New Hampshire Presidential Forums on Long Term Care

Hello I'm Doug Levy. What you are about to hear are excerpts from presentations made at pursuing solutions to the family crisis of long term care completing the New Hampshire presidential forums. This one day conference was held at the New Hampshire highway hotel in Concord. On January 26 and was the culminating event of the New Hampshire presidential forums on long term care a project of W E v o FM and WMUR TV. This project was made possible by grants from the Villars Foundation and the New Hampshire charitable fund and affiliated trust during this past autumn and early winter. New Hampshire was the scene of a series of individual forums with the major presidential candidates the topic was long term care for the elderly and disabled. What had been a personal problem for many Americans now became an issue for discussion by the presidential candidates campaigning in New Hampshire's first in the nation presidential primary. The impetus for this project came from the belief that New Hampshire's unique status in the electoral process brings with it a special responsibility to ensure that topics of concern

to all Americans are discussed by the candidates visiting the state. Having heard the candidates proposals on long term care this concluding conference was organized to underscore the importance of the issue by taking a closer look at the options both from a national and a New Hampshire perspective. Earlier in the day the candidates issues advisers explored their campaigns proposals with the conference participants Following lunch. The audience listened to a speech by Dr. Arthur S. Fleming Dr. Fleming served presidents Dwight Eisenhower and Richard Nixon in major policy making and advisory roles regarding health welfare and aging. He is introduced by Representative Sarah Townsend of merit in New Hampshire with whom he presently serves on the board of directors of the National Council on the aging. Dr. Fleming was the president of the Ohio Wesleyan University and 48 to 53 and 57

58 president of the University of Oregon 1961 through 68. President of McAllister college 68 to 71. Is government experience and positions include Secretary of Health Education and Welfare which is what it was known as under the Eisenhower administration. Chairman of the White House Conference on Aging in 1971 and extremely active in the White House Conference on Aging I may add in one thousand eighty one U.S. commissioner on Aging for the Department of Health Education and Welfare under President Nixon. Chairman of the U.S. Commission on Civil Rights. And many many other attributes which I shall not go into at this time as I know we're all anxious to hear from Dr. plumbing. I think in all of the years that I've listened to people speak on the subject of

aging long term care elderly if there's no one. No one has ever with the possible exception of Frank Manning in Massachusetts put the punch and do what he says. The way Dr. Fleming does I'm sorry that I shall be unable to stay and hear him because I have to go up. We have a session beginning at 1:00 o'clock and I hope to be there soon after. But I just want to say to you. You will be challenged. You will be stimulated. You will listen to and believe every word that Dr Fleming has to say. And I know that you will join with me in welcoming Dr. Fleming in the indomitable traveler to New Hampshire. Thank you. Thank you Verb very much. I deeply appreciate

those very generous words of introduction from my colleagues on the board of the National Council on Aging. We appreciate so much our service I'm not bored because you appreciate those of you who live in New Hampshire. She comes to the meetings of the board with creative ideas and she knows how to advance those ideas in the discussions that take place. We're delighted the cheese associated with us. Because of what she does for the board of the National Council on Aging but also because of the outstanding leadership that she's provided. The field of aging here in this state and throughout our nation. I'm very grateful to those who planned this meeting today for inviting me

to come and depart with you. I have felt that the elections of 1988 provide a window of opportunity for those of us who are deeply concerned by about. The pitch for health care system. That we have in this nation. I feel that those who have put so much time. Into the forums that have taken place. Here in the state of Ohio are a source of inspiration to all of us who believe that we should take advantage of this window of opportunity. You have taken advantage of it.

You have been a very very significant way. Succeeded in putting long term care on the agenda not only for the presidential campaigns but also for the congressional campaign as a member of the billers board. I'm delighted to have been associated with this effort and we serve on the board are very very appreciative of the leadership that Ron Pollack has brought to this project. The same kind of leadership that he has brought to many of the projects for which the velour advocates and so should have been responsible. As you approach has abated in forums as you carry on the discussion here today I know that the figure

sword figures have been repeated time and time again. I know the persons of underline the fact that there are 37 million persons in our nation today who are not under any kind of a health care plan public or private. I know that persons of underline the fact. That there are at least 15 million additional persons who are under insured. Well I had no access to anything resembling long term care. As I use those figures as I traveled throughout the country I often stop to think about a talk that I heard Archibald MacLeish deliver back in the early 50s. He was one of my close friends when he became Librarian

