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Sick enough, poor enough: A comparison of long term care systems

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A Washington Post article recently compared the U.S. Medicaid system unfavorably to the long term care systems for the elderly and those with disabilities employed in France and the United Kingdom. Going back 20 years, most of the developed world relied on a system similar to the one the United States uses: Poor enough and sick enough and you received some assistance; middle class and you were on your own (until your resources became so depleted that you no longer qualified as middle class.)

Most developed countries determined that this approach was unnecessarily cruel and fiscally unwise, and revamped their systems to address the need for long term care, often in arrangements that combine government assistance with private long term care insurance. The U.S. response was to encourage its citizens to purchase private long-term care insurance. Despite tax subsidies, a government marketing campaign and efforts to coordinate private insurance with public benefits, the approach has been less than successful, as today only about seven million Americans own private insurance.

The systems in place in other countries have not been without problems, such as increasing costs and uneven availability of benefits. Germany has been forced to raise taxes to pay for the benefits it provides. France, Japan and the Netherlands have had to reduce benefits. In England, the long term care model is disparaged as the “postcode lottery,” as benefits vary by local jurisdiction.

Although insurance-based systems are difficult to administer, they are superior to those that force people to impoverish themselves before they qualify for help. In revamping the U.S. health care system, perhaps legislators will examine the long term care systems of other countries and attempt to learn from their mistakes.