Stephen Moses is President of the Center for Long-Term Care Reform. The Center promotes universal access to top-quality long-term care by encouraging private financing and discouraging welfare financing of long- term care for most Americans. As President, Mr. Moses publishes and speaks throughout the United States on public versus private financing of long-term care and related issues.
Interview below cartoon
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Twenty years ago, I was a career U.S. government employee with 14 years of service (starting with two years in the Peace Corps in the late 1960s). I was the "Medicaid State Representative" for Oregon in the Seattle federal regional office. My job was the liaison between that state's Medicaid program and the Health Care Financing Administration's (HCFA's) Baltimore headquarters. HCFA administered Medicaid and Medicare back then. The more I learned about the country's long-term care financing problem, the angrier I got. I ended up working at the Health and Human Services (DHHS) Office of Inspector General (OIG).
Twenty years ago, while working for the feds, I decided to start working for reform. I continue to work, and won't stop, until the perverse incentives in public policy that discourage responsible long-term care planning are reversed. It's been a long haul but the progress, especially lately, is very gratifying.
The most misunderstood aspect of long term care is the answer to the question "Who Pays for it?" The insurance industry tries to sell LTC insurance by convincing people they could lose their life savings to long-term care. There are two problems with that strategy. It isn't true and it doesn't work. It isn't true because most people qualify easily for Medicaid-financed long- term care without spending down their own wealth significantly. It doesn't work, because, although the public doesn't know who pays for LTC--Medicaid, Medicare or Santa Claus, who cares?--they have a pretty good idea that somebody must. You don't see Alzheimer's patients dying in the gutter. The big irony is that the public doesn't believe their assets are at risk for long-term care, and they're right! That's why they don't believe the industry hype. That's why no amount of education or incentives will get them to buy LTCi, as long as government is giving it away for free. That's why the only hope for LTC insurance is for government to target Medicaid to the truly needy so everyone else will have a reason to purchase insurance or use their home equity through reverse mortgages. The Deficit Reduction Act made some steps in the right direction, but we have much further to go. Thus, it's denial by the insurance industry and public policy makers that is the real problem. The public isn't as stupid as they think.
Puerto Rico, where I extended for a week after a professional appearance, to explore the island by car with my son, Damon, the Center's VP for Administration. Before that, Damon and I spent three weeks traveling from the far north to the far south of Japan, visiting long-term care facilities and interviewing LTC experts for my forthcoming book, Long-Term Care: The Preventable Tragedy.
When planning trips and traveling with my wife and/or son, reading, and basking in the glow of a published work or some other job well done.
I spent two years in the Peace Corps in Venezuela in the late 1960s with my wife to whom I've now been married 40 years.
I don't think I'll cling to care at home. Full-service assisted living with regular physical exercise, frequent visits to the theatre and opera, more time for downloaded audio books and old-fashioned print, ready access to solitude or socializing, and medical assistance adequate to age in place: that seems to fit the bill.
