Overview

Minnesota lacks a workable strategy to address rapidly growing long-term care expenses for its low-income residents. These expenses, now more than $1.1 billion a year, are creating significant pressures on state taxes and squeezing the state's ability to finance other services.  Calling the current approach "unsustainable", the Citizens League says individuals should take more responsibility for their own care. The League recommends new incentives to stimulate personal savings and greater use of long-term care insurance, including co-insurance with Medicaid. The League calls for new types of long-term care insurance and an intense effort to offer unbiased information to help individuals make intelligent decisions.  

For the complete interview summary see: http://bit.ly/fCYrpK

Response Summary:  Readers have been asked to rate, on a scale of (0) most disagreement, to (5) neutral, to (10) most agreement, the following points discussed by Becker.  Average response ratings shown below are simply the mean of all readers’ zero-to-ten responses to the ideas proposed and should not be considered an accurate reflection of a scientifically structured poll.

1. Savings.   (7.9 average response)  Entice individuals to set aside more personal savings.

2. Insurance.   (7.8 average response)  Offer more types of long-term care insurance.

3. Medicaid.   (6.1 average response)  Change Medicaid to a form of co-insurance, expanding coverage to middle income families.

4. Family care.   (7.1 average response)  Provide compensation to caregivers to encourage more informal, family care.

5. Appropriations.   (3.0 average response)  Cut back on other services, such as education, to find revenue for long-term care expense.

6. Taxes.   (4.4 average response)  Increase taxes

Individual Responses:

Anonymous  (7.5)  (10)  (5)  (10)  (2.5)  (0) 

Pat Barnum  (2.5)  (10)  (0)  (0)  (2.5)  (0) 

1. Savings.  I don't agree any government agency should be in the business of providing "prizes", large or small, as incentives for people to save.

2. Insurance.  LTC insurance can be affordable and is a great option. But most people I know don't know about it, or why it's important (I bought a policy when I was 50). Most insurance agents don't want to even sell it  - let's ask them why not. It's easy to imagine that government regulation and shifting tides has made them gun shy.

5. Appropriations.  Certainly there are many current services that need to adopt "lean" principles to produce/service more with less cost. But robbing Peter (Education) with empty pockets, to pay Paul (LTC or any other social scheme) with projected empty pockets in the future is silly and futile.

6. Taxes.  I cannot fathom the mindset that believes more distribution of wealth via growth of government programs is a good thing for our country. Are we intentionally trying to bankrupt America?

W. D. (Bill) Hamm  (5)  (0)  (0)  (10)  (0)  (2.5) 

1. Savings.  Not likely with real spending power still dropping.

2. Insurance.  Support non-profit self-insurance coops that accomplish the same thing without profit or bureaucratic costs.

3. Medicaid.  Again smaller locally controlled coops can both eliminate profit and bureaucratic costs.

4. Family care.  It is much cheaper than public or for-profit employees. It could just as well be a tax credit.

5. Appropriations.  Shift Education and control of long term care back to the local level. No need for a bureaucracy for either.

6. Taxes.  Get the socialism out first.

Don Anderson  (2.5)  (5)  (5)  (7.5)  (2.5)  (7.5) 

1. Savings.  How do you entice low-income individuals who only have enough funds to barely exist as it is?

2. Insurance.  Biggest problem is how to keep the premiums low enough that older persons at or near retirement could afford to buy long-term care insurance.

5. Appropriations.  Do you rob Peter to pay for Paul?

Ray Schmitz  (10)  (7.5)  (10)  (7.5)  (5)  (2.5) 

1. Savings.  Let’s think about the fact that the taxpayers have paid something for this benefit; depending on their income they may have paid a lot.  The question is how do we fund the fact that costs are increasing. One issue is that we do not invest the funds paid into the system; that is, we look at the then value of the taxes paid vs. the now cost of the care.

2. Insurance.  Like, for example?

3. Medicaid.  See above.  If the taxpayers have paid into the system then they deserve credit for that.

4. Family care.  At least cover some of the increased costs of doing so.

5. Appropriations.  Need to balance programs.

Peter Hennessey  (7.5)  (7.5)  (2.5)  (7.5)  (2.5)  (0) 

1. Savings.  Whenever you are changing the culture, you have to provide three plans:  (1.) the new "normal";  (2.) a solution for current needs, for people stuck under the rules of the old "normal"; and (3.) a smooth transition from old to new.

