News:

Blessed are they who hunger and thirst for justice: for they shall be filled. Mine eye also shall see my desire on mine enemies, and mine ears shall hear my desire of the wicked that rise up against me. The glory of the Lord shall endure for ever: the Lord shall rejoice in his works. He looketh on the earth, and it trembleth: he toucheth the hills, and they smoke. I will sing unto the Lord as long as I live: I will sing praise to my God while I have my being. My meditation of him shall be sweet: I will be glad in the Lord. Let sinners be consumed out of the earth, and let the wicked be no more. Bless thou the Lord, O my soul. Praise ye the Lord.

Author Topic: Medicare Advantage is Capitalist CORRUPTION of Medicare for Greedball "Health" Insurance Corporations  (Read 68 times)

0 Members and 0 Guests are viewing this topic.

AGelbert

  • Administrator
  • *****
  • Posts: 3137
  • Gender: Male
  • Location: Colchester, Vermont
    • SoberThinking

Laura Waters: My experience with Medicare Advantage

Oct 2 2022 This commentary was written by Laura Waters, a retired environmental consultant living in South Burlington.

I saw the recent article in VTDigger about the state employees union fighting the state's plan to go to Medicare Advantage and felt compelled to respond with our recent experience. There are way too many glib sales pitches for Medicare Advantage that hide the “inconvenient truth” about these plans. A recent Health and Human Services report stated that Medicare Advantage plans deny millions of requests for medical care each year and tens of thousands of those denials are for tests and treatments that should have been approved and paid for and would have been paid for if the insured had been covered by traditional Medicare.

In the VTDigger article, Beth Fastiggi, commissioner of the Vermont Department of Human Resources, stated that “A lot of the negative information regarding Medicare Advantage is not necessarily regarding group MA plans” However, my 93-year-old parents are on United Healthcare Medicare Advantage that was negotiated for Bank of America employees, which was supposed to be better than the UHC Medicare Advantage regular plan.

Well, we just had a horrible experience with UHC Medicare 😈 Advantage denying coverage for my dad after he broke his hip and needed to be in rehab for 4-6 weeks. UHC determined that after 2 weeks he was ready to be discharged to his independent living apartment. This was someone who couldn’t even get out of bed without two aides and a Sara Stedy lift for his sit/stand transfers. I immediately appealed the decision which goes into a black hole with an “independent” organization, Kepro, that has an “independent” doctor review their decision. When you go through the appeal process, they make it as difficult as possible to engage since the appeal goes to Kepro which, of course, has every incentive to find ways to deny coverage. The patient and family have absolutely no way to engage with anyone with Kepro to have a meaningful conversation about the needs of the insured. The mysterious Kepro doctor denied my dad’s coverage and when I asked why, the person who called me told me that they didn’t know. The only recourse I had was to re-appeal the decision.

The denial went into effect on Saturday night, so it was impossible to get any information about why he was denied because Kepro wouldn't (couldn't) email me the doctor's letter. I had to wait until the following Monday to go to the rehab facility to collect the information. To make matters even more anxiety-ridden, I only had until 11:00 on Monday to respond with the “family letter.” If I missed the deadline, they would not accept my attached response detailing our concerns.

As I was trying to navigate this impossible process, I got in touch with Vermont Legal Aid and was told that since it is a Medicare Advantage plan they couldn't help us since it was completely outside of state regulations.

Most of the folks in the state government who are advocating for this change are not old enough to have Medicare and are only parroting the talking points of the for-profit insurance companies. From our experience, Medicare Advantage works until you really need it — and that is what they are telling us at the rehab facility. They told us that we would never have been denied coverage for my dad if he had been in traditional Medicare. Once you are elderly or very ill, needing complicated or expensive tests and treatment, they do everything they can to deny coverage so they don't have to pay.

