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This article examines the nature of long-term care financing--who needs care, how they get care, and how care is financed. The article demonstrates that for long-term care, like health care, insurance is essential to spreading risk. But neither public programs nor the private sector, currently provide that insurance. Although Medicaid serves as a last resort, its protections vary considerably from state to state and become available only when people are, or have become, impoverished taking care of themselves. As the population ages, the inequity and inadequacy of current financing mechanisms will increase. The article concludes that enactment of public social insurance protection is essential to protect Americans against the unpredictable, catastrophic risk of needing expensive, extensive long-term care.