When Medicare was enacted in 1965, President Johnson predicted "every citizen will be able, in his productive years when he is earning, to insure himself against the ravages of illness in his old age.... No longer will illness crush and destroy the savings that they have so carefully put away over a lifetime so that they might enjoy dignity in their later years."
He may have been a good president, but he was a lousy prophet. The cost of long-term care is impoverishing the elderly, primarily because Medicare doesn't pay for it. The belief back then was that long-term care would be within the financial grasp of the average citizen. Few envisioned the enormous burden it would become.
To his credit, President Clinton recently proposed changes to the program intended to improve the health care of Americans. But the focal point of his plan is prescription drug coverage, neglecting entirely the long-term care issue, the most pressing problem facing the elderly and their families today. In 1997 alone, older Americans spent $115 billion out of their own pockets on home care and nursing-home care. With Americans living longer this cost will only increase.
There have been token efforts to address long-term care, such as proposals of tax deductions and credits to offset the costs of nursing home and other services. But Mr. Clinton's failure to address this as part of Medicare reform means, no matter the results of the debate, seniors with chronic care needs will continue to be forced into impoverishment. The cost of long-term care needs to be part of the debate over Medicare's future. Long-term care is exactly the type of "ravage" Johnson spoke about that destroys the savings and the dignity of our citizens in their later years. Medicare was intended, in spirit if not in fact, to prevent this ravage.