What’s next for disability and long-term care?

I had the chance to interview the Urban Institute’s Howard Gleckman, one of the nation’s leading experts on disability policy and long-term care.

I had the chance to interview the Urban Institute’s Howard Gleckman, one of the nation’s leading experts on disability policy and long-term care. The small piece below gives a flavor of things.

Pollack: So what’s next? Now that CLASS has failed. Is there anything that’s going to come in its place?

Gleckman:  The fiscal cliff law does create a new commission which is tasked to come up with a solution to the financing problem, and also to address delivery and workforce issues….

We haven’t really done a good review of long-term care policies since the Pepper commission in 1990. It’s absolutely time that we do it again.

But this commission will be hamstrung by a very short time frame. Its members must be appointed within 30 days. The commission has to make its recommendations within six months after that. I honestly don’t think it’s possible to perform a serious review and deliver a set of serious proposals in six months.

It’s also concerning that this commission is not connected to any federal agency. Normally, you would think that something like this would have some connection with the Department of Health and Human Services, but it’s not. It’s floating around out there with no bureaucratic home.

There is also no requirement that Congress actually vote on any of these recommendations. The Commission is required to submit its recommendations in six months but Congress could ignore them. I don’t know where that leaves us.

Pollack: If anything, I think you’re wildly overoptimistic. It just seems like it’s going to head straight to the write‑only memory, as we used to say in engineering school.

Gleckman:  I think that’s right. There are two reasons why Congress creates commissions. The first is that there is an intractable problem they want to get all the parties to sit down and work out. That was the case a few years ago, when there was a broad consensus that we needed to close military bases. The normal regular order of Congress wasn’t going to do it. So Congress turned it over to a commission. Everybody had agreed in advance what they wanted to do. Then there is the more common commission, which essentially is a way to make it look like you’re doing something when you’re really not. I fear that is what this one is.

See the full interview here.

Author: Harold Pollack

Harold Pollack is Helen Ross Professor of Social Service Administration at the University of Chicago. He has served on three expert committees of the National Academies of Science. His recent research appears in such journals as Addiction, Journal of the American Medical Association, and American Journal of Public Health. He writes regularly on HIV prevention, crime and drug policy, health reform, and disability policy for American Prospect, tnr.com, and other news outlets. His essay, "Lessons from an Emergency Room Nightmare" was selected for the collection The Best American Medical Writing, 2009. He recently participated, with zero critical acclaim, in the University of Chicago's annual Latke-Hamentaschen debate.

6 thoughts on “What’s next for disability and long-term care?”

  1. ” Then there is the more common commission, which essentially is a way to make it look like you’re doing something when you’re really not. I fear that is what this one is.”

    It’s my guess that the commission on gun control is that kind of commission, as well. Or, also likely, it is sort of like Roosevelt – ‘Okay, you’ve convinced me. Now make me do it!’

    1. Sorry, no. The measures on the table for US gun control are well-known and have been exhaustively discussed: extending existing regulations on automatic weapons to long-barrel semi-automatics, limitations on gun clip size, closing the gun show and private sale loophole, home storage requirements, an ammunition tax, a buyback, rescinding the ban on gun control research. That’s off the top of my head and I’m far from expert. The issue is political will.

      Long-term care is a fundamental dilemma of the welfare state. Better medicine means an increasing number of us will live on with major disabilities or chronic illnesses incompatible with truly independent living. Long-term care is a a pure economic cost, unlike child care whose cost is offset by the production of women freed to enter the workforce. It’s still unsolved in Britain, with a quite different and more generous welfare structure, in spite of the Sutherland Royal Commission reporting in 1999 on long-term care for the elderly.

      I agree with Harold that it’s not serious to think that the problem can be dealt with in 6 months.

      1. That second paragraph isn’t quite right. Perhaps in Britain it is, but in the US a substantial part of longterm care is done by family members, with effects on the labor market well beyond straight hours lost. (In addition to hours, you lose mobility, because the elderly patient being cared for typically can’t stand a move. You lose flexibility, because hours of care come first. And you lose focus, because caring for elderly family members is, if anything, more draining than caring for younger ones.) In addition, as long as an economy isn’t at full employment, long-term care isn’t a pure economic cost because a substantial fraction of those wages and benefits would have been paid out in any case, just from a different account.

        But yes, of course, this particular commission is just a show. (With a side order, depending on how the commission’s members are picked and stacked, of providing additional whitewashing for the “let them eat cat food” caucus.)

        1. Oops, I erred on the costs. The child-care analogy is as you say at least partly fair.
          One tricky implication of this, at least for liberals, is that subsidising care (of children or of old or disabled relatives) is regressive in its benefits: more time available for work by Harold or his dentist raises their income more than for their postman. This can be handled by good policy design, but it’s an issue.

          1. I agree with your call for good policy design, but I’m not entirely sure about the regressive-benefit thing. In a perfect market (ahem) anyone who earns substantially more per hour than a caregiver will already be able to (at their option) pay someone to do the “volunteer” work they would have done for a family member and come out ahead. Subsidy simply puts them further ahead. It’s only for people whose income is insufficient to pay for a caregiver that the subsidy makes a difference between working and not working.

          2. Let’s make the decision between working and hiring a carer discontinuous, which is realistic. The rich, by and large, already decide to hire and work. The poor have to work anyway, and arrange makeshift care or none. It’s those in between (say with one middle-class income in the household) who face a real tradeoff. It’s in this group that a moderate subsidy can tip the balance and induce working and hiring the carer. (BTW, that’s often a welfare gain beyond the income. Being tied to someone you are caring for all day is a psychological burden.) So the moderate subsidy is redistributive towards the middle. Helping poor carers would often involve paying them to quit low-paying jobs to care at home.

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