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.
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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.
Surging climate/war/pandemic-caused claims WILL happen, as will the collateral damage. These are virtual certainties. What’s uncertain is whether we will salvage anything worthwhile out of the debacle. The record so far is hardly encouraging, but perhaps if Americans get behind the stalwarts of Physicians for a National Health Program who have worked tirelessly for many decades to keep the dream of Medicare for All alive, we can make it happen.
Please, everyone, if you haven’t already joined them at http://www.pnhp.org, do so without delay!
Carla, the membership classifications imply that they intend this to be an organization of health care professionals. I think this increases the weight that they carry with lobbying and related campaigns. As a retiree from a non-healthcare profession I hesitate to just climb on. Perhaps there are alternative organizations of volunteers we might assist to further this effort. Do you have any favorites?
National Nurses United, when I was actively involved until a couple of years ago in Our Revolution in my state, offered comprehensive training (virtual) in M4A for anyone interested in joining the fight. NNU also offered support to organizations like OR etc in mobilizing and organizing locally.
PNHP welcomes everyone.
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.
News I can use. Thanks.
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.
Half of Traditional Medicare has already been converted to Medicare Advantage (which outsources management to insurance companies). The percentage on MA is growing rapidly. https://www.kff.org/medicare/issue-brief/medicare-advantage-in-2023-enrollment-update-and-key-trends/
And I believe the state governments are assisting MA: in Indiana it seems that if one is on Medicaid and Medicare, one must select one of four MA plans ; they also “manage” other benefits provide by the state – more privatization of government functions.
(If not forced, there is still a lot of pressure to use MA.)
Yes. Some states (e.g. PA and IL) are forcing retirees onto MA and others (like the North Carolina plan that I’m in) are making the choice between “90/10” MA and 80/20 or 70/30 Traditional. The vast majority of new NC retirees now choose “90/10” MA since the information provided makes it sound as if you’d be an idiot to choose traditional. Of course, they don’t mention the difference in quality of care – just the cost and the extra MA goodies.
I’m sure most other states are applying similar “pressure.” MA is quickly making inroads into group plans (states, unions, the handful of employers that still provide retirement health care, etc.) MA only has 20% of the group plan market now but expect that to balloon to well over half in the near future.
The TV is full of misleading ads on Medicare Advantage, and the companies send misleading mailers too..
This is not “forcing”. Again, there is NO coercion here. Ads that play on stupidity and laziness are endemic even if there effects are more pernicious in the health arena.
I don’t like these plans but I also have no tolerance for misinformation.
FWIW – back in 2018 IIRC Koch brothers did a study on Medicare for All and actually found out that it would save individuals and the government rather than increase costs –
https://www.latimes.com/business/hiltzik/la-fi-hiltzik-blahous-sanders-20180822-story.html
https://jacobin.com/2018/07/medicare-for-all-mercatus-center-report
That is a false statement.
Medicare has not “been converted”. No one at CMS force places Traditional Medicare policy holders to take Medicare language. Your depiction is deliberately misleading to try to win an argument, as opposed to be accurate and informative. That is a violation of our written site Policies. This is the second instance of you engaging in distortions in ten days, perhaps even less.
Traditional Medicare is being operated by CMS.
Medicare had allowed Medicare C, as in managed (HMO) care since the 1970s. That was pretty small until the Medicare Choice plans were renamed Medicare Advantage and allowed to include drug benefits, which under Medicare are offered as Medicare D.
No government body converted ANY plans.
I believe this is not entirely accurate. One of the new programs established under the Center for Medicare and Medicaid Innovation (CMMI) is called ACO REACH, which is essentially an HMO model that could be managed by a for-profit insurer. Medicare beneficiaries who are shunted into one of these experimental programs will NOT have the option to refuse–in fact, according to PNHP, they may not even be told.
Similarly, New York mayor Eric Adams tried to push retired city employees into an MA plan to save $600 million of city money, which the highly organized retirees fought both politically and legally, winning in both arenas. (Adams had to back down, and the union chiefs who went along suffered a serious loss in internal elections.) The retirees had the option of staying with traditional Medicare and buying a supplemental plan out of their own pockets (a breach of contract that they successfully challenged in court), so technically one could say they were not going to be forcibly converted. But the economic coercion was definitely there and in many cases would have amounted to the same thing.
