America’s health insurers have turned from middlemen to gatekeepers, deciding who gets care based on Wall Street. It’s time for doctors to blow the whistle.
We need for people to understand that Advantage is not a Medicare program, it is a private health program that gets paid through the government and preys on the illness of people for profits. Overhead for Advantage is 15% compared to ⅕ that of Traditional Medicare. Studies have shown no difference in health outcomes between the two. Also people need to understand that if on Advantage over one year that in most states it is difficult to go back to Traditional Medicare because the 20% coverage of Part B called Medigap can do underwriting and charge much higher fees than normal for medical illnesses. Of course Medigap is also administered by private health insurers. Medigap should be eliminated and Part B should be covered under one fee. Also Traditional Medicare should offer some pay relief for the chronic conditions plaguing the elderly regarding hearing, vision, dental. Better yet let’s go to a one payer universal healthcare system that most all other industrialized countries have.
Until there is a uniform fiduciary standard forcing all service providers to disclose all direct and indirect compensation, and to list all of its services and conflicts of interest, there likely can be no cost sanity. Violating the duty of loyalty and duty of care to the patient ought to come with civil and criminal fines and prison.
Good luck, Wendell. In my opinion, most of allopathic healthcare isn't worth saving. It's great for emergencies or acute situations. But for the chronic conditions that most people endure, allopathic healthcare is a big fat bust. Take orthopedic care, for example. People would not need many of those outrageously expensive knee and hip replacement procedures if they moved more, ate less processed food, and healed their emotions. Busting Wall Street is just the first step in true healthcare reform. We're getting the healthcare we asked for because in this country, it's all about money.
Correct! It’s called Predatory Capitalism and it’s what the US economy is based on. No I don’t agree with it but it is a fact. I have original Medicare and a supplement. Supplements are also private insurance but are required by the Federal government to be the same coverage for all within a plan. I also can go to any Dr anyplace in the US without prior authorizations. It’s fantastic coverage and Congress adds more coverage every year.
Thanks for another great article, Wendell. I was not aware that Humana has announced it will kick MA patients out because they cost too much. How can that be legal!!?? If a MA patient wants out, he or she is at risk of not finding a supplement plan for Traditional Medicare. This issue deserves another post.
It deserves to be in-front of Congress. It is one aspect of Medicare that is never talked about and catches people off guard. Then you are stuck with an expensive MA plan without coverage that you can’t get out of because Medicare rules don’t allow it. You get one shot at age 65. If you make the wrong decision, you are screwed for life.
While not my personal experience I can offer a family member's horrifying battle to get some kind of effective treatment for her knee injury. Both the primary care physician AND the orthopedic surgeon relently pushed opioids (for pain) for many months instead of treatment via surgery or even physical therapy. She refused repeatedly and finally even angrily when the primary care physician threatened to "turn her in" to the Medicare Advantage insurer for her alleged refusal to follow "doctor's orders." "Failure to follow doctor's orders" is first step to being kicked out of a MA insurance plan, by the way. She, and I, wondered not only about the MA insurance gatekeeping but also whether either or both doctors colluded by pushing opioids. Next enrollment period she went back to original Medicare and got appropriate treatment and no one pressured her to take opioids for the pain instead of having surgical repair to the knee.
We created Medicare in 1965 to save American healthcare because the for-profit private health insurance companies dropped people as they aged. After kazillions in profit theses companies show no remorse nor ethics
Physician whistleblowers are a great idea--but how can they possibly do that when they are already overburdened with writing letters and other documentation to get prior authorizations? Maybe they don't do this as much in orthopedic care? In neurology care, the ridiculous "peer to peer" conversations waste time and there is so much additional work on the physicians to prove the need for treatments. I wonder if there is a way for patients to take on this job? What if there was some kind of national clearinghouse where we could all share our experiences? Most of us who have gone through this horror show have documentation out the wazoo and we could redact and post what we've experienced.
I almost lost the ability to walk due to delays. I’ve had 2 back surgeries now. I can walk but permanently lost reflexes in my ankle. I had complete drop foot before the surgeries. So ya and unfortunately I have a Medicare advantage. United health care
My wife has had nine spine surgeries, so we are close to her neurosurgeon. If you had complete foot drop prior to the surgery, they should be sued for insurance malpractice, or whatever the correct legal term is.
I’ll talk to my caseworker about that. I’m not sure it’s possible. Yes complete foot drop before and a few months after surgery. The weakness in my right leg is profound to quote my neurologist. My surgeon was excellent. It wasn’t his fault.
You need to understand that MA is a private PLAN in which you have no ownership and thus no right to sue. See <www.killAbill.com> to understand the fraud in the system and how to WIN every time. Because, if you understand the fraud, they can't afford to deny you the care or coverage you are owed.
