By Michael C. Huntington, M.D.
Albany (Ore.) Democrat-Herald, December 11, 2020
Have your mailbox and TV been inundated lately with Medicare Advantage offers? The healthy and happy-looking actors might make you think the “advantage” will be yours.
What is Medicare Advantage? Traditional Medicare as created in 1965 was a simple and effective system. Millions of seniors no longer had to use up their life’s savings to pay for health care. Traditional Medicare helped them ascend out of poverty and avoid the “poor house” that my grandparents used to talk about.
Then, in 2003, insurance companies came up with a way to siphon money from the Medicare stream. Setting loose multiple lobbyists per member of Congress, they created Medicare Advantage, a privatized form of Medicare. You turn over your Medicare money and coverage to an insurance company and you get a few perks in return. What could possibly go wrong?
Lots, as it happens. Advantage plans, by necessity and like all commercial health insurance plans, put company profits above your health. Companies garner unjustifiably high per-member payments from Medicare funds and keep more than they should. They exaggerate and upcode clients’ illnesses to charge more. They cherry-pick the healthy and lemon-drop the unhealthy clients. They restrict access to care by setting up narrow provider networks and pre-authorization hurdles. They squeeze clients out of Advantage plans as networks and formularies end up being too narrow to meet client needs for extended or specialized care. They generate a 10% administrative overhead compared to 2-3% for traditional Medicare. Lastly, companies abandon unprofitable geographic regions at will, leaving clients to scramble for new doctors and other caregivers.
Because Medicare Advantage is so lucrative, it can sometimes reimburse providers more than traditional Medicare can. Ironically, the lucre is in effect stolen from traditional Medicare funds.
You may like your Advantage plan now, but for reasons mentioned above, you may not like its long-term effects for Medicare or yourself. Ask your broker, “Is Medicare Advantage right for me?”
Instead of Medicare Advantage, I depend on traditional Medicare. Traditional lets me choose the provider I want instead of being confined to a narrow network of providers or other restrictions that might effectively exclude me. I recommend preserving traditional Medicare, improving it, and extending it to all, as prescribed in H.R. 1384, the Medicare for All Act of 2019.
H.R. 1384 is endorsed by Sen. Merkley and Reps. DeFazio, Blumenauer and Bonamici. Please thank them and urge Sen. Wyden and Rep. Schrader likewise to endorse this bill.
H.R. 6906, the Emergency Benefits Act of 2020, also deserves our support. It would require the Department of Health and Human Services to pay the out-of-pocket expenses of persons receiving medically necessary care during the COVID-19 pandemic. It guarantees care for those who were uninsured before the pandemic or have lost insurance because of job loss during the pandemic. Both senators and the three representatives above endorse H.R. 6906.
In Oregon, the ORS Chapter 629 Universal Health Care Task Force (SB 770 Task Force) is designing a state-based universal health care system. Please follow its work on the Oregon Health Authority Office of Health Policy website and let the task force hear your opinions. Bruce Goldberg, MD, former director of the Oregon Health Authority, chairs the task force. Ed Junkins, MD, of Corvallis is vice chair.
The task force is designed and committed to achieve a true advantage for Oregonians, not an advantage for insurance companies.