of Congress. I was a member of the Civil Service Commission and I had the opportunity of working with him on some of his personnel issues are opportunities at the Library of Congress. But in an address he called attention to the fact that in the post-World War Two period the United States government was making an increasing investment in collecting statistics collecting facts bearing on issues related to the welfare of people. And then this talk he commended the government for moving in this direction. But he said the thing that kind of haunted him was whether or not as a nation we had the capacity to feel

those five. And I don't link that comment up in my own mind as I use the figures in the healthcare field. With one portion of Martin Luther King's address which he delivered now almost 25 years ago in Washington. When we come aberrated his words today we have our attention called to that address. Time and again and particularly that portion of it where he shared with it with us his dream for the future of our nation. But in an earlier part of the address he talked with us about the fierce

urgency of now. There's I think in terms of the premature deaths that are represented by our health care figures as I think of the on necessary suffering as I think of the million or more personal bankruptcies a year as I think of the millions of persons with mental and physical health problems who do not turn to anyone for help and IT systems because of the fact that they know that there is no room for them in the marketplace to use the title of a monograph. But the Catholic Health Association issued not long ago as I think of the

suffering that is going on in our nation today because of our own willingness as a nation to move forward in the health care arena. I can't help but associate that with Martin Luther King's concept of the fierce urgency of now. Thank you. No Permit me for just a few moments to shift over to the area of Social Security to do just a little reminisce. I recognize that at my age one should not get started reminiscing. And I I'll keep that in mind I promise you that. But nevertheless I feel there is a direct relationship

between what has happened in my lifetime what I've been able to observe or what I've been able to be involved in. To some degree in the field of social security and the basic fundamental issue that confronts us in the health care every. Back in the middle thirties I was a reporter for what is now the U.S. News and World Report. And I had enough seniority on not publication so that when FDR came into office I had the opportunity of covering the White House press conferences which were held in those days every Tuesday and Thursday. Quite a contrast with the present situation. And as a result of covering those press conferences I had some

opportunity to get a feel of his dream for our nation. Of his hopes and his aspirations. You know I remember when he set up a Cabinet committee to take a look at the cornerstone of whether or not our nation should start traveling down the road of social insurance. Do you notice Frances Perkins the first woman to serve in the cabinet of the president of the United States but then Secretary of Labor to chair. Just a footnote after President Roosevelt died and President Truman took office I was still on the Civil Service Commission and President Truman appointed Francis Perkins as a member of that commission. I was served with her for three years as a colleague.

She was a great lady. One of the most outstanding public servants that our nation has. Her committee went to war and within a very short period of time comparatively speaking reported to the president of the United States. But they felt that the time had come for our nation to start down the road of social insurance. They said they felt that the time had come for us as a national community to pool our resources in such a manner that when the families of those nation confronted the hazards on both sides the dude growing out of love because of retirement. Lot of those families who confronted those hazards and

us as a dude could count on certain benefits but avoids which would flow from an intergenerational column about a vote. Watch what Russ Bach on payroll contributions which they would have helped to make during their period of work. Did you know the president accepted that recommendation very quickly submitted it to the Congress of the United States and the Congress accepted the recommendations from the president so totally a few years ago that we celebrated the 50th anniversary of the start of our social insurance program start under which families were provided with income insurance.

Again it's the hazard and vicissitude of loss of income because a retard then within just a few years the Congress decided to also deal with the hazard in a sense to do that confronted the families of the country because of loss of income by reason of the death of the member of the family that they had been counting on for in the survivorship became a part of our social insurance package. During the 50s during the period that I was serving in President Eisenhower's kept the country through the Congress decided to deal with another hazard investments into confronting the families of the nation. Namely that growing out of the loss of income because of the fire but the member of the

family they've been counting on for income became disabled. When that program was finally enacted into law nationally it had an age requirement and the president recommended that that age requirement be eliminated in the Congress. So it's for all disabled irrespective of day one slide had been completed. We did have a family and Sean's program designed to give protection to the families of our nation against loss of income because of retirement because of because of disability all the time had its ups and downs over a period of time. But I think most of us recognize that that social

