I’ve been talking through this loudspeaker I found in my crib 80+ years ago, and just now noticed it’s not plugged in!
Blogging unplugs my gutters. If I get too backlogged I’m afraid I’ll get a nosebleed.
So–what should my criteria be for something worth a blog? Today I deleted several topics, due to their relative triviality, when so many more grievous situations are unfolding worldwide. Ergo, my tendency to include more than one issue per blog.
MEDICARE ADVANTAGE — I never fell for this because I got so much advertising in the mail that I doubted they could be looking out for me rather than themselves. Seems like I may have been right: “The Medicare Advantage scam in 2003 was a way of routing hundreds of billions of taxpayer dollars into the pockets of for-profit insurance companies. Those companies, and their executives, then recycled some of that profit back into politicians’ pockets via the Citizens United legalized bribery loophole created by five…Republicans on the Supreme Court.” I just learned what caveat emptor means, and it fits. See more on Alter Net October 9.
HOMELESSNESS in Finland has been all but eliminated by simply providing housing to those who need it, with no conditions. Finland’s strategy is “Housing First,” then help them grapple with their other problems. Old shelters and hostels have been turned into flats that the previously homeless can call their own…having a large stock of state-owned housing helps). It turns out to cost less to provide housing than to deal with the consequences of homelessness.” CLEVER: In the same Economist article (11/26/22, p. 45): In Britain a court can demand that when suspicious types buy yachts or penthouses in Knightsbridge, they must reveal where the money came from.
UNDERLYING MORAL CODE? Essay from Francis Fukuyama’s Liberalism and Its Discontents via Harper’s May 3022: “At the heart of the liberal project lies the assumption that if you strip away the customs and accumulated cultural baggage that each of us carries, you’ll find an underlying moral core that we all share and can recognize in one another. It is this mutual recognition that makes democratic deliberation. But…” Social scientists and economists fell prey, he writes, to the attractions of power and money. “Deregulation, privatization, and a strict defense of property rights were pushed by wealthy corporations and individuals , who created think tanks and hired big name economists to write academic papers justifying policies that were in their private interests. Moreover, according to Fukuyama, the language of modern science was used to mask the exercise of power: “The definitions of mental illness. the use of incarceration to punish certain behaviors, and the medical categorization of sexual deviancy were not based on neutral empirical observation of reality, but rather they concealed the operation of broader power structures that subordinated and controlled different classes of people.”
WHAT DO YOU THINK? At least I respect honesty, despise manipulation, and try not to harm others. Sound like a goody two shoes? No, since honesty is often far from comfortable.
Just the overcharges happening right now in that scam are costing Americans over $140 billion a year: more than the entire budget for the Medicare Part B or Part D programs. These ripoffs — that our federal government seems to have no interest in stopping — are draining the Medicare trust fund while ensnaring gullible seniors in private insurance programs where they’re often denied life-saving care.
Real Medicare pays bills when they’re presented. Medicare Advantage insurance companies, on the other hand, get a fixed dollar amount every year for each of the people enrolled in their programs, regardless of how much they spent on each customer.
As a result, Medicare Advantage programs make the greatest profits for their CEOs and shareholders when they actively refuse to pay for care, something that happens frequently. It’s a safe bet that nearly 100 percent of the people who sign up for Advantage programs don’t know this and don’t have any idea how badly screwed they could be if they get seriously ill.
Not only that, when people do figure out they’ve been duped and try to get back on real Medicare, the same insurance companies often punish them by refusing to write Medigap plans (that fill in the 20% hole in real Medicare). They can’t do that when you first sign up when you turn 65, but if you “leave” real Medicare for privatized Medicare Advantage, it can be damn hard to get back on it.
The doctors’ group Physicians for a National Health Program (PNHP) just published a shocking report on the extent of the Medicare Advantage ripoffs — both to individual customers and to Medicare itself — that every American should know about.
The report, titled Our Payments, Their Profits, opens with this shocking exposé:
“By our estimate, and based on 2022 spending, Medicare Advantage overcharges taxpayers by a minimum of 22% or $88 billion per year, and potentially by up to 35% or $140 billion. By comparison, Part B premiums in 2022 totaled approximately $131 billion, and overall federal spending on Part D drug benefits cost approximately $126 billion. Either of these — or other crucial aspects of Medicare and Medicaid — could be funded entirely by eliminating overcharges in the Medicare Advantage program.
“Medicare Advantage, also known as MA or Medicare Part C, is a privately administered insurance program that uses a capitated payment structure, as opposed to the fee-for-service (FFS) structure of Traditional Medicare or TM. Instead of paying directly for the health care of beneficiaries, the federal government gives a lump sum of money to a third party (generally a commercial insurer) to ‘manage’ patient care.”
With real Medicare and a Medigap plan, you talk with your physician or hospital and decide on your treatment, they bill Medicare, and you never see or hear about the bill. There is nobody between you and your physician or hospital and Medicare only goes after the payment they’ve made if they sniff out a fraud.
With Medicare Advantage, on the other hand, your insurance company gets a lump-sum payment from Medicare every year and keeps the difference between what they get and what they pay out. They then insert themselves between you and your doctor or hospital to avoid paying for whatever they can.
Whatever you decide on regarding treatment, many Advantage insurance companies will regularly second-guess and do everything they can to intimidate you into paying yourself out-of-pocket. Often, they simply refuse payment and wait for you to file a complaint against them; for people seriously ill the cumbersome “appeals” process is often more than they can handle.
As a result, hospitals and doctor groups across the nation are beginning to refuse to take Medicare Advantage patients. California-based Scripps Health, for example, cares for around 30,000 people on Medicare Advantage and recently notified all of them that Scripps will no longer offer medical services to them unless they pay out-of-pocket or revert back to real Medicare.
NANMYKEL.COM 