By Robert Pear
The New York Times, June 24, 2018
Congress and the Trump administration are revamping Medicare to provide extra benefits to people with multiple chronic illnesses, a significant departure from the program’s traditional focus that aims to create a new model of care for millions of older Americans.
The changes — reflected in a new law and in official guidance from the Department of Health and Human Services — tackle a vexing and costly problem in American health care: how to deal with long-term illnesses that can build on one another, and the social factors outside the reach of traditional medicine that can contribute to them, like nutrition, transportation and housing.
To that end, the additional benefits can include social and medical services, home improvements like wheelchair ramps, transportation to doctor’s offices and home delivery of hot meals.
The new law is a rare instance of bipartisan cooperation on a major policy initiative, embraced by members of Congress from both parties. The changes are also supported by Medicare officials and insurance companies that operate the fast-growing Medicare Advantage plans serving one-third of the 60 million Medicare beneficiaries.
Under the new law and Trump administration policy, most of the new benefits will be reserved for Medicare Advantage plans, which will be able to offer additional benefits tailored to the needs of people with conditions like diabetes, Alzheimer’s, Parkinson’s disease, heart failure, rheumatoid arthritis and some types of cancer.
“This is a big win for patients,” said Seema Verma, the administrator of the Centers for Medicare and Medicaid Services.
By Don McCanne, M.D.
Normally we should celebrate the fact that Congress and the Trump administration have decided to expand Medicare benefits for people with multiple chronic illnesses – essential benefits such as nutrition, transportation and housing that extend beyond the usual health care benefits. How could anyone criticize this, the Chronic Care Act?
The problem is that individuals who remain in the traditional Medicare program will be deprived of these benefits. The expansion is limited to individuals who sign up for the private Medicare Advantage plans. This is another blatant effort to privatize Medicare by providing more funds and better benefits through the private plans while depriving the traditional Medicare program of such funding.
Once enough Medicare beneficiaries transfer to the private plans, our government stewards can move forward with their plan to devitalize the traditional program, reducing it to a shrunken, underfunded welfare program if not totally shutting it down. At that point, they can convert the private Medicare Advantage plans into the premium support (voucher) program they have been dreaming of. But the nefarious scheme is that the value of the voucher will gradually be reduced “because Medicare is going bankrupt” (as they have claimed since the year it was enacted), and we can no longer afford to pay for it, they will continue to say.
Who favors this? It was the product of a “bipartisan” effort in Congress composed of conservatives and neoliberals, with the support of the Trump administration, but especially with the support of the private insurance industry. This is a windfall for the private insurers, with the promise of even more to come.
That improved Medicare for all we keep talking about is headed for the shoals. By infusing the private plans with ever more cash while depriving the traditional program of adequate funds, they will appear to have proved that competing private plans are superior to a public program, when, in fact, the private plans are being paid significantly more than is the cost of the public program for patients of comparable health status. The claim of lower costs through competition of private Medicare Advantage plans is a fraud. Why else would the champagne corks at Mar-a-Lago be popping?
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