Consider this column an exercise in fevered dream generalities. Sort of a hybrid train of consciousness somewhere between James Joyce and Salvador Dali. I would simply like to attempt to express a feeling of unease. It is more the growing weight of a persistent impression of an impending calamity. Since I can’t seem to shake it, I’ll graciously share with the hard-core readers of this column in the hope that I may again unload some of the burden on my friends. Specifically, those who refuse to give up this quest.

It seems we initially embarked on our journey with a clear vision of our destination; replace a visible retirement planning deficit (even if a little far over the event horizon) directly attacking a known, measurable risk clearly subject to amelioration with insurance. We took familiar well-known legacy vehicles of both the individual and group variety, adapted them to our perceived needs, and then somewhat innocently turned them out unprotected without adequate contingency plans into a basically virgin market. No one would deny that we may have missed the mark completely or that perhaps our audience was simply unprepared for our performance. The risk was bigger than anticipated which set the stage for brutal and onerous underwriting thresholds. Consumer resistance to understand the pending inevitable financial and emotional conflagration was much stronger than ever imagined and the cosmic irony that, when they did buy, it became the most loved and treasured insurance possession of all time. It was in its truest sense a case of the blind leading the blind.

The problem was baked in at the beginning and we have traveled down the same road for so long it seems impossible to turn around or back up. Every research project over the last twenty years aimed at understanding our consumers and product response in my humble opinion has simply chosen to begin its analysis at the point of sale or a public admission of perceived buying predispositions. Our universe is composed of matter that we can see and dark matter that we cannot. Nonetheless it is the background forces that impose the greatest motivational gravity behind all movement.

This is about control. Money may only provide a tape measure to best define identifiable parameters. It has little to do with who or what brought out a need to measure anything. It’s about control of the claim. It’s about basic personal human control. Control of location, quality, preference, maintenance, duration, transition. Will I or someone I love be making those most crucial decisions or not? It is specifically those who have witnessed personally or close at hand the loss of those decisions that have from the beginning provided any of us with successful sales histories.

What I am trying to suggest is that maybe we built this sale on the wrong foundation. Humor me for a moment that we have not adequately prioritized the value of “control of claim” issues or that my 25 years trying to get this right continue to point me in the same direction. If by some strange twist of fate I am right, the question should become who is best prepared to manage the administration of benefits. On the open market freedom side of the equation we have less than a handful of large companies or stand-alone TPAs. On the government controlled side we now have MLTSS, a state run Federal authorized program of Managed Long Term Services and Supports. These are “capitated” and regulated administrators of Medicaid both disabled and special needs. In addition, as home services expand under Medicare and its derivatives there has been substantial recent growth in dual eligible. Bottom line is these folks do anything and everything associated with long term care administration. In 2008 there were four states with an in-house claim manager; now there are 24. If you were to take a closer look at the relationship between existing/proposed Washington State Cares funding strategies and the existing expertise of these already in place in state and Federal long term care management bureaucracy you might pick up on some of the concerns building in the back of what is left of my mind. Capitated means finite and permanent control. Not yours. Theirs.

“Paranoia strikes deep…into your life it will creep.” The immortal lyrics of Buffalo Springfield inexplicably do come to mind.

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: