The New Republic

Over one fourth of the total expense for long term care is paid by Medicaid, or over $100 billion per year. That was several years ago, and both the amount and the percentage are rising rapidly due to the aging population. For the middle class, Medicaid is a supplement to Medicare when it comes to long term care. We may think of Medicaid as the health care program for poor people, but it's not. I suppose those who would cut Medicaid would argue that the family has the primary obligation to care for a family member unable to care for herself, and that if the government agreed to pay for all such care, families would not provide the care. The coming crisis in long term care will be experienced by all generations, the seniors who need the care and their younger family members who are able to provide it. There are two approaches. One, cut funding and let the chips fall where they may. Two, develop a rational and cost-effective way to address it, taking into account both a family's obligation and society's responsibility to its most vulnerable. Unfortunately, many would prefer the first choice, which is to ignore the crisis and pretend it doesn't exist. Anybody who believes she could never be in Pollock's shoes is living in fantasy land.

- rayward

September 28, 2012 at 11:17am

Amen rayward. I have a friend with an autistic child - a grown man now - who will need help and care the rest of his life. What are his aging parents supposed to do? Without help from Medicaid they'd be unable to care for him at all. They themselves have been hit hard by the recession. The school which has been so helpful to them and to their son is underfunded. They live with constant financial and emotional stress, with real fear for their son as well as for their own future. And - what will happen to the son when his parents are gone? If something happens to Medicaid he'll literally have nothing. Will he just be locked up somewhere? This could be anybody. It isn't just "bums" who experience misfortune, it's all of us sooner or later, if only due to old age. The GOP is trying to treat money as if were both a god and a scourge, completely overlooking people (unless we're so rich it doesn't matter.) Are they trying to turn us into Spain where people are now scrounging in garbage cans? This is what happens when social safety nets are shredded. It's punitive, pointless and cruel.

- Sophia

September 28, 2012 at 2:06pm

Thanks for the reminder to pay my LongTermCare insurance premium, even though only 3% of Americans are in this too-small cohort. As for Dr. Pollack's two minutes? No specifics, but I do not believe care for a developmentally disabled adult should justify an entire program, Medicaid, that is the synonym for corruption in New York State. Obamacare started with a LongTermCare program, but had to drop it. And suddenly, my premium jumped 45%, effective Oct 1 2012. Should I drop my coverage, even after paying for it for twenty years so that I would have a safety net, and join the rest of Americans who transfer assets so they can qualify for Medicaid longtermcare? or stay in the 3% who, in my case, is certainly NOT the top 3% in net worth or income? Just the 3% who were lucky enough to have access to a private insurance plan that was portable - I got to keep the plan even after a private equity LBO ended my working career.

- K2K

September 28, 2012 at 2:13pm

Private insurance only covers 7% of the total cost of long term care; Medicaid covers 43%; Medicare (post-acute) covers 24%; out of pocket covers 19%; "other private" covers 5%; and "other public" covers 2% (Kaiser Commission on Medicaid Facts).

- rayward

September 28, 2012 at 2:23pm

K2K, please review your policy for your own sake. My father-in-law died earlier this year at the age of 97. He too was a firm believer in long term care insurance and paid premiums for over 20 years. He spent the last year of his life in a group care facility. There was nothing really wrong with him other than old age. He simply could not get out of bed unassisted, bathe himself, feed himself, etc. It turned out the private long term care insurance was a joke. The family had to fight for every dime, and in the end we calculated that Dad spent $60,000 in premiums and received $10,000 in benefits.

- koppgeo

September 28, 2012 at 4:31pm

thx koppgeo. My concern was the possibility of needing care after a hip replacement, or an accident, and not having any family to rely on, and that was when I was 40. I just find it disengenuous for this video to be some sort of justification for ever-expanding Medicaid when there is a cottage industry of 'how to divest your assets so you can qualify for Medicaid for longterm care'. Red herring to use the case of a developmentally disabled adult, whose family prioritizes college tuition for their children. Plus, I like to note that MetLife raised my premium by 45% a few months after the Obama administration gave up on that component of ACA. I WANT Death Panels. Give me a pill when my money runs out. far less stressful. What a campaign of silliness we have.

