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Improved Medicare for All? -- or -- Medicare Advantage for All?

Improved Medicare for All? -- or -- Medicare Advantage for All?. What’s So Great About Medicare ?. Medicare Means. Freedom of Choice. Physicians in practice in USA. Physicians opting out of Medicare. Medicare’s “directory”. 685,000. 9,539. 98% of practicing physicians.

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Improved Medicare for All? -- or -- Medicare Advantage for All?

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  1. Improved Medicare for All? -- or --Medicare Advantage for All?

  2. What’s So Great About Medicare?

  3. Medicare Means Freedom of Choice • Physicians in practice in USA • Physicians opting out of Medicare • Medicare’s “directory” • 685,000 • 9,539 • 98% • of practicing physicians Go to any doctor or hospital Anywhere in the United States You’re back in control. 2013 data from Fiscal Times http://www.thefiscaltimes.com/Columns/2013/09/04/Are-Doctors-Really-Ditching-Medicare Accessed July 16, 2017

  4. Medicare Means Waste Less Money on Bureaucracy Insurance Overhead Q1 2016 Medicare Parts C and D Source: Day, Himmelstein, Broder, Woolhandler– Int. J Health Serv 2014 Updated data from firms’ SEC filings (Q12016) Overhead = (Premium revenue – Medical Expenses) / Premium Revenues Medicare updated with 2016 Medicare Trustee Report 2012 data as cited by Kip Sullivan, Journal of Health Politics, Policy, and Law. Vol 38, No. 3, June 2013 DOI 10.1215/03616878-2079523 available at http://www.pnhp.org/sites/default/files/Medicare_admin_costs_JHPPL.pdf .

  5. Medicare Means Healthier Americans USA Rank Age 65 Women Men Institute of Medicine. Shorter Lives, Poorer Health. Fig 1-9: Ranking of US mortality rates by age group among 17 peer countries, 2006-2008. 2013 Peer nations are Australia, Austria, Canada, Denmark, Finland, France, Germany, Italy, Japan, Norway, Portugal, Spain, Sweden, Switzerland, Netherlands, United Kingdom Age

  6. Medicare for All? NHI? Single Payer? Also known as “National Health Insurance” also known as “Medicare for All” “Single Payer”

  7. Medicare for AllMakes Economic Sense 25 independent studies, at the state and federal level, confirm that the savings would fund full coverage. http://www.pnhp.org/facts/single-payer-system-cost Accessed 2/25/2017

  8. Medicare for AllMakes Economic Sense $ Billions Increased market power (better pricing on drugs and devices) Admin costs to providers (hospitals and physicians) Increased utilization (home health, dental, etc.) Covering the uninsured Health insurance admin Medicaid Rate Adjustment Gov. admin ($23B) New Costs New Savings Analysis of HR676 Friedman, G. Dollars & Sense. March/April 2012

  9. “All Americans should have Medicare Advantage.” Erin Solaro, SeattlePi, June 21 2008 http://www.seattlepi.com/local/opinion/article/All-Americans-should-have-Medicare-Advantage-1277187.php Accessed Aug. 19 2017

  10. Medicare Part C Sounds Pretty Good • 100% Coverage • More Affordable Than Medigap • Extra Perks • No copays • No deductibles • No out-of-pocket • Very little (or zero) fee above Traditional Medicare • Gym clubs • In-home medical evaluation • Some include a drug benefit Too good to be true?

  11. “People retiring now are likely to pick a Medicare Advantage plan. They're used to those kinds of networks…. “People over 70 hold onto that red, white, and blue card for dear life.” • Mark Bertolini • Aetna CEO • Jan. 23, 2014 https://www.benzinga.com/media/cnbc/14/01/4242957/aetna-ceo-mark-bertolini-talks-medicare-advantage-growth Accessed Aug. 20, 2017. Excerpts taken in context.

  12. Medicare Advantage Now Has 31% of Medicare Beneficiaries Insurers are not required to sell a Medigap policy to anyone leaving a Medicare Advantage plan after one year. Millions of Americans in an MA plan Kaiser Family Foundation, as quoted at https://seekingalpha.com/article/4098838-single-payer-medicare-private-medicare-advantage (accessed Aug. 19. 2017)

  13. It’s Complicated “Single Payer” Part C (Medicare Advantage) Part D (Drug Benefit)

  14. It’s Complicated, and Complexity Wastes Our Money Medicare for All Privatized Medicare

  15. MA Plans Market to Healthy Seniors The healthiest members make the healthiest profits.

  16. Health Insurance Whack-a-Mole • MA plans try to attract the healthiest seniors away from traditional Medicare. • CMS responded by “risk adjusting” what they pay MA plans. • Makes sense…

  17. MA Plans Are Paid More for “Sicker” Patients…Free Screening Echocardiograms Medicare pays MA plans ~$4,000 more for every heart failure patient $4,000 MedPAC data for 2008

  18. MA Plans Are Paid More for “Sicker” Patients…Free Screening Echocardiograms

  19. Source: MedPAC and Geruso and Layton, 2015 (updated) Medicare Overpays Medicare Advantage Total overpayments 2008-2016: $174 Billion Overpayments ($ Billions)

  20. We Should Require Private Insurance to beAs Efficient As Medicare ACA today requires Medical Loss Ratios of 80-85%. Build on that and transition all payers to Medicare’s 98.6% Insurance Overhead Q1 2016 Source: Day, Himmelstein, Broder, Woolhandler– Int. J Health Serv 2014 Updated data from firms’ SEC filings (Q12016) Overhead = (Premium revenue – Medical Expenses) / Premium Revenues Medicare updated with 2016 Medicare Trustee Report 2012 data as cited by Kip Sullivan, Journal of Health Politics, Policy, and Law. Vol 38, No. 3, June 2013 DOI 10.1215/03616878-2079523 available at http://www.pnhp.org/sites/default/files/Medicare_admin_costs_JHPPL.pdf .

  21. MA Patients Get Less Healthcare TraditionalMedicare minus Medicare Advantage NBER Working Paper #23090, January 2017

  22. Medicare Advantage Eliminates Choice Insurers that include the best hospitals attract the sickest patients. Sickness becomes a liability for health insurers in the “free market”. • NYC Medicare Advantage Plans including Sloan-Kettering Cancer Institute in network? • FL Medicare Advantage Plans including BJC in network? • STL area Medicare Advantage Plans including Mayo Clinic in network? • 0 • 0 • 0

  23. Truly Sicker Patients Leave MA Plans Similar results with hospital or home care use Patient left: Health Affairs 2015;34:1675. 2011 data. Similar results for patients with hospital or home care use

  24. Truly Sicker Patients Leave MA PlansBecause They Can’t Get Healthcare Patient reasons for disenrolling from MA plans with relatively high health-biased disenrollment rates 41% 27% Disenrollment reasons for 126 Medicare Advantage contracts with relatively high disenrollment, 2014 GAO Report 17-393 April 2017 https://www.gao.gov/assets/690/684386.pdf Accessed Aug. 19 2017

  25. Medicare “Advantage” • Loss of choice • and control • Wastes our • tax dollars • Disappears when you need it • Directories of doctors and hospitals • Little out-of-network coverage • Marketing • Bureaucracy • Highly compensated executives • Attracts the healthiest seniors • Sickest seniors often decide to go back to Traditional Medicare

  26. The Best Way to Protect Medicare Improve and Expand Medicare for All Americans!

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