Medicare Is Quietly Being Dismantled, And Here’s How We Can Save It
Under the traditional Medicare program, the Center for Medicare and Medicaid Services directly reimburses providers for patients’ medical care.
The “direct contracting model” set up by former president Donald Trump’s son-in-law Jared Kushner began to roll out in 2021 and introduces private companies known as “direct contracting entities” (DCEs) as middlemen between the Medicare program and health care providers.
As Cleveland.com reports, the rationale is to reduce cost by spreading financial responsibility between the government and third parties. However, under the false guise of risk-sharing, private groups can siphon massive amounts of cash away from seniors to line their own pockets.
This experimental model currently spans 38 states, where doctors and private health insurers can switch patients from Medicare to privately run insurance without permission.
By paying corporate middlemen to administer our public option for older Americans and people with disabilities, this model only props up the corporate health care industry. And because so little has stood in its way since the program was first implemented, there is growing potential for the wholesale privatization of Medicare, MetroTimes reports.
Privatizing Medicare was done before, when President Ronald Reagan included the Medicare Advantage program in a deficit reduction bill.
According to the Medicare Payment Advisory Commission, a congressional agency set up to give policy advice on Medicare, risk scores for patients under Medicare Advantage’s semi-privatized system were 8 % higher than for those on traditional Medicare, costing taxpayers more than $106 billion in overpayments from 2010 to 2019.
“It’s hard to miss the big red flag that Medicare is grossly overpaying these plans when you see that beneficiaries have more than 30 plans available in their area and are being bombarded daily by TV, magazine and billboard ads,” Cristina Boccuti, director of health policy at West Health, told NPR.
Further, a 2018 HHS inspector general report found inappropriate denial of care was rampant in the program. Following that, a Kaiser Family Foundation reports showed Medicare Advantage enrollees tended to pay more for longer hospital stays.
“The insurance companies are making twice as much money from Medicare Advantage than they do from employer-sponsored health insurance,” Dr Ana Malinow, professor of pediatrics at the University of California San Francisco told . “Workers have no more money, employers don’t, but who does? The government.”
Direct contracting creates even more opportunity to undermine and overcharge patients by targeting those who think they are choosing to stay in traditional Medicare. They receive letters assuring them that everything is fine and that better quality care is on the way, but never given any idea if they can opt out, or how.
According to the Center for Medicare and Medicaid Innovation (CMMI) director Liz Fowler, it is possible to opt out of the DCE model by switching primary care providers, which can be an long and frustrating process for anyone, especially seniors who may already have years of history with a trusted provider.
“What direct contracting does is turn the public side of Medicare into a corporate goldmine,” says Diane Archer, president of Just Care USA, told PHNP.
As Buzzfeed reports, the Biden administration has continued this program with little public discussion. Now that the workings of the program are better understood, progressive lawmakers and doctor and patient groups are driving some of the strongest criticism. Many are outraged.
“To privatize Medicare without the knowledge of people who chose Medicare is scandalous,” said Rep. Jan Schakowsky. “We can’t let that happen.”
The Biden administration intends to run the program through the end of Biden’s term. This paves the way for a future president to expand its scope and further erode Medicare.
According to Politifact, Medicare spending on administrative costs is under 10%. In Medicare Advantage plans those costs are held to a maximum 15% of their premium revenue. The direct contracting model has no such limit, often leading to ad, and paves the way for not only the largest national insurers to become DCE, but virtually any company, even a venture capital firm, without congressional approval.
Companies like Aetna, Alignment Health, Humana, and Clover Health, backed by Google parent company Alphabet are all vying for DCE status, Home Healthcare News reports..
“The goal is to privatize all of Medicare through this program,” says PNHP president Susan Rogers.
According to CMS reports, all enrollees of traditional Medicare will be moved into “a care relationship with accountability for quality and total cost of care by 2030.”
For the sake of the health and wellbeing of all Americans, we cannot let this happen.
Help us ensure that beneficiaries of Medicare, the foremost pillar of healthcare in the United States, will be protected from the greed of private, for-profit entities. Sign the petition and tell the Center for Medicare and Medicaid Services to leave the DCE model behind and return to an honest system that puts people over profits!Whizzco