a scale of (0) most disagreement , to (5) neutral, to (10) most
agreement, what is your view on the following:
_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
_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.
_7.9 average response_____
Minnesota's state budget cannot possibly support projected increases
in Medicaid payments for long term care.
_6.6 average response_____
Mandatory long term care insurance, financed non-governmentally,
should replace Medicaid, financed governmentally, for long term care.
_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
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.
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.
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
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)
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
Bill Hamm (8) (6) (8)
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
Scott Halstead (10)
(10) (10) (10) (10)
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) (_)
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?
We do have long term
care insurance. Given the likelihood that we will use it at any
time the cost is exorbitant.
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)
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?
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
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
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)
(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.
(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.