Most long-term care costs aren’t paid by the government

Wrong.

America spent $121.9 billion on nursing home care in 2005. The percentage of nursing home costs paid by Medicaid and Medicare has gone up over the past 35 years (from 26.8% in 1970 to 59.6% in 2005, up 32.8 % of the total) while out-of-pocket costs have declined (from 52.0% in 1970 to 26.5% in 2005, down 25.5% of the total) See Table 10(http://www.cms.hhs.gov/NationalHealthExpendData/downloads/tables.pdf)

So what? The consumer's liability for nursing home costs has declined almost by half in the past three and a half decades, while the share paid by Medicaid and Medicare has more than doubled.

No wonder people are not as eager to buy LTC insurance as insurers would like them to be! No wonder they don't use home equity for LTC when Medicaid exempts the home. No wonder nursing homes are struggling financially--their dependency on stingy government reimbursements is increasing while their more profitable private payers are disappearing.

Unfortunately, these problems are even worse than the preceding data suggest. Over half of the so-called "out-of-pocket" costs reported by CMS are really just contributions toward their cost of care by people already covered by Medicaid! These are not out-of-pocket costs in terms of ASSET spend down, but rather only INCOME, most of which comes from Social Security benefits, another government program. Thus, although Medicaid pays less than half the cost of nursing home care (43.9% of the dollars in 2005), it covers two-thirds of all nursing home residents. Because people in nursing homes on Medicaid tend to be long-stayers, Medicaid pays something toward nearly 80 percent of all patient days.

So what? Medicaid pays in full or subsidizes four-fifths of all nursing home patient days. If it pays even one dollar per month (with the rest contributed from the recipient's income), the nursing home receives Medicaid's dismally low reimbursement rate.

No wonder the public is not as worried about nursing home costs as LTC insurers think they should be. No wonder nursing homes are facing insolvency all around the United States when so much of their revenue comes from Medicaid, often at reimbursement rates less than the cost of providing the care.

Bottom line, people only buy insurance against real financial risk. As long as they can ignore the risk, avoid the premiums, and get government to pay for their long-term care when and if such care is needed, they will remain in "denial" about the need for LTC insurance. As long as Medicaid and Medicare are paying for a huge proportion of all nursing home and home health care costs while out-of-pocket expenditures remain only nominal, nursing homes and home health agencies will remain starved for financial oxygen.

The solution is simple. Target Medicaid financing of long-term care to the needy and use the savings to fund education and tax incentives to encourage the public to plan early to be able to pay privately for long-term care.

I think you are all wrong regarding long term care and long term care insurance. My mother has been in a long term care facility for almost five years. She just recently qualified for Medical Assistance while the remaining time she paid her entire bill herself thereby draining all of her assets completely (with the exception of a funeral account that will be used for her burial). All of the money that my dad (deceased) and her saved their entire lifetimes is now depleted not to mention their farm and home all had to liquidated to pay for her long term care. They did not carry long term care insurance because the cost was very prohibitive and besides, if you read the fine print you will note that those benefits are somewhat limited as well (check for the daily benefits paid and for the term of the benefit - 3-5 years). What if your parents outlive the longterm care insurance? There was a time when parents could "gift" some of their assets to their children and at the same time qualify for Medical Assistance for payment of their long term care. However, our esteemed leaders in Washington took care of that approximately 2 years ago when President Bush signed the Deficit Reducation Act. It is almost impossible to do that now because of the new laws. So, if anyone now thinks they will get rich the old fashioned way (inheritance), think again because if either of your parents find themselves in a situation where they need this type of care I can guarantee there will be nothing and I mean nothing left for the children - even with the best laid out estate plans. Again, the very rich will take care of themselves (since they will be able afford the long term care policies) and the poor will be taken care of (as always has been true in this country because we take care of those less fortunate than ourselves) and the middle class will again be squeezed out because our incomes do not allow us to buy long term care insurance and yet we will have to pay our own way should we find we need long term care to the point that all assets that we worked so hard to attain will be depleted to allow Medical Assistance qualification. We all should have a crystal ball to see what our futures will be like, and then plan accordingly. Good luck to us all!!

There was an old adage to live like you will die tommorrow and save like you will live to be 100. LTC is another reason why we have one of the lowest saving rates in the world, leaving us vulnerable to the many life events that happen. We seem more fixated on who pays than on how much. Does anyone know how these issues are handled in other developed countries?

Opinions like JaneDoe's make me want to scream. Your parents saved for THEIR care and retirement. At 21 they no longer owe you SQUAT! Yes, ALL their assets should go to their needs in old age. It is unfortunate when each of us cannot save what we need due to greedy children and or rising cost of living. As a society we need to care for our parents. They cared for us already. Inheritance is a gift, not a right. If anything, kids should be raised to know if mom and dad run out of money it is the kids who need to pony up not the state!!

