Financial lessons from my family's experience with long-term care insurance

Insurance incentives and dysfunction

• Many see US insurance—especially health and long‑term care (LTC)—as structurally adversarial: “delay, deny, defend” is described as the default playbook.
• Core issue raised: incentives are reversed compared to normal products. The people who most need coverage are the worst customers for insurers, so profit motives push toward denial and avoidance.
• Some argue state insurance commissions work reasonably well for other lines (fire, liability, LTC) and should have stronger roles in health claims; others say even with commissions, LTC denials are common and hard to fight.

Long‑term care insurance: value and failure modes

• Experiences are split.
  • Positive: LTC policies paying ~$3.8k/month for several years meaningfully offset assisted‑living bills. Some note insurers stopped selling old‑style policies because they lost money on them.
  • Negative: others report never getting paid despite lawyer involvement and describe LTC and elder‑care industries as asset‑stripping machines.
• Concerns: benefits often lag rising care costs; you must buy decades early; you can’t know if you chose well until you claim.
• Washington State’s mandatory LTC payroll tax is debated as either necessary social insurance, a stealth income tax, or fiscally unstable due to opt‑out carve‑outs.

Broader critique of US healthcare

• Many frame US healthcare as a corrupted “natural monopoly” (like water or power) with misaligned incentives, regulatory capture, and layers of middlemen (insurers, PBMs, hospital systems) extracting rents.
• Several point to denial games (e.g., normal childbirth claims) and administrative burden that banks on patients giving up.
• Counterpoint: not all excess cost is “middlemen”; one cited analysis attributes only part of the cost gap to admin, with higher outpatient utilization and prices also important.

Universal coverage and foreign models

• Strong support for some form of universal care, but disagreement on implementation:
  • Single‑payer / Medicare‑for‑All, possibly phased in and supplemented by optional private coverage.
  • Regulated private, non‑profit insurance (Swiss/Dutch style), with mandatory coverage and standardized basic benefits.
  • Mixed public–private models (e.g., Hong Kong‑style free/cheap public baseline plus cash‑based private care).
• Cultural barriers emphasized: US distrust of government, moralized views of poverty, and fear of “rewarding bad choices.”

Care delivery, dementia, and facilities

• Thread returns repeatedly to dementia and LTC: much of what’s needed is “adult‑sitting” rather than acute medical care, yet it’s billed and insured as healthcare.
• Reports from assisted‑living and memory‑care facilities: severe staffing shortages, high prices (>$10k/month), and family members still doing much of the work.
• Some suggest in‑home care with privately hired nurses (sometimes recruited from facilities) can be both cheaper and better for patients.

Housing and family-based solutions

• ADUs / in‑law units are proposed as a partial answer: keep elders near family, expand housing supply, and potentially avoid or delay institutional care.
• Commenters note this depends on local zoning reform and on having family able and willing to provide support.

Politics, structure, and “jobs program” concerns

• Healthcare is described as a de facto jobs program and the largest employer in many places, which makes deep reform politically dangerous.
• Several argue that true fixes would slash administrative and insurance employment while expanding frontline clinical roles and training capacity, which current lobbying and regulation resist.

Miscellaneous

• Some technical discussion covers constraints on physician supply (residency caps, lobbying), nurse practitioners/physician assistants, and whether expanding training pipelines would reduce costs.
• A couple of comments aggressively promoting an “MS‑4 protocol” are called out by others as obvious spam, raising worries about commercial astroturfing even in patient discussions.