After many, many hours of battling UHC and Kepro, we did prevail and he was allowed to stay until the end of September. However, I had the time and ability to take on this fight. What the insurers are counting on is that folks will give up and they won’t have to pay. 
https://vtdigger.org/2022/10/02/laura-waters-my-experience-with-medicare-advantage/
« Last Edit: October 03, 2022, 03:14:46 pm by AGelbert »
So in everything, do to others what you would have them do to you, for this sums up the Law and the Prophets. Matthew 7:12

Share on Facebook Share on Twitter


AGelbert

  • Administrator
  • *****
  • Posts: 3137
  • Gender: Male
  • Location: Colchester, Vermont
    • SoberThinking
Oct 12, 2022

Health Insurance Whistleblower: Medicare Advantage Is "Heist" by Private Firms to Defraud the Public


Democracy Now! 1.17M subscribers

Many of the nation's largest health insurance companies have made billions of dollars in profits by overbilling the U.S. government's Medicare Advantage program. A New York Times investigation has revealed that under the Advantage program, health insurance companies are incentivized to make patients appear more ill than they actually are. Some estimates find it has cost the government between $12 billion and $25 billion in 2020 alone. We speak with former healthcare insurance executive Wendell Potter, now president ​​of the Center for Health and Democracy, who says Medicare Advantage will be recognized in years to come as the "biggest transfer of wealth" from taxpayers to corporate shareholders, and blames the lack of regulation over the program on the "revolving door between private industry and government." 

Democracy Now! is an independent global news hour that airs on over 1,500 TV and radio stations Monday through Friday. Watch our livestream at https://democracynow.org Mondays to Fridays 8-9 a.m. ET.

Support independent media: https://democracynow.org/donate
Subscribe to our Daily Email Digest: https://democracynow.org/subscribe

#DemocracyNow

Paul Mezhir
No surprises here. I worked as a sales rep for a company that operated New York State's first Medicare Advantage program. When the plans were first introduced, the programs were far more regulated and could only be operated as a not-for-profit organization. The beginning of the end for Medicare Advantage programs was in 2006, with the passage of the "Medicare Modernization Act," which opened the field to for-profit insurers like Cigna, Humana, Aetna and United Healthcare. The Part D drug program was a massive giveaway to for-profit Insurance companies and the Pharmaceutical and Pharmacy industries. These companies have become fully integrated, owning not only the insurance plans but also pharmacy benefits management, pharmacies and even hospital ownership. It's pure collusion and it does nothing but harm to Medicare-eligible enrollees who are restricted by  burdensome rules such as the referral system to see acspecialist, denial of expensive diagnostic imaging services, denial of care necessitated by one's own doctor's orders. In some cases, the benefit is worse even than what one would have if one had Medicare only.

And dont even get me started on the obscene amounts of profit and/or extravagant salaries for those executives fortunate enough to really rake in compensation that is easly higher than doctors and even hospital administrators.

We already have a multi-tier system of death panels in this barbaric country we live in.
« Last Edit: August 04, 2023, 01:25:27 pm by AGelbert »
So in everything, do to others what you would have them do to you, for this sums up the Law and the Prophets. Matthew 7:12

AGelbert

  • Administrator
  • *****
  • Posts: 3137
  • Gender: Male
  • Location: Colchester, Vermont
    • SoberThinking
Real Progressives

October 13, 2022 Economic Justice, Health and Well-being

BY CORY DOCTOROW

Radicalized Book cover

US health insurers get more and more federal funding, deliver less and less care 

Obamacare was poisoned aborning.

The American healthcare system is the worst of all possible worlds. Unlike every other wealthy country, the US leaves its health insurance to the private sector, where your health and your life are a distant second to shareholder profits. But it’s worse, because the majority of the money those terrible, “private” insurance companies “earn” comes from public subsidies.

In other words, the US has a privately run health care sector that is publicly financed, without any public accountability or duty to the public good. Insurance companies take ever more billions from the federal government and deliver ever less care to their customers.

Cigna-exec-turned-whistleblower Wendell Potter has just published a new report that breaks down share of federal subsidies in the largest US insurers’ bottom lines:

  • Humana: 91%
  • Molina: 89%
  • Centene: 86%
  • Aetna: 73%
  • Unitedhealth: 72%
  • Elevancehealth: 68%
  • Cigna: 42%

https://wendellpotter.substack.com/p/the-majority-of-big-insurers-health

See that? The vast majority of US insurers’ income is public funding. That’s because of Medicare Advantage, a privatized Medicare service that 27 million older people have been tricked into signing up for, which consistently delivers worse service with higher out-of-pockets, while billing the US government for billions.

