Swimming With The Sharks

When you are on the beach–my metaphor for retirement–you want to keep your worries to a minimum.  If I wanted to worry I would not have retired from health care.

From the beach you can see sharks circling but you don’t know whether they are man eaters or vegans.  That is worrisome.

I thought that I was through with Medicare for the time being after writing and posting “Medicare For No One” last week.  It was my intent to comment on another subject this week.

Then I saw what might be a shark in the form of a mass mailing from NorthBay Healthcare last Tuesday. They announced that they were going to offer effective January 1 a Medicare Advantage HMO product through the AARP/United Healthcare program.

Was this a shark attack? Should I be worried now that I had a choice regarding Medicare?

Until receiving the announcement I was going for the third year to cover myself and my wife with a finely crafted traditional Medicare coverage from the Feds (Parts A and B), Silver Scripts (Part D Prescription Drugs) and Mutual of Omaha (Medicare Supplement).  It takes a spreadsheet to keep everything in order.

Now I have another choice.  Currently the only insurance company offering a Medicare Advantage plan in my county of residence is the “Big K” ( whom I called the “Elephant” in the blog I wrote for NorthBay).  Since Medicare Advantage HMO programs eliminate the need for a Medicare supplement plan as well as sometimes offering additional coverages, the monthly premiums are significantly lower than traditional Medicare.

With Medicare Advantage plans you give up the freedom to go for care wherever you wish and must agree to have your care “managed” by sharks.  That is probably unfair–I was familiar during my career with health plans who were benign sharks.  Still, a shark is a shark and you need to worry about them.

The result is that my beach time is being spent going over another set of charts trying to decide whether I want to swim with a Medicare Advantage shark.  Once you commit to a Medicare Advantage plan and then decide in the future it is not for you, it may not be possible to get a guaranteed issued Medicare supplement plan when you switch back to traditional Medicare unless certain specific conditions are met.  At this writing I still have not made up my mind about switching.

The Big K as the only health insurance company offering a Medicare Advantage plan in the county is attracting members from other providers because of the cheaper rates.  I know from my own experience there were many NorthBay patients who prefered to stay with NorthBay but absent an alternative to the Big K Medicare Advantage plan decided it was in their best financial interest to switch.  Now NorthBay can seek to attract those patients back.

What this Medicare situation shows is that when people have it in their power to make economic decisions about their care, they will act as rational beings.  Too often, that is missing from our health care system.  We need  a health care financing system which gives  power to the people (shades of my Berkeley days).

We probably need more sharks even if they are a source of worry.

Footnote to my “Medicare For No One” blog entry last week

A long time colleague and friend whom I greatly respect and with whom I worked at both Berkeley’s Herrick Hospital and NorthBay Healthcare wrote a brief mild demurrer to some of my comments.  I want to share his comments  which were interesting and informed as well as my response–this is exactly the kind of dialogue the reflexive Washington politicians in both parties should be engaging in if they really want long-term reform in health care financing:

“Only Gary Passama wears a suit and tie to the beach!  I don’t think ‘Medicare for all’ necessarily means it literally as you suggest.  Rather, a single payer, publicly financed, rationally designed system that provides and adequately pays for the care people need.”

My response:

“You cannot see from the photo that l am wearing dress Bermuda shorts!  Perfect for the beach.

As for single payer systems, you describe utopia and I could support such a system. Having seen first hand though the cynicism of both Democrats and Republicans in Washington and Sacramento in meetings with them to discuss financing healthcare, I don’t believe such utopia is possible.  Medicare is the perfect example of that cynicism.”