Wednesday, December 30, 2009

Health care

Moral: Wherein we consider an important part of the economy. Might one call some aspects as bait and switch?


We've said that various medical metaphors can be used for the economy. Well, let's look at the thing itself.

For one, we have doctors making oodles of money. Okay, they pay good bucks and energy to get to play the role. So, some type of reward is to be expected.

Yet, one retired from being head of an insurance and HMO group with 800M (thereabouts) collected in his coffers. We have the whole gamut of insurance fat cats raking in the dough, many times by not paying claims.

We can use one example, in the bait-and-switch area of Medicare Advantage Plans (MAPs). You see, for those who are not of the age to care, many use what's called a Medigap Plan (MG). These, essentially, make up some of the 20% that Medicare does not pay which, by the way, can amount to a whole lot in certain situations. So, the MG doesn't have frills but can be a life saver. With the MG, the insured pays a separate premium (apart from the Medicare premium).

Sometime in the 00s (aughts), there was a new scheme to allow an insurance company to handle Medicare for an individual, provide a few benes, and then act as the prime insurer. That is, they billed Medicare. The idea was that they could make money, in fact, they could charge more to Medicare than could than those using MG.

Well, an analyst characterized the thing this way: But tens of billions of Medicare dollars funneled through insurers also pay for extras that never reach beneficiaries: multimillion-dollar salaries, executive retreats in Hawaii, Scotland and Cancun, and massive expenditures on marketing to lure more customers to the privately administered Advantage plans that serve as an alternative to government-provided Medicare.

Those going with the MAPs could get things like eyeglasses, dental, exercise plans, and more which are not available to the MG group since these things are not paid by Medicare. But, in many case, when a real need developed for the MAPs, necessary care was not there, similar to those things that we heard could happen with HMOs.

Well, those who could afford the premiums were much better off, medically, with the MG. Now, that, of course, ignores how the doctors, and other providers, feel about the situation. As, along with the MAPs advent came decreases in what Medicare paid doctors, and other providers, for care. Consider that payments were 50% less on the MG side due to cuts in reimbursement for treatment.

So, that brings up another thing to look at. We have a major shift in the country where the future look of health care is being defined and debated. Personally, there is no disagreement with PhilG's notion of health care being a right. Arguments otherwise do not consider near zero. Except, there are issues of costs which would abate if the notions of personal wealth for providers and insurers were less extreme.

Also, many naysayers (con universal health care) seem to not consider human dignity and seem to favor a worldview in which the 'fat cat' and 'best and brightest' (read banker) are some type of epitome of human existence deserving of endless benes from the rest (indentured servants, essentially) of humanity. The favored few, and elite, supported perpetually by the rest.

Naturally, this discussion leads to what government might have in terms of roles.


01/03/2010 -- In the post about Economics and Medicine, please follow link to the Goldhill article at the New Yorker. Insurance is for risk management, not care. Goldhill suggests a different approach (actually, from Herzlinger) that would separate out the insurance aspect and that would allow us to manage our health care, with assistance as required. Was this even looked at in the recent debates about universal health care?

Modified: 01/03/2010

No comments:

Post a Comment