Long-term care
Thursday, November 13, 2008Save More, Expect LessBy Stephen MosesCategories: Long-term careAt the rate we're going, Social Security, Medicare and Medicaid will consume almost the entire federal budget by 2050, says About.com. That's the LTC irony. The more we spend now while most boomers are still working in the productive economy and paying taxes, the faster we'll run out of benefits later when aging boomers need them. And the more individually responsible older boomers will be for their own retirement income, acute care and long-term care security. Read the following news item and see if it doesn't sound familiar. We've been beating the same drum all year on the Center for Long-Term Care Reform's 2008 National Long-Term Care Consciousness Tour. Bottom line: the less attention government gives to controlling the current hemorrhage in federal entitlement programs, the faster the long-term care insurance market will expand. That's always been true. But what's different now is this: the end game is finally upon us. Boomers will be taking out instead of paying into these already-bankrupt public programs. The immediate future looks scary, but the mid-range future promises a turn toward personal responsibility. Private savings, investment, annuities and insurance will replace the social safety net for middle class and affluent Americans. Our goal now should be to preserve enough of the social safety net to protect the truly needy. The rest of us are on our own. LESS GOVERNMENT, MUCH LESS GOVERNMENT Social Security and Medicare alone currently have a combined unfunded liability of $101.7 trillion, according to the 2008 Social Security and Medicare Trustees Report. The unfunded liability is the difference between total benefits to be paid, and the total projected collections in taxes and Medicare premiums. That $101.7 trillion unfunded liability is more than seven times the size of the U.S. economy and 10 times more than the national debt. Can anything be done, asks About.com? According to the National Center for Policy Analysis (NCPA), without raising taxes or massive reform of entitlement spending programs: o By 2010, the federal government will stop doing 1 in 10 things it's doing now. o By 2020, the federal government will stop doing 1 in 4 things it's doing now. o By 2030, the federal government will stop performing half of the services it provides. o By 2050, Social Security, Medicare and Medicaid will consume nearly the entire federal budget. o By 2082, Medicare spending alone will consume nearly the entire federal budget. How should you prepare to deal with this possibility of life with much less government? Addison Wiggin, coauthor of the suddenly popular book-turned-movie I.O.U.S.A. suggests, "For their part, individuals need to save more, invest wisely, expect less from the government, and be willing to pay for the services they do expect." Source: Robert Longley, "Less Government, Much Less Government," About.com, Tuesday November 11, 2008 For text: http://usgovinfo.about.com/b/2008/11/11/less-government-much-less-government.htm For NCPA study: http://www.ncpa.org/pub/st/st315/st315.pdf
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Wednesday, November 12, 2008Rationing Nursing Home BedsBy John LaPlanteCategories: Long-term care, South DakotaOne common criticism of government-funded health care is that it leads to rationing. Want to see that in action? Look at the situation with nursing home beds. South Dakota already ranks #7 in the country in its percentage of population over 65, and that population is expected to grow by twice the national rate over the next 17 years. That has some people in the state worried. Medicaid pays the bulk of nursing home expenses, which means that the state will be on the hook for millions more in spending. Aside from paying for it, there's the problem of finding beds for people who will need them. South Dakota law puts a quota on the number of nursing home beds. As you might expect in any situation where supply and demand are determined by government, not freely interacting individuals, there's a mismatch. The Argus Leader says "As the population has shifted, some nursing homes in rural areas have been left with more beds than their demographics dictate." On a positive note, a state report does recommend looking at ways to encourage people to buy long-term care insurance, so the burden of care doesn't fall on taxpayers.
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Tuesday, October 21, 2008Reverse Mortages and the Long-Term Care ProblemBy John LaPlanteCategories: Long-term care, MedicaidThe need to pay for long-term care (LTC) presents political, financial, and ethical challenges. Among other things, a growing use of Medicaid by the middle class to pay for LTC could threaten the solvency of state governments as the baby boom generation ages. One way around Medicaid financing, at least for some people, is the reverse mortgage, which uses home equity, built up over a lifetime, to pay for long-term care. Three scholars with the Urban Institute show that the reverse mortgage concept could be useful even for llow-income families who have built up equity. Though the use of these financial arrangements is still small, it is growing--a good sign for taxpayers and for families who will benefit from self-financing long-term care.
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Thursday, October 16, 2008Living on the Road, for LTC ReformBy John LaPlanteCategories: Long-term careStephen Moses, occasional contributor to this site, is living in a Gulf Airstream as he travels the country. Is this a retirement jaunt, taking in the sights? Not quite. He's promoting the need to focus public financing of long-term care on the truly needy, and of encouraging ways of enabling private individuals to make arrangements to pay for such care themselves. The need for changing the way we pay for long-term care will increase as the baby boom generation moves into the retirement years. You can read about his travels on the pages of the Center for Long-Term Care Reform, Inc.