Exactly! I agree with Jane Dow -- long-term care for the elderly and disabled is hugely labor- and time-intensive. I know that because I take care of my mom, who has a severe brain injury. In addition to needed 24/7 complex and labor intensive, physically and emotionally exhausting personal care, she needs someone to manage every aspect of her life and her complex medical and rehabilitation care... How can ANY person, but George Bush and ****** Chaney save enough money to pay for this on their own? And, while the children should be helping their parents, under the federal law (the Medicaid Act) the right of the disabled and elderly persons to receive needed long-term health care is not conditioned on their children providing any of it. Federal government does not deny care to parents whose children are disloyal/unloving.

The federal government spends huge funds on long-term care for the impoverished elderly/disabled -- but most of it goes to the bureaucrats, lining their pockets. The disabled do not get the quality and scope of services they need. They have horrible life expectancy in the nursing homes. Nursing homes resemble concentration/ death camps for the elderly and disabled... If your children and family are loving enough to care for your themselves -- they will end up out of work, impoverished, and in-humanly worn out, unable to live their lives, unable to save for their own retirement, so that poverty and illness will perpetuate from generation to generation... While the oil companies, the banks, and the insurance companies will keep their trillions in profits, huddled in off-shore accounts and exempt from taxation -- after they ravaged our society, the environment, and stole our democracy ....

It's disingenuous of gopher5 to recommend that I move to another country now just because the severely disabled persons (and those privately insured as well) in OUR country are routinely denied desperately needed long-term health care for costs reasons, resulting in injuries, death, abuse, and neglect against the disabled in shady and substandard care settings; resulting also in costly emergency room visits and avoidable expensive hospitalizations. Who is denying the care, you may ask? -- The health insurance companies, (including the state-run Medicaid programs). Note, also, that while a normal business charges only 15% for administrative and overhead costs, health insurance companies bury a 40% charge for these in your health-insurance premium. "Nice profit," you might say.

Doing away with the disabled through denying care or providing substandard and inadequate care may be cost efficient -- but it is unlawful, inhumane, and immoral, if you know what these mean. Perhaps, also, making a profit off the sick, off the blind, and the paralyzed seems like a good idea to someone, yet this is hardly the ideal most of us would like to strive for. Well, I guess, for someone, if the profit is real good, it might change things.

While I agree that entrepreneurship is a positive attribute of capitalism -- don't lose sight that enormous concentrations of capital in the hands of the few are incompatible with democracy and with anything good for the people or the planet. Let me politely remind you also, that while the American people spend many-fold the amount of money on health care compared with other developed countries -- the health care received by an average American is among THE worst in the developed world.... Perhaps this is due to the fact that for some "profit" is more important than community, family, and human life.... After all, insurance companies value human life just at a few million dollars -- so why not take it if profitable? And the law? Who cares? I guess, you must be very sure, this it is never going to be YOUR life, nor YOUR health -- always someone else's, huh?

BAnderson,if you think Universal Health Care will "solve it all", you are living in a fantasy world. Sorry, but that is the truth.

Health care in the US is far from perfect. I know your family (and you, for that matter),and how they have struggled since your brother's illness. It's been hard on them and I am sorry they have had to go through this. It wasn't the insurance company "weaseling" out of paying your brother's expenses so much as it was the cap on the insurance itself written into the plan..$25,000. Even though I can't agree with you on this, I do understand where you are coming from. We have a family member with a long term, chronic and expensive health issue. We have good insurance, but we still struggle to pay the medical premiums, copays and deductibles. But I also know that if we were in Canada or England (or any other place with UHC),our family member would probably not be alive today, and your brother might not have been either. That bronchoscopy that diagnosed his tumor...the wait can be a year for one in Canada. The surgery he had so quickly here in the US would have had a waiting list, months or even years long in Canada. I have lost count of the many families we have met from Canada during our frequent stays at a teaching hospital in the Twin Cities...they came to the US to get life saving health care for their children they can NOT get in a timely manner in Canada. It is illegal for Canadians to pay for the scans, treatment and surgery themselves while in Canada and illegal for Canadian hospitals clinics and xray centers to sell their services to the public, so many cross the border and pay for their treatment themselves here in the US. Our health care system is flawed, but I will take it any day over what is available in Canada, or in Europe.

