Wilford Brimley Is the Problem With Health Care

If you've watched television at all since 1995, you've probably seen Wilford Brimley as the spokesperson for Liberty Medical's diabetes testing supplies. Brimley actually pronounces it like "Dia-Beet-is" or "Di-uh-Beet-us" and that fact alone has gained him a cult following. Brimley tells people that if they, like him, have diabetes, it is important for them to regularly check their blood sugar, and that Liberty Medical will send testing supplies to their home at no cost to them and will bill Medicare on their behalf. What's wrong with this picture? Well, it pretty much encapsulates everything that's wrong the health care system: consumers are insulated from the costs of their care, providers are motivated to make a profit, and Wilford Brimley looks like a walrus. In case you haven't seen the video, take a look:

All you have to do is call the number, and Liberty Medical takes care of the rest. Sound too good to be true? It's not. Liberty Medical's making a ton of money off of this. In fact, they make so much money off of it that they're able to hire Wilford "The Walrus" Brimley and run these ads on television all the time. What you're witnessing is nothing more than a "Medicare Mill." People need services, so the supplier of those services markets itself to them aggressively, and may even suggest that there are other things the people need -- even if that's not entirely true. If Medicare will cover it (i.e., if Liberty Medical can get paid) and there's no cost to you, aren't you likely to agree to letting them send the stuff to you? After all, it doesn't cost you anything, so how can you lose?

This is precisely what happens when a third-party payer gets involved in the patient-provider relationship. The patient trusts the provider to provide the goods and services that are in the patient's best interests. The provider strives to provide the best care to the patient possible, but also makes a living doing it, and therefore seeks -- like any business -- to maximize profits. To the extent that the insurer insulates the patient from costs and pays the provider, we have the potential for these types of Liberty Medical operations that drive up costs and spending for unnecessary care. Now, that doesn't mean that we don't need the risk pooling mechanism of insurance. Rather, it means that we need heavy government regulation of insurers. That's the only way out of a situation where insurers either "Die-or-beat-us."

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Comments

[D. Brad Wright - Huffpost Blogger]

For everyone who'd like to enjoy a shallow, non-argume­nt-elevati­ng, chuckle, I submit to you the Brimley to Walrus morphing face video:

http://video.yahoo.com/watch/3960361/10749139

[goodnews7]

Health Care Reform and Medicare Advantage
One of the proposed ways of reducing Medicare costs that is being considered for inclusion in the health reform bill is to eliminate the subsidies paid to private insurance companies who sell Medicare Advantage plans. The savings will amount to $177 billion over the first ten years. The insurance companies have mounted a huge campaign to scare people, especially seniors, into believing that this will result in drastic cuts in benefits and increased premiums. Remember that independent assessments of the Medicare Advantage program say that it costs the government (i.e. the taxpayer) about 14% more to provide health care service through that plan rather than through basic Medicare and other channels. That extra government money goes into the health insurers’ coffers, not to seniors. We’ll look at how Medicare Advantage came about, how it works, the benefits offered, the potential effect of cuts and what the government and seniors can do to counteract the potential effects of cuts in subsidies. We’ll also look at how you can decide whether or not to enroll in a Medicare Advantage program and how to avoid the many scams that use them to defraud seniors. http://silverbuzzcafe.com/?p=3977=3977

[BunnyX]

I can't believe how many people are completely missing the point of this article. It's a beautiful example of what is driving costs through the roof. Because of things like this, people start to think of medical care as something that is, essentially, free.

Or probably a better analogy is that it's an all-you-can-eat buffet - yeah, you stuffed yourself with crap you didn't need, but why not? Taking twice as much as normal didn't cost you any extra. Sure, this Liberty Medical is taking the government for a ride, selling people more than they need so Uncle Sam will pay for it, but hey, that's the government's money! Well, yeah, except that it used to be our money..... and the thought that it might be better spent on other things, like expanding health care to cover the uninsured, never crosses their minds. It should.

Waste is waste. Medicare is constantly having to cut reimbursement to doctors, causing them to reluctantly drop out of the program and quit seeing medicare patients, because waste such as this in the program means they just don't have the money to pay a fair amount for an office visit. Exactly how does this help diabetics in the long run?

