Welcome to Our Wacky World

Life has a "Through the Looking Glass" quality to it these days, doesn't it? Not just because of the weirdest presidential election in modern history (one plausible scenario of which had vice-presidential candidates Joseph Lieberman and Richard Cheney emerging as president and vice-president, res-pectively). There are other particulars, both of general and specific interest to long-term care, that make one want to slap oneself awake, as if from a strange dream:

Item: Mike Stoil's "View on Washington" (p. 6) refers to a 50-50 split in the U.S. Senate-a Democratic achievement in playing catch-up, except that the Gore/Lieberman presidential ticket had to lose to make it happen. If they had won, Democrat Joseph Lieberman would have yielded his Senate seat presumably to a successor appointed by Connecticut's Republican governor, giving the Democrats a presidential administration but the Republicans a continued edge in the Senate. Continuing with the "good news, bad news" (and overall bizarre) theme, a 50-50 split in the Senate raises the prospect of key Senate committees being run by cochairmen. Not a pretty sight. Imagine this dialogue: Senator G.: "I want to hold hearings on that godawful nursing home industry." Senator B.: "I don't." Senator G.: "Oh yeah?" Senator B.: "Yeah. What're you going to do about it?" (Come to think about it, maybe that's not such a bad idea.)

Item: A high-level Medicare advisory commission suggests, as noted in Ronald Schwartz's "News Notes" (p. 8), that Medicare's RUGs just don't make sense as a tool for determining prospective payment. This will not come as a revelation to the skilled nursing field, but still, to have the Medicare Payment Advisory Committee (MedPAC) even hint at such heresy can only be encouraging. Don't get excited too soon, though; it could take years for the feds to come up with a new, more accurate (and, one hopes, more understandable) system. In the meantime, SNFs are stuck with what they've got. That means they have to behave as if RUGs made sense for the foreseeable future.

Item: Stephen Moses, president of the Center for Long-Term Care Financing, a private long-term care insurance think tank, issues a statement describing today's long-term care system as a "tragic mess," with "widespread bankruptcies, collapsed stocks, scant capital, scarce staffing, high costs, low government reimbursement, little private insurance, declining quality, expanding litigation, skyrocketing liability premiums, persistent institutional bias and a growing generation of overwhelmed family caregivers." I couldn't have put it better myself. But I can just hear the new Congress and President respond, "And your point is…?" Federal policymakers at all levels seem to have nary a clue about supporting long-term care, even as the baby boom clock continues to tick.

Offbeat Item: The hipsters, jokers and dead-on impressionists of Saturday Night Live and Comedy Central have emerged as serious political commenta-tors in their own right. Just check any TV morning show, where Katie Couric, Tim Russert, et al replay their skits endlessly along with the usual array of political talking heads. The situation got to the point recently that a Comedy Central producer felt compelled to beg his mainstream media colleagues to "please, stop legitimizing us!"

Sorry about that, bubba, but this is 21st century America. NH

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