Initiatives to increase the purchase of private long-term care insurance have achieved only modest success. Affordability is arguably the principal barrier to purchase, but lack of knowledge about the need for long-term care, misinformation about Medicaid coverage, and competing priorities also play a role. While private insurance can do more than it does now, the authors conclude that it is unlikely to finance more than a small proportion of long-term care expenses. The public policy question becomes: What should society do about the large majority of disabled older persons who have no private long-term care insurance?