Book Review

Health Care Politics

Sharing the Burden: Strategies for public and private long-term care insurance

N Engl J Med 1995; 332:194-195January 19, 1995

Article

Sharing the Burden: Strategies for public and private long-term care insurance
By Joshua M. Wiener, Laurel Hixon Illston, and Raymond J. Hanley. 243 pp. Washington, D.C., Brookings Institution, 1994. $34.95 (cloth), $14.95 (paper). ISBN: 0-8157-9378-2 (cloth), 0-8157-9377-4 (paper).

It is typical of the casual attitude of this book toward financial matters that nowhere on its cover or inside is there any indication of how much the book costs. Because the book's publication was funded by the Henry J. Kaiser Family Foundation, Merrill Lynch, Merck, and the College Retirement Equities Fund of the Teachers' Retirement and Annuity Association, there is apparently no great interest in its sales or expectation that anyone other than some libraries will buy it. There is certainly no sign that the authors are eager for royalties.

The authors confidently state that sometime during this decade so many Yuppies will be inconvenienced by the cost of long-term care for their mothers (fathers rarely living as long) that the Yuppies will exert political pressure to ensure that the Clinton Health Reform Act (assumed prematurely and erroneously to have been passed in 1994) is modified to provide long-term care. Although the authors expect private insurance to grow, they think it will play a minor part and expect government to pick up most of the bill. They also want Medicaid liberalized so that it no longer requires complete impoverishment before it takes on the burden of paying for long-term care. Because of Yuppie pressure, the authors expect the federal government to pick up most of the financial burden, although at several points they mention somewhat anxiously that people seem averse to paying higher taxes.

Because of my curiosity on this point, I delayed writing this review until November 8, 1994, the day after the midterm election. My observational finding is that most Americans dislike paying taxes so much that they gave Bill and Hillary Rodham Clinton one of the most complete and devastating political defeats in our history in this election -- a real repudiation. The House and Senate have gone Republican for the first time in decades, and many Democratic governors (Mario Cuomo in New York, for example) must yield their palatial residences to Republican occupants.

And the Wall Street Journal reports that an increasing number of upwardly mobile women in American business are now leaving their jobs to take care of their ailing parent or parents. There is no mention made of political pressure of the kind that this book assumes to exist.

Therefore, I conclude that the authors of this study, like the authors of many socioeconomic studies, are living in Cloud-Cuckoo Land. But the book is well printed and has many interesting statistics, although I have made no attempt to test their accuracy. I judge no book on this topic worthy of a busy doctor's time unless it faces the central issue squarely: the American people's great reluctance to pay more taxes, for long-term care or anything else. A reluctance that, at the age of 75, I share.

Harry Schwartz, Ph.D.
Scarsdale, NY 10583

Citing Articles (1)

Citing Articles

1. 1

   (1995) Book Review: Sharing the Burden. New England Journal of Medicine 332:24, 1654-1654
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