Gainesville, Fl. (Special to Informed Comment) –
1). Medicare Advantage (MA), the privately-administered version of Traditional Medicare (TM), is causing significant harm to America’s patients, providers, and health
2). Political support for the private health insurance industry and Medicare Advantage exists because our government permits private health insurance companies to exact large profit from its citizens as Wall Street banks and investors who back Big Insurance turn public money into a bonanza of private riches.
3). High health insurance costs are the result of a political decision to essentially allow Big Insurance to do what they want and charge whatever they want.
4). The recent JAMA IM article, “Less Care at Higher Cost — The Medicare Advantage Paradox,” details how private insurers have exploited loopholes in Medicare’s complex payment rules for decades to extract overpayments.
5). The federal government pays insurance companies a lump sum for each patient its Medicare Advantage plans sign up, with the amount of the lump sum based on enrollees’ “risk scores,” which the government calculates from diagnosis codes that the plans submit. The risk scores are meant to predict how much care enrollees will need.
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6). Research has repeatedly shown that the private plans game the system by cherry-picking the healthiest seniors to enroll, and then exaggerating how sick they are by so-called “upcoding,” i.e. padding enrollees’ medical charts with long lists of diagnosis codes that do not require specific treatment, jacking-up the risk score and hence the government’s lump-sum payment to the plan.
7). According to the JAMA IM article, privatized Medicare plans often refuse to cover providers that high-cost patients need, such as specialized cancer hospitals, mental health professionals and psychiatrists; restrict access to drugs and treatments; and pressure patients and doctors to curtail expensive care.
8). As a result, the privatized plans spend, on average, 9% less on medical services (including the extra benefits they promise) than traditional Medicare spends for comparable patients.
9).“Medicare Advantage plans have, in effect, stolen hundreds of billions from taxpayers,” says David Himmelstein, a study co-author who is a Distinguished Professor at CUNY’s Hunter College, a lecturer at Harvard Medical School, and a Research Associate at Public Citizen. “And the private plans’ schemes also raise seniors’ Part B Medicare premiums. Even seniors who don’t choose to enroll in Medicare Advantage are subsidizing the private plans’ profits.”
10). Medicare was created to serve the people, and MA betrays that promise. We must rein in the abuses of MA insurers, eliminate profit-seeking in Medicare and put an end to these egregious harms.
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