.  Heightened police presence is visible in the U.S. and the world as tensions rise.  

The media, often sympathetic to Palestine, is wringing its hands over Israel's bombardment of Gaza. The media fail to inform Americans the majority of Palestinians support Hamas terrorists and its leaders.  Palestinians regard Hamas as freedom fighters trying to take back disputed territory in Israel. 

The United Nations, a body known for its disdain for Israel, is already trying to head off an Israeli military response to attacks on its soil. Hamas is counting on worldwide condemnation of Israel so it can continue to stockpile weapons for an increasing number of bloody attacks.  

Hamas will resort to its playbook of using human shields once the ground war begins. Weapons, munitions and terrorists will relocated to hospitals, schools and residences.  Hamas wants civilian casualties. They have no regard for human life.  Innocents will be sacrificed in the name of jihad. 

The United States cannot bow to outside pressure.  Leaders must allow Israel to punish the perpetrators, just as the U.S. did after 9/11.  There can be no security for Israel until it roots out terrorists, who have traumatized its citizens for decades by killing Jewish civilians.