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Life Health > Long-Term Care Planning

Short can be fine

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Bernie Sanders, a U.S. senator who nearly won the Democratic presidential nomination, wants the United States to offer a soup-to-nuts, government-run American Health Security Act system that would provide all convalescent care services, and all long-term care services.

He’s continuing and expanding a battle that’s been going on in the United States for decades, and has been part of a general effort to expand U.S. social services programs.

In the life insurance market, one result of that effort has been hostility toward low-face-value life policies. At least in the past, a surge in the strength of progressive policymakers tended to go hand-in-hand with an increase in the number of National Association of Insurance Commissioners meetings on the plight of people who pay total life policy premiums that exceed the value of a policy’s death benefit.

In the medical insurance market, support for a universal government-run system has contributed to hostility toward short-term health insurance. Short-term health insurance competes with traditional major medical insurance, and it fills in gaps that, in the eyes of supporters of bigger, stronger government social services programs, ought to be eliminated by government programs.

Related: NAIC opposes federal short-term health limit

In the long-term care insurance market, the push for a universal long-term care support program seems to be at least partly responsible for simmering hostility to short-term care insurance, or policies that pay for skilled nursing care, home health care or other types of non-acute health care for periods of less than a year.

One, clearly stated argument is that it’s not clear whether anyone needs insurance coverage to pay for a few months of post-acute care. Another argument, that seems to be lurking quietly between the lines, is that Medicare ought to pay for the post-acute care, anyway.

On the one hand, I think it’s reasonable to say that, in connection with many of these issues, the supporters of a hard-headed, free-market approach are being sentimental, and the supporters of universal government support programs are the ones who are seeing the world as it actually is.

Most of us are nice. We end up with weak, patchy, annoying safety-net programs by default, because we’re (usually) too nice to let frail or disabled people who are willing to put up with red tape and miserable conditions die on the sidewalk.

We will get poor, uninsured into an emergency room that will make some effort to diagnose and treat their heart attacks today, even if it may not do enough to attack their high blood pressure and high blood cholesterol levels tomorrow.

We will, eventually, put those who are unable to function on their own into what may be an awful nursing home.

Given that just about all of us “want someone to do something” about frail people dying on the sidewalk, and few of us do enough when it comes time to make voluntary contributions to the United Way, that seems to create pressure for the government to do something.

Medicaid, for example, already pays for care for about 60 percent of U.S. nursing home patients. The French single-payer health care system pays about 77 percent of French acute health care bills, according to the World Health Organization. In other words: Medicaid is 78 percent of the way toward being as much of a universal single-payer for nursing home care in the United States as the French government health care system is for acute health care in France.

But, on the other hand: The U.S. long-term care safety net is a mess. One person in one place on one day could get terrific care immediately. Another, similar person living a few miles away could have to wait months, or years, to get low-quality care.

And recent events have shown how unpredictable the need for short amounts of post-convalescent care can be.

The new cancer insurance actuarial tables posted on the website of the Health Actuarial Task Force, an arm of the Kansas City, Missouri-based National Association of Insurance Commissioners, reveal that the average 19-year-old woman who files a cancer insurance claim related to leukemia or another form of blood cancer ends up spending about 56 days in the hospital, and the average 20-year-old male who enters the hospital for treatment of blood cancer stays for 221 days.

The U.S. Centers for Disease Control and Prevention has recorded about 20,000 Zika infectionsin the United States and U.S. territories. About one in 500 of the people known to have Zika infections has been identified as having Guillain Barre Syndrome, a condition that can cause temporary, or, occasionally, permanent paralysis.

Many people with Guillain Barre Syndrome end up needing rehabilitation services and other forms of post-acute care for periods of three months to two years, according to NSGMed, a nursing journal site.

In other words: If about 1 percent of Americans, or 3 million, come down with cases of Zika serious enough for doctors to test for Zika, it’s possible that as many as 6,000 of those people could end up with Guillain Barre Syndrome. A significant percentage of those people could use large amounts of post-acute health care services. Major medical insurance may pay for some of that care, but it might not pay for as much care as patients want, or exactly the kinds of care the patients want.

The lesson here is that consumer advocates should make certain that issuers of short-term care insurance give consumers clear explanations of what the policies do and don’t do, and that the issuers make good on their obligations.

But, if an honest company writes well-explained short-term care insurance policies that pay what they’re supposed to pay, then regulators should support that kind of company, not kill its short-term care insurance product because “no one needs special insurance to pay for short-term care,” or because Medicare or Medicaid ought to pay for that care.

Someday, diamond-encrusted-platinum major medical policies might pay generously for excellent, conveniently located post-acute care for all who want it, or government health care programs might do the job.

Today, however, people have real holes in their coverage. If an insurer sees a way to make money by filling those holes with a product that works properly when the insured files a claim, then that insurer ought to have a chance to try to fill those holes.

Allison Bell is health channel editor for


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