Universal Healthcare Infrastructure NOW

February 15, 2023

Feb 15, 2023

Healthcare Reform

Feb 15, 2023

Good Day Healthcare Advocates

I am so thankful for all of you and for the actions you take to move us towards a universal healthcare system. Some of the topics in work are:

The current state of healthcare providers and the potential impact of Universal Healthcare on them
How Universal Healthcare affects the insurance industry (it’s not what you think)
Rural healthcare challenges
Hospice Fraud revisited - this is worse than was reported

Please send topics to me via the chat button and I will research and report. If you need assistance in other ways, lectures, presentations, etc. Just let me know, I’m happy to help.

Current State - HHS/CMS About Face?

There are a number of flaws in healthcare delivery in the US. We have been discussing them for a while. Today I want to talk about Medicare because it could be a model for Universal Healthcare but it has been abused over the years, mostly by commercial firms, so that it is now a far cry from what it should have been.

When people discuss Medicare for All or Expanded Medicare, what they refer to is a single payer insurance fund managed by the government. Patients can go to any doctor/specialist no in or out of network, no copay/deductible and no cap (policy limits). This is possible due to all of the cost savings available according to the Congressional Budget Office’s report on Universal Health Care. The estimate is that more than $400B is wasted in overhead and about another $200B on prescriptions YEARLY!!

Medicare is administered by HHS’ Center for Medicare and Medicaid Services (CMS). They are continually looking to “buy down” risk by making fixed payments now to reduce the likelihood of payments in the future. Let me give you an example. Medicare Advantage (part C) is like a normal US health insurance policy. It has deductibles, copays but often limits that open ended 20% that Medicare has. It also takes copays on the first few days of hospitalization (free under Medicare) knowing that 95% of all hospitalizations are 3 days or less. Additionally, CMS pays the insurance company $1000/month/enrollee. That’s an additional $12,000/year per person, to provide coverage for that senior in addition to the senior making Medicare payments and any additional premiums to the insurance company.. All the Medicare Advantage Insurance company has to do is spend less than $12,000/year/enrollee on average and they win. Keep in mind that a little over ⅓ of all Medicare patients are in an Advantage plan.

Remember there are three easy ways to make money

More customers
Spend less
Charge more

In this scheme insurance companies do all three. They seek new enrollees until you can’t listen to people on TV selling the policies anymore, they spend less by having copays and deductibles and deciding not to cover many items and many insurance companies charge more by upcoding visits, using mid-level practitioners instead of doctors, and sometimes unbundling services that are often grouped together when claims are submitted. Some of these are shadier than others, but this is the real world and this is what happens.

In general, insurance companies are pretty happy they have Medicare Advantage and they are making a killing. Far more than on regular health insurance plans. They want all Medicare patients in an advantage plan.

How about if we sign them up without their knowledge and see if they continue in those plans? Yup. That’s what ACO-REACH is. It is a shifty deal whose goal is to have all Medicare patients in such a plan by 2030.

On their way out the door the Trump Administration created a giveaway for their insurance company friends called ACO-REACH. These are Accountability Care Organizations. They are essentially like an in network PPO and patients are signed up without consent. If they don’t like it they can try to extract themselves from it. There are currently 132 of these in the US.

Today, Physicians for a National Health Plan has reported “..that due to the outrage and advocacy of more than 300 organizations across the country, that CMS has scaled back plans to have all Traditional Medicare beneficiaries covered under ACO-REACH by the end of this decade. The growth of ACO-REACH has ended! Instead of all 36 million Traditional Medicare beneficiaries being enrolled in the "test model" it will be limited to the current 2 million enrollees. At the start of the plan in January 2023, 132 "organizations" were enrolled in REACH. Now, no further plans will be enrolled!”

We must continue to demand an end to ACO-REACH altogether and replace traditional Medicare and Medicare Advantage plans with IMPROVED MEDICARE FOR ALL. I mean for ALL not just seniors. Cradle to grave everyone in. Use RESISTBOT below to tell your senators, representatives and the President that it is time for Expanded Medicare for all. Quit giving away our money to insurance companies and start building the Health Care Infrastructure.

What You Can Do

You can cut and paste the text below into an email to the president and your senators and your representative or use it in phone calls. (feel free to personalize it) or use RESISTBOT to send an email to the president and your senators and your representative. Thank you to PNHP for the text below.

RESISTBOT Text “SIGN PQDRHO” to 50409

Traditional Medicare was created in 1965 as a public good to provide a national health care system for seniors and the disabled in the United States and has proven to be our most efficient and effective public health care program with administrative costs accounting for only 2-3% of Medicare spending.
The federal government has created various for-profit privatized health care programs within Medicare including Medicare Part D (prescription drugs), MediGap, and Medicare Advantage which is permitted to take up to 15% of every Medicare dollar for administration and profits for managing Medicare claims.
But it gets worse. The Trump administration doubled down on privatizing Medicare through the Direct Contracting Pilot, rebranded under the Biden Administration as ACO-REACH, which allows private equity firms and Wall Street companies to take up to 40% of every Medicare dollar for administration and profits for managing Medicare claims.
Recent investigations from the Inspector General’s Office at HHS, academic researchers, and investigative journalists, have uncovered wide-ranging fraudulent practices, like upcoding, delaying, and denying claims by insurers and other private businesses managing Medicare claims accounting for defrauding the Medicare Trust Fund and Medicare beneficiaries of between $ 12 and $ 24 billion in the year 2020 alone.
Insurers and Wall Street are fiercely lobbying to gain a larger share of the soon-to-be $1.6 trillion of annual Medicare spending by further privatizing Medicare turning it into a profit center, at a time when Medicare beneficiaries are among the most vulnerable populations served in health care, and need more, not fewer benefits.
That’s it. I want you to use the money that is available to save as specified in the Dec 2021 CBO report on Universal Health Care to end for-profit privatization of Medicare, including ACO-REACH and IMPLEMENT ENHANCED MEDICARE FOR ALL OF US. This is too important a part of our national infrastructure to leave to for profit entities whose interests are money and not our health. You can do this and I am counting on you.