Yves here. For those of less than advanced years, it might seem a bit parochial to spend a lot of time discussing Medicare. But aside from the fact that it is a large and popular program, its evolution is also a case study in privateering being held at bay, at least to a fair degree, via activists and the public at large.
So even for those cynics who regard the idea that social safety nets can be strengthened as naive, consider that making that demand early and often does make it harder for the neoliberal looting to proceed as quickly as it otherwise might. Here, in the case of Medicare, it’s important to stress that Medicare Advantage has been successful only in terms of private sector enrichment. No one admits in private company that aside from suckering seniors with misleading ads, another aim is to create a two-tier Medicare system, with “free” as in no-fee Medicare Advantage plans with skimpier coverage for the comparatively poor.
By Ed Weisbart, MD, a retired family physician in Olivette, Missouri, and board secretary of Physicians for a National Health Program. Originally published at Common Dreams
Fifty-nine years ago today, President Lyndon Johnson signed Medicare into law—a high-water mark in the fight for universal healthcare that had started decades before and that continues to this day.
Ever since Medicare became law, it has been a shining example of what is possible in U.S. healthcare: a truly public, truly universal program that has saved countless lives and prevented untold financial ruin among America’s seniors. But alongside this success, corporate health interests have also grown immeasurably more powerful. Insurers like UnitedHealthcare and Blue Cross Blue Shield have erected cruel barriers to care and are laughing all the way to the bank.
If we want to build on the promise of Medicare—and win the best possible version of Medicare for All—then we’re going to have to grapple directly with the power of corporate health insurance. That starts with taking on the so-called “Medicare Advantage” program.
The Strategic Importance of Medicare Advantage
Single-payer advocates understand that there can’t be “Medicare for All” if there is no “Medicare.” And no, Medicare Advantage (MA) doesn’t count as Medicare. The health insurance corporations that run these plans have a business imperative to prioritize profits above all else; this is anathema to any public health program.
Physicians for a National Health Program (PNHP) has compiled overwhelming evidence that MA insurers are harming patients, physicians, and hospitals by delaying and denying care—harms that are virtually unseen in Traditional Medicare. Nor is this cruelty even a trade-off for lowering the cost of healthcare. In fact, these corporations are paid far more than what is spent for similar patients in Traditional Medicare—up to $140 billion per year, or as much as 35% above the funding levels of Traditional Medicare.
There is no road to Medicare for All that ignores this existential threat.
Thankfully, support for eliminating overpayments to MA extends far beyond those who are already committed to single payer. This fight builds our movement by mobilizing a wide range of people who understand, or can be educated about, the damage insurance companies are doing to patients. When we find common ground, we should walk together.
For that reason, PNHP is exposing MA overpayments and demanding a more fiscally responsible approach from policymakers. We are working closely with several organizations to change the national conversation and provide a badly needed counterweight to the lobbying might of big insurance.
When MA was created, way back in 2003, corporate insurers promised to reduce the cost of healthcare by improving care coordination and health outcomes. A healthier population, they claimed, would be less expensive. We should demand that MA corporations live up to these lofty promises without billions of dollars in overpayments.
We’d like to see them try.
Improved Medicare… for ALL
Winning back $140 billion in annual overpayments begs a tantalizing question: How can we use those funds to improve Medicare for all seniors?
Instead of the paltry benefits that MA plans offer, those funds would help us add robust hearing, vision, and dental benefits; totally eliminate Medicare Part B premiums; and fold in the Medicare Part D prescription drug benefit. Imagine the relief a senior on Medicare Advantage would feel when enrolling in a plan that actually covers the full range of dental care, while also freeing themselves from the narrow provider networks and prior authorization requirements imposed by MA plans.
Most critically, we need to establish a low out-of-pocket maximum for Medicare. Insurance corporations lure seniors and people with disabilities into the MA trap by selling lower up-front costs while hiding substantial barriers to care. It’s a classic bait and switch. Eliminating the need to purchase Medigap would level the playing field and allow everybody to remain in Traditional Medicare.
Well, not everybody—but that’s our ultimate goal. PNHP advocates for a national single-payer health insurance program, and what better way to get there than through an improved version of the already popular Medicare program?
Where we see middlemen standing between patients and the care they need, we should remove them. Where we see limited provider networks, we should expand them. Where we see piles of pre-authorization paperwork, we should shred them.