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Wednesday, October 1, 2008Medicaid LTC Demand SoaringBy John LaPlanteCategories: Long-term care, MedicaidJust when you think state and federal budgets couldn't take any more, the trade group America's Health Insurance Plans has issued a report (pdf), "State Medicaid Expenditures for Long-Term Care 2008-2027" that describes the coming waves of Medicaid spending. It projects that over the next 20 years, governments at all levels will spend $3.7 trillion on long-term care. Of that, $1.6 trillion will come through state government budgets--making it a faster-growing category than The picture isn't looking any better. We're living longer, which is good, but two of three people who are today 65 or older will at some point need long-term care of some sort. Home and community-based care is growing relative to nursing home care, but it's not exactly a great way of saving money. The 81-page report has graphs displaying trends in spending on LTC for each state.
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Wednesday, August 13, 2008Infirm & EvictedBy Grace-Marie TurnerCategories: Long-term care, MedicaidLast week The Wall Street Journal reported that U.S. nursing homes are "forcing out frail and ill residents" and replacing them "with shorter-term residents likely to bring more revenue."
This is key: Medicaid reimbursements to nursing homes were $4.4 billion less than the cost of treating beneficiaries last year, the Journal reports, and approximately two-thirds of nursing home residents who stay in facilities more than 90 days depend on Medicaid to pay their bills. That's also fair warning to aging Americans who think the government will be there for them if they don't invest in their own long-term care insurance.
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Friday, August 8, 2008Nursing Home "Evictions": Another Problem of Government DependencyAnd A Stark Warning for Boomers Who Think Medicaid Long-Term Care is a Good Deal By John R. GrahamCategories: Long-term care, MedicaidYesterday's Wall Street Journal ran a feature article about nursing homes evicting frail residents. Spokespeople for the nursing homes claimed that these evictions were in accord with federal law, which allows evictions for only a few reasons, such as non-payment of bills, danger to others, or the nursing homes' inability to provide necessary care. However, the reporter honed in on the more likely culprit: most evicted residents' bills are paid by Medicaid, rather than private insurance or Medicare. Medicaid reimbursement is much lower, so nursing homes want to clear Medicaid dependents out in favor of higher paying residents. This article serves as a warning to boomers who fall for the line of the "eldercare" attorneys and accountants who profit from designing asset-transfers that make middle-class seniors eligible for Medicaid Long-Term Care. Indeed, the ease with which these "advisors" continue to operate causes a big problem for taxpayers as well as seniors, by crowding out private Long-Term Care insurance, a topic addressed by Stephen Moses of the Center for Long-Term Care Reform. However, I think the WSJ reporter was too easy on Medicare as an adequate payer: it only pays for 100 days of nursing home care after a hospital stay of at least three days. Americans should be wary of becoming dependent on government when we will be at our most vulnerable. It would be far better for the federal and state governments to give our taxes back to us, improving our ability to buy private Long-Term Care insurance, and extinguish the false hope that the state will be there for us when we need it.
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Tuesday, August 5, 2008The Cure for Government Intervention...is more government intervention By Joseph D. ColettiCategories: Long-term care, North Carolina, Single-Payer FolliesA true tale of love from Durham, NC, where an 80-year-old retired truck driver sold his house to cover $15,000 in debt from treatment of his wife's fatal cancer, is being used to justify expansion of the overburdened program and its taxpayer funders. An editorial in the Raleigh News & Observer makes clear just how high the hurdle is in some circles to a clear understanding of the causes and solutions, "there is little choice but further government intervention, not just with more investment (yes, taxes that cover Medicare will have to increase, helping to spread cost burdens) but in negotiating costs with drug companies and providers."
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Monday, July 14, 2008Housing assets should help finance long-term careBy Peter NelsonCategories: Long-term care, MinnesotaA recent decision from the Minnesota Supreme Court documents how the average senior can qualify for Medicaid long-term care financing while still maintaining a substantial amount of assets in there home. In a commentary published on MinnPost today, I recount the facts of that decision and how federal Medicaid law can actually restrict states from recovering housing assets from the estates of certain married couples. More broadly, the case highlights maybe the last substantial Medicaid long-term care qualification loophole and reminds us that our public long-term care financing system is plainly not working. While the case is only binding in Minnesota, the case represents a sound interpration of federal law and will likely influence how other states interpret federal Medicaid estate recovery law. In fact, the message here is actually more important for other states to heed because Minnesota happens to be one of the few states that actively pursues assets from the estates of Medicaid recipients.
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Monday, June 30, 2008New Videos on Long-Term CareBy Stephen MosesCategories: Long-term careTwo new short videos about the financial problems associated with financing long-term care (LTC) are now available from the LTC Consciousness Tour Channel on YouTube. Check out the brief conversations on critical topics with Michael Cannon, director of health policy studies at the Cato Institute and with Paul Hewitt, executive director of Americans for Generational Equity. Take heed. These are two of the best minds in the business of finding rational public policy solutions for the retirement financing crisis America faces.
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