So, what is the answer? Our family personally experienced a major health health problem several years ago when one of our children was diagnosed with a major health problem. He is fine today; however, if we would not have had health insurance to cover his treatment, we would have found ourselves bankrupt. And, we are hardworking, middle class people. Luckily we are covered by an employer provided health insurance. However, in today's economy this could quickly be eliminated because health insurance is a benefit that is not federally mandated to be provided by corporations for their employees. We would quickly find ourselves with no health coverage - we would be joining approximately 50 million Americans. And, unfortunately our combined salaries would provide perhaps only catastrophic coverage with a huge deductible. My point is that those of us who have health insurance can easily say "well, buy your own if your employer doesn't provide it" but unfortunately most of us have never had to go shopping for such coverage. Never judge anyone unless you have walked in their shoes. It is very, very expensive. I am very supportive of a universal health insurance plan for everybody, no matter how old, how rich or poor, where you live, etc. etc. I have worked in the health insurance industry, and I can only say it is the biggest racket in this country. Just drive down 494 and check our who has the biggest and most beautiful office buildings? Some one is making lots of $$ and guess who is paying those bills? Some taxpayers would complain that we can't afford to cover everybody; however, if you look at our situation today you will note that we are already paying for Medicare and Medicaid recipients - those numbers continue to rise. Why not include all of us?

I think we need universal health care and will support all measures to make it happen. If you think the US healthcare system works just watch "sicko".

I for one am prepared to pay more in taxes for health coverage. I don't think that the problems Canada and England have will show here, I think for the most part that is just over exaggeration "you have to wait a year". We have the infrastructure already in place and no one waits, what makes you think thats going to change?

I for one am sick of seeing people with medical problems running around and won't do anything about it because they cannot pay. The stress and disappointment I have watched my mother go through trying to get her teeth fixed, is ridiculous. Even for myself, for years I have needed my 2 front teeth to be replaced, a procedure that would cost aprox. $2,500, the county/state won't pay for it or even help pay for it, I'm left to figure out how to pay for it myself.

I am not saying that UHC doesn't or won't have problems, but the ones I foresee are solvable. The current system, you have a ton of greedy people running it. Think about it, insurance companies are making millions, how many millions of dollars does one company have to make? It is pure greed on behalf of your insurance company.

The "cap" on parents policy was not known to them when they started to purchase the insurance, in fact the issue was that there was a waiting period of 1 year before they would pay more, unfortunatly my brother got sick 7 days before the 1 year mark on the policy, therefor enacting a clause of the contract that the insurance would only pay the first $25,000. If he would of gotten sick 8 days later the whole thing would of been paid for.

all i want for christmas is my two front teeth........

THE ONLY WAY TO SOLVE the health-care problems in any country is to run the health insurance and the liability insurance companies efficiently and for the benefit of the public -- not for the enormous profits of the corporations. "Efficiently" means spending no more than 15-20% for overhead and administrative expenses-- that's the standard for a successful business -- not the greedy at least 40% currently charged.

Then, the federal laws must also mandate that the not-for-profit AND efficiently run health insurance companies insure EVERYONE. The insurance premiums should be income-based on a sliding scale and only the premiums for the very poor should be entirely paid by the taxpayers.

What about the doctor's salaries? The docs are already RAPED by (1) the health insurance companies, paying merely a fraction of the doctors' bill for each procedure (the so-called "usual and customary rate" -- which is sometimes set so low, the doctors can't even cover their overhead, let alone make a profit).

(2) In addition, while the health insurance companies press the docs on one side to see "one patient every five minutes, to make any profit"-- the docs are in eternal fear of a medical malpractice suit (afraid even of their own shadow here) --- and yet ANOTHER insurance company has the docs by the throat here -- their liability insurance company! In some states, there are NO obstetricians, no neuro-surgeons -- NONE -- they can't afford the ludicrously high liability insurance premiums!

You will say -- "SLASH the payouts to those unfortunate persons crippled by the doctor's oversight (when forced to see "one patient every five minutes'). Well, the malpractice payouts, even for the worst kind of brain injury in a new-born child, (cerebral palsy, totally blind, paralyzed, severely disabled for life) who have a long life expectancy, run around $3 -$4 million dollars -- the cost of about 5-10 years of the child's long-term care costs.... then Medicaid (YOU, the taxpayer!) kicks in and has to pay for the poor child's care!

What about the liability insurance company -- why does IT not pay for the TRUE costs of the crippled child's long term care costs? -- because it is making BILLIONS in profits - hard CASH in the form of doctors' premium payments...

Thus, where (1) the doctors are barely able to pay their liability insurance (with the little that the health insurance companies pay them), and (2) where the long-term care costs of the crippled child with cerebral palsy are ultimately shouldered by YOU, the taxpayer (through Medicaid), and (3) you and I don't have health insurance -- who won, you ask? -- Both the health and the liability insurance company posting enormous profits on their balance sheets!