insurance program is firmly embedded in the life of our nation today. I co-chair a coalition of honored 20 national organizations called Save Our security. We still have our battles designed to protect the integrity of that system. We just went through one the last few weeks. Some people wanted to undermine the integrity of the system by bringing it in to the summit discussions on the budget. We did one that will have other challenges to the integrity of the system. But I do not have any doubt at all but that if we stay on or Tolo will succeed when the entire gritty of the system is challah because it is firmly embedded in the life of our nation. The public opinion polls indicate that

this is overwhelmingly the case not just on the part of owner or person but on the part of all generations. This is the social insurance program is a very important program for older persons but it's a very important program for the three and a half million children who drop out Social Security benefits under their survivorship program. It's a birdie important program for the disabled. No matter what their age it's a very important family program designed to demonstrate that we as a nation can operate as a national community in pooling our resources in such a manner that we can help our people deal with the Hauser's

and substitutes of life no matter where they may live in this nation. I believe that the time has come for us to go all out as a national community and pooling our resources in such a manner as to help our people where ever they may live in this nation. Do you with their hazards and the sources of health problems and physical health problems. And I believe that you have been and are making a tremendous contribution in the

direction of this particular object. You've been talk to candidates about long term care and you've been talking to them about long term care that would rest on the foundation of social insurance. Them are judgment that is the only way we can move forward in a significant manner to touch the lives of all of our people in our nation. The private sector is playing a role in this area. It will continue to play a role but this has got to be a partnership approach and the foundation for this partnership must be the acceptance of the concept of social insurance.

In the long term in the health care area just as we've accepted it in connection with the problems that have come in front of the families of our nation. Now we've made some progress in this direction. You know Medicare Part A is social insurance. Here again we've pulled our resources through payroll contributions we put them in a trust fund and we draw on the trust fund in order to take care of the benefits that are set forth under part aid of Medicare Part B is not social insurance. That's one of the reasons why we've had some of the problems that we've been

confronting just within the past few months. Part B as you know is finance. My premiums hold 25 percent under the law the total cost is to be handled by premium payments on the part about a pressure. The rest is financed out of general revenue. I'm not going to add detail on the problems that we've confronted down through the years because of the fact that part B has not been rooted in social insurance or some of the problems that we confront at the present time. But nevertheless Medicare particularly part may represent an effort to deal with part of the problem for a part of the population.

RS I don't need to remind you that we do at Medicaid but that is basically a means tested program it's a welfare program. It is not in conformity with the concepts of social insurance. Well I feel the fact that presidential candidates have been confronted with a problem when confronted with the importance of our beginning to move as a nation in the long term care area is very very important. And that's why you have confronted them. You've always confronted them with the concept of are moving in accordance with the basic concept of social. In short

reaction the acceptance of all the commitments that have been made moves forward. As a nation. Four years ago this was an on the agenda no aspect of health care was on the agenda. Four years ago I feel that now within the next few weeks next few months we're going to be confronted with a very meaningful window of opportunity in the Congress of the United States in this long term care ERI. There isn't anyone in the Congress of the United States that has battled longer and more of. Them. Feel of aging in the field of health care than Claude Piper. He felt at the beginning of the session but the Congress did come

from a window of opportunity he said to me he said. My colleagues are more sensitive to the health care issue than they've been at any time since the middle 60s. He said the reason there are more signs is that people back home are talking to their talking to them about. Their dissatisfaction with our health. Care system as it stands at the present time. They're talking about the problems that they confront. Now he was very unhappy over the fact that the catastrophic health care bill did not come to grips with the long term care issue. It does come to grips with one aspect of it in that it has a prescription drug benefit. You know you all know that Bill is in conference

between the House and the sun. Congressman Barber voted for that bill on the floor. I happen to chair a national health care campaign made up of more than 90 national organizations. We support the bill even though some of us are very unhappy over the method of financing and so on. But Card is one part but the Congress was letting a window of opportunity close when it didn't move in the area of long term care. So he introduced a bill which would provide a Medicare benefit for chronically ill older person does save a person and children. In the area of home care. Are you willing to offer that as an amendment to the catastrophic but what

