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Life Health > Long-Term Care Planning

The calories that don't count

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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.

Related: Health care stocks plunge as Australia restricts long-term care fees

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.

The providers were trying to get around what they say are unrealistically low rate caps by adding separate maintenance charges. 

Australia’s Department of Health says that violates the terms of its agreement with the providers and banned the maintenance fees.

Meanwhile, in the United States, the U.S. Food and Drug Administration has added this requirement, and that requirement, and another requirement, all in the name of safety, and add so many little requirements that, at least for now, it’s shut out all but one major maker of consumer-friendly adrenaline injectors aimed at people with severe allergies who are suffering from life-threatening anaphylactic shot. 

The Australian government is pretending, in effect, that those maintenance costs don’t count, because providing affordable long-term care is important.

The FDA is pretending that the cost of its safety rules doesn’t really count in any way that matters, because making sure that drugs are safe is important.

Of course, government agencies around the world are now pretending that they’re allocating more resources for future long-term care needs than they really are. Agencies are proceeding on the unspoken belief that keeping taxes low now and providing solid long-term care benefits in the future are both so important that the growing gap between hope and reality doesn’t count, any more than a carton of Ben and Jerry’s ice cream on my birthday counts.

But, of course, the calories in the ice cream always count. The gap between what government agencies will likely need to pay for long-term care services and the amount they’ll actually have, will count, too. Even on the government agencies’ birthdays.

Allison Bell is the health channel editor for


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