Mitchell on Law
Spring 2007WILLIAM MITCHELL COLLEGE OF LAW MAGAZINE SAINT PAUL | MINNESOTA
CARING FOR AN AGING WORLD
Worldwide, the population of older people over age 60 is projected to more than triple over the next half century. Professor A. Kimberley Dayton is researching long-term care solutions for this aging population.
By Cynthia Miller
Consider this paradox: In the United States, under current Medicare regulations, a 100-year-old person with a heart ailment can be approved for a $100,000 pacemaker but not $20,000 in home-care services if he or she prefers living at home. Such skewed priorities are symptomatic of a health care system that hasn’t come to terms with the realities of an aging population and the need to finance long-term care.
William Mitchell Professor A. Kimberley Dayton, a leader in the field of elder law, is currently turning her lens on this problem and has teamed up with a group of international scholars to write a proposal for a book, titled Global Perspectives on Long Term Care, which will compare long-term care policies in different nations. As she points out, many countries that we think of as having a more socialized approach to health care aren’t dealing effectively with the issue, either.
In fact, long-term care is a new challenge for all of the more affluent nations, as life spans continue to lengthen. The need for such care typically occurs when people reach their 80s.
“Japan and the European nations are 15 to 20 years ahead of us in terms of dealing with the aging issue,” says Dayton. “Their populations are peaking now, because the birthrates in Europe and Japan were lower than ours after World War II. They don’t have the base of economic support in terms of a younger population that we have, so the problem is becoming critical earlier.”
Dayton notes that some nations, such as Germany, are trying to solve the problem by paying people bonuses to have more children, which in theory would strengthen the base of the population pyramid. However, the payments aren’t high enough to be an effective inducement. She finds it more useful to compare the approaches used by Japan, which has the oldest population, and Italy, which has the second oldest.
As Dayton explains it, Japan has created a new social insurance program for long-term care by levying an automatic payroll tax averaging around $30 per worker per month on taxpayers aged 45 and older. Long-term care is available to people 65 and older; with the amount of the benefit tied to their level of need.
Italy, on the other hand, has forced a lot of responsibility on families and encouraged immigration to supply a source of cheap service labor. Its policy is to make families pay for the care, a lead that the United States is currently following.
Dayton regards Japan’s approach as a more functional, compassionate model and believes it also presents a solution to the problem of money being siphoned from the Medicaid program. By imposing a small worker tax beginning at age 40 or 45 when people tend to have more disposable income, we could remedy the deficit. She comments that Americans are not very well-educated about how social programs work, or we’d be better able to make decisions that affect our lives in any number of ways. She also notes that with Medicare, administrative costs are 2 percent, versus 25 percent with private health insurance, so allowing the private sector as much control as we do makes no sense at all.
The essays in Global Perspectives on Long Term Care will focus on financing efforts and public policy reform in Canada, Australia, and Israel, with possible chapters about Japan and New Zealand, each written by a research scholar from that nation. Dayton plans to write the introduction to the overview of U.S. policies. She has also written an article on the subject which is pending publication in the Canadian Journal on Elder Law and presented another article at a symposium at Marquette University. Dayton’s intent is to influence financing efforts and reform of the current system by raising awareness, educating, and networking.