Options for long-term care financing reform: a view from the inside out.

The goals for any proposal for long-term care financing reform must include the development of a deliberative, organized and coordinated structure of consistent benefits and service capacity that is accessible to individuals with administrative simplicity and operating certainty for providers. The best way to achieve these program goals is to foster a radical new system that relies on the maximum use of private long-term care insurance. Elimination of the Medicaid program as the primary funding vehicle for long-term care and federalization of all nursing home and home care services will serve as an interim measure until private options are developed and in place. A continued federal role will be needed for maximum risk pooling, standard setting and acting as the stop-loss reinsurer and ultimate safety net for those outside the reach of the private market. Certain interest groups, including the state governors and the advocacy groups on women's issues have unique roles to play in shaping the coming debate. The shifts in thinking and in behavior change needed to commit to such a vision will not be easily achieved. Long-term care is as much about roles, relationships and responsibilities as it is about health, illness, rules or regulations. These inherent and intimate characteristics of long-term care mandate a clear vision of what the system should look like and very deliberate steps to devise and to enact the progressive reforms necessary to meet the coming demand. Reasonable people will differ about the appropriate mix of public and private responsibilities in any system to provide long-term care.(ABSTRACT TRUNCATED AT 250 WORDS)