LTC Bullet: Health Reform and Economic Reality

Monday, November 9, 2009


LTC Comment: What facts of economic reality should you consider in evaluating health reform proposals? Answers after the ***news.***

*** HEALTH REFORM RAMIFICATIONS. According to Dennis Smith, who ran the Medicaid side of CMS for eight years under the Bush Administration: "By expanding Medicaid in the health care bill, Congress will set off political tornadoes across the country that will leave governors and state legislators to clean up afterward. The math is simple. State revenues are still in a slump and will continue for at least a few more years. The two largest state and local expenditures are education and Medicaid. If you have to balance a budget, which nearly every state does, and you cannot touch the entitlement to Medicaid, where will you turn to fill the budget gap? There will be little choice than to go after education." More here. ***

*** ANOTHER MEDICAID PLANNING HUSTLE. With Medicaid under water financially all across the country, and sinking fast, how can Florida elder law attorney Alice Reiter Feld suggest:

"At this FREE informational seminar you will DISCOVER:

· How to avoid having your life savings wiped out by a nursing home spend down!

· How the new law restricts protection of assets and why it may not be too late to plan under the old law!

· Why most people don't have the proper asset protection language in their Power Of Attorney documents, which can protect their life's savings! . . .

· How Medicaid works . . . and the steps you need to take now to protect yourself and your family under the new rules!"

If you're in the area (near Boca Raton, FL), why not attend this "seminar," hear what she has to say, and ask the tough questions she won't pose or answer. Details and a schedule here. ***

*** ANTIDOTE FOR MEDICAID PLANNING and prescription for responsible LTC planning: Join the Center for Long-Term Care Reform. Subscribe to LTC Bullets and LTC E-Alerts. Gain access to "The Zone," including the "Almanac of Long-Term Care" and many other features. Cost is nominal: $150 per year or $12.50 per month. Contact Damon at 206-283-7036 or or subscribe here. Thanks for supporting your Center for Long-Term Care Reform. ***



LTC Comment: The Center for Long-Term Care Reform's mission is to "ensure access to quality long-term care for all Americans." We usually stick pretty close to our knitting. But nowadays the pursuit of rational LTC public policy is closely wrapped up with a potential sea change in overall health care policy. So, today, we bring you an essay on health reform and economic reality, written by a pioneer in the field of long-term care insurance. I think it will be clear how the author's practical and philosophical observations about health insurance also apply to long-term care.


"Health Reform and Economic Reality"


Dale Larson

It has become a cliché that today there is nothing as uncommon as common sense. This is particularly true when it comes to the subject of healthcare reform. Everyone is in favor of better healthcare, at lower cost, available to everyone who needs it (that is pretty much everyone). Disagreement arises about how to achieve those goals, and/or whether they are all achievable in the real world.

Amid the cacophony of emotion laden rhetoric, distortion and misinformation surrounding the healthcare "reform" debate, certain indisputable realities remain. Whatever the form of final "reform" legislation, if any, that is passed, common sense tells us that these realities will not go away. I hope that the following observations will help the interested cut through the clutter.

The issues surrounding the healthcare debate are both practical and philosophical. The practical issues are principally about finance and access. I say finance because it is both about the cost of services, and how the services are paid for and by whom. The philosophical issues relate to whether people have a "right" to healthcare.

Health Finance Issues

The cost of healthcare for any individual is a function of the cost of the factors comprising it. The most obvious of these is the cost of direct providers: the doctor, nurse, medic, etc. Fairly obvious to most are the additional costs that may be involved, such as the cost of a hospital or clinic where care is provided, medications, medical technology involved, and so on. Less obvious are indirect costs such as meal preparation in a hospital, waste disposal, cleaning, billing, processing claims to insurers, compliance reports to government agencies, taxes, utilities, license fees, malpractice insurance premiums, etc. An increase in any of these costs affects the total cost of healthcare services.

The total of all these costs for healthcare for each person receiving care is aggregated to the total amount spent on healthcare in this country.

There are two ways to cut health care costs:

--Reduce the cost of services

--Reduce the amount of services provided

Some ways to reduce cost of individual health care services

--Reduce the pay of physicians (exacerbating the existing shortage of doctors, especially GPs [general practitioners])

--Reduce the pay of nurses, aides, other hands-on care providers

--Reduce the pay of other support staff (cooks, janitors, etc.)

--Reduce what is paid for food, medical supplies, bedding, etc.

