8.2 What organizations and interests are likely to support or oppose the endeavor and what strategies might forge a consensus to proceed?

For themselves and their families when they are frail, virtually everyone wants a MediCaring approach. It ensures reliability, respects preferences and priorities, and reduces costs. But acting as defenders of the status quo and its rewards, one would expect powerful forces to reject this reform – implementing MediCaring Communities stands to reduce the revenues now going to health care and allied businesses and to reduce their power in the society. Meal delivery might be found to be more important than ready availability of a low yield, high cost drug. That comparison does not happen now.

The rising numbers of frail elderly people provide a helpful response to those concerned about reducing utilization of medical services. If we generally keep the medical service capacity from growing along with the numbers, all current supply can stay very busy, while the per capita costs go down. This won’t work in every instance, but it will overall, and that effect stands to mitigate the impact on medical service providers of prudent reductions of medical services per elderly person.

What organizations are likely to take up the cause? The consumer groups that try to represent the frail elders and their families have had very limited power. Some caregiver group will probably catch the rising tide and organize political pressure to get things right for the family caregiver. The paid caregivers are gradually finding their voice in unions and organizations advocating for fair wages and benefits. Physicians and other professionals who serve this population find professional satisfaction in improving care and in making it easier to serve these patients well, so some professional organizations will be allies. Perhaps the largest array of groups that might take up advocating for MediCaring Communities are the many publicly funded programs that are now being starved of funds by the steady growth of health care costs. We might find allies among those looking to improve transportation infrastructure, parks and recreation, schools and early childhood development, and all the other initiatives that are being crowded out by health care costs.[213]

The country has swung deeply into divisiveness and polarity and our political processes seem to have been frozen in unproductive debates. To find our way back to allowing thoughtful policy development, having (current, future, and past) family caregivers ready to vote on the basis of policies supporting a better deal for frail elders and their caregivers is a promising strategy. Getting many people upset over long wait lists for life’s essentials, such as food, may well tap into both our fellow-feeling and our fears that we will be next to be in need without services to meet that need. Creating a climate of urgency that enables innovation and learning would help get MediCaring Communities onto the list of current policy issues. Many cities, counties, and states are interested. A push from Congress or a hot topic in visible political campaigns would break that open. This reform turns out to meld the best of the current political philosophies. It returns control to local communities and limits costs to government, it returns choices to elders and their families, and it takes responsibility for all frail elders in the community. Building MediCaring Communities is both compassionate conservatism and pragmatic social responsibility.

The cost of a pilot to expand PACE on a MediCaring Communities model is trivial, the risks to beneficiaries are very small, and the likely improvements are substantial. Indeed, the potential return is a sustainable and reliable care system.

So, do what you can. Push your Congressional representatives and state officials to allow MediCaring Communities to proceed and to get serious about encouraging savings and insurance for LTSS. Encourage consumer and professional organizations to join in. Get angry when your frail elders don’t get good care. Encourage employers to focus on supporting family caregiving. If you have a PACE program in your community, see if their leadership is interested and help them plan. Write to your newspapers, call your radio and TV outlets, and tell them about a way forward with MediCaring Communities and PACE expansion. Subscribe to the email newsletter at MediCaring.org, where up to date information and activist suggestions will be posted. Tell us about improvements you see to this book and its plans by sending an email message to [email protected]. Help to build a citizen and caregiver voice in public policy! We can do this.

[213] (Berwick, Report from Xanadu. Institute for Healthcare Improvement (IHI) 26th Annual National Forum Keynote Address 2014)