The Washington Post Column

‘Ownership Society’ or Snake Oil?

Trying to be a good citizen, I start from the beginning, and do what the government ads tell me to do: I open my computer, and type in A screen comes up, asking me what I want: A personal health plan? A prescription drug card? A nursing home? I pick the first, type in my Zip code, and am immediately presented with 15 choices. Do I want “original Medicare”? “Kaiser Permanente”? “Insurer Medigap Plan H”? Arbitrarily, I pick one of two “Elder Health Maryland” plans — and get six more pages of information.

Among other things, I learn that if I opt for this plan, I will pay a deductible of $876 for inpatient hospital care, and $109.50 for each day over 20 days, but less than 100 days, that I spend in a skilled nursing facility. I also learn that I am entitled to bone mass measurement (if I pay 20 percent of the cost) and a hepatitis B vaccine (if I pay 20 percent of the cost) but flu and pneumonia vaccines are free. I can also go to a chiropractor (at 20 percent of the cost) as long as the goal is “manual manipulation of the spine to correct subluxation.”

If I were being a good citizen I would spend the rest of the morning comparing that set of offerings to all of the others. If I were a really good citizen, I would read the footnotes to these plans, some of which contain phrases such as: “5) Covers the difference between your doctor’s actual charge and Medicare’s approved amount, if your doctor doesn’t accept assignment. Plans F, I, and J pay 100% of the excess charges. Plan G pays 80% of the excess charges.” And if I were an exceptionally good citizen, I would then compare and contrast the various skilled nursing facilities in my area.

But the statistics are weirdly useless. What, for example, does it mean if a nursing home has a low percentage of residents who have moderate to severe pain, but a high rate of urinary tract infections? What does it mean if zero percent of the residents are bedridden — well below the national average — but that 76 percent (nearly double the national average) regularly lose control of their bowels or bladder? Does that mean that this is a good nursing home or a bad one?

Fortunately for me, I don’t have to be a good citizen, because I’m not old enough to qualify for Medicare or a nursing home. But the well-documented, continuing confusion of those who are eligible represents the greatest and least-discussed obstacle to what President Bush calls “the ownership society” in the campaign rhetoric he’s been using on the road this week.

“The ownership society” is innately appealing and eminently logical: Everybody has his or her own health care policy, which can be taken from job to job. Everybody has his own Social Security savings plan, which grows along with the stock market. Nobody is harmed by a sudden congressional decision to raise the retirement age or to cancel coverage of manual spinal manipulation. When offered the choice in Britain some years ago, I happily chose to pay a part of my contributions to a private rather than a government pension plan. I wish I could do it here.

Over time (quite a lot of time) both “private” Medicare and “private” Social Security should — in theory — save money as well, if the rules are written to make genuine competition possible. What I don’t think anyone has figured out is how competition works in practice when, as the president puts it, “consumers are empowered to have choices” but are simultaneously drowning in information. I cannot honestly say that if I were retiring tomorrow, I would be able to pick the most efficient of the myriad Medicare options available.

Nor am I alone: When private pension plans first became available in Britain, thousands of people were talked into buying the wrong ones. The Bush administration’s prescription drug discount cards, which became available four months ago, have been unpopular and underused, largely because people don’t understand them. Research into other kinds of investment decisions shows that the more options available, the more likely consumers are to panic and choose the simplest — and least lucrative.

Maybe this is the sort of teething problem that will just go away once better software is invented. Or maybe information overload will eventually make people think “ownership society” is another way of saying “snake oil.” Perhaps it’s too much to expect the president to talk about the possible side effects of poor consumer choice on the campaign trail. I’d still feel a lot better if he didn’t make the phrase sound like a panacea, either.