Angry actuaries

In theory, the next two years could be a golden era for all kinds of health policy, including long-term care policy.

Americans have had a pretty good chance to check out the Affordable Care Act system and to see what we like about it, what we hate about it, and what’s mathematically possible.

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President-elect Donald Trump, and most of the Republicans who now control the House and the Senate, said while they were campaigning that they would fight to replace, and replace, the ACA. Any ACA feature that survives in that environment will have to be very popular, very practical, or, ideally, both.

While the Republicans were campaigning, they talked about expanding the health savings account program. They occasionally mentioned long-term care, and dementia.

Trump, for example, said during a primary appearance in New Hampshire that the country needs to invest more in Alzheimer’s research.

Mike Pence, the vice president-elect, said during a vice presidential debate that a society can be judged by how it cares for the elderly disabled.

One policymaking challenge could be Americans’ chronic lack of understanding of how insurance works.

We have a hard time grasping the reality that small, consumer-friendly tweaks in insurance rules, programs or products can lead to 2,000-page regulations, push the best risks out of the market for coverage, encourage insured people who could handle negative events on their own to file claims, and put enormous financial strain on insurers.

Even agents, brokers and home office workers in lines other than health insurance or long-term care insurance occasionally have a hard time empathizing with the people in charge of keeping health insurance companies from going broke.