By Jack E. Lohman
It was hard to believe my ears.
Either Congressman Jim Sensenbrenner was spinning his vote for the insurance industry, or he truly doesn’t get it.
At a recent town hall meeting Jim boasted that he voted against reducing the funds for Medicare’s Advantage program because some of his constituents like the program. And yep, 19% of seniors have fallen for the claims by Advantage salesmen, as did he.
But in the process, he tossed to the wolves the other 81% of seniors with traditional Medicare!
Medicare Advantage plans cost taxpayers up to 17% more than traditional Medicare, and generally provide less patient care. HR6331 would have lowered the private Medicare payments to equal those of public Medicare, but Jim wouldn’t stand for it.
Forget that “private” should be less costly than “public,” it isn’t.
Medicare Advantage plans (a clever oxymoron) are more costly not because they offer more services to patients — because they take more than they give — but because they waste more money on salesman commissions, actuarial costs (cherry-picking), utilization review (gatekeepers and denial of care), higher CEO salaries and bonuses, and in some cases shareholder profits and even lobbying and campaign contributions that get added to patient costs.
Hereby lies the key: private Medicare Advantage companies can give campaign contributions and public Medicare cannot!!!
So what else would you expect from Jim Sensenbrenner? He also opposes campaign reform, which would greatly reduce the corruption in Washington and fix a lot of our nation’s problems.
The Advantage plans are usually fine, until you get really sick and need care. The Medicare Rights Center found serious problems when, too often, these plans did not provide the care they promise. This has prompted several state attorney generals to sue the companies on behalf of patients.
Among the faults found:
- Care can cost more than it would under Original Medicare;
- Private plans are not stable;
- Difficulty getting emergency or urgent care;
- Continuity of care is broken;
- Members have to follow plan rules to get covered care;
- Choice of doctor, hospital and other providers is restricted;
- Difficulty getting care away from home;
- Promised extra benefits can be very limited;
- People with both Medicare and Medicaid can encounter higher costs.
Worse, in order to pay for the 17% subsidy to the private Advantage companies, congress allowed a 10.6% cut in physician payments from “traditional Medicare” to take effect on July 1st. The obvious result is that physicians will significantly reduce (or sometimes eliminate) the number of new “traditional” Medicare patients they take, and/or start skimping on the number of needed diagnostic tests they perform.
So, many of the remaining 81% of seniors will now have to start looking for lesser-quality and more costly Advantage plans, which is exactly what the private insurance industry wanted!
Thank you, Congressman Sensenbrenner.
Another problem is that most of these plans are “capitated” and paid at a fixed rate by Medicare. So whenever the company can avoid providing tests or surgeries, that savings adds to their bottom line in profits. A major incentive for denial of care.
I asked Jim why, when the taxpayers give politicians health care, he calls it “employee benefits.” But when taxpayers give citizens health care he calls it “socialized medicine.”
Not surprisingly he launched into a tirade defending the federal health care system. He ignored that most seniors have paid into Medicare over the past 40 years, and are subject to the same 20% deductible federal employees are.
Funny how that works, but you have to know the mentality. Sensenbrenner’s gold-plated plan is neither a capitated plan nor a health savings account (HSA), both of which he supports for the masses but not for himself.
Reports on Medicare Advantage Plans:
Sensenbrenner’s Republican challenger, Jim Burkee, has promised to self-limit his stay in the House to 6 years, which would be quite a change from Jim’s 30 year stand. His website outlines his disagreements with Sensenbrenner, though he (inappropriately, I think) supports free-market health care.
This bill ultimately passed the senate with a 69-30 veto-proof majority on July 9th, no thanks to Sensenbrenner and Paul Ryan. After Ted Kennedy (D-MA) cast the deciding vote, nine Republicans changed theirs to vote their conscience. To understand why they didn’t vote their conscience in the first place, just follow the money!
That is our corrupt system. Get used to it… or change it!