Tag: Medicare

New York City Retirees Fight Their Own Unions to Stop Catastrophic Health Care Cuts / by Jenny Brown

Union retirees protested the mayor’s and the the Municipal Labor Committee’s effort to change a city law protecting their health care benefits in January. The law is unchanged but on Thursday the MLC voted to shunt up to 250,000 city retirees into a for-profit Medicare Advantage plan anyway. Photo: CROC.

Originally published in Labor Notes, on March 10, 2023

Defying two years of protests and lawsuits by union retirees, New York City’s Municipal Labor Committee voted March 9 to scrap some of the best retiree health care coverage in the country. The change would put 250,000 city retirees into a for-profit Medicare Advantage plan run by Aetna.

Twenty-six unions in the MLC voted no, while others abstained. But their votes were swamped by the votes of the largest unions on the committee, AFSCME District Council 37 and the New York United Federation of Teachers.

Retirees and active members protested during the MLC vote and marched to City Hall. They are asking the city council to strengthen the law protecting retiree health care. The NYC Organization of Public Service Retirees promises to sue.

The New York City fight has wider implications as for-profit Medicare Advantage insurance companies come under fire for second-guessing doctors, blocking patient care, and ripping off the public while they reel in record profits.

What is Medicare Advantage?

In traditional Medicare, available when you turn 65, you present your card, get care, and the government pays for it.

With Medicare Advantage, a for-profit insurance company gets money from the government to cover you. But they get to take a fat cut—Medicare Advantage is now the most lucrative sector of an already-lucrative health insurance industry. And they get to say what care you can get.

Medicare Advantage plans negotiated by employers and unions do provide worse coverage than traditional Medicare. But they are generally better than the individual Medicare Advantage plans that seniors may sign up for themselves and which are advertised on late-night TV.

INDIVIDUAL VS. NEGOTIATED

Medicare Advantage plans that individuals buy on the private insurance market may work out to have cheaper premiums than traditional Medicare because they wrap in a drug benefit and may cap out-of-pocket expenses. But they are notorious for denying expensive care, imposing narrow networks of doctors and hospitals, and ripping off the government.

On the other hand, union-negotiated Medicare Advantage plans are the result of insurance companies having to negotiate with unions and employers to sign up large groups of retirees, and that may restrain the most egregious abuses. Still, some retirees in negotiated plans report that they were denied care at the most difficult time in their lives.

In both cases, the for-profit insurance companies that run the plans have a strong incentive to deny care. Every dollar they don’t pay for your care is a dollar earned by shareholders and CEOs, who often take most of their compensation in stock. Stock prices are based on how little care the company can pay for.

MEDIGAP VS. MEDICARE ADVANTAGE

Traditional Medicare (part A & B) costs $164.90 a month, and covers hospital costs and 80 percent of non-hospital costs. But medical costs are such that the 20 percent gap in coverage can quickly become ruinous. So the government set up a regulated market of Medigap supplements. Retirees can pay additional premiums to private insurance companies to cover the final 20 percent, and cap out-of-pocket costs.

Medigap plans can cost as little as $75 a month, but can cost hundreds more, depending on the plan, your age, gender, and whether you smoke. Unlike Medicare Advantage, however, these Medigap plans are heavily regulated.

It is this gap for which New York City union retirees over age 65 are covered by the city’s Senior Care plan. The city also pays the monthly premiums for traditional Medicare, so retirees get premium-free coverage.

NUMBERS DON’T ADD UP

States and municipalities have increasingly tried to put retirees into Medicare Advantage plans once they reach age 65. Where unions have fought the change, as in Washington state and Vermont, they have been able to prevent the switch. But in New York City, retirees have been fighting not just the city but also their own unions to keep from being shunted into a for-profit plan.

Public employees in New York City have given up a lot over the years to keep their ironclad retiree health care coverage, and it paid off until now. Along with paying traditional Medicare premiums, the city pays for a wrap-around supplement called Senior Care that picks up nearly all costs not covered by Medicare, along with drug benefits.

Leaders of District Council 37 and the UFT claim the Medicare Advantage plan will save money and provide the same coverage. But the numbers don’t add up, said Len Rodberg, a retired City University of New York health policy expert who will be affected by the change. “Medicare Advantage starts out 20 percent below what Medicare does, in terms of actual money available to spend on health care,” Rodberg said.

Traditional Medicare pays 3 percent overhead. By contrast, Medicare Advantage plans have to make a profit for shareholders, and they also pay huge executive salaries and maintain enormous staffs to protect their profit margins by delaying and denying care. In these for-profit plans, Rodberg said, “basically anything that costs money would need pre-approval.”

MLC leaders said their consultants told them the difference would be picked up by the federal government, Rodberg said. But while the federal government used to subsidize for-profit Medicare Advantage plans 20 percent over what they paid out for traditional Medicare patients, that subsidy is now down to 2 percent.

Medicare Advantage plans also cut costs by contracting with certain providers. This means the insurance company will only pay for care provided by certain doctors or hospitals. For retirees who move to states with spotty coverage, Rodberg said, “suddenly their Medicare card won’t work, cause they’re in Medicare Advantage, not Medicare.”

QUICK REACTION

Retired teacher Gloria Brandman heard about the change in 2021 from friends in PSC-CUNY, the union of faculty and staff at the City University of New York. She and other teacher retirees swung into action, holding a webinar that drew 400 people. The recording of the webinar circulated widely, leading to a whirlwind of protest which forced UFT’s president, Michael Mulgrew, to hold a town hall where he tried to sell the change.

Retirees from the teachers, AFSCME, and several uniformed service unions formed a Cross-Union Retirees Organizing Committee to fight. Brandman and other CROC activists hounded newly elected Mayor Eric Adams at every opportunity.

They rallied when the MLC met: “We marched on the hottest day of the year,” Brandman recalled. They held a Valentine’s Day “Don’t Break Our Hearts, Mayor Adams” event.

In October they held a “Halloween Horror” press conference, saying “Mayor Adams, You’re Scaring Us to Death.” (“Death masks optional,” said the invitation flier).

NO MAGIC SAVINGS

A city law requires that all the health care options the city provides be premium-free. That law turned out to be an important backstop, and the NYC Organization of Public Service Retirees sued to get it enforced. A judge agreed that it was against the law for the city to charge seniors an extra $191 per month to stay in original Medicare.

So Adams and the MLC leadership asked the City Council to change the law. They walked into a buzz saw. After vigorous protests and reams of testimony from retirees and active union members objecting to the change—which could have undermined active members’ health care as well—the City Council declined to alter the law.

In her testimony before the council, Jen Gaboury, PSC chapter chair at Hunter College said, “We know these ‘savings’ don’t come from some brand of private business magic. If you get this money, you’ll be denying care and/or delaying treatment to your own people, older city workers.”