--Reduce what is paid for medications,

--Reduce what is paid for operating costs, such as rent, taxes, insurance, energy, water and sewer, garbage disposal, maintenance and repair, etc.

Few people would argue that nurses, aides or hospital and clinic staff are overpaid now. It is highly unlikely the cost of energy, water and sewage, or government fees and taxes will go down.

That leaves doctors and medications. You can cut doctors compensation. However, here is problem: there is already a shortage of primary care physicians in this country and the problem is only expected to get worse, without any contemplated cuts to compensation for doctors. (See: You have to be reasonably smart to get into and through medical school. It is hard work, expensive, and takes a long time to become a doctor. I'm not suggesting that most people who go into medicine do it for the money. But I am suggesting that if you can make more money as a plumber or longshoreman, than as a primary care doctor or brain surgeon, you might find that altruism has its limits. Of course reducing the availability of doctors does force a de facto rationing, if that is your goal. But that isn't appealing if you are trying to find a doctor.

There is a report circulating now that about 45,000 doctors say they would leave the practice of medicine if the current proposed cuts to physicians are implemented. You might ask your doctor if he or she could stay in business if the most that could be charged to anyone and everyone was what Medicare or Medicaid (current government programs) pay for their services.

One thing that could immediately allow doctors to lower what they charge without affecting their income would be to lower the amount they have to pay for malpractice insurance. Simply limiting the amount that could be awarded for intangibles like pain and suffering to the same limits imposed in government controlled workers compensation plans would positively impact the cost of this insurance. An additional benefit of tort reform might be the lessening of the incentive to practice "defensive medicine." But addressing this issue doesn't seem to be on the agenda for the majority party.

Pharmaceutical Finance

Much is made about the expense of prescription drugs. Little is ever discussed about the expense of developing a new drug, paying for the testing needed to prove it is both effective and reasonably safe enough to get FDA approval, and getting it into the marketplace.

Currently, drug companies can sell extra production to other countries at lower prices because they are able to recoup most of their development costs from the sales at higher prices in the U.S. If all Americans bought their drugs through Canada or some other country or countries, that would effectively create a single market for the drug companies comprised of the U.S. and other countries exporting their drugs back to the U.S. They would then have two logical choices. One would be to establish a single market price, which would be a little less than the current U.S. price and a lot more than the current other-country price or they could simply stop supplying other countries with enough drugs for them to supply both their own and the U.S. market. For example, one prime source of imported drugs, Canada, has a population less than 11% of the U.S.--about the size of Pennsylvania and New York combined (31 million), and less than that of California (35 million). It really doesn't have that much leverage.

Limiting the ability of companies to recoup their research and development costs through patent protection may bring cheaper generic drugs to the market sooner, but anyone who thinks this will result in maintaining even the current level of research let alone accelerated research is not in touch with reality. Generic drug makers simply replicate proven drugs. They do not engage in research, which is very expensive and often leads to dead ends. Nor do they have to take their drugs through the extensive expensive approval process, which does not always result in approval. Drug companies must recoup those expenses, including losses from developing drugs that don't get approved, out of the profits they make on drugs that are approved and sell successfully.

You could implement government price controls. It is easy for government to cap profits or profit margins. But government does not put a floor under risk. For example, the low profit, high risk equation exists in the vaccine business, which is why there are fewer and fewer companies that are willing to engage in that business. That has contributed to the shortage of vaccines, such as the H1N1 vaccine. Price controls (whether direct or indirect) would only make the situation worse.

Another thing that can lower cost of healthcare at the margin is to stop the development of new medical technology. New technology is expensive to develop and costs money to provide, especially until it reaches sufficient scale that economies of production can be implemented. Of course when you have a serious medical problem, you may want access to the latest technology that may literally mean the difference between life and death. We could immediately lower healthcare costs if we just eliminated all access to any advances in medicines or medical technology that have occurred in say the last 15 years. Is anyone up for that?

Moderating Demand for Health Care

Some ways to reduce the amount of health care services provided


--Do not provide some services to anyone

--Limit or do not provide expensive procedures, services, or medications

--Limit the availability of medications, especially new expensive, cutting-edge drugs

--Do not provide some services to certain individuals while making them available to others based on criteria such as:


--Length of expected benefit vs life expectancy

--Estimated (by some arbitrary criteria) chance treatment will be successful


--Political connection

--Ability to co-pay

--Number of services allotted and where a person stands in the queue

--Patient responsibility in causing or exposure to the health problem (e.g. problems caused by lifestyle or risky behavior)

--Legal residency status

--Reduce redundancy, inefficiency and unnecessary treatment i.e. waste, fraud and abuse.

