Yes, just the other night, watching Monday Night Football, there was that horrible TV commercial featuring a pathetic Joe Namath and his “Medicare Coverage Helpline”. And early this morning, while working out at my local gym, three of the six TV screens displaying programming from six different channels were simultaneously showing similar commercials in various stages of play.
Are you as sick as I am of these TV commercials featuring Namath or other washed-up celebrities like former “Good Times” star J. J. Walker of “dyn-o-mite!” fame, long-retired boxer George Foreman, or now bonafide Blue Origin “astronaut” Willian Shatner, (for whom no testimonial fee is too small, having shilled for dozens of corporations over the years) offering to “eliminate copays, provide eyeglasses, dental care, dentures, transportation, meals, even to put money back into your Social Security check”?
And these irritating TV commercials have only scratched the surface of the flood of other invitations to call the “Medicare Advantage Hotline” or to obtain your Medicare through Blue Cross Blue Shield, Aetna, Humana, the healthcare corporate behemoth, United Healthcare, or a mere upstart like WellCare, based in Florida. Even in little old Vermont, our second “home state”, another upstart is soliciting for medicare advantage enrollment. Yes, “from two trusted names – UVM Health and MVP Healthcare” comes “a new kind of Medicare Advantage plan” – UVM Health Advantage, bolstered also by the tired cliche trope “You spoke. We listened.” I seriously doubt that any opinions were either solicited or heeded and I don’t think that the healthcare vultures are listening. This new Vermont company was simply intent on grabbing yet another chunk of the hefty profits accruing to companies offering Medicare Advantage plans.
I have received a flood of Medicare Advantage invitations in my daily dose of junk mail, random emails and even the other day, an invitation from my own credit union:
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|Your plan premiums have become too expensive. You’re paying for benefits you don’t need. Your benefits needs have changed since you turned 65. You’re dissatisfied with the service your current insurance company provides.|
|Desert Financial Insurance Services is here to help you review your individual situation. We’ll shop the market to help you find the right coverage for your needs at the best price available.|
|Since 2003, we have helped over 6,500 members find better solutions for their Medicare insurance needs. We promise to do the same for you!1|
|Call (602) 336-5531 (Option 4) or click below to put one of our licensed and certified advisors to work for you.|
And a pop up ad on my computer this morning invited me to “Compare Medicare”, that is, to “compare top rated medicare plans”. What? I thought that Medicare was a government program started by President Lyndon Johnson and his Democratic majority back in 1965. I thought that everyone when turning 65 or whatever the age is now, could stop worrying about medical insurance from their employers, or worrying about ceilings on coverage, pre-existing conditions and all the limitations that private insurers place in their plans. I thought that Medicare was a government program which we all helped pay for through our income taxes and deductions from our Social Security stipends. How on earth did private insurers get into “providing Medicare”?
Why this flood of solicitations and advertisements, obviously quite expensive, to solicit your purchase and enrollment in Medicare Advantage? And what is medicare advantage anyway. Why are we taught to think that now, rather than enrolling directly in Medicare when we reach the qualifying age, we should instead rush to Humana, Aetna or any one of hundreds, now maybe thousands of companies advertising “Medicare Advantage”? How did a Federal program become so corporatized? Well, there’s an easy answer to that question – profit. And moreover, it’s profit from direct government subsidies, the best kind – not properly earned profit, the result of comprehensive research, increased investments, new products or a daring business plan – just government money – direct from taxpayers to corporate coffers.
How did Medicare Advantage begin? Well, the seeds were planted by President Clinton with his “Medicare Choice” legislation, part of the Balanced Budget Act of 1997. Then after spending much of his two terms trying to privatize Social Security and Medicare, George W. Bush did the next best thing to Medicare with the “Medicare Modernization Act of 2003, formalized Medicare Part D and replaced “Choice” with “Medicare Advantage”. Accordingly “risk adjusted” large batch payments then began a year later, paying private companies to take care of Medicare-eligible enrollees. So this semi-privatization of Medicare has thrived, enrolling more and more people because of the massive advertising blitz described above.
