Health Insurance and Public Policy: Risk, Allocation, and Equity

By Miriam K. Mills; Robert H. Blank | Go to book overview

PART III
HEALTH INSURANCE IMPLEMENTATION

Part III considers better implementation of health care to promote responsive collaboration. Structural and procedural approaches have very human impacts on care and well-being.

Retired middle-class individuals face the dire prospect of divesting themselves of most assets and income in order to qualify for Medicaid, the major public program to pay for long-term care. Brandon in Chapter 7 suggests that it is improper to force those to whom financial security has been promised as a right through Social Security and Medicare into a welfare program that defines poverty. Although costly and debilitating, in actuality the need for long-term care is relatively rare for the elderly population. Only 24 percent of those turning 65 in 1990 will have a cumulative lifetime use of one or more years.

Social insurance is suggested as an appropriate mechanism for long-term institutional care. Brandon's proposal for a Medicaid Part C long-term care insurance proposal would draw its revenue from current Medicaid and Medicare payments for institutionalized long-term care, old age survivors and disability trust funds, and copayments from Social Security checks or publicly administered pensions. The chief protection against overuse of even the best institutional long-term care derives from the widespread reluctance to enter a nursing home. Having insurance for that purpose would not exacerbate elderly people's use of such services, but it would help cushion the blow for those who have no choice but to use long-term care when medically necessary.

In Chapter 8 Jacobson reviews the Arizona Medicaid program, which

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