The Longterm Care Crisis in the United States
We talk with Linda Benesch of Social Security Works about the state of longterm care in the United States – the skimpy coverage provided by public programs like Medicare and Medicaid, the outrageous costs, the for-profit corporations running the vast majority of our nursing homes, and the people – the 70% of Americans who will eventually need longterm care – who are left behind. We explore how Medicare for All would finally establish longterm care as a right and ensure our dollars are spent on care rather than profit.
Ben & Stephanie reflect on police violence and systemic racism in the U.S. – how insane we appear from the rest of the world, and how racism in healthcare probably kills more people than racism in the criminal justice system, but has far less visibility.
We turn to Linda Benesch, Communications Director at Social Security Works, to talk about long-term care (LTC) in the United States (we got an incredible window on long-term care in Denmark last episode). Linda highlights that, although we think of long-term care as a service for seniors, almost half of people in the U.S. who need LTC are under the age of 65 living with a disability. The disability rights movement has also played a leading role nationally in advocating for LTC.
If you need long-term care and don’t have a family member to care for you for free, your options are very bad. Nursing homes cost $100,000 per year on average – as Linda says, this is really a 99% vs. the 1% issue, since almost no one can afford that without a national LTC plan. Since only Medicaid (and not Medicare) covers LTC, and you have to be poor to qualify for it, to get LTC you will need to sell your home, sell your car, spend down your savings, everything you’ve worked your whole life for, to make yourself poor enough for long-term care.
Remember that study from the last podcast where you’ll need to save over $240,000 for medical and LTC costs to retire at 65? Woops – Linda tells us that’s only for medical care, and won’t help you with LTC expenses. To retire with dignity in America, you essentially have to be a multi-millionaire.
Why does LTC cost so much in America? For-profit companies and private equity firms are rampant in the long-term care system, and they profit by driving up prices on the one hand and squeezing staff (paying them poverty wages, understaffing) and slashing services for their clients. On top of this, Medicaid drives people into nursing homes, even for people who could be autonamous and functional receiving home-based care for less.
The Medicare for All movement has been increasingly embracing the movement for comprehensive long-term care. Rep. Jayapal’s Medicare for All bill in the House would cover all long-term care with taxpayer dollars, free at the point of service – much like Denmark! It would also remove the bias towards providing LTC in facilities like nursing homes, and prioritize home-based care.
Only something on the order of 7% of people have any private long-term care insurance, so – unlike universal medical care – there is no massive private insurance system that defenders of the system can try to defend. How does anyone defend our system of LTC? Linda says they don’t have to – the conversation is mostly out of sight & out of mind, and is kept there intentionally.
Time for a change!
We close with a smack-down of AARP, the group supposed to be advocating for seniors in the country, which is deeply compromised by corporate partnerships and income from health insurance and LTC companies.
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Under the circumstances, how can seniors and their families afford to pay for long term care when they need it? With private insurers retreating, government could step up and design a new program, as it did in 1965 when Medicare was enacted to address a lack of affordable, accessible health care coverage for older Americans.