[Myaleaux]

The role of the 1970's health planning eliminated by the Regan administration in 1981 would have prevented the disastrous increase in today's health care costs it . It limited to actual need, health services resource development expansion. No new hospital beds, MRIs, cat scanners, ESRDs, and other costly resources could be acquired within a "catchment area" without a "certificate of need" from the Health Services Planning agency! Based on the notion that amotization of loans needed to acquire costly resources creates utilization pressures, regardless of medical necessity; designed to stabilize the 12% annual increase in health care costs (now 14%), planning would have avoided or greatly attenuated today's crisis had it not been removed in 1981. Most first world nations have health services planning to model development of resources actually needed by area residents. This "wrinkle" of how we got to where we are today needs to be revealed; it is ridiculous to leave the development of tour health care resources to unbridled pleuralism as has been done by the short-sighted prior administrations! We must not leave to chance, the development of this crucial sector of our economy - planning will avert furture disasters and develop resources actually needed by the health staus of area residents, not the investment opportunities of enterpreneurs, professionals or businessmen who have entered the field for profit!!!

[D. Brad Wright - Huffpost Blogger]

I've got to disagree with you here. The HSAs of the 1970s did not work well at all. They aspired to do great things with consumer representation, but in the end there was no effective mechanism for consumers to actually be involved, and those who were involved were steamrolled by the provider faction, which a minority by the numbers, still had all the influence. You should look up Jim Morone's work on this. He has written quite a bit about it.

[threegoal]

Another question: Does making fun of Wilford Brimley's appearance at all elevate the discussion?

[D. Brad Wright - Huffpost Blogger]

No, it doesn't elevate it at all. But that doesn't change the fact that he looks like a walrus, which may be juvenile of me to point out, but I still find it hilarious. Consider this post less Uwe Reinhardt and more Dave Barry, and then maybe you'll pick up on my tone.

[yellowdoggie]

I'm fanning you simply because of the walrus comparison, elevated discussion or not. Generally speaking, anything that smacks faintly of "wise@ss" is fine with me. AND, I agree with your more serious comments.

[SonofLiberty1]

Well then you shouldn't have personalized it.

Personally, I DON'T CARE HOW MUCH IT COSTS...

I DON'T WANT TO GET STUCK WITH PAYING FOR SOMEONE ELSE'S PAYCHECK WHEN MINE GOT OUTSOURCED.

[BlueFloyd]

he's also the egg man

[Mag7]

I remember when he was the oatmeal czar.

[jeaton]

Best remembered in, The Natural.

[raker]

Do I understand this blog correctly? It argues that financial burdens for sick people with diabetes are good because it makes them, what, grateful to their health insurers, and therefore keeps costs down? It makes them appreciate the high cost of health care and therefore hesitate to inflict this pain on their insurance company? And people will order blood glucose monitors whether they need them or not, because Wilford Brimley makes it easy? WTF?

I worked in customer service for Blue Cross in the 80s, just when they made the change from member-submitted claims to provider-submitted claims. It was the best thing that ever happened to covered members. Then they inflicted the odious "managed care" and the tyranny of the referral and the pre-admission review systems that accomplished nothing except increases in rejected claims, as though we were all dashing off for surgery on a whim because of something Wilford Brimley said. Member-submitted claims are a nightmare, especially for the elderly. And Medicare pays what it pays for services whether or not my Grandma gathers her paperwork and submits a properly executed claim or her insurance company does it. Go after fraud, but leave my Grandma out of it.

Health care costs are stratospheric for lots of reasons, but I reject your suggestion that part of the fault lies with our desire for ease and simplicity. I reject the suggestion that getting health care ought to hurt us financially, to make us feel guilty.

[D. Brad Wright - Huffpost Blogger]

Yeah, you missed the point entirely..­..as it seems many others have, which suggests I didn't make my argument clearly. Let me try again. I am not asserting that people with diabetes should go without needed testing supplies. What I am asserting is that there is a lot wrong with actively marketing a product to people on the basis of the fact that it won't cost you anything and we'll throw in some more free stuff (if you qualify). They are trying to play the role of medical educator and medical supply provider all at once, and who knows if their solution is the best alternative?

Now, I don't think that that means that people with diabetes are calling up Liberty Medical to request a free meter, but I do think it demonstrates the perverse incentives inherent in insulating consumers from the real costs of their care. That is NOT to imply that they should be paying for them. I was only using the Brimley example as an analogy. What if there were a commercial that peddled Viagra "at no cost to you".....w­e're on the verge of it with the aggressive marketing of "ask your doctor about...." It's all bad news.

