Unfortunately the world does not come in strict shades of black and white. You cannot be healthy or ill. There are multiple shades in between from minor symptoms to chronic disability through injury or illness. This creates a problem for the insurance industry. If you have a family saloon car and it’s damaged, repairs are authorized if this is economical. Otherwise, you throw the old car away and use the fair market value check to buy a replacement. This allows the insurers to cap their losses and pitch the premium rates to stay within fixed limits. When it comes to health cover this is something that simply doesn’t work.
When a decision needs to be made on what to do after breaking your arm it will not be to cut it off and replace it or to repair but will instead be to pay for drug companies to control the pain, a surgeon to make the necessary repairs and for a physical therapist to work on improving your mobility. In most cases involving a clean break, the costs will be controlled but, when there’s a compound fracture, there’s a risk of long-term problems. Again, the costs are still not too heavy even though there may be continuing use of physical therapy and painkillers. But once you get into more serious injuries or disease, the cost of long-term care can be uncontrolled and open-ended. This includes both medical and non-medical costs to care for those who can no longer look after themselves.
We take it for granted that we can move freely around the home, take a shower when we feel the need, change our clothes to match our mood, and so on. Depending on the nature of the medical problems, none of these routine tasks may be possible without someone to help. This is not skilled nursing care. It’s something more or less anyone can do. Except there’s a limit to what families will do and so paying someone to come in and help becomes necessary. If you move up to skilled nursing care in the home, the costs rise. Now add in the cost of visits by a physician to review the treatment regime and write new prescriptions. If care in the home is no longer possible, the costs just took off like a rocket because care in assisted-living facilities or nursing homes is very expensive. Although Medicaid will pay for some of this care for older seniors both in the community and in nursing homes, Medicare does not cover long-term care.
In the past, we have looked to the private insurance companies to include long-term care in their health plans or as free-standing policies. But the economics have been changing rapidly as for-profit hospitals and nursing homes increase their charges. A large number of insurance companies have now made the decision to not accept new long-term care business as a part of health insurance plans for individuals as everyone is now living much longer lives.
There’s still access to the cover through group plans for now but, unless something is done to control costs, even this may become unaffordable. Although no one wants to see Medicare expanding indefinitely, it may become necessary for more federal aid to be channelled to this sector. As with flood insurance, this aspect of health insurance needs support or it will disappear from private insurance plans.