This presidential race has been so crazy, with the threat to our democracy and the vitriol over Haitian immigrants and childless cat ladies, that there’s been very little talk about big policy issues. Kamala Harris is starting to change that, to cut through the nonsense and talk about things of concern to American families.
She is castling new light on a serious problem long overlooked in America, but so central in other countries: The need for home care services for the elderly.
Last week on The View, Harris said she’d ask Congress to expand Medicare to cover the cost of this long-term care in people’s homes, so elderly and disabled people can get help without having to go into nursing homes.
This is huge for caregivers, too. It would relieve the burden on the more than 37 million Americans – or 14 percent of adults – who provide some form of unpaid eldercare, around 59% of whom are women; particularly the so-called “sandwich generation” who are caught in a real bind, caring for both children and elderly parents.
Currently, Medicare rarely covers home care costs, so millions of elderly couples must drain down their savings until they qualify for Medicaid, and even then they face long waiting lists. Harris is doing a real service in bringing this issue out of the shadows, and what she’s proposing would finally catch us up with the likes of the Netherlands, Germany, France and Sweden, which already provide these kinds of services.
“We’ve been talking about this for 40 years,” Teresa Ghilarducci, a labor economist at The New School, told us, and while the issue has been picked up by some politicians on the sidelines, like Democrat Bernie Sanders or Republican Marco Rubio, Harris is giving the discussion a turbo boost. “What Harris said the administration would do was so revolutionary,” Ghilarducci said. “I never in my imagination would have thought a presidential candidate would take leadership of this.”
Harris can’t wave a magic wand and promise that she’ll achieve this, of course, given the Republican strength in Washington, where the latest polling shows the GOP is almost certain to take control of the Senate. But this plan tells us about her priorities, and steers the conversation towards substance, and away from crazy.
“It’s about dignity for that individual,” said Harris, who cared at home for her own mother, a cancer researcher, when she was diagnosed with cancer herself. “It’s about independence for that individual.”
It’s sad, really, how we treat the elderly. America is unique among its peers around the world in that we don’t have a widespread mechanism to pay for their home care; it’s the biggest gap in Medicare, experts say. We’re nowhere near prepared for when the baby boomers reach peak demand for these services, which is still probably several years off, and the lack of options is a big hole in our safety net. Paying for a round-the-clock, live-in home health aide can cost more than $288,000 a year out of pocket, according to the nonpartisan health research group KFF.
As a result, spouses or adult children are forced to step back from their jobs and burn through their own savings to be uncompensated caregivers. Elderly people often don’t get enough help, and those without family caregivers are on their own – skipping meals and meds, or falling down the stairs until the neighbors call an ambulance and they end up in an emergency room, or a nursing home. It’s awful.
This is an issue that’s long been neglected in the U.S. because it’s not seen as affecting economic productivity, unlike childcare, which frees parents to work. But the absence of care for the elderly is a job-market issue as well, especially for working women in their 40s, 50s and 60s. “Without compensating care for elders, we are creating another generation of people who are financially vulnerable,” Ghilarducci said.
Harris’ proposal is short on details and doesn’t include a cost estimate, and although she says she’d pay for it with savings from expanding the ability of Medicare to negotiate prices with drug companies – which would also lower drug costs for seniors and the federal government – the reality is, we are on an unsustainable debt path and this would add new spending. Adding a Medicare benefit of 20 hours of home care a week for those who need help with at least two major activities of daily living, for instance, would cost about $40 billion annually, the Brookings Institution calculates. Harris also wants to expand Medicare to cover vision and hearing benefits.
But if we’re talking about the national debt, let’s compare what she’s proposing, which would primarily benefit the middle class, to some of Donald Trump’s proposals, like extending his tax cuts. That would cost more than $400 billion a year over the next decade, 10 times the potential cost of Harris’ Medicare home care plan. And Trump’s tax cuts primarily benefit the wealthy. It’s a telling statement on their differing priorities. Ask yourself: What kind of a nation do we want to live in?
Think of Harris’ plan for home care as an insurance against “an unpredictable, catastrophic risk,” says Judith Feder, a professor of public policy at Georgetown University – one that’s currently lacking in both the public and private sphere. Private insurance for home care has spotty coverage at best, she notes, and the premiums keep rising. And while some people will never need this kind of care, for every family, there’s a chance. So we all benefit. “Even if you don’t end up using it,” she said, “you have the comfort of mind of knowing that you won’t be left out in the cold.”
After a lifetime of hard work, don’t America’s elders and their families deserve that much?
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Publish date : 2024-10-14 00:03:00
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