You should not sign up for Medicare Advantage, nor let anyone you love do so. Medicare Advantage will deny you care you are entitled to and leave you to sicken and die, while draining the last of your savings in co-pays:

https://www.nytimes.com/2022/04/28/health/medicare-advantage-plans-report.html

The insurers aren’t done. They raised their prices by 24% in a single year:

https://wendellpotter.substack.com/p/the-price-of-health-insurance-has

Despite these massive profits, spiraling fees, and mounting premiums, the Biden admin is on track to let the insurers raise their prices again, though not by as much as originally announced:

https://www.cnn.com/2022/09/27/politics/medicare-premiums-biden/index.html

You don’t have to be on Medicare to be part of the health insurance scam. If you’ve got an Obamacare subsidy, you are helping to transfer billions in public money to insurers, even as these ACA plans grow steadily worse. ACA plans deny one in five claims:

https://www.kff.org/private-insurance/issue-brief/claims-denials-and-appeals-in-aca-marketplace-plans/

Meanwhile, the out-of-pocket expenses your ACA insurer can rook you for just went up to $14,700/year:

https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/#:~:text=For%20the%202022%20plan%20year,and%20%2417%2C400%20for%20a%20family.

ACA coverage is so poor that many of the people paying for it are best understood as “functionally uninsured”:

https://www.forbes.com/sites/forbesbusinessdevelopmentcouncil/2022/07/27/functionally-uninsured-the-fiction-of-healthcare-coverage/?sh=5e6547a2680b

ACA was sold as a brokered compromise between public healthcare advocates and private healthcare cultists. It created a situation where private insurers could grow larger, more powerful, more profitable, and less accountable to government, patients or doctors, so that care would steadily erode and prices mount.

ACA set the stage for Medicare privatization through Medicare Advantage. It was the template for the public-private-partnership from hell, teeing up a future where we finally get the wildly popular Medicare For All, but delivered by the same murdering profiteers who run the private system it was supposed to replace: Medicare Advantage For All.

As David Sirota writes in The Lever, Biden’s 2020 campaign recognized this, and promised us a public option where “premiums could be substantially lower than those of private plans,” but “Biden hasn’t once mentioned a public option since becoming president.”

https://www.levernews.com/health-insurers-get-government-cash-then-jack-up-prices/

When Congress votes to give billions in public money to the health insurance industry, it also votes to give millions to itself — our legislature is awash in health insurance company dark money, and Democrats — including members of the Progressive Caucus — are carrying its water:

https://bettermedicarealliance.org/wp-content/uploads/2022/01/final_2022_house_ma_letter_.pdf

Giving for-profit insurance companies more public money will not translate into better care. The CEOs of every one of those publicly subsidized insurance companies took home more than $20 million in pay last year. 86% of Centene revenues came from the public coffers. Its (recently deceased) CEO Michael Neidorff paid himself $20.6 million.

It doesn’t have to be this way. We know how to fix this. Biden laid it out in 2020:

Quote
Giving Americans a new choice, a public health insurance option like Medicare. If your insurance company isn’t doing right by you, you should have another, better choice. Whether you’re covered through your employer, buying your insurance on your own, or going without coverage altogether, Biden will give you the choice to purchase a public health insurance option like Medicare. As in Medicare, the Biden public option will reduce costs for patients by negotiating lower prices from hospitals and other health care providers. It also will better coordinate among all of a patient’s doctors to improve the efficacy and quality of their care, and cover primary care without any co-payments. And it will bring relief to small businesses struggling to afford coverage for their employees.

https://joebiden.com/healthcare/

People are angry at their insurers, and justifiably so. Cigna isn’t just raising prices and co-pays, it’s committing mass-scale fraud: “exaggerat[ing] the illnesses of its Medicare members to obtain higher payments from the federal government.” Also credibly accused of Medicare fraud: Unitedhealth and Elevance.

https://www.modernhealthcare.com/insurance/doj-joins-cigna-medicare-advantage-fraud-case

In 2019, I published Radicalized, a collection of four novellas subtitled “four tales of our present moment.” The title story, “Radicalized,” was frightening and upsetting to write, but I couldn’t stop myself. It’s a story about angry men who watch the people they love the most slowly and agonizingly murdered by care-denying insurance companies, who meet on message boards where they plot to murder health-care executives.

https://us.macmillan.com/books/9781250228598/radicalized

Having grown up in Canada and then spent more than a decade in the UK — and now become a US citizen — it’s incredible to me that Americans tolerate this ghastly, worsening system. Not that I want to see terrorist violence! The very idea is sickening and terrifying.

