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Ralph Nader: Beware Of The Medicare ‘Disadvantage’ Corporate Trap, Wake Up AARP – OpEd

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While the Democratic presidential candidates are debating full Medicare for All, giant insurance companies like UnitedHealthcare are advertising to the elderly in an attempt to lure them from Traditional Medicare (TM) to the so-called Medicare Advantage (MA) – a corporate plan that UnitedHealthcare promotes to turn a profit at the expense of enrollees.

Almost one third of all elderly over 65 are enrolled in these numerous, complex MA policies the government pays so much for monthly. The health insurance industry wants more enrollees as they continue to press Congress for more advantages.

Medical Disadvantage would be a more accurate name for the programs, as insurance companies push to corporatize all of Medicare, yet keep the name for the purposes of marketing, deception, and confusion.

Elderly people enrolled in MA will experience its often merciless denials when they get sick. As hospital expert – attorney, physician, Dr. Fred Hyde put it: “It’s not just what you pay, it’s what you get.”

Start with the cross-subsidy of MA from TM. In 2009, the Congressional Budget Office estimated these overpayments would cost the federal government $157 billion over the coming decade. Obama’s Affordable Care Act started to reduce these subsidies to the giant insurers, but they still amount to many billions of dollars per year.

Add that with Medicare Disadvantage you are restricted to networks of vendors. That restricts your choice for competence and skills, and sometimes, requires you to travel longer distances for treatment. This could mean fewer enrollees will utilize their healthcare and more profits for the insurance companies.

Under Medicare Disadvantage you are subject to all kinds of differing plans, maddening trapdoor fine print, and unclear meaning to the insurers arguing no “medical necessity” when you’re denied care.

The advertisements for Medicare Disadvantage stress that you can sometimes get perks – gym memberships, hearing aids, and eyeglasses, as enticements, but they avoid telling you they are not so ready to cover serious needs like skilled nursing care for critically ill patients.

Under Medicare Disadvantage, there is no Medigap coverage as there is for TM. Co-pays and deductibles can be large. Under a recent Humana Medicare Advantage Plan in Florida, your co-pay for an ambulance is up to $300, up to $100 co-pay for lab services, and another $100 for outpatient x-rays.

A few years ago, UnitedHealthcare corporations dismissed thousands of physicians from their MA networks, sometimes immediately, sometimes telling their patients before telling their physicians.

Dr. Arthur Vogelman, a gastroenterologist, said he received a termination letter in 2013 from UnitedHealthcare. He appealed, documenting his successful treatment of many patients. The company denied his appeal, with no reason, as it had for thousands of network physicians.

Dr. Vogelman called it “an outrage. I have patients in their 80s and 90s who have been with me 20 years, and I’m having to tell them that their insurer won’t pay for them to see me anymore. The worst thing is I can’t even tell them why.” Except that the company wanted more profits.

After a lengthy protest by national and state medical societies in 2013, UnitedHealthcare began to be less aggressively dismissive.

Studies show the main reason MA enrollees return to TM is how badly the corporate insurers treated them when they became sick.

Medicare itself is getting overly complex. But nothing like the ever changing corporate rules, offerings, and restrictions of Medicare Disadvantage. How strange it is that AARP, with its Medigap insurance business run by UnitedHealthcare, doesn’t advise its members to go with the obviously superior Traditional Medicare. AARP reportedly receives a commission of 4.95% for new enrollees on top of the premiums the elderly pay for the Medigap policy from United Healthcare. This money – about seven hundred million dollars a year – is a significant portion of AARP’s overall budget.

AARP responded to my inquiries into their Medicare Advantage policy saying that it does not recommend one plan over another, leaving it to the uninformed or misinformed consumerThat’s one of AARP’s biggest cop-outs— they know the difference.

There is no space here to cover all the bewildering ins and outs of what corporations have done to so-called managed Medicare and managed Medicaid. That task is for full-time reporters. The government does estimate a staggering $60 billion in billing fraud annually just on Medicare – manipulating codes, phantom billing, etc. You need the equivalent of a college-level course just to start figuring out all the supposed offerings and gaps.

Suffice it to say that, in the words of Eleanor Laise, senior editor of Kiplinger’s Retirement Report, “the evidence on health care access and quality decidedly favors original Medicare over Medicare Advantage, according to a Kaiser Family Foundation review of 40 studies published between 2000 and 2014.”

All this anxiety, dread, and fear, all these arbitrary denials of care – prompted by a pay-or-die commercial profit motive – all these restrictions of what doctors or hospitals you can go to, do not exist in Canada. All Canadians have a Medicare card from birth; they have free choice of health care vendors. There are few American-style horror stories there; patients have better outcomes, and almost never even see a bill. The whole universal system costs half per capita of that in the U.S., where over 80 million people are uninsured or underinsured – still! (See singlepayeraction.org, for civic action to rid Americans of this perverse chaos).



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Ralph Nader

Ralph Nader

Ralph Nader is a politician, activist and the author of Only the Super-Rich Can Save Us!, a novel. In his career as consumer advocate he founded many organizations including the Center for Study of Responsive Law, the Public Interest Research Group (PIRG), the Center for Auto Safety, Public Citizen, Clean Water Action Project, the Disability Rights Center, the Pension Rights Center, the Project for Corporate Responsibility and The Multinational Monitor (a monthly magazine).

4 thoughts on “Ralph Nader: Beware Of The Medicare ‘Disadvantage’ Corporate Trap, Wake Up AARP – OpEd

  • Avatar
    November 24, 2019 at 12:10 am
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    Thank God for you Ralph. The Karen’s are just like you. I am the maverick UAW local President on Chicago on pensions in the 80 s n 90 s. Keep fighting great guy

    Reply
  • Avatar
    November 24, 2019 at 6:05 pm
    Permalink

    Ralph Nader, Thank you for doing this investigative reporting. I have delayed getting anything above my part A and B Medicare while being “courted” by a lot of different programs of mainly Medicare Advantage… The main reason for this delay is that the system just does not make sense. I don’t fully understand hot the MA insurer does not charge the insured any premium and even gives out lots of perks. What also does not make sense to me is that the MA insurer gets (I am told) approximately $700.00 per month per enrollee from the government each month. Ron Paul (one of my other mentors) says that “If what they (The government) are telling you does not make sense, they are lying to you”. I think that this might apply to the MA industry too. I will pass right now on signing up for an MA account until I fully understand what is going on and who and how is everyone earning their money and how effective their insurance coverage is for patients who need it. I have not seen that kind of information readily available…

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  • Avatar
    November 25, 2019 at 2:15 am
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    I love Ralph Nader for his humaneness. He doesn’t have to care about what unceasing corporate greed does to all the rest of us working stiffs, but he does, and he informs us to give us a heads up. A US style “Medicare For All” won’t be good for us when Congress and Insurance lobbyists are through with it.

    Reply
  • Avatar
    November 27, 2019 at 9:43 pm
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    Ralph, your frames of reference and MA currency are as outdated as your Medicare Advantage and TM reference dates within your article. I am curious; what is that you are suggesting: Medicare for All disaster ? Check where the careers of Bernie Sanders or Elizabeth Warren are going to end up in just a few weeks. Kamala did not listen. The American experience has never been about trusting the US Gov to run a better health care solution. Please get up to date. Actually, even Obama is wiser when it comes to H. Care. I think you can do better if you stick to auto, and consumer products. Do better.

    Reply

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