Cliffs and Tsunamis

Wednesday, May 25, 2011
The patient was being prepped to be transferred to Hillcrest Hospital. It was at this point that the attorney, a senior citizen covered by a Medicare Advantage policy (Medicare Part C) objected. In pain, he had been rushed to Hillcrest. After some initial testing, he was packed up and delivered to Ahuja Medical Center, the new University Hospital facility. And now the administrators wanted to send him back to Hillcrest, part of the Cleveland Clinic system.

What medical condition would cause two of the most advanced hospital systems in the country to treat the patient like a hot potato? He had a tummy ache. Seriously. It wasn’t the medical condition. It was the insurance.

The attorney and his wife had purchased a Brand X Medicare Advantage contract. The company has a well-defined network of providers in its home market several counties from here. There was nothing wrong with the product. The Federal government certified and approved it. Our hospitals were unsure of the network, which meant that both hospitals were unable to determine that they would be properly paid.

Let’s stop and review this:
* Educated consumers evaluated their insurance choices.
* All of the products were government approved.
* Two of the largest, most successful, hospitals in the country reviewed the coverage.
* The insurer’s “Home” territory is less than 100 miles away.

The patient could have been treated by either hospital. There was no reason to transfer him. None.

Representative Paul Ryan would like to reform Medicare. The Democrats claim that he is trying to kill Medicare. Pictures of little old ladies being pushed off cliffs will be on your TV by this weekend. This is, of course, a gross exaggeration. Mr. Ryan would never push elderly people off a cliff. He would, however, lecture tsunami victims for their inability to out swim the wave.

Mr. Ryan introduced his Roadmap for America’s Future in 2008. he has had three years to refine it. He has had three years to learn how to explain it. He has failed on both counts. His Medicare plan does not involve vouchers. In truth, Representative Ryan appears to have borrowed the worst parts of the Medicare Advantage program, Medicare Part D (Rx), and the Charter School Voucher initiative, thrown all of these ingredients into a malfunctioning blender, and poured his concoction into a couple of broken martini glasses. Delicious.

I have read the Congressman’s website several times. I wanted to ask him a couple of questions, but his site only accepts emails from residents of his district. If he wants to be a national leader, he should be nationally accessible.

The current Medicare Advantage program allows senior citizens to acquire coverage online, by phone, by mail, or through a specially trained and licensed agent. There is no difference in price. The attorney went it alone. He was never in any real danger. He was always covered, but there had been better options. Representative Ryan’s plan is far more complicated and it doesn’t carry any guarantee of success. It is important to note that the attorney and his wife CHOSE the Medicare Advantage route. They could have stayed with traditional Medicare and purchased supplements. Mr. Ryan eliminates that choice.

The good news is that there are no cliffs involved. But Paul Ryan thinks that you better learn how to swim.

DAVE

www.bcandb.com