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How About a Health Care Changeup?

By September 25, 2022Commentary

Been a while since I got back to my health care roots, but here goes.  Medicare has two primary ways to access benefits, which at this point have relatively equal enrollment.  One is the traditional fee-for-service Medicare and the other is Medicare Advantage, in which beneficiaries enroll in a private plan and receive their benefits through that plan.  While you always pay your Part B premium, many Medicare Advantage plans have no additional premium, but do provide extra benefits, often have no cost sharing on services and may offer items like rides to the clinic, meals and other social type services.  Medicare Advantage has grown rapidly and if it hasn’t become bigger than the fee-for-service arm, it will within the next year or so.  At some point we need to ask why everyone doesn’t just go into an MA plan and we could dismantle most of the worthless Medicare administrative bureaucracy.

There has always been controversy in the Medicare risk programs about whether the private plans cherrypick beneficiaries and whether they actually cost more.  Most of that is griping by single-payer advocates who want to believe that the pathetic fee-for-service program is the model for sticking it all Americans in regard to their health and health care.  I think the plans are good at playing coding games that boost their payments, but that is a different issue than whether they manage a beneficiary’s care more effectively.  The research is tricky in terms of matching up enrollees appropriately for these analyses.

This study, which was sponsored by the health plan association, so could be biased, suggests the plan’s definitely provide less expensive care.  This is consistent with most of the research and there is little question in the research that the plans provide better quality care, mostly because the Medicare fee-for-service arm pays little attention to actual quality.  The study points out clear flaws in how CMS came up with its claim that the MA plans aren’t creating savings, including the obvious error in not treating FFS beneficiaries as though they had the same out-of-pocket maximum that MA plans are required to implement.  And there are issues with how CMS compares similar beneficiaries.  The net is that in fact, CMS does not spend more for the same beneficiary in MA, but then CMS knows that; it is just full of single-payer ideologues.   (AHIP Study)

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