US must help pay bill for long-term care, study says

A new study thrusts further forward the issue of long-term care in America, now moving rapidly from back to front burner. By concluding that a major federal role will be required to meet long-term care needs, the Brookings Institution study buttresses the fundamental argument of top congressional health specialists who are preparing a variety of proposals to deal with the issue.

Next week the issue advances another step: Sen. George Mitchell's Senate subcommittee on health begins the first of a spate of Capitol Hill hearings on America's needs for long-term care. Senator Mitchell is trying to lay the groundwork for congressional passage, probably not before next year, of a proposal to provide financial aid to elderly Americans who require extended assistance in daily activities, such as eating and dressing.

Supporters of an expanded federal role in long-term care immediately praised the report, by economists Alice Rivlin and Joshua Weiner; opponents criticized it.

The significance of the report lies in part in its careful conclusions and in part in the respect accorded Dr. Rivlin, a former director of the Congressional Budget Office. ``Alice plays a key role in this town,'' says Douglas Besharov, a resident scholar at the conservative American Enterprise Institute. ``She has no ax to grind, great personal integrity in the numbers,'' and is a major influence on moderates of both parties. Mr. Besharov says ``her report will set the benchmark for the coming debate'' on long-term care.

The report provides supporters with something heretofore missing: ``a very sophisticated model in terms of projecting the need into the future,'' says John Rother, legislative director of the American Association for Retired Persons. ``We've never had that before.''

The Rivlin report recommends that private insurance ``should be strongly encouraged and should expand to take a larger part in long-term care financing.''

The report also validates the warnings of conservatives that great care must be taken to prevent an explosive growth in costs, especially of home care.

Representatives of large insurance companies immediately criticized the report; one called ``premature'' the conclusion that government aid is necessary and that private insurance cannot by itself protect Americans against long-term care costs.