Forget the Greedy Geezers and Put Long-Term Care Back on Our Health Agenda

The persistence of a stubborn federal budget deficit doesn’t prevent social needs from piling up; it just shoves them off the public agenda. Exhibit A is health care.

In defiance of the conventional fiscal wisdom, Sen. Edward M. Kennedy (D-Mass.) has joined Rep. Claude Pepper (D-Fla.) in proposing that Medicare be expanded to cover long-term nursing-home care, as well as home care for the aged. This would, of course, cost money--$18 billion a year, Kennedy projects.

Lately it has become fashionable to portray old people as a selfish army of lobbyists for federal benefits, cashing their inflated Social Security checks on the way to some watering hole for retirees in Florida, living high at the expense of us working youngsters. The New Republic recently ran a cover article titled “Greedy Geezers.” The annual cost-of- living adjustment under Social Security has become a tempting target for budget balancers.

But the reality is that the vast majority of old people are not wealthy. Half of them depend on Social Security to stay out of poverty. Only a tenth of retirees earn enough income from all sources ($25,000 a year for a single, $32,000 for a couple) to pay tax on their Social Security benefits.

And the vulnerability of older people to abrupt financial ruin from catastrophic illnesses or from the risk of having to enter a nursing home remains a terrifying reality. Congress has never faced the problem head on, leaving a gaping hole in the social safety net.

Instead, current policy leaves Medicaid, our charity program for officially certified paupers, to haphazardly plug the holes once serious illness leaves people totally destitute. If you have a catastrophic illness, or if you need long-term nursing-home care, you can eventually become a ward of the state under Medicaid. At present, almost half of all Medicaid outlays go to pay for nursing-home care for the elderly.

Some states are relatively lenient about permitting older people impoverished by medical bills to hang onto some financial assets. Others treat them like welfare chiselers. Not long ago the press reported the case of an Iowa woman, forced to divorce her paralyzed husband of 33 years so that he could qualify for Medicaid nursing care. That moved even Sen. Bob Dole (R-Kan.) to endorse socially insured long term care.

Despite the caricature of greedy geezers, the health costs of the elderly are an issue not just for old folks but for their working-age children as well. With women as well as men in the paid labor force, few middle age children can drop everything to care for an enfeebled parent. A recent poll by the Villers Foundation found that more than 80% of people in every age group thought that the government had some responsibility for long-term care. People age 30 to 39 actually supported the proposition by a slightly higher margin (89%) than old people did.

The issue of plugging the holes in Medicare is only one part of a larger social default on health care generally. The current crazy-quilt system leaves about 35 million Americans with no health insurance, millions of others with charity medicine under Medicaid, and others with private health-insurance plans that often have enormous gaps. Canada, with a coherent system of universal health insurance that is administered by provincial governments, manages to buy more health care and spend a lower fraction of the gross national product than the United States does, and the Canadian system includes nursing-home care as well.

At present, the Social Security trust fund is running an annual surplus of $36 billion. By 1992 the annual surplus will be$75 billion. This surplus was deliberately incurred in order to deal with lengthening life expectancies. It should be increased to finance future health-care costs, not tapped to cut the deficit.

It’s time to broaden social insurance to cover these gaps in medical care not just for the elderly but for everyone. And Congress would be smart to finance these needs out of social insurance, and to remove the Social Security funds from the federal budget so that the deficit-reduction crusaders keep their hands off them.