😷 Why The Panic? It’s No Worse Than The Flu … Uh, No

I have a number of Conservative friends are who are making fun of the whole COVID-19/Coronavirus response. I’m sure you’ve got friends like that. The ones who insist that the name-your-flu-pandemic was worse. The ones who insist that events shouldn’t be cancelled; the high-risk population should just avoid going to them. The ones who believe this is just a conspiracy theory.

These folks are wrong. I’m taking a break from working at home to share why.

The charts in this post from Vox give a great summary of why the response you are seeing is warranted. In short:

  1. The virus is spreading rapidly. There are charts that explain this in the Vox post, but the updated SciVs podcast on the subject gives more detail, and it was an update of their first episode on the subject. Basically, there are standard equations that those who deal with epidemics use to predict the spread of an epidemic. These are governed by the R0 value of the disease. R0 a mathematical term that indicates how contagious an infectious disease is. It’s also referred to as the reproduction number. R0 tells you the average number of people who will catch a disease from one contagious person. It specifically applies to a population of people who were previously free of infection and haven’t been vaccinated. If a disease has an R0 of 18, a person who has the disease will transmit it to an average of 18 other people, as long as no one has been vaccinated against it or is already immune to it in their community.  The estimates of the R0 value for the Novel Coronavirus was 2.2: If one person gets it, they will infect on average 2.2 other people. Working from that number, 20 to 70% of the population of the world will be infected. That doesn’t mean they will get sick: people can have a mild or no response to this. But they can go around infecting others. Even if we’re a bit off on that number, we’re looking at 20-60%. The risk is manyfold: not just person to person contact. We now know the virus can remain in the air for 3 hours, and on some surfaces for 3 days. So being out and about where an infected person has been can be very risky — and even if you don’t get sick, you can bring it back with you.
  2. This disease is deadly for certain populations. If you are young and healthy, you’re just going to get something mild and spread it. If you are older, have underlying health problems: this could kill you or land you in an ICU. So how does this compare with the Flu? According to Vox:The Spanish flu of 1918-’19, the most horrific pandemic in modern times, focused mainly on the young. It had biological similarities to a flu pandemic in the 1830s that gave some older people in the 1910s limited immunity. Covid-19 is not like that. So far, deaths in China have been concentrated among older adults, who have weaker immune systems on average than younger people and have a higher rate of chronic illness. People of all ages with chronic medical conditions are also at higher risk. The risk of death is real for younger people as well, but older people have the most reason to take care. Vox also notes: “It is tempting to compare Covid-19 to a more familiar disease: the seasonal flu. After all, the flu also has mild symptoms for most people, and can be dangerous and lethal among vulnerable populations like the elderly. But as the case fatality data shows, there’s no real comparison. About 6 percent of people 60 or older infected with Covid-19 die, according to data we have so far; that’s over six times the fatality rate for elderly people infected with the flu. The overall case fatality rate is at least 23 times greater (the fatality rate has risen since this chart was made). The LA Times also has a good article explaining why this is a greater risk than the seasonal flu. A later Vox article notes the real risk for the elderly: “In Italy, a country with one of the world’s oldest populations, a March 4 analysis by the national health institute found that of the 105 patients who died from the virus, the average age was 81. This put a 20-year gap between the average age of people who tested positive for the virus and the deceased, the institute said. On Friday, an ICU physician in Lombardy — the epicenter of Italy’s outbreak — told JAMA there have been only two deaths of people under the age of 50.”
  3. Our hospitals could be overwhelmed. When COVID-19 is lethal, it is often due to secondary lung infections that require ventilation in a hospital. If the hospitals are full, that treatment isn’t possible. So our goal must be to keep the hospitals below full. How do you do that? Delay the infection rate, and #FlattenTheCurve. If you can reduce the rate at which people get the disease, we can respond and it will be less deadly. Thus, the orders for social distancing and the cancellation of all the events.
  4. But couldn’t those vulnerable just not go to those events?. Sure. But that’s not the real risk. Remember that R0 number. Remember also that people can have this disease, be contagious, but have mild or no symptoms. So those not vulnerable go to the event and either spread the disease and/or get infected and bring it back home. We want to curb the spread rate. This disease is more contagious that the normal flu, which has an R0 of 1.3.  The “Stomach Flu” (Norovirus) is 1.3 to 3.1; measles is 11-18; ebola is 2, zika is 3-6.6. This is 2.2-3.1. That’s bad. Remember also this is a new disease: there are no vaccines, there is no immunity from it.
  5. But Only A Small Number Have This. Actually, we have no idea how many people have this. You only know if someone has it if you test for it, and our testing has been woefully lacking. When China started testing everyone, their numbers jumped. So it is quite likely that a lot more have this than we know. That’s why President Trump’s delayed response was so bad: he delayed getting the testing done, which would have allowed us to contain the first few cases before they spread into the general population. It’s too late for that now.
  6. How Do We Fight This? The answers for most folks is easy: social distancing, to stay away from others who might have the disease and #FlattenTheCurveWashing your hands and using hand sanitizer. If you look at the science of the Coronavirus, it is surrounded by an oily protective layer. Soap destroys this layer and destroys the virus. I’m going so far as to wash not only my hands, but my face as well to get rid of anything that got there through accidental touching. The right hand sanitizers do something similar.
  7. We Can’t Do It Alone As this Atlantic article notes: “Right now, one of the most important things Americans can do is deploy measures like social distancing and self-quarantining, even if they do not feel sick and are not at risk of the worst effects of the disease, in order to “flatten the curve” (epidemiologists’ term for slowing down the natural progression of an outbreak). This requires a radical shift in Americans’ thinking from an individual-first to a communitarian ethos—and it is not a shift that is coming easily to most, especially in the absence of clear federal guidelines.” It goes on to note: “If you are privileged enough to skip an event or work from home, you may save a life—even though the life you save may not be your own. It might be the life of your cousin with cancer, or your colleague’s brother, who has diabetes.”

