Peanut Butter Stuffed Jalapenos

We are in a series exploring the idea of a single payer healthcare system.  Click here to find the prior posts.

I will confess that I am highly deficient in most skills in the culinary arts, unless I get to count my love of consuming the end product.  If it does not involve firing up the grill, I am likely going to screw it up.  Take that sauce I tried to make one night – four hours and 16 dirty bowls later…

So I marvel at chefs, what with those rapid chopping skills that never seem to leave blood on the carrots and the oh-so-casual pan flipping stuff they do.  But besides the technical skills, it is the artistic side of their craft that I admire.  What the heck caused you to think that putting that with that would work?

One night, we had peanut butter stuffed jalapenos as an appetizer.  What?  But, it worked.  The chef told us he just got this weird idea that the texture of the peanut butter would cut the heat of the pepper without taking away the taste.

Today, we are going to at least start exploring a similar unexpected combination making the rounds in some healthcare policy circles.  It combines the liberal idea of a single payer system with the conservative principle of market competition.  Crunchy Peter Pan spread on a roasted habanero.

Call it ‘Medicare Advantage for All.’

Now, some of you know the MA world well because you live in it every day; in fact, for some MA is the primary financial driver of your practice.  Others of our readers have only some foggy notion and its mostly negative because, to you, this sounds like the ugly baby that would result from an HMO and Medicare getting together to produce a kid.

Let’s start with an overly simplistic level set for the latter group. MA plans are administered by private insurance carriers.  They persuade beneficiaries to opt out of traditional Medicare and switch to an MA plan.  When that happens, the person brings their per capita Medicare spending with them to pay the premium for their MA plan.  The care delivery they get then looks a lot like an HMO, with a pretty well defined network and some guard rails (‘gatekeeper’ sounds oh so California, doesn’t it?).

The MA option has been around since the 1970’s, but enrollment stayed pretty low for a long time.  It took off at the turn of the new millennium.  We are up from about 5 million folks in 2004 to  almost 18 million now.  That is 31% of all Medicare beneficiaries opting for the MA alternative.  So some people seem to like the chef’s appetizer.

Yes, yes, my apologies for butchering reality.  I said it was overly simplistic.  Relax, we’re just getting started here.  Next week we’ll look at the pro’s and con’s of MA as it exists and then ponder what it might look like if we had MA for all.



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Tim Coan, ALN’s CEO, writes an insightful and witty blog three times a week about a variety of topics relevant to independent physician practices.

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