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Richard Behan's avatar

Thanks for this, Thom. From painful experience we heartily endorse especially your last paragraph. We were suckered into switching to a United Healthcare Advantage plan when we moved to Portland from Washington state, and now we're well and truly screwed. Moving to Corvallis a couple of years later, we could switch to Samaritan Advantage, but to return to regular Medicare is prohibitively expensive. At least we're dealing with a local scammer now, not the national vulture United Health. Meanwhile, a great pleasure just now posting your piece on Facebook, with a caveat in CAPITAL LETTERS.

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Lee Wenzel's avatar

I learned in Insurance 101 that insurance has premiums actuarially related to risk or probabilities of unaffordable events. Medicare is an entitlement, not insurance, since the taxes paid are not statistically tied to the promise of event-driven claims. When Medicare sells the risk to a third-party, I think it is still an entitlement transaction rather than insurance. The euphemism of insurance conveys an entailment that I have no control over my health, since we only insure events over which we do not have control or moral hazard. Also, insurance is always for a loss, never for a gain such as health as a goal. The insurance framework of finance keeps the medical industry focused on disease rather than health. The system is designed to not be transparent, witness all the funny numbers on any E.O.B. and the difficulty of getting comparable costs for consumers to make any decisions. (Actually, I'm the product, not the consumer.) How do my annual Medicare Advantage "claims" compare to what the plan is paid by Medicare? The underlying problem is that it is hard to define in a policy and administer objectively the legal obligation of a goal-oriented claim. It is not like life insurance where there is general agreement on whether a person is alive or dead.

Having worked in corporate buying of medical and health services, the complaints of specific Medicare Advantage companies is not a surprise. Reputations persist for years. The consumer needs to do some digging as to the fiduciary credibility of specific companies.

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