Real Choice in Health Care: A Story and Cry for Help

A doctor writes . . . :

Recently, however, Mr. Alipate had received in the mail a glossy booklet explaining that he now had 'more choices' for his health care coverage. He reviewed the booklet with the assistance of his American-born nephew but, confused by the options, called the 'help' number for assistance. He only had one fundamental question of the choices: Could he continue to see his personal physician and the specialists I recommended? Reassured by the agent at the other end of the line he elected an HMO Medicare Advantage Plan offered by Humana.

The problem is, the agent was wrong, or misleading. I am not in their network. Indeed, in our heavily populated suburban community there are only two physician practices within a five mile radius of my office which are contracted to see Humana Medicare Advantage patients.

Medicare advantage plans, a privately administered version of Medicare, were created by offering private companies an average 12% premium over the average costs of treating Medicare patients. They in turn use a portion of this premium payment to "enhance" the traditional Medicare benefit package to lure patients into their programs.

The problems with this arrangement, however, are manifold: Although this has resulted in enhanced benefit packages, the marketing of these enhanced benefits has been focused upon the healthiest of Medicare recipients, thus "creaming" the Medicare program and contributing to its financial difficulties. Those enhancements which are offered do not in total equal in value the increased cost to Medicare; a substantial portion of the 12% premium payment is retained for corporate profits and bureaucratic infrastructure. The basic structure is unfair: If there is to be an enhancement to Medicare, why should it accrue only to those who manage to sign up with a Medicare advantage plan? Finally, the "enhancements" may be misleading: As in Mr. Alipate's case..... there is always a dramatic reduction in choice of physicians when one signs on to a Medicare Advantage plan.

It is easy to see that even a prominent spokesman for Obamaesque health care reform really knows that only single payer reform can solve our nations health care crisis, he just finds it politically unfeasible.

Political infeasibility is no excuse for failing to advocate for the best solution to our problems. I am struck in my daily practice of medicine by how the overwhelming majority of my diverse patient population supports the kind of change I and untold others are advocating.