Do consumers buy health insurance like they buy canned peas?  Or should they?  That’s the big question market place advocates have been trying to answer now for more than a decade.  The government and others have thrown gobs of money at this vexing problem trying to figure out the best combination of stars, bars and other symbols that will catch the shopper’s eye.

The hope is that patients will also become good consumers, always choosing the best options whether it’s a doctor, hospital, or an insurance policy.  The danger is that if they don’t, and things go wrong, they will be blamed for the bad outcomes. An ethicist I heard speak recently was troubled by all the emphasis on health care choice which she called  “simplistic market rhetoric.”   “The emphasis on choice blames the victim for not reading the fine print when they have made a wrong one,” she said.

That brings me to the problem of Medicare Advantage plans and the apparent wrong decisions millions of seniors are making.  The Centers for Medicare and Medicaid Services (CMS), which runs the Medicare program, rates Medicare Advantage plans using a star system—the more the better.  The stars supposedly offer clues about plan quality including whether plan members get timely screenings and vaccinations and how how quickly they respond to complaints.  But a consulting firm, Avalere Health, did a little study and found that seniors choosing Medicare Advantage plans pick the ones with fewer stars, not more. Avalere said that nearly 50 percent of Medicare beneficiaries chose plans that merited only two or three stars.  The number may be higher.  CMS says that seniors pick plans based on costs and their ability to see a doctor they like, not ratings.

As someone who helped invent health plan ratings in a previous job, I’ve come to agree with that assessment, and that raises the fundamental question of how useful all these stars and bars are in the first place.  To find out, I did a quick survey of the Medicare Advantage plans that are available in Manhattan where I live.  There are 103 choices, way too many for the average senior to wade through and make an intelligent decision.  Most people would throw up their hands and ask their best friends or run for the nearest insurance agent to help narrow the choices.  That solution presents other problems which I will explore in later posts.

But if seniors decide to examine the ratings, they still may make their decisions based on price and the plan’s network of doctors.   To use the quality ratings, they’d first have to decide which rating factors were most important to them—screening tests, chronic care management, how the plan responds to complaints, how responsive it is when members need care.   That’s tough.  If you’ve already had timely screenings, why do you care how good the plan is at making sure other people get them?  The way plan representatives talk to customers on the phone may be important.

Once you make those decisions and start inspecting the stars, you run smack into another problem. Many of the plans have the same ratings.  Looking at the stars that summarize all of the quality dimensions, I find that Aetna’s standard plan HMO rates three stars but so does its value plan HMO.  So does GHI’s PPO II and Healthfirst’s  65 Plus Plan HMO.  And how much better are these plans than the Fidelis Medicare Advantage Part B Reduction HMO-POS, or for that matter, Aetna’s standard plan PPO?  They merit three and a half stars.   Then there are a slew of plans for which there is too little information to rate.  That would turn a shopper off right there.

In sum, there are a lot of problems with Medicare’s ratings and seniors know that.  CMS says it is going to reassess them, and there will be updated info out in the fall.  Down the road the better plans will get bonus payments from the government.  That, too, raises another question.  Will the plans really be that good, or will they simply be teaching to the test?