Having the ability to reflect back on 35 years of considering the long term care conundrum should afford me some level of comfort that progress has been made. That we have systematically learned from our mistakes. That we have with purpose and growing experience influenced the normally progressive course of history. The vision in my mind that will not leave me alone however is my dog chasing its tail. According to Google, dogs chase their tails for several reasons: Something bit them and spiked their curiosity; they are young and simply exploring their own physical limitations; or, they are really bored. Albert Einstein famous quote concerning the definition of insanity rushes to mind but I like this one better: “We cannot solve our problems with the same thinking we used when we created them.”

Just for fun let’s meander through the big concepts which appear to repeatedly coalesce through our public thinking.

  • There is a consistent chorus from all quarters that we need to focus on the middle class. That those with and without the ability to fend for themselves will proceed to fall into solutions based on their circumstance. Our focus must again be on those with the most at risk. Once upon a time, before we understood the true nature of long term care claims, this was our purpose and frankly our greatest historical sales success. As underwriting restricted and premiums rose we simply abandoned our original quest and have satisfied ourselves with picking up the low hanging fruit—those with sufficient wealth to leverage the risk. It is the original crusade that haunts our purpose and brings us back again and again to acknowledge and attack the real need.
  • There seems to be a growing acceptance that Custer’s 7th Cavalry is riding hard to our rescue, yet we also privately suspect that he will find the same overwhelming circumstances waiting just over that rise. The problem, as we know, is that the intended solution speaks with a forked tongue. Medicaid and Medicare are already bursting at the administration and financial seams. Adding the administration cost and homogenized managed claim bureaucracy of yet another national social insurance plan would not be built on previous government success stories. We will again come to realize that there are more Indigenous Americans than we thought. Yet the mounted cavalry with sabers extended presses forward. Recent consumer research by the NORC-Center for Public Affairs Research claims 88 percent of Americans wish to receive care at home and 60 percent want the government to pay for that care. Washington State is now collecting employee payroll premium. California has now basically removed the means tested restrictions of access to Medicaid. A number of states are keeping their eye on this cavalry charge. Ultimately those who become enamored with the bugles blowing will suffer the same fate. Underwriting liberties will fester, bureaucracies will bloat, public trust funds will be depleted and the quality of care can only suffer.
  • The market reality of all current pricing assumptions is that institutional care is more expensive than home care. There is an almost religious belief that building on home care saves money. In my view it is the same gaslighting that proclaims that electric cars save money. It is the same Utopian fantasy future currently being espoused that AI robotics are at the core of future home care scenarios. According to the Nationwide Retirement Institute: “One third of Americans and over half of millennials believe AI robotics will provide their future in home long term care.” The survey further explained that they would talk to their robots if they were lonely, depend on them to help provide physical safety and trust them with their medical history. You do not have to read Issac Azimov or Ray Bradbury to get a funny feeling in your gut about weaponized self-aware AI.

Honestly, I am tired of worn out excuses. Exhausted by more of the same formula thinking. Frustrated by the continuing lack of a united and industry coordinated education crusade. I am therefore specifically weary of the recurrence of perceived easy answers and utterly dismayed by the continued lack of consumer awareness. I cannot shake the vison of the circular motion of that dog intent on some form of personal gratification when all that will be actually accomplished was perpetual redundant motion and the continued illusion of potential success.

Other than that I have no opinion on the subject.

Ronald R. Hagelman, CLTC, CSA, LTCP, has been a teacher, cattle rancher, agent, brokerage general agent, corporate consultant and home office executive. As a consultant he has created numerous individual and group insurance products.

A nationally recognized motivational speaker, Hagelman has served on the LIMRA, Society of Actuaries, and ILTCI committees. He is past president of the American Association for Long Term Care Insurance and continues to work with LTCI company advisory boards. He remains a contributing “friend” of the SOA LTCI Section Council and the SOA Future of LTCI committee. Hagelman and his partner Barry J. Fisher are principles of Ice Floe Consulting, providing consulting services for Chronic Illness/LTC product development and brokerage distribution strategies.

Hagelman can be reached at Ice Floe Consulting, 156 N. Solms Rd., New Braunfels, TX 78132 Telephone: 830-620-4066. Email: