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Destruction Of Healthcare Delivery System Underway
By HERB DENENBERG, For The Bulletin
If you want to understand why Aetna, Independence Blue Cross (Keystone), and other insurance companies are dropping some, though not all, of their Medicare Advantage policies, you have to understand the way these plans have been tainted by President Obama and the Democratic proposals for Obamacare in its various forms. Their proposals, not yet enacted, will destroy the greatest health care delivery system in the world if enacted. But what they have already done has started to do serious damage to our system, as exemplified by what is going on with Medicare Advantage. Medicare Advantage plans are popular and have many advantages for senior citizens. So, naturally, Mr. Obama wants to kill them.
The trade association America’s Health Insurance Plans (AHIP) describes Medicare Advantage plans as follows: “An increasing number of Medicare beneficiaries are choosing Medicare Advantage (MA) plans. Medicare Advantage plans offer a different approach to health care delivery than beneficiaries experience under fee-for-service Medicare. Instead of focusing almost exclusively on treating beneficiaries when they are sick, these plans also place a strong emphasis on preventive health care services that help to keep beneficiaries healthy, detect diseases at an early stage and avoid preventable illnesses. In addition, MA plans help reduce beneficiaries’ out-of-pocket costs by providing additional benefits not covered in the Medicare program and reducing cost-sharing for Medicare-covered benefits.” AHIP says about 10 million people are now enrolled in Medicare Advantage plans, accounting for 25 percent of the market.
Mr. Obama has proposed cutting the heart out of Medicare in general and Medicare Advantage plans in particular by trying to save about a half a trillion dollars to finance his government takeover of our health delivery system. This Obama proposal and its reasons are, of course, as phony as a three-and-a-half dollar bill, as everyone knows those savings have been talked about for decades, but never achieved. They are virtually inherent in a government system of health delivery and the fraud, waste, inefficiency and abuse it produces. If those savings from eliminating fraud, etc. are there, why haven’t they already realized them?
But the Obama Medicare and Medicare Advantage savings ploy is not only a phony idea, but also an immediately damaging one. Mr. Obama has demonized Medicare Advantage, virtually painting it as a fraud, involving government payments for no good purpose. This has probably raised concerns in the minds of Medicare Advantage providers, who may wonder about the future of this form of coverage. But there’s more. When you see the disgraceful performance of Mr. Obama and his leftist radical Congress who are in the process of acting more like junior dictators than legislators, you wonder why anyone would even want to be in the business of selling health insurance. Consider what Congress is doing:
• The Democratic Congress has been passing bills of astronomical cost and complexity without reading them
• The legislative process has frozen out the Republicans, so what should be a bipartisan process, as promised by Obama, is turning out to be hyper partisanship at its worst, Obama style
• These same Democrats have voted against giving the public 72 hours before a vote to read the bills. You’d think if Congress doesn’t want to read the bills, at least it would allow the public the right to do so, given Mr. Obama’s promise of transparency
• Then there’s the U.S. Senate Finance Committee, which just passed not a bill with legislative language, but a bill with “concepts.” This means no one knows what the bill will cost or what it will really mean once it is translated into legislative language. The Democratic Senate is, in a real sense, flying blind and is about to crash not only our health care delivery system, but our economy as well
• Finally, Mr. Obama and Congress are willing to ignore the Town Hall meetings, the Tea Parties and public opinion, which concertedly, repetitiously and loudly say, “Read the bills, let us read the bills and don’t wreck our present health care delivery system.”
I would think this would frighten much of the health insurance industry, and they may well want to start pruning or cutting back some of their coverage. But there’s one other striking development about the Medicare Advantage scenario. Mr. Obama seems to have a knack of doing exactly the opposite of the right thing. He’s never off just 20 or 30 degrees in one direction; he’s usually off 180 degrees, being totally, absolutely wrong. Consider his views on Medicare Advantage. He wants to cut their special funding which will effectively abolish them.
What makes this view bizarre is that Mr. Obama has been singing the praises of prevention and even claiming huge savings because he plans on introducing more prevention into the health care delivery system. Yet, the Medicare Advantage Plans already stresses prevention and the kind of case management of chronic illnesses that generates prevention of complications and disease. Medicare Advantage Plans have built in features that encourage preventive medicine. For example, they may feature comprehensive disease management for such medical problems as asthma, diabetes, and congestive heart failure. A spokesman of Aetna, Inc., Walt Cherniak, told me their plans may provide online tools for managing disease, access to nurses for medical management, and the monitoring of cases to make sure each patient gets the care they need. The Medicare Advantage plans also feature first dollar coverage so policyholders have no incentive to skip routine tests and monitoring. Like Aetna, Independence Blue Cross also has an impressive list of features to promote prevention.
