- BIOETHICS FORUM ESSAY
A Modest Proposal for Long-Term Care
“Why should taxpayers bail out the people who have squandered their money and can’t afford to pay for a nursing home or home care services?” “Can’t pay for home care? You should have purchased long-term care insurance!” “Long-term care? Doesn’t Medicare pay for that?”
These comments occur frequently on blogs and in letters referring to news about the high cost of long-term care or, just recently, the apparent demise of the Class Act, the part of health care reform that was intended to create a national long-term care insurance program. While these comments come from different people with varying political and economic perspectives, the message is the same: It’s up to you to pay for your own long-term care.
Taking this early planning advice seriously, I offer a modest proposal. Instead of giving a new baby presents like fuzzy animals, cute clothes, and toys to learn by, well-wishers should give each newborn a long-term care insurance policy or start a savings fund that can only be accessed at age 75 or when advanced illness strikes, whichever comes first. As Baby grows, instead of investing in computers, books, sports, and music lessons, parents should put their money into the long-term care fund. Teenagers should be encouraged to avoid higher education, which is costly and could lead to a job that would make them ineligible for Medicaid (assuming that Medicaid still exists or has been reincarnated as a 21st century Poor Law).
Health care should be kept to a minimum, since it takes a big chunk out of any income. Ditto travel and housing costs. Marriage should also be avoided, since it frequently results in children, starting the expensive cycle all over again.
When this lucky newborn reaches his declining year or two, he will have enough money to pay for a semi-private room in a nursing home, which now runs an average of $78,000 a year (higher in places like Alaska and New York). And it would all be done without the government getting involved. Families – the current providers of most long-term care – would not have to worry about helping a sick relative. And that’s just as well. Given their single-minded focus on saving money for long-term care, these forward-looking individuals would probably not have had time or interest in sustaining family ties anyway.
Critics may say that some people might cheat and spend money on unnecessary things, like immunizations and bicycle helmets. Or make foolish choices, like starting a business, writing a book, or donating money to charity. To these naysayers, I ask: Do you have a better plan?
Carol Levine is director of the Families and Health Care Project of the United Hospital Fund and a Hastings Center Fellow.
Published on: November 7, 2011
Published in: Health and Health Care