We need for people to understand that Advantage is not a Medicare program, it is a private health program that gets paid through the government and preys on the illness of people for profits. Overhead for Advantage is 15% compared to ⅕ that of Traditional Medicare. Studies have shown no difference in health outcomes between the two. Also people need to understand that if on Advantage over one year that in most states it is difficult to go back to Traditional Medicare because the 20% coverage of Part B called Medigap can do underwriting and charge much higher fees than normal for medical illnesses. Of course Medigap is also administered by private health insurers. Medigap should be eliminated and Part B should be covered under one fee. Also Traditional Medicare should offer some pay relief for the chronic conditions plaguing the elderly regarding hearing, vision, dental. Better yet let’s go to a one payer universal healthcare system that most all other industrialized countries have.
And thank you for using the more appropriate term "universal health care" instead of the negative connotation-ridden label of "Medicare for all."
Until there is a uniform fiduciary standard forcing all service providers to disclose all direct and indirect compensation, and to list all of its services and conflicts of interest, there likely can be no cost sanity. Violating the duty of loyalty and duty of care to the patient ought to come with civil and criminal fines and prison.
I agree 100%. Congress could impose such rules and penalties but they’re bought off. 😖
UnitedHealthgroup is buying providers and leasing community buildings to keep the corporate welfare/cash cow alive.
Good luck, Wendell. In my opinion, most of allopathic healthcare isn't worth saving. It's great for emergencies or acute situations. But for the chronic conditions that most people endure, allopathic healthcare is a big fat bust. Take orthopedic care, for example. People would not need many of those outrageously expensive knee and hip replacement procedures if they moved more, ate less processed food, and healed their emotions. Busting Wall Street is just the first step in true healthcare reform. We're getting the healthcare we asked for because in this country, it's all about money.
Correct! It’s called Predatory Capitalism and it’s what the US economy is based on. No I don’t agree with it but it is a fact. I have original Medicare and a supplement. Supplements are also private insurance but are required by the Federal government to be the same coverage for all within a plan. I also can go to any Dr anyplace in the US without prior authorizations. It’s fantastic coverage and Congress adds more coverage every year.
Thanks for another great article, Wendell. I was not aware that Humana has announced it will kick MA patients out because they cost too much. How can that be legal!!?? If a MA patient wants out, he or she is at risk of not finding a supplement plan for Traditional Medicare. This issue deserves another post.
It deserves to be in-front of Congress. It is one aspect of Medicare that is never talked about and catches people off guard. Then you are stuck with an expensive MA plan without coverage that you can’t get out of because Medicare rules don’t allow it. You get one shot at age 65. If you make the wrong decision, you are screwed for life.
While not my personal experience I can offer a family member's horrifying battle to get some kind of effective treatment for her knee injury. Both the primary care physician AND the orthopedic surgeon relently pushed opioids (for pain) for many months instead of treatment via surgery or even physical therapy. She refused repeatedly and finally even angrily when the primary care physician threatened to "turn her in" to the Medicare Advantage insurer for her alleged refusal to follow "doctor's orders." "Failure to follow doctor's orders" is first step to being kicked out of a MA insurance plan, by the way. She, and I, wondered not only about the MA insurance gatekeeping but also whether either or both doctors colluded by pushing opioids. Next enrollment period she went back to original Medicare and got appropriate treatment and no one pressured her to take opioids for the pain instead of having surgical repair to the knee.
Thank you for your voice.
We created Medicare in 1965 to save American healthcare because the for-profit private health insurance companies dropped people as they aged. After kazillions in profit theses companies show no remorse nor ethics
Physician whistleblowers are a great idea--but how can they possibly do that when they are already overburdened with writing letters and other documentation to get prior authorizations? Maybe they don't do this as much in orthopedic care? In neurology care, the ridiculous "peer to peer" conversations waste time and there is so much additional work on the physicians to prove the need for treatments. I wonder if there is a way for patients to take on this job? What if there was some kind of national clearinghouse where we could all share our experiences? Most of us who have gone through this horror show have documentation out the wazoo and we could redact and post what we've experienced.
I almost lost the ability to walk due to delays. I’ve had 2 back surgeries now. I can walk but permanently lost reflexes in my ankle. I had complete drop foot before the surgeries. So ya and unfortunately I have a Medicare advantage. United health care
My wife has had nine spine surgeries, so we are close to her neurosurgeon. If you had complete foot drop prior to the surgery, they should be sued for insurance malpractice, or whatever the correct legal term is.
I’ll talk to my caseworker about that. I’m not sure it’s possible. Yes complete foot drop before and a few months after surgery. The weakness in my right leg is profound to quote my neurologist. My surgeon was excellent. It wasn’t his fault.
You need to understand that MA is a private PLAN in which you have no ownership and thus no right to sue. See <www.killAbill.com> to understand the fraud in the system and how to WIN every time. Because, if you understand the fraud, they can't afford to deny you the care or coverage you are owed.
It’s our representatives job to vote to end “for profit medical care”….. as someone said above they’re bought out