In closing, I’d like to leave you with this, which is in tribute to Spongebob Squarepants at the Dolby, which had its run shortened due to social distancing:

Spongebob Squarepants Wash Chart


🤣 It’s All How You Look At It (PS: The Banks are Closed Today)

[Today is Illegal Immigration Day — the day that we celebrate when the inhabitants of Miami Beach discovered an illegal boat person on their shore, and made the gigantic mistake of offering him and the others on his boat asylum… and look at what happened. In Los Angeles, of course, they just renamed the day Indigenous People Day. Back in the 1950s, however, the day was called Columbus Day, when we celebrated a city in Ohio for reason no one really knows, other than we needed to give bankers a 3-day weekend in October, because we all know they need the respite.]

In 1961, the humorist Stan Freberg issued Volume 1 of The United States of America, a musical telling of the founding of America through the Battle of Yorktown (Volume 2 goes through the end of World War I (“They’ll never be another war…”)). The first scene on Volume 1 relates the story of how the Indians discovered Columbus. Although many things have changed since 1961 when this was recorded — Columbus is no longer held in the same regard, the portrayal of the Native American would likely be very different — there are still points that ring true, especially the exchange:

Columbus: Alright. Hello there. Hello there. We white man. Other side of ocean. My name, Christopher Columbus.
Chief: Oh, you over here on a Fulbright?
Columbus: No, no. I’m over here on an Isabella, as a matter of fact. Which reminds me. I want to take a few of you guys back on the boat to prove I discovered you.
Chief: What you mean discover us? We discover you.
Columbus: You discovered us?
Chief: Certainly, we discover you on beach here. Is all how you look at it.

As today is Columbus Day, let us remember that unfortunate day that the Native Americans discovered a Italian sailor, and the world was never the same. Just look at all he brought us: “real food: starches, spaghetti, cholesterol, … all the better things. That’s called progress.”

I present a transcription of the scene, just as it happened:

Read More …


📰 Inspired Miscellany: A Random Collection of Things I Found of Interest

As I continue to review the collected links, here’s a random collection of articles that I found of interest:

