What the debate's entitlement discussion means for LTC

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Elizabeth Newman
Elizabeth Newman

While I never expected long-term care to be a serious part of discussion within the three presidential debates, the wonky part of my heart still jumped for joy when moderator Chris Wallace asked about entitlement programs during the last debate Wednesday night.

To be fair, there are so many noteworthy parts of the debate that there's a legitimate question as to whether we spill ink over this question and answer. It could appear to be obsessing over the appearance of a meal you made while your kitchen is going up in flames around you.

But I'm going to make the case for why the question, and the candidates' answers, matter.

Wallace noted that the Committee for a Responsible Federal Budget looked at both Hillary Clinton and Donald Trump's plans, and said neither had a good agenda for solving how Medicare is going to run out of money by 2020.

I don't need to tell you how the funding of entitlement programs is something that keeps many in the profession up at night.

Wallace asked, “Would President Trump make a deal to save Medicare and Social Security that included both tax increases and benefit cuts, in effect, a grand bargain on entitlements?” (The full transcript is here. )

Trump answered he was going to cut taxes to grow the economy and Wallace said, “That's not going to help in the entitlements.”

Trump responded, “No, it's going to totally help you.”

And then he talked about the need to “repeal and replace the disaster known as Obamacare. It's destroying our country.”

Wallace reiterated the question to Clinton, saying, “At this point, Social Security and Medicare are going to run out, the trust funds are going to run out of money. Will you as president entertain — will you consider a grand bargain, a deal that includes both tax increases and benefit cuts to try to save both programs?”

Clinton said there needed to be more money in the Social Security Trust Fund, funded through taxes on the wealthy. When she tweaked Trump about not paying taxes, he called her a “nasty woman.”  It was perhaps the second most notable moment of the night, according to many broadcasters.

Clinton returned to the topic of the Medicare Trust Fund and asserted that the ACA extended its solvency, adding “if [Trump] repeals it, our Medicare problem gets worse.”

Trump interrupted her to say her husband disagreed with her, and Clinton countered how there needed to be “long-term healthcare drivers” focused on decreasing costs, increasing value and emphasizing wellness. That is, of course, basically reiterating the “Triple Aim” goals of the ACA. Clinton also said that entitlement spending would be under control through “more resources and harder decisions.”

I'm not naive enough to think either candidate would risk alienating senior voters by talking specifics related to curbing Medicare benefits, even if that's what many policy experts believe needs to happen. But it seems Trump could have scored better by using any of the many ways other GOP leaders have discussed plans impacting long-term care, such as Medicaid block grants or lowering prescription drug costs. It also would be completely reasonable to appeal to a Republican base by discussing overly burdensome government regulations that stifle healthcare providers. Clinton, meanwhile, could have offered blunt talk related to her support, per WikiLeaks, of the Simpson-Bowles commission and its discussion of trimming Social Security.

In a debate, there are reasons to pivot. As bland as the answer “cutting taxes” is to a question about entitlements, what struck me was Trump's pouncing on the Affordable Care Act.

Some might feel he acted as a skilled debater in moving away from a thorny topic. But my interpretation was he came off as a presidential candidate who couldn't be bothered to talk about Medicare. He didn't seem to know, nor care, about a couple of weighty issues impacting long-term care.

I'm not asking either candidate to discuss value-based purchasing at length, but it's not as if the future of Medicare and Social Security are questions out of left field.

Compare it to what is expected of you. You work in a highly complicated environment that involves taking care of complex seniors. You go to meetings where you are expected to be experts on clinical and financial topics. If you gave a presentation and merely spewed word salad, everyone in the room would know you had no idea the real challenges facing the industry. You would not be invited back.

Confidence and charisma have elevated many chief executive officers, but at a certain point the work also needs to get done. The entitlement issue appears to be a microcosm of what recent polls indicate the American people think about the candidates for the White House: One is qualified to be president and the other is not.

Follow Elizabeth Newman @TigerELN.


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Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Marty Stempniak.