On some weekends, the Disease Management Care Blog listens in on a certain car-themed National Public Radio call-in show that features the often entertaining and sometimes helpful advice of two wacky automotive repairmen brothers. They’re the inspiration for this futuristic posting on another Golden Boy of health reform called “insurance exchanges”…..
Click: ….. and that’s why the answer to this week’s puzzler is that you have to cut the banana in half and then divide it into thirds! But now its time for another caller.
Caller: Hello, my name is Marcie and I’m calling from Lake Nogebow, Illinois.
Click: Hello Marcie. What’s on your mind?
Marcie: Well, I drive a 2014 Insurance Exchange and it's driving me crazy. I can’t get it out of first gear and it will only go to one place no matter how I much I turn the wheel!
Clack: Hey, that’s what my wife says about me nyuck nyuck nyuck!
Click: Marcie, I have bad news. You’re not driving a "Fix It Again Tony" or FIAT, you’re driving a DIAB or a Defund It Again Boehner! That jalopy may need to be junked!
Marcie: Oh no, my State paid millions of dollars for it!
Clack: My wife paid nothing for me, so what a good deal for her nyuck nyuck nyuck!
Click: Well Marcie, Insurance Exchanges were manufactured using parts made in Massachusetts using European engineering. That's a really bad combo.
Clack: And we know nothing good comes out of Massachusetts, just look at my brother!
Click: Unfortunately, it’s impossible to adjust the innovation to actuarial equivalence ratios anywhere in the drivetrain. There’s a shortage of new insurance design parts and drivers can’t read any of the dials to easily compare one insurance plan to another!
Marcie: So that’s why I can’t steer my Exchange to a benefit design that I want or that I can afford....
Click: That’s right Marcie. This is just like the government’s approach to electric cars: you can have any kind you want, any style you want with any features you want so long as it’s a Chevy Volt.
Marcie: Oh, my wife is going to be so mad!
Click: There was good advice back in 2010, like this from the Brookings Institution that was published in the American Journal of Managed Care. Those heavy weight authors recommended that Insurance Exchanges be specifically configured to promote a wide array of innovative benefit plan designs. In addition, they argued that Exchanges need to provide consumer-friendly information on quality, cost and patient experience information. The Disease Management Care Blog also warned its readers, but few in government seemed to think about it.
Clack: When the subsidized public option was inserted in the engine, it was all over nyuck nyuck nyuck!
Marcie: So that's why I can only go to one place in it!
Click: You're right. Since the government ultimately decided which insurers appeared on the exchange and the decision logic favored the public option, "crowd out" happened faster than an Obama tax-cut veto.
Marcie: So what should I do?
Click: Now that's a puzzler!
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1 comment:
But it's not a real Car Talk episode without a reference to paying for a boat. *grins* Otherwise, thanks for the Monday morning pick-me-up. By the way, did you see e-CareManagement's post this morning on "MGH Medicare Disease/Care Management Demo Shows Home Run Results!" Thought you might be interested in it.
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