  • Amazon’s streamlined plastic packaging is jamming up recycling centers. One area of interest to me is plastics, and the growing amount of plastics in our waste stream. They are hard to recycle, and even their presence makes things that are normally easy to recycle very difficult (think plastic tape on packaging). This article explores a recent change made by Amazon in their packaging. Amazon is an interesting case, for they require extra packaging as they ship everything. Over the last year, Amazon.com Inc. has reduced the portion of shipments it packs in its cardboard boxes in favor of lightweight plastic mailers, which enable the retailing giant to squeeze more packages into delivery trucks and planes. But environmental activists and waste experts say the new plastic sacks, which aren’t recyclable in curbside recycling bins, are having a negative effect. The problem with the plastic mailers is that they need to be recycled separately, and if they end up in the usual stream, they gum up recycling systems and prevent larger bundles of materials from being recycled.  It’s a really hard question. Cardboard is easier to recycle. But it is heavier, takes up more space, and requires more trucks, which have more environmental impact. Plastic takes less space and less trucks, but is harder to recycle and can contaminate the recycle stream.
  • Why your desk job is so damn exhausting. Think about it: Which is more exhausting: a job that requires physical manual labor, or a desk job behind a computer all day. You would think the former. This articleexplores one of the more hotly contested issues in psychology: What causes mental fatigue? Why is desk work so depleting? It presents the two main hypotheses for why we get so tired from work when we’re not physically active. Hypothesis 1: we get so tired because we deplete an internal store of energy. The problem is, increasingly, psychologists aren’t sure it’s real. Hypothesis 2: we get so tired because our motivation runs out. We become drawn to the things we want to do, rather than the things we have to do. And this tension possibly causes fatigue… and blog posts like this… did I type that with my public fingers?
  • How to Make Your Office More Ergonomically Correct. Here’s another thing that could be making you tired: Your office layout. At the end of last year, I moved offices — meaning a new desk and new monitor support, and it took me a while to make things comfortable. I’m still not 100% sure it is right. This article explores how to ensure that. Remember: About $1 billion a week is spent in the United States to deal with entirely preventable work-related musculoskeletal injuries, many of which are caused by small flaws in body positioning. You can do a surprising amount of damage to your body if you hold parts of it in strange positions for hours at a time, five days a week. But some research suggests that you can also prevent and even reverse damage by engineering your office work environment properly.
  • How to responsibly get rid of the stuff you’ve decluttered. Right now, society is on a decluttering trend. More and more stuff is being removed from closets and houses, and it has to go somewhere. You want it to go to the right place. Last thing you want to do is add it to the trash stream, especially for clothing. This article explores the best way to get rid of different classes of stuff you may be (shall we say) de-accessioning. For us, it will probably be participating in a multi-family estate sale in a few months.
  • Why so many financially independent adults are still on their parents’ phone plans. You would think, as you become financially independent and move out of your parent’s house, that you would financially separate from them. But that doesn’t always happen — and for good reasons. Kids stay on their parent’s health insurance until they are 26 because that’s often much cheaper (especially for insurance you get through work). Often Car Insurance is bundled if it makes financial sense. This article explores the reason that kids are on their parent’s phone plan — and it is often for the same reason: adding an extra line to your phone is much much cheaper than having a separate plan.
  • The periodic tables we almost had. Design is an area that fascinates me. This explores how we got the current design of the periodic table, exploring its evolution over time. It was surprisingly hit and miss, settling down as we began to learn more. But in many ways it is still imprecise, and not an accurate model. I tend to like the “Underground Map of the Elements” m’self.
  • The Aldi effect: how one discount supermarket transformed the way Britain shops. Yes, I know, I’m not in the UK. But this article — which looks at the evolution of Aldi as a market and its expansion into the British market — provides some fascinating insights into the US: especially the difference between Trader Joes (owned by Aldi North), and Aldi (owned by Aldi South). If you don’t know what I mean by Aldi North and Aldi South, you really need to read the article.
  • Community colleges can cost more than universities, leaving neediest students homeless. We’ve all been taught that it is cheaper for students to go to community college than a big university. But what if that is wrong? This article explores why it is wrong — and the answer is interesting. Community colleges do cost less tuition-wise. But because they have lower tuition, they also have lower financial aid — meaning that students get less support in paying for those units. There is also less to no housing aid, meaning students are on their own to find housing. This makes the total cost often higher than a mid-tier state university with aid.
  • Off the chart: the big comeback of paper maps. We often think mapping apps will be the death of paper maps, but that’s not the case. This article explores why. In a time when facts are to be treasured, perhaps paper maps have real significance, recording as they do a version of the truth less susceptible to tampering and fakery. The effects of the digital era on humans’ mental map abilities are becoming apparent. A recent study at the University of Montreal found that some video games that relied on non-spatial strategies could reduce growth in the hippocampus, an all-important region for mental mapping.



🤣 It’s All How You Look At It (PS: The Banks are Closed Today)

[Today is Illegal Immigration Day — the day that we celebrate when the inhabitants of Miami Beach discovered an illegal boat person on their shore, and made the gigantic mistake of offering him and the others on his boat asylum… and look at what happened. In Los Angeles, of course, they just renamed the day Indigenous People Day. Back in the 1950s, however, the day was called Columbus Day, when we celebrated a city in Ohio for reason no one really knows, other than we needed to give bankers a 3-day weekend in October, because we all know they need the respite.]

In 1961, the humorist Stan Freberg issued Volume 1 of The United States of America, a musical telling of the founding of America through the Battle of Yorktown (Volume 2 goes through the end of World War I (“They’ll never be another war…”)). The first scene on Volume 1 relates the story of how the Indians discovered Columbus. Although many things have changed since 1961 when this was recorded — Columbus is no longer held in the same regard, the portrayal of the Native American would likely be very different — there are still points that ring true, especially the exchange:

Columbus: Alright. Hello there. Hello there. We white man. Other side of ocean. My name, Christopher Columbus.
Chief: Oh, you over here on a Fulbright?
Columbus: No, no. I’m over here on an Isabella, as a matter of fact. Which reminds me. I want to take a few of you guys back on the boat to prove I discovered you.
Chief: What you mean discover us? We discover you.
Columbus: You discovered us?
Chief: Certainly, we discover you on beach here. Is all how you look at it.