--Reduce the need for services by improving the health and lifestyles of members of the society

--Take aggressive steps to reduce lifestyle illness

--Tobacco use

--Other substance abuse

--Excess fat, sugar, and calorie consumption

--Insufficient exercise

--Ban high risk behavior

--Male gay sex

--Extreme sports

--Child contact sports

--Motorcycle riding or bicycling on roads

--Deport unhealthy aliens

Of course no one likes to talk about rationing since it is in immediate and obvious conflict with the idea of healthcare for all. But when there is more demand for healthcare that there is supply, not everyone is going to get what they want.

Waste, Fraud and Abuse

As long as I can remember, people talk about saving money by eliminating waste, fraud and abuse from federal programs. It never happens to any significant degree. The biggest argument against believing it will be different in the case of healthcare is the record of Medicare and Medicaid (started in the '60s), and the fact that nothing is being said about attacking waste and fraud in Medicare, UNTIL health reform passes. And Medicare is projected to run out of money in 7 years. (Are you listening Baby Boomers?). This is despite the fact that healthcare providers generally lose money under Medicare reimbursement rates which they must subsidize with higher charges to private-pay and insured individuals. As a result many practitioners limit the number of Medicare patients they will take, or refuse to treat them at all.

Medicaid is a joint Federal and State program which was originally designed to provide healthcare to the poor. However, today its greatest expense [proportionately] is providing long-term care to the exploding population of frail elderly. It is a program rife with problems of underfunded care mandates, price controls and de facto rationing of services. The state share of the cost is already crushing strapped state budgets. If health care "reform" requires states to expand their coverage, the states will need to get the money from the taxpayers in their states by increasing their taxes.


As noted above, there is another way to reduce healthcare expenditures. It has nothing to do with the cost of care, and doesn't require restricting access to care through some form of rationing. It is simply to reduce the demand for care by reducing the need for care. In other words, be more healthy. If you are healthier, your own medical expense will be lower. If society is healthier, the nation's total expenditure for healthcare will also be lower.

One factor in the debate about contrasting America's health with its cost of care that is often missing is the very poor health habits of many Americans. Besides the obvious things like substance abuse and lifestyle behaviors, excess weight and especially obesity, which is rampant in the U.S., are known to be major contributing factors to health problems, both chronic and acute, such as diabetes and cardiovascular disease. Will we someday have the government fat police marching everyone up and down the street? How much abridgement of freedom of choice and action are acceptable? Americans have demonstrated a tenacious determination to indulge in whatever lifestyle and behavior they choose, while wanting someone else to insulate them from the natural consequences of their choices.

Some common sense on preventive care is also needed. It is a good thing, and obviously taking care of yourself and getting regular medical check ups can prevent an otherwise undetected problem from getting worse. So it can reduce an individual's long term healthcare cost by early intervention. But there are a number of studies which show that it doesn't reduce overall medical costs. That is because many people will incur the costs of additional preventive care and screening who won't get sick anyway. And screening can generate false positives, leading to further screening and even unnecessary treatment.

How do you define unnecessary treatment? It seems beyond dispute that people respond differently to different medications or treatments. There is little consensus on what is the best treatment for any disease, and if you thought you were one of the few likely to be subject to possible side effects listed on the warning label of many medications, you wouldn't take them. They may work for most people but are bad or even fatal for a few. How then, does any individual or group of individuals or computer program determine what is the "best" care for you, based on what seems to be the best care for some "majority?" Not only are doctors incentivized to do every conceivable test to reduce their chances of being sued because they "overlooked something," but also if you are sick and haven't yet found out why, you want to exhaust every option to determine your problem and a solution.

I haven't noticed any specifics in any of the proposals for curbing the insatiable demand for new wonder drugs, expensive technologies, and unproven treatment alternatives. But I am pretty sure that you cannot provide more coverage to more people and have it cost less money.

Health Insurance

Much is made in the current debate about the cost of health insurance and its rapid rise in the last number of years. But most of the reasons thrown up in the debate by proponents of "reform" have little to do with reality.