THAT'S WHERE CHANGE HAS TO COME -- operating the health insurance and the liability insurance companies efficiently, TRANSPARENTLY, and SOLELY for the public benefit. The REAL change is NOT about robbing the sick of the care they desperately need, and it is NOT about squeezing the daylights out of the doctors, who work like hell and shoulder inhuman stress and responsibility levels on a daily basis for years (after having served as veritable slaves in some residency program, working 90 hours per week and making less than a nurse in some cases).

AND WHY is it that no-one seems to note where all the money is REALLY being siphoned away from you and me? Because it is MUCH easier to rob the blind and paralyzed child, the elderly senile woman next door who needs long-term care -- than to take ONE dime away from any insurance company. The insurance companies of modern day, the way they are run, hold EACH AND EVERYONE OF US by the throat and are the real highway robbers.... But it's too scary to speak out against these giants, with operating budgets equaling those of entire countries in some cases. They BUY the presidents for us too.

The ONLY way to ensure ALL Americans have decent and quality Health Care is to eliminate the Health Insurance Industry, and replace it with a government funded system, paid for by tax payers.

The problem with requiring all Americans to buy health insurance is, some cannot afford it. PERIOD! You can't pay for something without money to pay for it. Make sense?

The other problem your gonna have is co-pays, and caps, what happens if you get sick before your waiting period runs out? Or if your co-pays are enormous? Some families cannot take on those expenses.

Their hospitals are virtually much the same as ours. The wait time that most people talk about is not caused by the government and a MAJORITY of the time it is for non-emergency surgery or elective procedures. Also note that Americans often have to wait to see a specialist and also for some procedures. Average wait times in the US can be 38 days to see a dermatologist in some cities. In Canada, there are no waits for emergency surgeries! Americans spend double what Canadians spend on health care per-capita, I don't see that problem appearing here.

Also alot of people are saying Canadians are flocking over the boarders to our hospitals, also not true, out of 136 hospitals near the border that were asked 52 reported seeing no Canadians, 56 reported seeing fewer then 10, 21 reported seeing under 25, and 7 reported seeing over 25. Hardly a flock of Canadians, sounds more like a few accidents or something unexpected happened here in the states.

Also it should be noted that some Canadians choose to have procedures here that are not available in Canada, much like some Americans goto other countries for procedures that are not approved here in the US.

Canadians have better access to most types of medical care, were more likely to have a regular doctor, Americans are twice as likely as Canadians to go without a needed medicine due to cost, uninsured Americans are particularly vulnerable with over 30% having an un-met health need due to costs involved.

http://search.yahoo.com/search;_ylt=A0geu_PWpqJHwyEBPHRXNyoA?p=Canadian+...
http://www.alternativesmagazine.com/40/bayer.html
http://en.wikipedia.org/wiki/Canadian_and_American_health_care_systems_c...
http://www.amsa.org/studytours/WaitingTimes_primer.pdf
http://www.heritage.org/Research/HealthCare/wm782.cfm
http://www.prospect.org/csnc/blogs/ezraklein_archive?month=07&year=2007&...
http://www.emergingdemocraticmajorityweblog.com/donkeyrising/archives/00...

We all have to understand that there is only so much of the "pie" available for the government to provide services to its citizens. I for one do not appreciate our government (city in this case) to frivolously spend my tax money on a tunnel on the west side of Hutchinson for walkers to cross Highway 7 when the stop lights in that particular intersection do just fine for the pedestrians (if they follow the lights though is another matter). I do not appreciate the school district spending more taxpayers $$ on a consulting firm to tell them how they should approach building improvements for the school district when they could just fix the buildings they have and go on with educating our kids which should be their top priority. However, I think our federal government absolutely needs to provide a universal health care system for its citizens. It is unbelieveable that a civilized/industrialized country like ours does not provide health care for all of its citizens. And that over 50 million Americans are not covered by health insurance. Of course, it will cost $$. Of course our taxes will increase. I understand that!!! However, maybe we need to re-evaluate our priorities, and spend our taxes (the pie) in a more appropriate manner which will benefit everybody. I would rather my tax money be directed towards this project rather than those mentioned above. We are already paying a tremendous amount of our annual incomes to taxes, so why not add a national health insurance program for everybody's benefit. What we pay personally for health insurance could be directed to taxes for this project. We are there already, so lets give all of our citizens a health care system that would benefit everybody. It won't matter where you live, how much you earn in income or if you are employed or not, etc. We need this implemented, and we need it sooner than later!!