There is yet another relatively silent power grab by the government to limit
your freedom of medical choice in the Medicare program.
To retell an old anecdote, the bureaucrat was asked why the driver's
licensing offices couldn't be opened on Saturdays. He replied that they'd
tried it but had to abandon the idea when they discovered that too many
people were using them.
Apocryphal, perhaps. But something very similar is happening in Washington,
D.C., as the usual unholy coalition of penny pinchers (for you, not them),
ideologues, and bureaucrats try to curtail the growth of the most popular
aspects of Medicare:
As originally enacted in 1965, Medicare permits its enrollees to seek care
from any approved source that is willing to accept the government's payment
rates, put up with its paperwork and run the risk of going to jail for
When Medicare was established, everyone (including the bill's backers)
understood that their cost estimates were preposterously low. Every few
years since, the government has dickered with the program to try to make it
more "cost-effective" from their point of view even while expanding
Herding people into HMOs has long been a favorite and dismally ineffective
tactic. But another attempt, originally conceived as a minor corrective, now
enrolls 20 percent of Medicare's 43 million-plus beneficiaries.
In 1993, Congress passed the Medicare Modernization Act, which established
Medicare Advantage as the successor to the problem-plagued Medicare + Choice
program. Under Medicare Advantage, private insurance companies contract with
Medicare for the right to sell policies to Medicare beneficiaries; in 2007,
there were 602 contracts between Medicare, insurers, and healthcare
Medicare beneficiaries who buy these policies then deal directly with their
insurers and providers, who then are paid by Medicare. Today, about 80
percent of Medicare Advantage beneficiaries are enrolled in HMO or PPO
But the fastest growing segment is the remaining 20 percent who opt for
unrestricted private fee-for-service coverage. No managed care, no quality
control, just the old-fashioned, "Thank you, I'll make my own decisions
No one expects Medicare Advantage to grow less popular; by some estimates, a
third of all Medicare beneficiaries will be enrolled within a few years.
The program is especially popular in rural areas and among the less
affluent. It also appears that Medicare Advantage members are, as a group,
And the Beltway doesn't like it one bit. And they've got their reasons:
- Cost. Advantage runs about 10 percent higher per year per person, which
adds up to about $54 billion over the next five years. Much of that money
goes to providing additional benefits and services. Still, the chatter is
that the drain on the "trust fund" is intolerable and that the money could
be "better spent elsewhere."
- Lack of the Draconian detailed supervision and oversight found in
traditional Medicare and complaints that care is not properly managed.
Again, the only people who seem not to be complaining about this are the
- Complaints of real and alleged marketing abuses by private insurers,
especially after a New York Times article strung together a lot of
allegations regarding high-pressure and misleading sales tactics, including
one company that offered its sales people trips to Las Vegas as a
particularly sinister incentive.
So what is the government doing to rein in this popular program?
In May, the Centers for Medicare and Medicaid Services (CMS) proposed
strengthening its negotiating and regulatory powers over Medicare Advantage.
In June, CMS suspended the seven largest providers of Advantage plans (who
account for the vast majority of policies) from active marketing until they
could correct real, alleged and purely fictive abuses and irregularities.
Allegedly, the providers have already corrected these deficiencies.
Meanwhile, the House of Representatives passed legislation (The CHAMP Act)
that would fund expansion of children's care by deep cuts in Medicare,
including Advantage. In no way are we against better childhood healthcare
but it seems senseless to rob Grandma and Grandpa to pay for their
granddaughters and grandsons.
President Bush has threatened to veto this legislation; results won't be
known until the bill goes through conference with the Senate and achieves
In the meantime we suggest that those currently on Medicare Advantage, those
who soon will be and those who ultimately will be, speak out now to your
congressional representatives or give up one of the last advantages you have
-- your freedom of medical choice.
EDITOR's NOTE: Michael Arnold Glueck, M.D. pitched this week's column