CONTRACTS HELD HOSTAGE

Part of the problem is that the unions created a $600 million hole in the last round of contracts and they’re trying to plug it now. They negotiated to use a health care stabilization fund, designed to equalize costs between health plans for active members, to bolster wage increases. Now the fund is broke and that threatens to raise health care costs for active members.

At the City Council hearings, PSC-CUNY proposed a way out of this mess. Retired professor James Perlstein described it in his testimony: “(a) Redirect funds the City holds in reserve to bridge the Municipal Labor Committee Stabilization Fund for three years, (b) Create a stakeholders commission charged with finding a path to control health care spending, with hospital pricing as a priority, and (c) Develop a sustainable mechanism for funding City health insurance.” PSC also suggested that New York City’s very profitable non-profit hospitals contribute, since they don’t pay taxes.

None of these steps have been taken, so far. Instead, city administrators continue to push Medicare Advantage. “The city’s taken a hardball position that it won’t negotiate new contracts until the unions save them $600 million by moving forward with Medicare Advantage plan,” said Rodberg in February. The city promises to replenish the stabilization fund with the estimated $600 million it will save from the switch.

AFSCME DC 37 members have been working for 18 months without a contract. Recently the city and the union inked a tentative agreement with raises that don’t even keep up with inflation. Other city unions object that this low bar will harm their negotiations, since the city expects the first agreement settled by a major city union to set a pattern which the other municipal unions will largely follow.

And while members will get to vote on the agreement, they won’t be able to vote on the retiree health care concession their union agreed to behind closed doors. It seems that as a condition for settling, the dominant MLC unions agreed to impose what the retirees call “the nuclear option,” deliberately misreading the city law they tried to change, and making Medicare Advantage the only option for retirees.

Any retiree who wants to stay in traditional Medicare would have to pay for all of their coverage, as if they had no union at all.

Head shot of writer

Jenny Brown is an assistant editor at Labor Notes.

Let Them Die! / by Greg Godels

Why the US has lower life expectancy than other countries | MDLinx

In the spirit of Jonathan Swift’s satirical world (A Modest Proposal), we might facetiously attribute the recent decline in US life expectancy to a concerted effort to strengthen the social safety net.

Politicians have been maintaining for decades that it would be necessary to reduce social security, Medicare, and Medicaid benefits to keep the systems solvent. Leaders of both political parties have urged cutting benefits, changing eligibility requirements, or raising the already-high age thresholds to preserve the reserves for future recipients. Alarmists have persisted for decades, and seniors and the poor have passionately and successfully resisted cuts and changes. 

But now comes a new way of stretching the available funds for the poor and elderly: Enable and encourage them to die earlier! 

From 2019 to 2021, a calloused response to a pandemic emergency, shamefully inadequate mental health support, a poor outcome, profit-driven healthcare system, unprecedented inequality, and a ruthlessly self-centered, individualistic civil society knocked off nearly two-and-a-half years from the expected lifespan from birth. In the US, a person born in 2019 would be expected to live to be 78.8, while the same person born in 2021 would be expected to die at 76.4, according to the Centers for Disease Control and Prevention (CDC). What a clever way to lessen the burden on the social safety net! No doubt, hundreds of billions of dollars will be saved! And undoubtedly, our representatives will give the savings to the military.

My guess is that many free-marketeers and debt-hawks wish that they had come up with this solution even earlier. It is far less politically volatile than raising the eligibility thresholds.

Of course, shortening life expectancy by two-and-a-half years cheats millions of the money that they have invested in social insurance. The hundreds of billions “saved” corresponds to the hundreds of billions invested in a secure future. Responsible government has stolen those benefits from those denied the same life chances that other advanced economies ensured their people over the same period.

Certainly, money is nothing compared to the prospect of premature death. The CDC estimates that the 5% drop in life expectancy between 2020 and 2021 alone accounts for 1.2 million “excess” deaths, the largest percentage drop in life expectancy since World War II. 

While the CDC has not yet offered a further analysis of life expectancy by race and ethnicity, The Wall Street Journal reveals a recent study that shows Native Americans suffering the largest drop (1.9 years) in 2021. The eight million or so US citizens who identify as Native American have lost 6.6 years of their expected lives since 2019, now living 65.2 years from birth. 

Thanks to US age eligibility, that means that Native Americans will pay into Medicare while never receiving any significant return in benefits! Further, they will only receive, at best, a token return in Social Security benefits for a lifetime of contributions! 

Similarly, an African-American worker should expect to receive approximately six years’ less of benefits than his or her white counterpart, given the disparity in life expectancy. 

Thus, many white retirees are “free riding” on the benefits earned by early deceased minorities, a stark rebuke to the racist depiction of minorities as welfare grifters.

In a society where losing one million, one hundred thousand victims to a viral infection is taken in stride, it may be more impactful to express human losses in dollars and cents.

In a society that places the health of its people in the hands of private profiteers and distributes life-giving drugs based on the ability to pay, it should be no surprise that life expectancy is declining.

In a society where citizens are expected to bear accidents, misfortune, and poor life choices alone and with no social scaffolding, death is a predictable outcome.

In a society where life-prospects are locked into an ordering based upon income and wealth, it should be no surprise that the poor and less fortunate are most likely to die prematurely.

If the US is the bellwether of capitalism and its trajectory, then the world must come to live without capitalism. 

Greg Godels grew up in a working-class family in a rural coalmining community in the United States. He joined the Communist Party in 1975 and wrote frequently for the Daily World and other Communist Party papers as well as Political Affairs and Nature, Society and Thought. Articles by him have also appeared in numerous publications, including Communist Review (London), People’s Voice (Vancouver) and Socialist Voice (Dublin). He was joint founder of the website Marxism-Leninism Today and writes a highly regarded blog under the pen name Zoltan Zigedy

ZZ’s blog, January 7, 2022, https://zzs-blg.blogspot.com/

Architects of Medicare Privatization: Congress, Biden and the CMS / by Sandra M. Fox

Photograph Source: Molly Adams – CC BY 2.0

Originally published in Counterpunch, December 30, 2021

It is easy and appropriate to target the private health insurance companies who earn excessive profits from the Medicare Trust Fund through Medicare Advantage plans, especially given the well-documented evidence of overcharging and fraud.

But it is essential that we remember that it has been the U.S. Congress and the Executive Office that promoted the privatization of Medicare, to varying degrees, since it was first signed into law by President Johnson in 1965 and enacted the following year.

