Yves here. For those under advanced age, it may seem pointless to spend too much time discussing Medicare. But apart from the fact that it is a large and popular program, its evolution is also a matter of secret research conducted in a certain area, at least to a reasonable extent, by activists and the general public.
So even for those critics who take the idea that social safety nets can be strengthened as absurd, consider that making that demand early and often makes it difficult for neoliberal plunder to proceed as quickly as possible. Here, in the case of Medicare, it is important to emphasize that Medicare Advantage is only successful in terms of enriching the private sector. No one in the private sector admits that aside from weaning seniors with misleading ads, another goal is to create a two-tier Medicare program, “free” as in no-cost Medicare Advantage plans with skimpier coverage for the relatively poor.
By Ed Weisbart, MD, a retired family physician in Olivette, Missouri, and secretary of the board of Physicians for the National Health System. Originally published in Common Dreams
Fifty-nine years ago today, President Lyndon Johnson signed Medicare into law—a high-water mark in the fight against universal health care that began decades earlier and continues today.
Since Medicare became law, it has been a shining example of what is possible in US health care: a truly public, universal system that has saved countless lives and prevented major financial losses among older Americans. But alongside this success, corporate health interests have also grown immeasurably stronger. Insurance companies like UnitedHealthcare and Blue Cross Blue Shield have built brutal 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 version of Medicare for All—then we will have to confront the power of corporate health insurance head-on. That starts with taking out a plan called “Medicare Advantage”.
The Strategic Importance of Medicare Advantage
Single-payer advocates understand that there can be no “Medicare for All” without “Medicare.” And no, Medicare Advantage (MA) does not count as Medicare. The health insurance companies that run these plans have a corporate responsibility to prioritize profit above all else; this is a disgrace to any public health system.
The Physicians for a National Health Program (PNHP) has included overwhelming evidence that MA insurers are harming patients, doctors, and hospitals by delaying and denying care—dangers hardly seen in Traditional Medicare. And this brutality isn’t even a trade-off for lowering health care costs. In fact, these companies are paid more than what is used for the same patients in Traditional Medicare—by far. $140 billion per year, or about 35% more than Traditional Medicare funding levels.
No road to Medicare for All ignores this existential threat.
Thankfully, support for eliminating overpayments in MA extends beyond those already committed to single payer. This fight builds our movement by bringing together more people who understand, or can be educated about the harm that insurance companies do to patients. When we find common ground, we must go together.
For that reason, the PNHP discloses payments in excess of the MA and seeks a fiscally responsible approach to policy makers. We are working closely with several organizations to change the national conversation and provide a much-needed counterweight to the quest for greater insurance power.
When MA was created, back in 2003, corporate insurers promised to reduce health care costs by improving coordination of care and health outcomes. A healthy population, they say, will cost less. We must demand that MA corporations fulfill these lofty promises outside billions of dollars in overpayments.
We would love to see them try.
Improved Medicare… for ALL
Returning $140 billion in annual overpayments raises an interesting question: How can we use those funds to improve Medicare for all seniors?
Instead of the small benefits offered by MA programs, those funds can help us add strong hearing, vision, and dental benefits; completely eliminating Medicare Part B premiums; and wrap up your Medicare Part D prescription drug benefit. Think how much easier it would be for a senior on Medicare Advantage to enroll in the plan actually includes a full range of dental care, while also freeing themselves from the limited provider networks and pre-authorization requirements imposed by MA programs.
Most importantly, we need to establish a lower out-of-pocket cost for Medicare. Insurance companies lure seniors and disabled people into the MA trap by selling low costs while hiding significant barriers to care. It’s an old nickname and a change. Eliminating the need to buy Medigap would level the playing field and allow it everyone staying on Traditional Medicare.
Well, not everyone—but that’s our ultimate goal. PNHP advocates for a national single-payer health insurance program, and what better way to get there than with an improved version of the already popular Medicare program?
When we see middlemen standing between patients and the care they need, we must remove them. When we see limited supplier networks, we have to expand them. When we see a bunch of pre-approved documents, we have to sort them out.
We must also expand benefits to cover all medically necessary care, and ultimately eliminate out-of-pocket costs that prevent people from seeing a doctor. Once these improvements are in place, we will have a program truly worthy of the name Medicare for All.
The work of advocating for these priorities—ending MA overpayments, improving Traditional Medicare, and realizing our single-payer vision—overlaps and builds on one another.
Let’s work to build an organization for seniors, doctors, students, people with disabilities, and everyone who cares about Medicare. Together, we can take on the insurance companies that cause so much damage in our lives and lay the groundwork for a winning single-payer system that delivers everyone in between and leaves no one came out.
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