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 Response Page - Lindh  Interview -      


These comments are responses to the questions listed below,
which were generated in regard to the
Dan Lindh Interview of
03-05-10.
.

 
The Questions:
 

On a scale of (0) most disagreement , to (5) neutral, to (10) most agreement, what is your view on the following:

1.  _9.3 average response_____ Minnesota in coming years will face unprecedented state budgetary pressure for long term care as the size of the over-65 population doubles.

2. _8.1 average response_____ Informal unpaid family care, still by far the largest means of assisting older adults, will decline--putting more pressure on the state--as fewer family members are available.

3.. _7.9 average response_____ Minnesota's state budget cannot possibly support projected increases in Medicaid payments for long term care.

4.  _6.6 average response_____ Mandatory long term care insurance, financed non-governmentally, should replace Medicaid, financed governmentally, for long term care.

5.  _7.6 average response_____ Instead of paying institutions directly, long-term care insurance proceeds should be distributed to individuals, who can make choices about where and how care will be delivered, including in-home care. 

Dennis L. Johnson (9) (6) (10) (10) (10)

Sounds  like even the libertarians among us would approve this plan. But will the progressives?

Carolyn Ring (10) (8) (10) (8) (8)

Tom Abeles (8) (5) (5) (3) (8)

Great care must be taken when looking at where the actual money comes from to pay for long term care. The private sector does the actuarial work on two sides. The first is the expected pay out based on costs over time of the services and the anticipated use (based on health and demographics). The second actuarial analysis is based on the income generated from the premiums, basically the returns that can be achieved in the financial markets. They have no guaranteed protection on the spread should they guess wrong on either side. There is no government bailout as with AIG in the sub-prime debacle, unless we create a government back up.

The government program is a much different model for financing long term care. We see this today with the public sector retirement funds which are severely underfunded but guaranteed by the tax payer.

Ultimately the cost of long term care falls on the citizens, either through their providing unfunded services or providing their tax dollars as guarantees for service.

The question one needs to ask is whether the State's investment teams can perform the same actuarial analysis as the private sector at equal to or greater accuracy and at lower cost than either the for-profit or not-for-profit insurance sector for the paid portion

The second question is whether there are paths to greater community support for LTC that husband scarce fiscal resources. The question must be answered in the affirmative under either of the above schemes because, in the global, or Tom Friedman flat world, the financial markets, at least those of the United States, much less Minnesota, will not be able to provide all the services, including LTC that it has under the past financial exuberance, the sub-prime bubble. In other words Dan Lindh's ideas are based on an economic past that will not or cannot exist in the future.

Humans need a physical space for their corporal existence. It seems the current model is to have facilities with levels of care and amenities that follow a person's changing physical needs from leisure living to high need support. One of the problems in today's society, at least in the US has been the idea of "mobility", the freedom to live, and work, where they want. The idea of the intergenerational community has become, in most instances, almost Mythic. The problem is that this mobility also exists for businesses, many of whom are now taking jobs not just out of communities but out of national borders for a variety of reasons. Yet, with time, humans become less mobile and businesses remain or increase their moving velocity to meet economic sensibilities. I don't think adequate consideration has been given to this phenomenon. Can we afford to have integrated senior housing at multiple levels as now being developed when the larger service and community issues may not allow for the external support needed for these through the informal or low/no cost network now surrounding these facilities?

Charles Lutz (7) (7) (8) (9) (9)

Wayne Jennings (10) (8) (7) (3) (6)

Ray Schmitz (8) (8) (3) (1) (5)

My major concern is how does the large group who today cannot afford to save anything or even cover their needed expenses add this cost to their budget.

Bill Hamm (8) (6) (8) (0) (5)

Question 1: Not only will the state and county governments feel the pressure, so will seniors as they watch the state and counties gobble up their assets at an ever increasing rate too.

Question 2: This is a greater problem for the DINK's (double income no kids) so sad, and the "Brain Drain" rural families whose children had to move away to find work. For Northern Minnesota, a situation largely created by our metro neighbors killing 20,000 forest jobs in less than 20 years that we needed. Thanks for nothing.

Question 3: Maybe Obama should have fixed Medicare before he created a new bureaucracy for health care, do ya think?

Question 4: You just can't seem to come up with a non-Socialist approach to anything can you? Obama hasn't gotten his hand out of our pocket and here you are ready to dig right in again. Even if this were not governmentally achieved it would again be a windfall for Insurance Companies who would again be investing in the stock market (Legalized Gambling) while profiting from our money regardless of whether or not the market crashes and steals all our money like it just did recently. What kind of Ponzi scheme do you have in mind, unless you're going to follow the Teacher Union model and invest heavily in drug companies while pushing drugs on kids to help boost profits? 

Question 5:  Maybe you can work with AFLAC on that one, good luck.

With just a little incentive and some state loan money we could accomplish this and health insurance through user owned Coop structures with no Government interference and local decision making. Imagine that, people actually doing something for themselves instead of big Government doing it for them, but we can't be having any of that now can we? 

Donald H. Anderson (10) (10) (5) (7) (7)

Long-term care demands will increase as the population ages, but how will an insurance plan for everyone be funded individually given the different pay levels of society without some public tax money being involved?