2. Insurance.  I don't know what this could possibly mean. I've been involved in the long-term end-of-life care of five family members so far, and each case was vastly different from the others. I have not met anyone who could possibly foretell what kind of coverage he might need. We all hope we'd die in a flash, yet we also know most of us will just fade away at a great cost to everybody else. But it is certainly easier to make a choice if you are given alternatives. This is why the free market is the best hope, because it is the free market's incentives that drive thinking and innovation.

3. Medicaid.  Forget this one. If there is one thing that Medicare and Medicaid have demonstrated, with a clarity to convince everyone except the most rabid partisans, is that any kind of government involvement and control leads only to waste, fraud and abuse, and a dramatic drop in quality of care. The solution is always free market competition and free flow of truthful information, so individuals can choose and adjust as their needs change.

4. Family care.  This is one alternative and it depends on many highly individual factors.

5. Appropriations.  Whenever you are faced with impossible choices, the source of the problem is always in a defect in your starting assumptions. Who says government has to provide this or any number of other services? Who says these services must be paid for by government, or be delivered by government employees?

6. Taxes.  Forget it. You might as well come out and declare -- paraphrasing the words of that great hero of the progressive left, Ted Kennedy -- that 100% of your income belongs to the government and your take-home pay is simply what the government, in a moment of temporary lapse of good sense, allows you to spend in some stupid selfish way. Sure. Do that, and you'll achieve the same result that the Bolsheviks did in the USSR.

Bob White  (10)  (7.5)  (7.5)  (10)  (2.5)  (5) 

Bright Dornblaser  (10)  (10)  (10)  (10)  (5)  (10) 

Clarence Shallbetter  (6)  (8)  (4)  (5)  (3)  (3) 

A couple of follow-up thoughts about Sen. Marty's health care proposal.

1. Some people are nervous about the idea of leaving the choice of what health/dental services are consumed solely up to the doctor/dentist.  There are a growing number of services that some may view as discretionary. Examples: Many upper middle income and upper income people may choose to have all their younger family members receive braces to improve their smiles and appearance. Others may desire whitening treatments as they age while others would prefer porcelain on all their crowns. Whatever the acceptable standards, there is no reason those presently uncovered with dental care should not desire and receive the same in an expanded care system. 

2. Some people are not sure the doctor/patient choice is much of a limit- witness the apparent ease with which many receive handicapped tags.

3. Some recent studies suggest preventive screening for both breast and prostrate cancers are not very good predictors of the diseases. Yet the fear of these diseases creates a demand for such tests that is hard to overcome. 

4. Many doctors report patients ask for or demand prescription of highly advertised, expensive drugs. Such drugs may only be marginally better than existing generic ones. Will the new system fund without limit any new designer drugs or will it pay only for the cost of generic ones as Medicare Part D providers conventionally do today?

5. There are enormous differences in quality of nursing homes. Currently those with more private rooms, higher-cost capital facilities, more room, attractive decoration, and many amenities limit the number of government-paid (Medicaid) beds. Will these homes be readily available to all covered by this new insurance? If so there will be a big demand for many new nursing homes and many more staff in these new homes.

In these budget constrained times I think the Civic Caucus should ask redesign proponents of improved or innovative services whether these services will be delivered or provided at lower cost than the existing services or at least at one that is no more costly.

Will Shapira  (na)  (na)  (na)  (na)  (na)  (na) 

See w.democracynow.org, Jan. 21. Amy Goodman reports on State of Vermont going for single payer itself. Since Dayton and the Legislature never will do this, why don't you look into feasibility of VT plan in MN and report to the public on it? Challenge Dayton and the Legislature to at least explore it.

Scott Halstead  (5)  (0)  (10)  (10)  (0)  (8) 

Set up a Roth Long-Term Care Savings account that can be rolled over to the family or donated to an account for the general public with a tax break to the donor/estate.   The present long-term care policies through the insurance industry are a rip off.

Austin Chapman  (3)  (5)  (7)  (9)  (5)  (3) 

Paul and Ruth Hauge  (8)  (5)  (8)  (9)  (2)  (9) 

All are commendable and in general fit into many of the other short funded programs and options for state services.

