LTCI Watch: Scooters

Private long-term care insurance (LTCI) carriers may want to keep their product separate from acute health care insurance and retirement income benefits because silos make nice little markets.

Medicare, Medicaid and Social Security — and the fraud investigators that investigate them — may want to keep acute medical care expenses, durable medical equipment expenses, and long-term care housing expenses in separate silos because government employees have as much of an interest in protecting their nice little markets as managers of private enterprises do.

But I think the endless operatic bickering over how Medicare pays for “power mobility devices” — the scooters and electric wheelchairs advertised with catchy ads on cable TV and elsewhere — shows that all policymakers and policy watchers interested in aging, including those in the LTCI community, ought to be thinking hard about we align responsibility for the costs associated with aging.

Obviously, just about any time you have companies going on cable TV to promise viewers that they can get an expensive, really cool toy paid for by the government, with no out-of-pocket cost to themselves, you know something is going wrong with financial incentives. Aside, maybe, for something that’s of obvious value to society as a whole, such as measles shots or elementary education, just about nothing paid for by the government ought to be all that easy to get.

But, on the other hand: For older people who really need scooters to get around, and who will be able to continue to live independently, with a minimal level of formal care, with the scooters, maybe easy access to scooters — and “smart houses,” and even robots — is a great thing for public and private long-term care (LTC) finance programs as well as for the older people and the scooter makers.

If the deluxe $5,000 scooter with a cup holder and flashing rim lights will do a much better job than a $500 wheelchair at keeping Jane Doe from needing a home care aide who will cost at least $30,000 per year, then maybe it would be good for everyone involved if Jane Doe has the $5,000 scooter, not the $500 wheelchair.

Instead of the government, private insurers, older people and relatives dividing bills and responsibility for paying bills into many different conflicting categories, some individual or entity ought there really ought to have a financial stake in making sure that Jane Doe maximizes her happiness, her independence and cost efficiency.

But who?

If Jane Doe and her children are great consumers who’ve already outfitted Doe with the latest in value-priced aging services technology (AST), then, obviously, Doe and her children should be in charge.

What if, like most consumers, Doe and her children can barely get a cable modem up and running after many calls in to the cable company, let alone make great decisions about AST?

In theory, Doe’s doctor, “medical home” managers or “accountable care organization” could make the decisions — but will they have any real interest in, or knowledge about, Doe’s overall living expenses? What if they simply minimize the cost of care and equipment but push doe into an expensive nursing home sooner than she ought to go there?