069 The Erickson Report for January 26 to February 8, Page Three: Turning Medicare into a corporate piggy bank

I'm going to talk briefly about two programs relating to Medicare, one of which you likely have heard of and one which you may well have not unless it affected you directly.

The first is Medicare Advantage. If you are older, that is, of Medicare age, you may even be on one of these programs. Approaching half of us are. I am, in fact. For me, personally, it seemed the best option I had. And if you're a senior in overall good health, as I am, it may well be for you too.

But it's a scam, a cheat, a rip-off - not necessarily of anyone in the program, but of the taxpayers, of the people as a whole.

Who says so? Among others, Wendell Potter, former vice president for corporate communications at insurance giant Cigna and someone who helped design the PR campaign that convinced Congress to go along with the scheme.

He now says: "Medicare Advantage is a money-making scam. I should know. I helped to sell it."

The first thing to know here is that Medicare Advantage is not Medicare. It is a separate corporate health insurance industry program established under Medicare Part C. And it stands, bluntly, as a step on the road to a total privatization, that is, the destruction, of Medicare.

Here's how Medicare Advantage works: Insurance corporations, unlike real Medicare, don't deal on a person-by-person, procedure-by-procedure basis. Instead, every year, Advantage providers submit a summary to the federal government of the aggregate risk score of all their customers and, essentially, are paid in a massive lump sum based on that figure.

This is all done under the notion that being private capitalist corporations, they'd be more efficient that any government agency could be, and so the whole programs would save taxpayers money. It doesn't, as repeated audits have shown.

Instead it has become an enormous cash cow for insurers, in large part because of the way they have rigged the risk-scoring system to maximize profits.

Your risk score is a measure of how much the company thinks you will cost in benefit payouts. Simply put, the sicker you are, the higher the score. And the higher your score, the bigger the payout to the company from the government. Which creates a clear incentive for the corporations to inflate their risk scores.

Consider how this could happen in my case. Again, I am in overall good health. But I'm getting older, I'm in my 70s, and as folks get older some issues can arise just in the course of ageing.

For example, I've developed a tremor in my left hand. It's something that sometimes happens to older folks. It's an annoyance, especially because I'm left-handed. It can make it difficult to type and I sometimes have trouble when I try to write things down and yes I do still write in cursive sometimes. It's an annoyance.

The point here is that I had a neurological exam and it was negative. It's what's called an essential tremor; it just is. There is no neurological involvement.

But in my medical records, under diagnoses, it says "hand tremor," not "essential hand tremor." An insurance company could look at that and despite the exam say "Ooh, so there is still a risk of neurological involvement. Raise his risk score."

I've had surgery on both shoulders due to osteoarthritis. Even though there has been no other issue before or since, nothing that has required any medical intervention, still the corporation could say "He's got a history, there could be more in the future. Up his score."

I've had in some past some digestive issues. Again, this is a matter of annoyances, not something that impacted my day-to-day life. But under diagnoses, it says Irritable Bowel Syndrome. "Oh my," says the insurance company, "that's serious. Higher score."

The point being that you can take someone in overall pretty good health and make them seem much sicker, with a higher score, depending on how you want to interpret the record.

Which is exactly what has been happening.
 
The Centers for Medicare and Medicaid Services (CMS) estimated that “net overpayments to Medicare Advantage plans by unconfirmed medical diagnoses" came to $11.4 billion in fiscal year 2022 alone.

And on top of all that, the program is designed such that once you're on it, you're pretty much stuck. There are significant financial obstacles to switching to real Medicare, making it as a practical matter almost impossible for a lot of people. Which means that over time the portion of Medicare-age people on these so-called Advantage programs grows and the fear is that once that figure is over 50%, which it almost is, that will be used to justify shutting down real Medicare, leaving these programs the only option.

The whole thing is, as Thom Hartmann called it, a Trojan horse to privatize Medicare. The entire program should be shut down - now.

Oh, and if you're on traditional, that is, real, Medicare? You are still being thrown into the clutches of grasping insurance companies.

Which is that other program I mentioned, the one you might night know about. It was set up under Tweetie-pie under the name Direct Contracting Entities as what amounts to a for-profit corporation acting as a benefits manager contracted by Medicare to sit between you and the health care provider. That is, instead of Medicare in that space, dealing with claims in and benefit payments out, there is a private corporation contracted to do that.

These DCEs are paid monthly by the CMS to cover a specified portion of a patient's medical care instead of Medicare dealing with reimbursing providers directly. The issue is, these companies are paid that contracted amount and anything they don't spend on care they keep as profit.

Which clearly gives these corporations an incentive to skimp on Medicare patients, including finding ways to deny claims or only approving the cheapest treatment methods even if a more expensive one is called for.

This began as pilot program and was deliberately designed with the idea of being another step to privatizing Medicare and another way to rip off the public even as it was being sold with the traditional mantra "private enterprise efficiency."

