By Elizabeth R. Rosenthal, M.D.
The Riverdale Press, Bronx, N.Y., October 31, 2021
As a physician for 54 years, my career is just about the same age as Medicare.
When I was in practice, I appreciated that it always paid me promptly, in contrast to corporate insurance companies, which tried very hard not to pay me what was promised. Now retired, I worry about the ongoing attempts to further privatize this popular and effective public program.
We all know privatizing Social Security would harm us. Privatizing Medicare is worse — and insidious. As a volunteer Medicare advisor, I’ve seen patients lured into Medicare Advantage plans and then feel betrayed when illness strikes: What they need isn’t covered.
Original public Medicare treats health care as a social need, not as a profit-making commodity. We trust Medicare because it provides affordable, comprehensive health care equitably. Decades of research shows that Medicare improves the health of senior citizens. Medicare actually increases our life expectancy — dramatically. Hence its popularity.
But now accelerated privatization threatens Medicare. We must urgently oppose this. Privatizing began in 1997 and has been called Medicare Advantage since 2003, interposing profit-seeking middlemen — corporate health insurance companies — between physician and patient. It harms our health care and increases its costs — paid by taxpayers.
Medicare Advantage plans shift incentives away from the delivery of health care to profit-taking. For a health insurance company, the more health care it delivers, the smaller its profit. This perverse incentive leads to denials and delays of care — the reasons for prior authorizations. Never mind that in more than 75 percent of appeals against denials, patients win: Most patients are too sick and stressed to appeal, letting insurers win.
Presently, 40 percent of Medicare recipients are in Medicare Advantage plans, the most profitable of all for-profit plans. For-profit insurers want even more of this golden goose.
The corporate middlemen — the insurer — pockets 15 to 20 cents of every dollar paid by the government for Medicare Advantage recipients, contrasted to original Medicare’s 3 cents per dollar. Paying for bloated administrative costs — the wages of those who deny care — tens of millions annually for each chief executive, hundreds of millions in advertising, and out-sized profits for shareholders, all means less money for patient care — 80 to 85 cents, not Medicare’s 97 cents.
Unfortunately, because Medicare was designed with coverage gaps to protect corporate insurance, it can be expensive for seniors. It requires a monthly premium, out-of-pocket costs, and 20 percent of the doctor bill as well as deductibles for hospital stays. To be fully covered, seniors must purchase costly — too often, unaffordable — private insurance: a supplemental, or “Medigap,” plan, and a private plan for prescription drugs.
These gaps allow Medicare Advantage to lure patients with added benefits such as gym memberships and limited coverage for eye care, dental, hearing and prescription drugs. They require the same monthly Part B premium as original Medicare, but tout having no other upfront costs.
The fine print is hidden: Small physician networks, particularly specialists — many do not take these plans as they pay less and require more trouble to actually receive payment. If one becomes seriously ill, out-of-network specialists and hospitalization can make Medicare Advantage plans ruinous.
I like to call them “Medicare Disadvantage.”
Even worse is a new privatizing gimmick called “direct contracting entities,” or DCEs. Patients who chose original Medicare can be assigned to a Medicare Advantage plan without recourse. Some of these entities are Wall Street firms, entirely focused on profits. Green-lighting today’s pilot program will put all Medicare recipients at risk.
There is a better path forward. An expanded and improved Medicare for All would fix these problems. A federal bill, H.R. 1976, would bring everyone affordable, comprehensive medical care without the corrupting effects of profit-making entities. It would save patients, taxpayers and our government hundreds of billions per year. During the coronavirus pandemic, the vaccine rollout — an example of federal health care — was popular.
We New Yorkers don’t have to wait for Congress to enact a federal bill. We have a state bill: the New York Health Act. It would bring affordable, comprehensive health care for all residents of New York with progressive taxation replacing premiums and out-of-pocket costs. Only the wealthiest would spend more on health care than they do now.
It has a majority of co-sponsors in each chamber in Albany.
Let us all make sure our elected representatives know we oppose privatizing Medicare, and that we want Medicare for All. Call your state and federal representatives.
It’s only health justice if we protect everyone.