By Kenneth Dolkart, M.D.
Valley News (West Lebanon, N.H.), Letters, June 17, 2024
Lake Sunapee VNA & Hospice CEO Jim Culhane shared how unacceptably low reimbursement by United Healthcare threatens essential services by community visiting nurses (“For-profit companies use Medicare as a lever”; June 11). He notes how seniors face harmful denial of services, limited inpatient rehab and restrictions to narrow medical networks and unexpected discontinuation of coverage for medications. These measures maximize profit, but harm patients.
There is a “bait, then can’t switch” feature: the initial guarantee to purchase affordable Medigap insurance disappears after a year’s enrollment with Medicare Advantage. Supplementary policies are thereafter denied or unaffordable for those who try to switch. Since 20% of traditional Medicare costs are covered by Medigap, many are financially trapped in a plan they don’t want. So much for the “consumer choice” touted by ads. Four states do preserve “guaranteed issue” but this can raise premiums, since higher costs of ill seniors are passed back from Medicare Advantage to traditional Medicare and Medigap plans. Of course, since the plans are all owned by the same corporations, that’s a win-win for Wall Street!
Medicare Advantage proposed to expand benefits and use managed care “efficiencies” to save Medicare money. In reality, Medicare pays privatized plans 22% more per beneficiary than traditional Medicare expended for identical services, despite their enrollees being healthier. Such “efficiencies” cost $104 billion to taxpayers. These excessive capitations to for-profit intermediaries offers a tax-funded Medicare Advantage gravy train. $100 billion is better spent improving long-term and home care, dental or vision benefits under traditional Medicare, with lower administrative costs and burden for hospitals and clinicians.