[Congressional Record Volume 145, Number 112 (Tuesday, August 3, 1999)]
[Extensions of Remarks]
[Pages E1733-E1734]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




               OMNIBUS LONG-TERM HEALTH CARE ACT OF 1999

                                 ______
                                 

                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                        Tuesday, August 3, 1999

  Mr. STARK. Mr. Speaker, today, Representative Ed Markey, I and others 
are introducing legislation that will affect the qualify of life for 
all Americans with long-term health care needs. Each day, millions of 
families struggle as they care for their loved ones who suffer from 
chronic and debilitative diseases. Alzheimer's disease, Parkinson's 
disease, multiple sclerosis, and the ravages of old age make many 
people dependent on others for their basic care. We legislators have a 
fundamental obligation to act decisively to ensure the quality of life 
for all citizens, especially those who can no longer care for 
themselves.
  The simple fact is that we need to act now to avoid the ``baby 
boomer'' crisis in long-term health care. As Professor Ken Thorpe 
testified before the Senate Finance Committee on May 26, 1999,

       The number of persons requiring assistance due to physical, 
     cognitive or other disabilities is expected to rise from 7 
     million today to over 15 million by the year 2030. Our 
     current patchwork of programs funded through Medicare and 
     Medicaid are not well positioned to meet the demographic 
     challenges that await us.

  There are no ``good-old'' days we can turn to and proclaim as the 
golden age of care for the elderly. The simple fact is that old age and 
the need for long-term care is a modern phenomenon. In the 1930s, the 
life expectancy of most people was around 65 years. Consequently, 
previous generations did not have to confront the prospect of tens of 
millions of citizens needing long-term care.
  Current estimates greatly expand the life expectancy of Americans. A 
man born in 1957, the height of the baby boom, can expect to live to 
78. A woman born the same year will live to 85, an additional 7 years. 
Improvements in general public health and medical practice, and changes 
in life style will continue to extend the average age that people can 
expect to live. The practice of medicine has witnessed monumental 
changes during recent decades. What was once considered medically 
impossible is now common place. Lifestyles have changed as well. Our 
constituents are learning to ignore the lies spread by cigarette 
manufacturers and are turning away from this deadly habit. Similarly, 
more Americans now understand how diet and exercise can improve their 
health and extend their lives.
  A common urban legend we must avoid is the belief that families 
gladly dump their parents into nursing homes as a ready convenience. 
The truth is that families want to look after each other and use 
nursing homes only as a last resort when the burden of care is beyond 
their control. The majority of the persons with long term health care 
needs continue to live in their home. Of the extreme elderly, those 85 
and older, only 21 percent live in nursing homes. Most of those 
residents are not there by choice, but because they require skilled 
nursing services.
  We need to focus on the facts and plan for the future. The end of 
World War II was the beginning of the baby boom. By 2010, those 
children born in 1945 will begin to retire. According to a recent CBO 
report, in the year 2010 there will be 40.6 million people over the age 
of 65--a 14 percent increase from the year 2000. The trend will 
continue. By 2040, there will be 77.9 million people over the age of 
65, 118 percent more than in 2000. Indeed, the 85 and older age group 
is the fastest growing segment of the population. As the average age of 
Americans increases, the proportion of citizens with disabilities will 
also increase. According to the CBO, by 2040 over 12% of the elderly 
will be disabled by a physical or mental condition. The growth in the 
number of persons with Alzheimer's disease illustrates the need to 
develop a comprehensive long-term care program.
  As many as 4 million of the nation's elderly currently suffer 
Alzheimer's disease. Unless someone finds a cure for this condition, 
the numbers are sure to grow. Within the next 20 to 30 years there may 
well be over 14 million persons with this terrible disease that slowly 
destroys the brain. According to recent surveys, over 50 percent of 
persons with Alzheimer's disease continue to live with a relative or 
spouse who sees to their day-to-day care. This personal care may last 
for many years and represents the equivalent of a full-time job.
  Most Americans neither understand nor have prepared for their long-
term care needs. Many of our constituents do not understand the 
difference between Medicare and Medicaid. They also have many 
misperceptions of the benefits available from Medicare. The general 
public does not understand that Medicare does not provide for long-term 
care. This error is compounded by the fact that most people mistakenly 
believe that their health care will cover their long-term care needs. 
For these reasons, and many others, Americans do not have sufficient 
financial resources to pay for long-term care.
  Women are especially hard hit by the lack of planning for long-term 
care. In general, women live longer, earn less money, and are often 
required to be the primary care giver. The consequence is that they do 
not have sufficient resources to meet their own health care needs. Take 
as an example a young woman who decides to take time from her career, 
stay at home, and raise a family. The time out of the job market means 
that she is not earning an income and contributing to a retirement 
plan. In addition, she is not contributing to social security. Finally, 
she is not keeping pace with her career and her salary will be less 
than those who remained in the work force. When this women retires, her 
Social Security benefits will be far less than a man the same age who 
worked uninterrupted his adult life. Moreover, this women will not have 
comparable financial assets including pensions and health care 
insurance. All too often, women then deplete their retirement savings 
and assets paying for the ailing husband's long-term care needs. Anyone 
who believes that women now enjoy equal opportunity is woefully ill-
informed.
  These facts and trends lead to a clear conclusion: We must plan for 
the future and act decisively now. If we do not, millions of our fellow 
citizens will face catastrophic health care problems without ample 
financial and social support.
  We cannot depend on single simple-minded solutions. Neither private 
insurance nor Medicaid can cover long-term care to any meaningful 
extent. Long-term care insurance is a shell game of dollar trading. 
Those who can afford these policies are usually better off investing 
their money in other ventures that produce better financial yields. 
Those who need long-term care typically cannot afford the insurance. 
Those who are young enough to afford the policies typically have other 
pressing financial obligations including raising a family, mortgages, 
and college tuition. Any mandate to require folks to buy long-term 
insurance is a regressive tax hidden behind a fancy name.
  We cannot count on Medicaid as it is the resource of last resort. 
Patients cannot use this benefit until they have exhausted all their 
personal resources. Do we really intend to demand that people face 
financial ruin to maintain health care? Suffering a severe physical or 
mental health problem is stressful enough, we should not further burden 
patients with the anxiety surrounding financial disaster.
  Mr. Speaker, my colleagues, we have the opportunity to create the 
golden era for long-term care, but we must start now. The legislation 
that we offer today sets the stage for better long-term care.
  Our legislation recognizes that there is no single quick fix for 
long-term care. For this

[[Page E1734]]

reason, we propose a range of legislative initiatives that, when 
combined, offer a comprehensive package. We describe the details of the 
Comprehensive Long Term Health Care Act elsewhere in today's Record. We 
hope that our colleagues and advocacy groups will join in support and 
in recommending refinements and improvements.

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