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Biden is continuing Trump's privatization of Medicare. Here's what you need to know.
The most devious part: they've made it easier for seniors to be placed into a for-profit Medicare plans without their knowledge.
You may have heard that President Biden is supporting the continuation of a program started under the Trump administration that will further privatize the Medicare program. If you have indeed heard about it, it likely is not because of media coverage of the scheme itself but because of the alarm raised by Physicians for a National Health Program and the efforts the organization has made to get the Biden administration to scrap it.
Veteran health care journalist Trudy Lieberman has just written one of the best pieces I’ve read yet that explains what is going on, what is at stake, and what PNHP, some Democrats in Congress, and now other advocacy groups are doing to pressure the Biden administration to put an end to what the Center for Medicare and Medicaid Services euphemistically (and I would argue deceptively) calls ACO REACH, which stands for Accountable Care Organization Realizing Equity, Access and Community Health.
That’s actually a new name for a somewhat “redesigned” program that under Trump was called the Global and Professional Direct Contracting (GPDC) Model. CMS announced the new name in a February press release. CMS said at the time that the program was being renamed and rejiggered “to advance Administration priorities, including our commitment to advancing health equity, and in response to stakeholder feedback and participant experience.”
But as Lieberman wrote in her article, published by the University of Southern California Center for Health Journalism:
The shift would also complete the privatization of what has been a popular and successful social insurance program since 1965. Whether that underlying goal will be realized remains to be seen, but at the very least, millions of seniors still in the traditional fee-for-service program and presumably happy with their care need to know what’s in store for them.
It would be cause for concern if only nonprofit health care organizations were being invited to participate in the ACO REACH program. Instead, the door is being opened wide to include the for-profit insurers I used to work for as well as private equity firms. As Lieberman noted:
Insurance companies and private equity firms are now teaming up with physician groups to invest in these new accountable care businesses, generating profits for all involved if they can save money for the government.
Republicans have been lukewarm about the traditional Medicare program from the very beginning. When Congress approved an amendment to the Social Security Act to create Medicare in 1965, more Republican Senators voted against it than voted for it. Over in the House, 70 Republicans either voted against it or didn’t vote, while the same number voted for it. Had it not been for the fact that Democrats at the time enjoyed filibuster-proof majorities in both chambers and a Democrat, Lyndon Johnson, was in the White House, the much-loved government-run Medicare program likely would never have been created. And ever since then, many Republicans in Congress have tried to get rid of it or, failing that, completely privatize it. As Lieberman wrote:
Transforming Medicare into a program managed by private insurers has been a long-sought goal of politicians, dating back to House Speaker Newt Gingrich in the 1990s and embraced by successive administrations. The Biden administration is no exception and has set a goal of placing all Medicare beneficiaries in one of these so-called “value-based care” arrangements by 2030. In my view, such a move would fulfill Gingrich’s prophecy of letting “Medicare wither on the vine.”
Back to the current debate over what CMS under Biden is doing. Lieberman wrote that critics of the privatization efforts “fear that these programs will seek to save money by limiting health care services, some perhaps unnecessary but others not. If they succeed, investors can keep a portion of the savings as profit.” She added that:
Despite the bullish rhetoric that has historically been attached to accountable care organizations — improving the quality of patient care, lowering health care costs — private equity firms are not known for their social altruism or desire to pare government expenditures. Critics of these programs fear that these programs will seek to save money by limiting health care services, some perhaps unnecessary but others not. If they succeed, investors can keep a portion of the savings as profit.
Among those critics is Dr. Ed Weisbart, who once served as chief medical officer of Express Scripts (now part of Cigna, where I used to work) and is now chair of the Missouri chapter of PNHP. Lieberman quoted Weisbart as saying:
“The middlemen are more interested in their own financial well-being than the health of the people they are managing. The investment community is not investing for some noble interest. They’re not investing to improve the public’s health.”
Lieberman concluded with these insightful observations and questions:
The core issue in this debate is as it always has been: How should doctors be paid and who should profit most in a health system that is basically a for-profit endeavor rather than a public good as in most other peer countries?
That raises the underlying but key question: Will this latest Medicare experiment, which brings in more private equity firms that want a piece of the program, really solve Medicare’s cost problem, or will it simply hand over more of the program to private companies seeking to grow their profits? Is this solution really in the best interest of America’s seniors and their health, or another clever instance of American companies mining the health care system for fresh profits?
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Old Age Survivors Disability Insurance, Disability Insurance, Hospital Insurance
(OASDI, DI, HI).
Politicians and pundits should stop playing games with a confused public, and focus on total spending and total taxes, how they affect the economy, who gains and who loses.
I would like to tweak your assessment of the core issue, if I may. The core issue isn't who should pay doctors and how much, and who should profit.
I suggest we go more fundamentally to a deeper core: why is it ethical to make the so-called beneficiaries be the product and the labor that provides the so-called benefits?
Insurers make their money off of using our data, which we provide and doctors collect for them, to then restrict access to the care we need. But we have paid them premiums, which they then pool and prevent us from using. We should charge interest or get a certain amount back every year if we don't use it.
But that would bust the real model, which is to use our health and data about us as crops, if you will, that they harvest and trade but do everything they can to avoid having to actually tend to.
As for the doctors wanting to both be fairly paid and exercise clinical judgement and practice at the top of their license instead of acting as the middleman for insurance company shareholders' greed: no problem! The solution is to control the doctor.
The vertical mergers of CVS and Aetna, CIGNA and ExRx are all about owning the doctors' prescription pen. If CVS/Caremark/Aetna/Ceasar controls what drugs the docs can prescribe (which they now do with their formularies, and step treatment, etc.), but the doctors push back and demand that rxs be dispensed as written, then the doctors increasingly face exile from the plans, which CVS et al also own.
So, the core issue is when will we stop asking how to achieve these two aims of paying docs and finding the right line to draw for profit, and instead admit that we are not interested in providing healthcare at all. Full stop. It is a shell game where we are the product. Once we admit that we do not have better healthcare because our legislators, all of whom have THE BEST healthcare plans, don't want us to.
The Biden admin, the Trump admin, any other admin. It doesn't matter who is in control because the paradigm is what never changes and yet must if we actually want the system to change.