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Selling Sickness


Someone I know who is just over 65 received an unlikely solicitation'from The Scooter Store located in New Braunfels, Texas, on Independence Drive no less. The outside of the envelope promised a free personal mobility assessment. This person is totally mobile and hardly needs a scooter.

The solicitation had the flavor of those letters enticing seniors to buy Medicare supplement policies and Medicare Advantage plans. The business reply envelope said in big, bold, black letters that an immediate response was requested. That's the same kind of language that works so well for sellers of Medicare plans. Inside was the pitch:  People are reluctant to use mobility assistance because they think they will become dependent on it. But a power chair or a scooter can make them more independent than they ever dreamed.

To help them reach a decision, The Scooter Store enclosed a free personal mobility assessment so the recipient of the pitch could judge for him or herself whether a scooter would be right for them. The questions probed whether the person has trouble getting to the kitchen or dining facility for a meal, has fallen in the past year, has trouble dressing, feels like they are a bother to others or feels left out because they can't get together with family and friends.

Presumably if you answer yes to any of these questions, you need a scooter that The Scooter Store is happy to sell. An expert mobility consultant, aka a salesperson, will discuss your needs, answer questions and send a free puzzles-and-games booklet, which the letter says is 'filled with hours of fun.''  Along with the booklet you get information about how The Scooter Store can help you regain your freedom and independence.  Sending for the booklet sets someone up for a sales pitch.

What's really amazing, said the letter, is that you may be able to get a power chair or scooter at little to no cost to you with Medicare and private insurance.''  Uh-oh, I thought another seller trying to create a need and demand for a product and sticking Medicare with the bill. Power scooters can cost upwards of $700 and not many seniors have that kind of money lying around even if they do need help.

The solicitation raises a large question: Do pitches like these saddle Medicare with costs for services that may not be needed? Clearly, some people do need durable medical equipment, the Medicare term for things oxygen, hospital beds and scooters. Others don't. But if people manage to get payment for these things when they don't really have to have them, that adds more costs to Medicare. Health care providers, including those selling medical equipment, have often found all sorts of creative ways to elude whatever cost controls Medicare has attempted to put in place.

Selling medical equipment and creating demand is not much different from TV ads drumming up business for drug companies by suggesting to consumers they consult their doctors about this drug or that for illnesses they may or may not have. Studies show that those commercials work. When consumers ask for the drugs, their doctors usually comply. The marketing strategies of the world's biggest drug companies target the healthy and the well, is how authors Ray Moynihan and Alan Cassels put it in their illuminating book Selling Sickness published a few years ago.

They argue that the ups and downs of daily life have been transformed into frightening conditions and ordinary people are turned into patients.

The Medicare program is fragile. Its finances are weak. The day may come when politicians have to cut benefits or make them available only to a few. So a word to the wise: Think carefully before falling for some sales pitch for scooters, medicines, or anything else you may not need. Think about what the seller is trying to do. If you get some marginal benefit now, it may mean that a benefit you really do need later won't be there.

More Blog Posts by Trudy Lieberman

author bio

Trudy Lieberman, a journalist for more than 40 years, is an adjunct associate professor of public health at Hunter College in New York City. She had a long career at Consumer Reports specializing in insurance, health care, health care financing and long-term care. She is a longtime contributor to the Columbia Journalism Review and blogs for its website,, about media coverage of health care, Social Security and retirement. As a William Ziff Fellow at the Center for Advancing Health, she contributes regularly to the Prepared Patient Blog. Follow her on twitter @Trudy_Lieberman.

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Medicare   Trudy Lieberman   Pay for your Health Care   Aging Well  

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