LTC Bullet: What Topics and Speakers Do You Want for the Next ILTCI?

Monday, July 6, 2020


LTC Comment: Wouldn’t a debate on the merits and potential of private vs. public long-term care financing spice up the next ILTCI conference? Offer your own suggestions to the event’s organizers after the ***news.***

*** THE DEBT CLOCK shows the U.S. national debt will soon exceed $26.5 trillion, up nearly another quarter trillion since our last Bullet ten days ago. Total unfunded liabilities, including $20.6 trillion for Social Security and $31.8 trillion for Medicare, are $153 trillion. Every citizen owes $80,285. At the rate we’re going, this 2024 version of the Debt Clock estimates the debt four years from now will be $45.3 trillion with unfunded liabilities of $199.4 trillion on a debt per citizen of $131,857. So eat, drink and be merry until the bill comes due for this paroxysm of funny money printing and spending by the Federal Reserve and Treasury. ***



LTC Comment: The coronavirus curveball ruined all our plans to learn and network at the 2020 Intercompany Long-Term Care Insurance conference. After fighting to save the program, the ILTCI Executive Committee finally had to surrender to hard reality and cancel. But the ILTCI conference is back on for Monday, March 8, 2021 through Thursday, March 11, 2021 at the same Sheraton Downtown venue in Denver, CO where we would have met this year.

The 2021 convocation will be ILTCI’s 20th, so it is special. To mark the occasion, organizers have appealed to all potential attendees for their suggestions of “topics or content” to present and of speakers to address them. I don’t recall such a general invitation having been made before. It’s a great idea. I hope everyone will rack their brains and pour their recommended ideas in to the organizers. Here’s their appeal:

“Planning for the ILTCI Conference is underway and we can't wait to see you in Denver, Colorado from March 8-11, 2021. But first...

“We need your help with planning! 

“What topics or content do you want to hear about? Have you thought of a session topic or speakers you'd want to present at the next ILTCI? This is your opportunity to help shape the 2021 conference! If you want to offer your assistance in producing or speaking at a session, this is also the time to raise your hand and get involved. Session ideas are being generated now and we want to make this a collaborative process with your feedback.

“Please complete this quick 4 question survey and enter one session idea or speaker suggestion at a time through this simple tool. There will be a link to enter additional ideas at the end of the survey for anyone with multiple ideas/speakers to submit. We know you have some good ideas for session content and topics - send them in and let’s collaborate for the 2021 ILTCI.”

At my request organizers agreed to extend the deadline for submitting your content and speaker recommendations from the original deadline of Friday, July 10 until Tuesday, July 14. So, don’t wait—click “Submit your Ideas” now and offer your suggestions.

To spur your creative thinking about possible conference ideas, review the “History of Long-Term Care Conferences” that we published last year. You’ll find summaries of each ILTCI conference including the first, held January 21-23, 2001 in Miami. You’ll also discover some old photos of some LTCI leading lights who are still active in the field today, some with less hair and more heft, but still loaded with institutional memory and savvy. No one concerned about long-term care financing should miss the opportunity to confer with the long-term care insurance industry’s leaders at the 2021 ILTCI conference in Denver.

Now, while you cogitate, decide and submit your ideas for topics and speakers at the forthcoming conference, please consider my hopeful proposal.

I love debates. There is no better way to get a lot of ideas on the table in a hurry with contrasting points of view compellingly revealed. Nothing culls out bad ideas and elevates good ones like two contrasting experts challenging each other’s positions. So let’s debate this question at the next ILTCI conference: “Can and Should Private Financing Become a Bigger Funder of Long-Term Care than Government?” I’ll take the positive and I invite any of the leading advocates of expanding publicly financed long-term care coverage to take the negative. I’d especially like to debate Marc Cohen, Judy Feder, or Howard Gleckman, but there are many others who could bring the case for more government money and regulation thoughtfully.

As format for the debate I recommend the structure used by the distinguished Soho Forum of New York City. For their programs, the audience votes yes or no on the question under consideration both before and after the debate. The discussant who changes the most minds wins. The debate begins with each discussant delivering a 15-minute opening statement. Then each has five minutes for rebuttal followed by questions from the moderator, from each other and from the audience. Five minute closing statements end the debate. After the votes are counted, the winner is announced. (By the way, since the pandemic has shut down in-person events, the Soho Forum has gone virtual. You can follow their debates in Zoom here.)

The ILTCI Conference has a long history of hosting debates. There were probably others, but these are the ones I recall distinctly and fondly:

At the fourth annual Society of Actuaries Long-Term Care Insurance Conference (the meeting’s name before ILTCI) in Houston, Texas on February 10, 2004, I squared off with Dr. Judith Feder, then Professor and Dean of Public Policy at Georgetown University. Winthrop Cashdollar, then the Executive Director for DI & LTCI at AAHP-HIAA, moderated. My assignment was to make the case for more private financing of long-term care. Dr. Feder argued for heavier public funding. My remarks at the time are available here. Judy Feder is a distinguished scholar and more active than ever today researching and promoting her preferred solutions.

