Last week during the conservative victory lap on twitter about the demise of the CLASS provisions, I was asking various folks to focus on the actual policy content of LTC and give their ideas for moving LTC policy ahead. Stuart Butler (@stuartmbutler) of Heritage actually replied with this testimony from Dennis Smith, given before the Senate Finance Committee on the role of LTC in health reform, on March 25, 2009.
This is mostly standard fare, long on the problems of Medicaid crowding out private options, but shorter on solutions related to moving ahead from where we are, though there are some interesting suggestions about providing more flexibility to Medicaid to allow rebalancing of LTC services toward community based options. However, what really caught my eye in light of the glee over the plug being pulled on CLASS was his response to the question posed to witnesses at this hearing,
“Are there different policy options for improving long term care for the elderly in comparison to the disabled? His reply:
There clearly are differences between the elderly and people with disabilities in the use of long-term services and supports when we examine the length of time the two populations use LTSS and the array of services. However, policies for both populations should be the same: they should be person-centered and money should follow the person. (emphasis mine)
This, of course, is the big idea behind CLASS; providing flexible benefits to be used as those in need see fit. In fairness, CLASS would have to be set up and properly functioning to fulfill this aim, and I agree that the benefit would need to be changed to have a chance of being self sustaining. However, flexible benefits that allow those with disability to decide how to spend them is the idea whose demise is being celebrated by conservatives, leaving us with the default system they do not like, with its central role for Medicaid.
The worst thing about the entire CLASS episode is the degree to which the discussion of the program has been nearly devoid of LTC policy. If CLASS is only a political scalp, it will be a missed opportunity, and it looks like that is where we are heading. I wonder if our political system is capable of any substantive policy discussion of any difficult topic?