Author: Jeff Goldsmith
This morning, after twelve years, I dropped my Medicare Advantage plan and signed up for a Medicare Supplement policy. My long-suppressed dissatisfaction finally broke out. . . I'm leaving. This is a large network-based nationwide plan with zero premiums.
My decision to enroll in the MA was partly ideological. I love the idea of program design that rewards healthy behaviors. But I found that none of the so-called MA perks were actually available—neither my health club nor my dentist had internet access. When I got cancer in 2015, the plan didn't prepare me for my decision to fly 600 miles to the University of Chicago for treatment. They only paid UC about a third of the cost of treating my cancer.
For twelve years, there was not a single refusal of care. But they relentlessly badgered my primary care doctor, insisting that he sign off on every care decision I made during my cancer battle or anywhere else I went – spending hours on unnecessary “paperwork.” I blocked it sixteen Offered a “wellness visit” – a nurse came to my home to upgrade my code. My relationship with the carrier was basically on the receiving end of hundreds of automated calls.
I see little sign that their network is shrinking. The University of Pennsylvania, Cedars-Sinai and Hospital for Special Surgery wouldn't accept them. But when Mayo announced they wouldn't accept them, that was the last straw for me. Mayo is my “safety net” provider if my local Charlottesville folks are unable to meet my needs.
From a policy perspective, I think MA made sense when it was redesigned and renamed in the early 2000s. If there were SCAN or even Kaiser in our market, I would probably still be a member. Especially for older adults with functional disabilities or dual qualifications, thoughtful protocol-driven care delivered by a close-knit multi-specialty medical team makes perfect sense. On this point my old friend George Halvorson and I agree.
But the idea that capitation or a new version of it – micromanaged care run by warm and fuzzy artificial intelligence – is somehow a panacea for our society’s problems is increasingly being questioned on its face. It’s not about incentives, folks. I have been eating MA dog food for twelve years. It’s about the care system you rely on when things get scary. For twelve years, being a carrier added no value to my life except for the frozen dinners they sent me after my cancer surgery. Even if it's free, MA is not worth it.
Jeff Goldsmith is a veteran healthcare futurist, President of Health Futures Inc and regular THCB contributor. this comes from him Personal substack
