Universal Long-Term Care is an urgent policy matter that is massively popular even when paid for with a broad-based payroll tax. Check out me and @ColinJMcAuliffe's latest in the @DataProgress blog: https://www.dataforprogress.org/blog/2019/11/28/long-term-is-a-political-winner

A growing number of Americans need support with basic activities of daily life, like dressing, eating, and using the bathroom, due to old age, chronic illness, or a disability. But we're near the bottom of the OECD in public LTC spending

The private LTC market is in a state of market failure. The remaining policies are geared towards the rich. One in four millionaires has private LTC insurance, compared to only 1 in 25 people with wealth between $50k-$100k.

Contrary to popular belief, Medicare does not cover LTC. Mediciad covers the majority LTC in the US, but it has strict asset and means-tests (you can't have more than $2000 in countable assets), forcing people to impoverish themselves to qualify (or get medical divorces)

The ACA contained a public option for LTC, called the CLASS Act, but it was scrapped before being implemented because premiums would have to be too high to attract healthy participants, leading to a death spiral.

The failure of the CLASS Act and the private market makes a universal social insurance model the clear way forward. We all pay in via a payroll tax, and we all receive benefits in the event we need them https://twitter.com/dylanmatt/status/1191056787350474752

Sanders and Warren have endorsed Long Term Care as part of M4A (thanks to pressure from activists like @AdyBarkan). Joe Biden meanwhile has pushed a non-refundable tax credit that would exclude the most vulnerable by design, and impose a bureaucratic burden on those who qualify.

Most of the other candidates have not released specific LTC proposals ( https://twitter.com/taragolshan/status/1186295056224776192). But they would be wise to embrace a universal social insurance program, because it's both the right policy response and a very popular idea

We tested LTC for the elderly and for people with disabilities, and even with GOP talking points and an explicit mention of a payroll tax pay-for, they were both *wildly* popular

Interestingly, LTC reverses the usual distribution of support among old vs young

I understand the desire to own the Boomers. But really it's a small majority of Boomers that have ruined everything. And the long term care crisis hurts many young people too, who do $470 billion of unpaid care work every year.

In terms of policy design, we should structure LTC benefits to pay out in cash, and allow recipients to self-direct care, either paying family and friends or professional caregivers. Home and community based care should be prioritized over institutional care.

In one study on a Medicaid pilot, patients receiving paid care from family (rather than professional home care) were 30% less likely to have bedsores, 50% less likely to go to the emergency room, and reduced Medicaid spending by $1,370 over 9 months https://www.nber.org/papers/w22249 

We should also ensure that care workers are paid living wages. It can literally save lives, and help attract workers in a sector experiencing worker shortages https://twitter.com/jdcmedlock/status/1190650402066186241