https://healthcareuncovered.substack.com/p/celebrating-medicares-59th-birthday?utm_source=post-email-title&publication_id=255152&post_id=147167248&utm_campaign=email-post-title&isFreemail=true&r=59t65&triedRedirect=true&utm_medium=email

Today, we celebrate the 59th birthday of Medicare, a cornerstone of American health care that has provided critical services to millions of seniors since its inception in 1965.

This historic program was a watershed moment in our nation’s history, transforming the landscape of health care and ensuring that older Americans and the disabled could access necessary medical services without facing financial ruin. Medicare’s legacy is one of promise and protection, grounded in the belief that no American should go without the health care they need.

However, as we celebrate this milestone, it is crucial to reflect on the current state of Medicare and the growing threat posed by big health insurers’ Medicare Advantage plans. These plans, most of which are operated by private, for-profit insurance companies, have been aggressively marketed as a superior alternative to traditional Medicare.

But the reality is starkly different. Medicare Advantage plans are siphoning off vital resources, wasting taxpayer dollars and ultimately leading to poorer health outcomes and often untimely death of many senior enrollees.

The original intent of Medicare was to provide a straightforward, government-managed health care solution for seniors, but over the years Medicare Advantage plans have deviated from this mission. 

These plans often prioritize profit over patient care, leading to higher costs and more restrictive networks. In many cases, seniors enrolled in Medicare Advantage plans face significant hurdles in accessing the care they need, such as dwindling provider choices and burdensome prior authorization requirements.

Moreover, Medicare Advantage plans are a drain on the Medicare Trust Fund. These private plans receive substantial overpayments from the federal government, which has been documented in two bombshell reports this year from MedPac (estimated $83 billion Medicare Advantage overpayments) and Physicians for a National Health Program (estimated $140 billion Medicare Advantage overpayments).

These overpayments, often justified by health insurers through dubious risk adjustment practices, divert funds away from traditional Medicare. This not only threatens the sustainability of Medicare but also undermines the quality and availability of care for all beneficiaries.

As a former insurance executive, I have seen firsthand how corporate interests can aggressively game public programs. And they’ve gotten really good at the Medicare game.

The good news: A growing number of regulators are focused on the encroaching influence of Medicare Advantage plans and health insurers’ business practices. Which is great, because reducing overpayments to private insurers and ensuring that Medicare dollars are used efficiently is the only way lawmakers and regulators can protect this vital program for future generations.