The Market in Old People
The latest Republican PR creation, the Brilliant Seriousness of Paul Ryan, wants to abolish Medicare and replace it with markets for insurance for old people. Repeating the wisecracks of an army of madcap economists, Ryan says it’ll push down costs, by making old people shop for insurance and by making them careful consumers of medical care. Now I don’t mean to be offensive, but someone has to point out the obvious: lots of old people are going to be really bad at shopping.
First, how many people have any practice at shopping for insurance? If they have it now through their employers, they have no experience, and hopefully, they won’t need to practice before they retire. When they do, suddenly they are confronted with an industry known for tricks and traps, and weakly regulated by 50 different state insurance commissions.
Pick a plan that meets your needs, say the witty econobots. What does that mean in real life? Typically large employers provide a choice of three health insurance plans. Each has a different combination of deductibles, co-pays, maximums and minimums, doughnut holes, networks of providers, costs for in and out of network providers, and an array of sweeteners, like free glasses and gym memberships. How do you decide which to pick? How do you have any idea of which one is “right for you”? And if you don’t work for a big employer, you get whatever is on offer, or you visit an agent and hope for the best. Now you are picking from offerings from people who aren’t even trying to hide the complexity, and don’t have to offer any comprehensible explanation of the differences. And you are young and competent. What happens to those who aren’t?
Second, who in their right mind at any age wants to go shopping for insurance? Does Ryan think anyone is actively looking for excitement and an intellectual challenge? Or does he think that the world is full of kindly and smart insurance salespeople who will unerringly steer old folks into the right policy? Surely Republicans, including their clownish economic advisers, realize the reality of shopping: you get Plan A if you are rich (all the care you want when you want it and in a nice hospital), and Plan B if you are can’t put your own money in with the voucher (we’ll try to keep you from dying in the street but no promises). Everyone else gets to choose among 20 plans, sold by agents trying to get you to spend all of your spare money with the voucher.
How about this for sales tactics. Kindly lady insurance agent visits 78 year old Grandmother who responded to an ad for the American Beauty Plan (Bait). Opening line: I know you don’t want to be a burden on your children. We do offer the American Beauty Plan, which covers some things, but it won’t cover this and that, and I see you really worry about that. For just a bit more you can cover this and that (Switch). Repeat as necessary until you extract the last nickel.
Alternative: we do offer the American Beauty Plan, but you qualify for the United States Tea Rose Plan which includes a, b, and c, and which also provides for additional services and which adds this and that coverage and some life insurance, and burial insurance, and if you buy it with your house insurance, you get a discount, and it all comes to a mere $Y more than the American Beauty Plan.
Now imagine that Grandmother is 82. According to the Cleveland Clinic:
About 5 percent to 8 percent of all people over the age of 65 have some form of dementia, and this number doubles every five years above that age. It is estimated that as many as half of people 85 or older suffer from dementia.
Now imagine Granddad trying to figure out whether he needs a specific medical treatment. Maybe Ryan, decked out in his harlequin costume, and his buffoon economists, will help him explore treatments for Parkinson’s Disease to figure out which treatment is best, considering Granddad’s history and insurance policy.
Hey, I’ve got an idea: let’s get rid of the State Children’s Health Insurance Program, and give kids vouchers to buy insurance. Think of how much money we could make!