Medicare On Life Support

In NYC it is the major unions that pushed to shift NYC retirees from Medicare into Medicare Advantage that would shift the health cost to the federal gov't in order to get bigger raises for their current workers. The unions/NYC are pitting retirees against current workers.

There's a lot that's critically important about this post. And we can start here: "health care" in this country is far more expensive than it is in any other country, and our results are worse than many. We just spend too much, and we don't get our money's worth. This is a longstanding problem, and it is not caused by Medicare (Dis)Advantage. It is true now, and it has always been true, that the commonest cause of personal bankruptcy in this country is an inability to pay medical bills. Nothing (not health insurance, Medicare, the ACA, or anything) has fixed that problem. The government in this country does not exert, and has never exerted, effective pressure on the "health care" system to keep costs controlled and reasonable. When this post talks about "lobbying Congress," that's what the "health care" industry lobbies Congress about. One partial exception, which the government should have adopted more broadly, was a scheme called the "Diagnosis Related Groups (DRG)" back in the 1980s. That program compensated hospitals in advance a fixed fee for treating Medicare beneficiaries, and the determinants of the fixed fee were the admitting diagnosis and any other diagnosed problems (comorbidities). The medical guilds and vendors were up in arms about this (because they relied on hospitalizing people who didn't need to be in the hospital), and keeping them there as long as the doctors wanted to continue to create a daily bill. To give a specific illustration, I was in Miami Beach, which had four complete and fully functioning hospitals at the time. It has one now.

One question that could be asked is why the government wanted to outsource Medicare to Medicare (Dis)Advantage in the first place. And there are two, or three, answers. One is the right wing love affair with privatizing things. A second is that "health care" continues to be too expensive, and Congress mindlessly imagined that privatizing would make "health care" more efficient, and consequently less expensive. (And Congress was moved to entertain this fantasy because of the "unethical marketing" to which it was subjected: lobbying.) And paying off Congressmembers to do whatever lobbyists want done is the third motivating factor.

This post mentions an idea that gets publicity and advocacy from a few places: a "single payer" system of reimbursement. The fact is that most advocates of single payer are only telling themselves that it cuts out a collection of middlemen. Which it does, but this is a minor part of the problem. If one payment source is overpaying everyone, how much of an advantage is that over various payment sources overpaying everyone? The task is to stop overpaying everyone. In theory, a single payer could do that by representing so much of the reimbursement that it would have real and strong bargaining power. But Congress, which loves that lobbying money, has been very resistant to limiting what people and providers and vendors in the "health care" industry can make. And until someone does that, we're all just pissing into the ocean.

I strongly recommend Michael Moore's "Sicko." He focuses mostly on Canada and France, and he shows that in a properly run system, where health care is a public service, and not just a means of mining for gold, everyone gets what they need, no one gets what they don't need, patients don't pay (because the cost of the system is covered by adequate taxation), and all providers and vendors make what they need, but no one gets rich. That's the answer.

Fred (MD)

PS: It might be a sick joke that Congress' attempt to rely on Medicare (Dis)Advantage to make the system cheaper has actually made it more expensive.

We are a proud Union Strong family who are now retired. My husband's Union Benefit package includes Medicare Advantage. We contacted the Benefit Office to insist we be removed from that portion of our benefit package. They insist we have no choice in the matter because the Union Board voted to include the scam rip-off program. It would be terrific if this issue was addressed by activists fot Medicare justice.

The link at "400 members of Congress signed letters last year" does not appear to be working; tested in multiple browsers.

I believe one reason that Medicare (Dis)Advantage continues to grow is that many seniors have no idea they are enrolling into a private insurance scheme.

My wife and I are bombarded with a deluge of junk mail from (Dis)Advantage health insurance peddlers, especially around this time of year when Medicare enrollment is about to start. All of these come-on mailers look very governmental and officious, making it hard to discern them from genuine federal Medicare information.

I recommend the August 2023 issue of The American Prospect (entitled The Business of Health Care: How corporatization is cracking the medical system) for an in-depth dive into the cesspool of privatized health care in America. It's a grim but enlightening read.

And many thanks to The Lever for its continuing coverage of this immensely important issue.

