A Feature, Not a Bug

It has become increasingly apparent that Medicare Advantage, the private and heavily taxpayer subsidized private for profit variant of health insurance for the elderly, does not work.

It is designed to draw people in with things like paying for gym, memberships, but when the healthcare sh$# hits the fan, you face limited networks and denial of essential care.

This is not a surprise.  The goal was to create a constituency for the program and aggressive lobbying by the industry, which would eventually lead to the dismantling of the second most efficient and effective healthcare system in the United States. (The most efficient is the VA)

Well, mission accomplished, with a bill being proposed that would make Medicare Advantage the default option.  People would have to explicitly ask for the original single payer program:

A story in Rolling Stone last month offered an ominous prediction about our nation’s health care. “The right-wing policy agenda written for a new Donald Trump presidency would ‘greatly accelerate’ efforts to privatize Medicare,” Andrew Perez wrote.

That story should be seen by the millions of seniors who might not read Rolling Stone but who have traditional Medicare coverage with a supplemental policy that pays for virtually every medical bill when they get sick. Those are the people who have not yet been enticed into Medicare Advantage plans with promises of groceries and gym memberships but with little or no notice about the delays in care and the up-front, out-of-pocket costs common in many plans.

As I pointed out in an earlier story, there are roadblocks to care that have been reported by hospitals that were no longer accepting Medicare Advantage plans from some companies. The CEO of the Brookings Hospital System in Brookings, South Dakota, was candid: MA plans “pay less, don’t follow medical policy, coverage, billing, and payment rules and procedures, and they are always trying to figure out how to deny payment for services,” he said

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Stories in Stat by Bob Herman and Casey Ross have carefully dissected what patients with Medicare Advantage plans have had to endure to get needed care. As I pointed out in a post about their work, patients often struggle to get the care they need. In one story about UnitedHealthcare, the largest Medicare Advantage company, the reporters noted that the insurer’s stunning financial success was driven by “brazen behavior,” such as cutting off payments for seriously ill patients and “denying rehabilitation care for older and disabled Americans as profits soared.” UnitedHealth is far from alone in using such tactics to boost profits. Herman and Ross told of the struggle of a sick, 80-year-old North Carolina woman whose plan with Humana, the second largest Medicare Advantage company, would pay only for cheaper care in a nursing home instead of in a long-term acute-care facility.

Until the polity in the United States acknowledge that health insurers are the problem, and NOT the solution, this sort of profit driven rat-f$#@ery will only get worse. 

This needs to stop.