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 (āFor-profit companies use Medicare as a leverā; 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 ābait, then canāt switchā feature: the initial guarantee to purchase affordable Medigap insurance disappears after a yearās 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 donāt want. So much for the āconsumer choiceā touted by ads. Four states do preserve āguaranteed issueā 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, thatās a win-win for Wall Street!
Medicare Advantage proposed to expand benefits and use managed care āefficienciesā 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 āefficienciesā 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.