In the past few months, important events and circumstances have highlighted the need for an effective, sustainable way to finance the often-astronomical costs of long-term care services and supports.
The growing political and financial pressures on Medicaid–the state/federal program that funds nearly half of all paid long-term care; the deepening problems in the private long-term care insurance market; and the demise of the CLASS Act–the failed attempt to create a national, voluntary long-term care insurance system– have all added urgency to what was already a problem that was growing with the aging baby boom population.
Now, a valuable new e-book describes the challenges of long-term care financing and suggests some potential solutions. “Universal Coverage of Long-Term Care in the United States: Can We Get There from Here?” (Russell Sage Foundation 2012), was edited by Douglas A. Wolf and Nancy Folbre and includes chapters by a broad range of highly-respected policy experts.
The books asks whether a universal long-term care financing system is possible and imagines what some models may look like. There is nothing Pollyanish about it–the book recognizes the political and financial difficulties of reaching this goal. But it suggests that it is possible.
Carol Levine puts financing reform in the context of family caregivers, who are the bedrock of the care system. Robyn Stone looks at the issue from the perspective of the paid workforce. Robert Hudson reviews the broad history of long-term care in the U.S. and I contributed a chapter on the rise and fall of the CLASS Act.
David Stevenson, Marc Cohen, Brian Burwell, and Eileen Tell look at the private insurance market in the U.S. David Bell and Alison Bowes, Svein Olav Daatland, and Mary Jo Gibson study the experiences of long-term care financing reforms in Europe and Japan,
Finally, Len Burman analyzes the economic effects of long-term care financing reform in the U.S.
As the title suggests, this book focuses on the idea of universal insurance. But many different models can rise from a foundation of universal (or near-universal) coverage. Just think about Medicare, where only Part A is truly universal, while Part B and the Part D drug benefit are not, though participation is extremely high. And Medicare includes traditional government insurance, supplemental coverage sold by private carriers, and, increasingly, privately-issued managed care.
There are just as many ways to insure against the risk of needing long-term care, either at home or in a facility. It is not hard to imagine some combination of private insurance, public coverage, and a safety net for the very poor. The Germans already have a system such as this, and it works pretty well for them.
There are many paths down this road. and each raises big questions: How much insurance should a universal system provide? Should it offer first-dollar benefits, or catastrophic coverage only? Will benefits be paid in cash, or through services? Can such a new system enhance care integration and thus potentially improve the quality of both health and long-term care for those with chronic disease? And, perhaps, most controversial of all, how will we pay for it–premiums, taxes, or some combination?
The volume can be downloaded for free from the foundation website. If you want to take a deep dive into the challenges of long-term care financing, it is worth a look.
[…] Howard Gleckman brings attention to a new book on Long Term Care, that can be downloaded for free. As readers know, LTC is a near and dear topic to this blog (a recent post), and I will look forward to integrating this book into my teaching. This recent post highlights lots of LTC issues. […]
It’s about time the government should think of ways on how to improve the long term care system. But this time I hope it’s not that ambitious like CLASS Act, which was abolished right even before it begins. The people behind this system should take their time reading the said book and incorporate what they’ve picked up with planning, structuring and implementing their new ltc financing. In my opinion, the responsibility shouldn’t be put solely to the government. People should do something on their own, research about a private ltc insurance, find ways to make the premiums more affordable and compare benefits. If you have the means and you really care about your future, there’s no need to wait for the government to provide a solution. Start on your own little way and the government will provide help in some way.