The health reform debate in the United States has so far failed to consider the important matter of helping people with care needs stay in their own homes. But this is crucial to precluding or deferring use of much more expensive health services, say campaigners for a voluntary national insurance programme that would cover the cost of home assistance.

The Community Living Assistance Services and Support (CLASS) Act legislation, which was first proposed by the late senator Ted Kennedy, is just such a scheme. It would provide cash payments to disabled beneficiaries to buy assistance that would allow them to remain functional, productive, and independent, explained Connie Garner, senior staff member of the Senate health education, labour, and …