Close to 30 years ago, I decided to devote my career to the field of aging and focus on issues related to the finance and delivery of long-term services and supports (LTSS).
Even back then, as a young graduate student, I saw how demographics and economics could easily conspire to crush the public financing system our rapidly aging population relies upon.
The future I feared wasn’t pretty. Families would shoulder even greater burdens when caring for parents with disabilities. More elders would be forced to spend their life savings for long-term services and supports, or figure out how to hide assets so they could qualify for public benefits. State Medicaid programs would not be able to keep up with the rising demand for services. I saw the social equivalent of Edvard Munch’s “The Scream,” except it was elders with disabilities and their families doing the screaming!
The future I anticipated back then is now the present and, with few exceptions, we are no better prepared to deal with its challenges. People’s lives are being turned upside down by our current LTSS financing system, and policy makers have been hoping no one would notice. It’s a problem that has the potential to grow even worse soon.
On the bright side, this situation has created a unique coming together in America: No one is happy with the system. Families, people with disabilities who need LTSS, providers, and policy makers at all levels agree that something has to change because our current system is woefully inadequate.
That’s why my good friend and colleague Judy Feder and I recently put forward a detailed plan describing a better way for America to finance its LTSS needs. The basic idea is to improve and transform both the private LTSS insurance market and the public LTSS welfare system.
How?
By taking advantage of what each sector does best and reimagining the LTSS system as one that is insurance-based rather than welfare-based. The public sector would play a catastrophic protection role and the private insurance sector would help people with their more manageable and affordable risks.
No one needs to tell us how difficult it is to make policy makers seriously discuss ideas like this in the current political environment. And, yes, our plan does envision a new, limited public benefit, but we also suggest a good way to pay for it. The fact is, our plan could really help America’s middle class and break the prevailing consensus about how terrible the current system is.
Perhaps I’m tilting at windmills. But I choose to view this endeavor in the same way Nobel Prize-winning economist Milton Friedman views policy work in general:
“Only a crisis—actual or perceived—produces real change. When that crisis occurs, the actions that are taken depend on the ideas that are lying around. That, I believe, is our basic function: to develop alternatives to existing policies, to keep them alive and available until the politically impossible becomes the politically inevitable.”
Marc A. Cohen, PhD, is co-director of the LeadingAge LTSS Center @UMass Boston, a professor of gerontology at the University of Massachusetts Boston, and research director at Community Catalyst. His research focuses primarily on issues affecting the financing and delivery of long-term services and supports.