Connections: Your Tired, Your Poor

How do you, personally, Republican or Democrat, expect to pay for your own health care when you are 80 or 90 years old?

   Amid all the acrimonious and confusing debate about health care as election rhetoric rises to a fever pitch, one fact is indisputable:
    Medicaid “is the only safety net for millions of middle-class people whose needs for long-term care, at home or in a nursing home, outlast their resources.”
    The statement is from the first paragraph of a page-one story in The New York Times of Sept. 7. It haunts me, although it wasn’t a surprise. Getting older myself, I am fortunate to be able to afford long-term care insurance, and I hope it will help me live on my own in my last years without becoming a burden to anyone in my family.
    My parents were lucky to live a long time in good health. They eventually moved to a pleasant apartment in a complex for seniors in Deerfield Beach, Fla., and my father, who collected premiums as a Prudential Insurance agent with a route in a lower-class neighborhood of Jersey City, lived till 96. My mother, who died at 94, spent the last two years of her life with me.
    My mother’s surviving sisters were not so lucky. One was widowed as a young woman and did not have children; the other never married. By the time they were in their late 60s, they were sharing a subsidized apartment in a poorly maintained building in Bayonne, N.J. Neither had anything much in the way of income, although Miriam’s husband had been in the Army during World War II and worked in a hardware store after the war. As they aged, I arranged for one, and then the other, to go to nursing homes — on Medicaid. My brother and I, their only close relatives, were in no way able to pay for their nursing-home care. Such care, according to The Times, now averages $80,000 a year.    Let me repeat that: $80,000 a year.
    The Times article described a retired schoolteacher with dementia who went on Medicaid after depleting rather impressive lifetime savings of $300,000. All but $50 of her monthly income, $969 from a pension and Social Security, went to the nursing home. “I’m so scared about what’s going to happen to me,” her 66-year-old daughter, also a retired schoolteacher, told The Times.
    And if this is the fate of someone who dedicated a lifetime to a unionized public profession like hers — during those halcyon decades when a pension was what most people earned and expected — what should everyone else (the self-employed, people in service industries, people working for Wal-Mart — America’s and the world’s biggest employer — people who have bounced around from position to position in the “new economy”) expect?
    How do you, personally, Republican or Democrat, expect to pay for your own health care when you are 80 or 90 years old?
    The personal becomes the political when you consider that 63 million Americans depend on Medicaid, not only the elderly but poor children who otherwise would not have medical care and disabled people with conditions such as Down Syndrome and severe autism.
    Although there has been vociferous debate about the Republican plan to redesign Medicare, if approved the changes wouldn’t begin for 10 years. However, the Republican candidates for president and vice president have promised that next year, in 2013, they will start cutting Medicaid by one-third (some sources say 35 percent, others 39 percent), or $810 billion, over the next 10 years. Meanwhile, as baby boomers get older, the ranks of Medicaid recipients can only increase.
    “And just think about it,” said President Clinton, who laid all this out very effectively at the Democratic National Convention last week, “If that happens, I don’t know what those families are going to do. So I know what I’m going to do. I’m going to do everything I can to see that it doesn’t happen.”