From the time I began watching television in the early 1950s, I learned one fact. If anything is heavily advertised, costing thousands of dollars then and millions of dollars today, there are enormous sums of money involved for those trying to sell it to you and a product of lesser quality and higher cost for the consumer. This has become my ‘rule of thumb’ about every such issue, and it has never failed me.
Every day I see between five and ten ads for Medicare Advantage. Those who pay for the ads promise “everything for nothing.” Sadly, seniors like myself are often gullible and easily fooled by ads, especially those which include testimony from famous people, and the older, the better.
Medicare Advantage is a scam. Designed as a precursor to privatizing Medicare, it morphed into a complete farce, robbing Americans of their money who need it most. “America is a business, not a country.”
Medicare Advantage, or Medicare Part C, is not part of the Medicare system. With a few non-profit exceptions and larger HMOs, the providers are, in reality, large for-profit insurance companies. These greedy corporations seek the most at-risk patients as subscribers. They are not reimbursed on a case-by-case or procedure-by-procedure system. They are paid yearly in one very large lump sum based on the level of risk involved. The higher the risk, the bigger the paycheck.
These are private companies, not part of our government as we are led to believe on their expensive and frequent television ads. They are reimbursed by Medicare, but Medicare has no part in its operation.
In 2003, congress passed the Medicare Modernization Act under the guidance of the George W. Bush administration, a Republican. Like their efforts to privatize Social Security, this was their plan to do the same with Medicare. It was specifically planned by Republicans, and a few Democrats indebted to corporations and would have ended protection for millions of older Americans. Medicare Part C is a part of the ultimate plan.
The payment plan for insurers encourages a larger number of very sick subscribers and fewer healthy participants. What benefits are distributed to the subscribers?
The biggest part of this scam is what participants are led to believe constitutes a benefit. Many companies send a registered nurse to evaluate the overall health of many of their more seriously ill patients. Their real purpose is to make risk assessments. Remember, the greater the risk, the larger the reimbursement from Medicare. Subscribers experience huge increases in their payments into the Medicare system and fewer benefits.
Overall, Medicare Advantage providers receive 30% more in reimbursements than their actual costs. Medicare Part C participants receive 25% lesser payments for medical care than traditional Medicare payees with the same risk scores.
The Centers for Medicare and Medicaid Services is the Federal Medicaid Administrator. Under Trump’s administration, the CMMS actually encouraged Medicare Advantage to move Medicaid closer to privatization. Their reasons? Highly paid, secure employment. Part of the philosophy of the “what’s in it for me administration.”
Medicare Advantage patients receive 15% fewer colon cancer screening tests, 24% fewer diagnostic tests, and 38% fewer flu shots.
The truth is that all of the ills reported related to Medicare Advantage began during the Bush 43 administration, which became obsessed with privatizing Social Security and Medicare, which, as you can see, would increase the cost of what is already the most expensive healthcare system in the free world. It is another clear reason why universal healthcare must be a major issue in our elections. Politicians who reject the idea of increasing systems designed to care for the majority must themselves be rejected at the polls.
To my fellow older friends, be wary of the proverbial “free lunch.” Seek advice from friends, family, and healthcare professionals you trust before giving anyone your hard-earned money.
“If it seems too good to be true, it probably is.”
Written by James Turnage, Novelist
Daily KOS: Stop the Medicare “Advantage” Scam Before Medicare is Dead
Common Dreams: Medicare Advantage Is a For-Profit Scam. Time to End It. By Thom Hartmann