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Americans want health-care and long-term-care reform. But it won't happen as long as the most powerful lobby in Washington is made up of doctors, lawyers, drug companies, medical technology companies, insurance companies and nursing home operators.

That's the view of Richard C. Ladd, administrator of Senior and Disabled Services in the Oregon Department of Human Resources. During a keynote address Wednesday at the Governor's Conference on Aging, Ladd said those powerful lobbyists are the people who benefit from keeping medical costs high. Further, one-quarter of the country's national lawmakers come from those professions.Elderly health-care consumers are being hit hard, he said. "Today, the elderly are paying a higher percentage of their available income to medical costs than (in the early 1960s) before Medicare was available.

"It's essential, in my opinion, that major change be implemented."

Ladd recommends "limits on health-care costs, limits on malpractice settlements and limits on where medical technology can be placed and used." Portland, Ore., for instance, has more Magnetic Resonance Imaging (MRI) machines than all of Canada, at a cost of about $4 million each.

The United States spends 12 percent of its gross national product on health care - more than any other developed country - yet has the highest infant mortality rate. And only the French have a shorter lifespan, he said.

Ladd said doctors blame costs on malpractice insurance rates. Insurance companies blame lawyers and a "sue-happy mentality." Lawyers say it is the doctors' fault, because they don't give adequate service. Hospitals say charges are high because they compete to get the best doctors and technology to attract patients. Drug companies say costs are high because of overhead on research.

"Everyone agrees the high cost of health care is not their fault. They say the government is not paying its share of Medicaid and Medicare," but when the Oregon Legislature gave nursing homes, doctors and hospitals a large increase, no one dropped their rates. "There's only one payer and that's us. We pay all the bills," Ladd said.

Although home care is the preferred method of long-term care, almost 90 percent of government dollars targeted for that care are put into nursing home placements. Ladd predicts the average annual increase for nursing homes will continue to be "double digit" and nursing home costs in the next five years will approach $300 a day.

"The elderly want to remain at home, and if they must leave home, they want to live in the most homelike atmosphere. Nursing homes are the least homelike," he said.

Oregon provides 9,000 adult foster home beds with no more than five people in a home. They receive the medical attention there that they might otherwise get in a nursing home. Another large home-care program lets people live in facilities where they can lock their doors and have their own furniture. They can cook for themselves or use a congregate dining room and all other nursing-home services are provided. The cost of home care is 20 percent less than the cost of nursing home care.