As today is Columbus Day, let us remember that unfortunate day that the Native Americans discovered a Italian sailor, and the world was never the same. Just look at all he brought us: “real food: starches, spaghetti, cholesterol, … all the better things. That’s called progress.”

I present a transcription of the scene, just as it happened:

Read More …


📰 Crafting Some Chum

Lots of news chum accumulated over the last few months while I’ve been focused on other articles. Here are some articles related to crafting and such:



💊 Safe and Effective … Or Perhaps Not

As I work, between other tasks, to clear out the news chum, here’s a collection of articles related to health, medicine, and drugs:

  • Co-Pay Accumulators. One of the big problems with our medical system in the US today is how we pay for drugs, and a large part of that are the games insurers make us play. Consider co-pay accumulators. These impact use of those coupons drug manufacturer’s provide to make their drugs affordable. Copay accumulators mean that coupons no longer will be counted toward patients’ deductibles. When you use the coupons, you pay a fixed amount. The drugs manufacturer takes care of the difference between that fixed amount and what the drug company charges (or what insurance would pay). More importantly, the coupons are often applied to the insurance deductible (especially for injectable drugs ), speeding up the point where your out-of-pocket max is met. Co-pay accumulators, on the other hand, allow insurers to double dip: They get their full co-pays and they get to extend the duration of patients’ deductibles. The article is an interesting read for the exploration of the pros and cons.
  • Anticholinergic drugs and Depression. Recent studies are showing that some classes of anticholinergic drugs — particularly those used to treat depression, Parkinson’s and urinary incontinence — carry a higher risk of cognition problems or dementia. The concern is those anticholinergics used for depression (e.g. amitriptyline), urinary incontinence (e.g. oxybutynin) and Parkinson’s disease (e.g. procyclidine) were associated with around a 30% increased risk of developing dementia. Amitryiptyline is of interest to me, as it is a common drug used for migraines as well.
  • Depression Drugs and SuicideMore than a third of American adults use medications that list depression as a risk, and a quarter use drugs that increase the risk of suicide. The 203 drugs researchers identified aren’t obscure; they include some of the most commonly prescribed medications around — like birth control, beta blockers for high blood pressure, and proton pump inhibitors for acid reflux. Many are drugs used for migraines. The researchers from the University of Illinois and Columbia University discovered people using these drugs had an elevated risk of depression compared to the general population. And the more medications with depression as a side effect people took, the more their risk of the disease increased. It is certainly something to be aware of. [And while I’m ending a sentence with a preposition, here’s why that is considered bad.]
  • Yogurt and Chronic Inflammation. A recent study provides new evidence that yogurt may help dampen chronic inflammation. The study explored the hypothesis that yogurt may help reduce inflammation by improving the integrity of the intestinal lining, thus preventing endotoxins — pro-inflammatory molecules produced by gut microbes — from crossing into the blood stream. While anti-inflammatory medications like aspirin, naproxen, hydrocortisone and prednisone can help mitigate the effects of chronic inflammation, each comes with its own risks and side effects. There is a need for additional options — particularly safe, gentle, long-term treatments. Researchers have been exploring dairy products as a potential dietary treatment for more than two decades. Findings have been mixed, setting up a scientific debate about whether dairy products are pro-inflammatory or anti-inflammatory.
  • Baking Soda and Auto-Immune Disease. Here’s another interesting study, this time concerning baking soda (the most effective antacid, in my book). It appears that a daily dose of baking soda may help reduce the destructive inflammation of autoimmune diseases like rheumatoid arthritis. The study is some of the first evidence of how the cheap, over-the-counter antacid can encourage our spleen to promote instead an anti-inflammatory environment that could be therapeutic in the face of inflammatory disease, Medical College of Georgia scientists report in The Journal of Immunology.
  • Dealing with Chronic Pain. We’re all hearing about the opiod epidemic. Yet for those with chronic pain, they are often the only choice. What if they weren’t, and I’m not talking CBD as an alternative. Pain often has a psychological cause or at least a psychological component. There are 100 million Americans who suffer from chronic pain, and an unknown number of them with back pain, neck pain, fibromyalgia symptoms, or other forms of pain that have no diagnosed physical cause. There have been numerous studies showing the benefit of placebos — in other words, belief that something will work — and belief is a large component of why prayer works for some. The problem is  the psychological component is often dismissed or never acknowledged. Cognitive behavioral therapy, meanwhile, shows meaningful benefits on chronic pain — both for psychogenic pain, and for pain with a physical cause — according to systematic reviewsof the research. There’s also promising research around mindfulness-based stress reduction and therapies inspired by it.