In 2017 The Commonwealth Fund published “The Evolution of Private Plans in Medicare,” which detailed the increasing role in healthcare granted to private companies since 1966 through Acts of Congress and the Office of the President.   Privatization was boosted significantly by the Medicare Modernization Act of 2003, which–in addition to providing private drug coverage (with non-negotiable prices) through Medicare Part D–provided an alternative payment structure to private health insurers as a way to incentivize and increase their participation in the Medicare program.  And it worked; more health insurance companies decided to enter the Medicare “market” and labeled their plans “Medicare Advantage.”  Almost 50% of Medicare beneficiaries are now enrolled in private plans, compared to those in traditional Medicare.

There are many reasons why seniors and those with disabilities continue to enroll in traditional Medicare.  Traditional Medicare does not have restrictive provider networks and individuals can seek care from any provider in the country who takes Medicare.  Further, prior authorizations are not required, as they are in Medicare Advantage plans.  Delay and denial of care are hallmarks of Medicare Advantage plans–not traditional Medicare–as a way of increasing the profit margin of private companies.  However, delay and denial of treatment also mean worse health outcomes and an increase in premature death.   The Mayo Clinic has stopped accepting patients with Medicare Advantage plans and is encouraging patients to enroll in traditional Medicare instead.

Traditional Medicare has no profit; its administrative overhead is less than 2%, compared to 15% overhead and profit for Medicare Advantage plans.  As a result, traditional Medicare is less costly, while payments to Medicare Advantage plans are draining the Medicare Trust Fund, a fund workers pay into, as they do for Social Security.

Advocates for a national single-payer healthcare system in this country, often referred to as Improved Medicare for All, acknowledge the weaknesses in the current version of traditional Medicare.  While the federal government has allowed for perks to beneficiaries in Medicare Advantage plans, including free gym memberships and some (limited) dental and vision care, these benefits are not available to those choosing traditional Medicare.  Why not?  They are a clever way for private companies to increase enrollment in their plans, in addition to lowering their premiums, made possible through excessive payments received from the Medicare Trust Fund to private insurers.  So far, Congress has not expanded those benefits to beneficiaries in traditional Medicare, thus favoring for-profit companies.

The money is there to improve traditional Medicare and expand it to cover all residents of the United States, as substantiated by the Congressional Budget Office.  But many elected officials on both sides of the aisle will say otherwise and are compensated by private health insurers with handsome campaign contributions.

Meanwhile, the Center for Medicare and Medicaid Innovation (CMMI), under the Center for Medicare and Medicaid Services (CMS) within the Department of Health and Human Services (HHS), was established as part of the 2010 Affordable Care Act (ACA).  According to its website,

“the CMS Innovation Center, through its models, initiatives and Congressionally-mandated demonstrations, has accelerated the shift from a health care system that pays for volume to one that pays for value.”

The ACA also allowed CMMI to make changes without Congressional oversight.  And CMMI is determined to reframe privatization as value-based care.

CMMI has been quietly contracting with for-profit companies to engage in “pilot programs” that insert middlemen into traditional Medicare without the beneficiary’s consent and often without their knowledge.  The Trump Administration, which launched the program, contracted with 53 for-profit middlemen called Direct Contracting Entities (DCEs).  The Biden Administration re-branded the program ACO-REACH (Accountable Care Organizations Realizing Equity, Access, and Community Health) and increased the number of corporate participants to 99.

These participants include private health insurance companies as well as private equity/venture capital firms, which can keep up to 40% of Medicare dollars in administrative costs and profits by “managing” patients’ healthcare.  The supposed goal is to lower costs through “value-based care.”  We already know that lowering costs in Medicare Advantage means delaying and denying care by requiring prior authorizations, as well as restricting provider networks.  Furthermore, an excellent analysis by healthcare policy experts Kip Sullivan, J.D. and James G. Khan, M.D., refutes the premise of CMS that Accountable Care Organizations will save money, given evidence of past performance.

The intended goal is the complete privatization of Medicare by 2030, as posted on the CMS website:  “All Medicare fee-for-service beneficiaries will be in a care relationship with accountability for quality and total cost of care by 2030.”  Starting January 2023, the number of ACO-REACH programs managing the care of traditional Medicare beneficiaries is slated to increase dramatically, from 99 to over 200.

The appointment of Elizabeth Fowler, Director of CMMI, whose past work in the private healthcare sector as Vice President for Global Health Policy at Johnson & Johnson and as Vice President of insurer Wellpoint (now Anthem), not only poses a huge conflict of interest.  It reflects the intention of many within the federal government to privatize healthcare.  During the Obama administration, Fowler assisted in the development and implementation of the ACA, which created the CMMI, the office she now directs.

Since Congress does not have oversight of CMMI, it will take an Executive Action by the President to eliminate the ACO-REACH program.  President Biden could do this with a stroke of his pen.

Healthcare advocates must recognize that the instruments of privatization are in the government’s hands and that CMMI, CMS, the Secretary of Health and Human Services, Members of Congress, and the President of the United States have been complicit for years in the privatization of a beloved public program, Medicare, and must all be held accountable.

What constitutes government accountability in healthcare?

There are those in Congress, as well as some healthcare advocates, who ascribe to a “bad actors” paradigm; i.e., if we can issue new rules, fine, and/or weed out the private companies that engage in Medicare fraud we will be doing our job in protecting the public.  Diane Archer, a long-time healthcare advocate and President of Just Care, writes on 12/21/22 that the current fines are grossly insufficient to de-incentivize corporations from committing fraud.  And she is right.

However, as Archer concedes in a March 2022 interview, private corporations in healthcare are following their profit-driven mission to maximize profits and satisfy their shareholders, not the public, and that an improved system of Medicare for All is the solution.

Don McCanne, M.D., another long-time healthcare advocate, writing for Health Justice Monitor on 12/22/22, comments that CMS’s new proposed regulations for Medicare Advantage programs are “camouflage for perpetuating” a “wealth-creating business model” and calls for the end of privatization in Medicare and Improved Medicare for All.

The majority of Americans favor a “single government program to provide healthcare coverage.”

Even in a county that voted overwhelmingly for former President Trump–rural Dunn County, Wisconsin–a referendum asking “Shall Congress and the President of the United States enact into law the creation of a publicly financed, non-profit, national health insurance program that would fully cover medical care costs for all Americans?” passed.

Whether it’s tax incentives for polluters, with EPA issuing fines for environmental degradation and health risks, or the federal government designing a system for the privatization of Medicare and CMS issuing fines to the profiteers, we need to reckon with our government’s history of working hand in glove with corporate interests, often at odds with the best interests of the people and the planet, and not compromise our own expectations and the demands we make of elected officials.  As McCanne wrote, the proposed regulations are indeed a means of perpetuating the status quo.  We need to get the middlemen out of healthcare, improve traditional Medicare, and expand it to cover everyone.

Sandra M. Fox, LCSW, is a psychiatric social worker who has worked in healthcare in southern West Virginia and Pittsburgh, Pennsylvania for over 40 years, was a co-founder of the Western PA Coalition for Single Payer Healthcare and is on the steering committee of National Single Payer.

