Long-term care need won't vanish

Nobody likes to think about old age. Now we can all go back to pretending we don't have to.

What happened? The Obama administration last week finally threw in the towel on its overly optimistic project to entice Americans into buying long-term care insurance through the federal government.

This was probably inevitable. The quixotic plan was to offer people a basic lifetime benefit of $50 a day in exchange for years of premiums. Enrollment was to be entirely voluntary. But the young and healthy had no reason to sign up, leaving only those most likely to collect as potential enrollees. This would have made premiums unaffordably high, in turn driving away even more potential participants. Aware of this actuarial Catch-22, the administration was unable to come up with a workaround and so decided to call the whole thing off.

Republicans in Congress are crowing, since the long-term care program was part of the president's larger health care package, which they vie with one another in opposing. But nobody should be too happy, because in abandoning the Community Living Assistance Services (or CLASS) Act, the government forgot to repeal old age.

As a result of this oversight, a great many Americans -- 27 million by 2050, according to one estimate -- will grow frail enough to use some kind of paid long-term care, and society has no good mechanism to provide it outside of expensive nursing homes, a fate dreaded by almost everyone. Yet experts estimate about two-thirds of Americans older than 65 will have needed help with cooking, bathing or other basic tasks by the time they die.

Long-term care is already a burden on taxpayers. Leaving Medicare aside, two-thirds of Medicaid is spent on Americans over 65 or disabled. Much of this goes for nursing home care, since Medicaid traditionally could pay for care only in such settings, although in recent years the rules have been relaxed to let it cover more home care.

Nor has private long-term care insurance ever gained much traction. Few people sign up, and then only when they're so advanced in years that the premiums are sky high or insurers reject them for ill health. It's also hard for consumers to judge if a company is going to be around decades later to pay any benefits.

The end of CLASS only underscores the glaring need for a coherent national insurance plan for long-term care -- one focused on keeping the elderly at home, where they can be cared for in dignity and comfort at the lowest possible expense. Such plans are common in Europe and Japan. Affluent countries typically spend 1 percent of gross domestic product on long-term care -- about the same as we spend, except the emphasis here is on institutional care for the few rather than thriftier alternatives for the many. That's why paying for a national program shouldn't be too hard; we could take a huge step toward covering the cost by diverting some of the billions now poured into nursing homes and costly medical procedures for elderly patients who, too often, don't benefit from either.

One thing is clear: CLASS is dismissed, but aging is here to stay. hN