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.
edman:
You should break down your $10,000. I use Medicare also and am going to the VA since they started to accept those of us who were poisoned by the water going in and out of Camp Lejeune for years.
Part B coverage is ~$175 per person or $350/person a month which equals $4200.
United Healthcare Plan N (3rd best) Supplementation Com. Insurance is ~$400/month = $4800
Part D Pharma costs for 2 = $0 monthly costs. We have nothing exotic, so we chose a plain plan.
Basic Medicare is free. If you want greater coverage then basic, you will need to pay or meet certain income limits to get more coverage under Medicare/Medicaid.
Regular Medicare is Fee For Service which is not cheap but it is less costly than Commercial Healthcare for people not on Medicare. In Medicare Advantage, the Gov pays healthcare plans to cover people over 65 also. In the MedPac report they estimated, Medicare Advantage 22% more than FFS Medicare. As reported by MedPac and CAP, this was an ~$83 billion more than what would be paid by ordinary FFS Medicare.
Commercial Healthcare is not the answer. What we pay Medicare Advantage could be used to drop the costs in FFS Medicare and also expand it to cover more people. However, FFS is not the end-all in itself.
There is a lot more to be said here. I am going to stop at this point. For those of you who wish to know more? Get the most recent MedPac report and start scanning it. The numbers are there. Healthcare in the US is a for profit enterprise which makes far more profit than it needs.
Bingo! Thanks for this post.
Ads are tax deductible as “an expense of doing business”.
What also happens here is that huge insurance companies are now buying up physician practices, such that we are getting larger and larger vertically integrated entities that own the very practices they then provide insurance for, and as this accelerates people are finding more and more of a shift to pushing MA plans at these practices. Eventually these conglomerates will spread across the country, and then the MA people can offer “national” MA plans and further erode Original Medicare.
I absolutely abhor private medical insurance, but there’s no way in hell I want M4A as the solution. I can only imagine the potential lobbying, regulations, and other general frustrations of a slow, unanswerable body running the show.
Look at Medicare Advantage invading — it would only be a matter of time or administration change for that same creep to impact a hypothetical M4A.
I don’t know the answer, but I enjoy my Health Savings Account– it should be available to all citizens. And the less middleman in healthcare obscuring, marking up, and getting their hands in the pot, the better.
Look at cost of elective vs. non-elective surgeries, electives have increased at a FAR lower rate than non-elective. No insurance involved, competition involved, and the end consumer knows the cost beforehand.
99% of people on Medicare think “Medicare for All” will hurt their existing Medicare
“Single payer”, and nothing else will do
Medicare For All was probably the wrong strategy for selling this. It should have been Medicare Expansion, namely staged lowering of the age when one could enroll in traditional Medicare. The next step, if that first step could happen, would be extending Medicare as a replacement for the patchwork of children’s health insurance programs, for at least the low end of that age group. In other words, get people used to incremental expansion of who would be covered by Medicare, so you could keep creeping the boundaries every year or two.
Medicare Advantage is almost the reverse of this, shrinking the pool of people covered by Medicare in favor of one population fully on it and a bunch of people whose coverage is in a Schrödinger’s cat state at the whim of a private entity. Of course having multiple smaller pools will make everything more expensive and subject to easier infiltration by bad actors (as in the story a week or so back of MA insurers adding fake diagnoses to patient records to allow them to bill for nonexistent conditions).
Review post by edman, 12:08.
My wife and I are healthy and active. We pay over $10,000 per year for Medicare Parts B and D plus Supplement (Medigap), not Advantage. Regarding Part D “insurance”, the government won’t intervene with the pharmaceutical industry to force reasonable pricing. One of my two drugs costs ~$2100 per year under Medicare Part D. The drug is generic in every other nation. In Canada a year’s supply costs ~$360. Under my wife’s former corporate policy the cost was ~$650 per year. Hooray for Medicare, 300% higher!
Wife recently received a perfectly routine and justified imaging procedure ordered and scheduled by her PCP. Medicare has refused to pay the claim. $443.00. The dispute has been unresolved for five months. Medicare hasn’t offered a sensible reason. M4A, right?
Oh, and we pay extra for dental insurance, not included in the $10k above. Nor does the $10k include our combined $480 deductible. And it gets more expensive every year. Medicare isn’t the answer!
