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
For the complete
interview summary see:
Readers have been asked to rate, on a scale of (0) most disagreement,
to (5) neutral, to (10) most agreement, the following points discussed
ratings shown below are simply the mean of all readersí zero-to-ten
responses to the ideas proposed and should not be considered an
accurate reflection of a scientifically structured poll.
(7.9 average response)
individuals to set aside more personal savings.
(7.8 average response)
Offer more types
of long-term care insurance.
(6.1 average response)
to a form of co-insurance, expanding coverage to middle income
4. Family care.
(7.1 average response)
compensation to caregivers to encourage more informal, family care.
(3.0 average response)
Cut back on other
services, such as education, to find revenue for long-term care
(4.4 average response)
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.
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?
(5) (0) (0) (10) (0) (2.5)
1. Savings. Not
likely with real spending power still dropping.
Support non-profit self-insurance coops that accomplish the same thing
without profit or bureaucratic costs.
Again smaller locally controlled coops can both eliminate profit and
4. Family care.
It is much cheaper than public or for-profit employees. It could just
as well be a tax credit.
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?
Biggest problem is how to keep the premiums low enough that older
persons at or near retirement could afford to buy long-term care
Appropriations. Do you rob Peter to pay for Paul?
Ray Schmitz (10) (7.5) (10) (7.5) (5) (2.5)
1. Savings. Letís
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
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.
Appropriations. Need to balance programs.
Peter Hennessey (7.5) (7.5) (2.5) (7.5) (2.5) (0)
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.
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
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
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
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)
w.democracynow.org, Jan. 21. Amy Goodman reports on State of Vermont
going for single payer itself. Since
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
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)
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)
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)
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)
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.
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)
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)
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.