leadership father would be better to wait and have it voted on separately. It is going to be voted on separately in the house sometime probably early in February. It's a bill which as I've indicated would provide a chronically ill older person disabled bird with benefits that would be of tremendous help to them in dealing with all timers disease dealing with Parkinson's disease and so on. How's he going to finance. All those or making payroll contributions know that up until the beginning of this year you've been contributing seven point one

into the trust fund that's gone up. Point 5 0 the beginning of this year. But you probably haven't stopped to realize that. One point four or five of that goes into health care trust fund health insurance fund or Medicare. Now you also know that you paid up to forty five thousand dollars last year. You make your payroll contributions up to 45000. So does the employer Congressman Popper would lift that ceiling as far as the one point four or five as kms or so that on the one point four or five everyone would pay off on what ever they earn. The employer would do likewise. Doesn't a perfect bill mean people could work out it and improve it.

I'm sure now I have an opportunity to do it and want to get over to the sign of the song but it is a significant breakthrough in that aspect of long term care that deals with home care and a third significant breakthrough. I do not see how any candidate for president or any candidate for re-election to the House or Senate or anyone who wants to get in the House and Senate can say in one breath that he favors our nation doing something about long term care without in the next breath also saying that he supports Congressman Popper's effort to provide this nation with a significant breakthrough in this area. Here's an opportunity to test generalized commitments to find out whether or not those who have made generalized commitments

along the line that we want them to make about much are prepared to go on the line in terms of a specific measure that would provide us with a significant breakthrough in this area. This is going to be a real tight national healthcare again pain and yellers II because he's associates and many many others doing everything they can to sayto people out of their grassroots. If you believe that there should be a breakthrough if you believe in the social insurance approach here is an opportunity for a breakthrough in the home care area. Write your congressman or senator and tell Our him that this is where you stand on our problem and that health

care is to tight what we know is the conviction out of the grassroots you talked about the polls you had information presented to you about the ball. We know where people stand. But how do we get it not only on the political agenda but how do we get action on specific proposals. I'm sure our system of government we can take grassroots sodomite such as exist at the present time and translate it into action which will be helpful and meaningful to people at the grassroots. We don't I don't wait for new administration for new Congresses and so on. Here's an opportunity. The present citation of carvers to demonstrate the strengths of this grassroots following this grassroots conviction.

Get those laws through by a wide margin that will put us in a position where we will be responsible for the development of a moment. Which will keep moving us forward until we achieve the objective that every other industrialized nation in the world has achieved and we have yet to achieve. Namely legislation that will give universal right of access to adequate health care with adequate provision for cost containment not WASPy are all of an objective. Not on long term objectives but a short term object. You talk to people about it now and they say you know a lot actually they agree with you but they say this isn't the time. The climate is wrong. Well one of the ways to demonstrate

that the climate is right for a consideration of long term care issues for their consideration of issues that will open up access to the 37 million that do not have. Access at the present time is to get. Good strong vote in favor of the proper bill we have the same opportunity confronting us in all probability in connection with the Kennedy watchman bill as far as the access issue is concerned. Where employers would be required to include minimal health insurance policy in their pocket judgment boii a done deal only with acute care doesn't deal with long term care. But again 60 percent of the 37 million are the working population 12 million of them are children. It would move us forward

because of the time and thought and investment you make in the long term care which is a source of inspiration to the entire nation. I hope that you will see the proper bill as a real opportunity. People asked me is there opposition I have not been able to identify organized opposition to the proper bill. The only thing that will kill the proper bell is apathy. Faith here on the part of some of us to get the message across to the people at the grassroots so that they can have the opportunity of talking with or writing to their congressman and their son. I really believe that we're on the verge of a grassroots movement that is going to

take this parched Wark health care system of ours in hand and bring us to the point where point we will have assessed. Which will represent a decision on the part of our national community to pool edge where each source in such a manner that when our people are confronted with these Hauser's and assess the duties of how they can count on a system where ever they may live. You know our age so this is a story. Yes it is. It's one that I personally hope. To see the reality and

I believe that will be because of the convictions of people out of the grassroots and because of my conviction growing out of 50 years of experience with our governmental system that that kind of conviction exists out of the grass roots. Our system will produce results. I want to thank you for what you have done to get this movement underway. I can assure you that many of us are prepared to work with you in order to keep it going till we got the kind of results that our people deserve. I will do it I'm sure each one of them's keeping an eye on Martin Luther's calms the fear urgency. Now we can't afford to keep polls.

