Policymakers planning to reform Medicare by moving more beneficiaries into managed-care plans must sort through a confusing stack of surveys showing that a majority of people either like or don't like managed care.
To make things easier for the lawmakers, the Word from Washington staff found some general patterns in the surveys. We then interviewed our own focus groups (sort of) and present the following summary:
WFW: What is your general opinion of HMOs?
Ray: Cool movies, but I'd rather watch MTV, dude.
WFW: Not HBO. We mean health maintenance organizations.
Ray: Do they cover extreme Rollerblading injuries?
Ray: Then I think they are totally cool.
WFW: Would you ever consider joining a managed-care plan?
Doris: Absolutely not. I like my Medicare the way it is, and I don't want the government taking it over with some socialist medicine program.
WFW: What if Dr. Wagner was included in the plan?
Doris: Well, I might think about it then, but not if it costs more money. I'm on a fixed income, and not only that, I already paid for Medicare with my taxes.
WFW: What if it costs less?
Doris: Too much paperwork.
WFW: Actually, there is less paperwork.
Doris: I still wouldn't join.
WFW: Even though your doctor was included, it costs less, and there is less paperwork?
Doris: I'm scared.
WFW: Are you satisfied with your HMO?
Ralph: Sure. It's just like we had at the bus company.
WFW: Do you generally consider yourself healthy?
Ralph: Never missed a day of work in 35 years.
WFW: Were you able to keep your family doctor when you moved to Medicare?
Ralph: I don't know, let me ask my wife, Alice. I don't think I ever saw the doctor when I worked at the company.
WFW: Have you ever considered moving to a managed-care plan?
Mary: Not really. We like our pediatrician, and I have heard too many horror stories about women giving birth as they were being wheeled out of the hospital because the HMO wouldn't pay for an extra day's stay.
WFW: But you have never actually had any experience with an HMO yourself?
Mary: Not really. My husband was in one before we got married and he said it was fine; but now that we have a family, I'm not so sure. I have a friend who has a child with asthma, and she says she has had to wait longer to see a doctor since she joined an HMO.
WFW: Have you noticed any changes since you enrolled in an HMO?
Dan: Besides my copayments being less? Not really.
WFW: Do you feel your care is as good?
Dan: Yes, if you mean getting a physical once every three years is care.
WFW: So your experience has generally been good?
Dan: Definitely. But I still don't see any real difference. Insurance is insurance.
What does this thin cross-section of Americans prove? Probably not much. The fact remains that young, healthy individuals in managed-care plans are satisfied, as are seniors familiar with managed care. Seniors that have never been in a plan or those with serious health problems are scared of managed care and would just as soon not change. The hurdle for Congress is to convince those who are wary of managed care that change is for the better.
One key is to devise a workable point-of-service option that allows people to see a specialist of their choice when they want but at a cost that makes it a fairly rare occurrence.
The other key is money. It may be slightly cynical, but there is reason to believe that if the monetary rewards are high enough, most objections can be overcome. For Medicare, that means overturning the current system, which requires that any savings be plowed back into the plan in the form of increased benefits. A better system would allow the federal government and the beneficiary to share any savings that accrue from the beneficiary choosing a lower-cost managed-care plan.