On Friday, the stepchild of health reform died at the hands of the Obama administration, and the obits for the troubled long-term care program were mostly similar recitations of why the administration was not going forward to implement that portion of the Affordable Care Act, how it was part of Ted Kennedy’s legacy, and how gleeful Republicans were at its demise.
The media amply quoted Senators Mitch McConnell of Kentucky and John Thune of South Dakota. Thune’s quote in The New York Times, “the Obama administration ignored repeated warnings about the financial solvency of this massive new entitlement,” gives a flavor of what they said.
The CLASS Act, short for the Community Living Assistance Services and Support Act, was a voluntary program where people could join a government plan to pre-fund some of the long-term care they might need in the future. Under the plan they would pay premiums during their working years. If they later became disabled and needed assistance, they would be entitled to a daily cash benefit of say, $50, that they could use to buy services such as a personal care attendant, home improvements that would let them stay in their house, or even to help pay nursing home costs.
Supporters saw the CLASS Act as a first step toward a national long-term care insurance program like those in other countries. Whatever its technical flaws, supporters argued that it would begin to solve the dilemma millions of families face—how to pay for a loved one’s care. Many politicians and the insurance industry weren’t keen on that idea since it could also be a first step to a publicly-financed insurance program (anathema to insurance sellers) and might cut into the market for long-term insurance, a product that has never really become a big seller primarily because of its high cost. The CLASS Act barely made it into the final bill.
Shortly after the health reform law cleared Congress, Medicare’s chief actuary Rick Foster warned that over the long term the CLASS Act may have been “unsustainable.” Because the program was voluntary, it depended on lots of healthy people signing up. That way the risk of insuring those likely to need care could be spread over a healthier population. But on Friday, Health and Human Services Secretary Kathleen Sebelius agreed with Foster and declared that there appeared to be no way to, as the reform law required, make the act actuarially sound over seventy-five years. The secretary did not have authority to change the act, but she had the task of making it sustainable, which she said could not be done. Sebelius noted that the premiums consumers would have to pay to join the plan ranged from $235 to $391 a month and perhaps as high as $3,000 under some scenarios. That was such a steep outlay that they might not enroll, causing the program to fall apart. Long-term care is expensive no matter who is providing the benefit—private insurers or the government—and that fact gets us into a discussion of social insurance with everyone in the risk pool, which I will save for another time.
Because budgets are the dominant story narrative out of Washington these days, it’s not surprising that the negative budget implication of ending the CLASS Act was as prominent a story line as those quotes from joyful Republicans. The program was supposed to reduce the federal deficit by $86 billion over ten years because people would be paying premiums and bringing new revenues into the program.
- 1
- 2
If there are private alternatives, then what good is another government boondoggle, exactly?
This is another example of a supposedly "deficit-reducing" government doleout that turns out to be a money-sucking monstrosity that nobody wants.
$3000 per month to score a $50 daily benefit?
That's the government for you.
And if you think Medicaid is bad, boondoggle-wise (which it is), just imagine how this thing would have worked!
Large gobs of cash in the hands of people who can't take care of themselves...
Yeah... That's a great plan!
#1 Posted by padikiller, CJR on Mon 17 Oct 2011 at 05:36 PM
But we already have a publicly-financed long term care solution, called Medicaid and Medicare. It's the way probably 75 or 80 percent of everyone handle their loved ones' "long term care" needs, and has been for decades.
It's a crappy system and it forced crappy choices on people, but it has one overarching advantage: it is universal.
Private "long term care insurance" (and, apparently, the public kind that was just ended) suffered from the same alleged problem all private health care insurance programs have: adverse selection. That is, they can only work if only healthy people are insured, and to make sure that only healthy people are granted policies, they develop layers of highly skilled, well-credentialed and highly-paid people to keep any sick people off the rolls. If it works--and it does!--then massive overhead costs pay literal dividends to stockholders, while thousands of well-meaning executives and actuaries and fraud examiners get good jobs in a vital industry. The only losers are, well, the LOSERS! The sick and the old.
Amazing how that works.
So the choice we face as a society is simple enough, and well illustrated by the long term care failure: We either develop a compulsory universal system that covers everyone, cradle to grave, with no exceptions and no barriers to the sick (and some of our best judges have already said that such a compulsory system cannot be built by the government mandating private coverage), or we get what we have, in all its glory.
"The Best Health Care System in the World" (TM)
#2 Posted by Edward Ericson Jr., CJR on Tue 18 Oct 2011 at 04:30 PM
The Class Act did not make sense from a numbers point of view. Too many people need care ... private long term care insurance, which is a very affordable way to plan, requires two things. Relative good health to qualify and teh need to purchase the coverage. Many people don't purchase because they are in denial of ever needing care down the road despite the fact that the federal government says if you reach 65 you have a 70% chance of needing long term care services before you die. It is also not just an old age issue and 42% of all Americans who require care are UNDER age 65.
CLASS would sell this "benefit" to ANYONE as long as it was a payroll deduction. It was a very small benefit which would not pay for much care and the cost would be high. So this means to only people who have any incentive to buy would be those who are in poor health.
The feds got the surplus up front since you had to be on the plan so long before ever having a chance to use it. Once the flood gates were opened up, there goes the money and more money would go out then go in.
The answer it to get more Americans to purchase affordable private long term care insurnace. You can puchase meaningful benefits (not 50 bucks a day) at an affordable premium, as long as you purchase in your sometime before 65, ideally in your 40's or 50's and when you are in good health.
People should work with a long term care specialist and research ahead of time. One good place is www.completelongtermcare.com.
As far as the federal government goes, get out of the way, provide some tax incentives to encourage people to plan, cut overall spending and reduce regulations and watch the jobs increase as the economy grows.
#3 Posted by Dr. Robert Weed, CJR on Tue 18 Oct 2011 at 04:34 PM
Well, at least Trudy is becoming more frank with her readers.
She's admitted her view that the best medical care for patients may not be what's best for the good of the "system" (whatever that means to commies).
Putting this commie notion in plain view is a good thing - finally the readers can see plainly where she stands.
And the simple truth is that most Americans want good health care - not cheap health care. They don't want a "system" cramming crappy health care down their throats.
#4 Posted by padikiller, CJR on Wed 19 Oct 2011 at 10:54 AM