But it is baffling to me that there are Americans who shoot each other over road-rage and yet as far as I know, the $20m/year vampire CEOs of profiteering, fraud-addicted insurance companies are living in comfort and safety.

It’s one of the great paradoxes of the American psyche: all of that macho, don’t-tread-on-me posturing turns to vapor when the person who’s literally condemning your family to die is a distant corporate executive.

All that anger has to be out there, somewhere, channeled by cynical operators into scapegoating and nihilism. It’s a ticking time-bomb. Imagine the political win that would accrue to the party that made saving your life and the lives of the people you love its political centerpiece. A party that met astroturf with naming names, hauling insurance execs into Congress to confront grieving mothers, fathers, children and spouses. A party that refused to let Lucy yank the football again with a “compromise” that gives us a privately managed, publicly funded service that only serves shareholders and executives.

Originally published on the author’s Medium blog.
https://realprogressives.org/us-health-insurers-get-more-and-more-federal-funding-deliver-less-and-less-care/
« Last Edit: November 11, 2022, 12:21:08 am by AGelbert »
So in everything, do to others what you would have them do to you, for this sums up the Law and the Prophets. Matthew 7:12

AGelbert

  • Administrator
  • *****
  • Posts: 3137
  • Gender: Male
  • Location: Colchester, Vermont
    • SoberThinking
COUNTERPUNCH 

DECEMBER 30, 2022 BY SANDRA M. FOX 


Architects of Medicare Privatization: Congress, Biden and the CMS

SNIPPET:

Advocates for a national single-payer healthcare system in this country, often referred to as Improved Medicare for All, acknowledge the weaknesses in the current version of traditional Medicare.  While the federal government has allowed for perks to beneficiaries in Medicare Advantage plans, including free gym memberships and some (limited) dental and vision care, these benefits are not available to those choosing traditional Medicare.  Why not?  They are a clever way for private companies to increase enrollment in their plans, in addition to lowering their premiums, made possible through excessive payments received from the Medicare Trust Fund to private insurers.  So far, Congress has not expanded those benefits to beneficiaries in traditional Medicare, thus favoring for-profit companies.

The money is there to improve traditional Medicare and expand it to cover all residents of the United States, as substantiated by the Congressional Budget Office. But many elected officials on both sides of the aisle will say otherwise and are compensated by private health insurers with handsome campaign contributions.

Meanwhile, the Center for 🐍 Medicare and Medicaid Innovation (CMMI), under the Center for Medicare and Medicaid Services (CMS) within the Department of Health and Human Services (HHS), was established as part of the 2010 Affordable Care Act (ACA).  According to its website,

“the CMS Innovation Center, through its models, initiatives and Congressionally-mandated demonstrations, has accelerated the shift from a health care system that pays for volume to one that pays for value.”

The ACA also allowed CMMI to make changes without Congressional oversight.  And CMMI is determined to reframe privatization as value-based care.

🐍 CMMI has been quietly contracting with for-profit companies to engage in “pilot programs” that insert middlemen into traditional Medicare without the beneficiary’s consent and often without their knowledge.  The Trump Administration, which launched the program, contracted with 53 for-profit middlemen called Direct Contracting Entities (DCEs).  The Biden Administration re-branded the program ACO-REACH (Accountable Care Organizations Realizing Equity, Access, and Community Health) and increased the number of corporate participants to 99.

These participants include private health insurance companies as well as private equity/venture capital firms, which can keep up to 40% of Medicare dollars in administrative costs and profits by “managing” patients’ healthcare.  The supposed goal is to lower costs through “value-based care.”  We already know that lowering costs in Medicare Advantage means delaying and denying care by requiring prior authorizations, as well as restricting provider networks.  Furthermore, an excellent analysis by healthcare policy experts Kip Sullivan, J.D. and James G. Khan, M.D., refutes the premise of CMS that Accountable Care Organizations will save money, given evidence of past performance.

