Medicare Part Z: Every Man a Lawyer
posted by Frank Pasquale
A lot of health law experts are puzzled by the Bush Administration’s decision to subsidize private Medicare plans. They don’t appear to be saving the government much money, as they have “much higher administrative costs than government-managed Medicare.” But perhaps they’re really about sharpening the skill set of the elderly–particularly their advocacy and accounting skills. Consider this example from a report by the Oklahoma insurance commissioner:
In one case in the report, a man was switched to a Humana plan from traditional Medicare. As a result, he lost the extra benefits that he had under a Medicare supplement policy from Blue Cross and Blue Shield of Oklahoma, and he incurred additional costs when he became ill. The Oklahoma Insurance Department said: “The member had to borrow against his house to pay for these uninsured hospital and medical expenses. This was solely due to the failure of the agent to properly explain his existing coverage and the impact of purchasing a Medicare Advantage plan.”
How do we think about a story like this? Did the Humana subscriber just make a bad bet, and now has to face the consequences? Perhaps. But is this development really a triumph for cost containment? Doesn’t it just speed the man onto Medicaid? I worry that the new emphasis on multiple tiers and types of Medicare services is ultimately just a way of shifting costs to the consumers least able to understand fine print or advocate for their rights.
I’m pretty sensitive to stories like this because my mother turned 65 last year, and is perusing all manner of plans offered via or in conjunction with Medicare. She pores over fat packets of information, websites, and other materials for both doctor/hospital and drug coverage. She’s always amazed at what she calls “litte tricks” within each plan–for example, one trumpets “hearing aid coverage,” only to tell you in the fine print that the maximum it pays toward that cost is $100….a pretty trivial contribution to the cost. Another seems to think “dental care” merely amounts to cleanings. (By the way, good luck finding a dentist if you’re on Medicaid; in one recent case, “It took the combined efforts of one mother, one lawyer, one help-line supervisor and three health-care case management professionals for a single Medicaid-insured child.”)
For the healthy, an array of medical insurance options probably seems the best realization of consumer choice. But once you’re really sick, you want the best care you can afford. And since the chronically ill routinely consume the majority of health expenses, perhaps reform should focus on their perspective, rather than the joys of comparing endless private insurance contracts. If we continue going down this road, we may well need to set up satellite legal clinics in assisted living facilities. And this woman will be off to law school.
May 15, 2007 at 3:29 pm
Posted in: Health Law
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Responses (2)
Listless - May 17, 2007 at 4:59 pm
[O]nce you’re really sick, you want the best care you can afford.
Of course you do. Especially when you’re not bearing the entire cost.
And since the chronically ill routinely consume the majority of health expenses, perhaps reform should focus on their perspective…
This is a recipe for medical costs to spiral out of control even faster than currently projected. And it’s either naive or disingenuous to focus on the benefits of medical reform without examining their costs. We can’t afford all of the things we want.
Frank - May 17, 2007 at 5:10 pm
Listless, these are valid points. However, here’s a little unpacking of what I am trying to get across that may be of interest:
My worry is that many schemes that are based on offering people many various levels of care at various prices are trying to take advantage of the following:
1) A person at Time 1 not having adequate understanding of the desperation of himself at Time 2 in case he is rendered bankrupt by medical bills. (ala, say, Jon Elster’s volume on The Multiple Self).
2) People’s general lack of understanding of the cost of medical care, leading to things like the Florida Medicaid cap on payments of $25,000 per beneficiary per year.
You say “We can’t afford all of the things we want” in health care, and I agree. The key question is: how is the rationing to be done? Is it to be done solely via money, all the way down? Or are there ways of committing ourselves, societally, to some robust minimum of care, and then letting people bid for things above the minimum?
I am in favor of a healthy, robust minimum of care because I don’t want people stuck spending dozens of hours reading the fine print on insurance policies to be sure they aren’t bankrupted by some exclusion.
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