Health insurance is highly regulated by state governments. In many states, companies are legally required to cover certain services, often including services of marginal value to the patient. Profit margins are also affected by regulation, which is why health insurance companies are not particularly attractive investments. Most, if not all, states mandate that health insurance companies pay a minimum amount of premium out in benefits (called "minimum loss ratio"). Health insurance companies basically pass on the cost of the health care services they pay for plus a mark up for expenses and profit. Medicare does the same thing, except for the profit margin. Although highly subsidized, Medicare is required by Congress to annually adjust its premiums to cover the same percentage of what it is paying out.

But what about the insurance companies' excess profits you say? Because the amount of money spent on healthcare and health insurance is so large, the profits, although a small percentage, still constitute a large amount of dollars.

In actual fact, an analysis by Pricewaterhouse Coopers actually shows that profits only amount to 3 cents on the premium dollar and that that on average 86 cents of every premium dollar is spent on medical benefits. The analysis found that the largest contributor to premium increases (43%) is increased utilization of benefits by insureds and more expensive treatments. The analysis also found that "administrative costs, taxes, profits, and other non-benefit expenses of private health plans have averaged about 12 percent of premiums over the last 40 years." (

It is also important to understand that insurance companies must apply to the state insurance department and secure approval for every rate increase. The insurance departments of most states, are there to protect consumers, not insurance company profits. But in order to protect consumers, insurance departments want to make sure that insurers remain solvent. The insurers have to show their expenses, their claims experience and fully justify any rate increase request. If unjustified rate increases are approved to fatten company coffers (highly unlikely), blame the state government. Of course the state government benefits from the added tax revenue, since insurers pay a premium tax to the states of generally around 2% to 3%.

In reality the only way to significantly reduce, slow down, or reverse the increase of health insurance premiums is to reduce, slow down, or reverse the increase in the cost of paying for covered services. Even eliminating all insurance company profits would only have a marginal effect on premiums.

Another thing that many people don't know is that unlike most other forms of insurance, the health insurance premiums individuals pay rarely reflect their true risk. Group insurance rates are more likely to reflect the average risk of the total insured group, but individual rates are regulated by states. Most states, for example require "community rating." This means premiums must be the same for people in the same age group, regardless of gender. This ignores a simple biological fact. The female reproductive system provides an additional level of health problems and issues that don't occur in men. They incur more medical services. So women pay less than they should and men pay more. Add to this that many times, comprehensive health insurance is required by state mandate to include maternity benefits. This means men, and women who are no longer fertile, are being charged to pay for coverage for something they will never need. It is also a fact of biology that as we age we are more prone to health problems, yet states only allow limited differentiation of rates based on age. Thus young people subsidize the true cost of insuring the elderly.

Pre-existing Conditions

One of the hottest issues in the debate is coverage of pre-existing conditions. Sad story after sad story is brought out of someone who has an expensive health problem and can't get insurance now to pay for it. Presumably what these poor people want by insurance is something that will pay for the cost of their medical treatment for a premium that is something less (usually a fraction of) that amount. This is analogous to wanting to recoup the entire cost of your house if it burns down, but pay only a fraction out of your pocket for that benefit.

The reason any insurance costs less that an expected claim is because of the presumption that insurance is a pooling together of the funds of numerous individuals, only some of whom will actually incur claims in a given period. If everyone paid in only a small amount and then everyone wanted to collect large amounts of benefits, there wouldn't be enough dollars to go around. Essentially what insurance companies do is handle that aggregation of everyone's small contribution and handle the payment to the relatively few who collect benefits in excess of those contributions, and take administrative and overhead costs, plus a profit for providing that service. Of course in reality they also attempt to assess the risks and determine the appropriate amount of contributions in order to pay the expected claims and stay solvent.

Now if you require insurers to take people who are already sick, what happens? This means that people can avoid paying any insurance premiums until they get sick and then sign up for insurance benefits. So the company gets the huge claim cost with very little premium income. This is hardly a way to reduce premiums for everyone else, since their premiums must cover these additional costs, without the benefit of prior contributions by the claimant. How motivated would you be to carry fire or auto insurance if you could wait until you had a fire or accident and then buy it for the same premium or only slightly higher than you would have been paying if you had bought it beforehand?

Currently insurers protect themselves by imposing waiting periods for coverage of preexisting conditions, rejecting outright people with serious conditions likely to lead to large claims, or by only accepting them as part of a large, generally healthy group, where the cost for the sicker individual can be spread among the premiums for the entire group. That is, the group, and therefore every member, pays more. But the visibility of this increase is masked in the overall group premium. It is often further masked to individuals because the group premium is paid by their employer. But the cost is still there, and it is still paid.

