Long-term care and insurance monopolies

My grandmother, who is 101 and an amazing person (hi granny!), still lives at the home in Amherst, Mass. where she and my grandfather raised their family. More seniors want to stay at home like her instead of going into a nursing home, but it’s cost-prohibitive. That’s because there’s really no program that pays for long-term care unless you spend down all your savings, or unless you had the foresight to get long-term care insurance, which often doesn’t pay out anyway. I’ve long been interested in what older people do for housing and help as they age, and I looked into this for a recent story:

Why Seniors Can’t Afford Long-Term Care

It turns out the U.S. is an outlier in long-term care—many countries, including the Netherlands, Japan, and Singapore, have mandatory long-term care insurance programs that take a bit out of people’s paychecks and then gives them a fund for long-term care when they retire. But the U.S. has nothing like that, with the exception of long-term care insurance, which is private. There are many horror stories about long-term care insurance, and about people who pay premiums for decades and then are told that because of some loophole, they don’t get the care they need. Only about 4-5% of Americans have long-term care insurance.

The other two options: be super rich and pay for a fancy retirement community that costs $1 million for entry and has monthly fees of $13,000 a month or so. Or spend down all the money that you’ve worked your whole life to earn, and qualify for Medicaid, the government payer of last resort. But nursing homes that have a lot of Medicaid clients don’t always have the best reputation, and are often chronically understaffed.

My story talks about why there aren’t many options for middle-income folks, and what happens to the millions of people who are too “rich” for Medicaid but too poor for good long-term care.

Why So Many Seniors Can’t Afford Long-Term Care

I also wrote about a phenomenon that I’ve been mulling over in my head since my 2024 reporting trip to Alabama to write about IUDs being forced on poor women. A doctor there told me that it was extremely difficult to negotiate better rates because there is essentially one insurer in the state of Alabama: Blue Cross Blue Shield. In fact, BCBS controls about 94% of the group insurance market in Alabama. That’s a huge market share and what you could definitely call a monopoly if you did mind getting persistently pestered by their PR folks.

Alabama has the insurer with the biggest market share, but it isn’t alone; lots of other states have one dominant insurer. That makes premiums go up, doctor pay go down, and nuisances like prior authorization processes take longer, according to research. One doctor told me a story of an Alabama spine surgery that he was going to perform that he had to cancel at the last minute because of prior authorization problems, all of which he blamed on BCBS Alabama. That story is here:

How Health Insurance Monopolies Affect Your Care

I also wrote about how domestic violence support groups are seeing sharp funding cuts because of declining federal resources, a problem that is going to get worse if Trump’s 2026 budget goes through as currently proposed. I talked to groups that have closed shelters, shut hotlines, and put a lot more stress and work on remaining workers. These people are professionals who already have tough jobs and are working on shoestring budgets, but all of these factors are getting worse.

‘People Are Going to Die’: Cuts Leave Domestic Violence Support Groups Reeling

I also sat through an interminable FDA hearing last week in which many many scientists, dentists, and doctors weighed in on whether the FDA should ban fluoride supplements from the market. This was at times fascinating, in part because of the personalities involved, some of whom seem to have drunk the current administration’s Kool-Aid (but not its fluoride) and think that scientific studies can’t be trusted. There were many scientists, pediatricians, and experts who pointed to studies and cases of fluoride really helping people avoid cavities, but the administration seems disinclined to listen to them. (As do the two states, Florida and Utah, that recently banned fluoride from the water.) The new FDA exec who talked at the hearing, a longtime pharmaceutical CEO, seemed predisposed to ban fluoride supplements no matter what doctors said. You can read more here:

The FDA Might Ban Fluoride Supplements. Dentists Are Upset

Books To Fall Asleep To

Women are spies, too! That’s what I’m learning in the audiobook I am listening to now, The Sisterhood: The Secret History of Women at the CIA. It’s meticulously researched and quite engaging, and there is only one flaw: the author narrates the audiobook. Authors, I compel you, unless you are Tina Fey (and maybe even if you are Tina Fey), DON’T NARRATE YOUR OWN AUDIOBOOK. There are professionals who will do this for you and they are much nicer to listen to than you are.