These plans, therefore, follow Mr. Obama’s recommendation not only as to prevention, but also as to comprehensive coverage. By less reliance on deductibles, co-pays, and coinsurance, the Medicare Advantage policies do exactly what Mr. Obama says he wants, yet, at the same time, those are the plans singled out for phasing out by Mr. Obama.
There’s another important feature of Medicare Advantage plans that make sense. They transfer the handling of the policies to free enterprise, private insurers like Aetna, Inc. and Independence Blue Cross. They handle claims and other administrative matters. But this poses another contradiction. Mr. Obama said he wants to build on our existing insurance system and not abolish it or remake it in the form of a single-pay system. But his views on Medicare Advantage are taking us in the opposite direction of what he supposedly advocates, destroying a segment of the private insurance industry, rather than building on it and utilizing it.
Mr. Obama made one other move that will help kill the very kind of coverage he advocates. A spokesman for Independence Blue Cross, Ruth Stoolman, told me that one of the reasons the company dropped some of its Medicare Advantage policies was a high cut in reimbursement that was unprecedented. There were other reasons for the cutting of certain Medicare Advantage policies. For example, Ms. Stoolman said one discontinued plan had few members. That helped make it a candidate for elimination. Ms. Stoolman said still another factor was rising costs of the medical services provided by these plans.
Before going further, the situation of policyholders losing their present Medicare Advantage policies should be clarified:
• Every such policyholder should have received a letter from Medicare explaining what is happening and listing all other offering plans and their contact numbers
• The two companies mentioned above, Aetna Inc. and Independence Blue Cross (Keystone) offer other Medicare Advantage plans that might be options worth considering
• Any policyholder dropped from their Medicare Advantage policy can enroll in another plan without medical underwriting, consequently eliminating any problem of pre-existing conditions
• The open enrollment period will run until the end of the year, so policyholders will have ample time to consider their options
• The dropped plans discussed in this column are all Medicare Advantage plans and do not involve Medigap, the Medicare supplements other than Medicare Advantage
• There’s no reason to panic, as there are all kinds of alternatives for those whose plans are being discontinued
It should be noted that this is another example of the endless lies told byMr. Obama and the Democratic Congress to sell Obamacare. He endlessly promised everyone they could keep their coverage if they are happy with it. At the same time, he said he’d be taking steps to initiate a severe cutback or even an end for Medicare Advantage. But if you haven’t figured out by now that Mr. Obama’s a habitual liar, you haven’t been paying attention. Remember his promise of bipartisanship? It has instead has become a policy of Chicago thuggishness. Remember his policy of transparency? Now the public doesn’t even have a chance to read the bills before passage and the various bills will be put together behind closed doors. But if I would list all the Mr. Obama lies and broken promises, I would need not a column but a multi-volume encyclopedia.
The trade association America’s Health Insurance Plans (AHIP) describes Medicare Advantage plans as follows: “An increasing number of Medicare beneficiaries are choosing Medicare Advantage (MA) plans. Medicare Advantage plans offer a different approach to health care delivery than beneficiaries experience under fee-for-service Medicare. Instead of focusing almost exclusively on treating beneficiaries when they are sick, these plans also place a strong emphasis on preventive health care services that help to keep beneficiaries healthy, detect diseases at an early stage and avoid preventable illnesses. In addition, MA plans help reduce beneficiaries’ out-of-pocket costs by providing additional benefits not covered in the Medicare program and reducing cost-sharing for Medicare-covered benefits.” AHIP says about 10 million people are now enrolled in Medicare Advantage plans, accounting for 25 percent of the market.
Mr. Obama has proposed cutting the heart out of Medicare in general and Medicare Advantage plans in particular by trying to save about a half a trillion dollars to finance his government takeover of our health delivery system. This Obama proposal and its reasons are, of course, as phony as a three-and-a-half dollar bill, as everyone knows those savings have been talked about for decades, but never achieved. They are virtually inherent in a government system of health delivery and the fraud, waste, inefficiency and abuse it produces. If those savings from eliminating fraud, etc. are there, why haven’t they already realized them?
But the Obama Medicare and Medicare Advantage savings ploy is not only a phony idea, but also an immediately damaging one. Mr. Obama has demonized Medicare Advantage, virtually painting it as a fraud, involving government payments for no good purpose. This has probably raised concerns in the minds of Medicare Advantage providers, who may wonder about the future of this form of coverage. But there’s more. When you see the disgraceful performance of Mr. Obama and his leftist radical Congress who are in the process of acting more like junior dictators than legislators, you wonder why anyone would even want to be in the business of selling health insurance. Consider what Congress is doing:
• The Democratic Congress has been passing bills of astronomical cost and complexity without reading them
• The legislative process has frozen out the Republicans, so what should be a bipartisan process, as promised by Obama, is turning out to be hyper partisanship at its worst, Obama style
• These same Democrats have voted against giving the public 72 hours before a vote to read the bills. You’d think if Congress doesn’t want to read the bills, at least it would allow the public the right to do so, given Mr. Obama’s promise of transparency
• Then there’s the U.S. Senate Finance Committee, which just passed not a bill with legislative language, but a bill with “concepts.” This means no one knows what the bill will cost or what it will really mean once it is translated into legislative language. The Democratic Senate is, in a real sense, flying blind and is about to crash not only our health care delivery system, but our economy as well
• Finally, Mr. Obama and Congress are willing to ignore the Town Hall meetings, the Tea Parties and public opinion, which concertedly, repetitiously and loudly say, “Read the bills, let us read the bills and don’t wreck our present health care delivery system.”
