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Don't let salesmen, politicians lead on Medicare Advantage

Judy Garland • Mar 30, 2018 at 8:15 AM

My last article was written to caution folks nearing Medicare age to tread cautiously and be well informed on pros and cons of so-called advantage plans, as opposed to traditional Medicare and a supplementary Medigap plan. Many nonpartisan websites offer the pros and cons. At least check out the pitfalls, as there always are some when providers’ main motive is profit and serving Wall Street.

There were many online comments, several seeking to disprove my argument, which I’d expected, some particularly articulate and factual. I’m not surprised by that either, and I read them with interest. These alternatives to traditional Medicare would not be subscribed unless they had, so far, pleased many of their policyholders.

But please know it wasn’t unusual for a couple hundred thousand subscribers to drop out every year, until for many that was made an unaffordable option. In a 2013 article titled “Medicare Advantage — or DISAdvantage?”, Wendell Potter referred to a study, recent at the time, by a researcher at the Center for Medicare and Medicaid Services, which looked at the 240,000 who dropped out in 2007 and concluded the sickest beneficiaries registered the lowest satisfaction with their MAs. No way is it reassuring that some serious medical condition might lead your for-profit “advantage” provider to get rid of you, invent ways to do it, AND could also hinder you from re-enrolling in a Medigap plan. Remember, Medigap providers are for-profit insurers, though under federal monitoring, who contract with you for the 20 percent which Medicare does not pay. But there is no “guaranteed issue” now, which means they can reject you because of your “pre-existing condition” if you’ve had an “advantage” plan for more than a year. Traditional Medicare, of course, still would accept you.

Everyone must decide this for themselves, but I reiterate that it should never be decided when the only “expert” advising you is a salesman or bought politician. Another caution should be the year-round barrage of hugely expensive television ads promoting “advantage.”

What we must be concerned for is the future of Medicare. It and Social Security have enabled seniors for many decades to live their retirement years with a degree of security our forbears wouldn’t have imagined. It’s ironic that it’s Medicare’s great success at enabling longer lives that strains its solvency today. Contrary to conservative argument, privatizing it, or Social Security, conserves nothing and would instead, probably in very short time, erode away the benefits of both.

The private sector for-profits never really wanted seniors as clients, which probably inspired their “pre-existing conditions” strategy. (You may have noticed that the Obamacare Affordable Care Act’s prohibition against pre-existing conditions is the primary target for insurers and conservatives who keep trying to weaken it after failing to repeal outright.) Why, then, did private insurers proposition Congress to let them into the Medicare program in the first place? That’s easy. It gave them an inroad to Medicare’s huge trust fund. Just like for-profit schools and prisons and probationary services, all were drooling over the pool of public funds, with limited accountability.

That’s why all of us, but particularly those in “advantage” plans, should resist all efforts to repeal Obamacare and instead push to improve it. To curb insurers’ outrageous milking of Medicare funds Obamacare at least requires some accountability from the “advantage” plans, including tying the insurer’s reimbursements to the star rating system — a measure of how plans are required to provide quality care. Obamacare also provides for the closing of the dreaded donut hole by 2020. That’s a diabolical scheme to shift the largest share of drug cost from insurer to beneficiary when total monthly drug cost reaches a set total, until the next enrollment period which can be many months away. To serve the insurer’s profit interest, those dependent on more expensive drugs can pay twice as much or more. How cruel and counterintuitive is that?

Democrats desperately wanted a provision in Obamacare to allow Medicare, with almost 60 million enrollees, to negotiate the drug prices and combine drug coverage into traditional Medicare, eliminating extra expense to enrollees for purchasing the separate Rx policies (dreamed up by the Bush administration). That would have been like the VA with its 5 million clients. Like European countries and others, including Canada, where drugs are half US costs. So-called market-oriented conservatives and Big Pharma monopolists bestirred themselves to block that cold.

One online commenter says the “lefties” just want to deny MA policyholders the good thing they have. Not at all. Those plans seem entrenched for now. We are certain, though, that curbing further inroads toward privatization of Medicare is necessary. Without a strong publicly-managed Medicare, all seniors will lose.

Recall the audacious roll-out of Paul Ryan’s House plan for privatizing Medicare. Essentially, seniors would use their Medicare allotment to shop around for a private insurer. Cost-of-living adjustments would be tied to regular inflation. The hidden caveat: healthcare inflation is normally 2-3 times regular inflation. A steady erosion of Medicare value, shifting ever-increasing cost to the ratepayer. Leaving too many at the mercy of money grubbers. We should be in this together, and it takes vigilance, folks.

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