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Is Medicare a Public Good or a Market Commodity?

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Seniors, beware: Traditional Medicare is under attack. It was established 56 years ago for the health benefit of all seniors and those with chronic disabilities. It is already almost half gone — and without public outcry it will never return. 

Medicare disintegration started with a program with the misleading name of Medicare Advantage, run by a number of for-profit health insurance companies. MA now serves 46 percent of former traditional Medicare enrollees and has been promoted by celebrities, glitzy advertising, promises of increased benefits and lower premiums. What they don't tell you: In order to increase profits, they create networks that limit your choice of doctors and hospitals.

MA practices the more unsavory methods of fleecing the system to seniors' disadvantage. It prefers to insure the healthiest of seniors, a practice called "cherry picking." If one becomes very ill or develops a rare disease requiring specialty care outside the contracted network, this may not be covered — a practice called "lemon dropping," forcing that client from the MA plan. Thus, the unfortunate senior has to wait to sign-up for traditional Medicare during the narrow, few months' enrollment period.

The most insidious (and illegal) practice is reviewing the health history of enrollees and fraudulently making them look sicker than they are in order to receive a higher compensation from the Medicare Trust Fund. Never has there been a more egregious bait and switch poisoning health care performance and security. Many mega-corporations have been fined repeatedly for this practice — for them a mere wrist slap. Bottom line: The less they pay for you, the more they pocket for themselves and shareholders, their top concern.

But wait, there's more: Under the Trump administration, another unsavory corporatization scheme was launched through the Affordable Care Act, allowing for certain "innovative programs" to be initiated without oversight from Congress. These programs, called "Direct Contracting Entities" (DCEs), are continuing full speed ahead under the Biden administration. DCEs are loosely defined. They may be a health insurance company or a private equity firm that inserts itself between patients and physicians, managing treatment and payments in a way similar to MA. A big difference is that MA programs are required to spend 80 percent of their payments from the Medicare Trust Fund for medical care of their enrollees, keeping 20 percent for profit and overhead while DCEs are allowed to keep a whopping 40 percent of intake. It should be noted that Medicare's overhead is 2 to 3 percent with no profit. 

Some 53 DCEs are already operating in 38 states, including California, affecting some 30 million former Medicare beneficiaries. They do this by enticing physician practices to sign up with promises of increased salaries and decreased administrative burdens. Once the physicians are signed up, the DCEs have access to the panel of traditional Medicare seniors they are treating, who are then automatically "aligned" with the contracting company. Unbelievably this is done without the seniors' knowledge or consent. Once aligned, it is very difficult for a senior to return to traditional Medicare and even harder to sign up for supplemental insurance. Initially seniors are promised they have a choice of physicians and hospitals. But, this can and will interfere with the companies' ability to make enough profit to satisfy their shareholders. Driven by profits, DCEs will ultimately constrict the choice seniors were promised. 

The final plan is to "align" every senior not already enrolled in Medicare Advantage into a DCE by 2030, which will mark the final death blow to our publicly funded Medicare, causing public costs to spiral upwards, bankrupting Medicare while making mega salaries for their CEOs and huge profits for their shareholders. Meanwhile, quality of care continues to decline. Gone is the choice of physician or hospital. Without Congressional oversight, the DCEs are surging forward in their efforts to privatize Medicare completely.

Assemblymember Pramila Jayapal from Seattle has sent a petition signed by 54 fellow Congressional representatives (Jared Huffman has signed on) to Health and Human Services Secretary Xavier Becerra to promote Congressional oversight of DCEs and ultimately eliminate them. Physicians for a National Health Program (PNHP), along with several other advocacy groups, have launched educational campaigns to alert the public to this under-the-radar Medicare attack orchestrated by Wall Street.

It is up to us to inform our friends, neighbors and legislators, and to demand protection of Medicare. So many of us have been working for decades to improve Medicare — and guarantee high-quality, accessible, equitable health care to all residents regardless of age, ethnicity, race, religions, job, gender identification, documentation or marital status. If by 2030, Medicare Advantage and Direct Contracting Entities have their way, there will be nothing left to improve. 


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