Health insurance is big business. The insurance called Medicare Advantage is a massive business. Profit-making private corporations using that name make their money from all of us who pay into our public health care system for those 65 or older: Medicare.
The “advantage” plans are technically Medicare in that they have since 1999 “Part C.” I was rather taken aback when I discovered that. Part C was established by the Balanced Budget Act of 1997, effective January 1999. Some people object to private corporate use of the name of a Federal government program. However, they sell so well that they avoid legislative reform. Quoted in a New York Times article a year ago, Representative Lloyd Doggett, a Texas Democrat who chairs the House Ways and Means Health Subcommittee, said, “You have a powerful insurance lobby, and their lobbyists have built strong support for this in Congress.” An indication of its bigness is the amount of recruiting going on during the time that is called “open enrollment.” We taxpayers are supporting that recruiting.
Check out the number of “Medicare Q and A sessions that have been booked at our public Community Center. These were also advertised at the literature rack in City Hall at no cost to the enterprises. There were 6 “x 11” heavy stock cards on the rack advertising “Medicare annual enrollment workshop meetings.” You don’t have to enroll annually in Medicare.
These cards clearly stated, “These are sales meetings.” Four meetings were listed. There were also fliers for the sessions at the Community Center. The “Medicare” sessions–there were at least four of them –were billed as “informative.” They were hosted by insurance brokers who were advertising various insurance companies.
One broker said he paid nothing because it was an “educational” event. He passed out bags with the insurance company name and literature, pens and hand sanitizers, and his card and he had little slips for people to sign up for a session with him. The cost for a non-Fullerton business is $80 an hour. Two of the brokers were from Brea and Garden Grove. A large Fullerton organization held a four-hour-long “Medicare Expo” in the gymnasium area. The price to rent a half gym for a Fullerton business is $90 an hour. I do not know if this enterprise paid fees. There were many tables for various brokers and six for insurance companies listed as “Our Medicare Partners.” The enterprise offered packaged snacks, chapsticks, pens, water, and tissue packets advertising “Affiliated Physicians.”
One broker said he was paid $30 monthly for each person enrolled with an insurance company. He said all insurance companies paid the same to all brokers. I asked how the insurance companies made money from signing up an older person. He said they estimate your health, then tell Medicare how much they want to cover you. He quickly eyeballed this reporter and said, “..for example, $15,000 for you.” I said, “So if I don’t use that much in medical care, they keep the rest of the money?” He said that was correct. He said the big companies will send a nurse to a prospect’s home to do a medical check so they can better estimate what your care will cost per year.
As stated in the New York Times last October, “The government pays … with higher rates for sicker patients. The insurers have developed elaborate systems to make their patients appear as sick as possible, often without providing additional treatment, according to the lawsuits. As a result, a program devised to help lower health care spending has become substantially more costly than the traditional government program it was meant to improve.” (The government has brought lawsuits against many “Advantage” insurers for frauds of various sorts.)
Dr. Donald Berwick, a former C.M.S. administrator, quoted in the Times, said, “Even when they’re playing the game legally, we are lining the pockets of very wealthy corporations that are not improving patient care. It has been estimated that the government gives enough money to Medicare Advantage insurers for additional diagnoses to cover hearing and vision care for every American over 65.”
We also fund the numerous emails that Medicare sends out, telling us to check into enrolling in an “advantage” plan. Even my congressman, Lou Correa, sent such an email notice to me on October 21; I had sent him an email on October 5, asking that he advocate reform so that private profit-making corporations could not use the honorable name “Medicare.” I was incensed! I sent back a letter of stern rebuke.
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Thanks or the article. The Clinton era sellout of Medicare to corporate insurers happened in the aftermath of Hillary’s disastrously fumbled attempt at universal healthcare for all Americans, effectively blowing the issue for a generation. We are the only industrialized country without a universal healthcare system, saddling many Americans fortunate enough have insurance with needless bureaucracy that adds an estimated 30% to medical bills. Don’t look to corporation-friendly Delaware Joe Biden for any leadership, but California did, after several attempts, finally pass a bill exploring the process. Yes, that actually counts for progress, even though Democrats, who have universal healthcare in their party platform, control the state government. it’s only more frustrating to find out that private insurers operating on the public dime extends to local government. I’d love to know if they paid for the use of public facilities. (While writing this comment I received yet another robot phone call trying to sell me Medicare benefits, and I don’t even qualify for it yet. I’ll bet everyone reading this comment gets those calls every day.)
