Sunday, November 21, 2010

What Part of Single Payer Don't You Understand?

Republicans and Medicare: The Final Solution

Now, MeanMesa realizes that there is no shortage of content criticizing the overall make up and performance of Medicare.  Every voice from disgruntled senior to "ideologically paralyzed" neo-con has taken a turn at the wheel when it comes to lambasting the plan.

Although not the case that it couldn't be, this posting isn't simply another one of those rolling "bitch sessions."

Instead, this little article is more of an NPR-style, "flannel shirt," Sunday morning commentary.  MeanMesa had been "putting it off" for long enough.  The more or less complete stack of information required to re-enlist for next year's Medicare plan had been building up in a pile of unopened mail for a couple of weeks, and now it was, grumble, grumble, time to figure out just what was to be done.

However, rather than simply "jumping into the fray, whole hog plus the postage," MeanMesa was suddenly -- and unexpectedly -- cast into an unanticipated reflective moment.  That pile of stuff was, well, one hell of a pile of stuff, indeed!

(image source: MeanMesa )

So, rather than simply demand that MeanMesa visitors just mindlessly subject themselves to yet another gaseous, detail-starved tirade, the idea arose that a  more meticulous account of just what was "on the table" might be in order.  Let's take a look.

137 pages - Medicare and You 2011:  This publication from the US Health and Human Services Department presents a basic outline of the law.  The content has been carefully "dumbed down," making it not only somewhat narcotizing, but, theoretically, intellectually available to geriatrics with early on-set dementia and other Americans who are -- or have become -- educationally challenged as a result of age.

1 page - "Personal" Cover Letter from Presbyterian Senior Care (PSC):  The "letters" must be counted with the total pages because, although form letters, they contain vital information about the rest of the stuff, including a description of exactly what actions will be required from those "served."

40 pages - PSC Summary of Benefits:  This booklet presents the specific parts of Medicare which are provided through the HMO.  Most of this content duplicates what is presented in the US Health and Human Services catalogue, but there are important exceptions.  The implied message is that the additional monthly premium cost of the HMO provides additional services, but "on the ground" experience suggests otherwise. 

The "persuasion" campaign details why the HMO is justified in charging an additional 15% or so above what raw Medicare would charge.  The actual facts suggest that HMO doctors are willing to provide services for the HMO compensation, but that they wouldn't be so agreeable if they received only the Medicare payments.  The argument is a bit "too light on facts" for MeanMesa to totally buy into the idea.

105 pages - PSC Formulary:  This is a reference document which lists which medicine will be covered by the HMO's repackaged version of Medicare Part D.  MeanMesa's experience suggests that most of the HMO doctors have not ever looked at this document.  They seem to have no problem continually prescribing medicine which is not covered in the formulary list.  These prescriptions become impossibly expensive when they are not covered by the insurance.

169 pages - PSC Evidence of Coverage:  This contains primarily a more carefully constructed explanation of exactly why the HMO's policies are legal in the sense that they comply with Medicare laws and regulations.  Although a little more "legalese" than most folks have any appetite for, this booklet more or less represents the actual contract which describes what is insured and what isn't.

The Evidence of Coverage manual is most likely the one which MeanMesa will store away in a safe place for future reference.

8 pages - The PSC Summary of Ratings of Health Plan Quality:  This is a "representative summary" of client opinion polls dealing with satisfaction levels of people using this health plan.  Of course, the questions tend to be a little "leading," and the "results" have a suspicious "cherry picked" quality to them.

9 pages - PSC Annual Notice of Changes:  Digesting this little jewel might produce some fleeting coherency if the reader were intimately informed about  the details in last year's form of the policies which were now being changed.  However, absent that awareness, the document amounts to little more than new policies for coverage which are being instituted for this plan period.

The main reason for such "changes?" 

Limiting payments for previously covered costs and adding to the "non-profit" PSC's revenue stream by cutting liabilities, in other words, "Because we can."

1 page - Cover Letter Invitation to (Annual Notice of Changes) ANOC Explanation Seminars:  At the last ANOC "convention" MeanMesa attended, there were around 1,200 PSC subscribers.  Everyone attending got a Presbyterian Senior Care umbrella, a small bowl of "breakfast fruit," and half a dozen marginally relevant lectures by PSC executives.

The "breakfast fruit" was to encourage better eating habits among those of us still able to digest fresh fruit.   Only about the first 800 got a chance at the free pancakes and sausage.

The "cover letter" includes an RSVP for this year's event.  MeanMesa says, "No thanks."

2 pages - Invitation to join Silver Sneakers:  This is an exercise program offered through a deal with several local fitness centers.  Old people are supposed to attend low impact "arm moving" and "waist turning" groups.  The big attraction?  It's FREE!

1 page - Getting Help with Your Premiums:  This letter details ways for seniors to get discounts or subsidies for their PSC premiums.  The US Health and Human Services booklet describes a Federal program which covers this for straight Medicare recipients, but the Federal program also includes ways to get help paying for services and pharmaceutical co-payments.  This is another case where the extra 15% you pay for the HMO actually provides less benefit than what you would get from straight Medicare.

142 pages - PSC Provider Directory:  This reference book provides lists of the doctors who work with the Presbyterian (PSC) plan.  During the time that MeanMesa has been covered by the plan, approximately one third of the doctors seen have not been listed in this Provider Directory.  This is caused primarily by by high rate of turn-over the plan experiences.  MeanMesa has to assume that this is the result of low payments to plan doctors.

2 pages - Invitation to Join Free Dental Source Plan:  This is the equivalent to a CostCo discount group.  MeanMesa tried this plan a few years ago, but found that most local dentists won't even touch it.  Medicare does not, generally, include dental coverage.  This phony discount scheme is one of the "additional benefits" the HMO uses to justify it's 15% high rates.

This posting is not about whether or not MeanMesa is grateful for Medicare health coverage.  MeanMesa is incredibly grateful!

( image source: MeanMesa )

However, when the sheer volume of the required details is considered, most of which have arisen from irritating little caveats injected into the process by Republicans serving their corporate insurance company sponsors, the single payer idea gains some real traction.  The coverage dollars unavoidably consumed by each claim trying to swim through such an immense bureaucratic swamp tells us that we made the wrong choice when we obliterated the single payer idea.

1 comment:

  1. What a mountain!!! I'm with you -- as far as I'm concerned, single payer IS the reform!