Aetna 2002 Annual Report Download - page 25

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Disability: A Risk Society
Should Share
 , ..
Professor and Dean of Public Policy, Georgetown University
Americans with disabilities are doing better, but our society
must do a better job of sharing the burden.
In recent years, people with disabilities have made great strides in changing our society from
one that inhibits to one that promotes their participation and quality of life. Sadly, however,
we have made little if any progress in an area key to that goal: insurance to finance the per-
sonal services and assistive technologies that constitute long-term care.
The risk of needing long-term care increases as people age. But people of all ages face
some risk. Today there are nearly as many people under as over age  in need of long-term
care. Among younger and older disabled Americans, needs vary. For many, however, care needs
far exceed individuals’ or families’ capacity to provide or finance. Indeed, long-term care is
precisely the kind of unpredictable need for an unmanageable expense that insurance is
meant to address.
But currently insurance protection is sorely lacking. Medicare, which provides health
insurance to many who need long-term care, covers very little long-term care. Private
insurance for long-term care is growing, but currently reaches only a small portion of the
population. Medicaid is our long-term care safety net. But its protections differ consider-
ably from what we think of as “insurance.” Its benefits are available only after people have
exhausted virtually all their own resources. As a result, Medicaid does not protect against
financial catastrophe; it finances services only after catastrophe strikes. And, though invaluable
to many, Medicaid’s emphasis on last-resort nursing home care and its variation across states
leaves it far short of insuring access to the range and quality of services that people deserve.
We can do better — not only in meeting today’s needs, but in meeting the greater needs
that will come with the aging of the baby boom generation. To do better, we must recognize
that the way we currently deal with the risk of needing long-term care is not the only way to
deal with it. The risk can be spread through insurance, just as the risks of needing health care,
disability or retirement income are spread.
Promoting insurance will require a public policy initiative. We can look for ways to spread
the risk across taxpayers and individuals to promote public and private insurance. My own
priority in the use of taxpayer resources would be to support public insurance for low- and
modest-income people. But the advancement of any successful insurance will require policy
changes and additional public resources.
These changes will only come if we put long-term care on the policy agenda — as part of
public debate about Medicare, Social Security and Medicaid. Our society does better than
it used to for people with disabilities. But we can do far better still.
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