“The Clinton era sellout of Medicare to corporate insurers happened in the aftermath of Hillary’s disastrously fumbled attempt at universal healthcare for all Americans, effectively blowing the issue for a generation.”
You can only pass what the American people believe they want, and what the Congress they elect is ready for. Blaming the people at the very top spearheading changes for the final outcome is almost always missing the forest for the trees.
Who were the bad guys in the process? It certainly wasn’t the vast majority of the Democratic party that in both time periods wanted universal health care. It was those on the fringes of the Democratic party and more importantly ALL of the Republican party that were ready to kill any reform. So, no, not really “fumbled.” That’s to place the blame in on the wrong people.
Both Hillarycare and Obamacare were reasonable approaches to a difficult problem in a nation that has not decided it needs or wants socialized medicine. Both plans were savagely and of course unfairly attacked by vested interests. Hillarycare failed but that doesn’t mean they did anything wrong. The American people were simply snowed by vested interests… remember that iconic and effective “Harry and Louise” ad.
Ultimately the promise of a comprehensive health care reform was delivered on by Obama and Biden, but they almost didn’t manage to get it done either.
As to the “sellout” of Medicare… Part C was a reasonable reform to allow people to *choose* a private plan. It was reasonable… competition between public and private keeps both honest as long as it is truly a choice which it is. Part D which the Republicans did alone is OK too except for the explicit prevention of drug price negotiation which has been very costly.
“Socialized Medicine” is a term used to scare people away from universal coverage. Single Payer healthcare does not envision healthcare workers as government employees any more than single payer auto insurance would require government owned auto repair shops. Conflating the two terms is misleading.
“Who were the bad guys in the process?” Lobbyists for insurance companies and the politicians who cater to them instead of to their constituents, that’s who. Get the money out of politics and we’ll see Congress do what Americans actually want, not enact periodic half measures like Obamacare, etc.
Single payer, socialized medicine… I think most people understand it either way. Yes the doctors don’t work directly for the government in any proposal I know of.
If ultimately the government/taxpayer is paying for it, costs are going to run out of control. But the same thing happens with private insurance, because those getting the care aren’t writing the check to pay for it. They pay for premiums but that only indirectly pays for care. Costs run out of control.
Ultimately it doesn’t really matter much who the “single” payer is. If you don’t pay it out of your pocket there is little to no control on the price. And it’s likely there can be no such control for “big” health care expenses since the patient has no real ability to make a rational economic decision on their own care. The doctor is the expert, not the patient/consumer, and nothing about getting health care or our system make it possible to really shop around.
I disagree that Obamacare was a “half measure” nor is it “periodic.” It was quite comprehensive. And it would be nice if we could count on periodically doing such significant reforms. It was a massive reform that went as far as the working majority in congress and the will of the American people could take it. And that was quite far particularly with the Medicaid expansion. Unfortunately the Supreme Court made Medicaid expansion more optional for the states than Congress intended.
“Get the money out of politics and we’ll see Congress do what Americans actually want”
First we’d need to get the right wing Supreme Court and to a degree, the Constitution out of politics (“money = speech”). I’m not holding my breath.
I think both of you make good points. Here is the overarching reason I support a single payer, socialized system:
In our current system, commercial payers are incentivized to delay paying for your medical costs, anticipating that you’ll jump to another employer, and thus another health plan, in a few years. Your medical problem may worsen, and your costs may eventually go up because of it, but hey, at least your current insurer isn’t paying for it.
Meanwhile, a socialized, cradle-to-grave system is incentivized to provide excellent preventive care, since they’re paying for it no matter what. We would pay for this service with taxes. I currently pay hundreds of dollars per month for my useless commercial plan, and another huge sum for Medicare. I would gladly pay all of that toward a socialized system; I, as a young and healthy person would be subsidizing care for others, and that service would also be there when I need it. Plus, there are no shareholders.
