1. Mason, Diana J. PhD, RN, FAAN, AJN Editor-in-Chief

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On November 23, 1985, my brother David died in a terrible accident in his job as a welder. A seven-ton pair of tongs had fallen onto him because of inadequate support equipment. His body was left unrecognizable. At age 28, David left behind an unemployed wife and four children.


David loved his family deeply and worked hard to provide for them. Earning not much more than minimum wage, my brother worked overtime often to make ends meet, even when tired or sick (his employer provided no sick days and only one week of vacation a year). Social Security taxes were deducted monthly from his check. Given a choice, he most likely would have preferred to have those deductions available to help pay the bills. But Social Security saved his family from dire poverty, paying his wife a monthly survivor benefit for her and their four children.


In the debates over Social Security, almost no one is discussing what will happen to this important aspect of the program. Social Security is more than a retirement benefit designed to protect Americans from abject poverty in old age. One-third of Social Security payments go to participating workers who are fully disabled for a year or more and to the spouses and children of deceased workers who have paid into the fund. The Social Security Administration notes that one in six Americans will die before reaching retirement age, and 70% of Americans have no long-term disability insurance. On its Web site, the agency describes the program as "America's Family Protection Plan" (see


I suspect that many nurses are concerned about how President Bush's proposed privatization of Social Security will affect their own retirement benefits. Even that self-interest should be enough to get nurses involved, as Shirley Chater, nurse and United States commissioner of the Social Security Administration from 1993 to 1997, notes. Chater has been an advocate for women and has urged nurses to be part of the debate on the future of Social Security. She knows that women are vulnerable to changes in this pay-as-you-go system, in which today's workers pay for today's beneficiaries. Chater told me, "The president has said repeatedly that 'everything should be on the table.' It is our responsibility to understand what those 'everything' solutions are and how they affect women-wives, widows, and divorcees. We need to ask: What are the unintended consequences for children and the disabled?"


At the time of this writing, no bills have been put forth in Congress, but the House Ways and Means Subcommittee on Social Security is expected to review proposals for privatization sometime this year. Nurses know the impact a parent's death or disability can have on a family, and they can and should bring this knowledge to the deliberations on Social Security's future. Here are some questions I have about privatization:

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* Would the survivors' and disability benefit survive?


* If privatization had been in effect in 1985, would my brother's family have been limited to the funds he had contributed to his account when he died at age 28?


* What will happen to those permanently disabled when young? Will they be dependent upon the funds they have accumulated in their accounts?


* Since the proposed personal investment accounts would be subject to the idiosyncrasies of the market, what happens to beneficiaries if the stock market is down at the time of retirement, death, or disability?



Occasionally I receive letters from readers who chide me for writing about political matters "that have nothing to do with nursing." I'm a community health nurse who is concerned with prevention and knows that poverty undermines health. Public policy is one of the most important tools we have for promoting public health. For these reasons, I urge you to join me in discussing the future of Social Security and exploring viable solutions that will protect our most vulnerable citizens.