Where’s the Advantage? Private-Insurer Medicare Plans SHOULD Go Away
“ . . . contracting functions as governmentally assisted corruption”. Edward Snowden in his 2019 memoir, Permanent Record.
“Medicare Advantage, it’s not what you pay, it’s what you get. Insurance companies are great at denying claims.” Ralph Nader, February 12, 2020: Jimmy Dore Show
Corporation X (my Medicare “Advantage” Plan Insurer) contracts with the Medicare administration to manage the Federal Medicare I get as an over-65 U.S. citizen, and to, of course, profit from this relationship. Corporation Y exists to manage the behavioral health benefits I get through Corporation X. And to likewise profit from this relationship. Then there are the various other corporate service providers with whom corporation X contracts. Who of course also profit from this relationship. This is what the opponents of Bernie Sanders’ Medicare-for-All plan tell me I should love; along with all the other Americans who purportedly love their health insurance.
No Shortage of Middlemen Contractors and Sub-contractors
Sorry. I’m not lovin’ it. It routinely feels like there are more middlemen with their forks in the pie than there are practitioners directly involved in my healthcare. And with each one of these corporately structured intermediaries, the system experiences a waste of patient healthcare dollars.
For example, the fact that some fraction of my healthcare dollar is paid by Corp. Y to Corp. Z, with whom I have no contract, exhibits one of the numerous reasons why the current Medicare situation is inefficient and wasteful. And therefore, why Sanders is right about getting private insurers out of proposed Medicare-for-All solutions to the US healthcare fiasco. And why I hate my health insurance despite it being Medicare. Not that I ever loved any of my job-associated heath plans when I spent 40 years with numerous employer-supplied plans, mostly because they were juggled annually, leading to the search for new providers and diminished continuity of care. And because they always involved a plethora of shekel-sucking middlemen with whom my insurer contracted behind the scenes.
As a biomedical scientist and close observer of the Medicare plans of my contemporaries in addition to my own, I’m personally acquainted with issues and inefficiencies that make private insurer sticky fingers into Medicare a waste of resources at a time when the planet’s tolerance for such waste is decidedly low. And when healthcare dollars are so fawned-over by politicians, practitioners and insurers.
Why do we geriatric Boomers bother with such an advantage plan or with other supplementary insurance? Because unlike the Sanders plan, straight Medicare doesn’t cover drugs or dental or vision. Other than the five pharmaceutical drugs I take, neither does my advantage plan, not without a monthly payment and annually significant drug co-pays. Ironically, the most symptomatically beneficial drug I take, Medical Cannabis is, of course, not covered. This situation prevails despite the fact that dental and vision are out of pocket unless one can afford to also add supplemental plans to advantage plans or directly to Medicare. Unfortunately, I can’t afford all that, so preventative procedures like dental cleanings are not covered by my personal configuration of Medicare. As so-called health maintenance, they should be, based on the clinical science.
Hold the Paper
Supposedly such advantage plans offer paperless solutions to their insured, but this is misleading to put it mildly. To avoid paper and facilitate payment, I agreed to have a credit card billed for my monthly. Yet I receive a monthly envelope of paper containing a “bill” that instructs me to “please do not send in a payment”; plus several other full sheets, one containing my name and address, another offering language translation services. Upon receiving that first mailing during a past January, I phoned to object, insisting that I had chosen to go paperless. I was told that Medicare required this hard-copy record. This may be a Federal Medicare administrative glob of waste, but either way it’s unnecessary. And it’s what tends to happen when we add administrative layers to bureaucracies.
Then, in addition, there are at least two different mailings of several pages each that I am supposedly required to receive monthly— connected with summaries of prescription drugs and other out-of-pockets. Snail mail is also used to browbeat the insured, and this is certainly under my insurer’s control; or that is, of a third party they contract to do their billing (for fourth, fifth, etc. organizations contracted to perform procedures like CT or MRI scans). For example, while copays for procedures such as x-rays and scans do post on an online portal, should one wait more than a few days from those postings to pay the bill, the insurer’s/biller’s software automatically cranks out a mailed paper invoice. I have experienced the receipt of such a paper invoice a day after I paid a bill online, a mere five days after the online invoice posted. This stinks of typical corporate behavior: beneficial to the corporation, bad for the environment. Over two years of taking count, I have received between two and three pieces of mail per week. That’s around 125 well-stuffed mailings per year — while signed-up for “paperless.” Regardless of how much paper we recycle, such behavior is nonetheless ecologically counterproductive. And wasteful of healthcare dollars. And ultimately emblematic of the dishonest and profligate behavior that pervades this system of Medicare-with-private-insurers.
Then, there’s no stopping the literal flood of snail mail solicitations that reach all Medicare recipients each October. In my five years on Medicare, I’ve generally received between a dozen and 20 between late September and early December. Fear Message from one of my mailed solicitations: “Medicare is Complicated.” Simpler message: ditch your current Advantage or supplement plan and give us your healthcare dollars, instead. We may be listed as nonprofits, but that really only means tax relief for us. It’s still for-profit healthcare for you.
If Medicare is really so complicated, one cause of this situation is the presence of so many competitors to siphon those healthcare dollars into investor pockets. For-profit healthcare is an oxymoron. Man cannot serve two masters.