[comrade leviathan]

I understand what you're saying, Brad, and for the most part I agree with you. But I'm not sure I understand what you're saying the preferred alternative to this is. Were you implying there should be stricter regulations on the kinds of things that providers who bill Medicare can advertise, or the ways that they can advertise (the No Wilford Brimley clause)?

This concept of "free" is extremely problematic and is creating a society that expects handouts instead of caring how something which maybe rightly was provided by the federal government got to you in the first place. This is the argument that even conservatives don't seem to be able to give accurately right now. The issue isn't whether or not it's government provided..­. most Americans agree that things like this should be. The issue is how it's paid for, and right now the government is sucked into this Health Care Industrial Complex and forced to play by their twisted rules. The problem is the rules themselves need to be changed.

One thing I'm encouraged by is the fact that at least the House appears to be unwilling to even let this behemoth health care bill be the entirety of what they're prepared to do for American health care, and are already working on removing the anti-trust exemption for health insurance companies. This all points to a government that is finally willing to accept the dire nature of the situation and work to completely reshape the system.

[SonofLiberty1]

I think you've missed the point entirely here....

MANY FOLKS, AS THEY GET OLDER HAVE A GREAT DEAL OF DIFFICULTY MOVING AROUND....

AND NO, IT'S NOT BECAUSE EVERYONE IS JUST PLAIN FAT...

IT'S BECAUSE YOUR LEGS DON'T WORK AS WELL AS THEY USED TO..AND MOVEMENT CAUSES PAIN AND LOTS OF IT AND SOMETIMES IT'S BECAUSE OF BACK PROBLEMS..­.


THAT CAN'T BE CURED...

PLEASE DO A BIT OF RESEARCH AND ACTUALLY "ASK" FOLKS BEFORE YOU DIVE INTO THE WATER NOT REALIZING THAT IT IS ONLY 6 FEET DEEP!

[undecidedaboutPOTUS]

I read your blog, important points as to economics and costs appear to be missing from your post.

1.Will Brimley's comments are aimed at Medicare recipients, and testing supplies are covered by part B. and that this provider accepts the assignment (e.g. payment in full) for those testing supplies.
As a suggestion it might helpif you had information about what the cost of those testing supplies are without the Medicare part B, and what Liberty Medical accepts by way of assignment - For example if a brand name test strips costs $100 retail – no insurance; with private insurance combined cost is $85 – then the important question becomes -- what is the amount that Medicare pays under the “assignment” amount.
In other words if the payment via Medicare assignment is less than $85.00, then Will Brimley and Liberty Medical are not driving up medical costs -- if however, the amount paid via the Medicare assignment is greater than $85, or even equal to the retail price w/o insurance, then yes, it’s contributing to cost increases.

2.Also FYI a retail pharmacy such as Walgreens has signs that say they accept Medicare Part B assignment,

3.Comments about Will’s speech patterns – given regional speech patterns in the US, IMO doesn’t help your basic thesis.

Lastly, while I agree that how Liberty Medical markets its services is an issue, this blog, IMO doesn't support your conclusion.

BTW, I strongly support single payer a la the Canadian system.

[BunnyX]

The price is not the issue. If Liberty is selling people twice as many supplies than they use, or selling them supplies they don't need just because Medicare will bay for them, then yes, they are driving up the cost of Medicare.

[DHicton]

Only one problem with the article... "di-a-beet-is" or "di-a-beet­-(schwa)s" is a perfectly OK pronunciation of diabetes. No need to excoriate Wilford over that, and to do so is no support for your argument. If you like, though, you could mention again that he looks like a walrus.

[TryToBeFlexible]

"Consumers are insulated from the costs of their care."


Translation, we could save a bunch of money if poor people just died instead of getting medical attention, then the deserving rich could afford much more plastic surgery and botox treatments.

[Joel Redman]

No, you didn't read apparently. Translation -- since people don't know how much things cost, they can't rationally choose between alternatives. The point here is that a company is sending additional unneeded supplies to people who need testing supplies, thus driving the cost of medicare up for everyone. Quite simple.

Oh and Brimley looks like a walrus.

