My Word Private entities are chiseling away at Medicare as we know it

This month heralds the end of 58 years of Medicare as we know it. Designed as a public safety net for people 65 and older plus those with certain disabilities of all ages, this program has been and still is a cherished lifeline for millions of Americans, including a large Humboldt County population.

All that is disappearing. Private corporate powers have been chiseling away at traditional Medicare for many years: the so-called Medicare Advantage programs promise cheap health insurance to traditional Medicare recipients with additional benefits like limited dental, vision and hearing care — benefits that traditional Medicare recipients subsidize but do not receive. These plans seem like good deals until inevitable aging demands more specialized and more expensive medical help at which time appear the bureaucratic mazes and barriers to care designed to keep corporate profits high. Almost 50% of all Medicare patients have been persuaded to enroll in these “advantage” plans.

Additionally, privatized plans use unethical and fraudulent approaches to maximize financial return to the companies and their investors that drain the Medicare Trust Fund. In 2020 alone, the CMS (Center for Medicare and Medicaid Services) estimated that $12 billion to $25 billion was fraudulently billed to the Medicare Trust Fund. The minimal fines imposed are accepted as a wrist slap and the cost of doing business by the perpetrators. The stolen, full amounts will never be recovered.

This month, however, marks the official launch of even greater threat to traditional Medicare. ACO-REACH (Accountable Care Organization Realizing Equity, Access and Community Health) is a re-naming of an earlier program, DCE (Direct Contacting Entities) that inserts profit-seeking middlemen into traditional Medicare by private financial interests.

REACH programs propose even greater corporate remuneration. While Medicare “Advantage” programs may keep 15% of all revenue from the fund for profit and overhead, the REACH programs may keep from 25%-40% of billed monies. This is a dangerous incentive to ration and restrict seniors’ care. These financial incentives do not exist in traditional Medicare, which only spends 2% on administrative costs and exacts no profit. How do these entities extract high profits for their investors?

1. Maximize money from the Medicare Trust Fund by using diagnostic codes that exaggerate a patient’s health problems.

2. Minimize health care spending by reducing office staff, hiring staff with less training and increasing the number of patients a physician sees.

3. Enroll as many beneficiaries as possible by automatically “assigning” traditional Medicare seniors into their program if their primary physician joins REACH — without seniors’ knowledge or consent. They may opt out but only by finding another primary care physician who is not yet part of a REACH program.

REACH operatives are not restricted to health insurance companies; rather, they may be headed by private equity, venture capitalists, investment bankers or anyone with the wherewithal to gain access to our Medicare Fund. It is hard to imagine any self-restraint on a program whose bottom line is profit, which must necessarily come before patients. CMS unabashedly trumpets its intention to see ALL of Medicare privatized by the year 2030. Very importantly, this dangerous trend to complete the privatization of Medicare by REACH programs is done without Congressional oversight.

The more REACH takes root the harder it will be to extract. Until we elect representatives who are not owned by corporate money we must look to a massive public response to demand the protection of the health and safety of seniors. That is why now that REACH has begun, it’s essential that everybody take action in defense of traditional Medicare.

Traditional Medicare is not perfect. There is much to do. Medicare supplement plans are expensive. No long-term care, no vision, hearing or dental care means additional expense for elders. That’s why so many grassroots organizations are fighting to improve Medicare and expand it to everyone that it remains for our children and grandchildren.

Start by going to protectmedicare.net and sign the petition to President Biden who has the power to eliminate REACH with one stroke of the pen. Find also, additional information about privatization and steps that can be taken by anyone to end this threat at: pnhp.org and healthcareforall.org. Educate yourselves and share the information with family, friends, colleagues, community, religious, or political groups.

Please join the Humboldt Chapters of Health Care for All-CA And Physicians for a National Health Program in this local effort. Contact [email protected].

Patty Harvey, HCA/PNHP-Humboldt, resides in Willow Creek.