Without their knowledge or consent, many Medicare patients have been swept into for-profit third party organizations with power over their healthcare decisions. You may already be one of these patients. The intent of this article is to make you aware of this possibility and to encourage you to take action to protect yourself. A good start might be an informational webinar being offered on Monday, May 23rd.
Since 1965, when Lyndon Johnson signed healthcare for seniors into law, most Americans have been able to rest relatively easy about the healthcare of their later years.
Though eligible seniors have long been able to choose between Traditional Medicare (provided by Uncle Sam with their taxpayer dollars) or Medicare Advantage (MA- a privately-run plan also funded by tax dollars), the vast majority have chosen Traditional. The simple reason for this preference is that most seniors do not trust a “for profit” organization to be in the driver’s seat of their healthcare vehicle.
Names have been changed, but not to protect the innocent
Private Plan Medicare has been somewhat of an option for decades, though the name has been changed often, and its inducements “improved” to attract customers. Promotions for these private plans have variously promised “improved healthcare”, “coordination of benefits”, “timely care,” etc. Think HMO, Medicare + Choice, peer-review group, managed care, benefit coordination, Accountable Care Organizations (ACO) and many, many others. Traditional Medicare has also adopted many of these same methods in its quest to provide decent care at acceptable prices.
Even with all these improvements and inducements, as of 2017 only about 33% of Medicare-eligible seniors chose to be in private plans. The Congressional Budget Office estimates that 2027 will see 41% enrollment in whatever such programs are calling themselves by then. Using their billions of dollars in taxpayer-funded profit, the private insurers who administer these plans aggressively (and expensively) advertise these perks to seniors via television and social media ads, mail solicitations, and invasive telephone calls. Despite their promised enticements of coverage for glasses, hearing aids, prescription coverage, gym memberships, etc., the majority of seniors still stick with Traditional care plans. Go figure.
Denying care = Profit
Amazingly, Traditional Medicare, for all its unwieldiness and occasional missteps, provides its services with only 2% of its funds going to “administration” and spends 98% of its funds on services to senior citizens. In contrast, Medicare Advantage, currently the most prominent private-care plan, spends 60% of the taxpayer funds it receives on services and manages to retain 40% for itself.
MA has been very successful-especially for the private insurers. But, it is perhaps not so great a deal for the majority of seniors. The only way to take the same dollars per case and retain huge profit is to reduce spending on services. While approximately 99% of Medicare patients are eligible for MA, its subscribers tend to be the healthier and more affluent seniors. It is extremely unlikely that the model can work for those seniors who require a lot of healthcare services. Most anyone can do the math. What it adds up to is seniors being denied care that a profit-driven insurer deems “unnecessary” or “too costly”.
Wake up and smell the…smell
Anyone who has not spent the past several decades in a coma is aware that the rich and powerful of the world have not eschewed the judicious sharing of their wealth and power with willing recipients in elected office. In other words, many a politician will take many a “brown bag”.
Taxpayers/voters continue to elect their “favorite sons,” with almost no regard for whether they actually achieve anything for the benefit of those who vote for them. Elected office holders of both political parties bestow the “productive” part of their allegiance to those who give them the dollars to continue being elected, term after term. Taxpayers and voters generally get the worthless “promises” part.
That scenario is currently playing out again right under the noses of today’s senior citizens, as well as under the younger noses of those who will be the senior citizens of the future.
This secret train is speedily on its way to deliver the golden egg of senior healthcare funds to powerful for-profit organizations. It may still be possible to derail the train, but time is very short.
Nothing to see here; move along!
You may have received a notice from Centers for Medicare & Medicaid Services (CMS) that your doctor or healthcare group is now part of a Medicare Direct Contracting Entity (DCE).
A DCE is an organization, (generally a for-profit) that acts as the middle man between the patient and the care provider. Entry into a DCE may be voluntary or automatic (based on prior claims). See more details here.
