CLASS Act Failure Mirrors Medicare Failure

October 18, 2011 in Health Care "Reform", Health Policy by RangelMD

Long term care for the elderly and disabled typically covers home care, assisted living, adult daycare,  nursing home, and Alzheimer’s facilities for those who, as a result of aging and/or progressive chronic conditions can no longer care for themselves at home and perform necessary activities of daily living (ADLs). Medicare benefits do include nursing home and home care coverage but typically only for relatively short term recovery from an acute illness like pneumonia or a heart attack. Medicare beneficiaries who need long term care beyond their benefits but don’t have supplemental long term care private insurance must pay out of pocket. This is not an option for millions of seniors who have little if any financial assets or savings and are totally dependent on their Social Security income.

Enter the late Senator Ted Kennedy who advocated for a government run long term care insurance program and thus CLASS (Community Living Assistance Services and Supports program) was born as part of the mega health care reform of 2009. Except it was stillborn.

Basically, liberals looked at the long term care of rich retirees or at least those who had the foresight to purchase a long term care policy and decided that this is a new entitlement that everyone should be able to get regardless of financial ability! So they decided that they could perform a magic trick and create a government sponsored and run long term care insurance program with monthly premiums as low as $5, a short 5 year purchase period before becoming eligible for benefits, no apparent age or time limits for benefits, and no underwriting in the selection of beneficiaries. Basically it was an insurance plan without any of the rational limits and restrictions that real insurance companies use to prevent themselves from going bankrupt.

CLASS didn’t even provide all that great a benefit compared to most private policies which usually provide $200-400 per day coverage. But even a $50 a day in-home care assistant to help with cooking, cleaning, and bathing would cost over $18,000 a year.  Nursing home care would cost even more. And with no signup restrictions and no increased premiums based on overall health and age at the time of signup, the possibility that the vast majority of beneficiaries in this program would be the sickest and most infirm was too much to be able to assure that the program would be solvent in 75 years. Thankfully, an amendment was added to the act that required the department of Health and Human Services to prove to Congress that they could perform magic and create a stable and self sustaining program.

They couldn’t. And perhaps for the first time in history, a disastrous social program that would have cost the tax payers an additional $75 Billion per year was stopped before it could join the phalanx of entrenched entitlements. Once again, liberals have proven that you can’t pull water from a stone, create gold from lead, have your cake and eat it too, or buy something without paying for it.

CLASS failed for the same reason that Medicare is failing. The amounts that people pay into the system are falling short of matching the actual costs. Like CLASS, Medicare has few restrictions on the amount and types of care that beneficiaries receive. Liberal egalitarianism (“health care is a right”) demands that a severely demented 99 year old nursing home patient with terminal cancer receive the same life extending care as a 65 year old with no medical problems.

In a way, CLASS was even worse. It tried to create a new social entitlement where it’s debatable if there even is one. Despite hysterical claims otherwise, long term care boils down to one single benefit. Comfort. There is no proof that nursing home care or home assistance care or assisted living or adult day care increase life expectancy or prevents such old age maladies as falls, hip fractures, pneumonia, or strokes.

Severe cost over-runs raise the issue of whether Medicare should continue to provide for such aggressive care in those over 80 and CLASS raised the question of whether long term care is even the way to approach caring for our elders. Only about 50% of the population needs a nursing home stay at any point in their lives and the average nursing home stay is usually less than a year. The majority of elderly patients who do need assistance are cared for at home by family members or in some community care setting. Home and community care is far less expensive than facility care or having daily private assistance. More attention should be paid to assisting those families who do make the time and effort to care for an elderly loved one at home.

Then there is the rational approach to caring for the elderly. Statistically, a patient who has deteriorated in their ability to care for themselves and live independently as a result of advanced age and/or progressive medical conditions has a far shorter expected survivability than one who is relatively healthy regardless of aggressive medical care. The CLASS act does not appear to concentrate or particularly promote the option of hospice care (even for patients without a specific terminal illness) nor is there a provision to promote comfort over continued aggressive medical care. I can guarantee you that the vast majority of patients in a long term care situation continue to receive aggressive health care including blood pressure medications, statin medications to lower cholesterol, mammograms, colonoscopies, frequent testing and office visits, and frequent trips to the ER for any cough or fever or issue other than one strictly of comfort. Aggressive medical care accounts for a big part of the cost of caring for the elderly.

The Medicare lunacy of continuing to treat elderly patients in the last few weeks, months, or year or two of their lives with aggressive medical care designed more to extend lifespans rather than to promote comfort is a big part of what sank the CLASS act. Rather than concentrate on keeping the elderly alive and warehoused in facilities or with expensive home services indefinitely for the benefit of the working poor, the CLASS act might be still viable with a change in philosophy. The same goes for Medicare.

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