Jan. 26, 2007

Dear Mr. President:

Your State of the Union message surely highlighted fundamental and enduring American ideals reflected in our "commitment of conscience," so eloquently stated. Our members, mission-driven care and services providers who serve the elderly and disabled, support your assertion that a "future of hope and opportunity requires that all our citizens have affordable and available health care,"... and that "government has an obligation to care for the elderly, the disabled, and poor children." Well said, sir!

You then mentioned the challenge of "entitlements." Please understand that remarks like that have become code for cutting Medicaid, social programs and senior housing for the very same populations that commitments of conscience should be faithful to. So, lest we all talk of commitments in one breath and cuts in another, perhaps this is the time for you and Congress to clarify what you believe all Americans are entitled to.

America's early historical principles say we are entitled to life, liberty and the pursuit of happiness. Noble, universal, enduring umbrella ideals forged in the crucible of the great American experiment of self-governance, freedom and promotion of the general welfare. Our existing entitlements did not come easy. A century after the Civil War, it took major national unrest to assure equal access to the ballot box for all Americans.

Over time, other apparent entitlements have evolved. For example, we now require all children to attend school and receive immunizations, and we afford them universal protections from abuse, neglect and exploitation. It is safe to say that we as Americans believe they are entitled to be educated and protected, as we decided that seniors are entitled to prescription medication two years ago — a long overdue benefit.

But we quickly reach the limits of entitlements for children because not all of them have health care. Are not our children entitled to health care? You made that a priority in your speech. I suspect virtually every American would support that as an entitlement. Mr. President, you and Congress, as the elected representatives of our commitments of conscience must make it so.

What of other vulnerable populations? Are they not entitled to basic health care as part of Americans commitment of conscience? As a matter of practice, do we turn them away at our emergency rooms and public health clinics? No, usually not, but we often don't make it easy for them. In fact, we often channel them through a two-tiered great divide system of inner-city mega-facilities and the blue chip insurance hospitals. The former is chronically under-funded and take in our difficult, uninsured and Medicaid populations. Then, some politicians complain that the tax burden to support them is too great, so we cut their funding. Yet, no major city or rural community can survive without these large and small oases of health for all citizens. Are these services an optional commodity or a basic entitlement? Our collective conscience would say the latter, I would wager.

So, why not recognize what we, in our hearts, already know and believe — that all Americans are entitled to basic health care as a right? It took 400 years for people of different races in America to agree that we all are entitled to vote, socialize, shop, worship, dine, ride and be educated. So, is not the time long overdue that we should all finance, support and have equal access to the considerable, miraculous and advanced health resources of America? Let's do it in two years—not another 400.

Mr. President, do you, your family, members of Congress and federal employees have immediate access to excellent health care? Of course—and you deserve it. The American people have a moral obligation to see that you have it. But, how then do you differ in status from a convenience store worker, a nursing assistant, a domestic worker, a teacher's aide, a new graduate looking for job, a homeless person or a family down on its luck? I'd bet your upbringing would say we are all equal in the eyes of the Almighty. If so, isn't it time to declare that all Americans are entitled to health care?

Health care feasible as an entitlement, pundits might ask? The money to cover the cost might be found in a surprising place: the restructuring of long-term care financing. Many American families face the cost of practical obligations of a family or friend chronically impaired. The demographics say that the majority of this growing group of American citizens are elderly, but one third are younger. They all need care and support.

The conventional wisdom is that Medicaid's problem is greedy families wanting to hide assets and the solution is tax breaks to buy long-term care insurance. Neither conclusion reflects but a minuscule amount of truth. Yet, there are existing long-term care financing models in Europe and successful experiments in the United States that could create a sound and viable long-term care financing model that could save Medicaid and help us fund health care as an entitlement. Mr. President, there are solutions to financing of health care beyond the current, and narrow, scope of inquiry and the protection of special interests health care businesses. Yes, health care in general, and long-term care in particular, can be affordable entitlements!

Mr. President, you made no mention of Katrina and Rita recovery. A surprise for many who listened to you. Are the people of the Gulf Coast region entitled to funds and support to restart their lives? We made them a promise to rebuild their community, and money was committed. Yet, efforts are slow and priority of national interest seems weak. While your attention is focused on unimaginably complex issues, surely there must be a surge plan to catalyze the Gulf Coast recovery. Are not all Americans entitled to the opportunity to recover from great tragedies? Surely we are.

And, Mr. President, you made no mention of housing policy. Not surprising with the press of other issues. Isn't housing, either rented or owned, a basic entitlement for all Americans? Certainly your leadership has made it easier for more people to own their homes, and the economic climate you have created has made it easier to obtain affordable loans. Both great achievements. But what about low-income elderly people unable by personal circumstances of health or pocket book to live alone in a home? Two generations ago, the U.S. Department of Housing and Urban Development created subsidized housing to address this emerging need for senior housing assistance and low interest capital to stimulate construction. A very successful program. Now, there are 10 low-income seniors on a waiting list for every unit that becomes available. Yet, funds are continually squeezed, the bureaucratic barriers to new construction and renovation daunting and the mechanisms to coordinate housing with services to keep older people out of nursing homes and emergency rooms are limited — all of which have negative impact on health and the cost of health care. The loop circles back to health care.

So, Mr. President, isn't it time we decided that all Americans are entitled to health care, housing and recovery from catastrophe as the new era manifestations of enduring and hard-earned, assured American ideals of life, liberty and the pursuit of happiness? None of us can feel secure at home without these essentials. To deny them sears our souls and masks the real costs of inevitable conditions and untreated sickness. A moral failure and bad business. Not what makes America great.

We'd support your leadership on these matters the last two years of your Administration. That would be quite a legacy. You could be remembered for your "commitments of conscience." I like that phrase a lot.

Thank you, Mr. President. AAHSA will help you fulfill these commitments. We believe that Americans are entitled to them.

Sincerely,

William L. Minnix

President & CEO
The American Association of Homes and Services for the Aging