Up for Discussion

Things have been busy, busy, busy, and the chum has been piling up. I’m spending this morning clearing out the backlog. Here are a few articles that didn’t categorize, but I found extremely interesting and worthy of discussion:

  • Employee Loyalty. At work, one of the big ongoing discussions relates to the company’s proposal to move from our long-standing defined benefit pension plan plus 403(B) to a 401(K). For some employees, it has been reported this could cost them up to $1 Milllion. For others, like me (I’ve been there almost 30 years, I’m on the original retirement pension plan, and have at least 10 years to retire), the impact is significant, but not that high. The proposal has raised questions on the commitment of the company to its employees, and thus this article on “Where Have All The Loyal Employees Gone?” is quite fascinating. It explores why more employees aren’t like me: at one company for 30 years. Employees today don’t find a company and stick with it, unlike our parents or parent’s parents era. The conclusion of the article: There isn’t employee loyalty because employer’s aren’t loyal to the employees — they are just in it for the profit. As the article writes: “Why should anyone be more loyal to you than you are loyal to them?”. It suggests five ways to get employee loyalty: (1) give them long term incentives like you give yourself; (2) give long term employment contracts; (3) pay them market rate or better; (4) give them visibility into the future of the business; and (5) Make your employees’ retirement plans as rich as your own retirement plan. This is great advice — something more companies should heed. Take care of your workers, and they will be there for you.
  • The Eviction Experience. We’ve all heard stories about people being evicted. But what is the process? This is especially true as folks get evicted as part of gentrification. Here is an interesting tale about someone who has been evicted, through a series of bad circumstances. In this particular case, it was bad circumstances created by Internet Conservatives who directed their political anger at a journalist who was just doing their job — and they destroyed his life. As he wrote: “The salacious news—the black guy who suggested Romney was a racist also beat his ex-wife—ricocheted around the internet, and my job prospects evaporated. I suddenly became unhireable, even for bottom-rung media jobs. The modest severance package I got from Politico drained away in a few months, along with my ability to pay my bills and child support.” (This seems especially interesting now that Romney has rentered the political fray as he campaigns for a senate seat). As for the process itself, it is dehumanizing: deputies show up, pack up belongings in black plastic trash bags, and dump them at the curb. Further, this process disproportionately affects minorities. All sorts of questions get raised, worthy of discussion.
  • Bodies Are Awesome. The extent to which people are judgmental about others is incredible — certainly, in the Internet echo chamber. This bullying is serious business. Look at many of the mass shooters, and you’ll find they’ve been the target of bullies at some point in their life. No where is this more visible in how people are bullied for their looks. This is an interesting article that celebrates all bodies, shapes, and sizes — by looking at photos of the wide variety of Olympic athletes — all shapes, sizes, and you name it — all making the best of what they were given. The photos alone are fascinating.  As the article says, “Bodies are awesome. Everyone should get one.”. I find, as I watch people, the bodies I find the most interesting are not the perfectly airbrushed, plastic surgery ideas; the ones with silicone everywhere. What makes people interesting is not their perfection, but their imperfections. That dimple. That unique look. We must celebrate our differences and stories.
  • Crafters and Hoarding. If you live with a fabric artist, you know hoarding and craft rooms. Here is an interesting blog post exploring the broader question of “artist as hoarder”. Just consider the opening paragraph: “As an artist, you’re bound to collect stuff. After all, how can you create art without lots of paint, paper, canvas, clay, stone, metal, fabric, thread, and yarn? But how much stuff? Has your textile stash migrated into every part of the house because one closet won’t hold it all? Is your garage so packed with recycled materials for assemblage that you can’t park your car in there? Do you have any space left for yet another bin of plastic pieces in the barn?” Oh, this sounds so familiar.
  • Comicsgate. If you’ve been on the internet at all, you’re likely well aware of the bullying that goes on — especially towards minorities and women — often coming from the Conservative, sometimes White Supremacist, side. To put it bluntly, the haters. You might recall the Sad Puppies incidents from the Hugos which worked against women and perceived “leftist” authors. You might recall Gamergate, which targeted women in the Video Gaming industry. Both were horrid incidents, reflecting the growth of hate in our society. [As an aside, you want a reason we have so many shooting incidents? The answer is simple: We let hate grow, and we allow weapons to be an outlet to express hate.] There’s a new campaign now: Comicsgate. A campaign by bigots to attack minority and women writers and themes in the comics industry. Recently, as the article notes, “Comicsgate proponents on social media released a public blacklist of names for their followers to boycott. The names are organized under inflammatory titles like the “Pravda Press” and the “SJW Vipers” (“SJW,” for social justice warrior, a derogatory title for progressives). Those attacked are major figures in comics like Larry Hama, Mark Waid, Alex de Campi, Kelly Sue DeConnick, Matt Fraction, Ta-Nehisi Coates, and others. Nearly all of the people singled out are either women, people of color, or left-leaning.” Don’t let the haters win. Support minority and women artists. Fight against the growing intolerance in society: be it intolerance against the immigrant, the intolerance against women and minorities; the intolerance against non-Christians; the intolerance of the non-binary or non-heterosexual. We need to embrace and celebrate difference, what makes us unique, and our unique viewpoints.

