SNAKE OIL FOR SALE

In the old days, they sold snake oil and people bought it.  Today, they sell Medicare supplements/Advantage programs.  Can someone explain to me how the Advantage companies work?

I barely made a living off of Medicare.  As a matter of fact, I refused to take new Medicare patients for seven years.  In the last years of my practice, if I spent more than 10 minutes with a Medicare patient, I lost money.   How do United Health and the other companies succeed?

First, they advertise hourly on TV and cable.  They hire famous people, like William Shatner, to tell you about the benefits of their Advantage product.  The benefits include free medication, dental and eye care and, if you live in the right location, they’ll even deposit over a thousand dollars a year into your bank account.  By the way, you may get a free membership to the gym as well.

The kicker is that all of the perks are free.  You don’t even have to pay for the policy.  Too good to be true?  Wait!  According to their pitches, your doctors are probably already in plan and will see you promptly.  If that’s not enough, they may even help you make appointments.

Sounds too good to be true, doesn’t it?  If you’re well, it’s true.  Yep, if you rarely see a doc, rarely take medication, and are a “young” 65, you win big time with the Advantage program.  JUST DON’T GET SICK!

One of my last new patients had just retired and was on the Advantage program.  He had 3 major medical problems and 3 minor problems.  He wanted referrals to 5 specialists.  After 6 months, my staff managed to get him 4 of the referrals he requested.  He had to drive 30 miles to see one of the specialists.  He had obtained one half of the tests that I had ordered and had to change the majority of his medications to meet the company’s formulary requirements.  His blood pressure, previously controlled on 1 medication, was finally controlled on 3 medications. He was not a happy camper.

Insurance companies are very clever.  They never refuse care.  They simply tell you what they cover and at what price.  You are always free to buy whatever you want.  He could have seen all five specialists in a matter of weeks; he just would have had to pay them.  He could have stayed on the one medication that controlled his BP as opposed to the three generics which barely controlled his BP. Doing so would have cost him an extra $150 a month.

How do the insurance companies give you so much for free? That’s a question that demands an answer.  Perhaps restricting access to specialty care and high-end medications may be one way.  Before you buy, ask lots of questions!  Just don’t ask the salesman, ask the docs!

Now for a little secret.  There is sound reasoning for delaying your consults and care.  The best medicine is often referred to as “tincture of time.”  Yep, wait 3-6 months and almost everything corrects itself.  Unfortunately, using “tincture of time” can be hazardous.

Here is today’s joke:

4000 YEARS of MEDICINE

2000 BC : Here, eat this root.

1000 AD : That root is heathen! Here, say this prayer.

1865 AD : That prayer is superstition! Here, drink this potion.

1935 AD : That potion is snake oil! Here, swallow this pill.

1975 AD : That pill is ineffective! Here take this antibiotic.

2000 AD : That antibiotic is poison! Here, eat this root.