    Republicans Will Never Stop Trying to Destroy Social Security / by Ben Beckett

    House Minority Leader Kevin McCarthy (R-CA) speaks during a news conference with House Republicans outside the US Capitol on March 11, 2021. (Drew Angerer / Getty Images)

    GOP leaders are threatening to cut Social Security and Medicare if they take back the House this fall. Elected Democrats won’t have the will or power to stop them unless ordinary Americans are willing to put up a real fight.

    If Republicans take back the House this fall, they want to cut Social Security and Medicare. And according to Minority Leader Kevin McCarthy in an interview last week, they’re prepared to shut down the basic functions of government by holding the national debt ceiling hostage in order to do it.

    That would be catastrophic for everyone who will rely on either program at some point in their lives — which is to say virtually the entire country. Given the two programs’ immense popularity, successfully undermining them would also be a blow to the very idea of public programs as ensurers of human welfare and dignity.

    Social Security remains immensely popular. Eighty two percent of respondents were in favor of expanding benefits in a June 2022  poll, and less than a quarter were in favor of privatizing even part of the program. Similarly, significant majorities of voters support expanding Medicare to cover more forms of care as well as more people.

    That might explain why McCarthy’s only option to cut the programs amounts to blackmailing the nation. Refusing to raise the debt limit, as Republicans have repeatedly done in the past, forces most parts of the government to shut down entirely. That creates difficult situations for millions of people, especially when the shutdowns last for an extended period. But because Republicans’ long-term strategy is based on degrading the government’s ability to carry out most of its functions, they generally feel they have little to lose from shutting it down.

    “[I]f people want to make a debt ceiling [for a longer period of time], just like anything else, there comes a point in time where, okay, we’ll provide you more money, but you got to change your current behavior,” McCarthy said, later refusing to rule out cuts to either program when asked.

    Other House Republicans are gunning for a fight even more strongly. “You have two simple leverage points: when government funding comes up and when the debt ceiling is debated,” Texas Republican Chip Roy said.

    So far, to their credit, Democrats are not taking the bait. “I will not cut Social Security. I will not cut Medicare, no matter how hard they work at it,” President Joe Biden said last week. House Democrats have also seized on the issue in the final weeks of campaigning, promising to protect the programs against McCarthy’s and the GOP’s threats.

    But it would be a mistake to get too comfortable. At the same event, Biden also ruled out the idea of eliminating the annual debt ceiling altogether, which would remove Republicans’ leverage to cut the programs. That idea is supported by Biden’s treasury secretary Janet Yellen, among others.

    Perhaps more significant is Biden’s long history of proposing freezes, cuts, and privatization to Social Security and Medicare. As Branko Marcetic has reported, Biden has been an active advocate for cutting the programs since the 1980s, often allying with Republicans and opposing the majority of his Democratic colleagues to try to do so.

    Biden campaigned on raising the retirement age when he ran for president in 2008, while also saying he would “absolutely” consider cutting the programs. Notably, he did not campaign on cuts to the programs in 2020, changing his tune as Bernie Sanders attacked his record on the issue.

    On multiple occasions, Biden outraged Democratic colleagues during his term as vice president when, during negotiations with Republicans, he proposed cuts to Social Security, Medicare, and other programs seemingly on his own initiative. As Marcetic put it, this behavior caused congressional Democrats at the time to “believe Biden had gone over to the [Republican] Cantor-Kyl side.”

    Nor is there much reason, beyond that one quote from last week, to believe that Biden has really transformed in recent years. Biden has continued a Donald Trump program that many experts say is designed to lay the groundwork to privatize Medicare. In May, Biden nominated a longtime proponent of privatizing Social Security to the program’s advisory board.

    Of course, no one who proposes cuts to the programs will call them that. They will be couched in phrases like “reform” and “strengthening.” The programs’ supposed insolvency will be presented as a given, with “reforms” the only “responsible” way to ensure their continued existence.

    Facing immense pressure to get things done in a divided Congress, a notoriously difficult group of conservative Democratic senators, and a House GOP willing to crash the economy and close the government to get what it wants, how strongly would Biden really stand against cutting programs he’s said he wants to cut for forty years? The answer depends on the actions of ordinary Americans. If we want to protect Medicare and Social Security, we’ll have to prepare to mount a popular movement against the GOP’s plans.

    Ben Beckett is an American writer in Vienna.

    Jacobin, October 26, 2022, https://jacobin.com/

    Opinion: How to Stop the GOP From Killing Medicare, Social Security, and Us / by Thom Hartmann

    Sen. Ron Johnson (R-Wis.), Senate Minority Leader Mitch McConnell (R-Ky.), and Sen. Rick Scott (R-Fla.) in the Visitors Center Auditorium at the U.S. Capitol on July 20, 2022 in Washington, DC. (Photo: Jabin Botsford – Pool/Getty Images)

    The Republican Party is quite literally taking aim at the lives of low-income and working-class people of this country.

    It’s The Ronald Reagan Memorial Competition: which Republican can make the rich richer and the poor poorer the fastest?

    This week, Republican Senator Ron Johnson of Wisconsin wants to one-up Republican Senator Rick Scott of Florida in this perpetual GOP contest over who can most effectively screw working people.

    Johnson wants Congress to vote every year whether or not to continue funding both Social Security and Medicare, while Scott says it should only be every five years.

    On top of that, in a true tribute to Saint Ronny, they’re competing for how to most aggressively raise income taxes on working-class people, and how quickly.

    (You may remember Rick Scott as the guy who ran the company convicted of the largest Medicare fraud in the history of America, who then took his money and ran for Governor of Florida, where he prevented the state from expanding Medicaid for low-income Floridians.)

    Scott is the second-richest guy in the Senate and, true to form, he’s now echoing the sentiments of the richest guy in the Senate, Mitt Romney.

    “There are 47 percent who are with him,” Romney said of Obama voters back in 2012, “who are dependent upon government, who believe that they are victims, who believe the government has a responsibility to care for them, who believe that they are entitled to health care, to food, to housing, to you name it. These are people who pay no income tax.”

    Most low-income working people in America actually pay a higher percentage of their income as taxes than do many billionaires and multi-multi-millionaires. 

    Working people pay Social Security taxes, Medicare taxes, property taxes, sales taxes, and other taxes in the form of fees for everything from a driver’s license to road tolls to annual car inspections.

    Billionaires, on the other hand, have bought politicians to write so many loopholes into the tax code that most — like Donald Trump — will go decades without paying a single penny in income taxes.

    But that level of inequality isn’t enough for Senator Scott, who’s committed to out-neoliberaling Ronnie himself. He wants everybody in Romney’s “47 percent,” even people making $7.25 an hour or less, to subsidize billionaires by paying income taxes on their meager wages.