The intended goal is the complete privatization of Medicare by 2030, as posted on the CMS website“All Medicare fee-for-service beneficiaries will be in a care relationship with accountability for quality and total cost of care by 2030.” Starting January 2023, the number of ACO-REACH programs managing the care of traditional Medicare beneficiaries is slated to increase dramatically, from 99 to over 200.


The appointment of 💵🎩 Elizabeth Fowler, Director of 🐍 CMMI, whose past work in the private healthcare sector as Vice President for Global Health Policy at Johnson & Johnson and as Vice President of insurer Wellpoint (now Anthem), not only poses a huge conflict of interest.  It reflects the intention of many within the federal government to privatize healthcare.  During the Obama administration, Fowler assisted in the development and implementation of the ACA, which created the CMMI, the office she now 💰😈 directs.

Full article:
https://www.counterpunch.org/2022/12/30/architects-of-medicare-privatization-congress-biden-and-the-cms/

                                                     
« Last Edit: January 01, 2023, 06:28:29 pm by AGelbert »
So in everything, do to others what you would have them do to you, for this sums up the Law and the Prophets. Matthew 7:12

AGelbert

  • Administrator
  • *****
  • Posts: 3137
  • Gender: Male
  • Location: Colchester, Vermont
    • SoberThinking

January 13, 2023 This commentary is by Dr. Deborah Richter, M.D., a practicing family physician in Cambridge, Vt. She lives in Montpelier.


Dr. Deborah Richter: Yes, we can do something about Vermont’s health care crisis

Legislative leaders have already laid out their agenda for this session. Despite the dire state of health care for the almost half of Vermonters under age 65 who are “underinsured,” it is clear that they have no intention of doing anything meaningful to address the state’s health care crisis.

Underinsured is an abstract idea that is easy to dismiss, but it has serious, potentially deadly real-life consequences. The underinsured 😞 have two alternatives when they are sick:

Delay care and risk their health.
Pay for care and risk falling into debt, getting evicted, etc.

Delaying care can cost them 🥵 dearly. Two examples:

A diabetic with a huge deductible fails to get routine checkups and ends up needing a foot amputation.
A person with a high fever and shortness of breath waits days to seek care and dies of bacterial pneumonia.

The other alternative, paying for care you can’t afford, also costs them dearly. That’s how “around 30,000 Vermonters” ended up with medical debt turned over to collection agencies, while “tens of thousands more … are paying down medical bills” that have yet to be turned over to collections.

If you want to see what medical debt does to your life, read over some of the stories collected by the state’s health care advocate. Medical debt has dramatic effects on these people’s lives, from ruined credit to skimping on food to postponing retirement. It goes without saying that these people avoid getting future medical treatment for fear of running up even more debt.

This kind of deciding between a rock and a hard place goes on every day in Vermont. It amounts to the worst, most unfair kind of health care rationing. 🥺

Why do we allow it? Here are the excuses we hear from some of our 💵🎩 legislators:

Excuse 1: Because Medicare and Medicaid are federally directed, we can’t change the rules they have in place.

This is simply not true. Waivers of federal rules are very common in Vermont and other states. In Vermont, VHAP, Dr. Dynasaur, and the all-payer model and the accountable care organization running it all operate under waivers of federal rules. And anyone watching the recent circus in Washington knows that we cannot expect a national universal health care system anytime soon.

Excuse 2: We don’t have enough primary care clinicians and expanding coverage would just make this worse.

Again, not true. Implementing universal primary care would be a magnet drawing primary care clinicians to this state. Including all patients in one program, with one set of rules and regulations rather than hundreds they now face, would vastly reduce the amount of time and effort they are forced to spend on administrative tasks.

Few people outside the medical profession appreciate how heavy that burden is now: 15.9 hours a week for family medicine doctors, according to a 2020 survey.

Excuse 3: It is too expensive to expand coverage to everyone.