Then there are the rare mailings from corporation Z, which tells me that it “manages behavioral health benefits” for corporation Y, my insurer. The latest of these arrived in my mailbox to let me know that some of my information may have been “put at risk.” Not only did I never sign up for a relationship with Corporation Z, but I discover that their enlistment by my insurer as a factor in my healthcare has subjected me to potential identity theft. My current Medicare is indeed complicated. But clearly not for my benefit.
Now a Phone Plague
This year’s (2019) Medicare revision period (October 15–December 1) has also unveiled the direct phone contact solicitation. Promptly at 8 am, I am besieged by unwanted phone calls from hired call center workers being paid to shill for some insurer’s Medicare advantage or supplement plans. Just another excuse for someone to intrude into the lives of the elderly in an attempt to siphon precious dollars away into corporate pockets. And another reason to exclude insurance companies from sticking their noses into Medicare.
And if Medicare is so great, why does their administrative arm, the Center for Medicare Services, send me an email a week urging me to “compare Medicare plans”? It strikes me as the same sort of federal government–private corporation collusion that I reject as a source of many of our problems. It clearly shouts: Medicare is incomplete, inadequate. Privatize. Find a corporate middleman to close the holes in your social safety net. For progressives, this isn’t an answer in the long run.
Online Patient Portals: Misleading Advertising
Online portals are big advertising points for Medicare-plan insurers, touted as offering ease of contact with one’s physician, as well as the guarantee that all one’s practitioners will have access to medical records. This arrangement is promoted as facilitating contact among a patient’s practitioners. But like any digital linkup, the promise of the technology depends upon the human factor. That is, none of this works unless all practitioners are equally willing to use the portal to familiarize themselves with a patient’s history prior to appointments requiring high specialist copays. In my experience, this is sometimes not the case. For example, I exposed myself to a CT scan and a hefty copay to compensate my insurer for its negotiated arrangement with the scan provider. I subsequently arrived at a specialist appointment to discover that the specialist practitioner’s first contact with the scan’s results was a printout of those results that I’d brought with me and handed to that practitioner. Considering that the purpose of that high-copay appointment was to obtain a specialist’s opinion of those scan results, this was disappointing at best.
Adding insult to injury was the fact that in scheduling that appointment, I’d discovered that the scheduler had no notion that I had already endured the scan. So I proactively contacted my primary care physician, who agreed to send a note to the specialist regarding the appointment’s purpose as providing an opinion on the scan results. Somehow that communication also got lost in the healthcare jungle. Blame it on crowded practitioner schedules leaving little time for such online consultation. Blame it on faulty data entry (GIGO). Whatever the reason, the portal provided little real benefit. Online portals tend to become just another outlet for false advertising. As in the invitation to join our health plan because we have the best portal that will make your healthcare so much easier and efficient at meeting your individual needs.
Rubbish. Stronzata. The fact that these ads would urge you to switch insurers to obtain a better portal is disingenuous at its core because the most important aspect in continuity of care is continuity of providers. And switching among advantage plans frequently guarantees that a patient must scramble to find providers in the new insurer’s network who are accepting new patients. This game of change-partners virtually guarantees non-continuity of care.
Extended Hospital Stays Break the Bank
All Medicare recipients are currently obliged to pay for Parts A and B, the former supposedly hospital insurance. Yet, under my advantage plan, admittedly not one of the best (but what I can afford), copays for several days in hospital would set me back several thousand dollars, not including ancillary costs for procedures while hospitalized. Stories also abound of Medicare recipients saddled with unanticipated bills from in-hospital practitioners who were deemed not in-network. It’s absurd that while enmeshed in the stress of a hospital stay, folks should be capable of interrogating each physician, nurse, or other practitioner about their membership in various insurer networks. Any catastrophic illness and I would readily become one of the many folks in the U.S. who face possible financial ruin during a period when coping with the illness is quite stressful enough. And while current privately insured patients are also subject to this aspect of confusing healthcare coverage, to my mind, in the context of Medicare, this violates the entire spirit of universal coverage to which so many politicians mouth a skin-deep fealty.
The Tangle of Federal and Corporate Bureaucrats
This combination of a nexus of middleman corporate bean counters and Federal Medicare bureaucrats is a prescription for inefficiency, particularly when the relationship is often adversarial.
Now I’m no ingenue when it comes to the mind-numbing inefficiencies of federal bureaucracies. I spent 12 years as a Department of Energy contractor at two National Labs, and the festering inefficiency of that environment is burned into my synapses. But to you folks who take the position that the government is so inept that we should honor Ronald Reagan’s prescription to drown it in a bathtub. You small-gov libertarians might want to pay closer attention to how that government inefficiency grates against — and is augmented — by the actions of multiple corporate contractors grappling for their slice of the healthcare pie.
Accept No Substitutes
Medicare Advantage Plans are emblematic of what most of us don’t want: control of our healthcare by corporate bureaucrats who wouldn’t know a knee-joint from a lobe of liver. Meanwhile, Bernie Sanders’ Medicare-for-All bill in the Senate and Pramilla Jayapal’s in the House would do away with these advantage and supplement plans by making then superfluous. Supplemental plans would still be available for procedures such as cosmetic surgery, but not for basic Medicare services, which would all be covered. It’s time to bring that vision to fruition.
