It does seem like a bit of a contradiction to use a market-based Homo economicus model of patient qua consumer behavior to motivate the widespread use of private insurance for the same individuals who are supposed to be institutionalized because they can't care for themselves! Single-payer may not always be the best model but at least it avoids this particular absurdity — of course Medicaid wouldn't stand for this.

Of course, when you absolutely need indefinite care, the situation changes and you get our monstrous nursing home ecosystem.