1st Long-Term U.S. Health Plan Proposed by UC Panel : Insurance: The program would expand nursing home coverage and encourage home-based services. Critics say the new taxes needed to pay for it will scuttle the idea.
California researchers today proposed the first comprehensive national plan for long-term health care--a program that would cover nursing home care, institutional or day treatment for the mentally ill and home-based services for disabled people seeking to maintain their independence.
The plan, published in today’s Journal of the American Medical Assn., would scrap the current spotty system of paying for long-term care that in many cases favors expensive institutional care over cheaper home or community-based services. It would also expand existing nursing home and home health care services to meet patients now shut out of the system, and shore up quality through improved staffing and better training and wages.
The proposal, devised by UC San Francisco researchers, joins the growing list of suggested national health insurance plans. The long-term plan would be funded under one public program administered by the federal government through contracts with state and local agencies. Essentially, the program would shift the burden of payment for long-term care from the chronically ill to the general public, through broad-based taxes.
The cost in new taxes is estimated at up to $75.5 billion, or $410 annually per adult. But proponents of the plan say it would eliminate $52 billion in out-of-pocket costs.
New taxes to pay for such a retooling of the long-term care system would be in addition to any required to meet the short-term needs of about 37 million Americans without basic medical insurance to cover hospitalization and preventive health care. Numerous insurance reform measures, including single-payer, government-run systems, have been put forth to solve this crisis.
Critics say the costs could doom the long-term care plan, at least during the country’s current economic downturn.
“Quite frankly, a $75-billion proposal doesn’t have much chance of being taken seriously in Washington today,” said Paul Willging, executive vice president of the American Health Care Assn., which represents most of the nation’s 19,000 nursing homes. Willging’s group is vehemently opposed to one aspect of the proposal--the phasing out of for-profit nursing homes in order to eliminate financial incentives to skimp on care.
The proposal’s authors, however, argue that long-term care must be included in any national health plan. To do otherwise, they contend, would be to perpetuate a system that consigns the elderly and disabled to “warehouses,” rather than promoting independent living.
Of those currently in nursing homes or receiving home health services, 51% pay out of pocket. Many who cannot afford to pay and fail to qualify for the government’s Medicaid program for the poor (called Medi-Cal in California) are now unable to obtain services.
“People are now losing their life savings because of the way we currently pay for these long-term care services,” said Charlene Harrington, a UC San Francisco professor of nursing and sociology at the Institute for Health and Aging, who authored the proposal along with colleagues at UCSF and Cambridge (Mass.) Hospital.
The proposed long-term care plan would increase the number of nursing home beds by 20% and home care services by 50% to 100%. Based on 1990 estimates of the disabled population, these increases would be adequate to meet everyone’s needs, according to Harrington and her colleagues.
Among the proposed tax hikes would be increases in the Social Security contribution by workers and employers and a removal of the cap on earnings subject to Social Security taxes. Increases also are proposed in taxes on personal and corporate income, death and capital gains.
Harrington and supporters of her proposal believe that public unhappiness with the current system would overcome opposition to new taxes.
“Recent public opinion polls have shown people are willing to pay higher taxes to open up the health care system to everyone,” said Dr. Howard Waitzkin, professor of medicine at UC Irvine, and a founding member of the group sponsoring the proposal, Physicians for a National Health Program.
Harrington and her co-authors are an offshoot of that group, called the Working Group on Long-term Care Program Design. The physicians’ group has put forth its own proposal for a national acute care health insurance program, similar to the Canadian system. It was published in the Jan. 12, 1989, issue of the New England Journal of Medicine.
