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Last July, in a blog entry about the growing trend of “medical tourism”–in which more Americans are forced to seek cheaper health care outside the country–I asked: “Is this really what we've come to in the United States?” Now I'm hearing buzz that more folks are considering foreign long-term care facilities to cut costs. Again, I say, must our own citizens leave the greatest country on Earth to be properly cared for?


In purely economic terms, such a move makes perverse sense. We are struggling here in the United States to find enough qualified, caring individuals to take care of a burgeoning elderly population as the Baby Boom goes bust.

These attendants–mostly working at or slightly above a minimum wage that can't cover decent living expenses, often without health insurance of their own–are shouldering the bulk of the responsibility for the feeding, cleaning and safekeeping of those no longer able to care for themselves.

If these folks are lucky, they get to remain in their homes or move to an assisted living facility, with shopping, cooking and cleaning handled at least partially by home care attendants. Family members often must chip in and do a large portion of the grunt work themselves, sometimes while raising kids and seeing to their own careers and personal lives–the hapless Sandwich Generation.

But not everyone can afford an assisted living facility, and if someone is so bad off physically or mentally that around-the-clock care is required, and a family cannot handle the burden alone, a nursing home may be the only option.

With a growing number already forced to seek cheaper medical care offshore, and assisted living facilities reportedly on the rise in Mexico, how long will it be before we start dumping our elderly for nursing care in foreign countries, where the cost of labor is far cheaper, and government regulation perhaps nonexistent?

This nightmare scenario would be a tragedy if offshoring becomes the only affordable nursing home option down the road. Yet neither of our major political parties or presidential candidates has spent any time discussing the long-term care crisis facing our country.

Long-term care insurance, of course, is designed to alleviate such concerns. But sales have not taken off, despite the inherent logic of this product. That's mainly because of the cost (how can anyone except high-income individuals eager to protect their retirement portfolios afford the premiums?), as well as fear about whether the insurers offering this coverage will actually be around in 10, 20 or 30 years to pay the bills?

We need to start a national dialogue on long-term care challenges–with insurance a key component, perhaps via a mandatory payroll deduction system like we have with Medicare and Social Security. At least that way Medicaid–now the insurer of last resort for those without the resources to pay for their own care–will not have to carry a huge unfunded liability.

If we don't start tackling this looming challenge soon, we're all going to end up in some desert facility in Mexico or Central America, and it won't be for a vacation.

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