“I honestly do not know the answer. I have dealt with government paid systems enough, from VA to Medicare to know that the systems are inefficient and prone to waste and they are slow. But then again the costs is so high that it is obscene.”

Part of the problem is the refusal of the various players and the citizenry to accept the fact that the cost is inherently obscene. There isn’t as much waste in nursing homes as you might think, given the rules and expectations under which they must operate.

What they do have is obscenely lousy care (on average) for the money spent. Part of it is regulation and malpractice. Part of it is that they can’t hire good help for every nursing home. (Those nursing homes hiring nurses with criminal records that include stealing meds from patients, you think the nursing home picked that hire because the nurse was the best available? Think again.) Mostly, however, the nursing home model is inherently broken. It’s the poster child for a society that cares more about the appearance of caring than real caring. It’s a place to put granny when she interferes with the fast-paced lifestyle of junior. You could make nursing homes entirely private, and they’d be slightly better but still awful.

Home Health and Hospice are starting to make significant but real improvements. Here’s another case where government impedes solutions. In my opinion, HH and Hospice ought to be the default and nursing homes the extreme, rather than the other way around. That’s about as popular as the suggestion that we don’t need pre-school starting at age 3 to give junior and his wife state-run day care.