Whenever I’m depressed about the state of the long term care (LTC) system in America, my mind wanders to other countries. What’s it like in Uganda, France, or Kazakhstan? Is it better, worse, or about the same? Apparently, Howard Gleckman heard my cry. A senior research associate for the Urban Institute (and author of “Caring for our Parents”), he tackled this topic (in response to a Washington Post piece) in a recent column for Kaiser Health News.
Starting with a nutshell history, Gleckman states that, even just 20 years ago, most developed countries approached LTC in much the same way that our current Medicaid system operates. If you’re poor enough or sick enough, you’ll get the care you need. But if you are a person of modest means, well give us a ring when you’re broke or too sick to manage on your own. Not really a great system, and certainly not financially sustainable.
Purchasing private long term care insurance has yet to turn the system around for the US, despite a strong government push towards this solution. Even today, only 7 million Americans have a policy.
European countries built on their existing national health systems to integrate a social insurance approach to paying for long term care, rather than the welfare bent so familiar to American citizens. But countries like Germany and the Netherlands have been forced to reduce benefits in response to rapidly increasing costs so I guess the grass isn’t necessarily greener there.
In Japan, the creation of a national long term care insurance system – funded by taxes and premiums based on income – successfully covers 90% of the cost of care for their 65+ citizens. Despite this achievement, Japan is also struggling to keep up with the rising costs of LTC like their European friends mentioned above.
So who’s got it right? The Washington Post seemed to think England had done a bang-up job, but Gleckman disagrees, stating, they “may face the biggest mess of all.” Entrenched in a failing welfare model and in need of reform (sound like any place we know?), the United Kingdom has struggled for more than a decade to improve its LTC system.
I’m afraid, Mr. Gleckman, that I’m just as depressed as I was before I found your article. It seems that long term care is and will be the elephant in the room for years to come, both here and abroad. The global population is aging as rapidly as the costs for care are exploding. Nothing, especially health care, is getting cheaper, and seniors aren’t getting any younger. Maybe no one has it right yet (has anyone checked that island where good health and longevity seems to be the norm?), but someone needs to figure it out soon.
SFL followers, what are your ideas for improving the massively flawed LTC system? Any thoughts on how we got in this mess in the first place?