[toastiest]

Q: Why did Wilford Brimley cross the road?

A: He doesn't need to cross the road. Liberty Medical brings his diabetes testing supplies right to his front door!

[BlueFloyd]

i like

[Lon]

I don't know enough about Liberty Mutual to know if they are providing a service here or not. But there does not seem to be a particularly good case in the argument above that they are not.

For people with diabetes testing supplies are a valuable thing. This is hardly the kind of product that people without diabetes are going to get because they like poking themselves every day.

It would seem to be a good thing that medicare makes such supplies available. And if people are unaware that they can get these supplies, then it would seem to be a good thing that someone is informing them of this. If the people doing the informing are making a profit then that should be weighed against the costs involved. Could people be helped more cheaply by having medicare run the commercials? Is there some other mechanism for as effectively getting the message out? Is the health advantages of getting this message out not worth the cost to Liberty Mutual?

I have no idea. But the fact that Liberty Mutual is making a profit off this does not show that it is a bad thing.

[ObamaSheeple]

Good post.

I was thinking the same thing. I know, they ARE making some kind of profit if they can afford a spokesperson and commercials. But, from a medical perspective, diabetes patients not following a strict regimen, would COST much more to medicare and possibly just out right die.

What he should have pointed out is that Americans being so OVERWEIGHT is causing severe strain to health care and health in general. I'm not talking about Type 1 diabetes and I'm looking in a mirror when I say that, though I do not have die-a-beet-is. I've been working on my weight for the last 4 months and have a bit more to go.

[yellowdoggie]

It can also be a reason so many people need those "hovercraft" scooters. Maybe it's just my perception, but almost every person I see in one of those scooters, which cost thousands of dollars that you and I pick up the bill for, is morbidly obese. Wouldn't it make more sense if they tried to walk? Just a little?

Okay, now people, you can let me have it. I'll get out my protective gear.

[BunnyX]

Telling people they need diabetic supplies is not Liberty's job - it's the doctor's job. The Medicare program also spends a ton to educate people on what Medicare covers. Liberty's extensive advertising is not any sort of public service, but merely a way to make them money by sucking it out of the government's deep pockets.

[comrade leviathan]

"Telling people they need diabetic supplies is not Liberty's job - it's the doctor's job."

I think that's the one line that Brad was missing, that would have made the point of his argument much clearer. Well done.

[seawolf77]

What about the hoverounds? Those are like $4000. Imagine that. You get old , infirmed, debilitated and government gives you the equivalent of a good used car. You mean to tell me that $4000 could not be better spent elsewhere and grandma gets a wheelchair. I tell you middle age is that time when you don;t know who drives you off and crazy the worse, old people or young people. They are both utterly retarded.

[Aldyth]

As the aunt of a woman who has an intellectual disability, I would appreciate it if you would leave the "r" word out of your vocabulary. People with intellectual disabilities don't deserve to be insulted.

[michaelws]

Walk a mile in grandma's shoes before you condemn the investment in a hoveround as better spent elsewhere. And I agree about the "r" word. Easy to sit in judgment of others when you yourself are not immersed in their world, experiencing their limitations and frustrations.

[WShawn]

The problem (and point of the article) isn't the legitimacy of the item being advertised, it's that it's being offered to the Medicare consumer as something they can get for "free."

"I didn't pay a thing for my Hoveround," says grandma. Well, great. Someone's paying for it. Someone else. So who cares how much it costs and how much profit they're getting?

People really need to start thinking about how much their medical care is really costing. Those with good insurance don't give a second thought to that. They think about their co-pay, and everything else is up to the insurance company, out of sight, out of mind.

My health insurance is mediocre. I often don't know what will be covered and what won't. A dermatologist suggested removing a suspicious growth. I asked how much they charged for that, and they could not tell me. I asked an ENT how much it would cost for a visit. The first thing they asked was "who is your insurance company?" All they could tell me is what my co-pay might be, not how much the actual visit would cost in actual dollars should the insurance company refuse to cover the visit.

It's a huge disconnect, and it's a huge part of the problem. To me it's like going to a restaurant with no prices on the menu. You have your meal and you're then presented with the bill.

[SonofLiberty1]

Well I'm middle aged too and I take care of an elderly parent.

Be careful...­life tends to hand out disabilities as we age and pride is a great way of getting them.