Health reform debate overlooks long term care, Tom Daschle says

As Congress takes up health care reform, too little attention is being paid to long term care.

That was the overall assessment of speakers participating in a forum in Washington last Monday on the future of health care for seniors. The forum, which drew about 400 attendees, was sponsored by the Volunteers of America, a faith-based social services organization in Alexandria, Va.

“As we consider the whole issue in the next hundred days of health care reform in America, so little attention is being given to long term care,” said former Senate Majority Leader Tom Daschle, D-S.D., a participant on the panel. “The repercussions of this explosion in long term care are huge.”

Mr. Daschle, a special policy adviser in the Washington office of Atlanta law firm Alston & Bird LLP, withdrew his nomination to be secretary of the health and human services in February due to tax problems.

Many seniors need access to LTC services but are unable to get it, said Charles Gould, national president of Volunteers of America, which is the third-largest non-profit provider of nursing care in the United States and the seventh-largest non-profit operator of nursing home facilities.

Today, 10 million people are in need of long term care, he said.

The number is expected to climb to 15 million in less than 10 years, and 60% of them will be seniors, Mr. Gould added.

“This is the greatest problem they have, that Medicare doesn’t provide long term care,” he said.

People eligible for Medicaid, the federal health care program for the poor, can receive long term care, but only after beneficiaries have exhausted almost all their financial resources, Mr. Gould said.

What’s more, Medicaid has “an institutional bias” because relatively few home care services are covered under the program, he said. States have different rules for covering home-based services, and there are about 330,000 people in the United States waiting to receive home-based services, Mr. Gould said.

“We find that we have to help people maneuver this complicated system,” he said. “It’s a very broken system.”

Mr. Daschle, who was nominated by President Obama to lead the effort for health care reform, said that he isn’t optimistic that comprehensive legislation will be enacted this year.

“I wish I were a little more optimistic about it, but I’ve been through a lot of these battles in the past,” Mr. Daschle said.

There was general agreement among the panelists that health care costs must be brought down.

Although there will be an initial cost to bring the nation’s 50 million uninsured into the system, an estimated $1.7 trillion could be saved if health care costs can be trimmed by just 1.5%, Mr. Daschle said.

In addition to covering everyone, comprehensive health care must address the needs of the 48% of people who have health insurance but are underinsured, including those without LTC insurance, he added.

In making his case that U.S. health care must be improved, Mr. Daschle cited a report released in 2000 by the Geneva-based World Health Organization in which the United States was ranked 37 out of 190 countries in terms of the overall quality of its health care.

“We should be ashamed as a nation where we stand in terms of care,” said anthropologist and writer Mary Catherine Bateson, president of The Institute for Intercultural Studies Inc. of New York. “We need to find a way to address the issue of care as a national emergency, as part of who we are as a nation.”

The panelists were optimistic that a solution will be found to address the expected insolvency of Medicare, which is forecast to happen in 2017.

“We will find ways to deal with it,” said former House Speaker Newt Gingrich, who founded the Center for Health Transformation in Atlanta.

Mr. Daschle agreed, saying that the president will have to get involved in the issue in order to find a solution.

E-mail Sara Hansard at [email protected].