LTC Bullet:  Hillary on LTC:  Now and Then

Friday, May 27, 2016

Seattle --

LTC Comment:  LTC policy plays in this year’s presidential election even less than in 2008.  Now and then, after the ***news.***

*** Here are two ominously connected news items we sent this morning to our Clipping Service subscribers:

1.)  5/25/2016, “Could Alzheimer’s Stem From Infections? It Makes Sense, Experts Say,” by Gina Kolata, New York Times

Quote:  “Could it be that Alzheimer’s disease stems from the toxic remnants of the brain’s attempt to fight off infection?  Provocative new research by a team of investigators at Harvard leads to this startling hypothesis, which could explain the origins of plaque, the mysterious hard little balls that pockmark the brains of people with Alzheimer’s.  …  Recent data suggests that the incidence of dementia is decreasing. It could be because of better control of blood pressure and cholesterol levels, staving off ministrokes that can cause dementia. But could a decline in infections also be part of the picture?

LTC Comment:  Fascinating new research and speculation that seems more promising than most such reports.

2.)  5/27/2016, “The superbug that doctors have been dreading just reached the U.S.,” by Lena H. Sun and Brady Dennis, Washington Post

Quote:  “For the first time, researchers have found a person in the United States carrying bacteria resistant to antibiotics of last resort, an alarming development that the top U.S. public health official says could mean ‘the end of the road’ for antibiotics.

LTC Comment:  Juxtapose this report with the clipping I just sent you tying Alzheimer’s to infection and you’ll see the combined problem is potentially much bigger than either.

Receive these LTC-relevant news items (with original analysis) in real time and stay on the forefront of professional knowledge by subscribing to our Clipping Service. Contact Damon at 206-283-7036 / damon@centerltc.com to start your subscription immediately or go directly to our secure online subscription page and sign up for $250 per year or $21 per month. Already a Center member? Contact us to add the Clipping Service to your membership for only $100 per year or $8.25 per month. ***

*** BACK THEN:  When we published LTC Bullet:  Hillary on LTC in February 2008, the Center’s National Long-Term Care Consciousness Tour was just getting under way.  So was the “Great Recession.”  There’s been a lot of water under the bridge since then.  So we thought we’d take a look at how LTC policy aspirations were before and are now from the perspective of the once and current presidential candidate, Hillary Clinton. ***

 

LTC BULLET:  HILLARY ON LTC:  NOW AND THEN

LTC Comment:  Most of this year’s long list of now-passed-over presidential candidates had little or nothing to say about long-term care.  This January 29, 2016 piece in Forbes gave some perspective:  “Why Candidates Aren't Talking About Long-Term Care.”  Hillary Clinton broke from the pack, however. 

Here’s her “Plan to Invest in the Caring Economy:  Recognizing the Value of Family Caregivers and Home Care Workers” offered November 22, 2015.

As president: 

  • Clinton will provide tax relief to family members who care for ailing parents and grandparents. Family caregivers spend as much as $5,000 or more in expenses related to their elders’ care, but in many cases they receive no tax deduction or credit. This shouldn’t be this way: caregiving can be a win-win for our families and our overall health system. This is why Clinton will offer a 20 percent tax credit to help family members offset up to $6,000 in caregiving costs for their elderly family members, allowing caregivers to claim up to $1,200 in tax relief each year.
  • Launch a Care Workers Initiative to create a coordinated, government-wide initiative to address the challenges faced by care workers—by developing strategies to improve opportunities for care workers to earn the skills they need; creating paths to professionalize the workforce through career ladders and apprenticeships; improving the rate-setting processes in the child care and health care systems to ensure fair wages; providing care workers with an opportunity to come together and make their voices heard in support of a stronger system; and by developing and enhancing matching services to connect care workers to the families who need them.
  • Expand Social Security by counting the hard work of caregivers and giving them the benefits they deserve. Millions of women—and men—take time out of the paid workforce to raise a child, take care of an aging parent or look after an ailing family member. Caregiving is hard work that benefits our entire economy. However, when Americans take time off to take care of a relative, they do not earn credits toward Social Security retirement benefits. This can reduce their Social Security benefits at retirement, since those benefits are calculated based on their top thirty-five years of earnings—an issue that disproportionately impacts women. For years, leaders like Congresswoman Nita Lowey have called out these disparities. No one should face meager Social Security checks because they took on the vital role of caregiver for part of their career. Hillary Clinton believes this is an idea whose time has come: Americans should receive credit toward their Social Security benefits when they are out of the paid workforce because they are acting as caregivers.
  • Build on the Caregiver Respite program.  Caring for a sick family member day in and day out can exact a significant emotional and physical toll. Both caregiving family members, and those they care for, can benefit from occasional temporary relief. As a Senator, Clinton was the lead Senate sponsor of the Lifespan Respite Care Act, which was enacted. It authorizes grants that continue today to improve respite care access for family caregivers of children or adults of any age with support needs. As president, Clinton will go beyond President Obama’s Caregiver Respite budget request—investing $100 million in the initiative over 10 years.

That is now.  This was back then as pulled from our archives:  LTC Bullet:  Hillary on LTC, February 7, 2008:

LTC Comment:  The February 2008 issue of Health Insurance Underwriter, the monthly magazine of the National Association of Health Underwriters (www.nahu.org), contains my article "Hillary Clinton on LTC."

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Hillary Clinton on LTC
by Stephen Moses
February 2008

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?

Hillary Clinton announced her plans for long-term care public policy a few weeks ago. 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, then our comments:

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 $3,000 Caregiving Tax Credit to provide financial relief to millions of seniors, people with disabilities and their families. Clinton will also invest more than $300 million per year to support unpaid family caregivers.

-- Giving more seniors the ability to access long-term care services where and when they need them, including in their homes.

-- Doubling 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:

-- Requiring 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.

-- Offering consumers the same secure long-term care insurance options that members of Congress enjoy.

-- Providing 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:

-- Tripling federal support for nursing home ombudsmen programs to protect consumers of long-term care.

-- Directing 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.

-- Reversing 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.

-- Strengthening 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 and 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 that.

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 the 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. For example:

-- Expand 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.

-- Give 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 ever.

-- Improve 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 worse the very problems they are trying to solve. Then will come another set of politicians who propose more of the same. After 40 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 commission.

The next 20 years will tell the tale.

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LTC Comment:  How has Hillary on LTC changed?  In 2008, she called for a $3,000 tax credit for caregivers.  That proposal doubled to $6,000 for 2016’s campaign.  In 2008, she proposed a “Long-Term Care Insurance Tax Credit.”  No more; she’ll “expand Social Security” instead.  In 2008, Hillary took aim at nursing homes, calling for more ombudsmen, litigation, background checks and information on poor performers.  No longer, this year it’s all about supporting family caregivers.

Is the new Hillary on LTC any better than the old one?  Hardly.  I stick by my critique above.  But I’ll double down in this respect.  Eight years later, we find ourselves deeper than ever in the financial hole that will bring America’s LTC service delivery and financing system crashing down. 

Our national debt has nearly doubled from $10.9 trillion when President Obama took office in January 2009 to $19.3 trillion now.  Medicare’s and Social Security’s unfunded liabilities are staggering.  Medicaid continues to crowd out responsible LTC planning.  Self-indulgent fiscal and monetary policies push up spending and debt and sustain the excess with artificially low interest rates.  When will this bubble burst? 

I repeat:  “The next 20 years will tell the tale.”