You’re probably correct (I’m 30 and don’t have a policy) but I can’t think of any financial instrument that would guarantee skilled nursing ($4-8k/month in MCoL) for 10-20 years. No one in the bottom 90% of American earners can afford that drawdown even if they saved considerably.

That’s sorta the point, and the problem. There’s a dependency ratio problem brewing: there are simply not enough working-age people to care for the old people who will need care. No amount of financial instruments can paper over this reality - they will just go bankrupt (eg insurance policies, social security) or steadily drop in value relative to the cost of care (401ks and other financial instruments) until the price of LTC equilibrates to actual capacity. Anyone not in the percentile that actually has eldercare capacity will simply have to go without, much like the price of housing has risen to shut out Millennials that are not in the income percentile needed to get one of the few scarce houses for sale.

Most people won't need it for long and so the risks average out to a more reasonable cost. However it is still thousands and people buy cheap not best coverage when they need it so that is what the market provides.