Alan Zendell, October 12, 2024

Promises made by presidential candidates are usually nothing more than statements of desire. Most Americans seem to have forgotten their seventh grade civics. The only things presidents can do on their own is appoint judges, including Supreme Court justices, and command military actions. Even in those cases, a president requires a cooperative Senate, and everything else they promise us is the responsibility of Congress. Presidents can propose legislation and veto bills they don’t like, but without Congressional approval, they must resort to Executive Actions that can be reversed by their successors.

That’s especially true for virtually everything Donald Trump has promised this year. Most of his promises involve attacking, incarcerating, or deporting people he doesn’t like. His occasional suggestion about a new, niche-targeted tax break likewise falls under the powers granted to Congress in our Constitution. He does seem to have broken new ground, however, proving that no one can stop a sitting or former president from cozying up to autocrats and people who wish us harm. The only protection we have against that is impeachment, which has become so politicized in recent years, it’s purely symbolic.

Kamala Harris has made a number of innovative proposals in her quest for votes. The things she has proposed are generally very popular with voters, but there’s little chance, realistically, that any MAGA-dominated house of Congress would approve raising taxes on billionaires to provide down-payment assistance for first-time home buyers. Similarly, it’s difficult to imagine how she would go about punishing price gougers, even if she had the power to do so. During World War 2, the FDR administration was very concerned about price gouging, with many popular commodities like gasoline, sugar, and meat in short supply and being rationed. The only workable alternative was price controls, which everyone hated.

That being said, Harris proposed something this week that got my attention. If you’re not close to retirement age, you might not think it’s urgent, but the idea that Medicare would cover Home Health visits is ground-breaking. It would totally transform retirement planning and financing for most Americans. As president, Harris would have to convince Congress it was a good idea before a penny of tax revenue could be spent. But this idea might have better sailing in Congress, because it would so fundamentally impact the lives of seniors, who vote more consistently than any other subgroup of voters.

Long term care insurance for seniors, especially nursing home and rehabilitation center care is so expensive, it’s beyond the means of most Americans, and applicants can be rejected due to pre-existing conditions. Nursing home care is the most expensive category of Medicaid-covered services, and Medicare offers such coverage only on a short-term basis. People who can afford to purchase private long-term care insurance represent a minority of Americans.

Most people cringe at the idea of spending their final years in a nursing home. Given a choice, they would rather live at home and hire health care professionals to help out. Home Health care is far less costly than nursing home care, too. Even so, paying for visiting nurses and therapists out of pocket would devastate most people’s savings fairly quickly. Considering the age distribution of our population, meeting the long-term care needs of seniors is something Congress would have a difficult time rejecting.

The caveat in all that is that Harris would likely require a voting majority in both the House and the Senate to expand Medicare coverage to Home Health Services. But this proposal would have such a revolutionary impact on seniors, it’s a great pitch to vote for both Harris and Congressional candidates who would support the idea.

It would be expensive, and it would require raising taxes on the wealthiest Americans, simply because no one else could afford to fund such a program. But there would be compensating effects. Poverty among seniors would be greatly reduced, as would the greatest source of stress faced by most seniors. As such, Medicare coverage of Home Health care is a family values issue that right-wing politicians would ignore at their peril.

Experts often compare our health care system with Canada’s, which MAGA people refer to as socialism. But Canada’s health care system doesn’t pay for long-term care, either. In the United States, people who require long-term care but can’t afford it can only resort to charity, family assistance, or Medicaid, with its negative stigma. In Canada, they can appeal to a rate-reduction board for assistance.

If a Harris administration could pull it off, having Medicare cover long-term Home Health Care might be the most impactful action since the Medicare legislation was past in 1965.