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RE: Long Term Care - Love it or Hate it?

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Message 21 of 46

In Response to RE: Long Term Care - Love it or Hate it? by kom2010

Wow!  That was a very well thought out and in-depth analysis.

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RE: Long Term Care - Love it or Hate it?

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Message 22 of 46

Imagine how different medical care in the US might be, if Richard Nixon had been able to convince Congress to pass his idea of a nationalized medical system in the 1960's. We might be having a very different debate here, LOL.

I agree with the posting re splitting into the "haves" and "have-nots". Congress, of course, has very little skin in this game, as they have outrageously good free healthcare and full pensions.

The comparison between LTC and homeowners/auto is quite apt. You don't seriously think the insurers are only charging you $300-900/yr to make a modest profit, I'm sure. Their price structure is set up to accumulate profit based on an average 45-yr in-force policy life.

If you live in earthquake country - which includes the entire Mississippi River area, BTW, which suffered one of the worst US earthquakes in 1811 or 1812 - be prepared for not just a high per annum cost but also a stunning exclusion. On our $500K home, the premiums run $1700 - 6000 PER ANNUM, with a exclusion of the first 20%, or $100K we get to come up with ourselves.

Why? Because an earthquake isn't a 'onesie/twosie". It will cover an entire region, extending into collateral damages. Anyone who has lived through a major flood or forest fire knows precisely what that means - the existing carriers suffer heavy losses, and promptly raise rates for all current and new clients.

You don't have to like or dislike insurers, any more than you have to like or dislike General Electric or Freeport-McMoran Mining. If we want to debate corporate America, we can certainly do so, although it would require opening another discussion thread. And if you've never researched the topic of how insurance came to be considered necessary at all, some reading on Lloyd's of London can be very interesting (although most books in print have to do with their spectacular collapse in the 1990's, LOL).

Going back on topic, the question is, can the seniors/elderly afford home healthcare to even stay in their homes? If they can't afford that help, how are they going to manage to buy groceries, visit the doctors, re-roof the house, etc.? Are we going to expect every community, every neighborhood, to develop a volunteer service network to help?  

I know WWII-generation elderly who are currently struggling with this issue. They don't want to sell their long-time homes, and it's a lousy market for doing so. But how do they manage without anyone to help? Don't forget that generation is intensely private about money and embarrassed to admit they might be a potential welfare claimant. Many times even their adult children have little idea what's going on.

My MIL's family is Canadian. They cannot believe the mess the US has made of senior healthcare. All her siblings, also in their 70's and 80's, still live in their own homes, but have mentally selected their next senior living option, which is high-quality assisted living facilities provided at reasonable cost by the provincial governments. They are flabbergasted that MIL will have to pay $7-8000/monthly for full nursing home care that they receive for less than $2K/mo.

We have a healthcare system that is akin to an inefficient auto industry. If everybody had to build their own cars, some would do a Rube Goldberg version. Some would do a car-in-a-box assembly. Some would hire someone else to assemble the car-in-a-box. Some would spend to have a Bugatti Type 41 Royale created for them (probably politicians and lawyers, lol). Some would don rollerskates or ride bicycles.

Instead of this chaos, Henry Ford streamlined the system and created an assembly line to efficiently build at the lowest cost. Eventually the human cost, which was ignored beyond wages, caught up and ground that system almost to a halt (the automakers' bankruptcy), but the basic principle holds true: assembling a custom product will cost you more, no matter what it is. Labor, in an industrial world, can be the cheapest component, or the most expensive of all.

LTC, and its attendant subject of senior care, is the same. Nothing will get done without people to do it. But like the factory assembly lines, you won't get people to do it well, consistently, or as a career, if it doesn't pay well. Not at the top, which as we all know, those specialists are very well paid indeed....but at the bottom and middle of the wage pyramid.

There is help if you are willing and able to pay for it. Trouble is, under our system, most people are willing to pay but have grossly underestimated the costs, because they have never been faced with having to underwrite the majority of the costs by themselves on virtually everything.

We take for granted we can get a loan for a house. But in most of the world, that isn't true. There is no institution that will enable you to leverage your small amount of cash into a large mortgaged asset. With healthcare, most people work for companies who pay the majority of their healthcare premiums, and the insurers provide leveraged coverage. Try buying healthcare on your own, as any self-employed or unemployed person knows, and you get very little for paying out a lot of money.

