Changes in Health Care

Two official commissions in Washington are giving priority attention to the problem of funding long-term health care, raising the prospect of substantial progress in the next seven months. That is a most welcome development.

The Bipartisan Commission on Comprehensive Health Care, which is to report to Congress on March 1, has already agreed that affordable insurance against the high costs of long-term care must be made available to all Americans, young and old. The commission is wisely considering the issue of long-term care as part of universal health care protection at a time when some 37 million Americans are without any health insurance.

And the Advisory Council on Social Security, in its quadrennial review of Medicare and Social Security, is developing models of a revised Medicare health insurance program that would include long-term care for the first time along with medical and hospital protection. The council’s report on Medicare is due in July and its review of Social Security next January.

The urgency of providing long-term protection is evident. At present, 2.6 million Americans, nearly half of them under the age of 65, require long-term care. Of this number, 1.7 million , including 400,000 under the age of 65, are in nursing homes at an average cost of $2,000 a month. The number of elderly will double over the next 40 years, and those over 85, who have the greatest need for nursing home care, will increase from 2.5 million in 1990 to 5.3 million in 2030. That means an increase among seniors needing institutional care from 1.8 million now to 5.3 million in 40 years.

There is now only one major program that pays for long-term care--Medicaid, called Medi-Cal in California. But it is limited to low-income patients. In the absence of any other significant programs, more and more elderly Americans must exhaust their life savings on nursing home care until their impoverishment qualifies them for Medicaid coverage. It is a cruel failure of the health-care system without parallel in other western industrialized democracies.

To focus attention on the problem, the staff of the Advisory Council on Social Security is developing a detailed model of a revised Medicare program that would include long-term care. In its initial draft stage, it has novel and promising elements that would shift basic Medicare coverage to private insurance, which would compete in offering a variety of services based on minimum standards set by Medicare. The insurance would be subsidized by Medicare for low-income persons. Everyone would have the same opportunity to choose among competing insurance plans, including fee-for-service, preferred provider and health maintenance organizations. The most novel provision would be a spending ceiling for each person. When that amount had been expended, as the result of catastrophic illness, ongoing acute illness or a chronic condition, the government would step in and cover the costs, ending the risk of financial ruin that haunts so many Americans now. Initial reviews of the plan suggest that it could be offered without an increase in cost to the federal government. But much would depend on the level of services provided and the ceiling set on lifetime medical expenditures in the event of catastrophic illness.

The Bipartisan Commission, headed by Sen. John D. Rockefeller IV (D-W.Va.), was appointed by the President and both houses of Congress. Among its members are the most influential legislators involved with health-care issues. The Advisory Council, created under terms of the Social Security Act every four years to review Social Security, is appointed by the secretary of health and human services. The new commission is headed by Deborah Steelman, a Washington attorney specializing in health-care policy.