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Presidential Candidates Lack Long-Term View on Long-Term Care

The case is clear: America is heading toward a fiscal tsunami. Surviving this wave will involve monumentally more than just shoring up the three key retirement pillars of Social Security, Medicare, and Medicaid.
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The good news is that Americans are living longer than they have previously.

The bad news is that our nation's financial and health-care systems are woefully unprepared for them.

What's worse, neither presidential candidate seems to be giving it much thought.

U.S. Sens. John McCain and Barack Obama may spar over Social Security and tinker around the edges of entitlement programs Americans know best, but neither has a serious plan to stabilize our retirement foundation to provide a true safety net for the elderly.

That's unfortunate, because both campaigns are missing out on an opportunity to engage and win over one of the most active and influential American voting blocs -- senior citizens and mature adults.

The reality is that how we pay for the long-term care needs of 80 million baby boomers, the first of whom are retiring this year, promises to be one of our nation's most serious social and fiscal challenges now and in the future.

The enormity of this issue shouldn't be a surprise.

AARP data show that only 35 percent of people 65 or older think they will need long-term care in the future. Yet, the Congressional Quarterly has stated that nearly 70 percent of those turning 65 this year eventually will require some form of long-term care.

The Urban Institute reported that long-term care is a leading cause of catastrophic out-of-pocket costs for families. Yet, few people have insurance coverage against the high cost of long-term care.

Part of the problem is that the nation's long-term care system is plagued by financial constraints and public misconceptions.

A recent poll found that 85 percent of Americans believe that their long-term needs will be met by Social Security, Medicare, Medicaid or their existing health insurance. They are wrong. Social Security, Medicare and health insurance do not cover long-term care, and Medicaid only covers care for the very poor.

The case is clear: America is heading toward a fiscal tsunami, unless it acts now. Surviving this wave will involve monumentally more than just shoring up the three key retirement pillars of Social Security, Medicare, and Medicaid.

The solution to our long-term care crisis should not -- and cannot -- be just another costly government-funded mandate

To finally begin wrestling control of this menacing issue, candidates and elected officials alike must understand that now is the time for the federal government to gradually shift its role as the major payer of long-term care services to helping individuals save and invest for their own long-term care needs using a variety of market-based mechanisms that enable compounding interest and time to work for us, not against us.

In effect, the expanded reliance upon private sector markets constitutes establishing a fourth pillar -- supplementary to Social Security, Medicare and Medicaid -- to stabilize a wobbling, crumbling retirement program foundation.

For all the talk we hear about repaying our "Greatest Generation," both candidates should be calling for a bipartisan national commission to address long-term care reform.

The last time our nation seized the opportunity to address the fiscal shortcomings of a key retirement pillar was the landmark 1983 National Commission on Social Security Reform, established by President Ronald Reagan.

Sen. John McCain recently called for a similar discussion --- but only for Social Security. That's not enough.

Rather than banging heads in a Social Security debate, which is dominated more by superficial "conservative" and "liberal" labels than by any real proposals for reform, our leaders should be putting their heads together to solve the long-term care problem.

America's population is old and getting older, fast. U.S. Census numbers show the number of older Americans will almost double between 2005 and 2030.

It's clear that America needs and deserves a vigorous discussion on the long-term care crisis facing this country.

Bipartisan reform of decades-old programs -- designed in a different era to solve fundamentally different historical challenges -- is not an option, but a necessity.

It's time both presidential aspirants stop sidestepping this domestic priority and start stepping up with answers.

Stuart H. Shapiro, M.D., is President and CEO of the Pennsylvania Health Care Association, an advocacy organization for the elderly and their providers of care. For more information, call 717-221-1800 or visit