It seems like everyone in Washington, DC is in favor of requiring insurers to insure people with pre-existing conditions. But generally they rationalize this with a proposal that everyone will be required to buy insurance, so they won't wait until they are sick and then buy it. There are a couple serious but generally ignored practical problems with this. One is enforcement. It is difficult to force people to buy insurance without draconian invasions of privacy and draconian penalties, none of which are being proposed. The penalty for not buying insurance now is pretty severe if you end up needing coverage, but you don't have any. Still millions of people who could easily afford it chose not to buy health insurance. If the benefit is great (getting insured only when you already need benefits) and the penalty is small (a small fine or tax if you get caught) for not buying insurance now, when you don't "need" it, most people will make a rational economic choice. The second problem is if all the healthy people sign up with one company, say one with lower premiums but fewer benefits, but the sick ones sign up with another, say one with richer benefits, then the company with all the policyholders with pre-existing conditions gets all the extra expense, but none of the extra premium from all the healthy ones. In order to stay solvent, and not go out of business, they will have to raise their rates, which will drive their remaining healthy policyholders to other insurers who, not having all the sick people, can profitably offer coverage at lower rates. This results in a death spiral where ever-increasing rates drive away ever more healthy policyholders, until the company cannot stay solvent. Expect health insurance rates to increase if this requirement becomes law.


One thing that could incentivize companies to squeeze their profits further would be increased competition. In fact providing competition is one of the arguments put forth for a so-called "government option." But the biggest barrier to competition is the fact that residents of one state cannot buy insurance that is not approved for sale in that state by that state's insurance department. The state they live in may mandate that all insurance plans cover all sorts of nice-to-have extras that the providers of those extra services have lobbied to have included as required coverage. Residents of another state may be able to buy perfectly adequate coverage without the bells and whistles. But you can't buy that policy if you live in another state. Removing that restriction would open the floodgates of competition among the circa 1300 health insurance companies operating in this country. In fact this state-by-state approval requirement gives a competitive advantage to the larger companies because it is a barrier to market entry for small companies that can't afford the extra staff devoted to working through the maze and morass of the various 50 state insurance departments and their mandates, requirements and bureaucracy. Again, nothing addressing this is appears in any of the majority party proposals.

I am not defending abuses by insurance companies, healthcare providers or pharmaceutical companies. Abuse is abuse wherever you find it. But in highly regulated industries such as these, such corruption often involves problems on the government regulatory side. Abuse, dishonestly and corruptions is not limited to private or for profit entities. It exists in government as well. Just mentally review the list of public "servants" who have been guilty of corruption of one form or another. A government healthcare plan has all the issues of maintaining revenue in excess of claims, controlling claims, etc. that private insurers face. Oh, they may be able to subsidize deficiencies with our tax dollars, or printing more money, but the money to pay the claims must come from somewhere. History provides little support for the notion that government bureaucracies are inherently more efficient, or less corrupt that the private sector.

Philosophical Considerations: The "Right" to Health Care

Many assert that people have a "right" to healthcare and insist that this is a moral issue. So the question that must be answered is: do you have a genuine right to something that must be provided by or at the expense of someone else?

I submit that the right to pursue good health does not extend to the right to demand that someone treat your health problem without compensation, or provide for that treatment at his or her expense. If you have the right to demand the services or the fruits of the labor of another person, that person is effectively your property--your slave. This principle is often lost in the debate over the plight of misfortunate people.

Most people who profess their belief that "people have a right to healthcare" don't really think through what they are saying. Your "right" to something from someone else is dependent on your ability to enforce or have enforced the extraction of that "right" from them. This is a far cry from the God-given inalienable rights envisioned by our founding fathers. Those rights were not an infringement of the same rights of another individual, or a collection of individuals--that is, it was not someone else's obligation (individually or collectively) to provide the enjoyment of your right. Let's call the God-given rights envisioned by our founding fathers in the Declaration of Independence and Bill of Rights of the Constitution "Fundamental Rights."

