National Physicians’ Organization Sponsored Long-Term Care Proposal

In Irene Wielawski’s article on the recent national long-term care proposal (“Long-Term Health Plan Proposed,” Dec. 4), three crucial paragraphs that appeared in other editions of The Times were inadvertently left out of the Orange County Edition.

As a result, the story published in the Orange County Edition did not identify the national physicians’ organization that sponsors the proposal. The published article also ironically omitted an important connection to Orange County.

The proposal, which advocates a fundamental restructuring of long-term care services for elderly people and the disabled, is an official proposal of Physicians for a National Health Program (PNHP). PNHP is a national organization of more than 4,500 doctors, in all states and specialties, who are seeking a national health program that provides universal entitlement to basic health services while controlling the costs of care. Our organization previously proposed a national acute care program, modeled along the lines of the largely successful, single-payer model adopted in Canada.

The new chronic care proposal, published Dec. 4 in the Journal of the American Medical Assn., calls for a major overhaul of the current chaotic, anxiety-provoking, and very expensive approach to long-term care. Nursing homes and other chronic care facilities very often are degrading and low-quality institutions that resemble warehouses for the elderly and disabled. Despite more than 80 uncoordinated federal long-term care programs, more than half of actual long-term care expenses are paid for out-of-pocket, and about 70% of services are actually provided by unpaid care-givers, usually women who are family members or friends.

The PNHP proposal would reorganize long-term care so that state and local public agencies would assure eligibility for needed services and would monitor quality. Informal care-giving at home, as well as institutional care, would be supported. Cost controls would result from reducing unnecessary administrative costs through a single-payer system and from phasing out for-profit activities in nursing homes and other long-term care facilities, with fair compensation to owners for past investments.

The program would cost about $70 billion per year, of which $50 billion would come from money currently spent by the federal government and by families out of pocket; about $20 billion would come from very limited, progressively structured, new taxes on such items as cigarettes, alcohol, emissions that pollute the environment and estates.

The PNHP proposal was drafted by specialists in long-term care and gerontology based at UC San Francisco and Harvard Medical School. This draft document was reworked and edited by a national, 18-member working group (of which I was a member), and then was ratified as an official position paper by PNHP’s national membership before it was submitted for publication.

Our long-term care proposal was presented at news conferences in all regions of the country one day before the article was published. UC Irvine was selected for the Southern California region. Three PNHP colleagues (Drs. Nancy Gin of Orange, Jerome Tobis of Corona del Mar, and Caroll Yap of Newport Beach) and I coordinated the news conference at UCI Medical Center.

We in PNHP continue to believe that our long-term care proposal deserves serious consideration as a way to deal with the disgraceful and very costly problems that currently confront us.

HOWARD WAITZKIN, MD, Professor of medicine, UC Irvine