As I say when I post my highway headlines: Ready, Set, Discuss.


Planning for the Future – An Exploration of Long Term Care Insurance

Our daughter frequently reminds us of one significant fact we should never, never, forget. When we get old and cannot take care of ourselves, it is she who will pick the home we will go into. The odds that we will need long term care are good. Forbes did a report on the costs and incidents regarding long term care, and noted that a 2005 report that provided forward-looking estimates for long-term care needs for the cohort of individuals turning 65 in 2005 estimated that 58% of men and 79% of women aged 65 and older would need long-term care at some point, and that average lengths for care were 2.2 years for men and 3.7 years for women. They also estimated that 38% of men and 63% of women will require care for one year or longer, while 11% of men and 28% of women will need care for at least 5 years.

In my family, we’re currently dealing with long term care issues. Luckily I didn’t have to deal with it for my father, who died of injuries sustained in a car accident after being hospitialized for a month, or my wife’s dad, who died on the way to the hospital after complaining he wasn’t feeling well. However, my wife’s mom is in a long term care situation, dealing with deteriorating memory and capabilities. She’s lucky that she had long term care insurance.

I understand the concept of insurance well. I’m a cybersecurity guy, and dealing with and assessing risk is my game. Insurance is just a form of dealing with risk: you transfer the cost of the risk from you to the insurance company, who accepts the risk… for a price. In that price, and the conditions, are the game.  Insurance is a bet with the insurance company. If you get really sick, you win, because they pay you out more than you paid in (and thus, you get money from other people). If you are healthy, you lose. Same thing with life insurance: if you die, you win (so to speak, because your family gets money). Art Buchwald has a great piece about this issue, and how the insurance company felt when he finally won and wanted to collect his money. You should read it.

I had dragged my feet on getting Long Term Care insurance. It is expensive, and that can slow me down. But I arranged for one of my insurance agents to speak to our Temple men’s group on the subject a few months ago. He pointed out a significant fact: When insurance companies went into the long term care market place, they misjudged it and had policies that were too generous — but were stuck because they can’t cancel a policy if the premiums are paid. So over the years they have been understanding the risk better, pricing the policies more in line with the risk, and adjusting the policies to reduce their exposure. For us consumers that means: if you wait to buy your policy, you will likely be buying a weaker policy. This got me off my duff, and I began our investigation.

This blog post summarizes what I have found. I’ll present my findings, and my conclusions. I want you to shoot holes in it — find things I didn’t think of or that I missed. By that way, I’ll get a better product, and you might even learn something that helps you. I’ll note that I didn’t just blindly take what my agent, Robert, sent me. My training in DOD acquisitions led me to try to get additional bids. I posted a call for recommendations on Facebook, which lead me to the fact that both the UCLA and CSUN Alumni association work with a company called Mercer for a long term care benefit for their members. Mercer, it turns out, is just a broker. I was on the verge of investigating that when a former camp counselor of mine, who does employee insurance plans, connected me with his insurance agent, Stan. Stan reps a different company from Robert, and got me an additional bid. Lastly, in reponse to my FB post, another fellow — Scott — chimed in. Scott is a co-owner at LTCShop.Com, a broker in Washington, who helped me look at the proposals I got and provided some additional information.  It is also very useful to read the AHIP Guide to Long Term Care. The National Association of Insurance Commissioners has also published A Shopper’s Guide to Long Term Care Insurance, which is also well worth reading for background.

My investigation focused on products from two primary companies: Mass Mutual (MM) and Mutual of Omaha (MO). The number of insurers providing long-term care is steadily shrinking, and these were the two companies that got the highest ratings when I did a web search. There are other companies out there, however. If you think yours is better, let me know. However, giving the shrinking pool of providers, you want a company that will remain in the business, and that will have the needed stability. This gives our first comparison. In terms of ratings, Mass Mutual looks stronger:

Rating Agency Mass Mutual Mutual of Omaha
A. M. Best Company (Best’s Rating, 15 ratings) A++ (1) A+ (2)
Standard and Poor’s (Financial Strength, 20 ratings) AA+ (2) AA- (4)
Moody’s (Financial Strength, 21 ratings) Aa2 (3) A1 (5)
Fitch Ratings (Financial Strength, 21 ratings) AA+ (2)
Weiss (Safety Rating, 16 ratings) A- (3) B+ (4)
Comdex Ranking (Percentile in Rated Companies) 98 93


