By Tom Murphy

Associated Press

Regulators clamped down last fall on shady sales practices for privately run Medicare health insurance for the elderly.

But customers and advocate groups say the plans’ confusing nature still leaves room for pitches bordering on the deceptive, and abuses still crop up.

Medicare Advantage plans are privately run versions of the government’s Medicare program, which provides health coverage for the elderly and disabled. The government subsidizes these plans, and the industry has developed what can be a mind-numbing array of them.

Seniors report being pressured with unsolicited phone calls or home visits that are clearly prohibited. Some have signed up for plans that didn’t include their longtime doctors or hit them with unexpected costs, things they learn weeks later.

CMS learns every year about areas that need more vigilance, said Timothy Hill, deputy director for the Center for Drug and Health Plan Choice.

http://abcnews.go.com/Business/wireStory?id=8446040

And…

Some question private Medicare plans’ advantage

By Matt Sedensky

Associated Press

Seniors have flocked by the millions to Medicare Advantage, privately run plans offered as an alternative to traditional, government-run Medicare.

In the debate on overhauling the U.S. health care system, Advantage has been criticized as an example of a broken system that costs too much, confuses enrollees and suffers from a lack of oversight.

But even many backers acknowledge one of its toughest problems is few seniors understand the essential difference in private plans: Even services covered by traditional Medicare that doctors deem medically necessary routinely need the insurers’ advance approval and are sometimes denied.

Participants have been denied visits to specialists, rehabilitation to help them walk again and countless other services they’d be entitled to under traditional Medicare.

“Every decision is based on not what’s right for the patient, but what’s right for the bottom line,” said Dr. Michael Sedrish, who coordinates HMO payments for Medisys Health Network, which runs three New York City hospitals.

With basic Medicare, seniors generally know what sort of coverage they’re getting. That’s not the case with the roughly 7,000 Medicare Advantage plans, where one person’s coverage could be completely different from a next door neighbor’s.

A 2008 Government Accountability Office report found wide differences in enrollee costs depending on the plan, including home health service costs that could be up to 84 percent more than traditional Medicare.

“The plans tell them they have the same coverage,” said Delores Bowman, who handles calls to the Medicare Rights Center, “and they don’t.”

http://www.washingtonpost.com/wp-dyn/content/article/2009/08/29/AR2009082900957.html

Comment:

By Don McCanne, MD

What’s beautiful about the Medicare Advantage program is that it has provided us with a real-life laboratory experiment which allows us to compare the functioning of highly-regulated private insurance plans as contrasted with the functioning of a public insurance program: traditional Medicare. The results are in, though that would be tough to ascertain if you simply observe the response of Congress.

What have we learned? The private plans take away the choice of health care providers that the traditional public program offers. The private plans insert intrusive interventions between the patient and the physician – interventions that are not found in the public plans. Private plans divert more resources to excessive, wasteful administrative services while increasing the administrative burden on the health care providers and on the public stewards who must provide oversight of our tax dollars that are diverted to this industry. Private plans also provide more entry points for the criminal element to cheat the taxpayers, patients, and providers. And for this we are paying far more of our tax dollars than we do in the traditional Medicare program for comparable levels of care. The obvious lesson is that we should dump the private plans.

What has Congress learned? They have decided that we should provide more subsidies to the private plans so that they can expand their markets!? And they have apparently decided that we will not even have a genuine public plan because it would provide unfair competition to the private plans because of Medicare’s greater efficiency and lower costs!?

It is true that a fragmented, multi-payer system is much more expensive and much less equitable, leaving too many exposed to suffering and financial hardship. But our Medicare Advantage experiment has demonstrated that it is the private plans that must be jettisoned, and it is Medicare that must be granted to everyone after modest, appropriate reengineering so that it works even better than it does now.

We need to send this urgent message to Congress and the administration, immediately:

IT’S THE INSURANCE COMPANIES, STUPID!