In fact, we already spend more than enough to provide comprehensive care to all Vermonters. That has been shown in study after study.

mplementing a universal system would save massive amounts — as much as $1 billion, according to some studies.

Excuse 4: We need to address cost of care before expanding access.

The truth is that we will never be able to make health care affordable until we implement a universal access system. First, keeping people out of the current system is administratively very costly, as discussed above. Second, our current system encourages delayed care, which ends up costing more because people get 🤧🤒🤮🤢🤕 sicker during the delay.

​Note that these arguments against needed reforms are generalities while avoiding real reform inflicts very specific and extensive damage on a large portion of Vermonters.

Everyone agrees that health care needs to be fixed. Admittedly it is a gargantuan task to try to fix the whole system at once. After all, health care is nearly 20% of the Vermont economy with big, entrenched 💵🎩 “stakeholders” who exercise considerable influence over what legislation gets “moved” in the Legislature.

So why not start with a smaller piece: Universal primary care.

That makes primary care — including mental health and substance use disorder services — a public good, like police protection and firefighting. Commercial insurers would no longer have to pay the cost of primary care, and premiums would be reduced accordingly.

Universal primary care is a small but important piece of the answer. It comes with a small price tag for taxpayers — less than 6% of total spending — and that is offset by lower premiums. But it would make a big difference. Everyone needs primary care, even healthy people.

Make no mistake: This legislation is within the power of the Vermont Legislature. Ask your legislators to support universal primary care.
https://vtdigger.org/2023/01/13/dr-deborah-richter-yes-we-can-do-something-about-vermonts-health-care-crisis/
« Last Edit: January 14, 2023, 12:56:36 pm by AGelbert »
So in everything, do to others what you would have them do to you, for this sums up the Law and the Prophets. Matthew 7:12

AGelbert

  • Administrator
  • *****
  • Posts: 3137
  • Gender: Male
  • Location: Colchester, Vermont
    • SoberThinking

November 27, 2023 by Cheryl Kunis, MD, MS 🗽🕊️

'Medicarelessness' Revisited After 50 Years

🎩 Privatization of the public program has simply bolstered 😈 corporateprofits
SNIPPETS:

Medicare has expanded dramatically since its inception in 1965. Supposedly to improveopens in a new tab or window its efficiency, Congress eventually created Medicare Advantage (MA) in 2003. This new program, which is publicly funded but privately administered, ushered in a new era of Medicare privatization.

With the advent of MA, the insurance industry has pioneered new and evolving strategies to maximize profits that have led to widespread accusationsopens in a new tab or window of profiteeringopens in a new tab or window and fraudopens in a new tab or window. In 1973, "Medicarelessness" referred to "reckless" government spending on what became life-saving treatment; today, I believe it's more appropriate to assign this label to reckless spending used to bolster corporate profits.

In a just society, healthcare is an essential service that benefits all. The U.S. stands apart from other industrialized nations in that healthcare is not guaranteed. Medicare represents an attempt by our country to partially remedy this injustice. It not only provides care to some of the most marginalized members of society (the elderly and disabled), it also helped to desegregate the healthcare system, promoting racial equity. ... ...

🎩😈 Proponents of MA claim that privatization promotes innovation and efficiency, but its role in healthcare appears questionable at best. The reality is that no matter what, profit-driven corporations will likely never put the interests of the public above those of their shareholders. Privatization allows the government to shirk fiscal and moral responsibilities at the expense of those it claims to serve. It is a myopic strategy that benefits  corporations, yet keeps costs largely public. In short, the privatization of Medicare is "Medicareless."

"Medicarelessness" poses a much greater threat in 2023 than it did in 1973. We are thoughtlessly subsidizing the private insurance industry at an extravagant cost to the American taxpayer, and dismantling a vital and beloved public program. We must accept that life-sustaining services should remain in public hands to safeguard citizens from the gravest injustices. Medicare remains a potent symbol of our most sacred democratic principles: equality, dignity, and self-determination. We can no longer afford to be "Medicareless," both ethically and financially. We must say no to privatization.

Full EXCELLENT article:
« Last Edit: November 28, 2023, 03:58:39 pm by AGelbert »
So in everything, do to others what you would have them do to you, for this sums up the Law and the Prophets. Matthew 7:12