Discuss: Share in Our Policy Ideas

Affordable Care is simple. The solution is not complex. Take a couple of economics classes. First: To make something affordable you must reduce the expenses behind it. Caring for a senior cannot be done by someone via a phone in India so you must increase the supply of nurses and physicians in this country so that the supply way out does the demand. Imagine a world where physicians are unemployment for six months along with nurses because there are too many of them. Now the equation is simple a nurse would be paid far less than they are now and physicians rate would be lower through competition. We do not need to nationalize anything. So how do you increase the supply of health care workers, simple the government should spend billions over the next 5-10 years opening free medical colleges. Instead of paying for welfare put people through medical education then in ten years you will have a supply that will not deplete because the next wave of a small generation the current middle school kids is tiny compared to the current baby boomers. Who would this plan piss off? The Unions, The democrats and of course the current nurses and doctors who would see there future rate severely drop. Why has this not been done because education is controlled by the unions and the current nurses who keep program growth tight.

Thanks NASI for facilitating a good discussion, as always.

I think Elizabeth Cullar's point about choice is an interesting one. To the extent that PACE and CCRC's recruit a self-selecting pool of seniors who prefer community living situations, the residents are more likely to be happy in these environments? As these models scale up across the country to a larger pool of seniors with different beliefs, it will be interesting to see the extent to which the same gains can be realized...

The students have accurately identified the limitations of each model and their failure to cover the vast majority of middle income Americans. What is missing, I think, is a sense that there other programs that offer long term supportive services (LTSS) to seniors who need them. In particular, many HUD-subsidized senior housing communities provide LTSS, in addition to housing, to a large number of low and moderate income seniors.

Unfortunately, our nation lacks a coherent, coordinated policy for providing LTSS to seniors (and people of all ages with disabilities). Consequently, we have a patchwork of programs for these populations and many empty spaces where needs are going unmet. CCRCs and PACE are 2 of the patches, so to speak; federally-subsidized (and tax-credit enabled) senior housing serve more seniors than those 2 programs combined.

Our organization operates 2 market-rate CCRCs and 5 subsidized housing communities for low and moderate income seniors (most of whom were middle class during their earning years). Subsidized senior housing is a cost-effective platform for providing LTSS to frail elders and keeping them in the community. We also operate LTC and assisted living communities and know that many of our housing residents would need these more intensive settings were it not for the LTSS provided to them in our housing communities.

In sum, it's important for the students to realize that CCRCs and PACE are important vehicles, but by no means the only ones, for providing LTSS to seniors. and, it would be a good idea to expose students to the possibilites of subsidized senior housing as a model for extending LTSS to a large number of community-dwelling seniors, many of are quite frail.

You mean I don't have to pay for expert advice like this anymroe?!

It is a very difficult task to plan a strategy to provide affordable health care to millions of people. Most of the countries have tried a lot of ways but nothing turned out well and everything ended up in making the people poor because of the over expenses. EMR software companies