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John Oliver Explains Why Joe Biden Is Trying To Revolutionize Long-Term Care

The long-term care industry is famous for abuse and neglect, and Joe Biden wants to support home care instead.

Via This Week, John Oliver looks at the scandal that is long-term care in America:

About 80 percent of home care is provided by unpaid caregivers, typically family members trying to keep their loved ones out of institutional care. But "taking care of someone at home can be an incredibly complicated full-time job that is almost always unpaid," Oliver said. "In fact, in terms of lost wages, the labor of family caregivers totals about $67 billion annually," or roughly the GDP of Bulgaria.

There are more than 2 million people in long-term care facilities, though, and that 0.63 percent of the U.S. population accounts for about 33 percent of COVID-19 deaths, Oliver noted. "The truth is, COVID just exposed what we've basically known for years: that the way the elderly and disabled are treated in far too many of these facilities is with, at best, indifference, and at worst abuse and neglect. So tonight let's talk about long-term care: how the industry is structured, how that structure creates bad incentives, and what we can do going forward."

There are different issues depending on whether you are underserved on Medicaid or inappropriately over-treated on Medicare — for the short period Medicare covers nursing home care, at least, Oliver said. But partly because of the myriad problems at both kinds of facilities, 90 percent of people 65 and older want to stay in their homes for as long as possible, something Medicaid generally doesn't cover. There are bills to fix that, and President Biden's infrastructure plan would help a lot, he said, "but we do need to do something, and it all starts with showing we give a sh-t about what happens to the elderly and people with disabilities in this country. Because right now, evidence points to the fact that we absolutely don't, and all the other problems are stemming from that." There is some off-color language, disturbing tales, and one Andrew Cuomo joke.

Oliver didn't mention it, but nursing home operators are traditionally big Republican donors -- because they hate regulation, obviously. But even worse, they're also famous for evading financial responsibility or lawsuits by shuffling corporate ownership around. And it's not unheard of for these facilities to keep terminal patients alive as long as possible to milk Medicaid and Medicare payments.

That's why Joe Biden includes some serious money for long-term care in his infrastructure bill.

The White House infrastructure package includes $400 billion to accelerate a shift from institutional care to home and community services through the federal-state Medicaid program. The size of the financial commitment — about 17% of the $2.3 trillion infrastructure proposal — leaves no doubt that Biden intends to put his mark on long-term care.

Republicans, of course, oppose it, because it cuts into a major donor base. They claim it's because long-term care has "nothing to do with infrastructure" but they're lying. They know how much it's needed -- and they understand a federally supported program to move it away from facilities and into homes will make workers much less desperate as they attempt to take care of aging parents -- and a lot more grateful for government help.

They hate that.

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