Planning for the future--long-term care and the 2008 election.

Long-term care has all the makings of a great campaign issue. It affects a large portion of the population, it is expensive (it currently accounts for about 10% of all health care costs), and it requires a unique partnership between government and citizens. Moreover, a range of constituencies perceive the current long-term care system as seriously broken. It exposes people who need services to considerable financial risk, and it too often relies on an institutional model of care that is at odds with consumer preferences. Nonetheless, the candidates in the 2008 presidential race have been virtually silent about long-term care policy. Health care received substantial attention during the 35 Democratic and Republican debates (garnering more than 1000 mentions), but almost nothing has been said about long-term care. Not a single major debate question has focused specifically on the topic, and it has been mentioned by candidates in response to other questions only 11 times. Nor has long-term care received much attention on the campaign trail. Only one candidate, Senator Hillary Clinton, has delivered a speech on the topic and proposed a detailed agenda for the future. Candidates have backed broadly appealing goals such as improving the quality of care in nursing homes, reducing hassles with companies that offer insurance for long-term care, and more frequently providing long-term care at home or in the community. There has not, however, been a serious discussion about a reformed vision for long-term care in this country — in particular, how it will be financed. (May 8, 2008)