Not too far in the future, 90% of retirees will be on Advantage because of pricing. Our disgusting government wants private insurance companies to control the process, and force patients to absorb the costs or forgo treatments and drugs. Politicians tweak the rotten system once in a while to give the impression that they are trying to make things better. Utter nonsense. Only a full collapse will force the necessary change. I’m not even convinced that will do it. Hope & Change have worn pretty thin in my household!
So the solution is not Medicare (improving/expanding it) and we have to hope for full collapse? I don’t like paying $3,300 a year for supplemental and dental on top of whatever they take out for traditional Part B and Part D, but I will definitely stick with that versus having no coverage at all, or getting forced to pay some private entity that can choose not to cover my expenses whenever the CEO needs a bigger bonus. I’m fortunate right now that Part D is covering the full cost of my medications, but I know in the last couple of years of my life, when my need for drugs and medical services will be greatly expanded, that I’ll have to pay more for everything. But my understanding is there is still an annual cap on how much. Without that I will undoubtedly be looking at homelessness in addition to terminal illness. Full collapse just sounds like bringing that worst outcome closer, so I can’t see that as a solution, even if it somehow magically (without proletarians waving AR-15s) causes the system to eventually correct itself.
The proverbial elephant in the room is the cost of Traditional Medicare. There’s a 20% copay and (I think) a deductible. To fix that, you have to buy a supplemental plan, and the premiums for those are above and beyond your Medicare premium (which is deducted from your Social Security payment). Medicare Advantage plans only charge your Medicare premium plus in most cases a small additional premium for various extras. The difference is hundreds of dollars a month in premium payments. That’s just not affordable for most people, which forces them into MA whether they like it or not, putting them at risk of treatment denials when they most need treatment. IOW, MA can cost them their health and their lives, because they can’t afford the Medicare supplemental coverage.
The premium differential is presumably covered by MA subsidies to insurance companies, treatment denials, upcoding, and other stratagems. Our government is paying private insurers a premium to take over–kill–Traditional Medicare.
I don’t know why the PNHP article doesn’t spell this out.
The introduction points out that Medicare Advantage is a second-tier service for those who cannot afford Traditional Medicare premiums.
Whoever on this site recommended “Behind the News: Doug Henwood’s radio archives” has my explicit gratitude.
I had somehow forgotten to check back on Henwood since the 2000s.
My first podcast experiecen was in fact rather emotional and everyone should check it out:
https://www.leftbusinessobserver.com/Radio.html
Despite some caveats such as Henwood´s – I guess rather limited understanding of Ukraine – which is one of the biggest failures of the genuine Left in the West in decades – which still needs a major scholarly assessment – there are highly valuable items.
E.g. the latest:
“July 25, 2024 Cole Stangler on the monumentally inconclusive French elections • David Palumbo-Liu on the Silicon Valley world that launched JD Vance as a politician • a brief bit from Jane McAlevey on power”
Which ends with a smashing McAlevey: “That´s like a butter knife to a bazooka.”
I am rather surprised that neither GOP nor NDC make more of the very charismatic array of US labour activists. Ok, McAlevey is dead – but take the RNC – the only speaker who possessed any impressive stage charisma was Sean O´Brien from the Teamsters.
Compared to him Vance, Trump, or this other clown Carlson are kids playing in the sandbox. I cannot understand how party leaderships can call for a leader and then come up with such jokes.
I am not talking about networking, and policy-wisecracks, and not about all that backstabbing capability – I am solely referring to quality of public performance.
What on Earth have any of these clones to counter a Charleton Heston with his “dead-hands-speech”. I would´t pay a dime to see them “perform” because they would bore me to hell. Considering that the US is the cradle of modern Western entertainment industry I am a bit disappointed. I bet even the younger Biden had more of these skills than many of the new generation.
i applaud the authors overview. however, to really understand the mess america is in, it was not 2003, but 1993. almost all problems facing america, bill clinton either exacerbated the problems, or created huge debacles that has made america a complete almost ungovernable mess.
besides his free trade gutting of america, and gutting the new deal and turning us over to rapacious parisitical wall street and corporations, then of course his and gores disastrous reinventing government, has left america in ruins.
it was bill clinton that created medicare advantage.
https://www.houstonchronicle.com/business/columnists/tomlinson/article/Tomlinson-Medicare-Advantage-plans-fail-to-16393181.php
“Congress and President Bill Clinton created the Medicare+Choice (Part C) option in 1997 to reduce the federal budget. Private insurance companies said they could better manage Medicare patients than could government employees.”