Health Care Like It’s 1972?

Growing older with health care and support needs is a “people” issue; not a partisan one.

As the entitlement debate rages on and the health care system evolves, the bottom line remains that there needs to be more affordable and accessible options for all people who need long-term care. This is the kind of care that we are all likely to need at some point in our lives as we age; it will range in scope from everyday assistance such as getting groceries, to more comprehensive help in the form of assisted living or nursing home care. Those few who are fortunate enough not to face these kinds of needs personally are likely to need to care for a loved one at some point in their lives, such as a parent, grandparent, or spouse. As a country, we seem blind to these realities, even as the short window that we have to make a meaningful difference for the emerging older population is closing rapidly.

The fact is that roughly 70 percent of Americans over the age of 65 will need some form of long-term care, on average for three years. Yet most people, when asked, think they will never need this kind of care.

To make matters even worse, many individuals mistakenly believe that Medicare will pay for long-term services and supports even (it does not). The result is a public that is woefully underprepared and ill-equipped to prepare for what are probably inevitable health needs.

This gap in knowledge and awareness has contributed to our current “non-system” of financing long-term care, in which people are left to fend for themselves to pay for services or spend down to near poverty levels to qualify for Medicaid; for only then is public help available. This is neither a sustainable nor a dignified policy. We need to develop a better model that will ensure that all Americans can age with dignity, choice, and independence. But what would that look like?

As a physician, I believe we have perfected the health care delivery model for 1972 that focuses on acute care, and is not necessarily designed to meet the needs of individuals living for an extended period of time with multiple chronic conditions. What we need today and into the future is an updated toolbox for financing long-term care that serves the needs of a 2013 population. In 1965, the average life expectancy was 69 years old. If an older person experienced a major health event—a heart attack or stroke, for example—they might have recovered, but they probably did not live much longer beyond that event. Today, with advances in medicine and technology and the increased number of intensive care units and critical care units, people are living longer than ever before, but with functional impairments and multiple chronic conditions. The delivery model we have today is not designed to meet these growing care needs, and the financial strains on individuals and families are significant.

In March The SCAN Foundation hosted a briefing at the National Press Club in Washington, D.C., at which a group of experts convened to present key highlights from a series of long-term care financing policy briefs that the foundation commissioned. The briefs present the current long-term care financing landscape, while looking ahead to possible solutions for creating a sustainable system of care that can meet the needs of an aging America. One thing most of the experts agree upon is that long-term care is an insurable risk, just like home or life insurance. With this in mind, the timing for the release of this series could not be more critical. The creation of a new federal Commission on Long-Term Care, on which I am honored to serve, offers an important opportunity to explore pragmatic solutions to this issue but our window for action is short. We have about five years to develop some form of product, whether through public or private solutions, or a combination of both, that will be available to working Americans so that they have enough time to participate, save, and create a large enough insurance pool to be able to manage the kinds of risks people will face over time. It will take about this amount of time to build the product, get it out there, and give folks the time to pay into it—whatever “it” is.

Our challenge is to get out of the 1972 mindset and create a system of care for the present and beyond that offers a range of financial options to protect individuals and families from having to spend all of their assets to pay for long-term care needs. By providing widely accessible and affordable options to families, we can enable individuals to take personal responsibility for planning for future care needs while ensuring that all Americans can age with dignity, choice, and independence.

Bruce Chernof, M.D., is president and CEO of The SCAN Foundation, an independent, non-profit public charity devoted to transforming health care for seniors in ways that encourage independence and preserve dignity. In February 2013, House Democratic leader Nancy Pelosi appointed Dr. Chernof, along with several others, to the bipartisan Commission on Long-Term Care, created earlier this year and responsible for developing a plan to establish, implement and finance a comprehensive set of long-term care services. This post originally appeared in Altarum Institute Health Policy Forum.

8 replies »

  1. People should be given more options these days and more coverage too. There are still some who think that government programs are more than enough to pay for their long term care expenses but the truth is, it will never be enough. There are some who do their homework by comparing long term care insurance quotes online in order to purchase affordable coverage. But what about those who can’t really afford a coverage? It’s the government’s responsibility to take care of its people, to provide them with the help they need and to serve them. For me, they should extended the coverage of the available federal programs now or they should come up with a new program that will greatly benefit people in need of custodial care and skilled care.

  2. Very good post. I too view the importance of stressing healthy living as well as access to preventative medicine as a cause our country should be deeply invested in.

  3. Germany provides long term care to virtually all those who need it, and no one spends down anything.

    This is because the Germans added a special tax for long term care to their social insurance program. I believe that the tax is about 1.75% of payroll.

    We could add a tax like this to Social Security tomorrow morning. The numbers will be large because this is a huge country, and because of the longer life expectancies noted above.

    Back in about 1980, Rep Claude Pepper was proposing something like this, but the insurance industry of America said that private coverage could handle this.

    Today less than 10% of seniors have any private coverage, and policies are lapsing every day due to rate increases.

    it is time to let social insurance solve the problem.

    Bob Hertz, The Health Care Crusade

  4. You’re right on when you say we need more affordable options for long term healthcare…and this is true for healthcare in general. It’d be awesome to actually see some real action on this.

  5. I disagree that requiring people to spend all their own assets before being eligible for Medicaid is undignified. Spending down lacks “dignity” only for middle class families that have assets to spend down. Why shouldn’t they spend their own assets as long as they have them? Why should they be able to protect their own assets to the detriment of poorer people who don’t have any assets? So that their children can inherit more of it? If middle class elders can protect their own assets from spending on their own care, how will we as a country pay for that?

  6. Healthy living has changed a lot compared to the past because of all the fast foods! Anyway, awesome share! Cheers 🙂

  7. I absolutely agree with your analysis! Healthcare needs to be updated to meet the demands of today’s patients. With the advent of the internet, social media, and mobile technology; the healthcare industry as a whole needs to take more advantage of these resources. My doctor certainly has tapped into these digital resources; interacting with his patients via Facebook, and Twitter as well as establishing an effective EMR system. The key is to use these platforms to enhance interaction between the patient and the physician.