Ignoring Long Term Care

In print and screen advertisements, retirement is often portrayed as a time to start a second career, spend more time with the grandchildren, volunteer for a worthy cause, or travel around the world. Any health problems can be managed with prescription medications and moderate exercise.

Realistically, however, many Americans will ultimately need long-term care in a nursing home or in their own homes when they get older. Medicare, which in most cases does not cover long term care, predicts that 12 million elderly will need long term care by 2020, and HHS predicts that 40% of 65-year-olds will ultimately go into a nursing home for some period of time. Non-skilled long term care is often provided by family and friends, such as help with daily activities, while skilled long-term care often must be paid out of pocket.

With the recent demise of the CLASS Act, a section of health care reform designed to encourage Americans to purchase long-term care insurance, the issue of long term care has come to the forefront. The CLASS Act had fiscal flaws, with high monthly costs for insurance, but dropping it does not solve the problem of long-term care. In this economy, with many families struggling, few want to contemplate the stress and expense of caring for an ill spouse or relative. But ultimately, many of us will need to help out.

Kaiser Health News' Howard Gleckman suggests providing long-term care in the future through universal coverage or through insurance policy incentives. Whatever the solution, the current gaps promise to cause many problems for families as the large generation of Baby Boomers ages, along with the rest of us.

Can We Afford to Keep Our Promises?

On June 1, Congress will decide whether to cut Medicare reimbursements to health care providers. This time, providers are looking at - and fighting - a 21% cut. If the cut goes through, providers who accept Medicare patients will need to choose between getting by with less income (Medicare already reimburses at lower rates than private plans), or dropping Medicare patients.

Realistically, with the powerful American Medical Association and other organizations lobbying hard to block the cuts, Medicare reimbursements probably will not be cut right now. As an alternative, Congress might freeze the current reimbursement rates for five years.

Unfortunately, the drama of threats to cut Medicare and lobbying to restore these cuts has been going on for years in Washington, with three delays in the proposed cut this year alone. Medicare reimbursement rates are based on a much-criticized GDP-based formula. As Robert Lowes explains in a cogent Medscape article on the cuts:

Right now, reimbursement is determined by the so-called sustainable growth rate (SGR) formula, which sets an annual target for Medicare spending on physician services based partly on the growth of the gross domestic product. If actual spending tops the target, Medicare is supposed to decrease physician pay the next year to recoup the difference. Congress has called off annual SGR-triggered cuts going back to 2003, so the gap between actual and targeted spending on physician services has continued to grow, resulting in the 21.2% decrease for 2010.

Congress has been slow to revise this formula to reflect the true cost of providing health care to seniors because it would be expensive to do so.

At the same time, President Obama is spearheading an international health initiative to prevent or treat certain tropical diseases such as river blindness and hookworm, reports Sabin Vaccine Institute President Peter J. Hotez in a New York Times Op-Ed. These "neglected tropical diseases" torment over one billion people in the poorest nations, but they are rare in the developed world, and as a result there has been little financial incentive to eliminate them.

Treating and preventing these diseases is not just an act of altruism. Because these diseases affect children's physical and mental development, preventing the diseases makes it easier for the world's poorest citizens to stay healthy enough to gain an education and care for their families. As a result, the economic and political stability of many troubled regions improves, ultimately improving our own national security.

But can we really have it both ways: provide health care coverage for U.S. seniors and the disabled, and help improve health care for the poor in other countries, while our unemployment rate is 9.9% nationwide, raising taxes scares politicians, and about 80 million Baby Boomers are poised to retire and draw on their federal benefits? Have we promised more than we can deliver? And if we have, what will we change to make it right?