It’s Still Up to You – Biden Proposes Billions for LT Care Reform

It’s Still Up to You – Biden Proposes Billions for LT Care Reform

Let’s talk about something we’ve ignored for too long: the long-term healthcare crisis.

Before we begin, I just need to pull myself out of this icy Maryland swamp, where my memory is trapped in waist-high water.

The Biden administration has proposed first-step reforms that we need to examine. We must also consider self-help alternatives, because governments, I’m afraid – which commonly lose the plot, lose elections, even fail without want of trying – can let you down under fire.

Back to that night: pitch black in autumn, and the mud was pulling me down. Trapped in a swallowing swamp; yes, that will do as a metaphor for America’s LT healthcare crisis. There I was, soaked and sinking, with seconds to reflect: bad things seek out good people, but occasionally they find me, too.

Here’s the odd thing: people are living a long time; average life expectancy is nearly 80 years in the US. I like that number, but another one truly catches the eye: over 70% of us will require LT healthcare in our old age.

Long-term care lasts an average of three years. It can take place at home, the preferred option for people, in a nursing home, private or otherwise, or in treatment facilities of various shades.

A private nursing home room costs around $9,000 per month. No matter where you receive treatment, the price is high, topping $100,000/year. It’s hard to pay without government help or powerful insurance coverage, or my favorite – both.

Back to the slime. I’ve already written about Sully, my buddy who came back from the Vietnam War by merciful Providence, and his skill with a field radio. He brought back odd notions and heaps of Marine Corps sagacity, which he foisted on all mere mortals within range.

First came a taste for one-upping. No matter what glories you’d chalked up and scored, you couldn’t top Sully. “That’s nuthin’” he’d toss back, laughing. Did I ever mention that Joni Mitchell flirted with me backstage at the Kennedy Center in Washington, where in my undergrad years I worked as an usher? For ten bucks and a crack at the buffet, I was on any dog-job. Joni’s aura is bright orange, if you’ve ever wondered.

“That’s nuthin’.” Sully’s topper: Katherine Hepburn taught him to kiss at age 18 – ‘à la française. I’m so sure… yet I know Sully’s mom, have examined family albums, and there is spry ‘Kate’, an old family friend. Maddening guy, our Sully, but good for a yarn and never stingy with – it’s decriminalized now, but let’s be discrete.

We were mates in the ‘80s, sure, but he wanted to be certain. He once spied out a cannon at Antietam, the nearby Civil War battlefield, that wasn’t staked down. Mission: move that cannon to a better firing position. I was a ‘yes’ sort of guy in my youth; people wonder why I’ve grown so contrary. I checked later on, and the Park Service had rolled it back – no tactical sense, sniffed Sully.

So it’s midnight, we’re out driving, and Sully needs a walk. He says, there’s a state park nearby, a great place for ‘patrols’. Uh-oh. We just need to sneak in – through a swamp. It didn’t look bad, with odd balls of grass popping up like stepping stones to keep sneakers dry. We’ll cross over, Sully can have his ghost hunt, then hit 7/11 for munchies. Home before the leaves fall.

Did I mention it was raining? Skating on slick grass, I slipped. Wet feet, that’s nuthin’. Sinking into mire up to your knees, then drowning waist-deep as you struggle, is something.

“Stay calm. Get yourself out. An inch at a time.” Thank you, lance corporal emeritus, for this tactical insight.

OK, I got out without revealing our position. My once-fine overcoat – I’m bragging, it was moth-bait from Ed’s Men’s Duds in lower Manhattan, but it looked sharp to me – now resembled a fudgesicle.

No help from the mirey clay from Sully: you hump your own gun in his platoon, though I was only carrying a mechanical pencil. We don’t love our friends despite their flaws, but because of those flaws – so say the wise ones. Wiseacres, I think.

Back to President Joe Biden. However you rate him – good, bad or mysterious – at least he’s extending a hand. How powerful his arm, or slippery his grip, is up for grabs. Whatever the case, he’s committing $400 billion over ten years to fund LT healthcare costs. Advocacy groups seem thrilled, unbelieving that instead of just warbling, the government is acting.

Let me spoil the party with a caveat: it’s baby’s first step. That tower of greenbacks will be poured into Medicaid with two key aims: raising the paltry salaries of care workers, and supporting care at home and in community health centers. Nursing homes, an important venue for LT care, are left out of this funding boost. Spending may reach the stratosphere, but expect it to rise higher

I think the proposal’s OK. LT health workers are paid like 19th century cotton pickers – a scandal. Take me: I write and edit, have plenty of clients. One is dependable, but a skinflint. And yet they pay four times the hourly rate an immigrant woman of color gets to mind your grannie. But oh, do I whine. Scandalous.

The homecare focus is good, too, because it’s what the people want: riders covering homecare are commonly added to long-term health insurance policies. The government’s picking up our vibrations; baby steps, baby.

The only cause for pause is the program’s cost, which tips off the iceberg. Forty billion per year just nudges the ice flow: most long-term care costs are still unaddressed. No matter what uncles Sammy and Joe might promise, we’re still on our own: we’ll have to insure, go it alone.

Insurers now have policies that pay homecare benefits equal to those traditionally offered to cover nursing home costs. In 2019, these products comprised over 96% of the LT care policies sold and their popularity is easy to see: a home’s very walls are healing. 

Standalone LT care policies cost around $3,000 annually. Customers should buy policies with a cost-of-living adjustment to keep inflation at bay. A COLA rider is especially recommended for younger people, who face a long road to retirement. It can be expensive, but it’s money well spent. When ruing death and taxes, the ancients forgot crass inflation.

Standalone policies have one weakness: if you pass away before using the benefits, the policy cost is sunk: they offer no death benefit or cash component. Hybrid life policies are an alternative: you can withdraw accelerated benefits to cover LT care costs, generally up to $6,000/month. Total withdrawals are deducted from the final death benefit.

Insurers have many products to meet the cost of LT care: annuities with long-term-care riders; short-term care insurance, an economical way to provide daily benefits; critical care policies that pay lump sums or regular payouts.

I’m glad the government is moving on this issue. Yet I always trust insurers over politicians: if they fail, they don’t eat. I’m forced to point out, the same goes for you – so get yourself going. Not everyone has Sully to hector them out of a swamp.

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