Braking short of the Donut Hole

A couple of weeks ago I got an unsolicited phone call from a survey research firm inviting me to attend a focus group session.

Curiosity and the promise of $75 to attend the two-hour session took me to the Convention Center Red Lion this afternoon where I joined 40 other gray hairs, all in their mid-60s.

I know our ages because that was part of a series of questions we answered using little wireless handheld devices called “Perception Analyzers.” You turn a dial until the red digital numbers ratchet what you want. “1” for yes; “2” for no. Or, in the hands of the programmer in the back of the room, the numbers can range more widely to allow for more nuanced answers.

We were asked to identify our ages in a range from only 64 to 68. (I’m 65 if you must know.) It was strange to be with 40 older people so close in age. That hadn’t happened since my last college reunion.

We were a pretty feisty bunch as it turned out.

We were led through questions projected on a screen by Susan, a facilitator half our age.

Each of our “analyzers” was numbered (I was #40) so that its answers were computer-tabulated and correlated for a particular user.

We started with the basics: Gender? Household income? Ethnic background (we were all Caucasian—was that intended?)? Home ownership? Own stock or bonds? 401 K, pension? Level of education?

And then we got down to cases, and we began to get a sense of who might be behind the survey. Who was picking up the tab.

What type of Medicare do you have? we were asked. Part A? Part A and B? Part D? Med Advantage HMO? Med Advantage PPO? etc.

This was suddenly heavy going. The guy next to me took out his Medicare card to read the fine print. We all had name tags. His read, “Charley.”

On a scale of 1 to 10 how satisfied were we with our plans?

How many doctors visits in the last year?

How many hospital overnights in the past two years?

Any chronic illness?

The questions were boring in, getting personal.

Somebody was extracting $75 worth of information out of each of us.

There were some forced choices about why we chose the plan we did? What was the main reason? Cost of premium, choice of physician, reputation of insurance company etc?

What was the second reason for our choice?

It went on this way for several more questions until we got to the crux of the survey, namely a new experimental form of Medicare coverage: medical savings accounts.

What if there were no monthly Medicare premiums to pay and the government simply gave you X dollars each year for medical costs? If your costs exceeded that amount, you would pay Y dollars out of pocket. After that “donut hole,” the insurance company would pick up everything else that year.

In other words, the government pays if you get a little sick, but if you get sicker, you pay for that until you are really, really sick and then the insurance company picks up the additional tab.

Question, will knowing that you are paying for graver illness discourage you from getting more care and lead you to find God?

The "donut hole" term comes from the language of the Medicare drug plan cobbled together by Bush, the Republican Congress and Big Pharma a few years back.

Oh, explained Susan, and what you don’t spend on health care in one year gets rolled over into the next. Oh, and the money is yours to cash in if you want — but there’s a penalty and you have to pay taxes on it….

But…and. ..but…and.

Next we were asked to consider several scenarios. What if the savings account infusion got bigger, but so did the donut hole payments? How about this much? How about that?

For a premium of Z dollars each month we could get dental and vision coverage. Our facilitator ran Z by us at several amounts: $40 per month, $50 per month, $60 per month.

Each time “better” coverage meant paying more. What would we be willing to pay … and for what?

Then Susan had us put down our Perception Analyzers. She invited us to tell her in actual words what we were thinking, as she put it.

What did we like about this medical savings plan idea? What didn’t we like?

A woman in front of me wanted holistic care included in coverage. Several men said that they liked the rollover provision because it rewarded good health, which they seemed to pride themselves in. Sixty-five is the new 40 and all that.

Stay fit and make money. What’s not to like?

Right. And what happens when get run over by an SUV or are hit with a stroke or Alzheimer's’s or Parkinson's’s disease? Or what happens if you discover you have spiteful genes?

Fear and uncertainty were the unacknowledged guests in the Red Lion Banquet Room. Ten years from now would this group answer these questions the same way?

Questions like these began to haunt me. I could feel an onset of eruptive crankiness.

Finally I raised my hand and said that the whole health system in this country was sick and that health care shouldn't become a game of donut holes, deductions, price points and marketing strategies.

Give us a break.

I got scattered applause.

“Who let him in?” joked Susan with a good-natured smile.

• • •

Who knows what the mysterious client and the perception analyzers will make of my editorial outburst. Did it make me worth less than $75, or more?

As we filed out the door, we got our $75 in cash in unmarked envelopes.

I chatted with Charley as we waited for the elevator. We made a three-degrees-of-separation connection via the Longview Daily News (his brother lives in Longview and Charley seemed to remember a story I had written for the paper about Harry Truman and Mt. St. Helens back in 1980, the year of the big eruption.)

Charley, a retired portrait photographer, surmised that Regence BlueCross/BlueShield was the likely client for the survey because the Regence name came up more frequently than other insurers, such as, I kid you not, Secure Horizons.

I thought the client might be Dick Cheney, Grover Norquist, the Heritage Foundation or the American Enterprise Institute.

Anyway, I’m spending the $75 on motor scootering boots that will protect my ankles in an emergency.

Call it preventive medicine. Under a medical savings account, the boots would allow me to brake short of the dread donut hole ... and I’d roll-over — but in a good way.