...the Obama administration is investigating the activities of health insurance giant Humana--a participant in Medicare Advantage that's been telling its aging consumers that the government plans to slash benefits as it reforms the U.S. health care system, and urging them to tell Congress not to touch the program.
Medicare Advantage plans are private health care plans that seniors can buy into with federal assistance in lieu of participating in traditional Medicare, and under terms the government erected, those insurers face strict limits on how they communicate to beneficiaries. The regulations exist to protect seniors from acting under the pressures of their insurers, who control their benefits. In response to a request from Sen. Max Baucus (D-MT), the Center for Medicaid and Medicare Services has demanded the lobbying effort cease, and is investigating the company to determine whether it violated those rules. Senate Minority Leader Mitch McConnell, who represents Humana's home state of Kentucky, and has received tens of thousands of dollars from the company over the years, called the CMS actions a "gag order"--a characterization that has been echoed by House Minority Leader John Boehner and Rep. Dave Camp (R-MI)--ranking member on the House Ways and Means Committee--who fired off an angry letter to CMS acting administrator Charlene Frizzera. Read more at TPMMuckraker
What’s beautiful about the Medicare Advantage program is that it has provided us with a real-life laboratory experiment which allows us to compare the functioning of highly-regulated private insurance plans as contrasted with the functioning of a public insurance program: traditional Medicare. The results are in, though that would be tough to ascertain if you simply observe the response of Congress.
What have we learned? The private plans take away the choice of health care providers that the traditional public program offers. The private plans insert intrusive interventions between the patient and the physician – interventions that are not found in the public plans. Private plans divert more resources to excessive, wasteful administrative services while increasing the administrative burden on the health care providers and on the public stewards who must provide oversight of our tax dollars that are diverted to this industry. Private plans also provide more entry points for the criminal element to cheat the taxpayers, patients, and providers. And for this we are paying far more of our tax dollars than we do in the traditional Medicare program for comparable levels of care. The obvious lesson is that we should dump the private plans.
What has Congress learned? They have decided that we should provide more subsidies to the private plans so that they can expand their markets!? And they have apparently decided that we will not even have a genuine public plan because it would provide unfair competition to the private plans because of Medicare’s greater efficiency and lower costs!?
It is true that a fragmented, multi-payer system is much more expensive and much less equitable, leaving too many exposed to suffering and financial hardship. But our Medicare Advantage experiment has demonstrated that it is the private plans that must be jettisoned, and it is Medicare that must be granted to everyone after modest, appropriate reengineering so that it works even better than it does now.
We need to send this urgent message to Congress and the administration, immediately:
IT’S THE INSURANCE COMPANIES, STUPID! Read it all at PNHP
If corporate income taxes were raised 10.5%, all hell would break loose.
Aon Consulting surveyed more than 60 leading health care insurers, representing more than 100 million insured individuals, and found that health care costs are projected to increase by 10.4 percent for HMOs, 10.4 percent for POS plans, 10.7 percent for PPOs and 10.5 percent for CDH plans.
In addition, health care rate increases for retirees over the age of 65 are projected to be 6.6 percent for Medicare Supplement plans and 7.3 percent for Medicare Advantage plans. The Medicare Advantage plans are overpaid deliberately to give the plans an unfair competitive advantage over the traditional Medicare program, with the intent of privatizing Medicare. Most of the extra payment is wasted in administration and profits, and what little benefit there is should be given to all Medicare beneficiaries, not just those enrolled in these plans.
The Medigap plans provide the worst value in the private insurance market. The insurers pay a much lower percentage of the premiums they collect for actual health care than they do in any of their other insurance product lines. Americans would be receiving a much greater value if the benefits of the Medigap plans were rolled into the traditional Medicare program, and these wasteful private supplemental plans were totally eliminated.
This Aon report should lead to two obvious conclusions: 1) get the private health plans out of our Medicare program, and 2) replace the private employer-sponsored plans with an improved Medicare program for all of us.
If you agree, let President Obama and the members of Congress hear your message loud and clear. Immediately. Read it all at PNHP
A doctor writes . . . : Recently, however, Mr. Alipate had received in the mail a glossy booklet explaining that he now had 'more choices' for his health care coverage. He reviewed the booklet with the assistance of his American-born nephew but, confused by the options, called the 'help' number for assistance. He only had one fundamental question of the choices: Could he continue to see his personal physician and the specialists I recommended? Reassured by the agent at the other end of the line he elected an HMO Medicare Advantage Plan offered by Humana.
The problem is, the agent was wrong, or misleading. I am not in their network. Indeed, in our heavily populated suburban community there are only two physician practices within a five mile radius of my office which are contracted to see Humana Medicare Advantage patients.
Medicare advantage plans, a privately administered version of Medicare, were created by offering private companies an average 12% premium over the average costs of treating Medicare patients. They in turn use a portion of this premium payment to "enhance" the traditional Medicare benefit package to lure patients into their programs.
The problems with this arrangement, however, are manifold: Although this has resulted in enhanced benefit packages, the marketing of these enhanced benefits has been focused upon the healthiest of Medicare recipients, thus "creaming" the Medicare program and contributing to its financial difficulties. Those enhancements which are offered do not in total equal in value the increased cost to Medicare; a substantial portion of the 12% premium payment is retained for corporate profits and bureaucratic infrastructure. The basic structure is unfair: If there is to be an enhancement to Medicare, why should it accrue only to those who manage to sign up with a Medicare advantage plan? Finally, the "enhancements" may be misleading: As in Mr. Alipate's case..... there is always a dramatic reduction in choice of physicians when one signs on to a Medicare Advantage plan. It is easy to see that even a prominent spokesman for Obamaesque health care reform really knows that only single payer reform can solve our nations health care crisis, he just finds it politically unfeasible.
Political infeasibility is no excuse for failing to advocate for the best solution to our problems. I am struck in my daily practice of medicine by how the overwhelming majority of my diverse patient population supports the kind of change I and untold others are advocating.
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