Thursday, July 30, 2009

A President's Invite for Beer as a Metaphor for Medicare's Current Coverage of Medical Necessity (Egads)

When it comes to Medicare, beneficiaries can generally have any service that is ‘medically necessary.’

And when it comes to having a beer with the President, apparently you can have any brand you want, so long as it’s…beer. For Mr. Obama, it’ll be a Bud Light, while Dr. Gates prefers a Red Stripe and Mr. Crowley likes Blue Moon.

The ever curious Disease Management Care Blog knows what 'medically necessary' is, but wanted to better understand the definition of beer. It found out that it is a starch-based beverage that is commonly based on rice, wheat or barley that is fermented with one of several different types of yeast (commonly lager or ale), that is combined with a variety of hops (gives that bitter taste) and allowed to brew to various levels of alcohol concentration. Depending on the style, type and mix of the base ingredients plus other additives (for example, cherries or even hot peppers), the variety is truly endless. What’s more, beer can range from really cheap to really expensive.

Which makes it a good metaphor for health insurance coverage. The beers chosen by Mr. Obama’s guests fell within the standard ‘covered’ White House ‘benefit’ preferred by many beer drinking consumers. If Professor Gates or Mr. Crowley, however, had asked for a lusty mead or a tall glass of Strongbow, the President’s staff would have probably had to mimic a Medical Director and review the definition of ‘beer’ as well as the text of the President’s invitation. They would have determined that neither of the requests were grain-based starch beverages and therefore not covered by the invitation. Unless there was an appeal or grievance, case closed. But suppose either of the guests had chosen, based on the advice of their physician, a unique Bar Harbor or a pricey Chimay Ale? Just like Medicare, the beer would have to be served, right? Medically necessary is medically necessary and an invite for brewskies with the President is an invite for brewskies. Cheers!

The DMCB realizes it’s being silly and knows how rude it would be to abuse the gracious hospitality of a President. Decorum and common sense rule in such situations. Unfortunately, that is not the case in another corner of the Federal bureaucracy, where we as a nation have come treat the Medicare benefit as an open tab for every conceivable fermented beverage that meets the broad definition of medically necessary.

Too bad Mr. Obama can’t invite folks over for a beer when it comes to health reform. It’s all just too complicated.

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