- K2K

September 28, 2012 at 9:54pm

So, K2K, your answer to the issues raised is? What about my friend. Should she just just shoot her kid or what? Or herself maybe? I am serious. People rant about social safety nets, but present zero alternatives. None. There are no merciful responses at all. Just complaints. And as for insurance, right. They will fight tooth and nail for every penny, making matters worse especially if you're ill and having trouble coping. People forget insurance companies aren't in the business of helping YOU they are in the business of making a profit.

- Sophia

September 29, 2012 at 6:19pm

Sophia: you need to stop moaning about the genuine case for the disabled as the primary purpose of Medicaid, which is meant for the poor. One in four residents of New York State are on Medicaid. Two of my former state senators are in prison for Medicaid fraud. If tnr.com wants to pitch the need for Medicaid, I suggest they find a video of a single mother in Mississippi, who does not qualify under Mississippi rules, instead of a college professor not wanting to choose between college tuition for his children and care for his brother. The NYT has exposed many of NY Medicaid's flaws, but nothing ever changes, except the NY model is built into Obamacare, which is why so many states want an opt-out on such a huge expansion of Medicaid. Obamacare even barred NY from changing the current generous benefits and qualification.

- K2K

September 30, 2012 at 1:49pm

Long-term, there is no other solution but national government health insurance for everyone. And it's coming, without a doubt. The main reason long-term care is so expensive is because some people are making obscene profits from it. And the taxpayers are stuck with the bill. America is ranked 37th in the world in health care now (Republicans lie like dogs when they say we have the best health care in the world). Government health care will rank no lower than 37th, probably higher, because many American doctors will quit under government health care, and cheaper (but just as good) Third World doctors will be imported. We will be much like Thailand, where they have government care with non-American doctors--and Thailand is ranked near the top, if not at the top, in health care in the world. Many American rich people go there for surgery, because it's much cheaper and just as high quality as they would get in the U.S.

- magboy47.

September 30, 2012 at 2:30pm

"The main reason long-term care is so expensive is because some people are making obscene profits from it. And the taxpayers are stuck with the bill." The one of the main reasons hospital groups make such obscene profits is that there is NO profit in preventative care. This isn't some recent phenomenon but something that the medical community has known for years. When the average person hits the age of 60 the rapid decline of health sets it due to several factors - poor health decisions earlier in life, lack of physical and mental activity, poor eating habits that cascade once the individual has some sort of earlier health issue. The doctors / physicians, will, regardless of guaranteed outcome, will encourage costly procedures and tests for the individual. Not necessarily because that procedure "helps" but because the procedure is encouraged by the hospital managers because of the profit margins. When the Mayo Clinic made the decision to stop offering preventative care program for its chronic diabetes patients it wasn't because the program didn't work (it did), but because the Mayo Clinic could make more money performing amputations and dialysis for chronic diabetes patients. Cutting medicaid or medicare funding would NOT prevent this type of cannibalistic management decision making. Over billing & wasteful procedure prescriptions occurs regardless of whether or not the individual is covered by private insurance, medicare or medicaid. K2K seems to be making the argument for medicaid reform & by "reform" we mean cuts, because of cases of fraud in NY and should only be for the poor but what if you're poor and disabled? I'm not sure cuts to medicaid solve anything other than resulting severe declines in health services and access. It would not and won't stop immoral individuals or private medical groups from over billing and defrauding Medicaid or Medicare. If it weren't for a combination of private insurance, medicare and SS, both of my parents would be in dire straits. Even if my sister or I could provide long term care (and we've done that for short periods of time) it is a bankrupting endeavor for either one of us even with parents who are moderately healthy. Not to mention we are spread over 4 states. Those on the Right look at health care as a privilege. Full Stop. There is no way of communicating the complexity of the social, economic and ethical implications of why universal healthcare in the 21st century is needed when you are debating with someone who see the world divided into the haves and have-nots.

- singlspeed

October 1, 2012 at 12:34pm