Monday, July 27, 2015
July 23, 2015
Priceless safety net reaches Golden Anniversary
Medicare's impressive milestone is reason to celebrate the safety net
and time for supporters to wake up to threat of increased privatization
By Wendell Potter
Happy birthday, Medicare! Happy Golden Anniversary!
The fact that we have such a special milestone to celebrate means that
the opposition of wealthy, entrenched special interests can be overcome.
But, as we will see, an entirely different group of special interests is
now profiting as a result of a very favorable financial arrangement with
what has become an immense federal program. They are making such rapid
inroads that the original Medicare program may all but cease to exist
over the next decade if the program's supporters don't wake up to what
is a real existential threat.
Public program increasingly becoming private
Republican lawmakers whose goal was to privatize the program succeeded
in passing legislation to enable insurance companies to provide coverage
to Medicare beneficiaries – on the government's dime. To entice them to
get in the game, the government agreed to pay them considerably more
than what it would cost to provide benefits to Medicare-eligible folks
if they stayed in the original program. This not only enabled the
insurers to make a tidy profit, it also allowed what are now called
Medicare Advantage plans to offer a drug benefit before the traditional
program was authorized to do so and to cover all medical costs, not just
80 percent. In exchange, beneficiaries could only get care provided by
doctors, hospitals and other facilities that were in their insurance
company's provider network.
Insurance companies have spent billions of dollars over the past few
years on sales and marketing campaigns to persuade beneficiaries to
enroll in or switch to their Medicare Advantage plans. They've been so
successful that a third of Medicare beneficiaries – 16.6 million at last
count – are now enrolled in Medicare Advantage plans, most of which are
operated as HMOs and PPOs.
Medicare's growing value to insurers
If Medicare Advantage enrollment trends continue – and there is no
reason to believe they won't – within a few years, possibly before the
end of this decade, we will reach a tipping point in which more people
will be enrolled in private plans than in the original program.
That very real possibility should be of great concern to health care
reform advocates who think Americans would be much better off if all of
us – not just senior citizens and the disabled – were enrolled in an
improved, "Medicare for All" program.
The word "improved" in that last sentence is essential. As medical costs
continue to go through the roof, the 20 percent coinsurance obligation
in the traditional program will make the Medicare Advantage plans
increasingly attractive. If I were leading the strategy for the
"Medicare for All crowd," I would focus a lot of attention on
strengthening the traditional program to make it every bit as
comprehensive and attractive as a Medicare Advantage plan.
If that doesn't happen, Medicare's next significant birthday will be
celebrated most enthusiastically by the shareholders and executives of
private insurance companies.
Comment by Don McCanne
Mark Wendell Potter's words. If we want an improved Medicare for all, we
need to focus on strengthening the traditional program "to make it every
bit as comprehensive and attractive as a Medicare Advantage plan." Yes,
but even more than that.
If benefits of the traditional Medicare program, especially the
deductibles and coinsurance, were even better than the Medicare
Advantage plans, then there would be no reason that Medicare
beneficiaries would want the restrictions of the private plans, such as
limiting their choices of physicians and hospitals to the networks
selected by the private plans.
For those who say that we cannot afford to improve Medicare's benefits,
they will have to explain to us why it is then acceptable to give the
private Medicare Advantage plans more taxpayer funds than are spent on
comparable patients in the traditional program. Aren't those in the
traditional program worthy of the same level of spending? Then we need
to explain to them how we could increase benefits without increasing
total spending, by putting in place the substantial efficiencies of a
single payer version of an improved Medicare for all.
With the release of the Medicare Trustees report, the conversation has
returned to the need to control spending. The privatizers are out with
their schemes to control government spending (but not total spending).
Jeb Bush says that we need to "phase out" Medicare and "move to a new
system" - presumably premium support vouchers which shift costs from the
government to the beneficiaries.
We need to control total health care costs, not control only government
spending while allowing total costs to escalate. So let's change the
conversation from that of cutting Medicare to that of improving Medicare
while making it affordable - a feat which we can accomplish only if we
convert it to a single payer system.
at 3:55 PM