Wait’ll They See the Price Tag!

It’s been a running joke in long-term care circles for many years how most Americans assume that Medicare covers nursing homes and other such services. Now we’ve had a fresh turn on the joke: This past Monday (July 21), the Commonwealth Fund and Modern Healthcare magazine released their Health Care Opinion Leaders Survey. One principal finding: nearly 80% of respondents favored adding to Medicare a premium-financed benefit to pay for long-term care. As a journalistic veteran of the national health insurance wars of the 1970s, when every healthcare interest group including private health insurers had a plan, and even as far-reaching plan as Senator Ted Kennedy’s shied away from long-term care—just too expensive—I was astonished at these 2008 findings. I thought it had become common knowledge by now, certainly among healthcare experts, that LTC is much too expensive a proposition to hang on to any one funding source. Ask any state Medicaid agency struggling to maintain LTC reimbursement rates as only a reasonably losing proposition, rather than a disastrous one, for nursing homes. Ask any would-be private LTC insurance policy purchaser who, suddenly waking up at age 65 and seeking such coverage, learns that it will cost several hundred dollars a month. There is simply no way for government or private insurers or citizens to carry the costs of LTC as individual entities themselves; there simply must be a blended sourcing of funds from all three entities. The trick, as we are certain to find out come the next session of Congress, is figuring out the proper blend. Apparently, though, we’re not even close to addressing that challenge. Americans—including Americans supposedly expert on healthcare issues—have yet to confront even the basic realities of the situation. It’s sort of like watching and waiting for a train wreck.