We should also expand benefits to include all medically necessary care, and ultimately eliminate out-of-pocket costs that deter people from seeing a doctor. Once these improvements are in place, we will have a program that’s truly worthy of the name Medicare for All.
The advocacy work for these priorities—ending MA overpayments, improving Traditional Medicare, and realizing our vision for single payer—overlap and build on one another.
Let’s work to build a movement of seniors, physicians, students, people with disabilities, and everybody else who cares about Medicare. Together, we can take on the corporate insurers that are wreaking so much havoc in our lives and lay the groundwork for winning a single-payer program that brings everybody in and leaves nobody out.
I’m skeptical of “winning back”, although it’s noble idea. Doom loops exist outside of climate, and here we see one. (Another, with similar barriers to throwing the bus in reverse would be Citizens United.) The eradication of for-profit insurance (and the FIRE sector in general) from within the health field won’t come from policy/regulation corner. A cocktail of higher interest rates and surging climate/war/pandemic caused claims might do the trick, but with serious collateral damage.
I’m 71, and rarely seek medical help, but keep my rear covered with, what I’m told, is a great supplementary plan to basic Medicare. I’ve watched cancer bankrupt one friend, and have seen the bills for two other patients. You would think I was pretty well covered, but it’s not free. My supplement plan costs me over 2500 a year. Yeah, a lot less than a decent family plan, but, still, it’s an illusion that our health care costs will be like living in France if we all get Medicare For All. Furgetabout a drug plan, that would cost me almost 2000 a year, and dental and vision plans are a blatant rip off. I’ll take my chances and pay cash, please.
So, anyway, last month I went to an urgent care facility for a bee sting that closed my eye and poison ivy everywhere. It wasn’t pretty. So I get a bill in the mail yesterday for 130 dollars for this treatment. What’s this, I ask. Oh, it’s your deductible portion. I never knew, outside of routine checkups, I had a Medicare deductible at $250. I thought, hey, Medicare, I’m out and beyond the world of petty deductibles. Nope. Even our great Socialistic medical benefits for seniors still has to stick it to you, just a bit, to remind you who’s boss, and nothing is free in this world. Even if you pay for it.
FWIW – I am highly allergic to Poison Ivy and spend a of of time in the woods. I have discovered “TECNU”. It’s a game changer. It can be found in any drug store. Whether you have a full blown case or know you’ve been out in it and want to be proactive. I lightly scrub it all over my legs/arms and the itching is gone and the rash slowly dries up. Works on many kind of bites/rashes.
Also, Jewelweed is often found growing alongside Poison Ivy – it also is a good cure, just rub the juice from the plant on effected area.
Best to you.
TECNU is also very useful as preventive, if one knows that one has contacted PI. IIRC it denatures the toxin and can prevent rash symptoms from developing at all.
I do not think that Medicare for all will work, because the management will be outsourced to the medical insurance companies.
This is why we need a national health service instead.
That has not happened to Traditional Medicare.
My total Medicare out of pocket costs last year for a couple was over $10,000. Yes, that what it cost if you add all the co pays, deductibles, medi gap, prescription premiums, etc. Many people pay significantly more.
This is essentially a “high deductible” insurance scheme. M4ALL can’t be won without exposing the abject corruption of both political parties who do nothing to stop privatization and the tax payer subsidies, let alone fight for a national system. A movement is needed, and it’s not going to happen unless we realize that the Democrats have abandoned national SP for insurance care, and incrementalism for the gullible.
Some people even cheer when Congress happily abandons all responsibility for HC and tell you to get it via a state plan. WTF…
Medicare was originally a quasi SP system and was useful to help educate and explain the waste of the for profit insurers when discussing the need for SP. As my $10,000 out of pocket costs with a Medi Gap plan and the crime of MA show that we need a mass politically independent movement that can galvanize the existing support and the screwed over public into action.
How can Dems, unions and the beltway non profit insiders who gave us the ACA insurance care and fought against even the exposure and collusion via Force the Vote in Congress lead us? Despite strong public support, we are left with the crumbs of the thoroughly compromised Democrats who are now defended as “this as all you can get opportunism.”
Don’t despair but look at things realistically for a way out. It’s not lobbying and political horse trading but growing our power via mass actions and building coalitions to change the conversation of what’s needed and possible. Yes, a tough road but the only way out.