We’ve heard a lot of talk about Wall Street and Main Street the past few weeks; most of it focused on how we can save them both. And we are putting our collective future at risk on schemes to save these economic engines. Only as an aside do we hear about what is happening on the street where we live – let’s call it Elm Street. We work on Main Street and a few of us work on Wall Street, but we don’t live there.
As we walk down Elm Street, at least every fifth house contains a family that is providing care for an elder or an adult – a spouse or adult child – with long term care needs. This family includes a couple who are working and hoping that they aren’t personally affected by the lay-offs they are seeing around the neighborhood. There might be young children, friends or various other family members in the house as well. The person they are helping might live with them, around the corner or across the country.
In the US, as in other industrialized countries, families provide 80% of the long term care services for an adult with care needs. Families do everything that is needed by the person they are caring for – from simple errands to more complex medical care tasks. It is estimated that these “free” services save the nation’s health care budget a whopping 20% of overall costs each year. One big difference between the family caregivers in the US and those in other developed countries is that, in the US, we don’t have universal health care. Even older Americans covered by Medicare who have the closest thing to universal health care we have, have large out-of-pocket costs. The US has employer-based private market health care which means the only thing standing between you and ongoing health care services is the relationship between you, employer and external market forces.
Last winter the findings of a study looking at the out-of-pocket costs of family caregivers were released by the National Alliance for Caregiving. The study, sponsored by Evercare, examined what families were spending on behalf of the person they were helping and how they managed that expense. In a survey of 1,000 family caregivers across the country only 178 respondents said they were spending nothing. The remaining 822 respondents were spending an average of $5,500 a year on services and products needed by the person they were caring for; the most common category being medical expenses. One out of five respondents reported spending their own money to pay for the medical costs of the person they were helping at an average annual expense of over $1,100. This means that not only are these families spending hours of their time each week – an average of 35 hours weekly; roughly equivalent to another full-time job--providing hands-on assistance, they are also purchasing goods and services with their own funds. When asked how they manage the extra costs, half reported they cut back on their own spending for leisure activities, a third reduced or stopped saving for their own future and one out of five borrowed or used a credit card to finance these unexpected expenses.
In the US, nearly half of personal bankruptcies continue to be due to medical expenses and, even more shocking, 75% of those who file for bankruptcy as a result of medical expenses had health insurance when they became ill. The costs of a market-based health care system have become unsustainable to Main Street as employers find their own global competitiveness diminished by the cost of covering their employees and to Elm Street as families find they can not continue to pay for their own health care or the health care costs of an elder, spouse or adult child. We have the most expensive health care in the world and the largest group of uninsured citizens in any developed nation… 47 million and counting.
A full recovery from the nation’s financial woes cannot be accomplished without addressing our out-dated and inefficient health care system. It is shortsighted to suggest that, because we are increasing our national debt to bail out failed banks and mortgage lenders, we can’t afford to take on the needed change in our antiquated and inadequate health care system. Addressing the problems of Wall Street and Main Street cannot overshadow the problems on Elm Street or a full recovery from our sick economy will not take place.
Donna L. Wagner, Ph.D.
Professor of Gerontology, Health Science Department
Towson University, Towson, MD