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A strange silence.

Those of us who specialize in purveying aging-related information have a great time scaring people with projections of "the graying of America." Over-85-year-olds have been proliferating for some time now, and over-100-year-olds are becoming our fastest-growing demographic cohort (there'll be over 100,000 of them in a few short years). We like to view these predictions with alarm and say, "Look out! What's going to happen to healthcare services, housing, our society in general, when the elderly Baby Boomers hit full force?"

Maybe it's just too scary to contemplate. Or maybe events occurring in the 21st century sound too remote. Whatever the case, Washington's silence on all this is overwhelming - or maybe "stunning" is a better word.

As our "News Notes" columnist Ronald Schwartz pointed out recently, President Clinton's "State of the Union" address made no mention of new long-term care programs for the elderly. His major proposals include extending Medicare to those frisky 55- to 64-year-olds, expanding children's health insurance and giving managed care enrollees a bill of rights. Long-term care providers got short shrift; perhaps it's a matter of "let them eat PPS and Medicaid waivers" (though no one in Washington puts it quite that way).

Then there is the Medicare Commission, which is bipartisan and therefore slow moving, certainly insofar as long-term care is concerned. In fact, as of this writing, there appears to have been no formal proposal or deliberations planned focusing specifically on long-term care. Apparently, Medicare's traditional acute care and subacute care concerns are enough for members to think about.

Washington's silence on long-term care in fact carries on a long tradition. Even during Senator Ted Kennedy's 1970s heyday as a national health insurance firebrand, not even his controversial "Big Government" plan made mention of long-term care. "It simply costs too much," was one Kennedy staffer's explanation at the time. The truth is, the real "third rail" in American politics - even more than Social Security - is (you guessed it).

There have recently, however, been a couple of semi-audible cries emitting from Washington's wilderness. One was from David H. Brenerman, representing the Health Insurance Association of America in hearings before the Subcommittee on Civil Service of the House Committee on Government Reform arid Oversight. Mr. Brenerman suggested that the Federal government should take the lead in offering its own employees private long-term care insurance, partly as a means of inspiring other employers to do so throughout the land. Leaving aside Mr. Brenerman's obvious corporate self-interest in proposing this, it seems to be a not-at-all unreasonable idea. If the Feds truly prefer private initiative to government programs in this area, they should put their money where their mouths are.

A second somewhat startling warning sound came from the unlikely direction of Speaker of the House Newt Gingrich (R-GA). Mr. Gingrich took the unusual stance, for him, of actually recommending expansion of a Federal government program - in this case, federally sponsored research on Alzheimer's disease. Following an Alzheimer's Association public policy forum in Washington, and amidst subsequent warnings from some of his Congressional colleagues that America faces a 21st-century Alzheimer's "epidemic," Gingrich signed off on a pledge to seek an added $100 million for Alzheimer's research, which he said offered "the biggest payback" of all scientific research.

So it's not as though nobody's paying attention. It's just that few Washington policy makers show obvious concern that today's Boomers are heading for an era of support services that, by and large, they won't be able to afford. That's why the silence is so strange and stunning.
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Title Annotation:healthcare services
Author:Peck, Richard L.
Publication:Nursing Homes
Article Type:Editorial
Date:May 1, 1998
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