LTC Bullet:  PBS’s 6 LTC Tips Miss the Mark

Friday, November 8, 2013


LTC Comment:  What’s wrong with the conventional wisdom about how to resolve America’s long-term care crisis?  After the ***news.*** [omitted]


LTC Comment:  Millions watch the Public Broadcasting System’s NewsHour every night.  So when that show addresses long-term care it’s worth paying attention. 

You can read about and view videos from a forum, titled "Global and Regional Models for Long-Term Care: Can They Work Nationally?," that MacNeil/Lehrer Productions (the NewsHour’s parent company) and the SCAN Foundation sponsored on Monday.

But if you have better things to do, such as advising consumers on how to protect themselves from LTC risks and costs without depending on tottering government programs, let me save you some time.

Following are quick summaries of PBS’s “6 tips for averting America's looming long-term care crisis” followed by our critique of each.

PBS Tip #1:  “Keep it Local”  The Urban Institute’s Howard Gleckman says don’t seek a “single answer.”  Rather work from the bottom up with friends, neighbors and families taking the lead.  “To the degree that we can, government can at least try to stay out of the way of those solutions . . ..”

LTC Comment:  Hear, hear!  Finally something from this writer with which I can agree.  But true to form, he reverts to form a few sentences later, advocating more and bigger government programs.

PBS Tip #2:  “Change the Financing”  Former CMS Administrator Dr. Mark McClellan, currently with the Brookings Institution, says “let people control how [Medicaid] money is spent on their behalf. That's what's behind our ‘Money Follows the Person’ [MFP] initiatives in states around the country . . ..”

LTC Comment:  Terrific.  MFP programs are a vast improvement over the current LTC financing system which makes providers--not patients--the program’s customers.  But “Money Follows the Person” still depends on payments coming from an unsustainable welfare program.  Making Medicaid more attractive to more people is not a solution.

PBS Tip #3:  “Focus More on the Poor”  Dr. E. Percil Stanford, president of Folding Voice and the KIND Corporation, says “Unfortunately, considerable [LTC policy] attention from the most well-intentioned institutions and organizations has focused primarily on the middle and upper classes.”  Instead, he says, they should focus laser-like on the poor elderly.

LTC Comment:  Right on, but how?  No answer from this source.  Research shows Medicaid’s LTC program benefits the middle-class and affluent as much or more than the poor.  The solution is to target scarce public benefits to the needy and use some of the savings to incentivize early and responsible LTC planning by more prosperous people.

PBS Tip #4:  “Build a Comprehensive National Strategy”  AARP’s Debra Whitman wants us to spend more government money to help family caregivers, grow Medicaid, expand “affordable” housing and transportation, “integrate” health care services, and eliminate LTC impoverishment.

LTC Comment:  Typical AARP eyewash.  Not a word about where the money will come from to pay for such wishful public program expansions.  The federal government already borrows a third or more of everything it spends.  It forces interest rates to near zero to make such borrowing feasible temporarily.  Watch out when this bubble bursts.

PBS Tip #5:  “Begin the Conversation”  Jennie Chin Hansen, CEO of the American Geriatrics Society [AGS], thinks we should "chat and chew" LTC issues with our friends and colleagues creating a "study group" opportunity to “discuss the universal journey.”  She says “Let's proactively help each other build greater confidence, clarity and capacity.”

LTC Comment:  Doesn’t that advice sound vacuous coming from the head of the AGS?  We’ve been jaw-boning long-term care for decades without addressing the real problem, i.e. government pays for most high-cost LTC which anesthetizes consumers to the risk and crowds out responsible LTC planning and private financing. 

PBS Tip #6:  “Make It a Human Right”  Dr. Laura Gitlin of the Center for Innovative Care in Aging says “We need to grow a long-term care system based on . . . [the] principle . . . that long-term care is a basic right."

LTC Comment:  Of all the empty rhetoric in this program, the prize for thoughtless irresponsibility goes to this proposal.  If people have a basic human right to long-term care whether or not they are able or willing to pay for it, their “right” means someone else must provide LTC whether or not they are compensated for their effort.  That is the definition of slavery, which is what this ostensibly caring academic actually advocates.

Closing LTC Comment:  When I see the subterranean quality of LTC policy analysis displayed in program’s like this one, I’m nearly ready to despair.  The one thing that keeps me going is that a few of you AMGs (altruistic, masochistic geniuses) are still out there having truly valuable conversations with real consumers about how actually to protect themselves from escalating LTC risks and costs.

The whole wobbly Rube Goldberg apparatus of government-financed LTC puts enormous obstacles in your way.  It gives away what you’re trying to sell.  It makes your product unprofitable by manipulating interest rates so that its programs are artificially viable.  It falsely assures citizens they’ll be taken care of by bankrupt social programs already under-funded by trillions of dollars.  Yet you soldier on.  Somehow.

Hail to the AMGs!