It has become fashionable among certain political points of view that, in the name of compassion, people should be entitled to all sorts of "rights" at the expense of someone else. The moral and practical problems with this view are most apparent when the "someone else" can be individually identified. Thus to make it more palatable, the "someone else" is generally identified as the anonymous "they," "the rich," "society," or "the government." But of course, under our system of government of and by the people, the government can only pass on that which comes from some or all of the aggregate of "someone elses" who make up the "people." Many of these so-called "rights" are very appealing on the surface in that the enjoyment of these "rights" is obviously beneficial to those who receive them. In this discussion I will refer to them as "Beneficial Rights."

The problem with this view is three-fold. One, it advocates the abrogation or abridgement of the Fundamental Rights of one or some in order to provide Beneficial Rights for another or others. This is morally untenable--asserting that you have a "right" to that which is your neighbor's (time, skills, efforts, property, assets or income, etc.) is an exercise of covetousness, whether you define neighbor as a particular individual, a group of individuals or simple everyone else. Enforcing such a "right" is outright theft. Two, there is no end to the list of benefits which could be asserted to be Beneficial Rights. This is not practically feasible, because demand can outstrip supply, no matter what the source. Three, "rights" that are conferred by government, can be taken away by government. Thus they are not really rights at all but merely benefices of government whim.

But let's say we ignore the moral issues and argue that compassion requires that we, society, should provide healthcare to everyone in need. What does that mean?

If healthcare is a "right," must the provider provide the care regardless of compensation? A provider of any service who is obligated to work for nothing is a slave. Is slavery justified for the provision of healthcare? If a provider does not wish to provide healthcare to a particular individual, should someone else, or the government be able to force them to do so? If the provider is entitled to compensation, is the compensation set by a mutual bargain between the provider and the recipient, by a government bureaucrat, or by whatever the recipient feels like paying? Indeed, if the provider is entitled to withhold services unless fairly compensated, then can healthcare truly be a "right?"

When people assert that Americans have a "right" to healthcare, what do they mean by healthcare? Do they mean every conceivable form of care, no matter how far outside mainstream medicine? How about care by a shaman or witchdoctor at government expense? Do they include things like elective and cosmetic surgery to improve how one feels about oneself? Does healthcare include first class treatment like a private room in a hospital or care facility, a private duty nurse, a personal attendant, or hospital level care at home?

Does the "right to healthcare" include the right to cures for diseases for which no cure currently exists? Is it feasible to believe that the discovery or development of new cures can be achieved at the point of a gun?

What happens to these "rights" if there are not enough healthcare providers willing or able to provide all this care? Does the government draft people into a National Healthcare Service and forcibly assign people to certain care specialties? Since our court system today seems to have an extremely broad definition of "health," are there any practical limits to what could be included under "healthcare." Must provision be made for the improvement of everyone's self-esteem and sense of well-being? Does the "right" extend only to U.S. citizens, or does it include any and every sick person who can penetrate our borders, legally or illegally?

By now it should be clear that the Beneficial Right of healthcare can only be provided at the morally untenable expense of the denial or infringement of Fundamental Rights of the providers and/or those who are forced to relinquish some of their rights in order to compensate the providers on behalf of others. Furthermore, even if a society voluntarily chooses to provide for some level of collective provision of healthcare to its members, the inherently limitless extent of "healthcare" means that as a practical matter, it must be limited and therefore cannot truly be a "right."

No one can deny that good healthcare is a valuable, even life saving benefit to recipients. But the same can be said for food and shelter. So do American's have a "right" to be provided food and shelter? If so, does that mean all of the finest gourmet food they can eat, and the finest accommodations available? The same moral and practical issues apply. And if moral and practical issues, or just the moral issues are abandoned, what other Beneficial Rights can be asserted--a job, a "good" education, a wage you like (these would presumably be of minimal necessity if "rights" to food, shelter and healthcare were enforced), insulation from any negative consequence of any action, a spouse or companion, etc. etc.?

Compassion and care for those suffering misfortune is a strong tenet of America's Judeo-Christian heritage as well as other religious traditions. But the recipients of such benevolence must appreciate it for what it is-charity, voluntarily extended; it is not a Right, enforceable from others against their will. Likewise, those in a position to help those less fortunate than themselves ought to feel a moral duty to respond appropriately within their personal means. But no one has a moral right to make that choice for any other person, or the right to impose their choice on anyone else.

As you look at proposed "reforms" of our healthcare system, ask yourself if they acknowledge and account for these realities.

Dale Larson is a philanthropist and former owner (with then-partner, now LTCFP CEO Cameron Truesdell) of LTC, Incorporated, one of the most successful marketers of private LTC insurance in the history of the product.