Alternatives and options for financing long-term care.

To the average citizen, no health issue could be of less interest - yet be so significant to his security in later life - - than long-term-care needs. Today's existing system throughout the field is fragmented and incomplete, indicating the importance for a comprehensive policy that would encompass federal, state, local, and private efforts to provide adequate financing of LTC services for the elderly. For pragmatic if not philosophical reasons, it is imperative to recognize that reliance on public financing may no longer be a feasible or acceptable option. This article purviews the current policies in the LTC arena, which contribute in financing policy and service delivery, and examines some alternatives and options in the public and private sectors that might help to formulate a more cohesive policy in the future.

Background of the issues

Youth clearly has the advantage and enjoys the protection and sustenance of a grateful society. The elderly, though once young themselves, have lost their utility and, hence, their "worth." In an ideal society, old age alone would qualify a citizen for income support, housing, and social and medical services. American society, however, embraces different priorities due to an ever-widening political pluralism and the great problem of megabudget deficits. No one, it seems, is championing the causes of the elderly with sufficient voice to establish the graying of America as one of the more important public-health issues. Much fairer treatment is afforded workers' families and children - - two of the more dependent and unproductive groups in society. New federalism has popularized reduced government responsibility to provide for dependent populations.

LTC financing of the elderly is opposed on two counts. First, the govemment's role in reducing the mounting national debt minimizes the fact that the elderly already have paid for care under Medicare and Social Security payroll taxes. The government, bowing to special-interest pressure, has allowed price escalation of health services to go unchecked, even though it is within society's interest and power to do something. The intimidation that lies at the heart of the U.S. political system results in governmental policies against those who can least combat such policies.

Second, and more important, those policies have the corrosive effect of jeopardizing even further a sense of responsibility to the elderly: the belief that government is under no obligation to provide for economically-unproductive people who have failed to provide for their old age.

Third, it proclaims that productivity and utilitarianism are the criteria of merit and worth to society. Not only is that view inhumane, but it delegitimizes the right of the elderly to lead dignified and independent lives.

No one in our society questions the provision of education to children who, asa group, are among the most unproductive. That investment is intellectualized in the belief that future contribution to the collective good and the continuation of society will prevail. When a child drops out of school, society goes to great efforts to rescue him and return him to the group. Don't the elderly deserve equal treatment? Our entire educational system has evolved and prospered through federal and state mechanisms in a highly-coordinated and controlled effort at the community level.