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As I mentioned
earlier, I was going to discuss the
Medicare Advantage program more, but nothing could do
it better than the document by the Medicare Rights Center (See
the complete report
HERE). Among the findings of the Medicare Rights Center:
1. Care can cost more than it
would under Original Medicare;
2. Private plans are not
stable;
3. Difficulty getting
emergency or urgent care;
4. Continuity of care is
broken;
5. Members have to follow
plan rules to get covered care;
6. Choice of doctor, hospital
and other providers is restricted;
7. Difficulty getting care
away from home;
8. Promised extra benefits
can be very limited;
9. People with both Medicare
and Medicaid can encounter higher costs.
Medicare:
To take Advantage, or not!
by Jack Lohman
Thanks to a
little gift from your favorite congressman, there's confusion
over Medicare and Medicare Advantage. Not happy with the
simplicity of plain-old-vanilla Medicare (and the fact that
insurance companies were left out of the financial loop),
congress came up with the bright idea of introducing
"competition" into the public system. They allowed private
insurers the opportunity to provide health care services to
Medicare patients.
For some
patients the plans work okay. But unfortunately for the
taxpayers, Advantage is 12.5% more costly than what straight
Medicare pays, so the myth that the private sector is cheaper
than the public has been terribly shattered. They do have added
costs, like marketing and actuarial, which is the process of
deciding which patients to allow into the system and which to
deny. Thus we pay extra for their sales commissions and the
cherry-picking that draws healthy people from the senior pool
and makes real Medicare look less efficient.
Traditional
Medicare is probably the only part of our health care system
that does work well. It didn't need competition, but if it did,
paying private insurers 12.5% more dollars is not the free
market approach most of us would expect. It's just another
government giveaway to private industry.
Medicare
patients currently go to their doctors for care and the
government pays the bill though a private administrator (which
is WPS in Wisconsin). What could be simpler? You get sick; you
get care; and the care-giver gets paid!
The biggest
disadvantage with Advantage (pun intended) is that the
government pays the private insurers a lump sum per patient, and
whatever health services the plan can avoid providing goes to
the bottom line in profits. Thus there too often is an incentive
to deny services even when the patient is in need, or to have
"pre-authorization" requirements that are easily overlooked by
the patient, who then gets stuck with the bill rather than the
plan.
To be fair,
some Advantage HMO plans have tried to offset these issues by
adding additional services, like limited dental and vision, but
still these features can have tricky referral and
pre-authorization requirements that void them. Medicare
Advantage plans can also deny coverage when hospital admissions
are not pre-approved, thus sticking the patient with a massive
bill. That's great flexibility, but it's all theirs.
In regular
Medicare physicians are reimbursed on a fee-for-service basis
and they get paid no matter how many times you see them or tests
they perform. But you are not denied care. If anything it can
actually increase costs to the government, especially if the
tests add profits to the physician's bottom line. But even while
providing more testing, Medicare's outlay per patient is still
12.5% lower than the Advantage system, and most certainly lower
than the high-profit policies. But we taxpayers are generous.
Our problem
is not competition between the various insurance entities; it is
systemic. A true single payer system, like the Medicare-for-all
system proposed by Sen. Mark Miller and Rep. Chuck Benedict
(SB51/AB94), would eliminate the gigantic waste of the insurance
bureaucracy which consumes roughly 30% of health care dollars
without ever providing direct health care services. The Health
Security Act would cut in half these administrative costs, add
dental and vision, eliminate co-pays and deductibles, and still
provide coverage for 100% of our population, all at a lower cost
than our current privatized system.
State
politicians can fix the problem if they are willing to shun the
delaying tactics being used. We've seen enough experiments; they
must simply sideline the special interests and adopt the
Miller-Benedict bill. Business needs it, and so does our
economy.
-- Jack E. Lohman is a retired business owner from Colgate, author
of "Politicians -- Owned and Operated by Corporate America" and
founder of
www.ThrowTheRascalsOut.org. He can be reached at
jelohman@gmail.com.
As bad as Medicare Advantage is, the pragmatic side of me
suggests that if we allowed this "private alternative" in
our single-payer battle we'd leave a role for the insurance
companies and make
our single-payer win more politically viable. (Got to think
of those politicians, don'cha know.)
At the moment 81% of seniors have chosen traditional
Medicare and 19% use Advantage, thus we are allowing the
private industry "something" and less to complain about.
Though they'd clearly prefer it all. So far they have not
shown us the cash benefits of the highly touted private
market, already being more costly than the government system
and promising to go even higher.
But I'd demand several things. First, they must provide at
least the services of Medicare, and eliminate
pre-authorizations and etc. Secondly, they must provide it
for the same price rather than 12.5% higher. And finally,
they must accept all comers and eliminate the cherry-picking
and denials. That levels the playing field with Medicare and
if they can achieve or better that, good for them. We can
co-exist.
My concern is that in order to offset their marketing costs,
they have to give up something in patient care. But if we
can later tighten the requirements the industry may just
decide to sit this one out. If we do that too soon they'll
just stay and fight. It's a tough call, especially knowing
that it is an inferior product being foisted upon the
public.
A friend of mine uses
Advantage and likes it, but of course he doesn't realize
that it costs the taxpayer more and probably doesn't
care. He also may not feel the affects of an abbreviated
service yet, and hopefully never will.
But all of
that said, if we can introduce competition for the
government why can't we turn the tables and create a
government entity that competes with the private oil
companies? They aren't investing in drilling because the
short supply keeps prices up. But with a public entity out
there drilling for public oil that will later compete on the
private market, increase supplies and bring prices down,
you'd think that's exactly what our congressional
representatives would want for us. Yeah, right!
See these
talking points: Medicare is not the problem, it is the
solution. Frankly, it is the only American health care system
that is not broken beyond repair!
"If the government paid the insurance
companies offering private Medicare Advantage plans the same
amount it costs to care for someone in the government-run
Original Medicare program, we would save $8.1 billion in
2008 and $159.8 billion by 2017.
If Congress required
Medicare to use its huge buying power to negotiate lower
drug prices directly with pharmaceutical companies it could
save $30 billion a year."
Official
Wisconsin Medicare Advantage
rules and information can be fond
HERE, or do
your own
Google search.
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Election
Night, November 7, 2006, exceeded all of our expectations. We
Republicans expected to take a hit that night, but the hit was
even deeper and sharper than anticipated. Gathered around
televisions -- in family rooms -- in up-north bars -- and in hotel
banquet rooms with political party faithfuls -- the sting was felt,
heads were shaking, fingers were pointing. Republicans fidgeted
as the results appeared across the screens, while Democrats
likely felt the elation of winning the battle of vindication.
