In the context of health insurance, choice may sound good, but it is a loaded word. The only time any of us has real choice is when we can actually distinguish among our health insurance options and at least one of them guarantees us affordable care from the doctors and hospitals we want to use. For that reason, Medicare Advantage plans, corporate health plans that contract with the government to provide Medicare benefits, offer no real choice.
Indeed, most Americans, whether working or retired, have no real choice of corporate health insurance plan. And, here, I’m not talking about the fact that employers often give people one choice. It’s that even when you have multiple choices, as you do with Medicare Advantage, you cannot distinguish among them in a meaningful way. And, more important, there’s no evidence that any of them will meet your needs if you get sick.
Because no one can predict future health care needs, the only health insurance that makes sense is health insurance that will cover us, no matter what care we need. at a cost we can afford. Consequently, the notion that we should pick a health insurance plan that’s right for us is preposterous. Not only do we not know what care we will need down the road, we also do not know what doctors and hospitals we will want to use to treat that care.
But, no private health insurer is willing or able to guarantee us affordable access to care from the doctors we want to use. Even when premiums are reasonable, deductibles and coinsurance payments can be sky high for people who need a lot of care. In Medicare Advantage, they can be as high as $6,700 a year for medical care alone.
Private health insurers cannot control costs. What’s equally problematic is that if any one of them offers high-value care for people with costly conditions, everyone with those conditions will join, their costs will rise, and they will not generate the profits they need to survive as a commercial business. So, Aetna, UnitedHealth and others will never promote the quality of care they deliver for people with costly conditions.
With Medicare Advantage, the good news is that the government pays for a large part of the premium. But, the problem remains that Medicare Advantage plans cannot compete to deliver high-value care to people with costly conditions or they would not survive as businesses. In fact, as should be expected, they do their best to avoid providing care to people with complex health care needs.
Government audits show “widespread and persistent … performance problems related to denials of care and payment,” and Medicare Advantage plans “threatening the health and safety” of their members. And, though Medicare Advantage plans are required by law to turn over data that would allow the government to know whether they are delivering appropriate levels of care–e.g., enough physical therapy, home care, cancer care–the data the Medicare Advantage plans disclose is unreliable and incomplete.
Only traditional Medicare, public health insurance, social insurance, guarantees you coverage for reasonable and necessary care from the doctors and hospitals you want to use. And, it reins in provider rates. But, it’s still expensive and requires you to have supplemental coverage to protect yourself from financial risk if you do not have Medicaid or retiree coverage that fills gaps.
Medicare for all strengthens and improves traditional Medicare, eliminating all premiums, deductibles and coinsurance, so you can go to the doctors and hospitals you want to use without worry about the cost. It covers vision, hearing, dental and long-term care. And, it costs less than our current health care system because everyone is in it. And, private health insurers are out. It reduces administrative costs by $600 billion a year and drug costs by another $250 billion a year.
If you support Medicare for all, please let Congress know. Please sign this petition.
Here’s more from Just Care:
- Senators ask Medicare agency why it is not holding Medicare Advantage plans accountable for violating their contractual obligations
- Health insurance choice is a health insurance industry meme, misleading at best
- Four things to know if your income is low and you have Medicare
- Four things to think about when choosing between traditional Medicare and Medicare Advantage plans
- Housing options for older adults
Leave a Reply