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.
With our economy strong and Medicare under reconstruction, it's morally wrong not to use the opportunity to address the problem. Imagine the US in 2050. When you're done dreaming of flying cars and robots, picture this: Nearly a third of the 97 million Americans over the age of 65 will be facing dire poverty. Medicare will still be solvent, but the very people it was designed to protect will be unable to afford a place to spend their extended lives.
The White House argues that revamping prescription-drug coverage will reduce the need for nursing home and home health care. Maybe, but only in the case of medical emergencies and a limited number of chronic care cases. Even if prescription coverage reduces the expense of care for a few, for most there'll be no change in the expense of long-term care. Census Bureau data show half of those over 85 need help with the activities of daily living - in addition to any other medical assistance they may need.
There is no doubt that, without significant help, Medicare will collapse under the sheer mass of aging baby boomers reaching retirement. The president's plan to use $794 billion from the budget surplus is good, but not enough to protect tomorrow's seniors. Like other half-hearted approaches being proposed, affordable prescription drugs aren't the solution. Entitlement to adequate health care should be neither a privilege of the very wealthy nor just a matter of chance. We owe today's seniors the dignity of not worrying about leaving their heirs with massive debt. If we aren't brave enough to use this opportunity to make Medicare work for all, our children and grandchildren will suffer the consequences.
*Peter J. Strauss heads the elder law department at Epstein Becker & Green, a New York law firm. He is the elder care columnist for the New York Law Journal.
(c) Copyright 1999. The Christian Science Publishing Society