When you hear proposals for a national single payer cradle to grave health insurance plan, the one most often discussed is extending Medicare to cover everyone in the United States. Up until now, most seniors and disabled Americans have been pleased with their Medicare coverage. It would be a relatively simple matter to begin adding new members to the program. Many providers would rather bill Medicare than run the gauntlet of HMO contracts, referrals, claims denials and appeals.
However, under the Bush administration, there have been a number of changes made within the Medicare program. While these at first these may look like good old fashioned Dumbya incompetence combined with the insurance and pharmaceutical industry's greed, I suspect that there is something more going on here.
Just as Bush/Cheney want to bankrupt Social Security, they also want to destroy Medicare. If Medicare goes, then the health insurance industry can claim "National health insurance can never happen in this country!"
Here is how they are doing it:
1.
Privatizing Medicare: the Medicare Advantage Plans are big fat failures. They cost the government more money and (at least for the fee for service version) a big chunk of that money goes to the insurance companies, not the enrollees.
http://healthpolicyandmarket.blogspot.com/2007/06/cbo-issues-major-report-on-medicare.htmlThe Medicare Advantage plans are also in hot water because they have resorted to fraud and even criminal activity to pad their enrollments.
http://www.washingtonpost.com/wp-dyn/content/article/2007/05/15/AR2007051502074.htmlPeople who sign up (or are tricked into signing up) for one of these Medicare Advantage plans will find themselves the victims of the managed care industries unethical tactics, as described in Michael Moore's movie <em>Sicko</em>.
2. You do not have to be on a Medicare Advantage plan to find that your health care takes a back seat to profits. The federal government is about to
offer your doctor a financial incentive to reduce your care. It is called Pay for Performance, and it is in its infancy. The government tested the program out with ten big clinics. Of the 10, 2 were able to cut their spending enough that they received checks for millions of dollars. Two of the others would have qualified but Medicare changed the ruled mid game. (I got the financials from a recent issue of the weekly newspaper put out by the AMA). Here is another link about the topic:
http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=1343Now, any time you start paying doctors to cut spending, there are dangers. The easiest way for doctors to cut costs in their practice is to drive away the patients who are sickest. When I was in private practice, I saw this done by primary care doctors in my community. Patients who had the more severe forms of chronic disease were told that they were "too complicated" for certain family docs to manage. Or, a patient can be selectively fired for failing to keep appointments. There are lots of ways to get rid of someone who is "too costly" to a practice. If part of their payment is dependent upon scoring well on tests of patients' wellness (such as blood pressure control, diabetes measurements etc) this can be even more profitable.
3.
Make it next to impossible to find a doctor who will take new Medicare patients. How do you do this? You cut provider fees across the board by 10%. With the current doctor shortage in many areas, physicians are not hurting for patients. The federal government knows this. Normal laws of supply and demand should make this 10% fee cut an impossibility. The only reason to go through with it is to anger Medicare patients who will tell their families "Medicare is awful! You are so lucky to be on private insurance!"
http://www.healthcarefinancenews.com/story.cms?id=66854.
Drain Medicare's resources to benefit the pharmaceutical industry. The drug benefit is a great big scam. Some people were better off before the plan, since their Medicare secondary insurance plans did not have the donut hole that forces them to pay for everything between $2251 and $5100 (and with today's sky high drug prices, it does not take long to reach the hole).
http://www.webmd.com/Medicare/news/20040601/report-warns-of-medicare-drug-coverage-gapsThe pharmaceutical industry has made sure that the federal government will never, ever bargain for reduced rates for any of the meds that seniors are buying. On the contrary, it has taken advantage of this opportunity to jack up the prices of the drugs that the government pays for (for the first half of each year until patients reach the Hole)---costing everyone in the US money.
http://oversight.house.gov/documents/20060221102046-85441.pdfThis grand experiment in pork barreling for one of the GOP's favorite donors was sold to America for $400 billion over 10 years, however almost immediately the White House admitted that that figure (like their stories about WMDs in Iraq) was a lie and the true number was twice as high--and that was before the drug companies began jacking up their prices.
If the government could bargain for lower prices for the drugs it is buying for its seniors, it might be able to afford to supply a decent drug benefit--like one that pays for necessary heart, diabetes and blood pressure medication for the entire year rather than just the first half. But then, families would not hear grandma and grandpa complain for four or five months about how uncaring/cruel/heartless/incompetent Medicare is, and that is part of the plan.
The result of the the Bush administration's meddling in Medicare has been to allow their buddies in the health insurance and drug industries to feed at the trough of public programs that are supposed to exist to help Americans, not to line the pockets of private corporations. However, if you look closer, you will see that these policies and programs also have the effect of undermining the financial stability of Medicare and making the public dislike and distrust a national, public insurance program which has been quite popular for years. If people are unable to find a doctor who will take their Medicare insurance, or if they perceive that they are being denied coverage for necessary treatment under Medicare because their provider stands to make more money, or if they worry about the financial solvency of Medicare, then they will be less likely to listen to Democrats who suggest a national health care plan which is based upon Medicare.
The Federalists have said that they want to roll the country's social programs back to the days before FDR. Medicare, one of the legacies of LBJ is almost certainly on their hit list.
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