Views from the Democratic National Convention.

Having served on advisory panels for the president and Congress, and after spending a week at the Democratic National Convention, I found clear differences between the Democrats and Republicans regarding the healthcare agenda. There were signs at both conventions that long-term care issues are beginning to get the attention they deserve. Comments and statements I was able to glean at the convention in my own backyard (Los Angeles) showed pretty clearly the direction in which one of the major contending parties is heading on healthcare. You can be sure that the Republicans will take issue with much of it.

A good place to begin might be with the party platform that the Democrats approved:

On protecting and strengthening Medicare: "It is time we ended the tragedy of elderly Americans being forced to choose between meals and medication. It is time we modernized Medicare with a new prescription drug benefit. This is an essential step in making sure that the best new cures and therapies are available to our seniors and disabled Americans. We cannot afford to permit our seniors to receive only part of the medical care they need.

"Democrats believe Medicare is worth fighting for--and worth saving. With the number of Americans on Medicare expected to double in the next 35 years, Al Gore has stepped up and taken responsibility by proposing a Medicare Lock Box that would insure Medicare surpluses are used for Medicare--and not for pork barrel spending or tax giveaways. We should also modernize Medicare by promoting competitive prices and remain vigilant against Medicare fraud."

On eldercare: "The Baby Boomers are the first generation with more parents than children. Many families are doing all they can to help and care for their elderly parents. These families are doing the right thing--and America must be on their side. We must do more to support the families and individuals who are caring for relatives suffering from long-term illnesses at home or at institutions. We should provide Americans with long-term care needs and their caregivers a $3,000 tax credit. We should hold those who care for our nation's elderly to the highest standards and improve these workers' wages, benefits, training and working conditions. We should make sure that every community in the country has a program to offer caregivers critical information, referrals, and respite from the difficult work of caring for a loved one."

President Clinton and candidate Al Gore both weighed in with their views on the matter. Said Clinton: "We have extended the life of the Medicare trust fund by 26 years from 1999 to 2025, lowered Medicare premiums nearly 20%, and strengthened protections for beneficiaries and low-income seniors. We need to have a National Patient's Bill of Rights that includes long-term care."

Gore added, "In 1997, I favored immediately rewriting the 1997 Balanced Budget Act to ensure that hospitals and nursing homes get the reimbursements they need. And in 1999, the administration fought for and won $16 billion over 5 years. Over $2.7 billion during 5 years would go to nursing homes, and caps on therapy services were to be lifted. In January, the administration announced a proposal to invest $28 billion over 10 years to support families with long-term care needs. This proposal would provide families with long-term care needs with a $3,000 tax credit, establish a Family Caregivers Program, and improve Medicaid eligibility for home- and community-based care. The proposal also encouraged partnerships between low-income housing for the elderly and Medicaid to promote home-based long-term care. Finally, the proposal called on the government to offer high-quality long-term care insurance to federal employees as a model for the private sector."

Gore's running mate, Senator Joseph Lieberman (D-CT), observed, "We know that healthcare is one of the most important problems facing families today... Medical decisions should be made by doctors, not bureaucrats. We believe that senior citizens shouldn't be stopped from filling a prescription because they can't afford... it. We want to use America's hard-earned success to preserve the future of Social Security and Medicare, to pay off our national debt, and cut the taxes of middle-class families."

The Senate's controversial "grand old man" of healthcare legislation, Senator Edward Kennedy (D-MA), hit closer to home when he said, "Hospitals, home health agencies, nursing homes and other Medicare providers have been seriously hurt by reductions in their Medicare reimbursements. The Congressional Budget Office now estimates that the savings from the Act are nearly double the original savings estimated in 1997. We must also address the fact that current Medicare benefits do not fully meet the needs of the elderly. Medicare does not cover prescription drugs, long-term care, eye care, or dental care. Due to gaps in Medicare and the high costs of supplemental private coverage, Medicare actually covers only 50% of the elderly's total healthcare costs. Senior citizens, on average, must pay almost 20% of their income for the full healthcare they need.... Only one-third of Medicare beneficiaries have reasonably adequate prescription drug coverage--usually through an employer-sponsored retiree benefit plan or thr ough Medicaid. A smaller fraction of beneficiaries have limited coverage through an expensive Medigap policy or a Medicare HMO, and one-half of Medicare beneficiaries have no coverage at all.... Without coverage, monthly out-of-pocket bills of $100 to $200 a month are not uncommon, and will go higher as drug prices continue to rise."

In personal interviews, First Lady and U.S. Senate candidate Hillary Rodham Clinton averred that "our generation has a rendezvous with responsibility," and Health and Human Services Secretary Donna Shalala said, "Nursing homes need opportunity and a clear vision, and Al Gore will give them that."

There were many references to the truly hot healthcare issue of the day--Medicare prescription drug benefits--and it will be interesting to learn how this will translate to nursing home providers who are responsible for the medications required by their residents. There were, on the other hand, interestingly few references to a healthcare crisis that is ongoing and taking place in a lot of people's backyards, i.e., the filing for bankruptcy protection by many of the largest post-acute care corporations in America during the past year. This is conceivably the most underattended crisis in America today.

I brought a personal bias to my observations of this convention. In my view, the Democrats offer a specific plan to address healthcare, but an underfunded one. The Republicans say they have a plan, but details have been a well-kept secret, at least as of this writing. Even with a president who is considered to be a "friend" to healthcare (if not necessarily long-term care), progress continues to be thwarted by the Republican-controlled Senate. Maybe the focus for healthcare providers ought to be on changing the composition of the Senate.

In the end it is true that, as the Democrats say, "it is the economy, stupid." But there are two integral parts to any successful economy: financial resources and human resources. Human resources depend on the nation's ability to promote human potential through education and quality of life through decent healthcare. Falling short of these goals will create a financial burden so great it could collapse even a booming economy. Expecting to accomplish any less is, to me, morally inconceivable.

As always, I would like to thank the readers who write in support of this column. Ideas that you feel would be helpful to readers should be addressed to Laura Hyatt, Hyatt Associates, 2956 Kelton Ave., Los Angeles, CA 90064. Be sure to include your name, organization, address and phone number.

Laura Hyatt, MBA, is president of Hyatt Associates, Los Angeles, California, and a member of the business faculty at Mount St. Mary's College.