It’s Not an Advantage, It’s a Scam

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The biggest, loudest, most expensive scam ever perpetrated on the American people is underway right now and people seem not to recognize that it is, in fact, a scam. This despite the fact that they are being hammered with advertising promoting it 24/7. The TV ads feature broken down football quarterbacks and elderly actors and comedians pitching “Medicare Part C.” (At the end of each spot there is a shot of a bunch of tiny type that, should you stop the playback, get a magnifying glass and read it, informs you that the sponsor of the ad is not, in fact, a government agency. In other words, when it says it is offering Medicare Part C, it is lying.) 

The hucksters yell that with Medicare Advantage (that’s what it’s called, this plan that is not, according to the small print, affiliated in any way with Medicare) you could get zero-dollar premiums, zero-dollar deductibles, money added to your Social Security stipend, and all manner of goodies not offered by the other Medicare parts, A and B. What they do not tell you is that they are asking you to leave one of the best, most efficient and best-liked health insurers on the planet — Medicare — and put yourself at the mercy of a private company, not even necessarily an insurance company but a hedge fund, a wealth management company,or a private investor, in business to make money from your afflictions. These companies are heavily subsidized, but not supervised, by the Medicare Trust Fund.  

These private companies, along with the regular insurance companies that offer health insurance are responsible for the fact that in this country, the administrative cost for each person with health insurance is a staggering $2,500, more than one-third of the entire cost of health care. These admin costs include the bill for all those TV ads, $370 million for lobbying Congress (in 2017), compensation for the army of people needed to deny your claims and the executives who cheer them on, and, of course, profits. 

 The administrative cost for regular Medicare is around 2%, but for care under the Advantage program ranges from 20 to 40%, and has been steadily increasing for ten years. Those costs are a major factor accounting for the fact that overall health care costs in the U.S. are double those in any other developed country. Canada spends $550 per person on administrative costs.  

The disadvantages of Medicare Advantage plans compared with regular Medicare are legion, and go far beyond the exorbitant costs:

• Doctors available are limited, many doctors who accept Medicare will not take Advantage plans;
• “Upcoding” is common in Advantage plans, meaning the administrators report a more serious — and expensive — condition to pad the payments to them (one insurer submitted a claim for treating prostate cancer in a woman.) ;
• Private insurers deny claims at a much higher rate than does Medicare, and the denials are issued by people with little or no medical training, based solely on expense. They deny you the treatment, but they still collect the money for it.
• Appeals of denial of service lead to dangerous delays in medical treatment.
• Under a program started by President Trump and continued by the Biden administration, more and more seniors are being switched the Advantage plans without their knowledge or consent.

As a result of all these factors, according to a recent study by the Medicare Payment Advisory Commission, private insurers in 2020 collected $12 billion more than Medicare would have charged for the same patients. Remember; that money comes out of the Medicare Trust Fund. The proportion of Medicare clients who are in Advantage plans has reached 37% –and they cost the Trust Fund more than the other 63%.

One of the most disheartening things about this situation is that the continued expansion of Medicare Advantage, with its fraudulent practices, callous denials of service, exorbitant expenses and screaming hucksters on TV is enthusiastically supported by none other than President Joe Biden, an implacable foe of Medicare for All.