    His logic is nuts. The simple reality is, if you want more Americans to pay income taxes, all you have to do is raise working people’s pay. This isn’t rocket science.

    We saw it work out in a big way between 1933 and 1980, before Reagan’s war on labor, when unions helped wages — and income tax payments — steadily rise for working people. Those rising wages literally built the middle class, which peaked in 1980 and then began its long slide under Reaganomics.

    In the early years of the Reagan administration, before his neoliberal “trickle down” and “supply side” policies started to really bite Americans, only 18 percent of Americans were so poor that their income didn’t qualify to be taxed. 

    As “Right to Work for Less” laws spread across America and Republicans on the Supreme Court made it harder for unions to function, however, more and more working people fell below the tax threshold. When Romney ran for president in 2012, it was 47 percent of working people who had fallen out of the middle class and were then so poor that they lived below the income tax threshold.

    Today, just a decade later (and after the $2 trillion Trump tax cut), it takes two working adults to maintain the same lifestyle that one worker could provide in 1980. That’s why an estimated 61 percent of working Americans this year will make so little money that they’ll struggle to pay the rent and buy food, and their income won’t be subject to taxation.

    But Rick Scott’s solution to this situation isn’t to raise the income of working-class people so they make enough to pay for food, rent, and qualify to pay income taxes. 

    Quite to the contrary, he’s suggesting that low-income people should be hit with their very own special income tax — in addition to the dozens of other taxes they’re already paying — so multimillionaires and billionaires like him and his friends can see their own taxes go down a tiny bit.

    “All Americans should pay some income tax to have skin in the game,” Scott says in his 11-point plan, “even if a small amount. Currently over half of Americans pay no income tax.”

    But for Ron Johnson, even that’s not quite enough of a club to beat working-class Americans over the head, particularly those who are retired and no longer working. He’s targeting the older folks, in fact, for his punishment this week.

    He wants to open the Social Security and Medicare trust funds to an annual vote by Congress by moving those programs from the “mandatory spending” category to the easily changed or deleted “discretionary spending.”  

    “Defense spending has always been discretionary,” Johnson said on a recent radio show. “VA spending is discretionary. What’s mandatory are things like Social Security and Medicare. If you qualify for the entitlement you just get it no matter what the cost.”

    While Scott’s plan would have Congress both impose an income tax on the lowest-wage workers in America and require Congress to vote every 5 years on whether Social Security and Medicare should even continue to exist, Johnson is in more of a hurry and wants to move that vote up to every single year.

    “What we ought to be doing is we ought to turn everything into discretionary spending so that it’s all evaluated so that we can fix problems or fix programs that are broken that are going to be going bankrupt,” Johnson said, echoing a Republican refrain dating back to the 1930s that “any day now” Social Security is going down the drain so we should just hand it over to Wall Street now.

    Democrats should flip the script — essentially, pull a Reagan on the GOP — with a plan of their own, only this one with some real middle-class tax cuts.

    For example, Democrats could propose ending the income taxes on Social Security, unemployment benefits, and income from tips.

    Before Reagan, the first two were totally tax-free and the IRS had never pursued tips until he directed the agency to do so in 1988.

    After all, the money you receive when you retire or become disabled and begin to draw Social Security is money that you already paid in, in large part, throughout your working life.

    Therefore, when Franklin Roosevelt signed the Social Security Act in 1935, the money people got from Social Security was not taxable and not even tracked by the IRS.

    When Congress passed legislation in the 1930s enacting unemployment insurance, they established a trust funded by employees, using money their employers could have paid them in other benefits.

    Most workers never use this fund, but those who do are simply receiving what they already, indirectly, have paid into a system to create a safety net that will catch people so they don’t fall too hard or too far when they lose their jobs.

    Because this money was usually deducted from people’s income before wages were calculated, unemployment benefits were also not taxable and not even reported to the IRS from 1935 until Reagan began taxing them.

    Finally, people who work in jobs where they receive tips rarely have their own accounting system to daily keep track of those tips and report them to the IRS, and, besides that, tips are actually gratuities rather than income and are wildly variable.

    They shouldn’t be subject to income tax. And weren’t from the beginning of the income tax in 1918 until just after the election of 1980.

    Back in 1981, however, Reagan passed the biggest tax cut for billionaires and giant corporations in the then-history of the world, lowering the top rate from around 74% to around 28% and shoveling, in today’s money, over fifty trillion dollars from working class people up to the top 1% in the years since. 

    The result was an explosion in the budget deficit the following year, so Reagan used that excuse to enact the largest tax increase since World War II. Being a Republican, he put it almost entirely on the shoulders of working people, unemployed people, and those receiving Social Security.

    Reagan and his Republicans made Social Security income taxable for the first time in American history. It still is taxed, crippling people trying to live on that meager fare.  

    Tips, Reagan and his GOP buddies figured, were actually part of wages so they changed IRS rules to force employers to count and report tips. As The New York Times reported in 1988:

    “According to the Reagan Administration, which proposed the change, the expanded [tips] tax would raise $200 million this year and $1.6 billion over five years.”

    And people on unemployment, Reagan decided, should also pay income tax on the money they received out of the unemployment trust funds that they, themselves, had paid into throughout their working lives via their employers.

    He also raised taxes substantially on working-class people who still had regular jobs, and ended the ability of working-class people to deduct credit card, car loan, school loan, and most other interest payments from their taxes.

    When Reagan arrived at the White House there was a 0% tax bracket for Americans making under the equivalent, in today’s dollars, of around $8,500 a year. Those folks paid absolutely nothing in income taxes.

    Reagan did away with that altogether, so pretty much everybody making more than $0 and less than $29,750 in today’s money would pay up to a 15% tax rate, and anybody making over $29,750 would be taxed at 28%.

    Finally, instead of indexing Social Security payments to one of the cost of living indexes like CPI-E that reflects the actual costs of older or disabled people, Reagan stuck seniors with a COLA irrelevant to retired people.

    As an added slap in the face, he increased the Social Security tax paid by working people making under $147,000. (The morbidly rich, to this day, don’t pay a penny after the FICA tax on their first $147k in income.)

    To add insult to injury, Reagan also raised the retirement age from 65 to 67, although to avoid political blow-back back in the 1980s he made sure it only applied to people born after 1960. Ironically, it phases into full effect this decade.

    Reagan is gone, but his attacks on working class people roll on. Now they’re being carried on by Rick Scott, Ron Johnson, and all the rest of the multimillionaire Republican senators.

    Let’s take the first step toward rolling back Reagan’s neoliberal legacy by making “income” from Social Security, unemployment benefits, and tips — money that exclusively benefits low-income and working-class people — free of taxation once again!