Hans Sandbo  (10)  (10)  (na)  (10)  (1)  (7) 

Very tough problem.  Requiring families/people to be as independent as possible by offering dormitory (very low quality) type care when on Medicaid.   Offer very little financial and/or medical help when we need it.  Do not encourage a healthy life style, once we are over 65 and cannot either work or afford medical care.   Families need to support their loved ones if they so desire, otherwise we are not long for this world after 65.   This is harsh and does not appear very Christian for those over 65 (I am 69), but burdening society with unproductive individuals over 65 does not seem right to me.

Terry Stone  (10)  (10)  (8)  (9)  (9)  (0) 

Roger A. Wacek  (5)  (5)  (0)  (10)  (5)  (0) 

Cost control will only be accomplished by dealing the institutions out of the direct funding loop. Long-term care facilities, clinics, hospitals, & even schools receive direct government funding. Therein lies the problem.

Mina Harrigan  (10)  (10)  (8)  (3)  (8)  (8) 

Tom Spitznagle  (10)  (8)  (8)  (7)  (2)  (1) 

Ms. Becker's points are very helpful towards understanding the challenges and then opening dialogue for looking at new, more effective approaches for financing long term care.

Wayne Jennings  (10)  (10)  (10)  (9)  (6)  (10) 

Bert Press  (10)  (10)  (10)  (5)  (5)  (0) 

Carolyn Ring  (8)  (8)  (5)  (9)  (1)  (4) 

4. Family Care. Rather than compensation, there could be a provision for the caregiver to claim the one in his/her care as a dependent.

Kevin Edberg  (8)  (10)  (10)  (5)  (3)  (5) 

The Citizens League has done us a great favor by studying this issue in such depth.  Civic Caucus has done a similar service by making more people aware of it. This issue is huge.

Ed Oliver  (10)  (7)  (2)  (8)  (0)  (7) 

Sheila Kiscaden  (9)  (9)  (5)  (4)  (2)  (9) 

Lyall Schwarzkopf  (9)  (8)  (4)  (6)  (2)  (4) 

Chuck Lutz  (9)  (9)  (9)  (9)  (2)  (10) 

Larry and Ann Schluter  (10)  (7)  (8)  (7)  (1)  (4) 

More incentives and greater deductions for having long-term care insurance might entice more to carry insurance.

Alan Miller  (2)  (8)  (5)  (5)  (0)  (8) 

Robert J. Brown  (10)  (10)  (7)  (8)  (5)  (5) 

William Kuisle  (7)  (6)  (6)  (5)  (5)  (0) 

None of the options looked at reducing the skyrocketing costs of long-term care.

Tom Swain  (10)  (10)  (5)  (2)  (1)  (7) 

David Detert  (10)  (9)  (5)  (5)  (0)  (1) 

 My feeling is that no law was ever passed where the state assumed full responsibility for nursing home care instead of the family.  (The state) has acquired the responsibility by default. There should be a balance between the state and family.  To achieve that balance I believe that paying for nursing care should be handled similarly to the way financial aid for college students is done.  The financial status of the entire family (children and not just the parents) should be assessed with the family expected to contribute based upon the total wealth in the family.  The parents can shift their assets to their children to avoid paying for nursing home coverage, but then they would have to rely on their children to help pay for nursing home care.  If they didn't trust their children to help them they would have an incentive to buy long-term care insurance.  If the children wanted to protect the assets they have and those they received from their family they would have an incentive to help their parents buy long-term care insurance.  If they refused to help the state would still provide basic care but it would a hospice type of situation where the state would make sure that the individual was warm, clean, fed and free of pain but there would not any intervention when there are medical problems.

 
The reason for constructing the system in this way is that as a family physician I see the situation constantly where the family refuses to address the issue of the appropriateness of ongoing medical care and its costs in their aged parents.  Because some one else is paying the bill they virtually always chose to do everything even though it is frequently inappropriate.  Having the family be responsible for at least a portion of the cost of nursing home care would bring reality to the family not only for nursing home care but also for the use of medical care.  These are inseparable issues and one that our society has been able to avoid because they do not have to face the financial impact of their decisions.  This system would address both.