How the Medicaid Debate Affects Long-Term Care Insurance Decisions
The latest version of the Senate’s health insurance bill appeared on Thursday, and it didn’t do much to change the drastic reductions in Medicaid spending that were in the original legislation.

There is another option: Life insurance that offers a long-term care benefit. If you don’t need it, your heirs get money when you die. It outsells traditional long-term care insurance, according to Limra, a research company. My colleague Paul Sullivan wrote about it late last year.

Financial services representatives are positively gleeful. One article in a trade publication described “off the charts” interest and “strong crowds” at professional events. This exuberance should make their clients extremely wary. If you’re considering any such product, hire an independent adviser on an hourly basis (say, from the Garrett Planning Network) to examine the policy side by side with traditional long-term care insurance and the possibility of paying for care out of pocket.

Sophisticated readers who wrote to me in recent weeks described doing all of the above and still throwing up their hands in confusion. It took a professional storyteller, Julie Gillis, to help me understand why.

Ms. Gillis spent many years watching her mother slowly melt away from dementia. In an interview this week, as she contemplated her own future, Ms. Gillis spoke of changing generational narratives: Once upon a time, you grew up, married, had kids, got your pension, the end. “The entire storytelling trajectory has now changed,” she concluded, after describing her mother’s last few years, when she did not recognize her daughter. It is not how she wants her own life to play out.

Image Ms. Flanders’s father, Robert Mann, who had dementia.

So here’s my guess as to how the story might end in the future — and why we should all think very hard before buying a lot of pricey insurance that we’d need to keep for decades. As several of you pointed out in your emails, there is something radically unfair about the fact that Medicare pays for years of expensive treatment for cancer and heart disease but won’t touch the long-term care and supervision that is, in effect, the prescription for people with memory conditions.

Given how strapped Medicaid is likely to become and how many more of us will live long enough to find our brains and bank accounts depleted before our bodies, it seems quite likely that the federal and state governments will have to do more, not less, to keep older Americans off the streets. No one in Washington seems to want to own up to that, but they will soon have no choice.