For years, Medicare Advantage has been defrauding Medicare and siphoning money away from Medicare. Medicare’s budget neutrality has led to declining reimbursements for a lot of specialties, giving rise to the shameful rise of hospital consolidation, private equity takeovers, managed care networks, monopolistic vertical intregration (a single private payer might own the healthcare plans & networks, the ASCs, the practices, the pharmacies, AND the PBMs), and scope expansion efforts by non-physicians like NPs, PAs, and ODs thanks to cost-cutting measures by PE firms and the like, all leading to poorer-quality care for you and me.
The Affordable Care Act had some positive effects, but it also partly led to some of the problems we see today. Requiring everyone to have a health plan was good, but a lot of those plans are commercial, meaning zero cost regulation. As a result, plans that would have been considered “catastrophic” 15 years ago, with obscene co-pays and deductibles, are offered as regular plans today. Physicians were barred from owning hospitals, meaning MBAs with no clinical background are making terrible decisions for patients and doctors. Medicaid expansion is good, but since Medi-cal reimbursements are insultingly low, few physicians (especially specialist surgeons) are willing to accept it, meaning networks are small and physicians who do accept it must make revenue through volume, further degrading quality of care.
Publicly-traded, commercial payers are a scourge on this country and we’ve let them absolutely destroy the quality of American healthcare. They’re making record profits while offering horrible quality care with stipulations that are cruel, even evil. A single-payer system would not likely cost significantly more, but it would greatly enhance quality of care, expand patient access to care, reduce physician burnout, and reduce costs for individual patients.
“If ultimately the government/taxpayer is paying for it, costs are going to run out of control.” I can’t afford to build most weapons systems either, but there they are in every budget. It’s just a matter of priorities. In this society we choose to build (and sell) weapons instead of a comprehensive healthcare system. The money/wealth is there, it’s just a matter of where we spend it.
Thank you very much for this important article. Medicare Advantage is a scam, and most of the major commercial payers are being investigated, or have already been fined hundreds of millions of dollars, for defrauding Medicare.
Last year, at our own Fullerton Thursday market in the downtown plaza, United Healthcare set up a tent to sell plans. The tent used the traditional red/white/blue striping of Medicare cards, and said something to the effect of ‘Sign up for Medicare plans here.’ It wasn’t until you got to the table and closely read their brochures that you realized that it was run by UHC, perhaps the most malicious commercial insurance payer in the US. The MA advertising tactics are deceptive.
When is the last time you saw a commercial for traditional Medicare?
Next up on the list of topics that are destroying American healthcare: private equity, hospital consolidation, vertical integration, pharmacy benefit managers, and the breathless rise of managed care.
We are the only G20 Western Industrial country NOT to have a national health plan to cover EVERYONE.
… and we have the worst patient outcomes, and spend the most per patient!
Ah, but we can’t learn from anyone else, can we? We’re exceptional! We’re #1! “USA! USA! USA!”
Urgh…Anyone got any Pepto…?
I think semantics is also an issue. There’s a massive difference between: “universal” healthcare and “single-payer” healthcare.
From Article 25 of The UN’s Universal Declaration of Human Rights:
Article 25
Section One: “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing _and medical care_ and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.”
=============================
Guess who pushed for those elements in the UDHR in the UN’s founding stages: WE DID, the US did! It’s a bloody shame we can’t practice what we preach to the world, eh?
I’m so tired of living through this Second Guilded Age with it’s Billionaire Worship Ethic I can’t stand it. We could fund anything we wanted to if we went back to a tax structure like we had after WW2; it led to the biggest and longest expansion of the economy is US history, 1945-1973. You want the money for universal healthcare, good healthcare, the right of every human being? START TAXING THE BILLIONAIRES LIKE WE SHOULD!
I’ll just sign off with a quote:
“It was once said that the moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; and those who are in the shadows of life, the sick, the needy and the handicapped.”
-Hubert H. Humphrey