I am less happy with private-sector managed confusion.
As I may have mentioned in these pages before, I am the beneficiary of socialized medicine in America. Yes, your tax dollars, supplemented by my lifetime of Medicare premiums (already spent on someone else) have been paying for my health care for the past year. Fortunately for you, I am in pretty good shape at the present time. Even better for me, the Supplemental Premiums paid into the kitty by my fellow United Healthcare Seniors are now paying my monthly gym fee through the Silver Sneakers program. That’s $30 or more a month I can spend on gin. I for one am in love with government-run socialized medicine.
Regular Medicare was easy for me. Uncle Sam signed me up automatically for the classic plan. It’s the private sector part of Medicare that is giving me fits. Picking a private Medicare supplement to cover copays and deductibles was relatively easy because UofL (my former employer) partially subsidizes only a single program for its retirees, and because of their feud with Humana, does not provide any support for Medicare Managed Care that might provide drug coverage. The University had earlier abandoned their promise to retirees that they would contribute to drug insurance coverage. (Ironic for an institution that aspires to be a drug company itself– or perhaps very smart.) We are on our own for drugs.
I had a tough time trying to figure out what to do for my Part-D Medicare Prescription coverage. You would think it would be easy for me, my being a doctor and insurance executive and all– but not so. As with Medicare Supplemental policies, there are a myriad of different plans from different companies, with different levels of coverage, different copays and out-of-pockets, different formularies, and all trying to fit around a doughnut hole of full-risk exposure. I suppose I have no right to complain. All of us have been bashing our heads against this kind of wall for some time dealing with our employer-sponsored or private insurance plans. Our employers can’t be enjoying it all that much either. You lucky people without health insurance have been spared these ordeals.
This is the private sector at work. If fact, I am beginning to suspect it is kept confusing on purpose to boost insurers profits. I still have half a brain. I can still sort-of look after myself– with my wife’s help. But I can’t help feeling sorry for those with even fewer brain cells left or less social support. In the name of “freedom of choice” and “private contracting,” vast numbers of seniors are being taken advantage of by the avalanche of offerings we receive in the mail, much disguised as official government correspondence. How do they get my name in the first place?
One of the things about Part-D drug coverage that bothers me the most is the routine advice given to seniors that they should look at the formularies of each plan and pick one that best covers the drugs currently being taken. To me this is absolutely a terrible spot to put us old folks through. I want insurance to cover me best for the unknown disasters to come, not the routine of today. Who knows what I will need tomorrow. To make matters worse, the drugs on the formularies change from time to time, depending perhaps on what
kick-backs rebates or deals can be made. What a mess: we seniors are asked to be pharmacists and crystal-ball-readers at the same time, but can still get hit with the old bait-and-switch.
I have already reported to you that my doctor and I put together a drug regimen for my needs that is built around generic drugs. I rarely submit any claim to an insurer for drugs because the copay would be more than I have to pay in cash! The insurance company takes a bigger profit, and my local pharmacy takes a beating trying to match Walmart’s $4 prescriptions. Extrapolating the “examine-the–formulary” advice, I shouldn’t pay anything for any drug insurance. However, since I have the good luck to be able to afford it, not having drug coverage would be a bad idea for at least two reasons. The first is that as a physician I know that despite my mostly-regular Silver Sneaker workouts, something bad and expensive can happen to me at any time. The second reason is that if I did not enroll in a Part-D program when I turned 65, I would be perpetually penalized by having to pay increasingly higher premiums forever. In the end, I enrolled in the least expensive reputable program I could find: the Humana-Walmart Preferred Rx Plan. I pay only $14.80 a month directly out of my socialist/communist Social Security payment. In truth, this premium is more than I pay out-of-pocket for my three daily drugs: one for life, one for longevity, and one for comfort. How crazy is that?
So far I have received only a single benefit (aside from peace of mind) from my Humana-Walmart Plan, and that is a 2012 calendar. In fact it was the receipt of that “gift” that prompted this present rant. On one full page of the calendar were four coupons, one for each quarter of the coming year, which promised $5 off the purchase of a particular brand of vitamin products, redeemable only in Walmart. This special offer was made to me “because your health is important to us.” I cannot know if this particular ad was targeted to me because of any specific knowledge of my medical history. I have already given you my viewpoint on that practice. The ad was certainly not targeted to me individually because Humana or Walmart knew of my opinion that the vitamin and supplement market takes advantage of peoples fears, is almost entirely medically unnecessary, and often dangerous.
Walmart, I expect that you may occasionally get confused about the differences between marketing soap powder and pharmaceuticals. The drug companies themselves do not give you very good advice in this regard. Humana, shame on you! You should know better. You are building your company on the principal that only evidence-based and medically necessary treatments should be paid for. I endorse and applaud that. Why then send me this marketing piece that puts your good reputation behind a unfocused effort to convince me that taking vitamins regularly is good for my health. Did your panels of medical directors advise you do so? I know several of them and I doubt they did. Please show me the evidence. Insurance companies make enough money from our premiums. In no way should you be encouraging us to spend money for what in the overwhelming majority of cases is worthless. Enough with the synergies and cross-marketing. It only makes me lose confidence in you.
Peter Hasselbacher, MD
March 15, 2012