Healthcare reform unlikely to include long-term care

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Stephen A. Moses
Stephen A. Moses
Will healthcare reform include long-term care?

In a word, no.

In fact, major healthcare reform, with or without long-term care, is highly unlikely despite building momentum and fertile political conditions.

The main reasons are the imploding economy and ballooning expenditures of money we don't have and can't get without dire consequences.

Consider the money. Add up the continuing resolution to fund the rest of fiscal year 2009 ($410 billion), the proposed fiscal year 2010 budget ($3.6 trillion), a $634 billion "down payment" on health reform, the "stimulus" ($787 billion) and an alphabet soup of public and private bailouts (TARP, TALF, etc.). What do you get?  Call it $10 trillion of money spent or obligated that we do not have.

That amount is staggering and unprecedented in American history. But it's only 10% of the larger unfunded liabilities this country's committed to spend.

The unfunded liability for Social Security is $16 trillion. Medicare's is $86 trillion. These programs have zero money in their "trust funds," which have already been borrowed and spent by the federal government.

Never mind Medicaid and long-term care. Medicaid doesn't even have a phony trust fund to hide its enormous unfunded spending commitments.

Now, what happens when you spend money you don't have?

Individuals can pay it back out of cash flow and/or borrow more money. Governments have a third option. They can print extra money.

Let's consider all three of the options available to government. What'll happen with each?

If politicians increase taxes enough to cover these hemorrhaging expenditures and promises, they will destroy the productive economy's ability to generate the profits to tax in the first place. That's an economic whirlpool.

If they borrow the money, interest on the burgeoning debt will gradually crowd out the very spending they're borrowing to cover and international lenders will demand higher and higher rates of interest. That's a vicious circle.

If they print more money to cover unfunded spending and liabilities, inflation will consume the value instead. That's "stagflation."

Clearly, the federal government has painted us into a fiscal corner from which there may be no collective escape. Individuals, especially the young, and the private sector will bear the burden of a long, slow return to financial stability.

By that I mean this: Because the government can't tax, borrow or inflate its way out of this mess, they'll have nowhere else to turn but to ratchet down entitlement programs and other public spending.

Medicaid, ostensibly a welfare program, but always before a de facto entitlement, will no longer finance long-term care for the middle class and affluent.  The best we can hope is to save something for the poor.

Social Security and Medicare will be welfare-ized. It's already begun with means tests that tax or reduce Social Security benefits and drive up co-insurance for Medicare's Part B and Part D for higher income people.

When current health and long-term care reform proposals hit the fiscal wall, government will pull back the traditional social insurance and welfare "safety net" little by little. As that happens, individuals and families will return to savings, private insurance and personal responsibility.

Maybe our Depression-era parents were right after all. Save, invest and insure, they warned. Don't count on anyone else, least of all the government, to bail you out.

Steve Moses is president of the Center for Long-Term Care Reform (, a private institute dedicated to promoting positive public policy for the long-term care field.  

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