The Long Term Is Now
As the population ages, the costs—financial and social—of long-term care will rise rapidly. And our current model of funding it will not work.
Every five years after the new long-term care program went into effect, an independent long-term care actuarial commission would evaluate the program’s financial soundness and recommend whatever changes it deems necessary to ensure its long-term sustainability. Any proposal involving changes in benefits or the payroll tax rate would be submitted to Congress for an up-or-down vote within 90 days. If Congress failed to act, a package evenly balanced between revenue increases and benefit cuts would be triggered and would remain in effect until such time as Congress accepted the commission’s recommendations or enacted its own package making financially equivalent changes to the program.
A Moral and Responsible Goal
Our current circumstances of fiscal constraint, intense controversy over federal health programs, and pervasive skepticism about government’s effectiveness may seem like an odd time to suggest extending our patchwork system of social insurance. But reforms along the lines I’ve suggested represent the only way of achieving a morally essential goal—providing for the long-term care of the physically dependent elderly—while also meeting the equally essential practical goals of preventing unsustainable claims on general public revenues and ensuring that the states retain the fiscal capacity they need to invest adequately in the future. Americans will have to accept a broadened principle of personal responsibility as part of any viable twenty-first century system of social insurance. If the need for long-term care is an insurable event—and I’ve argued that it is—then we must all do our individual part, as our means permit, to help insure against it.
If we do what we should, my son’s generation will not have to face the burden so many members of my generation do—struggling to help parents avoid an old age of destitution and dependency. Few children want to consign their parents to institutional care if there is a reasonable alternative. Few want their parents to be forced to divest themselves of what they have managed to accumulate through decades of hard work, a process that strips the elderly of dignity and pride. But that is what our current system does. We can do better.
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