Virtually any company can apply to be a DCE, including investor-backed startups - that is, even with no prior experience in insurance, health care, or medicine - along with other Wall Street types and insurance corporations already doing Medicare Advantage programs.

And if you're on Medicare, you can be assigned to one of these profit-hungry outfits without your approval or even knowledge.

Okay, but that was under Tweetie-pie, right? We have a Democrat in there now, so it's okay, right?

Dream on.

Not only is the Blahden Administration continuing the program, the CMS announced in January a significant expansion of the pilot program with the goal of making it universal - of having everyone on Medicare assigned to one of these outfits - by 2030.

About the only thing Blahden did was re-brand the program as, get this, ACO REACH - Accountable Care Organization Realizing Equity, Access, and Community Health. Because turning over administration of our health insurance claims to private corporations whose goal is, never forget, maximizing profit, increases accountability - somehow.

Bear in mind that the $650 million in Medicare Advantage overcharges discovered by federal audit back in 2013 and 2014 still have not been recovered from the corporations that claimed them.

Medicare and Social Security overall are about the most popular, most successful federal programs in US history and the right-wing and reactionaries hate them for precisely that reason and have been trying to shut them down from day one. We cannot let them succeed.

One last thing on this, a question all this raises: If we as a people, through our taxes, can in these programs pay - as is happening - for Medicare and Medicaid plus corporate profit plus the cost of illegal overcharges, how in hell can anyone continue to claim we could not afford a national health care plan?

I intend next time to look at the renewed attacks on Social Security, including the calls for a new version of a cat food commission.

069 The Erickson Report for January 26 to February 8

 

Episode 69 of The Erickson Report notes the anniversary of Roe v.Wade with some recent news on abortion rights, goes over how Medicare Advantage programs are actually backdoor ways to privatize Medicare, and reintroduces Two Weeks of Stupid: Clowns and Outrages, with three Clowns and the Outrage that is Florida.

The Erickson Report is news and informed commentary from the radical nonviolent left. It is advocacy journalism, dealing in facts and logic but having a point of view. Sometimes serious, sometimes sarcastic, sometimes even flip but always with the intent to inform and inspire,The Erickson Report strives to be a tool for justice

Reactions and comments are welcome.

SOURCES:

Guns
https://www.wbur.org/npr/1150667373/monterey-park-shooting-what-we-know-californi
https://www.gunviolencearchive.org
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Abortion rights
https://hymnary.org/text/onward_christian_soldiers_marching_as
https://thehill.com/policy/healthcare/3809346-alabama-ag-says-women-could-be-prosecuted-for-taking-abortion-pills/
https://www.npr.org/2006/02/21/5168163/partial-birth-abortion-separating-fact-from-spin
https://www.alternet.org/minnesota-lawmakers-partial-birth-abortion/
https://www.theatlantic.com/ideas/archive/2022/08/freedom-speech-mississippi-abortion-rights/671202/
https://www.scstatehouse.gov/sess124_2021-2022/bills/1373.htm
https://www.pewtrusts.org/en/research-and- analysis/blogs/stateline/2022/05/19/some-states-already-are-targeting-birth-control
https://www.vox.com/policy-and-politics/2022/12/13/23505459/supreme-court-birth-control-contraception-constitution-matthew-kacsmaryk-deanda-becerra
https://en.wikipedia.org/wiki/The_Handmaid's_Tale
https://www.aclu.org/press-releases/aclu-comment-nationwide-ban-abortion-introduced-us-senate
https://www.latimes.com/world-nation/story/2023-01-19/religious-leaders-sue-to-block-missouris-abortion-ban
https://www.biblegateway.com/passage/?search=Matthew%2023%3A27-28&version=KJV
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Medicare Advantage / ACO HEALTH
https://www.commondreams.org/opinion/is-medicare-advantage-a-scam
https://www.commondreams.org/views/2021/09/08/medicare-advantage-profit-scam-time-end-it
https://www.cms.gov/files/document/fy-2022-medicare-part-c-error-rate-findings-and-results.pdf-0
https://www.commondreams.org/news/2021/11/30/congress-asleep-switch-biden-continues-trump-era-ploy-privatize-medicare
https://docs.google.com/document/d/1G8B012QNk9rzEJvfYaLcPwr2HJdZe_hcrR7KU_mAibk/edit
https://www.cms.gov/newsroom/press-releases/cms-announces-increase-2023-organizations-and-beneficiaries-benefiting-coordinated-care-accountable
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Clowns
https://www.newsweek.com/jim-banks-plans-anti-woke-caucus-bolster-gops-war-wokeness-1773778
https://www.lgbtqnation.com/2023/01/hate-pastors-now-speaking-beer-say-makes-men-feminine/
https://sdg.iisd.org/events/2022-un-climate-change-conference-unfccc-cop-28/
https://apnews.com/article/russia-ukraine-politics-united-states-government-only-on-ap-john-kerry-b5d6482d465dcc8fa5063af9a0e44041
=
Outrage
https://www.msn.com/en-us/news/us/florida-blocks-high-school-african-american-studies-class/ar-AA16x9Ds
https://www.commondreams.org/news/ap-african-american
https://floridapolitics.com/archives/574045-in-andrew-warren-suspension-trial-gov-desantis-officials-answer-what-does-woke-mean/
https://en.wikipedia.org/wiki/Lester_Maddox
https://www.nhl.com/news/nhl-releases-results-of-diversity-and-inclusion-report/c-336511848
https://www.usatoday.com/story/sports/nhl/2018/11/09/racism-lingers-for-nhl-players-60-years-after-oree-landmark/38451681/
https://www.rawstory.com/desantis-hockey/
https://www.msn.com/en-us/sports/nhl/nhl-backtracks-after-florida-gov-ron-desantis-office-blasts-league-for-discriminatory-job-fair/ar-AA16kkpL
https://www.queerty.com/florida-flop-ron-desantis-manages-show-off-anti-blackness-queerphobia-one-sentence-20230124
https://www.nbcnews.com/feature/nbc-out/11-black-lgbtq-history-makers-you-should-know-n848631https://www.americanprogress.org/article/black-lgbtq-individuals-experience-heightened-levels-discrimination/