In my comparison, I attempted to compare apples to apples. I’m 57 (turn 58 in January); my wife is 60 (she turned in July). We looked at policies with comparable benefit amounts ($328,500 for MM; $325,000 for MO), with comparable benefit periods (6 years) and  comparable elimination periods (90 days) for reimbursement. Both were quoted with an inflation protection benefit (3% compound inflation protection), and waiver of premium for covered partner (meaning thus: when you are collecting, you don’t need to pay premiums, and the waiver means that you don’t have to pay premiums for your spouse as well).  Both covered home care as well.  So, for the apples to apples comparison, the “quoted” premium for both my wife and I was, after discounts, $6,272.19 for the first year from MM, and $6,604.71 for the first year from MO. For some reason, I thought there was a fixed premium period, but Robert clarified that premiums are payable for the life of the policy or until one spouse needs care. Note that premiums can be adjusted during that time. I don’t think either carrier has increased premiums in California, but MO has in other states.

I put “quoted” in quotes because of an interesting tidbit about that quote I discovered when I passed them by Scott. Both were quoted at “Preferred” rates — so you would think they are the same. They aren’t.  Each company has different underwriting classes.  Mutual of Omaha has four: (1) Preferred (15% less premium than ‘Select’); (2) Select (which is what most people get); (3) Class 1 (25% more than ‘Select’); (4) Class 2 (50% more than ‘Select’). This means that Preferred is the best, least expensive rate. Mass Mutual has three rate classes: (1) Ultra Preferred (10% less than ‘Select Preferred’); (2) Select Preferred (which is what most people get); (3) Preferred (25% more than ‘Select Preferred’). For MM, Preferred is the most expensive rate. You’ll get whatever rate class the underwriter chooses based upon your medical records regardless of what the agent quotes you.  This means that the quote from MM was the worst case, and the quotes from MO was the best case. Given that the MM amount was better than the MO amount, that makes MM look even better.

What about policy characteristics? I asked both my agents about what was unique about their policies. Most policies are very very similar, but there are a few distinguishing things.

Stan pointed out that, for MO, a Shared Care rider is available, and there is a buy up option for their inflation protection. The shared care rider allows you to draw from your spouse’s maximum care benefit when yours is exhausted, and if your spouse dies, their unused benefit is added to yours (and vice-versa). The buy-up option automatically increases the monthly benefit a set amount for inflation (but it looks like MM has something similar). Stan noted, regarding the buy-up option, that because the cost of care services will likely increase the client may elect to increase the inflation protection percentage which increase the monthly benefit and coverage maximum.

Robert pointed out that, for MM, they have unisex rates where women are not rated differently from men (although Stan counter-pointed that most LTCI carriers have gone to gender specific rates because women live longer than men and are more than likely to use their polices — and so it all depends on whom the unisex rates are based). This may effect future price increases on the MM policies.). He also pointed out that the MM policy has a home care monthly benefit rider, which changes the benefit from a daily amount to a 31-day monthly amount (every month is considered to have 31 days under this rider).  This gives you greater flexibility in arranging and paying for care.  The second is the joint spouse waiver of premium, which says that if either spouse is receiving benefits the premiums for both spouses are waived (although it looks like MO has that as well).

Stan also provided me with a comparison table of the two policies. Here are some of the relevant details. One thing you’ll see in the table is a strong distinction between monthly and daily rates. Stan pointed out that, in his opinion, monthly benefits are substantially better than daily benefits especially when receiving home care, as there may be days where the cost of care exceeds the benefit. If so, with a daily benefit, that amount will be out of pocket. Example; The clients purchases $200 per day vs. $6,000 per month. If billed for $250, on a daily benefit, $50 is out of pocket. MM, looking at the table, is primarily monthly, so the daily rider might be required, and would cost something extra:

