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Life Health > Health Insurance > Medicare Planning

On the Third Hand: Bad guys

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So, why exactly is it that the only true government-run health care systems are for old people, poor people, soldiers and military veterans?

I think it’s really because most of the patients in those systems are too poor, sick or frail to speak up for themselves, or because the patients are used to following orders and mentally unprepared to take on a system.

Most of the time, Congress puts private companies in charge of benefits decisions not because our leaders are such ardent capitalists, but because they don’t want to be the ones responsible for saying no.

Even if they’re budget hawk conservatives, members of Congress want to be in a position to wag their fingers at the insurance companies if the companies refuse to pay for (experimental, likely futile, extremely expensive) surgery for a photogenic child with parents who had a combined total of 100,000 Twitter followers and Facebook friends before they even got married.

On the one hand, certainly, there are greedy, insensitive jerks in the insurance industry, and it could be that the government has actually been paying too much to mediocre Medicare Advantage plans.

Jonathan Blum, the head of Medicare, testified about a year ago that the gap between per-capita support for enrollees in the traditional, government-run Medicare program and enrollees in private Medicare plans had shrunk to 4 percent in 2013, from 14 percent a few years earlier. But, of course, even if that 4 percent is now 2 percent, that 2 percent is a lot of money. Medicare managers should do something about that 2 percent.

But, on the other hand, I was just reading an editorial about the topic by the Bloomberg editors and wondering how much fun editors will have in their own personal lives when Bloomberg takes a budget cleaver to their health benefits and gives those healthy, young and hypereducated folks the kind of lovely “skin in the game” that Democrats and Republicans alike now want to give the frail older people in Medicare.

To some extent, Medicare Advantage may cost more because of inefficiency.

But it also costs more because it gives enrollees the kind of low-hassle care we’d all want for our loved ones, not technically competent refugee hospital-level care that will keep people who are willing to camp out in a doctor’s office alive long enough to spend their last days worrying about medical bills they’ll never actually be able to pay.

A few years ago, I naively signed up for a high-deductible plan that gave me some skin in the game. I’m young. I have a bachelor’s degree in economics, and many clips based on interviews with the developers of the modern U.S. health account programs. I’d interviewed all sorts of Davos-caliber experts on health care cost transparency.

The truth is, I did manage to chase away a $400 bill for a routine checkup with a barrage of rhetoric, but in no way did I have any ability whatsoever to keep that bill from arriving in the first place, or have any idea to tell what the care would really cost. The results from the Web cost calculators, and my understanding of the reasons I had sought health care, had no noticeable connection with the bills the doctors and labs sent.

This was especially true when I went to the hospital to have a baby.

Today, the trend among modern moms is to have a “doula,” or labor and maternity process helper. If I had to do it all again, I’d hire a former Manhattan criminal fraud prosecutor as a financial doula.

And folks at places like Bloomberg want to take the shielding the big bruiser negotiators at Aetna, Humana and UnitedHealth provide for Medicare enrollees? Blech.

On the third hand, it seems as if that’s the whole point of the war against the Medicare Advantage carriers.

The point is that Congress let insurers get involved with Medicare + Choice a few years ago, and now Medicare Advantage, so that it would have bad guys on hand to blame for any breezes that ruffled the hair of the doctors and the hospitals and their big bruiser lobbying groups. Now that there are some breezes, Congress can hang the Medicare Advantage carriers (as it hung the Medicare + Choice carriers), say yes to the doctors’ and hospitals’ big bruiser lobbying organizations, and pretend for a couple of years that those carrier bad guys were responsible for whatever’s wrong with Medicare.

Then, when new problems arise, and the memory of the Medicare Advantage carriers fades, Congress can haul out a new set of bad guys. Maybe accountable care organization managers, or hackers, or leakers.

But the fundamental problem is why the insurers are so lacking in self-esteem that they keep trying to do business with the programs that Congress sets up.

Maybe Aetna or UnitedHealth can give the top executives the toll-free numbers for their telephonic employee assistance program counselors and get these folks into a battered government health program contractor group therapy session…

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