I was enjoying drinks last week with Jody Holtzman (AARP), Terry Booker (IBC), and Doug Ghertner (change:healthcare) at a wonderful conference sponsored by Oliver Wyman. Jody was waxing eloquent about how every start-up needs a strategy for the senior population, when – after a few too many drinks – I emphatically told everyone at the table that I had the senior market cracked. I had experienced first hand the ills of the American health care system for seniors and had identified the perfect solutions.
My father-in-law grew up on a small, Kosher dairy farm outside of Pennsylvania (insert Jewish farmer joke here). He is 72 years old, he was about 40 pounds overweight, he has been widowed for about four years, and, about 30 minutes after my mother-in-law passed away, he started dating a woman that my wife never quite accepted, which is akin to saying that Russia is watching events unfold in the Ukraine from the sidelines (and to be clear, I don’t condone either position).
In January of this year, he was jumping from a backhoe onto a helicopter pad (don’t ask), fell 6 feet, and shattered his heel. The heel is a terrible bone to break in general (poor circulation) and, in particular, for someone who is older and a bit overweight (my goal is to not use the word “patient” once in this article because we aren’t patients, we’re people).Continue reading…
“Imagine a world without Medicare.” That’s the rallying cry of a new grassroots campaign being unveiled today by the giant seniors group AARP that will include town hall meetings in 50 states and national television ads.
Against a backdrop of proposals to overhaul the popular social insurance program and a presidential campaign likely to address entitlement spending, AARP is launching “probably the biggest outreach effort we’ve ever done on any issue” to activate its 37 million members, said Nancy LeaMond, AARP’s executive vice president.
The group will gather seniors at town hall meetings today in four cities – Richmond, Va.; Columbus, Ohio; Denver, Colo.; and Miami, Fla. – to start a conversation about the program’s future entitled, “You’ve Earned A Say.” It is also releasing a survey showing that less than half of adults ages 18 to 49 are confident Medicare will be there when they’re ready to retire.
In coming weeks, the group will hold town hall meetings in every state, and also conduct large-scale forums by phone. It recently sent members a survey to assess their views about potential Medicare and Social Security changes.
Groups on the other side of the political spectrum are also galvanizing. This week, a conservative seniors group called the 60 Plus Association put out television ads that targeted five Democratic senators and asked supporters to press them about their support for the Medicare provisions in the 2010 federal health law.
Imagine a Medicare Advantage (MA) policy which increases the quality of health care for seniors, saves the government money, brings MA to the few remaining places that don’t have it, and puts checks in the hands of senior citizens. What you are about to read should do all that, in theory. However, I’m sure there are practical issues that I am overlooking, and I am hoping to attract comments noting those issues that, as Woody Allen once said, can take this from being a notion to an idea, and eventually a concept.
First, each county would have a “default” plan that would automatically enroll people on their 65th birthday, rather than have the traditional plan serve as the default option. (Those of us already in an HMO with a Medicare option can stay in it, seamlessly, rather than join the default plan.) Anyone could still opt out into the traditional plan or another MA plan, of course, at any time.
The default plan is chosen based partly on its Stars rating, but partly on a bid process, in which plans offer to pay the government for the right to be this default plan. The payment would be substantial for three reasons:
1. In some highly populous counties, MA is profitable enough to support fifteen or twenty plans, far more than would survive in a competitive market with market-based pricing. Much of this “excess profit” would be bid back to the government by the default plan, in exchange for access to many more enrollees;
2. Member acquisition costs for the default (“opt-out”) plan would be a small fraction of the $500- $1000 that a new member costs in today’s opt-in MA environment. Much of this savings would be included in the bid;
3. The bid would be calculated not based on just on one year’s profit, but rather on the expected lifetime value of a member, taking into account projected member retention and any scheduled or anticipated relative reductions in reimbursement.