We can't have it both ways. You can't have efficiency with a chaotic system. And you can't have a large risk pool that will leverage costs and allow a reasonable profit (or even meet costs for a non-profit entity) without making it mandatory on both the carriers and the insureds, that as many people as possible be included in that pool of risk. Without that, it's a risky proposition for the carriers, meaning that they don't know how to price it and so won't want to go into the business. As any small business owner can tell you, pricing a product that's new is really difficult to figure out.

LTC is a complex equation that will definitely change in the future because it has to. HOW it will change is still up to us.

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Valued Social Butterfly

RE: Long Term Care - Love it or Hate it?

3,195 Views
Message 23 of 46

In Response to RE: Long Term Care - Love it or Hate it? by ASTRAEA

 I don't know of anyone who thinks of them other than a "necessary evil".

 

You do not know me. I think they are necessary and not evil. 

 

Are they perfect,...no, but what is? Obama care?

 

 

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RE: Long Term Care - Love it or Hate it?

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Message 24 of 46

In Response to RE: Long Term Care - Love it or Hate it? by KidBoy2

I think that's a more common attitude towards insurance companies, than you'd like to think. I don't know of anyone who thinks of them other than a "necessary evil".


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Valued Social Butterfly

RE: Long Term Care - Love it or Hate it?

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Message 25 of 46

In Response to RE: Long Term Care - Love it or Hate it? by kom2010

 

I thought that people would be interested in what I did and why. 

 

I believe that people have a responsibility to take care of themselves if able. That would include LTC insurance. I am not rich but have assets I do not want to give to the government if I need LTC and become a ward of the government.

 

I hope I never have to use my LTC insurance just like I hope I never have to use my homeowners insurance. 

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Valued Social Butterfly

RE: Long Term Care - Love it or Hate it?

3,193 Views
Message 26 of 46

In Response to RE: Long Term Care - Love it or Hate it? by ASTRAEA

 

Insurance companies don't just make a profit, which I fully understand, but their profit depends on people dying quickly & not needing to use their LTC contracts. 

 

With that attitude toward insurance I think that you can not look at LTC contracts fairly.

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Treasured Social Butterfly

RE: Long Term Care - Love it or Hate it?

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Message 27 of 46

In Response to RE: Long Term Care - Love it or Hate it? by retiredtraveler

I'm just thinking that with the large number of baby boomers that may require some level of care starting in another 15~ years from now, or want to move into an independent adult facility that's affiliated with continuing care, there will have to be a big expansion in the area. Also, boomers are used to a certain level of autonomy & options in life, that may have to be accommodated .. especially as you mention, regarding to assistance at home without moving.

It should also be interesting to compare what we want for ourselves, and what we think is best for those of our parents' generation! While I'm sure we want the highest quality for both situations, I think we want more options for ourselves. 


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RE: Long Term Care - Love it or Hate it?

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Message 28 of 46

In Response to RE: Long Term Care - Love it or Hate it? by ASTRAEA

    Oh man!  A difficult subject most people don't want to touch.... The problem with advanced dementia is that the person affected is no longer able to make a decision for themselves. So, they will 'waste away' in LTC, or in someones' home.

  I know, this gets into moral/ethical/religious issues for people so I won't hijack the thread with it.


Just think. The world was built by the lowest bidder.
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RE: Long Term Care - Love it or Hate it?

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Message 29 of 46

In Response to RE: Long Term Care - Love it or Hate it? by ASTRAEA

"..... I can personally see vast changes in the whole system .. both coverage & facilities .. over the next 20 years..........".

    What kind of changes??? I see nothing in an era, and it looks like several eras coming, of austerity (a.k.a. budget cuts and services cut). It's already difficult, around here, to find beds that take medicaid only. Your best bet is often to go into assisted living, as private pay, in a place that will guarantee you a bed even if your funds run out.  But those places are few and far between.

   Private pay is no problem, as far as availablility. There is a trend in more home care which seems to gradually be picking up steam.   

    But otherwise, to me, I think elder care in institutions is going the way so many other programs are --- haves  vs. haven'ts. 

     My family went through all this in the past few years with our mother, so we really had a lot of family talks along with going to various institutions and talking about costs, options, short term versus long term, transition from assisted living to skilled care, etc.

   Not a pretty picture, and my mother did have money for private pay.


Just think. The world was built by the lowest bidder.
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RE: Long Term Care - Love it or Hate it?

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Message 30 of 46

In Response to RE: Long Term Care - Love it or Hate it? by kom2010

Many people & their families think that life extension is the best/only course. But when you see people with full-blown Alzheimer's, or slowly wasting away due to some eventually fatal disease, there have to be more people beginning to consider other alternatives for themselves.


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