Family Issues

Neither Clinton or Obama had my enthusiastic support on the family issues vitally important to me. Universal health care will cure all family problems. We desperately need policies that will make it possible for both men and women to have careers and take care of their children and their elders. Maternity, paternity, and aging parent leave is obviously a priority. The medical and family leave act has to be extended to all businesses and organizations, large and small, and the government will need to be involved in funding that.

Excellent day care for babies and toddlers is usually too expensive for parents to pay for because it requires an extremely high teacher/child ratio. Only the affluent can afford a nanny even at the less than living rates most nannies are paid. The government is eventually going to have to support child care for children under 5 just as they support education for children over 5. Child care workers ideally would have college degrees in early child education and be paid the same salary and benefits as school teachers. Dedicated present child care workers should be eligible for governments grants paying their college tuitions.

The health care proposals of the candidates don't try to come to grips with long-term care. Virtually all private health insurance is no good whatsoever for what is dismissed as custodial care, which is care for people who are not going to get better, because they are old and are eventually going to die of their chronic diseases, even if they live 15 years with it. They don't need skilled nursing, so Medicare is no help. Instead they need help with dressing, bathing, toileting, medication, transportation, shopping, eating, laundry, transferring from one place to another. If they have dementia, they need constant supervision so they don't wander off and get hit by a car, fall down the stairs, leave the stove on and start a fire, leave the water running and flood the house. Medicare covers only very short-term care for people recently discharged from hospitals and capable of recovery and progress. For example, Medicare only pays for physical therapy if your therapist can document that you are making steady progress. They don't care about help that would keep you out of a nursing home.

Many people could stay out of nursing homes if there were government programs that paid for the necessary home modifications necessary to them in age in place. Financing ramps, guardrails , and stair lifts is lots cheaper than paying for broken hips and nursing homes.

Nursing homes in New York City and Long Island cost more than $100,000 a year. Home health agencies charge $18 to $20 per hour for home health aides. Medicaid is more likely to cover nursing home care than home care. Desperate, people spend down all their resources and are then eligible for medicaid. Well spouses don't fare that well, but at least they are now able to keep their houses. Affluent families hire lawyers to hide or transfer their assets, so they can go on Medicaid, make the government pay what they could afford themselves, and save their children's inheritance.

Don't think long-term health insurance is the solution. The amount that most long-term health insurance pays is laughable; my mom had a supposedly good policy that only paid for 6 hours a day. Lots of policies seem like a scam; they have so many disqualifying conditions that your only chance of collecting anything is hiring an expensive case manager. Home health aides are shamelessly exploited by home health agencies supposedly under government supervision. The aide gets less than half of the 18-20 an hour charged by the agency. Yet many long-term health care policies require you to go through a home health agency, instead of hiring the aide privately and paying her a living wage.