When Sen. Bernie Sanders, I-Vt., spoke about Medicare-for-all at the July 30 Democratic presidential debate, he talked about how it would improve coverage for people currently receiving it. "For senior citizens, it will finally include dental care, hearing aids and eyeglasses," he said.
But Sanders forgot to mention it would also help senior citizens pay for long-term care, something Medicare doesn't do now.
Sanders should not forget that again. Indeed, he should make long-term care the first thing he mentions when talking about how Medicare-for-all would help senior citizens. Add that it's especially helpful for women. There's likely no better way to counter scare talk designed to convince the elderly that adopting a significant Medicare expansion would result in less care - I'm looking at you, Joe Biden - than by pointing out how his plan would improve on the thing that seniors likely fear the most.
To anyone over the age of 40, uttering the phrase "long-term care" is like raising the subject of the Babadook. According to the most recent annual polling by The Associated Press and NORC Center for Public Affairs Research, about two-thirds of Americans over the age of 40 say they expect they'll need to provide assistance to a close family member or friend over the next five years. Nearly half believe they cannot fund their own long-term care. More than 60% of this cohort expect they will need some form of long-term care in the future, only slightly below the real number of 69%.
The problem: Medicare doesn't offer long-term help to people who need assistance with tasks such as showering and dressing and other tasks of daily living, whether that's because of chronic illness, physical frailties or something like dementia. It's a twofold issue: First, most people want to remain in their homes as they age if they can, something long-term care can make possible. Second, it also allows many to avoid more expensive institutional care - which, for the most part, is not covered by Medicare. (This is also true, of course, for private and employer-sponsored health insurance used by people under the age of 65.)
As a result, seniors are forced to rely on family and friends or to spend down their assets until they qualify for Medicaid. No surprise, the AP-NORC polling found adding long-term care to Medicare enjoys broad popular support, including with a majority of Republicans.
By the way, private long-term-care insurance is not the solution. Many insurers no longer offer the option, as payouts exceeded their estimates. Those policies that still remain are increasingly expensive - sudden rate hikes of 75% are not unknown - and financially out of reach for many.
Alex Lawson, the executive director of Social Security Works, told me he believes Sanders is less likely to bring up long-term health care because it wasn't included in previous Medicare-for-all bills. It's not as though Sanders doesn't speak about long-term care at all. He mentioned it, for instance, at AARP's presidential forum in Iowa last month - after dental care, hearing aids and vision coverage, things that are currently covered by many Medicare Advantage plans.
But he should talk about it more. Seniors support Medicare-for-all at slightly lower rates than most other age cohorts. It's possible greater awareness of how it would help them with long-term care could sway some of them. It could also give Sanders a needed assist with middle-aged and older female voters. Women are more likely to need long-term care in old age, and daughters provide twice as much help to elderly parents as sons do. In fact, women are responsible for the majority of all unpaid eldercare assistance and suffer no small amount of damage to their professional prospects and earnings as a result.
Medicare for America
This advice also goes for every candidate who supports Medicare-for-all or other plans that would offer help. Beto O'Rourke, for instance, says he supports Medicare for America, an expansion plan sponsored in the House by Reps. Rosa DeLauro, D-Conn., and Jan Schakowsky, D-Ill. That also beefs up Medicare's long-term coverage. Speak up! One plan that wouldn't help as much as it sounds: Biden's $5,000 tax credit for people who provide unreimbursed eldercare. If a woman leaves the workforce to take on eldercare responsibilities, she can expect to lose more than $300,000 in lifetime earnings.
It's not as though Sanders's proposal on long-term care is perfect. It could be better - the companion Medicare-for-all bill in the House, sponsored by Rep. Pramila Jayapal, D-Wash., also offers coverage for nursing home care, something Sanders' bill lacks. But it's still much more than the current status quo. So step up, candidates. Start talking about what you can do to help all of us with long-term care. It's personal. This middle-aged daughter is waiting.