It's the dental, hearing, vision and no charge prescription benefits along with the no charge or minimal charge doctor visits. When signing up no one sees the refusals to pay, the kickback schemes, the over charging of Medicare, itself. The proposed Medicare for All would provide all those same benefits without the scams and would save billions of dollars for patients and for Medicare every single year. But we are dealing with a political system that has almost entirely been bought by corrupt privateers.

Creating pathways for individuals and our Unions to move to Medicare, is key, as we age from younger to older retirees.
I want to be seen as getting it right, so I dig in.
No Worries.
A true sign of character is the unwillingness to say, "I got it wrong; and now I/We are making it right.
Pay it forward.

Thank you for covering this topic. However, one thing that needs to be pointed out re: traditional Medicare: doctors do not have have to accept Medicare. That needs to change.
Also, have you looked into denials of care/payment from Obamacare plans?

I'd like to add to my previous comment. As your article states, "In most states, once you enroll in a Medicare Advantage plan, it is nearly impossible to go back, since Medigap insurers can deny coverage to patients with preexisting conditions once they’ve opted for Medicare Advantage." That's due to a "loophole" that I think could be closed by Federal legislation. The ability for anyone to ditch (Dis)Advantage and go back to real Medicare would be a huge game changer.

Thanks for taking this on. "Medicare Advantage drains money from the Medicare trust fund — taxpayer money designated for the program and managed by the U.S. Treasury" — the trust fund is a legal requirement, not a funding one. Chapter 6 in The Deficit Myth explains. Problem with positioning this as contingent on the trust fund, is, it leads people to believe taxes fund Medicare and that we are in crisis because there is not enough money (and we need private plans that are cheaper). Congress should abolish the trust fund and just appropriate the money.

I am quitting my membership of AARP. They touted these dis'Advantage"Plans. They should know better. They reveled themselves to be a corporate front for BIg Pharma, Big Health, Big Insturance propaganda. I am sooooooootired of being ripped off by corporate profiteering.
Congress needs to start acting on the behalf of the American People rather than sucking on the corporate, billionaire titty and do their jobs. If they do not, America will not survive as a democracy.

The lure is, as Paine Sense posted, "the dental, hearing, vision and no charge prescription benefits" offered. Is there an article about how catastrophic dental issues can be to health, especially to older people, that might work toward getting dentistry covered as essential medical care? How do you carry out the "activities of daily living" if you can't read instructions and signs? How do you follow your doctor's advice if you didn't understand what she said?

When I qualified for Medicare I looked at the Medicare Advantage programs and like someone else said above, I only noticed the surface benefits. Once I educated myself with folks like Lever News and Wendell Potter, I switched back to traditional Medicare this year. I couldn't get a Medi-Gap policy, but I'm fortunate that I can probably cover the 20%.

BTW, for those not familiar, Wendell Potter is a former health insurance company executive who has a company and a Substack blog where he advocates for single payer, details the greed of the execs in the health insurance companies, and tries to get Congress and regulators to get moving.

His blog is definitely worth a look. He's become one of the good guys.

I’ll be 65 in 2024. I dread the Medicare decisions. All of my older siblings and friends (most are progressive Democrats) are on Medicare Advantage because of the ‘perks’ mentioned in other comments. They have not been unhappy with their coverage. Not yet anyway. I’ve talked to them about this privatization issue, but they insist that it saves them a lot of money. How can you convince someone it’s not in their best interest? I know it’s likely that once privatization is complete, that’s when the perks, or dangled carrots, will disappear.

The root cause to why people choose (Dis)advantage plans is that making a fact-based, intelligent decision is simply too difficult. For that matter, it's also true that making a good decision about Medigap and Drug Supplement plans is very difficult. Many seniors make the mistake of buying the most expensive supplements thinking that ensures the best coverage. Not true. I swear the insurance companies throw out these high priced and low value plans just to trap buyers who don't know better. So Yes... (Dis)advantage plans are worse coverage when you become ill but traditional Medicare gap/drug plans vary widely in price and can be very bad financial values if you are not willing, or able, to do the difficult work of choosing the right plan for your situation.

I am very proud to support the Lever. This work is excellent and so important. Please stay on it!