Comparison Parameter MM Signature Care 500 MM-500-P MO MutualCare Custom Solution LTC13
Plan Description Tax Qualified Reimbursement Indemnity with Rider Tax Qualified Reimbursement with Cash Benefit Option
Daily/Monthly Maximums Daily Benefit of $50 – $400. A rider is available to change this to monthly. Monthly Benefit of $1,500 – $10,000 in $50 increments.
Elimination Period (one in a lifetime — may be accumulated over several claims) Service Days Calendar Days. Stan pointed out that this means that if service isn’t needed on a day during the period, it doesn’t count.
Inflation Protection 5% and 3% Compound available Inflation percentage: 1%-5% compound in 0.25% increments. Duration: 10, 15, 20, or Lifetime. Inflation protection option: Inflation applied to policy benefits (not to exceed 5%) on or before each anniversary date. Increase is effective on the policy anniversary following the election, with benefit increases occurring the following anniversary. Only available prior to the lesser of 20 years or age 75.
Nursing Facility Up to 100% of daily maximum. A rider is available to change this to monthly. Up to 100% of monthly maximum
Home and Community Care Up to 100% of daily maximum. A rider is available to change this to monthly. Up to 50%, 75% or 100% of monthly maximum
Assisted Living Facility Up to 100% of daily maximum.  A rider is available to change this to monthly. Up to 50%, 75% or 100% of monthly maximum
Shared Option Available Yes. Available with optional rider  on policies with a two or three year benefit period. Rider offers a third pool of money equal to the maximum benefit amount. If a covered partner dies, the shared total benefit amount will remain available. Shared pool not available with lifetime benefit. Dual waiver of premium is available under a separate rider. Upon death of one spouse, the survivor must continue to pay the rider to retain the benefit. The way it works with MassMutual is — let’s say you have a two year benefit period for each spouse — the policy will have an additional two year benefit period that can be used by either spouse. Yes. Available with optional rider. Shared Rider allows partner to access partners lifetime maximum if benefits are depleted. Coverage must be identical and applied for at the same time in order to purchase rider. There is a residual benefit until a minimum of 12 times the current maximum benefit remains. Not available with Security Benefit, Return of Premium at Death, Return of Premium at Death – Three Times Initial Maximum Monthly Benefit, and Partner Premium Allowance.
Hospice Care Up to 100% of the daily maximum.  A rider is available to change this to monthly. Up to 100% of the monthly maximum, no elimination period applies.
Home Assistance Benefit Equipment may be considered under the Alternate Plan of Care; Caregiver training is covered up to 5x the daily maximum (lifetime maximum) Equipment, Home Modification, Medical Alert System and Caregiver Training are payable under the Stay at Home Benefit which pays 2x maximum monthly benefit.
Unlicensed/Uncertified Providers Outside of California, No. All caregivers must be certified or licensed.  However, that provision is not applicable in California, because California law says that you can use anyone who is not an immediate family member. Payable under Cash Benefit provision
Homemaker Services Incidental? No, Homemaker services do not have to be received in conjunction with personal care services. No, Homemaker services do not have to be received in conjunction with personal care services.
Care Coordination Unlimited care coordination services; does not reduce lifetime benefit amount. Optional. Not required; however, some policy benefits are only available when care coordinator is used.
Waiver of Premium Begins with receiving benefits after satisfying EP Begins when benefits begin. For HC, must receive care at least 8 days per month in any continuous 30 day period.
Respite care Up to 30 days per year. Up to one month per calendar year.
Bed Reservation Up to 60 days per year, for any reason. This means that if you are in a facility and need to be hospitalized, MassMutual will pay the facility up to 60 days to hold your bed.  That can be important if you have an extended hospital stay, because otherwise the facility — which you probably researched and chose because of its quality, location, etc — will sell your bed to the next person who comes along who needs it and you will therefore have to move to a different facility upon being released from the hospital. Up to 30 days per year, for any reason.
Cash Benefit Options Optional Indemnity Benefit Rider 40% of home health care benefit up to initial maximum of $2,400 per month.
Other Features and Options Indemnity Rider: Pays daily maximum regardless of expenses incurred.

HCSB Waiver of Elimination Rider: Permits days used for HCSB to apply towards elimination period for other benefits under the policy.

HCSB Monthly Benefit Rider: Changes HCSB from daily to monthly

Enhanced Elimination Rider: 1 day of service per week = 7 days

Share Care Rider: Limited to 2 year and 3 year benefit only.

Covered Partner Waiver of Premium rider

Survivorship Rider: 10 years; claims restriction.

Restoration of Benefit rider.

Nonforfeiture rider.

Waiver of Elimination Period for Home Health Care

Nonforfeiture – Shortened Benefit period

Return of Premium – Three Times Initial Maximum Monthly Benefit

Return of Premium (less claims paid)

Return of Premium – If death occurs before age 65

Joint waiver of premium

Survivorship Benefit

Shared Care Rider.


Based on all the above: strength, premium, and policy features, I’m inclined to go with the MM policy.  The costs still causes hesitation: that’s about 1.3x of a single property tax payment. Ouch! But I guess the cost will be a lot more if we need the care, and the likelihood of that is good, given society today. Each policy appears to have some slight strengths and weaknesses over the other. It all depends on what resonates with you, where you anticipate your care being and who will be giving it. Remember, it’s all legalized gambling, and sometimes you win the bet.

One additional notes: Both of the agents I worked with were very professional, and I recommend them depending on which policy you need — you might have needed different than mine and get different quotes based on your age. The agents were Robert Smith (who reps MM, among others) and Stan Israel (who reps MO, among others). Scott Olsen of LTCshop.com also provided information.

Update 2018-01-22: So what happened? We got turned down for medical reasons — weight, pre-existing conditions. So acceptance is not guaranteed. In the case, the best thing to do is be your own long term care insurance. Take what you would have paid in premiums and invest wisely. That’s what we’re planning to do. It also does keep the money there in case you need it for some other purpose that the policy wouldn’t cover. There are many ways to transfer risk.