By JEFF GOLDSMITH
This morning, after twelve years, I dumped my Medicare Advantage plan and enrolled in a Medicare Supplement policy. My smoldering discontent finally boiled over and . . . I’m gone. It was a large network style national plan with zero premium.
My decision to enroll in MA was, in part, ideological. I liked the idea of a program design that rewarded healthy behavior. But I discovered that none of the alleged MA perks were actually reachable-my health club was out of network as was my dentist. When I got cancer in 2015, the plan did not give me attitude about my decision to fly 600 miles to the University of Chicago for my care. They merely paid the U of C about a third of what it cost them to rid me of my cancer.
There was not a single denial of care during the entire twelve years. But they pestered my primary care doc mercilessly by insisting that he sign off on every single care decision made in my cancer fight or anywhere else I went- hours of needless “paperwork”. And I fended off sixteen offers of a “wellness visit”- a nurse coming to my house to upcode me. My relationship with the carrier was basically to be on the receiving end of hundreds of robo-calls.
I got little signs that their networks were withering. The University of Pennsylvania did not accept them, nor Cedars Sinai, nor the Hospital for Special Surgery. But when Mayo announced they were not accepting them, that was for me the last straw. Mayo is my “safety net” provider if my local Charlottesville folks are not able to meet my needs.
From a policy standpoint, I think MA made sense when it was redesigned and rebranded in the early 2000’s. And if we had SCAN or even Kaiser here in my market, I would probably still be a member. Particularly for the multi-functionally impaired older folks or the dually eligible, thoughtful protocol driven care by a tightly linked multi-specialty medical group makes a great deal of sense. In this, my old friend George Halvorson and I agree.
But the idea that capitation or the newer version-micro-managed care run by a warm and fuzzy AI- is somehow a cure-all for what ails our society is increasingly questionable on its face. It isn’t about the incentives, folks. I ate the MA dog food for twelve years. It’s about the care system you rely on when things get scary. In twelve years, except for the frozen dinners they sent me after my cancer surgery, the carrier added no value whatsoever to my life. MA just wasn’t worth it, even if was free.
Jeff Goldsmith is a veteran health care futurist, President of Health Futures Inc and regular THCB Contributor. This comes from his personal substack
Publisher: Source link
