Privatized Medicare Advantage plans are rationing health care for seniors

[PA Democrat]

<snip>

The 72-year-old Clearwater, Fla., resident had been on the federally subsidized, privately run Medicare Advantage policy through WellCare Inc. for about three years when she started having pain that made it hard to walk.

Her doctor's referral to an orthopedic specialist was denied by the insurer. Her out-of-pocket costs were higher than she was initially told. And when Ms. Sangiamo needed surgery, she said, WellCare offered some unexpected medical advice.

"Take pills and use a walker," Ms. Sangiamo remembered being told by the insurer, which declined to comment on the case. "I wanted to say, 'I'll take the walker and bang you in the head with it.'"

Seniors have flocked by the millions to Medicare Advantage, privately run plans offered as an alternative to traditional, government-run Medicare. Programs that promise lower premiums or other perks have combined with heavy marketing from insurance companies to make the programs double in size in the last six years to nearly 11 million members and growing.


Read more: http://www.postgazette.com/pg/09242/994293-114.stm#ixzz0PfxIPmEY

[BuelahWitch]

1. Of course they do! They ALWAYS have!

My mother's medical insurance refused to pay for a new drug that might have helped her with her dementia, nor would her doctors run a more comprehensive test to see if she was diabetic. So she gets into the nursing home and what do they find?
This "rationing" bullshit has been going on for years for seniors who can't pay higher premiums. That's one reason these teabaggers are so fucking disingenuous. It's this way NOW. It's been this way. We want to make it better.

[LiberalFighter]

2. Make sure everyone that reads this sends the link to those advocating reform.

[fascisthunter]

3. vampires=privatized health insurance industry

[Crazy Dave]

4. Rationing and denying benefits

Ever since health care became a profit making rather than a life saving business

[defendandprotect]

5. It's also up to Democrats to make clear what this is really about -- !!!

They have to properly inform citizens that this is not Medicare!

[PA Democrat]

6. These privatized plans also cost taxpayers more as well, according to the GAO.

Private Medicare plans often cost beneficiaries more than the traditional government-run Medicare program, Congressional investigators say.

Many private plans advertise extra benefits and low costs. But in a report to be issued Thursday, the Government Accountability Office, an investigative arm of Congress, says that many people in private plans face higher costs for home health care, nursing homes and some hospital stays.

About one-fifth of the 44 million Medicare beneficiaries — 9 million people — are in private plans, known as Medicare Advantage plans.

The report says, “Medicare spends more per beneficiary in Medicare Advantage than it does for beneficiaries in the original Medicare fee-for-service program, at an estimated additional cost to Medicare of $54 billion from 2009 through 2012.”

http://www.nytimes.com/2008/02/28/washington/28medicare.html?_r=1&scp=1&sq=private+medicare&st=nyt

[Hidden Stillness]

7. "Medicare" Advantage is a Total Fraud, Just Like Part D

"Medicare" Advantage is the shift from the publicly-run Government Medicare program to a corporate-subsidized, corporate-run operation, that Republicans did a few years ago when they still ran Congress (as opposed to the way they run Congress now). It is the same thing they did with prescription drugs and "Medicare" Part D, where all the money goes directly to corporations under one guise or another--incentive, tax cuts, subsidies, expenses, bonuses--until it drains the money away from people on the program, and their care. There are huge corruptions and thefts, and at a hearing a couple of years ago, Representative Pete Stark of Calif. did a great job of exposing how horrible, and what a corporate drain, the Advantage program is; how people were denied care to boost corporate profits, etc.. It is a complete fake and should be killed, with people put on real Medicare.

One thing I don't agree with from the OP/excerpt is the silly corporate-media phrase "seniors have flocked by the millions to.." whatever. This is corporations telling us "how popular they are" again, (like the ubiquitous "the popular diet drug" and all the rest of their propaganda filth). The fact is, millions of people were automatically cut off of their perfectly good Medicare or Medicaid coverage when this Advantage crap started, put on this, and had no choice. Many older people also talked, later, about how they were lied to and told they were signing up for regular Medicare, or that "Advantage" was better; just like the lies told about Part D later.

I would also like to be clearer on some of the Obama health plans. Much of it (secret meetings with phrarmaceutical and insurance representatives, offering to kill any public plans) is disgusting, but from what I understand, when they say part of Medicare will be cut, I think it is this horrible Advantage thing that is going to be partly killed--which I think would be great. Get people onto good coverage. Does anybody know about this part of it? Medicare Advantage is a total, money-draining fraud, and should be ended, and all enrollees put onto something good.

[TahitiNut]

10. Amen. Both are raids on the public pocketbook by privateers.

They're both detestable pieces of corporatist legislation designed to exploit human suffering for corporate profit.

[PA Democrat]

11. From what I have read, Obama has stated that he plans to go after the subsidies being paid to

private insurers for Medicare Advantage plans. I hope that he sticks to his word. Further on in the article, it states those subsidies to Medicare Advantage private companies total about $15 billion a year right now. The subsidies were part of the Republican's 2003 Medicare Modernization Act.

You are absolutely right in labeling the plans a fraud. Isn't it maddening to hear private insurers crying about having to compete with a public option when they are getting huge taxpayer-funded handouts to "compete" with traditional Medicare?

[OHdem10]

8. Medicare uses the same principles as HMOs.. They approve

medically necessary procedures. This is what HMOs do.

Come on. The reality is Insurance Companies and Doctors
make money on Procedures. As it is now, Doctors make more money
the more tests, the more procedures and get kickbacks from
Pharmaceutical Houses the more Meds they prescribe. There
is a lot of waste and abuse in Private Insurance. Many people
are made worse by this over treatment.



Doctors learn very quickly the items that Medicare will cover
and simply do not offer or suggest you have anything not
covered. Medicare covers Medically Necessay. Therefore most
people do not realize care is being rationed if we want
to hysterically call everything rationing.

[grasswire]

9. but Medicare offers MEDIGAP plans that are the real deal

The ADVANTAGE plans are purely HMOs and junk.

The MEDIGAP plans are real, with benefits mandated by federal law and clearly explained. No matter whether you have Medigap plan A, B, C, D, E, F, or G with Blue Cross, Kaiser, United Health, or whatever, the benefits will be the same, mandated by federal law and known to you in advance!

Of course, insurers would rather sell you an Advantage plan.

[OHdem10]

12. For many people the Medi GaP Policies are too expensive.

If all Americans could afford Medi-Gap Policies, we would
not need Health Care Reform

[SmileyRose]

13. I refuse to pass a judgement on this

because even Medicare advantage pay on the basis of procedures done there is an incentive there for doctors to recommend putting Grandma through procedures that may or may not actually benefit her. On the other hand the HMO has an incentive to make a profit, so the incentive is there to deny procedures that would improve Grandma's quality or length of life significantly. Throw in medical advertising direct to patients, who then shop a doctor until they find one who will give them what they want - the whole system is broken from top to bottom.

In this story too many of the facts are left out - thankfully. Ms Sangiamo deserves her medical privacy too.

We can guess we are talking about knee or hip replacement here. These are highly successful surgeries in the right situations. For a 72 yr old in otherwise good health, who can expect to live another decade or more, joint replacement is a very good option. For a 72 yr old with other very serious health concerns the question gets murky.

Unfortunately few if any of the people involved in Ms Sangiamo's care are making choices solely based on what is best for her. -- and that is why we have to nuke the system we have and start over.