Developing a Better Long-Term Care Policy: A Vision and Strategy for America’s Future
Sheila P. Burke, Judith Feder, and Paul N. Van de Water (eds.)
National Academy of Social Insurance
November 2005
Two Promising Approaches
Transforming long-term care ultimately requires fundamental reform of its financing and a substantial commitment of federal resources. Because the need for long-term care is a risk, not a certainty, it should be handled like other unpredictable and potentially catastrophic events-that is, through insurance. Private long-term care insurance, while growing, is affordable for only 10 percent to 20 percent of the elderly. To assure access to long-term care without making families face impoverishment, federal involvement is therefore essential. Expanded federal financing could take one of two forms:
* Universal Approach. One option, modeled on Social Security, would provide everyone access to a basic, limited long-term care benefit, supplemented by private insurance for the better-off and enhanced public protection for the low-income population.
* Means-Tested Approach. Another option would establish a national floor of income and asset protection that would reform or replace Medicaid’s coverage of long-term care. People could purchase private long-term care insurance to protect a larger amount of assets.
Other countries have demonstrated that either approach – or a hybrid of the two – can target benefits to those in greatest need, retain personal responsibility through cost-sharing, and control costs.
Our analysis gives us reason to believe that the public does indeed perceive government action as not only appropriate but necessary to address long-term care financing concerns.
Our analysis of international experience shows that other nations, with far larger proportions of elderly citizens than we have in the U.S. today, have adopted a variety of policies that more fairly balance personal or family responsibility and public support. Adopting similar policies is a challenge not to our abilities but to our political will.
However, as advocates for improving the financing of long-term care, we cannot simply sit back and wait.
* As researchers, we must continue to demonstrate the extent of unmet needs for long-term care, the financial costs of care, and the burdens of caring on caregivers.
* As advocates, we must frame the problem of long-term care financing in terms that resonate with the public, building on the increasing sensitivity to retirement security and equal treatment for people with disabilities.
* As analysts, we must refine and disseminate specific policy proposals, assess their costs and benefits, encourage debate among stakeholders, and build confidence that policy action is not only desirable but feasible.
* As activists, we must muster the evidence on problem, policy, and politics to convince political leaders that long-term care is the cause they ought to champion and to identify the political arenas where their cause can take hold.
The study panel recognizes that obtaining political and fiscal support for a humane, equitable, and effective long-term care system will be daunting. But inaction means deterioration in already inadequate financing and care. The nations’ governors have declared that states cannot continue to be the nation’s primary funder for long-term care. The aging of the baby boom generation will only intensify the already substantial pressure states face.
As policymakers grapple with the budgetary concerns, the long-term care needs of the nation’s elderly and disabled citizens must be recognized, and our society must not shrink from providing the resources that will be required.
http://www.nasi.org/usr_doc/Developing_a_Better_Long-Term_Care_Policy.pdf
Comment: It’s simple. Long-term care needs to be included in the single-payer package.
