Letter to Senator Bernie Sanders: Medicare for all and long-term care

Nov 8 2017
Members of PNHP Illinois steering committee

The following letter was approved by the PNHP Illinois steering committee and sent as an email  attachment to Lori Kearns, Senator Sanders' health policy staff person. 


November 8, 2017

Dear Senator Sanders

Thank you for the introduction of S 1804, the Medicare for All Act of 2017, on September 13. We appreciate the efforts you have made to educate the American public on the issue of national improved Medicare for all.

As you know, Physicians for a National Health Program (PNHP) has worked for health reform since 1987, with the goal of equal access to high quality health care for all residents of the US, with no financial barriers or burdens. Furthermore, PNHP members have dedicated themselves to the development of evidence-based health policy that will make that goal a workable reality.

Therefore, we are concerned with several aspects of S 1804 that do not meet standards of equity and support by evidence. In this letter we address the exclusion of long-term care from Medicare for all under S 1804, leaving it to Medicaid and the states. As you know, long-term care coverage is included in HR 676, the Expanded and Improved Medicare for All Act.

In addition, HR 676 includes a preference for home and community based over institutional care. This is an issue of the greatest importance to disability rights activists, as embodied in S 2427, the Disability Integration Act, of which you are a co-sponsor. This commitment is absent from S 1804.

Millions of older adults and millions of younger people with disabilities need long-term care services, which are financially out of reach for the vast majority, for the preservation of their life and health. As with all other medical care, these costs should be spread across the entire population through first dollar coverage and funding by progressive taxes.

Leaving long-term care to Medicaid and the states would have numerous adverse consequences, among them:

People with a permanent need for long-term care would be forced, as now, into life-long severe poverty in order to maintain Medicaid eligibility and access to care. Those who have some financial assets to start with would be forced to do without care or to impoverish themselves in paying for it. In both cases, the financial consequences fall on succeeding generations, indefinitely.

The state-based approach to long-term care makes it impossible to address widespread inequality in benefits, much of it based on race.

The state-based approach opens up the possibility of a repeat of the Medicaid expansion disaster, with states deliberately disqualifying their programs from federal funds.

Workers providing long-term care services would continue to face poverty level wages and lack of benefits under an under-funded and always vulnerable system, while their clients would continue to suffer from lack of a stable and dedicated work force.

Every group of people already living with social disadvantages would be disproportionately affected by the exclusion of long-term care from Medicare for all. Examples: women would continue to bear the burden of providing unpaid care; people of color would continue to receive inferior care because of their greater rates of poverty; people of non-conforming gender and sexuality would continue to face abuse in institutions in which they cannot choose their caregivers (as they should be able to do when living in the community); undocumented immigrants with long-term care needs would continue to face forced medical repatriation.

Long-term care is health care. The single-payer movement has moved the health care debate further and further toward a commitment to health care as a human right. It follows that long-term care should be covered, along with all other care, under the national improved Medicare for all program that all of us work for.

Senator Sanders, we urge you to amend the Medicare for All Act of 2017 to include long-term care on the same basis as all other health care.

Thank you for your attention to this important matter.

In solidarity,

Members of the PNHP Illinois steering committee:

Nahiris Bahamon, MD

Peter Gann, MD

Pamella Groneneyer, MD

Alex Neuman, DO

Peter Orris, MD

John Perryman, MD

William Reed, MD

Susan Rogers, MD

Anne Scheetz, MD

Alap Shah, MD

Phil Verhoef, MD


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