Optimizing US LTC Spending

Note: Content on this home page and on all blogs is human-written.
The About page is AI-written.

Welcome to the Optimizing US Public Investment in Long-Term Care modeling project landing page. This project will build a model of how different levels of long-term care subsidies by federal and state governments pose tradeoffs with healthcare spending, tax revenue, and economic growth. To do that, this project will build, in chronological order:

  1. a model framework
  2. a research plan
  3. a series of evidence reviews
  4. complex data analyses to generate key inputs
  5. a full model (published Excel or code + explainer)
  6. interactively visualized results allowing user inputs to influence model results.

Project updates will come through blog posts, and the above six major outputs will be living webpages. To sign up for project updates about either new blog posts (more detail) or major new outputs, provide your email below. (I'll email you individually about your preferred scope of updates.)

Get project updates

Model Scope

As stated in the founding blog post, the goal is to understand which of an array of long-term care (LTC) subsidy policy changes would yield optimal federal and state fiscal sustainability over 10 years. In the model's scope, we'll estimate changes relative to current policy in terms of:

The model's scenarios' fiscal trajectory effects (changed spending versus changed tax revenue) will compare to that current-policy baseline, driven by projected changes in LTC need under current Medicaid LTC generosity. LTC will be focused on (I)ADL needs, and will largely ignore the broader array of services and supports that indirectly meet community-living goals.

Empirical Questions Underlying the Model's Mechanisms

This project will follow these questions wherever they lead. Where these questions are poorly substantiated by evidence, the model will let users fill gaps with hypothetical inputs. Read the full framework and latest updates in the blog.

Why Undertake This Work

I have now worked in long-term care policy for more than 7 years, and intrinsically I feel obliged to convert my understanding into an explicit framework, clear and well-researched review of available evidence, and a public source of credible material.

For my entire adult life, I have been driven by the following quotes:

There is only one way to make sure of the validity of a chain of logical reasoning. This is to put it in the form in which it is most easily testable: we break it up into many small steps[...]. If after this anybody still raises doubts then we can only beg him to point out an error in the steps of the proof, or to think the matter over again.

– Karl Popper, The Logic of Scientific Discovery

I only know that if [one] does not come to value what is true above what is useful, it will make little difference whether [one] lives at all.

– Cormac McCarthy, All the Pretty Horses

Project Status

As of October 4, 2026: Published conceptual framework in "model scope" blog. Research plan in progress. Model building planned for 2027.

Get Project Updates

Sign up for custom email updates directly from me to hear about updates you care about (new evidence reviews, new outputs, or just when the final model's ready).