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The Honolulu Advertiser

Posted on: Monday, December 16, 2002

EDITORIAL
CarePlus plan needs to be kept moving

While there is strong agreement across the political spectrum that Hawai'i faces a long-term care crunch, there is little agreement on the best way to deal with it.

A panel set up by former Gov. Ben Cayetano has endorsed a version of CarePlus, the program advocated by former First Lady Vicky Cayetano.

The key element in CarePlus is a mandatory $10-a-month payroll tax into a fund that would provide cash care payments to qualified recipients. The plan would presumably generate around $70 a day (in today's dollars) that could be spent for home care or to offset the cost of institutional payments.

During the campaign, Linda Lingle was skeptical of the CarePlus program. She suggested she would prefer a tax credit against the cost of private long-term care insurance.

Now surely more people should buy their own long-term care insurance. But long-term care insurance does not come cheap, particularly to those who have aged enough to realize its importance.

Tax credits would be a benefit to those who can afford insurance, but would mean little to lower-income families that fall short of Medicare eligibility but do not have enough day-to-day income to pay for insurance premiums.

The CarePlus program is not designed as the absolute answer for long-term care. What it is designed to do is provide a minimal "floor" of support for people so they can afford to stay at home.

This keeps them out of more expensive full-time long-term care facilities, nursing homes or — as happens all too often — acute care hospital facilities.

The pattern all too often is those who could remain at home with some help go into a long-term care facility, competing for beds with others in greater need.

Critics of CarePlus, including recent visitor Stephen Moses of the Center for Long Term Care Financing in Seattle, contend the program won't work. It will create a false sense of security, slow down the development of a robust private long-term care insurance market and create false incentives for irresponsible health and lifestyle behaviors, he says.

Surely, a comprehensive private insurance system that all could afford would be an ideal solution. But that doesn't exist in other areas (think of the many who do not buy automobile insurance) and may be a long time coming.

The CarePlus program offers an innovative, modest ray of hope for our rapidly aging population, particularly those of modest means. It must not be rejected out of hand.