Medical
Disadvantage would be a more accurate name for the quasi-private
programs referred to as Medicare Advantage, as insurance companies push to
corporatize all of Medicare, yet keep the name for the purposes of marketing,
deception, and confusion.
Ralph Nader Published
on Friday, November 22, 2019 by Common Dreams
While
the Democratic presidential candidates are debating full Medicare for All,
giant insurance companies like UnitedHealthcare are advertising to the elderly
in an attempt to lure them from Traditional Medicare (TM) to the so-called
Medicare Advantage (MA)—a corporate plan that UnitedHealthcare promotes to turn
a profit at the expense of enrollees.
Almost
one third of all elderly over 65 are enrolled in these numerous, complex MA
policies the government pays so much for monthly. The health insurance industry
wants more enrollees as they continue to press Congress for more advantages.
Medical
Disadvantage would be a more accurate name for the programs, as
insurance companies push to corporatize all of Medicare, yet keep the name for
the purposes of marketing, deception, and confusion.
"All this anxiety, dread, and fear, all these arbitrary
denials of care—prompted by a pay-or-die commercial profit motive—all these
restrictions of what doctors or hospitals you can go to, do not exist in
Canada."
Elderly
people enrolled in MA will experience its often merciless denials when they get
sick. As hospital expert—attorney, physician, Dr. Fred Hyde put it: “It’s not
just what you pay, it’s what you get.”
Start
with the cross-subsidy of MA from TM. In 2009, the Congressional Budget Office
estimated these overpayments would cost the federal government $157 billion
over the coming decade. Obama’s Affordable Care Act started to reduce these
subsidies to the giant insurers, but they still amount to many billions of
dollars per year.
Add
that with Medicare Disadvantage you are restricted to networks of
vendors. That restricts your choice for competence and skills, and sometimes,
requires you to travel longer distances for treatment. This could mean fewer
enrollees will utilize their healthcare and more profits for the insurance
companies.
Under
Medicare Disadvantage you are subject to all kinds of differing plans, maddening
trapdoor fine print, and unclear meaning to the insurers arguing no “medical
necessity” when you’re denied care.
The
advertisements for Medicare Disadvantage stress that you can sometimes
get perks—gym memberships, hearing aids, and eyeglasses, as enticements, but
they avoid telling you they are not so ready to cover serious needs like
skilled nursing care for critically ill patients.
Under
Medicare Disadvantage, there is no Medigap coverage as there is for TM.
Co-pays and deductibles can be large. Under a recent Humana Medicare Advantage
Plan in Florida, your co-pay for an ambulance is up to $300, up to $100 co-pay
for lab services, and another $100 for outpatient x-rays.
A few
years ago, UnitedHealthcare corporations dismissed thousands of physicians from
their MA networks, sometimes immediately, sometimes telling their patients
before telling their physicians.
Dr.
Arthur Vogelman, a gastroenterologist, said he received a termination letter in
2013 from UnitedHealthcare. He appealed, documenting his successful treatment
of many patients. The company denied his appeal, with no reason, as it had for
thousands of network physicians.
Dr.
Vogelman called it “an outrage. I have patients in their 80s and 90s who have
been with me 20 years, and I’m having to tell them that their insurer won’t pay
for them to see me anymore. The worst thing is I can’t even tell them why.”
Except that the company wanted more profits.
After a
lengthy protest by national and state medical societies in 2013,
UnitedHealthcare began to be less aggressively dismissive.
Studies
show the main reason MA enrollees return to TM is how badly the corporate
insurers treated them when they became sick.
Medicare
itself is getting overly complex. But nothing like the ever changing corporate
rules, offerings, and restrictions of Medicare Disadvantage. How strange
it is that AARP, with its Medigap insurance business run by UnitedHealthcare,
doesn’t advise its members to go with the obviously superior Traditional
Medicare. AARP reportedly receives a commission of 4.95% for new
enrollees on top of the premiums the elderly pay for the Medigap policy from
United Healthcare. This money—about seven hundred million dollars a year—is a
significant portion of AARP’s overall budget.
AARP responded
to my inquiries into their Medicare Advantage policy saying that it does not
recommend one plan over another, leaving it to the uninformed or misinformed
consumer. That’s one of AARP’s biggest cop-outs—they know the
difference.
There
is no space here to cover all the bewildering ins and outs of what corporations
have done to so-called managed Medicare and managed Medicaid. That task is for
full-time reporters. The government does estimate a staggering $60 billion in billing fraud annually just on
Medicare—manipulating codes, phantom billing, etc. You need the equivalent of a
college-level course just to start figuring out all the supposed offerings and
gaps.
Suffice
it to say that, in the words of Eleanor Laise, senior editor of Kiplinger’s
Retirement Report, “the evidence on health care access and quality decidedly
favors original Medicare over Medicare Advantage, according to a Kaiser Family
Foundation review of 40 studies published between 2000 and 2014.”
All
this anxiety, dread, and fear, all these arbitrary denials of care—prompted by
a pay-or-die commercial profit motive—all these restrictions of what doctors or
hospitals you can go to, do not exist in Canada. All Canadians have a Medicare
card from birth; they have free choice of health care vendors. There are few
American-style horror stories there; patients have better outcomes, and almost
never even see a bill. The whole universal system costs half per capita
of that in the U.S., where over 80 million people are uninsured or
underinsured—still! (See singlepayeraction.org, for civic action to rid
Americans of this perverse chaos).
Ralph Nader
is a consumer advocate, lawyer, and author. His latest books include: To
the Ramparts: How Bush and Obama Paved the Way for the Trump Presidency, and
Why It Isn’t Too Late to Reverse Course, How the Rats
Re-Formed the Congress, Breaking
Through Power: It's easier than we think, and Animal Envy: A Fable
No comments:
Post a Comment