Is the death of Medicare is upon us?
Those of us who follow everything Medicare — policy, regulations, the people and companies behind the scenes — have been witnessing the efforts to privatize this valuable federal program for seniors with alarm. We are holding our breath as it goes from bad to worse.
Wait a minute, Toni, what on earth are you talking about? What do you mean Medicare is being privatized?
Simply this: as of this moment, the federal government, through the Centers for Medicare and Medicaid (CMS) still regulates and administers Medicare. But some legislators and administrators want to put it into the hands of private, for-profit insurance companies – the same companies that sell and administer health insurance for employees. As of 2021, even non-insurance companies without any experience in healthcare management are being encouraged to get in the game.
What’s changed?
In 2019 the Trump administration instituted a program specifically designed to privatize Medicare. And they did it without consulting Congress.
The program, Medicare Direct Contracting, allows for-profit companies to administer medical care for those enrolled in Traditional Medicare (Part A and Part B).
Beginning in 2021, seniors who were already enrolled in Traditional Medicare were put into Direct Contracting Entities (DCEs) by their primary-care doctors without their consent or their knowledge. Why? Follow the money.
Direct Contracting joins that other private-insurance program, Medicare Advantage, which in addition to costing tax-payers more money than Traditional Medicare, forces its customers into restricted networks of doctors, hospitals, and other healthcare providers.
Here’s a recent opinion piece about DCEs from the Washington Post.
Who or what can be a DCE? Any company can apply — hedge funds, venture capital, et al. No healthcare experience necessary. This leaves the field wide open to all sorts of profit-driven companies. Why? Once again follow the money — the profits to be made by getting into the healthcare-for-seniors game are huge.
The kicker? This reprehensible program is being continued by the Biden administration, which has no plans to scuttle it. Although a few changes are in the offing as the result of some pushback, it’s cold comfort to those who want Medicare to remain out of for-profit hands.
FACT: Did you know that Traditional Medicare (Parts A and B) spends a whopping 98% of its budget on patient care? Medicare Advantage administrative costs are much higher, according to the Kaiser Family Foundation.
Clinton and Bush
Medicare has been moving in the direction of privitization for a long time. The most obvious moves came with Medicare Advantage (formerly known as Medicare Part C) and Part D drug plans.
Part C was established under the Clinton administration as part of the Balanced Budget Act of 1997. The BBA authorized Medicare to contract with public or private organizations to offer health-insurance options to Medicare beneficiaries. Although the private health-insurance companies are required to provide the same benefits and services as Medicare Parts A and B, they are in fact private insurance. For more information on these private plans see the August, 2021 and October 2021 issues of the Medicare Reporter.
Medicare Part D, the privately sold and administered outpatient drug-plan, was established under the George W. Bush administration and went into effect in January 2006.
Why is all this bad for American seniors?
Most Americans recognize that Traditional Medicare Parts A and B is a very good deal that we paid for throughout our working lives. It allows us to go to any doctor, hospital, or other provider that we choose as long as that provider accepts Medicare — that’s the majority of healthcare providers in the United States. Unlike Medicare Advantage, there are no restricted networks. That means we, the patients, get to make our own decisions about who provides our care, not some insurance-company executive.
Tell your representatives that you don’t want corporations telling you what to do about your own care. If you want to prevent the death of Medicare, now is the time to act. Tell the Senate, Congress, President Biden, and Vice President Harris to stop privatizing Medicare. And while you’re at it tell them to expand Medicare’s services. All the contact info can be found here. US Senate, US House of Representatives, the White House.
Other Medicare news.
The Motley Fool: Medicare Owes Retirees a Refund, Says Powerful Senior Group
The New York Times: A New Right to Appeal Medicare Decisions
US News: Many Seniors on Medicare Falling into Medical Debt
Very Well Health: Mental Health Care Coverage for Adults on Medicare Falls Short
Listen: Supreme Court hears arguments in cases on prescription drugs and Medicare coverage
Not specifically about Medicare, but relevant.
From the New York Times: An Essayist Navigates the Labyrinth of American Health Care. Barely