Posted on: Sunday, April 13, 2003

EDITORIAL
Long-term care must start somewhere

It failed last year, and if we keep allowing naysayers to monopolize the long-term-care debate, it'll fail again.

We're talking — yet again — about CarePlus, a legislative proposal to tax Hawai'i residents $10 a month to create an insurance fund that would offer a year's worth of supplemental care at $70 a day.

Granted, CarePlus is an extremely modest proposal. It's easy to pick holes in it. But at least it's a first step to preparing for an onslaught of elderly medical needs.

As a society, we have an obligation to make old age more comfortable for those who cannot afford private health insurance, just as we have an obligation to educate children who cannot afford to go to private schools. Medicaid and Medicare help, but they're not enough, particularly when you consider the aging tsunami on the horizon.

Consider the conditions under which Japan turned to public long-term-care insurance in 2000:

Like Hawai'i, Japan's population was rapidly aging. The multi-generational household was shrinking in favor of a nuclear family arrangement. Younger family members were less able or inclined to care for their elderly, and women who might previously have been the caregivers were entering the workplace.

A trend was developing in which elderly folks were checking into hospitals because of the lack of alternative elder care. Meanwhile, the Japanese were struggling to pay the high price of long-term-care insurance premiums.

And so Japan launched a public long-term-care fund, half-financed by government subsidies and half-financed by insurance premiums collected from residents aged 40 and older. Municipalities administer the fund and determine eligibility, with the help of medical professionals.

Monthly insurance contributions range between $20 and $30. Depending on the scope of the plan, benefits include home help, visits to care centers and nursing home stays.

As one might imagine, long-term care in Japan is a work in progress. But at least they pulled it off. Hopefully, Hawai'i can do the same.

As we said before, the CarePlus plan is just a first step. Perhaps later, the law could be amended to offer a broader range of benefits. Meanwhile, the private insurance industry could fill any gap by offering affordable supplementary plans. Or if the economy perks up, the state could chip in.

We can build on this.