But these seemingly interminable flood of advertisements are essentially dishonest and purposely deceiving. When you enroll in a Medicare Advantage program you are essentially dis-enrolling from Medicare itself, giving up all the protections of this government program and placing yourself at the mercy of a health insurance corporation whose sole objective is profit, not keeping you well, although indeed your continued good health means profit for them since they will not be paying very much on your behalf from the money they are receiving from Medicare. However, if you get sick, it’s another story. Let’s look at how Medicare Advantage works.
When you leave Medicare, yes, you have to file your treasured Medicare card away, that card that you waited your whole life to obtain, that card which banished all worries about the effects of chronic illness and fears of potential bankruptcy, that card which finally rescued you from the vagaries of employer provided private insurance and made you more like a Swede or a Dane or a Canadian in that finally, with Medicare your healthcare became a right, not a privilege. Finally, that government which you supported all your working life with your tax dollars is going to return the favor and take care of you and your health with Social Security and Medicare.
So….you file away your Medicare card and sign up for a Medicare Advantage plan. Technically that private insurance company is supposed to provide everything traditional Medicare gives you – that’s part of the bargain. But read the fine print, dig into the details and you will find caveats for your care: huge out of pocket maximums, limits on which doctors you can see and the areas in which you can see them. And God help you if you get seriously ill. This is when medicare advantage enrollees discover the real limitations of the program they are relying upon. Forget the promise of “0 copays” – you will run up a huge bill seeing specialists. Diagnostic tests and lab services will cost a lot. And surgery and hospital costs are exorbitant as well, all totally glossed over in the commercials we see.
You see, when you are in Medicare Advantage, instead of Medicare taking care of you, Medicare pays the corporation for taking care of you. And how much do they pay? Well, it averages about a thousand dollars per month so if you stay healthy, the corporation puts this into their pockets, sends dividends to its investors and provides bonuses for its executives and CEO. Great business plan.
But this amount can vary based upon what’s called a “risk score”. If the Medicare Advantage company can claim that a percentage of its enrollees are high risk, maybe chronically ill, maybe showing signs of heart trouble or at risk for diabetes or kidney problems, then they can increase the risk score and obtain more money from Medicare.
Many Medicare Advantage programs provide a once a year “home visit” by a registered nurse as a “benefit” of the program. However, these often redundant visits, ostensibly to keep you well, have another purpose – to discover previously hidden conditions or propensities with enrollees so that the overall risk score can be raised. And many of these visits do exactly that.
Okay, you find yourself quite ill, needing repeated tests of all kinds, repeated hospital stays and multiple visits to specialists and you are going broke and approaching bankruptcy, even while enrolled in a Medicare Advantage program, and you wish to return to traditional Medicare. Well, it’s really not that easy. First, you have to wait until the next “open enrollment” season rolls around. Second, you need a “medigap” policy that will cover what traditional Medicare does not, and if ill, it could cost you much more than if you had purchased the coverage when you first enrolled in Medicare.
And what about the other benefits promised in the myriad TV commercials we’re forced to watch.Yes, dental, vision and hearing coverage, plus “transportation and meals”. Well, all of these are quite meager and subject to severe limitations, such as a maximum amount per year, or per procedure in the case of dental. And the hearing benefit may cover tests but hearing aids may be limited to a specific amount per multiple year period which comes nowhere near paying the full cost. “Transportation and meals?” Read the fine print.
Other problems with Medicare Advantage are simply that it costs taxpayers far more than traditional Medicare, even factoring in the monthly premium most enrollees pay. And this significant step toward total privatization of Medicare again exposes, just like Obamacare, the folly of using government money to pay corporations for what the government could do much more cost effectively. Basically the question to ask is this – why should taxpayer money be devoted to providing profit for corporations and filling the pockets of their investors and CEO’s? Again, it’s a pretty simple procedure – moving money from Medicare to hospitals and health providers to take care of the elderly. Why have the middlemen raking in their profit to do exactly the same thing?
