The calories that don't count

Why should your clients try to set up private long-term care financing arrangements, even though Medicaid has been acting as a de facto single-payer long-term care insurer?

One reason, of course, is conscientiousness. Responsible people like to carry their own weight.

Another reason is choice. People who pay their own bills may have a chance to get what they want, not just what some generous somebody or other feels is suitable.

But the most important reason is honest accounting.

Regulators look hard at commercial insurer solvency.

Clients who are managing their own money, or personally overseeing the managers, can keep track of what’s really in the kitty, as opposed to what ought to be there.

Government agencies have a way of acting like me at a restaurant. A taste of my husband’s croissant doesn’t have any calories, because it’s just a taste. A piece of cake on my birthday doesn’t count, because it’s my birthday. A slice of pizza on Labor Day doesn’t count because it’s a national holiday.

Before you know it, all of those tastes and holiday treats add up to 20 extra pounds of blubber belly and thunder-thigh weight that just plain shouldn’t exist, in a kind and merciful world, but, tragically, do exist in this remorseless world.

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And that’s why the story about Australia waving away nursing home facility maintenance fees and the skyrocketing cost of EpiPen adrenaline injectors are both long-term care finance stories.

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The Australian government’s Department of Health tries hard to make high-quality nursing home care available to all who need it on a sliding scale. An individual who has an annual income of about $50,000 Australian dollars and has no assets, for example, would pay just $30,000 Australian dollars per year for care.

The government negotiates reimbursement rates with the nursing home operators.