Monday, June 30, 2008

A chat about whether eldercare is a new demographic issue, and how the US compares to other countries


I had another conversation about eldercare and health care with an insurance and law professional today. I thought I would pass on the comment that he believed that health care is “the political issue,” particularly whether the country could ever embrace single payer (which he seemed to support from a political and social perspective). He also had an interesting perspective on the demographics of eldercare.

I said that the longer lifespans and fewer children would create, in a demographic storm, new concerns about filial responsibility, and could even cause us to rethink our whole concept of what generates family responsibility. I said I thought this had exploded in the past ten years. He said really it’s been going on for decades. Eldercare was a big issue in the 50s. What relieved the pressure was Lydnon Johnson’s “Great Society” and the implementation of Medicare in 1965. Before then, adult children had sometimes been pursued for their parents’ medical and nursing home expenses. This became infrequent, relatively speaking, once Medicare was passed. Then the sense of social awareness changed. For perhaps 25-30 years adults did not perceive responsibility for their parents as a high priority in comparison to their own children or themselves. But as lifespans started to lengthen, sometimes with increased frailty (and cognitive problems like Alzheimer’s) the demographics started to get serious, getting the attention of some conservatives. But now it is mainly custodial care that is an issue, not normal medical care, because of Medicare – although even then, seniors without supplementary medical insurance or prescription drug coverage (Part D or a substitute) can get into trouble.

I mentioned that even in Canada and Britain and generally the rest of Europe, nursing home care is not covered by single payer. He said, well it is, for people who don’t have enough money. It comes down to whether the government will pay nursing home care for people who do have some money. Germany and Japan do seem more generous.

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