I would think this would frighten much of the health insurance industry, and they may well want to start pruning or cutting back some of their coverage. But there’s one other striking development about the Medicare Advantage scenario. Mr. Obama seems to have a knack of doing exactly the opposite of the right thing. He’s never off just 20 or 30 degrees in one direction; he’s usually off 180 degrees, being totally, absolutely wrong. Consider his views on Medicare Advantage. He wants to cut their special funding which will effectively abolish them.
What makes this view bizarre is that Mr. Obama has been singing the praises of prevention and even claiming huge savings because he plans on introducing more prevention into the health care delivery system. Yet, the Medicare Advantage Plans already stresses prevention and the kind of case management of chronic illnesses that generates prevention of complications and disease. Medicare Advantage Plans have built in features that encourage preventive medicine. For example, they may feature comprehensive disease management for such medical problems as asthma, diabetes, and congestive heart failure. A spokesman of Aetna, Inc., Walt Cherniak, told me their plans may provide online tools for managing disease, access to nurses for medical management, and the monitoring of cases to make sure each patient gets the care they need. The Medicare Advantage plans also feature first dollar coverage so policyholders have no incentive to skip routine tests and monitoring. Like Aetna, Independence Blue Cross also has an impressive list of features to promote prevention.
These plans, therefore, follow Mr. Obama’s recommendation not only as to prevention, but also as to comprehensive coverage. By less reliance on deductibles, co-pays, and coinsurance, the Medicare Advantage policies do exactly what Mr. Obama says he wants, yet, at the same time, those are the plans singled out for phasing out by Mr. Obama.
There’s another important feature of Medicare Advantage plans that make sense. They transfer the handling of the policies to free enterprise, private insurers like Aetna, Inc. and Independence Blue Cross. They handle claims and other administrative matters. But this poses another contradiction. Mr. Obama said he wants to build on our existing insurance system and not abolish it or remake it in the form of a single-pay system. But his views on Medicare Advantage are taking us in the opposite direction of what he supposedly advocates, destroying a segment of the private insurance industry, rather than building on it and utilizing it.
Mr. Obama made one other move that will help kill the very kind of coverage he advocates. A spokesman for Independence Blue Cross, Ruth Stoolman, told me that one of the reasons the company dropped some of its Medicare Advantage policies was a high cut in reimbursement that was unprecedented. There were other reasons for the cutting of certain Medicare Advantage policies. For example, Ms. Stoolman said one discontinued plan had few members. That helped make it a candidate for elimination. Ms. Stoolman said still another factor was rising costs of the medical services provided by these plans.
Before going further, the situation of policyholders losing their present Medicare Advantage policies should be clarified:
• Every such policyholder should have received a letter from Medicare explaining what is happening and listing all other offering plans and their contact numbers
• The two companies mentioned above, Aetna Inc. and Independence Blue Cross (Keystone) offer other Medicare Advantage plans that might be options worth considering
• Any policyholder dropped from their Medicare Advantage policy can enroll in another plan without medical underwriting, consequently eliminating any problem of pre-existing conditions
• The open enrollment period will run until the end of the year, so policyholders will have ample time to consider their options
• The dropped plans discussed in this column are all Medicare Advantage plans and do not involve Medigap, the Medicare supplements other than Medicare Advantage
• There’s no reason to panic, as there are all kinds of alternatives for those whose plans are being discontinued
It should be noted that this is another example of the endless lies told byMr. Obama and the Democratic Congress to sell Obamacare. He endlessly promised everyone they could keep their coverage if they are happy with it. At the same time, he said he’d be taking steps to initiate a severe cutback or even an end for Medicare Advantage. But if you haven’t figured out by now that Mr. Obama’s a habitual liar, you haven’t been paying attention. Remember his promise of bipartisanship? It has instead has become a policy of Chicago thuggishness. Remember his policy of transparency? Now the public doesn’t even have a chance to read the bills before passage and the various bills will be put together behind closed doors. But if I would list all the Mr. Obama lies and broken promises, I would need not a column but a multi-volume encyclopedia.
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