Thursday, July 6, 2017

Our Dysfunctional Health Care System part 1 Medicare Advantage!

Most of the world's industrialized nations have already done their research, and found: private health care isn't safe, cost effective, or moral. Yet the Republican Party keeps pushing their deadly free market plan.

All payer, single payer, Medicare for all, universal health care is simple: All doctors are your doctors, all hospitals are your hospitals. No bills, co-pays or deductibles. We could cut costs by a third to half of of what we're paying now. We won't. Are we insane?

More horror stories about health insurers. It's stuff like this that distracts us from having the real debate, one that the Democrats are once again missing; All payer or free market, that's the choice, not tweaks or nibbling around the edges. 
Medicare Advantage: A recent report by the Government Accountability Office, the auditing arm of Congress, adds new weight to criticisms that some health plans may leave sicker patients worse off … reviewed 126 Medicare Advantage plans and found that 35 of them had disproportionately high numbers of sicker people dropping out. Patients cited difficulty with access to "preferred doctors and hospitals" or other medical care, as the leading reasons for leaving. "People who are sicker are much more likely to leave (Medicare Advantage plans) than people who are healthier," James Cosgrove, director of the GAO’s health care analysis, said in explaining the research.

David Lipschutz, an attorney at the Center for Medicare Advocacy, says the GAO findings were alarming and should prompt tighter government oversight.
Private Insurers, Profit Driven Health Care: So let’s talk about the Republicans free market health care dream. Here’s what you get, whether on a small or large scale…doesn’t matter:
In the first two months of this year the federal Centers for Medicare & Medicaid Services (CMS) fined 10 Medicare Advantage health plans a total of more than $4.1 million for alleged misconduct that “delayed or denied access” to covered benefits, mostly prescription drugs … health plans charged patients too much for drugs or failed to advise them of their right to appeal denials of medical services.

Last month, CMS officials ended a 16-month ban on enrollment in Cigna Corp.’s Medicare Advantage plans … Cigna (had) “widespread and systematic failures” … a “serious threat to enrollee health and safety.”

A flurry of whistleblower lawsuits … Freedom Health, a Florida Medicare Advantage insurer, agreed to pay nearly $32 million to settle allegations that it exaggerated how sick some patients were to boost profits, while getting rid of others who cost a lot to treat. Freedom Health allegedly kept a list of some “unprofitable” patients that it discouraged from staying in the health plan, while encouraging healthier, “more profitable” members to remain, according to the whistleblower suit. Federal regulations prohibit health plans from discriminating based on a person’s health.


  1. Medicare Advantage IS single payer health care insurance (at least as defined by single payer advocates in the U.S. such as Bernie Sanders). Original Medicare has three or four payers. So which do you want

  2. Medicare has big co-pays and care limits, usually covered by supplemental private insurers. Medicare Advantage is a private version, abiding by Medicare pricing.

    I prefer an "all payer" system that controls prices, by allowing the government and private insurers to jointly negotiated one price Nationwide for individual medical services. Insurers would manage the plan, being able to supplement plans with added services like cosmetic or some elective surgeries at an additional price.