Medicare “Advantage”?
Have your mailbox and TV been inundated lately with Medicare “Advantage” offers? The healthy and happy-looking actors might make you think the “Advantage” will be yours.
What is Medicare “Advantage”? Traditional Medicare as created in 1965 was a simple and effective system. Millions of seniors no longer had to use up life savings to pay for health care. Traditional Medicare helped them ascend out of poverty and avoid the “poor house” that my grandparents used to talk about.
Then in 2003 insurance companies came up with a way to siphon money from the Medicare stream. Setting loose multiple lobbyists per member of Congress, they created Medicare “Advantage,” a privatized form of Medicare. You turn over your Medicare money and coverage to an insurance company and you get a few perks in return. What could possibly go wrong?
Lots, as it happens. “Advantage” plans, by necessity and like all commercial health insurance plans, put company profits above your health. Companies garner unjustifiably high per-member payments from Medicare funds and keep more than they should. They exaggerate and up-code clients’ illnesses to charge more. They “cherry-pick” the healthy and “lemon-drop” the unhealthy clients. They restrict access to care by narrow provider networks and pre-authorization hurdles. They squeeze clients out of “Advantage” plans as networks and formularies end up being too narrow to meet client needs for extended or specialized care. They generate a 10% administrative overhead compared to that of 2–3% for Traditional Medicare. Lastly, companies abandon unprofitable geographic regions at will, leaving clients to scramble for new doctors and other caregivers.
Because “Advantage” is so lucrative it can sometimes reimburse providers more than Traditional Medicare can. Ironically, the lucre comes from the Medicare funds that Traditional Medicare depends on.
Medicare “Advantage” should not be allowed to continue siphoning our tax and premium dollars. You may like your “Advantage” plan now, but for reasons mentioned above, you may not like its long term effects on Medicare or yourself.
Instead of Medicare “Advantage” I depend on Traditional Medicare. “Traditional” lets me choose the provider I want instead of being confined to a narrow network of providers or other restrictions that might effectively exclude me. I recommend preserving Traditional Medicare, improving it, and extending it to all, as prescribed in H.R. 1384, the Medicare for All Act of 2019.
H.R. 1384 is sponsored by Rep. Pramilla Jayapal of Washington state and has 118 cosponsors in the House. It is also endorsed by Sen. Merkley and Reps. DeFazio, Blumenauer, and Bonamici here in Oregon. Please thank them and urge Sen. Wyden and Rep. Schrader in Oregon and your state’s representatives likewise to endorse this bill and thank them if they already have.
H.R. 6906, the Emergency Benefits Act of 2020 also deserves our support. It would require the Department of Health and Human Services to pay the out-of-pocket expenses of persons receiving medically necessary care during the COVID-19 pandemic. It guarantees care for those who were uninsured before the pandemic or have lost insurance because of job loss during the pandemic. Both of Oregon’s senators and the three representatives above endorse H.R. 6906.
In Oregon, the ORS Chapter 629 Universal Health Care Task Force (SB 770 Task Force) is designing a state-based universal health care system. Please follow its work on the Oregon Health Authority Office of Health Policy website at tinyurl.com/y2ef3wmx, and let the Task Force hear your opinions. Bruce Goldberg MD, former Director of the Oregon Health Authority, chairs the Task Force. Ed Junkins MD of Corvallis is Vice Chair.
The Task Force is designed and committed to achieve a true advantage for Oregonians, not an advantage for insurance companies.
If you are an Oregonian and would like to learn more about the Oregon Task Force please attend a virtual town hall at 7 p.m. on January 6, 2021. For details and registration go to the MVHCA.ORG website.
Michael C. Huntington MD
One Payer States, Secretary
Corvallis, Oregon
Edited by Kathryn Lewandowsky, BSN, RN
One Payer States, Treasurer
