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Previously in Politics & Prose:

  • The King of Drudge -- February 1998
    A look at a new biography of the man behind the assembly line -- whose ideas need to be acknowledged and abandoned.

  • Color Us Green -- January 1998
    A heretical new approach to economics puts ecology first -- and may change the way we think about growth.

  • The Deep Slumber of Decided Opinion -- December 1997
    Those who hail the virtues of trade without limits are this era's reactionaries.

  • A Barbarous Frenzy -- November 1997
    A new book documents the Rape of Nanking, China's "forgotten Holocaust."

  • Let Them Eat Empathy -- October 1997
    The era of big government has given way to the era of sharing leftovers.

  • Down With Majority Rule -- September 1997
    Imagine an America where the majority does not rule. That may be what's needed to resuscitate our political system.

  • Talkin' About a Coalition -- August 1997
    Is there a new Democratic majority in the making? Perhaps, but what will it stand for?

    More by Jack Beatty in Atlantic Unbound

  • The Price of Longevity
    The real problem with Medicare is that it pays for too little care

    by Jack Beatty

    March 11, 1998

    Remember the cliché "unmet social needs"? Once a staple of liberal Democratic oratory, it was a conceptual portmanteau bundling together urban poverty, slums, infant mortality, poor education, and chronic unemployment. These social needs were to be met on a society-wide basis by government action, which is to say by investing tax money in noble works of reclamation. Since the poor neither vote in great numbers nor give campaign contributions, and since, more importantly, white middle-class taxpayers ultimately proved impervious to calls for altruism toward the "inner city," these social needs were not met. Instead, poverty and its attendant evils came to be seen as fundamentally moral problems for which individuals, not society as a whole, bore responsibility.

    With the discrediting of social help for the poor came the scrapping of the whole idea of social needs, problems, and solutions, with grave consequences for middle-class Americans. It took Dr. Benjamin Spock, author of Baby and Child Care, the best-selling book in American history, to remind us of one of them. The Boston Globe recently reported that the ninety-four-year-old Dr. Spock had to ask friends for money to pay for the long-term home health care keeping him alive. His plight is a cautionary example for those of us who have not sold fifty million books.

    Aging is a social phenomenon and its problems require a social response. Moreover, the social revolution in medicine and public health means that more of us will live longer than people of earlier eras. Collectively, through Medicare taxes, we support medical care for those over sixty five. But Medicare, a middle-class entitlement, does not extend to full-time home care, and the compensation it provides for nursing-home or part-time care is meager at best -- it paid only eighteen percent of the $100 billion spent on long-term care in 1995. We socialize the costs of illness among seniors but not the costs of longevity. Thus social support helps keep you alive just long enough to abandon you when, like Dr. Spock, you find yourself facing the impoverishing costs of chronic illness or great age. In long-term care we have a serious unmet social need.

    Seventy percent of seniors requiring long-term care, whether in institutions or at home, rely entirely on private resources. Yet in 1995 private insurance paid only five percent of the money spent on long-term care. This is because premiums for long-term care can cost $4500 or more a year. One senior-citizen advisory group says that to afford this insurance seniors need at least $40,000 in savings -- just about the cost of a year's stay in a nursing home.

    Almost half of those who are now sixty-five will eventually need some kind of nursing-home care; forty percent of them will pay for this service through Medicaid, the government-supported health-care program for the poor. To be eligible for Medicaid, seniors who are alone have to exhaust themselves of every financial resource except money set aside for their burial. And the spouses of nursing-home patients receiving Medicaid can have no more than $70,000 in assets outside of their house, car, and personal belongings. Many have to spend down the savings of a lifetime until they reach that figure.

    Circumstances beyond your control will dictate whether you or your loved ones will ever need long-term care. Should the inheritance you have every right to expect from your parents go instead to pay for nursing homes or home health-care services? Should the inheritance you have every right to bequeath to your children be spent down to the vanishing point to pay for such care? Or would you rather extend the principle of social insurance to cover this social need? Medicare could pay for long-term care while leaving inheritances intact through a modest increase in payroll taxes -- an estimated $163 a year for workers earning $25,000, an insurance premium against indignity and impoverishment in old age. Consider the piteous ways you might leave this life when you next hear politicians bloviate about "the crisis in Medicare." The real crisis in Medicare is that it ends at the nursing home door.

    --Ben Snowden, a new-media intern at The Atlantic, contributed research for this column.


    Discuss this topic in the
    Body Politic forum of Post & Riposte.

    More by Jack Beatty in Atlantic Unbound


    Jack Beatty is a senior editor at The Atlantic Monthly and the author of The World According to Peter Drucker (1997) and The Rascal King: The Life and Times of James Michael Curley (1992).

    Copyright © 1998 by The Atlantic Monthly Company. All rights reserved.
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