Ady Barkan, a 35-year-old Yale Law School graduate who is dying from ALS, made a poignant plea for Medicare for All at Congress’ first hearing on a single-payer proposal in more than a decade.
His testimony touched on the myriad flaws of private insurance: high administrative costs, growing out-of-pocket expenses, endless bureaucratic hassles, and the restrictions even adequately insured patient like himself face in obtaining necessary care.
Yet his young family’s biggest problem, other than the sad fact that there is no cure or treatment for his debilitating disease, is the nation’s lack of a long-term care program. “ALS means paying out of pocket for almost 24-hour home care,” he said. “It costs us $9,000 a month.”
How can he afford it? “GoFundMe is a terrible substitute for smart congressional action,” he said. “We have so little time left.”
GoFundMe for the long-term care of this fatally stricken person in the few remaining years of his life. In the richest country on earth.
The event was held in the tiny hearing room of the House Rules Committee, which, as Kaiser Health News pointed out, can’t advance healthcare legislation. House Speaker Nancy Pelosi has tipped her hand. M4A legislation isn’t going anywhere in this Congress and probably won’t in the next, even if Democrats win control of both the Senate and White House and retain control of the House.
One can imagine advancing significant healthcare legislation over the objections of one or two industry stakeholders. But given the united opposition of most providers, all insurers, the drug and device industries, and most employers—not to mention significant sections of the Democratic Party—it’s not going to happen.
But that doesn’t mean the debate is a waste of time. The Medicare for All bills advanced in the Senate by presidential candidate Sen. Bernie Sanders (I-Vt.) and in the House by Reps. Pramila Jayapal (D-Wash.) and Debbie Dingell (D-Mich.) include coverage of long-term care. With 10% of the population suffering from disabilities and half the baby boom generation entering retirement without significant assets, coming up with a national plan that works is long overdue.
Detractors say the cost would be enormous, with estimates ranging as high as several hundred billion dollars a year. Some of that would relieve states of their Medicaid obligations to help the destitute. But, as the Congressional Budget Office noted in a new review of single-payer options, “public spending would increase substantially … if everyone received long-term services and supports benefits.”
Still, an Associated Press-NORC Center for Public Affairs Research poll last year showed 76% of Democrats and 56% of Republicans favor a government long-term care program. No wonder. The private market for long-term care insurance has largely collapsed.
Most of the people who sign up wind up using the benefits while the relatively healthy and the well-to-do, who can self-insure, avoid its huge premiums. Private insurance for long-term care inevitably breeds a massive adverse-selection problem.
The Legislature in Washington, whose governor, Jay Inslee, is running for president, recently passed a universal long-term care plan financed with a payroll tax of about 0.5%. Its benefits would provide up to $36,000 a year for personal assistance, whether at home, in nursing homes or at assisted-living facilities.
Today, less than 10 million people have long-term care insurance, which is very expensive. The rest of the population relies on unpaid family caregivers or liquidating assets until they qualify for Medicaid. Talk about a death tax.
If single-payer advocates were smart, they’d break off the long-term care section of their bills, come up with a progressive, adequate tax to pay for it, and pursue it in this Congress. Why not show that single-payer can work for this crucial but missing benefit before trying it on the entire system?