ABSTRACT
Health care policies in the United States carry an enormous and increasing financial cost that is heavily impacted by population aging. The rise in health care costs has been especially striking over the twenty years since Medicare and Medicaid were enacted. It is notable, given the prevalence of chronic health problems among the elderly, that the most prominent US health care program specifically for the aged is primarily focused on the treatment of acute episodes of treatable illness. The most important public program addressing institutional long term care for the elderly is Title XIX of the Social Security Act, Medicaid, enacted in 1965 along with Medicare. The current array of home health care services for the elderly has been shaped largely by public benefits programs. Many gap-filling, supportive services are made available to persons in need of home health care through the Social Services Block Grant, formerly Title XX of the Social Security Act.