    Our work is licensed under Creative Commons (CC BY-NC-ND 3.0). Feel free to republish and share widely.

    Thom Hartmann is a talk-show host and the author of “The Hidden History of Monopolies: How Big Business Destroyed the American Dream” (2020); “The Hidden History of the Supreme Court and the Betrayal of America” (2019); and more than 25 other books in print.

    Common Dreams, August 4, 2022, https://www.commondreams.org/

    Sanders Joins Chorus Demanding Rejection of Amazon’s One Medical Purchase / by Kenny Stancil

    Sen. Bernie Sanders (I-Vt.) speaks at a rally in Washington, D.C. on June 24, 2021. (Photo: Saul Loeb/AFP via Getty Images)

    “The function of a rational healthcare system is to provide quality care to all in a cost-effective way, not make billionaires like Jeff Bezos even richer,” said the Vermont senator.

    Sen. Bernie Sanders on Thursday joined the chorus of progressive voices demanding that the U.S. government reject Amazon’s purchase of One Medical, a subscription-based health services provider headquartered in San Francisco.

    “The function of a rational healthcare system is to provide quality care to all in a cost-effective way, not make billionaires like Jeff Bezos even richer,” the Vermont Independent wrote on social media, referring to Amazon’s ultrawealthy founder and executive chairman. “At a time of growing concentration of ownership, the Justice Department must deny Amazon’s acquisition of One Medical.”

    Sanders was echoing anti-monopoly advocates and privacy defenders who have sounded the alarm over Amazon’s “dangerous” $3.9 billion buyout of One Medical—a private equity-backed company that charges its 767,000 members roughly $200 in annual concierge fees to access a network of 188 primary care clinics.

    “Allowing Amazon to control the healthcare data for another 700,000+ individuals is terrifying,” Krista Brown, a senior policy analyst at the American Economic Liberties Project, said Thursday in a statement. “Acquiring One Medical will entrench Amazon’s growing presence in the healthcare industry.”

    The corporate behemoth bought the online pharmacy PillPack in 2018 for $750 million, launched Amazon Pharmacy in 2020, and expanded its Amazon Care telehealth program nationwide earlier this year, among other recent deals.

    “Amazon just set its healthcare efforts to warp speed,” Axios health tech reporter Erin Brodwin tweeted Thursday. “Where among Amazon’s sprawling health efforts does One Medical fit, exactly, and how will it weave the buy into its existing primary care bets?”

    One Medical “already has its tentacles in Medicare” through its 2021 acquisition of Iora Health, Brodwin noted, “and now Amazon’s got a clear foothold there.”

    The Lever reported Friday that Amazon “could use its new platform to advance the cause of Medicare privatization at a much more aggressive pace. The consequences wouldn’t just mean more taxpayer dollars funneled to the mega-corporation, but also Medicare recipients facing a healthcare system with ever more resources being allocated to profit instead of care.”

    As the outlet noted:

    President Joe Biden’s Center for Medicare and Medicaid Services (CMS) has expanded a Medicare privatization scheme launched under former President Donald Trump. That program, which is currently referred to as ACO REACH, involuntarily assigns Medicare patients to private health plans operated by for-profit companies, like One Medical subsidiary Iora Health.

    Medicare provides set payments to provide care for these patients, much like insurance. This arrangement incentivizes Iora and other privatization entities to limit the amount of care that seniors receive.

    Continued expansion of Medicare privatization seems integral to One Medical’s business model.

    The company’s most recent quarterly report shows that more than half of its revenue comes from Medicare. This includes Medicare Advantage plans operated by private health insurers, traditional Medicare fee-for-service payments, and the ACO REACH program.

    Amazon’s purchase of One Medical “will be a blow to the fight for universal healthcare,” journalist Aaron T. Rose tweeted Thursday. “Imagine all the money Amazon will pour into lobbying to stop Medicare for All now that they have a dog in the fight.”

    In addition, Brown warned, the deal—which would mark Amazon’s third-biggest acquisition after Whole Foods ($13.7 billion) and MGM Studios ($8.5 billion)—”will also pose serious risks to patients whose sensitive data will be captured by a firm whose own Chief Information Security Office once described access to customer data as ‘a free for all.'”

    “Amazon has no business being a major player in the healthcare space,” she added, “and regulators should block this $4 billion deal to ensure it does not become one.”

    Sen. Amy Klobuchar (D-Minn.), chair of the Senate Judiciary antitrust subcommittee, has asked the Federal Trade Commission (FTC) to investigate Amazon’s move to buy One Medical.

    “This proposed transaction raises questions about potential anticompetitive effects related to the pharmacy services business Amazon already owns and about preferencing vendors who offer other services through Amazon,” Klobuchar wrote Thursday in a letter to the agency.

    “I also ask that the FTC consider the role of data, including as a potential barrier to entry, given that this proposed deal could result in the accumulation of highly sensitive personal health data in the hands of an already data-intensive company,” she added.

    This story has been updated with information about Sen. Amy Klobuchar’s letter to the FTC.

    Common Dreams, July 22, 2022, https://www.commondreams.org/

    The Stealth Privatization of Medicare Is a Big Boon to Wall Street / by Matthew Cunningham-Cook

    via AFL-CIO

    The Biden administration recently expanded on Donald Trump’s efforts to privatize Medicare. Now patients are being assigned to new private plans without their consent, and private equity firms and major health care companies are the ones profiting.

    The Joe Biden administration’s recent entrenchment and expansion of the Donald Trump administration’s efforts to privatize Medicare is helping a shadowy set of big-business beneficiaries: private equity firms and major health care companies, including one that previously employed the government official overseeing the privatization plan, a new analysis from us shows.

    In April last year, the Biden administration contracted with fifty-three third-party companies to mandate privatized health care plans through Medicare. The resulting health care options are effectively Medicare Advantage plans, or private coverage offered through the national health insurance program for seniors and people with disabilities — but with one wrinkle: Patients are being assigned to these new plans without their consent.

    The fifty-three participating companies — called “direct contracting entities,” or DCEs — are allowed to offer benefits beyond traditional Medicare, like gym membership coverage. But as for-profit businesses that receive a set payment from Medicare no matter how much care they approve, these DCEs are incentivized to limit the care that patients receive, especially when they are very sick. The first DCEs were launched by President Donald Trump in 2019, and so far, at least 350,000 seniors have already been moved onto these privatized Medicare plans.

    Now, a new analysis by us of the fifty-three DCEs found additional cause for concern: fifteen of these entities, or slightly more than a quarter, are backed by private equity firms, which are known for extracting profits at the expense of workers, the environment, and even their own pension fund investors. The firms include big-name firms like the Carlyle Group, General Atlantic, Clayton, Dubilier & Rice, Benchmark Capital, and Warburg Pincus. What’s more, another fifteen DCEs are linked to big health care companies — including one with a direct connection to the Biden appointee in charge of the new privatized Medicare scheme.

