In an op-ed for The Nation, Ady Barkan, co-director of Be a Hero, makes the compelling case that Medicare Advantage, the part of Medicare administered by private health insurers, could be the death of Medicare. It could also be the death of guaranteed affordable health care for all in the US. Senator Bernie Sanders, Representative Pramila Jayapal, and Representative Debbie Dingell are trying to prevent that and breathing continued life into Medicare through their recent introduction of the Medicare for All Act in Congress, legislation that would keep corporate health insurers out of Medicare.
Several times in the last 70 or so years, progressive policymakers have tried to ensure everyone in the US has guaranteed access to affordable health care. And, several times, their efforts failed. Most recently, advocates on the ground and in the Congress pushed for a public health insurance option, like Medicare, for all Americans. Instead, we got the Affordable Care Act, health insurance through corporate health insurers.
During his campaign for the presidency, Senator Bernie Sanders brought to national attention the value of Medicare for All, guaranteed, government-administered, affordable health insurance. He called for an improved and expanded version of traditional Medicare that the US guaranteed everyone, with dental, vision and hearing benefits, and without premiums, deductibles and copays.
Ady Barkan testified in the US House of Representatives on the value of Medicare for All. He understood its value full well. At 35, he was diagnosed with ALS. He explained how everyone will need health care at some point.
“Our time on this earth is the most precious resource we have,” were his words. “A Medicare for All system will save all of us tremendous time. For doctors and nurses and providers, it will mean more time giving high quality care. And for patients and our families, it will mean less time dealing with a broken health care system and more time doing the things we love, together.”
Barkan interviewed all the presidential candidates on Medicare for All and then sat down with President Biden to discuss health care. At the time, Barkan supported Medicare for All but did not appreciate that corporate health insurers had sunk their teeth into Medicare through the Medicare Advantage program. Now, he recognizes that if corporate health insurers take full hold of Medicare, it is not likely we will get government-administered Medicare back.
The argument for Medicare Advantage when Congress debated it in the early 2000’s was that it would improve quality and save money through “managed care.” But, 20 years later, Medicare Advantage has always cost more per enrollee than traditional Medicare. And, several analyses show that quality of care, particularly for people with costly and complex conditions tends to be worse in Medicare Advantage than in traditional Medicare.
Because the federal government pays corporate health insurers upfront for the care they provide, regardless of the amount they spend on care, the insurers do what they can to spend as little of that money on people’s care as possible. The less they spend, the more they profit. The consequence for enrollees can be deadly–delayed and denied care, lack of access to top quality specialists and specialty hospitals and unaffordable out-of-pocket costs.
Medicare Advantage has become big business. Every business wants in and wants more. The insurance companies offering Medicare Advantage are buying up primary care providers in order to help control the care that people receive. To be sure, in the best of hands, this could be great. But, in the hands of corporate executives who are looking to return as much money to shareholders as possible, you can imagine the danger.
The corporate health insurer execs are likely dreaming of a time when Congress passes Medicare Advantage for All, a time when they control the full Medicare market and the hundreds of billions of dollars that come with it. Americans should be extremely concerned.
Without traditional Medicare in the mix, putting competitive pressure on the Medicare Advantage plans, without the tens of billions in excess payments to the Medicare Advantage plans, and without any freedom for enrollees to disenroll from Medicare Advantage, all bets are off on health care costs and coverage for older adults and people with disabilities, all bets are off on their health and well-being.
Fortunately, members of Congress are beginning to understand the fundamental differences between traditional Medicare and Medicare Advantage. They are holding hearings focused on abuses in Medicare Advantage–overpayments, inappropriate delays and denials, misleading marketing and ghost networks, among others. And, the Biden administration is passing regulations in an attempt to rein in the bad actor Medicare Advantage plans.
Unfortunately, the regulations are only as good as the government’s ability to enforce them. And, enforcement has been lax, to put it mildly. As of now, the Medicare Advantage plans that are engaged in keeping their enrollees from getting costly care can continue to do so, with impunity.
If we are going to guarantee Medicare for All, free or low-cost access to good care in the US, we must keep the corporate health insurers from taking over Medicare.
Here’s more from Just Care:
- Case study: Medicare Advantage delays, denials and consequences
- What we don’t know about Medicare Advantage plans
- Traditional Medicare v. Medicare Advantage? Different as night and day
- Seven reasons commercial insurance cannot meet our health care needs
- Ten ways to improve Medicare Advantage
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