We're Aging, but Our Care System Isn't Keeping Pace

By Laura Brod and Paul Thissen, The Star Tribune

September 18, 2008

The current malaise in America's and Minnesota's long-term care service delivery and financing system is the result of the well-intentioned, but often perversely counterproductive public policy incentives. To solve our long-term care problems, therefore, we will have to change the incentives in public policy which have caused the problems. This will mean finding ways to ensure that more people pay privately for long-term care so that those who have no other choice but to rely on public programs will have financially healthier programs on which to depend. By increasing private financing and reducing Medicaid dependency for long-term care, states can improve the access to and quality of care for all Americans: rich, poor and in between. Plan early. Save. Invest. Insure. 

We loved the spirit and passion for change reflected in our parties' recent national conventions. But missing from each convention's big stage was a discussion of one major challenge we face: How will individuals and government pay for the long-term services and care that millions of older Americans -- and younger people with physical challenges -- need now and will increasingly need in record numbers?

Tens of thousands of Minnesotans and 10 million Americans, including 6 million over age 65, need long-term care. Despite families' considerable efforts to provide care themselves, and despite huge public expenditures, the system is still failing many families and individuals. Many people are still left to struggle with unmet needs and catastrophic costs.

Medicaid -- Medical Assistance in Minnesota -- was originally designed to be a safety net for families. Unfortunately, Medicaid has become our largest payer of aging services and the sole long-term care insurance policy for most Americans. The system is not working.

State government will be hard-pressed to sustain the rising costs of long-term care under the current system. Since 2000, Minnesota state government's spending for long-term care has almost doubled to more than $1.3 billion, with $7 out of every $10 going to government-funded nursing homes. And that doesn't cover actual costs of care. Further, due to its origins as a "pay-as-you-go" entitlement program, Medicaid requires middle-class families to impoverish themselves in order to qualify for help. It makes no sense for that to be the default retirement and long-term care plan for the majority of our citizens.

How do we move forward?

As citizens, we need to adopt a different mind-set toward planning for our long-term care. We can't continue shirking solutions by ceding to complexity. We must change. Minnesota is in a great position to collaboratively push ideas forward. After all, the best public policy is born by finding areas of common ground.

One point we believe Minnesotans can agree upon is that those who can afford to do so should start saving for their retirement and long-term care needs. The state can jump-start that process by offering incentives for saving. The Legislature's 2020 Conference recently joined Ecumen, the Citizens League and Minnesota Chamber of Commerce to host Nebraska's state treasurer, Shane Osborn. He described Nebraska's new, one-of-a-kind long-term care savings plan. The model is similar to the college 529 savings plans with which many families are familiar. We think it is worth enacting a similar savings plan in Minnesota.

Minnesota doesn't have to create all ideas from scratch. And we don't have to wait for Washington. In the upcoming session, we plan to work with colleagues on both sides of the aisle to adopt the Nebraska plan for Minnesota. It's one of many communitywide, collaborative steps we see ahead to ensure that Minnesota not only rides the age wave but gets in front of it.

Of course, there are many other ideas for transforming long-term care. We look forward to a robust discussion during the rest of this election season and into 2009. But we know we must act -- and act together -- to make our vision of a Minnesota where people can age with independence and dignity a reality.

Tomorrow is knocking and will be here before we know it. We should answer.

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