But all these millions of dollars invested in the TV ads, the print ads, the mailings, email pop-ups and the rest, have really paid off for our for-profit healthcare industry. In 2020, private insurance companies offered an estimated 3,148 Medicare Advantage plans, according to the Kaiser Family Foundation (KFF). And of those that Kaiser reported, the following are the companies that welcomed the most Medicare Advantage enrollees in 2020:
- UnitedHealthcare: 26%
- Humana: 18%
- BCBS plans: 15%
- CVS (Aetna): 11%
- Kaiser Permanente: 7%
- Centene: 4%
- Cigna: 2%
So this tsunami of advertising has really paid off and after this year’s inundation during “open enrollment” we can rest assured that next year’s will be worse. And we can also assume that millions more elderly qualifying for Medicare will have signed over their healthcare to a for-profit corporation.
But guess what, many of these deceptive ads will not stop, even though the Medicare “open enrollment” period ended December 7. Because for the next few months, although those eligible for Medicare cannot any longer register for Medicare Advantage or move back into original Medicare, if already enrolled, you can switch from one “advantage” program to another. That period is until March 31. So I do expect many of these deceptive ads to continue. We shall see.
For those concerned with continued privatization and corporatization of the already largely for-profit US healthcare system, there is another nefarious plot being carried out as I write and as you read.
Near the end of the Trump administration the Center for Medicare and Medicaid Innovation (CMMI) decided to begin a program, with no input from Medicare enrollees and no oversight from Congress, a program called DC (direct contracting). In fact, this program has provoked barely a whisper in the media, though it has healthcare corporations and Wall Street private equity firms “lined up like pigs at a trough”, all eager to get their filthy hands on some more taxpayer money and further privatize our healthcare systems. So far 53 companies have signed up as DCE’s (Direct Contracting Entities) to administer the program – a mix of healthcare corporations and private equity firms.
Already, without them realizing it, thousands of Medicare enrollees who thought they were enrolled in traditional Medicare, have been quietly and subtly moved into this program, along with their primary care physicians, with the promise of greater Medicare reimbursements for the doctors and more “managed” and “focused” care for the patient. In reality, the program does little to nothing to improve care. What it clearly does is raise the Medicare price for taxpayers and give money to private companies.
What all this boils down to is just what do the American people want for a healthcare program for the elderly. Do they want a no profit government program or do they want a program farmed out to corporations who make profit from the government funds they receive. I know where the American people are. It’s their legislators in Congress who are the problem because private healthcare corporations have been contributing to their PAC’s and reelection funds for decades, corruptly buying their support. We should be furious about this – our legislators should be fighting for us but they’re not. What a country! What a political system! Thank God for the few legislators and the organizations that are fighting back on our behalf – organizations like PNHP (Physicians for a National Health Program) and legislators like Senator Bernie Sanders and Representative Pramila Jayapal.
And we need to ask about the role of this special Medicare office, Center for Medicare and Medicaid Innovation (CMMI). Truly it seems that their role is simply to surely and steadily turn Medicare over to corporations, while increasing the outflow of Medicare money to pad their pockets and increase their profits. What kind of “innovation” is this anyhow? This office needs to be investigated by Congress and I guarantee that they’ll find that the office is populated by ex- corporate healthcare executive doing everything they can to help their former employers and waiting until the Washington revolving door spits them out again to repopulate the healthcare industry.
Greg Henkel said:
Thanks Ralph. I’m turning 65 next year and have already started receiving advertisements from various Medicare advantage providers. I appreciate your research and thoughts on the insurance plans being offered.
The Watchman said:
Very good article!!!!!
Joe Blows said:
Excellent article…”pathetic” is a good choice of words for the Joe Namath antics in his Medicare commercial…we just automatically switch the channel whenever any of these misleading commercials airs. I will say though… JJ walker is the absolute worse. He looks like he is auditioning for night of the living dead!
Well said! I just retired from a career in health care. Many of our patients had Medicare Advantage plans from a large for-profit corporation. When they were ready for discharge from the hospital to rehab (as hospital stays are very short now), that company usually said they weren’t eligible for rehab payment. Frequently they then decided that they weren’t eligible for a hospital stay, either. Sometimes they would reimburse at the lower “outpatient short stay” or “observation” rate. Often the hospital stay was extended so we could provide rehab in-house, as they weren’t safe to discharge home (which is why we recommended rehab in the first place). If they chose to go home anyway, they were now leaving AMA (Against Medical Advice), which meant the Medicare Advantage plan could now refuse all payment. Scam is the right word.