By Judith Stein
JStein@medicareadvocacy.org

Medicare was enacted in 1965 when half of Americans aged 65 or older had no health insurance and were terribly vulnerable; the private insurance sector had failed them. Since then the federal Medicare program has served the country well. Today it provides health insurance and access to health care for approximately 43 million people. More than 95 percent of older people and people with disabilities have health insurance through Medicare.

The program has saved millions of families from being impoverished by health care expenses. In addition, Medicare coverage is known to sometimes improve the health of previously uninsured people. A Journal of the American Medical Association report shows that to be particularly true for people with cardiovascular disease and diabetes.

Regrettably, the current enthusiasm of key decision-makers for privatizing Medicare threatens to return us to a time when families had to make great sacrifices to pay for their parents’ and grandparents’ health care and when, even with these efforts, many older people went without the care they desperately needed. Following are a few key questions about the current status of Medicare.

Q.  What has happened to threaten Medicare?

The Balanced Budget Act of 1997 introduced a variety of managed care and other private plans into Medicare under a new Medicare Part C.  The new options were called Medicare+Choice plans. As the name of the Act that created Part C implies, the idea was to save money by using private Medicare plans to finance care, while providing the same level of coverage as the traditional program – or more. Bruce Vladeck, formerly the Medicare Administrator, said in Congressional testimony in 2003 that “participation of private plans in Medicare has yet to save the Medicare program a nickel." That is still true.

The lack of success of Medicare+Choice, however, did not end the privatizing of Medicare – nor did the departure of private insurers from Medicare in the late 1990s, when profits were deemed insufficient. The exodus then left many beneficiaries confused and scared that they were “losing their Medicare”. Instead, the Medicare Modernization Act of 2003 changed the Medicare+Choice name to “Medicare Advantage,” authorized over $150 billion in subsidies to encourage private plans to enter and remain in the Medicare market, and introduced the entirely private, Part D prescription drug system.

Q.  Aren’t we trying to reduce costs and preserve Medicare for the infamous influx of “baby boomers”?

Just the opposite. Congress and the Executive branch have failed to deal with lavish private Medicare subsidies and cost overruns. The subsidies result in costs of about 12 percent more, on average, to cover an enrollee in a private Medicare plan than in the traditional program.

In the last Congressional session, a powerful minority in the Senate blocked protection of the integrity and stability of the Medicare program by refusing to cut Medicare Advantage subsidies. Further, the Bush Administration threatened to veto any bill that even trimmed them. (NY Times, Medicare Private Plan Abuses, 12/26/2007; NY Times, Two Insurers Increase Bet on Medicare, Milt Freudenheim, 12/5/2007. The Times stands almost alone among news organizations for its coverage of Medicare issues.)

Thus it appears that cost-saving is no longer the mission of privatizing Medicare. Corporate Medicare subsidies continue into 2008, notwithstanding repeated studies, and little debate, about their wastefulness. Unless action is taken, private Medicare plans will collect their $150 billion in subsidies while doctors who care for Medicare patients face a 10 percent cut in pay in mid-year.

Q.  Who pays for the subsidies to private Medicare plans?

The cost of private Medicare is borne by taxpayers and by all people with Medicare. These unnecessary expenses lead to increases in Part B premiums and encourage plan proliferation and marketing abuses by companies looking to benefit from the robust Medicare payments. The overpayments affect all Americans by weakening the financial stability of the Medicare program and by increasing federal expenditures. Even a recent study by a for-profit insurance industry group shows that, at best, private Medicare plans spend 300-400 percent more on administration than traditional Medicare. (Council for Affordable Health Insurance, Medicare’s Hidden Administrative Costs: A Comparison of Medicare and the Private Sector, Merrill Mathews, 1/10/2006.)

Q.  Who are the winners and losers from privatizing Medicare?

The lavish subsidies to private Medicare plans continue at the same time that we are repeatedly told that "we just can’t afford Medicare" for our ever-increasing aging population. On the whole, private plans do not provide meaningful new coverage, more flexibility, or more stability than the traditional Medicare program. Nor do they provide more care coordination or choice of health care providers. As a result, taxpayers, most people with Medicare, and doctors, lose. Private corporations win – big time.

Judith Stein is the founder and executive director of the Center for Medicare Advocacy, Inc., and has long focused on legal representation of the elderly. E-mail: jstein@medicareadvocacy.org

Comments

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Posted by Stan Cohen - Medicare Volunteer Counselor - S. Maine Agency on Aging 01/24/2008, 04:56 PM Way to go Judith. Your organization and Medicare Rights Center are doing really important work. This article is "right on". Let's hope that a new administration can undo some of the great harm that the Bushies have created. Stan Cohen

Certified Elder Law Attorney Posted by Don H. Chapin 07/19/2008, 05:04 PM In Ohio, I find fear and misunderstanding about Medicare and the Medicare Choice decisions. Obfuscation helps the private insurers. We need a 2-tiered Medicare program to deal with the 'Boomers' and elimination of Medicare "HMO's" Judy is a modern day heroine. I'm grateful for her scholarship and continued advocacy. Submit a comment - Jump to top of list