036 The Erickson Report for April 22 to May 5, Page Three: Noted in Passing

036 The Erickson Report for April 22 to May 5, Page Three: Noted in Passing

Next, an occasional segment called Noted in Passing, where we touch on a couple of things we wanted to make sure got mentioned even if only quickly.

First up, the Ohio legislature is considering a GOPper-backed bill to change the name of an Ohio state park from Mosquito Lake State Park to Donald J. Trump State Park.

So basically changing the name from referencing one disease-carrying pest to another. Doesn't seem like much of a change to me.

It does remind me of the earlier efforts by GOPpers to have something named for Ronald Reagan in every single county in the US. But at least they had the decency to wait until he was dead.

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And here we go again: Sen. Witless Romney is proposing legislation to deal with the - according to the right-wing - supposed looming financial crisis of Social Security and Medicare, a disaster that is forever imminent but never actually arrives.

This time it's to be bipartisan 12-member "Rescue Committees," one for each of the trust funds with a deadline of 180 days to draft legislation to "improve" each program while securing long-term funding, with any such legislation receiving "expedited consideration" in, that is, to be rushed through, Congress.

It's claimed that this is a "bipartisan" effort because three of the 12 co-sponsors in the Senate are Democrats. The three are Joe Manchin, Kyrsten Sinema, and Mark Warner. Truly a varied group.

Oh, and we have long known the way to secure the long-term funding for SS and Medicare: remove the cap on income subject to the taxes, a change that would only affect those making over $143,000, that is, the richest 8% of Americans.

 

But wait, that's the rub: It would mean taxing the rich, so that's obviously off the table.

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Elizabeth Warren

On a happier note, here's another sign that Israel is finally losing its stranglehold on US policy in the Middle East, as progressives and even liberals become more open to questioning the so-called "special relationship."

On April 19, Elizabeth Warren, while continuing to support military aid to Israel, proposed conditioning the aid on none of it being used in the occupied territories. Quoting her: "By continuing to provide military aid without restriction, we provide no incentive for Israel to adjust course."

Not a very radical proposal by any means - personally, I would simply end military support altogether - but it wasn't that long ago that even suggesting Israel had to "adjust course" was beyond the pale.

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On an unhappy note, the Arkansas House of Representatives has overwhelmingly passed a resolution specifically allowing the teaching of creationism in public schools.

Federal courts - including in a case directly involving Arkansas - have repeatedly held that teaching creationism in the public schools is unconstitutional on the grounds that it is religious instruction, a fact to which the bill's main sponsor responded by saying she hoped the newly reactionary SCOTUS might feel differently.

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Finally, while most Americans have weathered the pandemic financially, about 38 million say they are worse off now than before the outbreak began in the US.

Overall, 55% of Americans say their financial circumstances are about the same now as a year ago, and 30% even say their finances have improved, but 15% say they are worse off.

Not surprisingly, the problem is more pronounced at lower income levels and among non-whites. Some 29% of Americans living below the federal poverty line say their personal finances now are even worse that they obviously were a year ago, while 47% of Hispanics and just 39% of Black Americans say they have been able to put aside some money recently, compared to 57% of whites, and. Black and Hispanic Americans are about twice as likely as white Americans to say they have come up short on bill payments.

Despite some recent degree of recovery, the United States still has 8.4 million fewer jobs than it had in February 2020, just before the pandemic struck.