LTCI Watch: Maine

A budget-conscious conservative shouldn’t want Medicaid to be spending any more nursing home care than it absolutely has to — if it spends anything on nursing home care at all.

A liberal who thinks the government should try to help the poor might think the government should use its money to help sick, elderly and disabled people who are genuinely poor, as opposed to people who do have serious health problems but also have $786,000 in home equity.

I think the secret here is that, aside from individual families that want to help Grandma stay in a nice nursing home and also keep Grandma’s house, the people who think Grandma should be able to keep $786,000 in home equity and still qualify for a program for poor people are people who are thinking with their kind, fuzzy hearts and not with their cold, rational heads.

I know, for example, a woman (let’s change all of the details to protect the identity of people whose stories I might be misconstruing) who inherited a house in Maryland with her sister. This woman has a lousy work history. She is poor herself, more because she has done a rotten job than because of the state of the economy. Her mom went into a nursing home, somehow qualified for Medicaid, and was able to pass a nice  house on to the Maryland woman. Because the woman inherited the house, she has a place to live, which is great. I’m so happy that she has that house. Who knows where she’d live if she didn’t have that house.

If I were an elder care planning lawyer who had members of that family as clients, of course I’d feel like going to Washington to defend the right of that family to keep the house and keep the daughter off the sidewalk. 

And, of course, there are other families in which the adult kids can all earn a real living, but Grandma’s house is a beloved treasure trove. How can we make families sell treasure troves full of memories just to hold down Medicaid spending?

And, of course, this problem is much harder for Kathleen Sebelius, the secretary of Health and Human Services, for other administration officials and for members of Congress.

When they are the gatekeepers, how can they say “no” to all of those feckless adult children who have trouble holding down a job and to all of those responsible adult children who can’t quite pay for 5 years of nursing home care, who didn’t think to buy private long-term care insurance early enough, and who want to keep their childhood tree house in the family?

How on earth can members of Congress and the workers who handle their constituent services slam the door in the face of voters who are just trying to hang on to a tree house?

The answer, of course, is that needs are endless, resources are limited, and we voters have to somehow get ourselves to be responsible and make it clear that we support efforts by government officials to say no. 

When we say we want our bread and circuses without being willing to pay a dime more in taxes, then we get the government we deserve. It’s fine to debate when we cut costs and when we raise taxes, but, somehow, whatever choice we make, we have to get real about the math, or there is no way our public servants will be able to do so.