NYT Editorial: The Long-Term Care Conundrum

A graying population and the fiscal woes of Medicaid are forcing the nation to reconsider how best to provide long-term health care for the aged and disabled. States are experimenting with ways to reshape their long-term care programs, the National Governors Association has proposed measures to restrain Medicaid spending for the needy and encourage greater use of private insurance, and Congress is moving to close loopholes that allow some well-off Americans to hide assets so as to qualify for Medicaid. The flurry of activity won't come close to solving the nation's long-term care problems, but it usefully highlights how far the country is from seriously confronting this issue - either through public programs or private insurance.

MEDICARE Long stays in nursing homes, where the average cost has reached $70,000 a year for private patients, are not covered by Medicare. In a more rational world, Medicare would cover long-term care much as it now covers short-term illnesses for older Americans. But with federal deficits looming for years to come and the government struggling to rein in existing entitlement programs, the political climate makes it impossible to even consider that now.

MEDICAID By default, Medicaid has become the primary payer for long-term care. It accounts for almost half of the nation's spending on long-term care and shells out more money to nursing homes than to hospitals or managed care companies. But Medicaid is a means-tested program that serves the poor and those in the middle class whose assets are quickly exhausted after a short stay in a nursing home. Given efforts in Congress and many states to restrain growth in Medicaid spending, people will find it harder to get help from this source in the future.