Dear Editor,

Original or traditional Medicare as our parents and grandparents have known it is under serious threat by very powerful for profit special interests. Original Medicare which is the only health insurance program that gives those insured the free choice of doctor and hospital is threatened by transitioning it to private rather than publicly funded privately delivered health insurance program.

Our Medicare plan is celebrating its 58th birthday on July 30th and has been a wonderful healthcare plan for older and disabled Americans. Even those who are not yet eligible can look forward to this coverage that will someday save you a boatload of money compared to what you and your employer is currently paying for health insurance premiums, copays, and deductibles. However, Medicare is currently being exploited by these private for-profit entities.

Currently over half of Medicare recipients are insured through Medicare Advantage (MA) which is neither Medicare nor a true advantage but rather private health insurance funded by inflated or bloated payments far in excess of what it costs Medicare to provide the same services.

Medicare Advantage programs receive a guaranteed or capitated monthly payment based on what it costs Medicare to provide all their services to the average Medicare enrollee. However, in addition to this capitated payment Medicare Advantage plans receive an additional 17% for administrative overhead compared to 3% overhead for traditional Medicare.

The Center for Medicare and Medicaid services in transfers even more additional funds to the Medicare Advantage risk adjustment program. This results in additional funding in the billions of dollars each year based upon the open exaggerated diagnostic codes submitted to CMS by Medicare Advantage programs. In the year 2020 these inflated risk adjustment scores were estimated to have resulted in a $12 billion in excess payments to Medicare Advantage plans.

Medicare Advantage plans then use these additional funds for marketing and the provision of additional services such as vision hearing dental and gym memberships that are not available under traditional Medicare.

All of this translates into a huge profit for commercial insurance companies. Who pays for this additional profit and administrative overhead? You and I, the taxpayers. All of these additional costs far in excess of what Medicare would pay to provide the same care will accelerate the insolvency of the Medicare trust fund and in essence a large taxpayer rip off.

The disadvantage of Medicare Advantage is that one is under the restrictions mandated by all private health insurance programs. There is no free choice of doctor and hospital co-pays and deductibles are determined by the private insurance company. The goal of private insurers are to make profit which is in direct contrast to traditional Medicare which is to provide services to all with no profit incentive and a very minimal administrative overhead.

A new threat to traditional Medicare has emerged in the form of new middle men called direct contracting entities. These entities need not even be a health insurance company. They could be private equity firms who would insert themselves between the doctor and patient in order to control costs and make huge profits. They would then take away the decision-making that is in traditional Medicare made freely by the doctor and the patient.

Original Medicare is not perfect. It needs to be improved by removing some of the significant copays and deductibles as well as providing additional benefits such as dental, vision, hearing, and long-term care. This could be done by allocating the billions of dollars in profits and administrative overhead currently siphoned off by the middle men in health care such as private insurers, private equity firms, and pharmacy benefit managers. By expanding traditional Medicare to cover all residents of our country the risk pool will contain many more healthy people paying into the program and thus enable affordable,universal, comprehensive affordable healthcare to be provided to all our residents.

With the upcoming 58th anniversary of original Medicare the goal should be to expand and improve our Medicare that has worked so well for seniors and those who are disabled to cover everyone. In order to accomplish this the very powerful well-funded special interests must be overcome by an informed electorate who will choose to vote and support representatives who ultimately will enact Medicare for All.

Vince Markovchich, MD

Senator Jeanne Nicholson

Peak to Peak