For long-term care policy wonks-and that should include all of us, editors and readers alike-one of the more heartening events in recent years was the recent release of a white paper called Defining Common Ground: Long Term Care Financing Reform in 2001. It was released by an organization called the Citizens for Long Term Care. For a rundown of its blue-ribbon members, see Ron Schwartz's News Notes column, p. 12. Suffice it to say here, any team that includes the American Health Care Association and the Service Employees International Union in the same lineup deserves to be taken seriously. There's a lot to like about the report-and some disturbing things, too. I liked, for example, some of the simple, declarative sentences about what's wrong with today's long-term care. For example (taken from Chairman David Durenberger's introduction): "A Congressional commission is not a national dialogue...the Pepper Commission's 1990 recommendations were totally bipartisan and nothing happened." Or (taken from the Executive Summary): "...we have a patchwork of programs that vary from state to state and community to community.... This patchwork of efforts is inefficient, inequitable and often ineffective.... Recruitment and retention problems create an unstable work force and are a barrier to high-quality care...long term care financing reform should be initiated on existing structures."
So what's disturbing about the report? My problem was with the frequent reference to a need for a national dialogue. "Dialogue"-by my definition, the exchange of views with the expectation of influencing the discussion-hasn't really been our national style of late. Take the national healthcare debate over the past several years, for example: When we seriously begin to address such issues as social insurance, taxes and the role of the private sector, suddenly our public landscape seems to be occupied by political caricatures-bumbling bureaucrats, spendthrift politicians, greedy businessmen, selfish interest groups, true-blue Americans and socialists. Notably missing are compromisers, get-things-done types or anyone who is portrayed as anything other than simple-minded. Nor have we seen much in the way of strong leadership for when the "dialoguing" really gets rough.
I'm also a little concerned about the "critical role" the report assigns to employers in purveying information about long-term care insurance and, one would assume, in offering LTC insurance policies, as well. Current trends toward reducing employment-based health benefits lead one to wonder about their future-or the future of the "established American system of pooling risk," as the report puts it, as opposed to the nationwide risk pools that other countries rely upon for their national health systems. But, hey, I'm ready to dialogue. What about you? NH