Hate may be too strong a word, but health experts certainly do not love private Medicare Advantage (MA) insurance plans. There is ample research that MA plans soak the government by gaming its reimbursement rules to unfairly boost their payments. Other studies have found that the plans’ rules requiring prior authorization of care – part of their mandate to minimize unneeded, expensive care – too often have delayed and denied care to people who need it. Marketing efforts to sell MA plans also are faulted as overly aggressive and misleading.
Thanks for the article! Based on your summary, i am not persuaded by Dr Jain’s argument but mainly because he does not address and rebut the points made by the anti-MA piece - at least not in your summary. more reading to come.
I suspect that MA plans are popular for two reasons: (1) Advertising; (2) "I'm all right, Jack": when I seem okay, it's easy to assume I'll stay that way. This is the same fallacy that sideswipes so many people who presume they will be able to retire way off in the future, with plenty of time to save before that point--and then get sidelined earlier and have to figure out how to cope.
I've no objection to private enterprise as an alternative to government programs. Only one of my own volunteer activities is with a government entity; the others are with non-profits. But what kind of alternative?
When MA programs advertise their benefits, and CMS does not offer similar marketing to tout its program's advantages, naturally we get a distorted view. If MA plans provided services as good as or better than traditional medicare, they deserve the profits. But when their overhead is higher and also their services are worse, their gaming the system sounds scam-like, I have to ask what public good they serve. Their existence does not seem to improve the procedures of traditional medicare. What's left? Happy lobbyists are not a public good. Their profits come far more out of tax dollars than out of member premiums, unless I'm much mistaken. Why should our taxes support them, partly by subsidy and partly by allowing them to cherry-pick the healthier enrollees, leaving sicker ones to default to traditional medicare based om premiums? This doesn't even count the public harm, or call it the human cost, that results from delayed care and under-care. It may wear the appearance of avoiding overtreatment, but in practice the incentive commonly is simply in favor of delay.
I cannot read either of the papers referenced. However, as a MediCare participant I can say that "Traditional" MediCare would be nearly worthless without the supplements. As it is, preventive care is not generally covered - although that would reduce program costs (prevention is far less costly than treatment). Instead, CMS is concentrating on turning "Traditional" MediCare into a giant, overpriced HMO via the ACO initiative. MA is the only currently authorized competition and should be encouraged as a means to make MediCare both more effective and less costly.
Thanks for the article! Based on your summary, i am not persuaded by Dr Jain’s argument but mainly because he does not address and rebut the points made by the anti-MA piece - at least not in your summary. more reading to come.
I suspect that MA plans are popular for two reasons: (1) Advertising; (2) "I'm all right, Jack": when I seem okay, it's easy to assume I'll stay that way. This is the same fallacy that sideswipes so many people who presume they will be able to retire way off in the future, with plenty of time to save before that point--and then get sidelined earlier and have to figure out how to cope.
I've no objection to private enterprise as an alternative to government programs. Only one of my own volunteer activities is with a government entity; the others are with non-profits. But what kind of alternative?
When MA programs advertise their benefits, and CMS does not offer similar marketing to tout its program's advantages, naturally we get a distorted view. If MA plans provided services as good as or better than traditional medicare, they deserve the profits. But when their overhead is higher and also their services are worse, their gaming the system sounds scam-like, I have to ask what public good they serve. Their existence does not seem to improve the procedures of traditional medicare. What's left? Happy lobbyists are not a public good. Their profits come far more out of tax dollars than out of member premiums, unless I'm much mistaken. Why should our taxes support them, partly by subsidy and partly by allowing them to cherry-pick the healthier enrollees, leaving sicker ones to default to traditional medicare based om premiums? This doesn't even count the public harm, or call it the human cost, that results from delayed care and under-care. It may wear the appearance of avoiding overtreatment, but in practice the incentive commonly is simply in favor of delay.
I cannot read either of the papers referenced. However, as a MediCare participant I can say that "Traditional" MediCare would be nearly worthless without the supplements. As it is, preventive care is not generally covered - although that would reduce program costs (prevention is far less costly than treatment). Instead, CMS is concentrating on turning "Traditional" MediCare into a giant, overpriced HMO via the ACO initiative. MA is the only currently authorized competition and should be encouraged as a means to make MediCare both more effective and less costly.