    Wall Street’s encroachment into Medicare is the latest example of private equity’s aggressive expansion into health care, which has ranged from hospitals to ER doctor groups. In 2021, private equity managers deployed $172 billion in capital in the health care sector — nearly four times the total budget of the National Institutes of Health.

    Biden himself has lambasted the for-profit industry’s takeover of eldercare services, noting during his State of the Union address in March: “As Wall Street firms take over more nursing homes, quality in those homes has gone down and costs have gone up. That ends on my watch.”

    Biden apparently doesn’t have the same concerns about Wall Street’s growing role in Medicare — a development that could lead to higher medical bills for patients. The financial industry has already demonstrated its willingness to take a forceful approach to generating health care profits; private equity waged an aggressive campaign to derail legislation designed to stop so-called “surprise” medical bills, which formed a significant part of their hospital staffing firms’ bottom line.

    President Joe Biden delivers remarks to Department of Defense personnel at the Pentagon in Washington, DC, on February 10, 2021. (Lisa Ferdinando / US Secretary of Defense via Flickr)

    Now, as private equity muscles into privatized Medicare, industry lobbyists are likely to push for more generous payment structures that benefit for-profit firms at the expense of Medicare patients. The Medicare Payment Advisory Commission, an independent body that advises Congress on Medicare, hinted at this scenario while discussing private equity’s role in the Medicare Advantage space at an April 2021 hearing.

    “The end result might or might not be better for consumers, but I think that it does have an impact on Medicare payment policy,” said commissioner Pat Wang.

    Experts fear that the Medicare space could be especially vulnerable to Wall Street’s predatory approach.

    “We have lots of evidence from many other situations in which private equity puts profits before patients,” said Eileen Appelbaum, codirector of the Center for Economic and Policy Research and coauthor of Private Equity at Work: When Wall Street Manages Main Street. “They are looking for a place where it’s easy to make money — and it’s easy to make money when it’s the taxpayer footing the bill.”

    Big Players, Big Profits, and a Big Conflict

    While the DCE program was launched under President Trump, Biden expanded the effort in February under a new name: the Accountable Care Organization Realizing Equity, Access, and Community Health program, or “ACO REACH.” Now, hospital-backed for-profit health benefit programs are also allowed to automatically enroll Medicare patients into their health care plans.

    Like providers of Medicare Advantage plans, these new firms receive a set payment from Medicare for their offerings, supposedly to incentivize more holistic and better care. In exchange, these firms acquire Medicare patients in their plans — often  without the patients realizing what is happening.

    In March, we reported on how one Medicare beneficiary who was quietly assigned to a DCE initially misinterpreted a message she received about the shift as a health-related communication from her doctor — despite being an experienced health policy expert.

    Along with the fifteen private equity-backed companies, the list of approved DCEs the Biden administration released in April 2021 includes fifteen operations owned by health care giants, such as insurers Humana, UnitedHealth, and Anthem, the pharmacy chain Walgreens, and the dialysis provider DaVita.

    Experts say these connections raise serious questions about conflicts of interest. For example, the DCE program is being led by a little-known federal entity, the Centers for Medicare & Medicaid Services’ (CMS) Innovation Center, headed by Liz Fowler — the former vice president of public policy for the insurer WellPoint, now known as Anthem.

    In response to our request for comment, a CMS spokesperson said that Fowler was not involved in the approval process for DCEs. They additionally asserted that many of the entities identified by us are not private equity–backed because they are public companies.

    But several of these public companies have received substantial investments from private equity firms, also known as “private investment in public equity.” For example, while 1LifeHealthcare — a primary care provider that owns one of the DCEs, One Medical’s Iora Health — is publicly traded, the major private equity firm Carlyle Group owns more than 7 percent of its shares.

    Critics say Fowler has a history of crafting policy to help her private sector contacts.

    “Honestly this just seems to add to the pattern we’ve observed with Liz Fowler,” said Fatou Ndiaye, a research assistant with the Revolving Door Project, which monitors the revolving door between the public and private sector.

    Ndiaye pointed out that before she lobbied for WellPoint, Fowler worked for Senator Max Baucus (D-MT), where she helped draft Medicare Part D, a program critics said was a huge giveaway to the pharmaceutical industry because it created massive new drug benefits without controlling prices.

    After working for Wellpoint from 2006 to 2008, Fowler rejoined Baucus’s staff, where she helped draft a version of the Affordable Care Act (ACA) that excluded the public health insurance option promised by Democrats, resulting in huge profits and no public sector competition for private insurers.

    “A year after [ACA’s] passage, Wellpoint’s profits increased by 91 percent to $2.3 billion,” said Ndiaye.

    Private Equity Muscles In

    The fact that private equity now backs more than a quarter of all companies in the DCE space stands in stark contrast to the fact that private equity owns just 2 percent of all for-profit Medicare Advantage programs.

    While Medicare Advantage options have been criticized by health advocates because of their extremely high costs, the fact that private equity is focusing its attention on this new kind of nonvoluntary privatized Medicare scheme suggests that Fowler and the Biden administration could be setting the stage for substantially larger private equity involvement in the national health insurance program.

    Examples abound of problems arising when private equity takes over health care operations. Just last month, Buzzfeed News reported that BrightSpring, a group home operator acquired by private equity megafirm KKR in 2019, has since been plagued by serious problems at its group homes for people with disabilities, leading to residents being seriously injured and in some cases dying.

    The Carlyle Group, which has an ownership stake in OneMedical, the parent company of Iora Health, has a particularly disturbing history in health care. After Carlyle acquired HCR Manorcare, a nursing home chain, the company was plagued by serious lapses in standards of care until it went bankrupt eleven years later.

    Other private equity–backed operations approved for the new DCE program have major connections to the Democratic Party establishment. The private equity firm Warburg Pincus, which backs a DCE called Excelera, was cofounded by the father of current secretary of state Antony Blinken and boasts former Barack Obama treasury secretary Tim Geithner as its president.

    Laura Katz Olson, a professor at Lehigh University and author of the recently published Ethically Challenged: Private Equity Storms US Health Care, said that private equity’s role in Medicare privatization raises significant concerns.

    “If you understand the private equity playbook, the dangers are fairly obvious,” said Katz Olson. “They’re borrowing money so they have to pay off debt. They’re taking money into their pockets through fees. You would have to be a magician to keep up quality of care doing all of these things.”

    She added, “Private equity is bad for health care, period, so I can’t imagine that it would be good for Medicare Advantage. I’m actually in a state of surprise that they’re even thinking about it.”

