Hoist on His Own Petard

Every once in a while, something appears in the press that make me laugh out loud because of its mistakes and contradictions. Today's column by Scott Gottlieb in the Wall Street Journal achieved that dubious distinction.

The column's core claim was that Congress in its annual reauthorization for Medicare is trying to turn medical decision making over to the "bureaucrats" at the Center for Medicare and Medicaid Services by cutting excess payments to Medicare Advantage plans, the insurance industry's answer to senior citizen health care. Congress launched the Medicare Advantage experiment in 2003 by giving its sellers a 13 percent increase over the costs of traditional Medicare.

And as a result, Gottlieb tells us, Medicare has just "20 doctors and 40 total clinicians (including nurses)" making coverage decisions, while private insurers "employ thousands of doctors, nurses and pharmacists, many experts in new technologies."

I thought to myself: What a miracle! Medicare with significantly less overhead has created a system whose overall costs rise at about the same rate (and sometimes slower) than private insurance, while it consistently maintains higher satisfaction rates in surveys of its users.

Thanks Scott! You just made THE central argument that favors making Medicare the default plan for covering the uninsured.

Then we're told that a recent Price Waterhouse Coopers survey showed that private plans spend four times more than Medicare on "consumer services, provider support, and marketing." Medicare would need to hire 4,500 clinicians to keep pace with the effort private insurers pour into "answering the telephone to adjudicate individual issues."

Isn't it possible that all those people calling private plans are asking why they were turned down for coverage? Or are they wondering if something will be covered? And since Medicare doesn't have such people, doesn't that suggest that Medicare doesn't generate the same level of complaints and queries? My mom, who passed away in April at age 86 (Gottlieb used a friend's dad as his sole anecdote, so I feel comfortable getting personal here), went through six years of declining health and was under constant physician supervision. Over that entire time period, the only coverage questions our family had involved the private drug plan she used.

Again, thanks Scott! Chalk up another argument for Medicare for All.

Next he complains that Medicare doesn't have a single oncologist on staff, yet its rules include 165 "restrictions" on the use of cancer drugs and diagnostic tests. As my teenage daughter would say, "hellooooo."

Did this blog not just cover the fact that Medicare has radically expanded its authorization for use of cancer drugs by putting off-label decision making in the hands of compendia writers in the private sector, many of whom are on the payrolls of the companies that make the drugs? Aren't cancer drugs the fastest rising component of Medicare spending, slated to nearly double by 2015? When I talk to oncologists (and I frequently do), what I hear about is the rapidly rising cost of drug co-pays for their patients, not about restrictions on the marginally useful products coming out of industry's labs.

The column concludes by returning to its original agenda: Congress is moving to cut the Medicare Advantage plans' 13 percent bump over traditional care, which proponents claim goes to pay for extra "benefits." As Scott so amply demonstrated earlier in the column, those aren't benefits, those are insurance industry costs.

Medicare (Dis)Advantage is proving day by day that it cannot compete with Medicare on costs, on service, or on customer satisfaction. The solution is easy. Level the playing field, Dr. Congress, and let the marketplace decide. And thanks Scott for giving them all the ammunition they need to argue their case.

Posted by gooznews at June 24, 2008 07:42 AM