However, hundreds of thousands of current Medicare patients who have consistently chosen Traditional Medicare have, without their permission or knowledge, already been “auto-aligned” into a DCE. While “voluntary alignment” at least suggests some customer choice, auto-aligned means about the same as “hijacked”. Millions more are slated for that pleasure in the not-too-distant future, unless something changes.
My particular CMS letter came literally filled with oft repeated assurances that “your regular Medicare benefits have not changed” and that you still have your “freedom of choice.” The letter helpfully provides a “list of the doctors and other groups that work with us” at https://avc2dc.com/. Also, I’m told that “some special features may be available” to me and that they “look forward to helping” my doctor care for me over the coming year.
I would never have chosen my doctor had I not thought him and his group perfectly capable of taking care of me without the intervention of a for-profit third party. This is the reason that I feel (temporarily?) lucky, because the only way out of most DCEs is to choose another doctor.
No action needed! or wanted.
The first line of my letter reads: REQUIRED ANNUAL NOTICE: NO ACTION NEEDED.
This is the line I find most doubtful.
Action is always needed when any controlling entity comes into power with as little fanfare as did the DCE and its spanking new Biden off-shoot, ACO REACH*.
The DCE got its start in the last couple of years of the Trump administration as a “pilot program”. Not too much of a surprise there.
Tellingly, there was no publicity. No public discussion, no public vote, no official Congressional oversight set forth. Most importantly, there was no public push by taxpayers/voters to privatize their healthcare plan.
Again, most seniors have consistently said “no thank you” to all the glorious advantages offered by private pay Medicare plans.
After relentless pressure from Physicians for a National Health Program (PNHP) and its allies, the Centers for Medicare and Medicaid Services (CMS) announced in February 2022 that they are terminating Trump’s controversial Medicare Direct Contracting program, four years ahead of schedule. But do not rejoice prematurely.
The Biden administration could have ended the Trump era privatization drive at any time, but has instead chosen to morph it once again, re-brand it as ACO REACH, and continue onward to privatization. No real surprise there, either.
The rich and powerful have quietly decreed that privatization of Medicare is the best possible future healthcare for all. Many doubt that. Unfortunately, they are mostly just taxpayer/voters. Regardless of what it is called, the wheels are now fully in motion.
Pay no attention to the man behind the screen
The insertion of private insurers into the senior healthcare model has, over the years, been somewhat slow and insidious. That changed drastically with the Trump administration. The Biden administration has been pouring new fuel on the rebranded project for the past 3-4 months.
How is it that these two so disparate presidents found common ground in a vision to turn senior healthcare over to entities that have a boundless appetite for profits? Take a wild guess.
If you can’t come up with any ideas, check the publicly available information on election campaign funding. Big dollars support bigger dollars. There is no getting around that truth, no matter what your political affiliation. Always, always follow the money!
For your additional information, AARP, the bastion of support for senior citizens, has been eerily silent on this subject. of course, AARP is, at its core, an insurance company.
There is almost no hope of a “short game” to fix this societal problem. Some cheer for term limits or campaign financing reform; some advocate ranked-choice voting. There are other, more disconcerting options to which I will not link.
Should you want to know more about DCEs and ACO REACH (and you certainly should want to know more), consider registering for the free webinar presented by Physicians for a National Health Program (PNHP) on Monday May 23: “Turning up the heat to protect Medicare”.
I encourage you to dig into this secretive situation. I have provided several links. If you have other preferred sources, you are likely to find the information on this topic is very similar, indeed. Find something you agree with that might make a difference and throw your support behind it. Check out the Monday May 23rd Webinar.
No one seems to be putting much hope on the “moral integrity” political model these days. But the truth is that we must find something that we can all live with, or they will surely succeed in buying something from which only they benefit.
See the biggest Medicare threat you never heard of here.
Follow the money: here.
Equal opportunity privatization: here
*ACO REACH (Accountable Care Organization Realizing Equity, Access, and Community Health)