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The United States is engaged in a critically important and
contentious debate on how to overhaul the way it delivers and pays
for long-term care. Most families that are confronted with caring
for a disabled elderly relative are often guaranteed financial
catastrophe. The authors of this book examine a wide range of
financing approaches to reforming long-term care and the impacts
they would have over the next twenty-five years. The central issues
in the debate about reforming long-term care concerns the relative
roles of the public and private sectors. The authors urge that
private insurance be encouraged and predict it will grow.
Nevertheless, they conclude, private insurance will probably play
only a modest role in financing nursing home and at-home care. For
that reason, careful attention must also be given to reforming
public programs. They recommend a strategy that includes expanded
social insurance covering more at-home care and some limited
nursing home coverage, the liberalization of Medicaid eligibility
requirements so that complete impoverishment is not required before
benefits are given, and an enhanced role for private insurance to
provide asset protection to the upper-middle- income and wealthy
elderly. The authors examine the cost of public and private
initiatives and who would pay for them. Their answers emerge from a
large computer simulation model that the authors developed. This
book is accessible to non-specialists and is essential reading for
anyone interested in the future of American health care.
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