Scott Halstead (10) (10) (10) (10) (10)

We need to improve the health/wellness of all individuals so we reduce the needs for extensive long term care and costly health care services.  Our methods and delivery of health care insurance and services need to changed drastically.  A pill, ineffective screening or medical device does not result in healthy individuals. There needs to be more personal responsibility for our own health.  To what extent should others pay for individuals that choose to be irresponsible and need  excessive health and long term care? 

Steve Tjeltveit (10) (8) (4) (7) (8)

Shari Prest (10) (9) (8) (4) (_)

Question 4:  This appear a simple shift of cost from government to consumer--sometimes consumers who not understand and/or make the most informed choices. It also seems to be a new tier of government. It is also in danger of becoming another opportunity for privitization at the cost of individuals.  That said...there is a strong base of cost/benefit factors here. I will be interested to see if, how and when this unfolds. Are there incremental steps that can take place now?    

Question 5: We do have long term care insurance. Given the likelihood that we will use it at any time the cost is exorbitant.

Question 6:  I like the exploration of new ways of addressing critical situations. I would like to see this conversation also include more about improving quality of life and costs at out-of-home care. I believe we can do a much better job for less money.

Carol Becker (10) (10) (10) (5) (5)

I think that the problems of forcing people to have private insurance is also rife with problems, the largest being that for-profit entities preying on investors.  The current pension system, which operates under the same theory, hasn't exactly worked out well and we are now having a very large number of people entering retirement with little or no pension in part because they don't save and also because they don't know how to save wisely or avoid being ripped off. Is a private solution really better than a public?

I think the idea that government being able to pay all those benefits out is problematic. There are not enough workers to support current benefit levels. One idea is to shift the burden off government to the citizen.  But then you have problems with the private insurance world taking advantage of people.  You also have the problem that current workers pay twice, once for everyone who got in line ahead of them and once for themselves, not a fair or financially possible option either, especially for a generation that already is underfunded for its retirement.  

But what you hope is that we can bring down the costs.  If Medicare costs would shrink, then it becomes much more doable.  If costs were half, like other countries, then the burden of extra folks becomes much more manageable.  But then that brings us back into the whole healthcare debate.  And we know how well that debate is going. 

Forcing people to have private insurance is also rife with problems, the largest being that for-profit entities preying on investors.  The current pension system, which operates under the same theory, hasn't exactly worked out well and we are now having a very large number of people entering retirement with little or no pension in part because they don't save and also because they don't know how to save wisely or avoid being ripped off. Is a private solution really better than a public?

Ralph Brauer (10 ) (10) (5) (4) (6)

Bob White (10) ( 8) (10) (10) (8)

Question 4:  Mandatory, but with opt-out provision for those who buy policies.

Shirley Heaton (10) (10) (10) (10) (10)

Altho not a resident of MN I, as an 80-year-old resident of Florida, see these issues confronting all of the USA.

Dick Angevine (9) (7) (6) (8) (8)

Kevin Edberg (10) (10) (10) (7) (9)

There are emerging a number of small projects that are aimed at this demographic. A worker-owned cooperative of home care workers in Waushara County WI was ranked in the top 5 in a Kennedy School of Government award program about 2-3 years ago, testing the approach that Lindh described of creating non-RN services that provide efficient home care in rural areas that allow seniors to more effectively remain in their own homes. MN (and to lesser extent IA) are home to senior housing cooperatives that studies have shown to allow seniors to age in place, and with a high degree of control of their surroundings. A key to the whole process of containing costs is the ability to keep (basically) healthy seniors as independent as possible for as long as possible.

Paul Hauge (10) (6) (9) (5) (5)

Al Quie (10) (10) (10) (10) (10)

Clarence Shallbetter (8) (5) (5) (_) (7)

Glenn Dorfman (9) (5) (5) (10) (10)

Question 3:  Depends upon whether Legislative priorities change with changing voter attitudes.

Question 4:  In the same way we require mandatory auto insurance.

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

Question 5: .  Given the opposition to healthcare mandates, the politics of a LT Care mandate seem problematical.  Whether if in place the cost would be affordable to middle and low income people needs to be known before making a more positive judgment.

Tom Swain (10) (9) (9) (7) (9)

Deb Frenzel (10) (10) (10) (10) (8) 

Rodney Bounds (7) (6) (7) (5) (5)

Ray Ayotte (10) (8) (10) (10) (10)

Dennis Fink (7) (9) (6) (5) (4)

Regarding question 6, The answer really is: it depends.   If the individual was capable of handling their private affairs before the health problem or the family has demonstrated that capacity then I think that payments to individuals is an elective option.  But there is a percentage of individuals that do not have the ability to manage their affairs and offering that option would do little to assure the service provider would be compensated.
 

    

The Civic Caucus   is a non-partisan, tax-exempt educational organization.   The Core participants include persons of varying political persuasions, reflecting years of leadership in politics and business. Click here  to see a short personal background of each.

   Verne C. Johnson, chair;  David Broden, Charles Clay, Marianne Curry, Bill Frenzel, Paul Gilje,  Jim Hetland,  Marina Lyon, Joe Mansky, John Mooty,  Jim Olson,  and Wayne Popham 


The Civic Caucus, 01-01-2008
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Verne C. Johnson, chair, 952-835-4549,       Paul A. Gilje, coordinator, 952-890-5220.

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