‘Medicare Advantage?’ Advantage Big Business

Health care reform and the 85 percent solution

By Dr. Stephen R. Keister / The Rag Blog / July 13, 2009

“There is nothing more difficult to take in hand, more perilous to conduct, or more uncertain in its success, than to take the lead in the introduction of a new order of things.” — Nicolo Machiavelli.

“The President has told visitors that he would rather have 70 votes in the Senate for a [health care] bill that gives him 85% of what he wants rather than a 100% satisfactory bill that passes 52 to 48.” — David Broder, Washington Post.

The President’s statement as quoted once again points to his uncertainty in assuming the office. It would seem far more rational to seek first rate health care, administered in a professional way, rather than the 85% solution produced by the despicable salaaming to the corporations now in control. This appears to be a continuation of the inept management that the administration has shown in facing the nation’s financial crises, turning to the folks who caused the disaster so that they can overcome their own misdeeds.

Is this the same administration that refuses to investigate the past administration’s use of torture, illegal detention, and spying on its own citizens? Is it the same administration that refuses to investigate the Bush administration’s perversion of the Justice Department for political advantage? One wonders if Mr. Obama is driven by naiveté in deferring to the Republicans in the interest of “bipartisanship” or whether deep within he feels that he and his family are threatened by the perverted, hate-filled right wing gun nuts who abound in our society today.

Laura Flanders addresses this issue in an article from The Huffington Post entitled “Obama Hushes Healthcare Advocates.”

But I digress… I have addressed the subject of “Medicare Advantage” in prior postings. We were aware that this was part of the Bush, “free enterprise”/neoliberal economic plan to do away with the social network that has given comfort to the American people since the administrations of FDR. Initially Mr. Bush attempted to “privatize” social security and by some fortuitous quirk of fate failed in the Congress to do so.

Step two was to gradually do away with Medicare as an entity. Initially there was the pseudo-prescription drug plan that was passed under the guise of helping the elderly, but indeed was a massive, multibillion dollar payoff to the insurance industry and Pharma. Then Bush and his advisers initiated the Medicare Advantage plans which sold much of the Medicare Trust Fund to the private insurance industry, and will in time accelerate the depletion of those funds. This clearly grew from the mentality of “screw the tax payer, screw the elderly, destroy the safety net;” however, it was not until the other day that I realized how badly this program helps destroy the physician and in doing so undermines the doctor/patient relationship.

This past Friday I had an appointment with my dermatologist, a dedicated physician, a great human being who who still practices for the well-being of the patient and has not integrated himself into the business community by becoming a cosmetologist and thus denying us all of necessary medical care. While I was waiting in an examining room I became aware of the following posted notice:

Important Message Regarding Medicare Advantage Plans… Please be advised that although we do participate in Medicare, we DO NOT participate in Medicare Advantage Plans (except for Highmark). According to the Medicare Advantage Plan rules, AS A NON-PROVIDER WE ARE NOT ALLOWED TO SEE PATIENTS switching to such plans. Although we disagree with such rules and find it disruptive to the patient-doctor relationship, we must abide by the rules until this “glitch” in the healthcare system is fixed.

To avoid misunderstandings, please carefully consider how your coverage is affected by your changing from traditional Medicare to a Medicare Advantage Plan. We have observed much confusion and misinformation given to our patients from representatives of these plans.

The resulting impact of these the Bush-created monsters is Byzantine and nefarious. There are multiple Medicare Advantage plans, each of which has its own rules and paperwork. A solo practice physician soon becomes overburdened by filling out forms and he or his secretary must also spend hours on the phone obtaining advance permission to see the patient, while his other patients are kept waiting.

But the worst is to come. If the physician inadvertently sees one of these patients, on any specific plan, he is automatically contractually bound to all patients in the plan and all of the terms and conditions unique to the given plan. The buzz word in the industry is that the doctor becomes “DEEMED” contractually bound to the plan’s rules by virtue of just seeing the one patient. In other words: a unilateral contractual agreement without signatures! Ordinarily, a patient seeking care from a non-provider would at least have the option of seeing the physician if willing to and capable of paying for the services himself. However, by the Medicare Advantage rules, the non-provider is even prohibited from SEEING the patient, let alone charging the patient.

Thus the Bush administration not only conned the public but took a giant step towards destroying the patient/physician relationship. The Republicans, the Blue Dog Democrats in the House, and the well bribed Senators would now refuse the American public access to decent, open, non-complicated health care. And the President will not stand up to this immorality and unethical behavior.

We need health care that is open and uncomplicated, with free choice of physician, or specialist, and choice of hospital; with consultation between the doctor and patient. The doctor must once again be able to admit and discharge patients from the hospital and not be guided by the dictates of the insurance. We need health care commensurate to that in other developed nations without a credulous public being misled by devious ads regarding health care in other nations, frequently passed off as “news” as CNN has recently done. Nick Baumann has written about this, as has Robert Parry (“False Health Care Scare Ad on CNN).

We might be better off should Mr. Obama abandon his attempt to pass legislation prior to the August recess; it might be wiser to await the return of our elected representatives in September with the hope that they may be pressured locally to pass a decent, unfettered health care bill such as single-payer, or a plan with an uncluttered “public option.” If the public were to show just a fraction of the zeal exhibited in response to the death of Michael Jackson perhaps, just perhaps, we could do something worthwhile.

Indeed, if the Congress can pass nothing but a monstrosity of a bill, dictated by the insurance industry, Pharma, the AMA, the U.S. Chamber of Commerce, and the AARP, we might be better advised to do nothing at all. Perhaps if nothing is done the public as a whole will awaken and demand a rational plan that benefits the people rather than the corporations.

Meanwhile, back on the cannabis front, the Webb Crime Bill is moving in the House. The Webb bill that would impact our entire outlook on crime, punishment, and especially the approach to drug policy, punishment and sentencing, is making progress. There are 30 cosponsors in the Senate and Rep. Bill Delahunt (D-Mass) has introduced a companion bill in the House of Representatives. Sen. Webb feels that there is a good chance of passage. Mother Jones editor Monika Bauerlein provides excellent background on this issue.

Once again we ask that the administration request the Congress to revise Medicare Part D, making it a plan where the elderly can obtain pharmaceuticals at a negotiated price, as can be done in most advanced countries. Further, we must eliminate the Medicare Advantage plans which are merely a sop to the insurance cartels. Finally, we should support the Webb amendment and bring some rationality — and billions in savings — to the taxpayer, by revising the official policy concerning marijuana and its medical use, opening up the possibility of using the financial savings to underwrite universal medical care.

[Dr. Stephen R. Keister, a retired physician who is active in health care reform, lives in Erie, PA. His previous articles on The Rag Blog can be found here.]

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