Medicare costs for calling to make sure you're being good.

http://www.nytimes.com/2008/04/07/business/07medicare.html?_r=1&ref=us&oref=slogin is just another version of the same old thing: Medicare dollars spent like those of private insurers on programs designed to save money that actually cost money. This brainchild discusses the cost effectiveness of government payments to private companies that call patients with chronic conditions and encourage their ongoing disease management. I have discussed this before and I do not agree with this program, which, by the way, has recently reached a compromise where as long as it doesn't cost the government too much it doesn't actually have to prove profitable in terms of saving money, in other words, it doesn't work. And it shouldn't.

The "nanny" approach to medical services cost management is never effective. While any doctor can wave his finger and any insurer can wave their finger telling you why you are uninsurable and why you are a great risk, this approach is not only ineffective, it is abusive. Using a position of power to manipulate, coerce, or belittle another is abusive and as verification we see the embarrassment and deception of the population in response to the finger wagging. There are few people I know who are going to be scolded into compliance by a doctor, let alone a third party call center person.

Patients could learn a thing or two from doctors. Look how they've reacted to the government telling them that their costs are too high, they must manage those costs more effectively to participate in Medicare: the response, threats: there will be fewer doctors who will accept Medicare, fewer patients able to get treatment under Medicare, in other words, doctors will walk away from the game. Any reader can find this approach in the many articles touting the proposed decrease in "medicare" payments for physicians (though the legislation also provides financial incentives for better performance). It's coming up in the next few months and the threats are flying as doctors try to bully Congress into granting another increase in payments rather than a decrease (this is what happened last time). Physicians do not follow the politics of appeasement, they walk away. To our credit, consumers have also begun doing this in droves but unfortunately, the other stakeholders, insurance companies and medical care providers have worked with politicians to FORCE consumers to pay... a la Massachusetts.

Third party management will never work, even if it is mandated. People will lie, or fail to respond because nobody opts into scolding for paying for a service unless they have bigger issues. Insurers trying to manipulate policy and thereby increase their profits have trimmed down their coverage to those who need it least, physicians want to only treat the richest patients, and patients, well, we're all shapes and sizes. If we're really being told that we are not good caliber customers, then we will still use emergency rooms for our episodic care and we will fail to pay when we are unable to pay and we will become one of those most wretched of people, the uninsured. Who cares? At this point maybe we shouldn't. If only the rich can afford good medical care then I really don't want to pay anything for that...let them foot the whole bill of the entire medical services field...there are not enough rich enough people to do so without the regular citizen dollars.

This program of having people employed by Medicare call and ask patients whether they are taking their meds is absurd. Further, as discussed in another blog about these companies, the privacy issues are enormous--third parties with access to insured information, third parties who often identify themselves as being employed by the main company whether it is Blue Cross Blue Shield or some other company instead of identifying themselves as members of third party contractors.

We must all become a little more doctor-esque: We'll pay or else, we'll take the or else.