edicaid and its essential benefits and potential pooled funding. Currently, U.S. long-term care policy has serious shortcomings, and the consequences of these shortcomings will only increase as the population of those in need of these services grows. Policymakers continue to face an array of complex policy problems regarding the balance between nursing home and home care, assurance of quality care, integrating acute and long-term care, and affordable access.Medicare and Medicaid policy resembles a fiscal tug-of-war, rather than a concerted effort to address peoples needs. Current public policy falls far short of assuring insurance protection. Meaningful insurance protection for long-term care requires far more expansive public protections than what is now available. My policy focus will involve expanding insurance to cover the cost of long-term care. Theoretically, there is little rationale for failing to finance long-term care as we finance acute care, relying on insurance to spread its risk. Typically, we rely on insurance to deal with costs that are potentially catastrophic and unpredictable. Long-term care satisfies both criteria. (Feder, Komisar, and Niefeld) Purchasing extensive personal care, at home as well as in nursing homes, is a catastrophic expense. Further, the probability that a given person will need long-term care is uncertain. For example, although 39 percent at age sixty-five are likely to use some nursing home care before they die, almost half will require less than a year of care, while about a fifth will require five years or more. (Murtaugh, 211) It is often assumed that the need for long-term care is an inevitable part of aging and that saving is therefore the right strategy to address it. With costs so varied and unpredictable, savings will be inadequate and inefficient. (Eckholm, 40) Insurance makes more sense.The U.S. long-term care system, however, does not provide insurance against the risk of long-term car...
