People are often astonished when they discover that “health insurance” is insurance for medical procedures and, perhaps, medication. When they first need care from someone who isn’t considered a health care provider, like a personal care attendant, or first need care that isn’t intended to be curative, like physical therapy for maintaining abilities, they discover just how much is left out.
So many Americans assume Medicare includes nursing home care until they find themselves left in the lurch. They debate quitting their jobs to provide unpaid care at the same time they’re hit by bills for the many things that insurance doesn’t cover.
Planning ahead for old age often means giving away money to family members so those who anticipate needing long-term care can qualify for government programs for the poor. It’s hard for me to imagine an America where people don’t fret over whether to hold onto their retirement savings for as long as possible and face losing it all to nursing home care and medical bills or to give it to their heirs now and be beholden to them to cover their bills in order to qualify for Medicaid.
It seems clear to many people that health care is one of those things that falls under the responsibility of the government. We all need it, to dramatically varying degrees. It’s not something individuals can reasonably prepare for, given the impossibility of predicting our needs at an individual level compared to the national level. Like childcare, it’s not something that can reasonably be provided by any one person. It’s something many people are uncomfortable monetizing, branding, and marketing. Yet the current governmental provisioning of health care leaves much to be desired.
Care work advocates have long been fighting for programs to ensure everyone who needs care can access care. They’ve fought for programs to ensure families can take care of their own without losing everything. They’ve fought for public options like day programs, home health, and residential facilities. They’ve fought for the right of care recipients and care workers to choose the care that’s appropriate for them. The pace of change in government can seem glacial. Especially for unpaid caregivers who are taking it one day at a time, one moment at a time, in the meantime.
Washington State passed the LTSS Trust Act three years ago, to fund long-term care. It was a huge victory. A victory for people who need long-term care seven years in the future, since that’s the time between signing and enactment.
KHN explains what’s happening:
The WA Cares Fund, which was set to begin collecting money for the program with a mandatory payroll tax on workers in January, has been delayed while lawmakers made adjustments during the current legislative session. Payroll deductions will start in July 2023, and benefits will become available in July 2026.
This wasn’t the first bill designed to address care work in recent US history.
The federal Community Living Assistance Services and Supports Act (CLASS Act), which was part of the Affordable Care Act, created a voluntary long-term care buy-in program, but it was never implemented because of concerns it wouldn’t be financially sound.
Of course, there’s the proverb: “The best time to plant a tree is twenty years ago. The second best time is now.”
In the meantime, we continue to rely on each other and our communities.
Mathias Jakobsen offers tips for what to do when shit is about to hit the fan.
Virginia Pelley has tips for supporting a partner who’s suffering from burnout.
Caitlin Owens explains the massive markups on cancer drugs in some US hospitals.
Nathan Yau has a neat little chart showing us who people spend the most time with, by age.