LTC Bullet: Hillary
Clinton on LTC
Thursday, January 3, 2008
LTC Comment: Presidential candidate Senator Hillary Clinton has promised a cornucopia of LTC benefits if elected. Would our service delivery and financing system be better or worse if she delivered? After the ***news.*** [omitted]
LTC BULLET: CLINTON
LTC Comment: Hillary
Clinton announced her plans for long-term care public policy a few weeks
ago. Check out the press
release at: http://www.hillaryclinton.com/news/release/view/?id=4592.
Let's give due credit:
none of the other presidential candidates have committed
themselves to anything like such a detailed plan.
At least she's on the record, with lots of ideas, some of which
are very appealing.
First a synopsis from the press release; then our
HILLARY CLINTON’S LONG-TERM CARE AGENDA
Supporting Seniors With Long-term Care Needs, and
The Invisible Army of Caregivers that Support them:
Enacting a new $3000 Caregiving Tax Credit to provide financial
relief to millions of seniors, people with disabilities and their
families. Hillary will also invest more than $300 million per year to
support unpaid family caregivers.
more seniors the ability to access long-term care services where and
when they need them, including in their homes.
the elderly standard deduction to provide additional financial relief
for 11 million elderly tax filers.
Helping the Elderly Prepare for Long-term Care
Needs by Making Long-Term Care Insurance More Secure and Affordable:
tough new consumer protections for long-term care insurance, including
ending discrimination against veterans and helping states create
consumer advocates for long-term care insurance.
consumers the same secure long-term care insurance options that members
of Congress enjoy.
a new Long-Term Care Insurance Tax Credit to make secure, high-quality
insurance plans affordable.
Protecting our Seniors By Improving the Quality of
Our Nursing Homes:
federal support for nursing home ombudsmen programs to protect consumers
of long-term care.
the Department of Justice and the Federal Trade Commission to assist
state consumer advocates and prosecutors to tackle persistent abuses and
new challenges in the long-term care industry.
the inexcusable policy of the Centers for Medicare and Medicaid Services
(CMS) of withholding information on poor-performing nursing homes and
giving seniors full access to usable data on nursing homes, including
data on nursing home ownership structures.
our nursing and direct care workforce with a national system of
background checks for long-term care workers and $125 million investment
in Workforce Improvement Programs.
LTC Comment: Senator
Clinton's laundry list of LTC promises includes something for nearly
everyone: a tax credit for
caregivers; a tax credit for LTC insurance; new LTC insurance options;
tough new LTCi consumer protections; expanded home and community-based
care; tougher nursing home regulation.
Well, nothing in there for the much-maligned nursing homes, but
they're supposed to be the problem that schemes like this are intended
to fix. So, no surprise in
Here's the flaw in this and any similar grab bag of
uncoordinated proposals: they
do not derive from analysis of what caused the problems they seek to
fix. Consequently, they run
the risk of making the problems worse instead of better.
So, to evaluate the Senator's plan, let's begin by summarizing
why America has such a dysfunctional LTC system in the first place.
Then we'll be able to see if her proposals are compatible and
progressive or contradictory and self-defeating.
LTC is a mess in the U.S.A. because government made
nursing home care free in 1965 by paying for it through Medicaid and
Medicare. That's why the
public is in denial today about LTC risk and cost.
That's why the system has a nursing home bias.
That's why a private home and community-based services
infrastructure never developed. That's
why the long-term care insurance market remains stunted.
It's a big reason why Medicaid and Medicare costs have exploded.
And that's why state and federal budgets are too tight to fund
access to quality long-term care reliably through public programs.
Now, does anything in Senator Clinton's LTC plan
address this underlying dysfunction?
No. If anything, her
plan would exacerbate all of the underlying causes of the problems.
Medicaid-financed home and community-based care? That makes Medicaid LTC even more attractive than it already
is. It would increase
Medicaid estate planning and ruin the LTCi market unless combined with
strict eligibility controls which the Clinton plan lacks.
-- A $3,000 tax credit for caregivers? That also sends the wrong message: don't worry about long-term care. Not only will Medicaid pay for it, but you'll get a check from the government if you provide the care yourself. Furthermore, it's an open invitation to elder abuse. Find an elderly person to put in the basement and cut your taxes $3,000.
a tax credit for LTC insurance? Great
idea, but it won't help much if combined, as it is in Senator Clinton's
plan, with so many expensive new initiatives to make publicly financed
LTC more attractive and responsible LTC planning less necessary than
nursing home care by adding more regulations and enforcement? Dream on. The
problem with nursing home care is that it is underfunded by parsimonious
public programs, not that it is under-regulated.
Nursing homes are already as regulated as the nuclear industry.
It is tempting for politicians to throw a lot of
money and popular proposals at problems.
But too often, as in this case, their proposals treat the
symptoms of social problems instead of the causes.
That's why the unintended consequences of their well-intentioned
ideas often make the very problems worse they are trying to solve.
Then will come another set of politicians who propose more of the
same. After 40-odd years of
this we find ourselves in a quagmire of conflicting policies and funding
sources so complicated it takes serious analysis to unravel and correct.
But serious analysis is something no politician has the time or
inclination to attempt.
And what about the cost?
Five billion dollars per year!
For what? To add
more government interference in the LTC marketplace which is exactly
what caused the problems in the first place.
Just think what $5 billion could do left in the hands of
consumers if they had real incentives to prepare responsibly for
long-term care risk and cost.
On the other hand, there is no chance Senator
Clinton's proposals will come to pass, whether she becomes president or
not. Before long, the
fiscal tide will turn (it may be turning already); Social Security and
Medicare will shirk their unfunded liabilities by becoming means-tested
welfare programs like Medicaid; Medicaid will sink further into red ink;
public financing of long-term care will retrench if not disappear
altogether; the burgeoning boomer generation will tap their home equity
(if any remains) to pay for long-term care; their heirs will get the
message and start to buy LTC insurance; and the marketplace will work
things out in the long run.
What's so very sad, however, is that a lot of poor
people for whom we could have preserved a social safety net will be hurt
as this scenario unfolds. And
here's the irony. The very
politicians who claim to care most about the needy and underprivileged
are the same ones who propose the policies that do the most harm.
But that is no defense for the other political side which errs by
omission almost as seriously as their opposition seeks to do by
The next 20 years will tell the tale.