Howard Gleckman

Two groups of lawmakers proposed commissions aimed at addressing the impending insolvency of Social Security. Unless carefully designed, these panels often fail.

Rising long-term care costs are fueling interest in public insurance programs. Washington State's WA Cares offers a front-end benefit ($36,500) via a 0.6% payroll tax. The proposed federal WISH Act, a catastrophic model, would provide $3,600 monthly after a waiting period. Initial WISH estimates of $200 billion (1.7% payroll tax) were too high. However, actuarial analysis reveals costs could be halved to around $100 billion (0.9% payroll tax) through design adjustments. These include replacing cash benefits with reimbursement, raising the eligibility age, linking benefits to the cost of living, differentiating home and nursing home care, and diversifying investment of program reserves. Such a program is crucial as most Americans cannot afford long-term care, straining existing systems like Medicaid, despite political hurdles for new federal initiatives.

This latest agreement would continue to assure that Trump and his sons would benefit from special tax treatment no other taxpayer has received.

Opus Newton, a senior living community in Boston, is successfully tackling the "missing middle" market by providing affordable options for middle-income older adults. Despite high local housing costs, Opus Newton maintains significantly lower entry fees and monthly rents than competitors. This is achieved by controlling construction and operating expenses, forgoing designated assisted living or skilled nursing units, and instead offering in-home care through a contracted agency. A crucial innovation is mandatory resident volunteerism, which reduces staffing costs, fosters a strong community, and has led to a substantial waiting list. This model presents a promising solution for retired professionals, though its long-term adaptability for residents with increasing care needs remains a key consideration.

Defying typical nursing home challenges, the Leonard Florence Center for Living in Chelsea, MA, offers extraordinary care, particularly for ALS patients. This facility, co-designed by CEO Barry Berman and an ALS resident, leverages high-tech solutions like eye-movement controls to grant residents unprecedented independence. They freely navigate the building and even participate in activities like skydiving. Operating on the 'Green House model' with high staffing levels, it fosters significant resident and staff autonomy. Consequently, ALS patients often live far longer than expected. While the center faces substantial financial hurdles due to inadequate Medicaid reimbursement, it showcases a model of compassionate, tech-driven care.

Besides helping protect millions of Americans from the costs of long-term services and supports, well-designed long-term care financing reform also could sharply lower Medicaid costs.

No amount of financial legerdemain can paper over the fundamental problem. The US Treasury, along with big tech, is borrowing far more than markets want to lend.

President Trump's decision to revoke what's known as Temporary Protective Status for immigrants from a dozen countries will severely damage health and long-term care in the US.

Even as seniors are living longer, their overall health in old age appears to be improving and they are living relatively healthy lives for longer,

The gap between Trump’s stated goals and his policy choices is widening, including inflation, interest rates, trade, manufacturing jobs, and his attacks on socialism.