Thank you. Dr. Arthur S. Fleming former secretary of Health Education and Welfare former U.S. commissioner on aging and currently a member of the board of directors of the National Council on the aging. Following Dr. Fleming's remarks those attending pursuing solutions to the family crisis of long term care completing the New Hampshire presidential forums conference were able to take part in several panel discussions on a variety of related topics from a New Hampshire perspective. These topics included home care as part of the long term care picture. Housing options and alternatives for elderly living pain for long term care quality of life can be assured and New Hampshire's a labor shortage. Where are the caregivers. At the conclusion of the conference the closing remarks were given by the Honorable John Sununu Governor of New

Hampshire who offered the conferees his views on the issues problems and their solutions in connection with long term care. Thank you very much I am pleased to be here today but I'm going to stress right at the very beginning that I'm not here as an expert. I suspect there are a lot of other people who think there are experts that have had a chance to talk to you. But I will talk at least not an expert in dealing with with long term care. But let me talk to you as one who has in the past made a living at dealing with complex problems. As a consultant you learn that most issues that people have addressed over a long period of time and spent a lot of money on and devoted a lot of resources to if they've done that and they don't have an answer then the reason is is that the problem probably has answers only in

nontraditional solutions. And I'll suggest to you today as one who has tried over five years to deal with some of the hard health issues but the fact of the matter is that yes the question of long term health care is a tough one. Yes it is complex Yes it is important. Yes it has been investigated. And I'll bet you anything you want that the solution is probably nothing you've heard of yet. And I say that because I have looked at the literature you have here. I have listened to people going around the country. I have talked to are professionals within our department and I have heard nothing that falls in the category of what I call the solution that goes ding. Because most of the times when you're dealing with something like this and you hear people coming with recommendations it's always will put more money will put more facilities will put more resources will add more taxes will

take here more people will put more beds in place more more more more more and how they're going to manage it they don't know. And it just never seems to go ding. So let me give you my version of the kinds of things that I think ought to be given more emphasis than I have heard. Not that they alone will create a solution but the taken together I think they may begin to frame the structure around which a solution can be developed. First of all I think the fundamental problem in long term health care is a national problem of having drifted away from a basic structure. Of having a strong relationship within families to a structure where we have assumed that we are all entitled to everything. And the government's going to take care of it. And I guarantee you as one who has worked

awfully hard. In trying to identify how to deal with tough problems that because of the numbers involved in this problem that will not work. You cannot have everyone entitled to everything. With nobody left to pay for it. And so this system. Most of what I have seen that moves in that direction is unstable. The lines never cross on the curve. The income and the costs never relate to each other. And with all due respect to all these folks running around the country asking for you to support them those that frame the solution in those terms I guarantee you have never put pencil to paper to try and draft a solution for this kind of a problem. And so I am convinced that we will not deal with the problem of long term health care until we build into the system. A whole series of incentives that really glues together if you

will the family relationships that I think are necessary to form the heart and soul of this problem. The solution to this problem. There's no other way the arithmetic works out. There's no other way you raise enough money to do it. If it is all at a given age in time everybody becomes a ward of the public and there's no other way to do it if you assume that some mechanism of exchange of resources will take place to take care of everybody's needs. The arithmetic does not work out. There are ways however to deal with those who by virtue of circumstance may not have a family structure to fall back on. There are ways to deal with those families where the structure is there but the resources don't exist. But it cannot be done fairly. In an environment of universal entitlement it cannot be done fairly. If we think we are all owed that solution

it can only be done fairly. If we approach the problem and say What can we give to the system in order to help those that have these needs. When I became governor we started to run numbers through on our healthcare needs and we looked at this issue. And there was no way we could meet our responsibilities with state federal. Dollars if all we were going to do was move into the basic traditional structure that everyone else had done. A Because they don't even do it themselves. And B because I really do think that when you address the kinds of things you want done for people you don't just keep throwing money at the problem. We looked at this issue and it was clear that the federal laws the federal regulations as well-intentioned as they might be had some terrible unintended consequences. We had federal laws that had built into

themselves incentives to break up families. And I can't think of anything. That is more inappropriate for government than to establish incentives to break up families. We couldn't get assistance into the system unless the parent or the grandparent was institutionalized in many cases. Young couples taking care of parents or grandparents that were only looking for help on one specialized care need were told You can't have it in a home setting. You've got to put them in a nursing home. And so we recognized that a system of incentives to break up a family as per se on its own inappropriate and B is not cost effective. And C once you resort to that the ingredients that for so many folks is the most important ingredient in health care caring sensitivity love is lost in the process.