In 2011, the CLASS Act was the hot topic at the eleventh annual Intercompany Long Term Care Insurance Conference in Atlanta. Peter Goldstein, then of Univita, now LTCG, moderated a program titled “Panacea or Problem: Point/Counterpoint on CLASS,” in which John Greene of NAHU and I debated Ted Kennedy-protégé Connie Harner and Rhonda Richards of AARP. Eileen Tell enforced time limits on the debaters. I’m not saying John and I won, but CLASS was later repealed. Check out my three-minute opening statement here where I proposed a CLASS-like program called “Steve’s Insurance, LTC for You” or SILY for short. It involved no policies, no underwriting, no set premium levels, benefits, or triggers; you’d pay premiums for five years before you’d qualify for benefits; I’d spend all the proceeds as soon as they come in, but our trust fund would have lots of IOUs, uh bonds. In other words SILY was just like CLASS.

But the pièce de résistance was the “Clash of Titans” at the 2012 ILTCI conference in Las Vegas. Here’s how I described that program at the time in “LTC Bullet:  LTC Embed Report from the ILTCI Conference in Las Vegas”:

“Now to recount the most fun that was had at the conference. In the afternoon of DAY ONE, a great debate ensued titled “Clash of the Titans: Moses vs Gordon on Medicaid and Other Dark Matter.” Ably produced and moderated by Federal Long-Term Care Insurance Program [now FedPoint] CEO Paul Forte, the program included a dramatic “fight poster” inviting the audience to attend, slides featuring great debates of the past, e.g. Lincoln vs. Douglas, etc., and a dual-podium presidential-style debate format. Moses and lawyer/author/entrepreneur Harley Gordon each began with 3-minute opening statements. (Find a transcript of the “fable” I began with at the end of today’s Bullet or here.)

After a coin flip to see who would get the first question, Forte pummeled the combatants in turn with six queries ranging from why the LTCI market languishes to what they’d advise presidential candidates to say about LTC financing. Answers were strictly enforced to no more than two minutes, with a one-minute rebuttal, and a final 30-second “re-direct” by the original answerer.

The program moved fast with lots of humor and more than just a little gentlemanly confrontation. In the second phase of the debate, the participants asked each other questions, with the same time limits applying. Neither knew what the other would ask so the questions and responses were totally spontaneous. Finally, the audience submitted written queries pinning down the debaters with new and different viewpoints.

Bruised, bloodied, but upright, Moses and Gordon shook hands at the end and affirmed they remain friends. They look forward to continue pursuing their different paths toward the common goal to improve long-term care for all.

Who won? Just between you, me and the lamppost, here’s how LTCI producer and author Craig McCormick, a former college debater himself, scored the matchup: 13 to 4, for Moses. Now, I acknowledge that Mr. McCormick may have a bias in my favor. So I invite any of you faithful readers out there who may have attended the debate to weigh in with your own scoring of the event. I’d particularly like to hear from anyone who gave the win to Harley instead of me. Well, I want to hear from anyone except you, Harley! I’ll publish any thoughtful comments or analysis of the debate in a future LTC Bullet. Let us hear from you.

The Elephant, the Blind Men and Long-Term Care:  Three-Minute Opening Statement” by Stephen A. Moses for the Debate with Harley Gordon at The 12th Annual Intercompany Long-Term Care Insurance Conference in Las Vegas, Nevada on Monday, March 19, 2012

Once upon a time, some blind men approached an elephant.

The first blind man grasped the elephant’s tail and exclaimed:  “This is a rope.”

The next blind man patted the elephant’s flank and said:  “This is the side of a barn.”

A third blind man clutched the elephant’s trunk and stated confidently:  “This is a hose.”

The moral of this fable? 

You don’t know any complex thing until you comprehend its entirety, including all of its facets and their interrelationships.

Long-term care is like the elephant in this story and LTC interest groups are like the blind men.

Government is a blind man of long-term care.  It’s paid for most expensive LTC since 1965, but can no longer afford the cost.  The elephant of LTC gobbles budgets.

The public is a blind man of LTC.  Most people don’t worry about LTC despite the apparent risk and cost.  Somehow the elephant of long-term care provides.

Senior advocates blindly demand more and better long-term care from the government.  To them the elephant of LTC is a cornucopia of free benefits.

Home care and nursing home providers obsess over low government reimbursements.  They see the elephant as a stingy, but demanding customer.

What do long-term care insurers see when they look at the elephant of LTC?  A puzzle.  Why don’t consumers buy the product when they obviously need it?

If you want to understand the elephant of long-term care, you’d better be able to explain why those five blind men see the elephant so differently.

How can the government be bankrupt; the public, asleep; senior advocates, naïve; LTC providers, spoiled; and LTC insurers, befuddled?  All at the same time.

No new policy designs, nor tax incentives, nor education programs will sell more LTC insurance until we resolve that paradox.

Here’s how I see it:

Government pays for most expensive LTC which desensitizes consumers to LTC risk resulting in a lack of demand for LTC insurance.  But senior advocates and LTC providers are hooked on government money and dubious of private LTCI.

Nothing will end this stalemate short of weaning the elephant of long-term care away from the trough of public financing. 

That’s what’s about to happen, either on purpose or by default, and that’s why the future of LTC insurance is bright.