    Jacobin, May 11, 2022, https://jacobinmag.com/

    Wall Street moves to privatize Medicare / by Tim Wheeler

    via AFL-CIO

    SEATTLE—Rep. Pramila Jayapal, D-Wash., is leading the struggle to block medical insurance profiteers from privatizing Medicare, a scheme covertly launched by former President Donald Trump and continued in a new guise by the Biden administration.

    Jayapal sent a letter Jan. 5 to Health and Human Services Secretary Xavier Becerra and Medicaid Administrator Chiquita Brooks-LeSure urging the Biden administration to terminate the Trump-initiated scheme to shift Medicare beneficiaries to so-called “Medicare Direct Contracting Entities” (DCE), such as Aetna and Humana, without informing the recipients.

    “As you know,” Jayapal wrote, “the previous administration started Direct Contract Entities (DCEs) which are privately owned and controlled networks in which for-profit companies are paid monthly to cover beneficiaries’ health care. Any funds left over after it covers care are kept as profits, creating a perverse motive to decrease the quality and volume of seniors’ care.”

    She added, “These models ultimately aim to privatize traditional Medicare by funneling beneficiaries, without their knowledge, into a DCE.”

    DCEs, she continued, “pose a threat to patient care and outcomes due to the encroachment of profit-driven organizations on their care.”

    More than 50 other members of the House, all Democrats, co-signed her letter.

    Physicians for a National Health Program (PNHP) denounced the Trump DCEs, circulating a petition signed by more than 13,000 physicians and other health advocates blasting the scheme to privatize Medicare.

    The pressure was so strong that the Center for Medicare Services (CMS) announced a few days after Jayapal’s letter a freeze on acceptance of new applications to the DCE program. CMS also announced that the DCE program will be replaced Dec. 31, 2022, by a new program, ACO REACH (Accountable Care Organization-Realizing Equity, Access, and Community Health).

    Critics charged the new plan was no better than Trump’s DCE.

    Jayapal pointed out that the 53 private equity firms and insurance companies that currently provide health care coverage “already take large profits from other healthcare ventures and will likely do the same from Medicare DCEs at the expense of patient care.”

    She cited Medicare Advantage plans that have invented “upcoding,” the practice of adding extra diagnosis codes to patient charts in order to squeeze more money from the Medicare Trust fund to increase their profits.

    “This scheme already costs the U.S. government $10.6 billion per year, and with the addition of traditional Medicare beneficiaries into this scheme those costs will almost surely rise.”

    DCEs are projected to spend as little as 60% of the taxpayer dollars they receive on care, allowing them to keep up to 40% as profit….” By contrast, the administrative costs of non-profit traditional Medicare are 1.5%, leaving 98.5% of every Medicare dollar for patient care.

    Jayapal requested a meeting with Becerra and Brooks-LaSure to “stop the expansion of these Direct Contracting Models and oversee the sunsetting of these programs.”

    While all Republican members of the House and even a majority of Democrats refused to sign her letter, the fightback against Medicare privatization is moving ahead.

    Here in Jayapal’s home district, Seattle, Puget Sound Advocates for Retirement Action (PSARA) has launched a grassroots campaign to stop Medicare privatization. PSARA Co-Presidents Jeff Johnson and Karen Richter sent out a letter, saying:

    “For decades, Wall Street has tried and failed to privatize our Social Security. Now they are trying to privatize traditional Medicare on top of the already existing Medicare Advantage plans. The financial rewards for achieving this goal are enormous.”

    They add, “The Trump administration has opened the door to complete privatization of Medicare. The Biden administration has furthered the Trump lead by continuing the Direct Contracting Pilot program until the end of 2022 and then beginning a new program labeled ACO REACH, which is privatization of traditional Medicare with a new name – Hands Off our Medicare!”

    Tim Wheeler estimates he has written 10,000 news reports, exposés, op-eds, and commentaries in his half-century as a journalist for the Worker, Daily World and People’s World. Tim also served as editor of the People’s Weekly World newspaper. He lives in Sequim, Wash., in the home he shared with his beloved late wife Joyce Wheeler. His book News for the 99% is a selection of his writings over the last 50 years representing a kind of history of the nation and the world from a working-class point of view.

    People’s World, April 6, 2022, https://www.peoplesworld.org/

    Biden administration bent on privatizing traditional Medicare / by Diane Archer

    There appears to be little light any more between corporate health care and government health care or even between government health care-speak and corporate health care-speak. In the latest government push to privatize traditional Medicare–“ACO REACH”–insurer and investor middlemen will responsible for assuming risk and paying claims. The Biden administration claims its goal is “value-based care,” though decades of evidence show that corporate middlemen drive up costs and do not deliver value for patients.

    What’s happening? The Biden administration is continuing a Trump administration experiment to pay middlemen–often entities with no meaningful medical expertise–a flat fee per patient to “manage care” for people in traditional Medicare. The administration just renamed the “Global Professional Direct Contracting” experiment–which works like Medicare Advantage–ACO REACH. It will privatize traditional Medicare by turning over “care management” read “money management,” to investors and insurers.

    Who will be in the experiment? People with Medicare whose primary care physicians are working for a middleman that contracts with the Centers for Medicare and Medicaid Services as part of “ACO REACH.”

    What’s the value to patients? If you look at the role insurer middlemen play in Medicare Advantage, it is hard to see that ACO REACH offers any possibility of value to patients and easy to see huge risk. Given the scant data available in Medicare Advantage, no one can demonstrate value in the care patients receive. MedPAC, the government’s Medicare oversight agency, has never been able to assess care quality in Medicare Advantage plans because the plans have never given it complete and accurate information that would permit MedPAC to assess value. At the same time, government agencies have found widespread and persistent inappropriate delays and denials of care and coverage putting patients at serious health risk.

    ACO REACH will offer “care coordination,” but what does that mean?  The Center for Medicare and Medicaid Innovation (CMMI) claims the ACO REACH model is somehow going to ensure people in traditional Medicare have their care coordinated in ways that improve health outcomes. But, there is no evidence that people in managed care plans have better health outcomes than people in traditional Medicare. In fact, “care coordination” is often a euphemism for delayed care, less care, and referrals to low-cost providers, none of which is by definition a good thing. Primary care doctors will have financial incentives to minimize costs.

    Will ACO REACH promote health equity? CMMI also says it is promoting health equity through ACO REACH, but there’s no evidence to support that claim. Participants will need to have health equity plans. But health equity plans are far different from results and, so long as cost is a barrier to care, it’s hard to see how participants can reduce health disparities. It’s also hard to imagine how CMS will ensure compliance by participants with model requirements.

    Diane Archer has been helping people navigate Medicare and retirement issues for more than 25 years. Just Care is her latest venture, which she is volunteering her time to build and test. Diane is creating Just Care in order to share helpful consumer-friendly information and to promote the organizations doing the best work.

    JustCare, March 9, 2022, https://justcareusa.org/