HCR -- Long Term Care, Ticking Bomb

By John Ballard

Those of us watching the healthcare reform carnival reached the eye-rolling stage some time ago. It's hard to believe that so many otherwise intelligent people -- I'm thinking not only of elected representatives but members of their staffs as well -- are so obtuse as they go through the HCR kabuki theatre performance. When  it comes to crony capitalism, the military, prison and petroleum industrial complexes have nothing on the medical community. Nothing illustrates the point better than Medicaid, the polite word for American welfare system. 

My guess is that even now, half a decade into a national conversation about medical care, a majority of Americans still don't know the difference between Medicare and Medicaid. I'm putting up this post by way of doing my part in spreading the word -- the so-called Obamacare legislation actually did little to "bend the cost curve" for medical care in general and virtually nothing to address the biggest challenge of all -- how will the costs of long-term care be addressed. 

The CLASS Act portion of PPACA was pitiful enough but even that has been deemed unworkable. 

Now the Kaiser people have published yet another warning that we are headed for a train wreck. 

I haven't the patience to summarize the details here but readers are urged to please pay attention to what isn't happening. The first link below provides a good overview. 
Following that is a link to the Kaiser report.

?Medicaid And Long-Term Care: An Unsustainable Union 

This Kaiser Family Foundation brief about the nation�s ballooning spending on long-term care insurance is particularly pertinent in the aftermath of the administration�s decision to abandon the Affordable Care Act�s CLASS program. To be clear, CLASS was never designed as an alternative to comprehensive insurance � it offered only a modest benefit, but advocates hoped that the program could serve as a first step towards a more serious (and sustainable) government investment in long-term care....

?Medicaid and the Uninsured -- Medicaid�s Long-Term Care Users: Spending Patterns Across Institutional and Community-based Settings  (Thirty-plus pages, pdf)

• Medicaid long-term care users accounted for 6 percent of the Medicaid population in 2007, but nearly half of total Medicaid spending 


• Among those using long-term services and supports, the average annual spending per Medicaid beneficiary was $43,296 compared to just $3,694 for Medicaid beneficiaries who did not use long-term care services 


• One-third of elderly Medicaid beneficiaries used long-term services and supports, but they accounted for 87 percent of all Medicaid spending on the elderly 


• Sixteen percent of Medicaid beneficiaries with disabilities used long-term services and supports, but they accounted for fifty-eight percent of all Medicaid spending on people with disabilities 


• Dual eligibles accounted for over two-thirds of Medicaid enrollees who used longterm services and supports and a similar share of spending 


• A total of 404,400 children and 1.3 million adults under age 65 used long-term services and supports

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Take another look at that last bullet point. That's our poor people whose families cannot take care of their needs. I had no idea that the number of children needing long-term care was approaching half a million. 
They will not be in private settings.
They will not be in assisted living facilities.
They will not even be at home ( which would be much less expensive) because their families haven't the means to care for them and outside assistance caring for them at home is out of the question. 

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Not directly related but central to the core of the challenge we face as a nation, this comment by the Capitol Steps helps us laugh to keep from crying. Not just retirement plans but savings of all types are now being tapped as the unemployed population grows increasingly desparate to pay for everyday needs. 

Politicians prate about jobs, jobs, jobs... but there are not enough. The idea that jobs are related taxes is totally crazy. If that were the case the so-called "Bush Tax Cuts" would have by now produced a shortage of available candidates, not the other way around.
The reason there are too few jobs is that there is too little demand.
Demand for goods and services is not related to taxes.
Demand is related to how much money consumers and other businesses have to buy those goods and services. 

I heard Congressman Mica make the amazing assertion on Washington Journal this morning (talking about how stimulus spending is of little or no value) that no one wants to buy pieces of a bridge. He seemed oblivious to the fact that every dollar used to build a bridge is one more dollar priming a dry pump we call the economy. The workers being paid to build and paint a bridge, highway or whatever are not likely to put their wages in some dark corner for a rainy day. They will use them for stuff they need. it is stupidly short-sighted to argue that stimulus money goes nowhere after a project is completed. 

America is eating the seed corn and no one is paying attention.