That doesn't mean our institutions don't do the best they can but there is no substitute for what transpires between people who are members of the same family who are sharing to meet a need. And that's why we went in for that waiver. And I think that waiver has been effective and it is allowed us to provide services in home settings. First of all to deal in an affective way with providing only the service that is required and not saying if you want to take this service you have to accept seven others as well. And secondly it allowed us to keep families together. And thirdly in fact. It was very cost effective. I am convinced that there is a balance amongst a menu of services and Mammy and menu of mechanisms that we can frame not merely by picking from the traditional approaches. By being creative that allow us to

deal with some of these very expensive and very critical problems. A great number of families would gladly gladly continue to care for their loved ones if they had some assistance in those specialized areas. They had some opportunity for a given period of time to get respite from the kind of pressure that's involved when you are doing that caring. The combination of home care and respite care and specialized services in periodic perhaps institutionalization to treat illnesses in a timely and effective way. Different kinds of communities communities where families might be able to share periods of time together. All of these in my opinion provide the kind of structure around which a program that can work might be framed without it. The dollars that are involved the resource allocation the changing age and

of the demographics of our changing population and the inversion of the pyramid on age. It's going to create a system that will not work any other way. And yes it is nice to say well we'll do it no matter what you say we will tax ourselves to death and put all the money in that is necessary. There gets a point where the arithmetic says that all the will in the world cannot change the capacity of the system to deliver. We do have about a 6 to 12 year period of time half a decade to a decade roughly in which as a nation I think we can begin to frame these solutions before that inversion of population numbers and the demographics begins to catch up with us. And the challenge is is to cut through the easy rhetoric of those that. Find it easier to promise than to deliver those that find it very easy to jump on the bandwagon of commitment without ever having to pay the piper

in terms of making systems work. I can't tell you today what the ingredients are all the ingredients are for a system that deals with this issue. And I can tell you what the ingredients are for a solution that is doomed to failure. And any solution that is simply designed to reach in and assume that there will be a population you can tax a small portion of to take care of the rest is not going to work. It is not going to work because it creates resentment. It is ineffective it is self limiting and the demographics on age suggest to you that at some point it falls apart. And so this structure that we're talking about taking care of those that have special needs in settings that are most effective of reestablishing the by and the the ties that that bind within families utilizing family roles as part of the solution recognizing that we need different components of

solution at different times and trying to tie it all together into a long term social framework of fabric if you will to take full advantage of all the thread that is there I think will make a difference. I hope that what we've started these past few months in terms of the discussions you've been having in terms of the approaches you've talked about is the beginning of understanding what can and can't come together. That is not going to happen quickly. It's going to be a long term dialogue. But I suggest to you that as you go through this over the next. Gosh knows how long it you just keep in mind the fact that as much as you would like to have a simple solution to this I really do think it's going to be a little bit more complicated and paste in the other. Some of the old traditional ones. Thank you very much for your commitment to the issue. Thank you very much for your involvement and let us make sure that we continue this dialogue. That is so much a part of

working out a solution to what is for all of us at some time in our life lives going to be the most important problem that anybody can be dealing with. Thank you very much for letting me join you. Thank you. Governor John Sununu in his closing remarks to the participants at pursuing solutions to the family crisis of long term care completing the New Hampshire presidential forums. This conference was held on January 26 at the New Hampshire highway hotel in Concord. It was the culminating event of the New Hampshire presidential forums on long term care a project of W E v o FM and WMUR TV project coordinators were Jay Joseph Grandmaison and Representative Tony Pappas form director and conference organizer was Terry C. Lockett the New Hampshire presidential forums on long term care were made possible by grants from the Villars Foundation and the New Hampshire charitable fund and affiliated trust recordings for this program were made by Larry beavers and

Malloy sound. I'm Doug Levy. This has been a special public affairs presentation of WEO FM.