HEALTH CARE/Joan Retsinas

The Vegetable in the Health Reform Pot

Bismarck was right: every law is a sausage, with programs thrown almost haphazardly into the pot. In legislation that proposes to expand health insurance to a major swathe of the population, while re-shaping the private insurance market, the nation has fixated on abortion, one small — if distracting — component.

But this legislation also contains CLASS (Community Living Assistance Services and Supports) — a sleeper. I liken it to the vegetable that savvy cooks throw into the pot: diners won’t know until they eat it what it is, but it’s good for them.

CLASS offers long-term care insurance.

In 1989, Congress repealed the just-passed Catastrophic Long Term Care benefit, before baby boomers recognized that their aging parents would eventually depend on them. Today’s “sandwich generation” now understands that only the lucky among us will die while jogging; for others — less fortunate — the trip across the Styx will be slow. We boomers may live longer than we expected, but near the end most of us will need help.

That help does not entail skilled medical care. Thanks to Medicare, we as a nation can finance whatever surgeries and wizardry aging Americans need. Medicare will pay for CT scans, for cataract surgeries, for hip replacements, for liver transplants, for bypass grafts.

Medicare will not pay for the $20-an-hour home health aide who bathes us, or the $150-a-day assisted living home where we move when we cannot maintain the two-floor Cape, or the $300-a-day nursing home where staff give us meals, medications, and help toileting.

Our current system of long-term care in this country revolves around poverty: theoretically a person who needs long-term care in an institution will pay from his assets/income, until s/he “spends down” to a government-set level of impoverishment. Then Medicaid will pick up the tab. Actually, families, recognizing that Grandma’s nest egg may one day be Grandson’s tuition, seek out lawyers to circumvent that “spend down.” Also, the financing favors institutions over home care (while some Medicaid money goes to home-based care, for it is far less).

We have a private-sector market of long-term care insurers, but their track record includes commission-fueled sales of expensive policies to people who cannot afford them, sharp increases in rates (to people who couldn’t afford the policies in the first place), delays in paying for benefits, and restrictive codicils that favor the companies over the policy-holders, who may easily die before claiming any benefits.

CLASS sets up a government vehicle for long-term care insurance. Briefly, with premiums set at $123 a month, enrollees would know that if they were disabled, they could draw on roughly $50 a day (determined by disability) to pay for help. Optimistic budget-crunchers estimate that the program would be solvent in 10 years, and represent a modest deficit in another 20 years. Pessimistic budget-crunchers (abetted by the long-term care insurance market) predict disaster: only the unhealthy will sign up, leaving an expensive pool that will soon deplete the funds, leaving taxpayers at risk. Of course, nobody knows whether enough young healthy Americans, recognizing that they will need to plan for their long term care, will opt to pay the relatively cheaper premiums for years and years, or whether the government-set benefit of $50 to $75 a day will prove so insubstantial that it doesn’t merit the effort. Indeed, nobody can predict whether CLASS will make it into the Senate version of the bill, or whether it will survive the legislative process.

What everybody knows, though, is that this challenge of paying for the care that most of us will need will grow more crucial as we espy our futures.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email retsinas@verizon.net.

From The Progressive Populist, December 15, 2009