Medicare Advantage Plans Prioritize Profits at the Expense of Patient Well-being
The Medicare open enrollment period — that special time of year when the purveyors of profit-driven Medicare Advantage health insurance plans target retirees for the hard sell — ended this week. And for the first time ever, more than half of all Medicare-eligible recipients nationwide have swallowed the bait and signed up. And what exactly is so wrong with that?
Well, not a thing, opponents charge. Unless, of course, you get sick and prefer not to have some corporate bean counter determine whether or not you can get the test or begin the treatment your doctor prescribes.
It could also be a big problem if you happen to like your doctor and the specialist they recommend you see — but you later learn are not “in network,” or have decided to drop Medicare Advantage all together because they simply cannot tolerate all the built in frustration and bureaucratic hassle.
Private health insurance companies, in fact, are great at touting the lower out-of-pocket costs and SilverSneaker perks associated with profit-driven Medicare Advantage plans. But, they are loath to talk about the narrowed pool of available physicians Medicare Advantage recipients can actually see, and the prior authorizations that are erected between Medicare Advantage recipients and the care they need — all in the never-ending pursuit of profit.
Across the country, an increasing number of physicians are reporting the prior authorizations that come with profit-driven Medicare Advantage plans have, indeed, become a “nightmare” for both themselves and the patients they are attempting to treat.
Just last month, the 125-year-old American Hospital Association (AHA) loudly decried and sought redress from the “inappropriate denials of medically necessary care” that come with Medicare Advantage plans.
More frighteningly still, Physicians for a National Health Program (PNHP) point to data showing Medicare Advantage patients are being forced to wait longer for cancer surgery than those using authentic or “traditional” Medicare.
“And on top of having to wait longer for cancer surgery then patients with traditional Medicare,” Dr. Claudia Fegan, chief medical officer at Cook County Health in Illinois says, “cancer patients in Medicare Advantage plans are far less likely to use a National Cancer Institute–designated Center of Excellence.”
That means cancer patients enrolled in profit-driven Medicare Advantage plans are more likely to have their surgeries done at hospitals far less experienced in performing complex oncological procedures.
“It turns out,” Dr. Fegan says, “these delays in getting treatment and the redirection to the less experienced hospitals, is literally killing patients.”
Astonishingly, it gets worse, Medicare Advantage foes insist.
Medicare Advantage purveyors including UnitedHealthcare and Cigna are currently facing class action lawsuits for allegedly using AI (Artificial Intelligence) to further deny Medicare Advantage recipients vital, necessary care — again, all in the name of profit.
The ongoing drive to funnel Medicare eligible retirees into privatized health insurance plans has sparked a nationwide revolt, however.
Municipal retirees from coast-to-coast who were promised traditional Medicare benefits when they initially signed up for civil service are leading the fight against privatization and refusing to allow Medicare-eligible recipients to be herded into profit-driven Medicare Advantage plans.
And they are winning.
This past summer, a New York State Supreme Court Justice permanently blocked the City of New York, and embattled Mayor Eric Adams from stripping municipal retirees of their traditional Medicare benefits and pushing them into a profit-driven Medicare Advantage plan administered by insurance giant Aetna.
Public service retirees in Delaware, too, have also been successful blocking efforts in their state to push them into a privatized Medicare Advantage plan.
A Stay Order issued in Delaware Superior Court blocking Governor John Carney’s administration from herding public service retirees into Medicare Advantage was issued on October 19, 2022, and remains in effect despite ongoing efforts to have it overturned.
Municipal retirees from New York, Delaware, Seattle and other places around the country, in fact, are in the process of organizing into a potent united front against the Medicare Advantage push they say not only harms recipients, but threatens the survival of traditional Medicare itself.
Medicare Advantage foes were celebrated as national heroes during a “Save Medicare” rally held in front of the U.S. Capitol steps on July 27.
In September, U.S Representatives Ritchie Torres (NY-15) and Nicole Malliotakis (NY-11) introduced bipartisan legislation aimed at stopping employers nationwide from pushing retirees into profit-driven Medicare Advantage programs.
In addition to threatening the health of elderly recipients and undermining traditional Medicare, opponents of privatization have long maintained that organize labor’s sloppy embrace of Medicare Advantage will ultimately prove disastrous for an already beleaguered labor movement.
Why would anyone want to join a union, retired civil servants argue, if after a lifetime of paying dues and advancing union solidarity, union leadership can simply “sell off everything that they have” in retirement.
“That is a travesty, and that will cause the end of the Labor Movement,” Marianne Pizzitola, president of the New York City Organization of Public Service Retirees said in June.
Veteran single payer advocate Kay Tillow insists union leaders scrambling to find a solution to soaring healthcare costs by acquiescing to privatization and the Medicare Advantage push are making a huge mistake.
“They’ve chosen [a solution] that takes us backward and will hurt their future retirees as well — and it’s going to destroy medicare in the meantime,” Tillow said.