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Americans 85 and older, our oldest old, are the Fastest Growing segment of our population. And this is the very population that is most at risk of the multiple and interacting Health Problems that can lead to disability and a need for longterm care. At the same time, declining birthrates mean that there will be fewer Family Members and paid caregivers to care for our nations growing aging population. Today, there are approximately seven potential caregivers for each person over 80, as this chart indicates. By the year 2030, there will be only for. And by 2050, the number drops to fewer than on...

If thats enough. Yes but go ahead. Its a good point. I think its critical to understand. People think we have medicaid. Ill be okay. If theres a problem throughout. And maybe another way to say it is to ask is this a sustainable path that is counting on medicaid to be the safety net whey see people doing in the marketplace right now which is essentially using their savings to purchase something that will keep them from being on the Medicaid Program eventually. In other words its not in theory you want it to be enable you to purchase the services you need in a setting most appropriate for your ...

Help me understand, because my perspective on our entitlement today is we cant afford the ones we have. The construct we work with is forget the multiple debt. The real challenge we have with our Pension Plans are underfunded, our health care weve are already exposed to come so were talking about a couple hundred trillion dollars of unfunded liability. I just dont know how thats a great question and im glad you asked because i will tell you, again because my professional background, the last thing you ever imagine myself doing as a budget analyst is suggesting we needed a new Government Progra...

Job and arguably they have been able to outmaneuver the dni in a number of cases. Was the National Counterterrorism center of part of this, or was a sort of evolving separately . It evolve separately but the yen with president bushs idea of a terrorist run integration center. The story of 9 11 of how do we fuse information collected abroad collected domestically . How do we make sure we reach this domestic divide. President bush created an entity and the 9 11 commission did him one better and suggested he expand its mission in khalid a National Terrorism Counterterrorism Center. This is an exa...

Overwhelmingly, and it made it with Social Security actuarially sound for the next half century. That was 1983. So, those folks knew how to get along. Chairman nelson, Ranking Member collins and members of the committee, thank you for holding this hearing. And especially for the opportunity to testify about the future of the longterm policy. The perspective that im about to share comes from my work over the past 20 years of the office of management and budget as a person responsible for the Medicaid Budget. And also the last ten or 15 years consulting to a nursing home providers and assisted l...