Do Politicians Understand That Long-Term Care is Part of the Health Care System?
During this year, a year in which our country will elect a new President, health care has become an important part of the agenda. Liz Rosto in her post entitled Decision 08, writes about the issue of heath care and the apparent lack of emphasis given to long-term care, especially through many of the major candidate’s policy advocacies. This appears to be an interesting phenomenon, which has not just appeared during this current election season, but has existed in past elections as well.
Although the amount of our Gross Domestic Product spent on health care is approaching 15 percent, with an expectation for it to climb to 17 percent by 2012, most individuals fail to apparently want to acknowledge the important contributions of long-term care to the GDP. With the burgeoning older adult population being a very important part of the electorate, an electorate that votes at higher levels than any other part of the population, you would think that politicians would not only focus on acute care, but long-term care as an important issue that needs to be addressed. Although the focus on changing the health care system is definitely important, to fix many of the deficiencies that currently exist in the system itself, it is important to recognize that these problems also extend to long-term care. However, it appears that many of the health policies that are frequently spoken about politically fail to address long-term care issues.
What appears to be an inherent contradiction here is this: Although politicians are aware of the importance of courting the older adult vote since they currently make up 13 percent of the population and have the most solid voting records of any age group, most fail to acknowledge a very important health care concern found in many families and among many elderly as it relates to funding and the provision of health care found in long-term care. Although the stereotypes of the elderly being a predominately nursing home bound population are false (in reality, only 5 percent of the elderly population is in nursing homes at any given period of time), long-term care will continue to have an important place in the American health care system.
It is estimated that there is a 70 percent likelihood that individuals in society will spend some time within a long-term care environment at some point in their lives, which includes home bound care (Gleckman, 2007). Furthermore, as many more long-term care facilities are becoming extensions of the acute care environment, especially for rehabilitation purposes, it becomes almost unfathomable to understand why the political environment often gives minimal to no attention to this area.
Total Medicaid costs for long-term care as a percentage of the GDP has increased from 0.7 percent in 1975 to 2.1 percent in 2003 (Gleckman, 2007). Furthermore, in 2000, the amount of long-term care expenditures that were part of the approximately 14 percent that made up the GDP was equal to 1.3 percent and it has been increasing. In fact, Medicaid and Medicare expenditures that are part of the GDP have been increasing. Moreover, public payment sources such as Medicaid and Medicare make up 60 percent of long-term care payment with another 23 percent of the payment coming from out of pocket expenses (Walker, 2002). When you couple this with budget constraints being placed on many long-term care programs and anxiety over the drying up of the coffers that support many long-term care programs, both on the state and federal level, one has to wonder why advocates for the elderly have failed to make this a more prominent concern to be addressed by politicians on both sides of the aisles in the 2008 political races.
So where does that leave us in the 2008 political race not only for the Presidency, but also for many other congressional offices that will be up for grabs. Unfortunately, it appears that long-term care will continue to be treated as the redheaded stepchild of health care policy. Possibly the most vociferous advocate of health care in the current presidential contest is Hillary Clinton and even Mrs. Clinton fails to address long-term care on a substantive level. It is without doubt that escalating costs, physicians forced to practice defensive medicine, escalating third party insurance costs, as well as too many individuals failing to get preventative care, or failing to be insured or underinsured is a national crisis. However, one needs to add to this the problems found in long-term care as part of the national health care system crisis as well.
Long-term care has to be recognized as part of the larger system of health care that exists in the United States. Yet, as has been evident, most politicians know very little if anything about the concerns faced by older adults, and in particular, the concerns that are faced by this population in long-term care. Therefore, not only is the national crisis in health care problematic since it often fails to address the long-term care part of our health care system, but it is exacerbated by the lack of knowledge by those who hold the most advantageous positions in our society to address this issue. With congressional subcommittees on aging having existed for some time, one has to wonder whether these committees have helped to educate the political faction on these very important issues?
With a plethora of elderly age groups in existence to address the concerns of the elderly, one has to wonder why they have not placed greater political pressure on our country’s politicians? And with the increasing level of the population that is currently over 65 years of age, a part of the population that is increasing quickly and have concerns about long-term care issues, one has to wonder why they as a group have not continued to place increasing pressure on the politically powerful to address many of their concerns in this area?
The above are all important questions that need to be addressed and addressed quickly. With each election that goes by, and with each year of failed response, the elderly population continues to grow. Along with this will be long-term care needs that will continue to increase. As our country continues to sit on the issue with little or no response, and as the older adult population continues to increase concomitantly with their growing long-term care needs, a growing lag between these two areas also will continue to increase. As the lag continues to increase between elderly needs and political response, our country sits on a powder keg that can and will explode. Prior to getting to this point, where our country has to mobilize into an emergency mode and reactive response, the American people and their political representatives need to forestall this growing crisis by acting proactively and with prudent foresight.
References
Gleckman, H. (2007/April). Medicaid and long-term care: How will rising costs
affect services for an aging population, An Issue in Brief: Center for Retirement Research, Boston University: April, no 7-4,
Gleckman, H (2007/June) Financing long-term care: Lessons from abroad. An
Issue in Brief: Center for Retirement Research, Boston University: June, no 7-8
Walker, D.M (2002/March 21). Long-term care aging baby boom generation will
increase demand and burden on federal and state budgets. Testimony made by Comptroller General of the United States General Accounting Office Before the Special Committee on Aging, U.S. Senate.