No one gets better Medicare benefits unless our pals in the insurance industry get a cut off the top - Opinion from Suddenly Senior

Your Weekly Medicare Consumer Advocacy Update

MEDICARE RACKETEERS

Frank Kaiser, Suddenly Senior
June 27, 2008

The Medicare bill defeated in the Senate last night would have improved coverage for mental health and preventive services and helped pay medical and drug costs for more people with Medicare living on fixed incomes. The Bush administration objected to these improvements, which were paid for with a modest cut to some of the excessive subsidies Medicare pays to insurance companies. Administration officials opposed this reduction in subsidies, they claim, because it would result in reduced benefits for people with Medicare enrolled in private health plans offered by these companies.

Translation: No one gets better Medicare benefits unless our pals in the insurance industry get a cut off the top.

It's as if the Medicare program had been taken over by Mafia goons.

Numerous independent, nonpartisan studies have shown it cost taxpayers substantially more--about $1,000 a head, according to one study--to provide coverage through a Medicare private health plan instead of through Original Medicare.

Just this week, the Government Accountability Office reported that, in 2005, insurance companies pocketed as profit $1.14 billion in subsidies that the companies had told Medicare would go toward medical benefits.

Last night, 39 Republican senators joined President Bush in opposing HR. 6331, the Medicare Improvements for Patients and Providers Act. As a result, the benefit improvements in HR. 6331 will not take effect, and on July 1, doctors will get a 10 percent payment cut, a disaster for both patients and doctors that the bill would have averted. None of the senators' excuses for this vote hold water:

• The bill was a partisan exercise. Not so. The bill passed 355 to 59, a veto-proof majority, in the House of Representatives. More Republicans voted for HR. 6331 than against it.

• President Bush would have vetoed it anyway. So what? If enough Republican senators put the interests of people with Medicare ahead of their loyalty to President Bush, there would have been enough votes to override a veto in the Senate.

Next week, these senators will be back home attending fundraisers and marching in Independence Day parades. We need to tell them to show a little more independence from President Bush and a little more backbone to the insurance company lobbyists. Medicare belongs to the American people. It is not a racket for the insurance industry.

Medical Record

Senate vote to invoke Cloture on the Motion to Proceed on HR. 6331 fell short of the 60 votes needed. Yea votes indicate support for passage of HR. 6331. No votes indicate opposition. Majority Leader Harry Reid, Democrat of Nevada, voted No to preserve the right to bring the bill up for a vote again (Roll Call vote on HR. 6331, June 2008).

"On average, [Medicare Advantage] organizations' self-reported actual profit margin was 5.1 percent of total revenue, which is approximately $1.14 billion more in profits in 2005 than [Medicare Advantage] organizations projected" ("Medicare Advantage Organizations: Actual Expenses and Profits Compared to Projections for 2005," Government Accountability Office, June 2008).

"I am an elder advocate with an Area Agency on Aging. Even though several Medicare Advantage plans, including four PFFS plans, are listed as plans accepted in our county, that is actually not the case. Once a beneficiary enrolls in one of these Advantage plans, they find out that providers in this county actually do not accept the plans. If the beneficiary cannot see a provider in this county, they are forced to leave the county to find providers. Some have to drive 50, 100 and 200 miles to see a provider, or get their prescriptions, because there are no providers in our county who will accept their plan. Many of these elderly people can't drive because they have poor eyesight, dementia, etc. These elderly beneficiaries come to our Area Agency on Aging to get out of these Medicare Advantage plans because the local hospital and their doctors will not accept the plans" (Story submitted to the Private Health Plan Monitoring Project from Spencer, Iowa, Medicare Rights Center, April 2007).

From John Curry