Long-term care is the music that nobody wants to face.
As politicians, policymakers and providers grapple over the direction of reform, long-term care remains America's ticking healthcare time bomb.
Death and taxes are the only sure things. But as the nation braces for the demographic/economic blast of an aging Baby Boom generation, there are two other certainties-medical costs will increase and life expectancy will rise.
Thus, it's ironic that long-term care became the disappearing benefit during the not-so-great congressional healthcare debate of 1994. As reform proposals were watered down in the name of fiscal reality, long-term-care benefits were reduced or eliminated.
Long-term-care spending exceeds $60 billion a year, but under reform proposals that amount might double if sufficient money is pumped into home care, nursing homes and community-based care. The springboards for more long-term-care utilization are affordable supplemental insurance for Medicare beneficiaries and greater support among providers for long-term-care programs.
Healthcare executives, as well as groups that represent the elderly and the disabled, are aware of the costs and the merits of enriching Medicare benefits. But increased federal spending for long-term care ultimately was victimized by President Clinton's baffling boast that the nation would save money if his plan was passed. When honesty and a call for sacrifice were most needed, the president gave us populist rhetoric.
Public opinion polls show stronger support for healthcare reform if more long-term-care spending is part of the mix. But where will the money come from? Once the benefits are scaled back, seniors' support for reform will evaporate.
This scenario shows the difficulty in achieving government-induced healthcare reform. The real impetus for change must come from providers. As organizations blend into integrated delivery systems, the infrastructure must emphasize the importance of long-term care.