Keeping Restaurant Workers Poor and Poorly Insured
The New York Times this week published a major investigative report about how the National Restaurant Association has for years been using money paid by low-wage workers for a mandatory food-handling course to finance its massive lobbying efforts in Washington and the states.
I can assure you that the NRA has spent huge sums of money to block legislation that would increase the minimum wage and that would improve health care coverage for millions of restaurant employees.
When I was in the health insurance business, my colleagues and I worked closely with folks at the NRA–most notably its former president and CEO Herman Cain, a former Republican candidate for president– to kill health care reform bills, going back to the Clinton years.
In 2011, I wrote an account of how we used Cain effectively to make sure Bill and Hillary Clintons’ health reform bill never got a final vote in Congress. I was part of the team that organized a nationally televised “town hall” featuring Cain to scare lawmakers, business leaders, and the general public about the bill. It was hugely expensive and took weeks of planning. We even hoodwinked respected 60 Minutes correspondent Lesley Stahl into moderating what she had been led to believe would be a balanced discussion of the Clinton plan. The money spent turned out to have a terrific return on investment: the Clinton plan went down in flames, and Insurance would go on to make billions and billions of dollars in profits.
Cain would go on not only to run for president but to serve as the co-chair of Black Voices for Trump–and ultimately to die from COVID in 2020.
The NRA was one of the organizations that joined insurers in their successful effort in the early 2000s to kill the bipartisan Patients’ Bill of Rights, which was co-sponsored by Senators Ted Kennedy (D-MA) and John McCain (R-AZ). Among other things, the bill would have allowed patients to sue their insurers or employers for wrongfully denying needed medical care. It didn’t have a chance.
The NRA apparently is still tight with health insurers. Aaron Frazier, vice president of health policy for the organization, appears on the website for AHIP, the lobbying and PR group for Big Insurance.
The (Dreaded) Medicare Advantage Tipping Point Has Been Reached
Thanks to being able to spend massive amounts of our premium dollars on lobbying and deceptive advertising, Big Insurance is on the cusp of achieving a long-sought goal: luring a majority of Medicare-eligible seniors into their private Medicare replacement plans called Medicare Advantage.
According to the Centers for Medicare and Medicaid Services, more than 30 million people are now enrolled in those private plans.
As Becker’s Healthcare reports:
The record enrollment marks a significant milestone for the public-private program. In 2022, 28.4 million people were enrolled in MA out of 58.6 million Medicare beneficiaries overall – or 48 percent. MA has been predicted to overtake traditional Medicare enrollment in 2023. Under current growth, the program is expected to make up 69 percent of all Medicare enrollments by 2030.
Becker’s went on to quote AHIP’s President and CEO Matt Eyles:
"With more than 30 million seniors and people with disabilities now enrolled in Medicare Advantage — nearly half of all who are eligible for Medicare — it is a huge endorsement of the value of this program. This milestone shows that people are choosing MA for better affordability and health outcomes."
My take: As you probably know by now, Matt and I do not see eye-to-eye on MA. Today AHIP and its allies reportedly are beginning their annual effort to get as many Democratic and Republican lawmakers as possible to sign a letter they wrote extolling the supposed virtues of Medicare Advantage. I, on the other hand, am working with reform allies encouraging lawmakers NOT to sign the letter and to stop Big Insurance from continuing to raid the Medicare Trust Fund, which they are to the tune of billions of dollars a year.
How Medicare Advantage Pulls Off That Raid
As STAT is reporting:
One unexpected “benefit” of (Medicare Advantage) plans is an offer by the insurance company sponsoring the plan to send a nurse or physician’s assistant, often from a startup company, to an individual’s home. There is no charge for the visit, and the insurance company may even pay the beneficiary for agreeing to do this. Some companies call relentlessly to get the offer accepted. Before explaining whose interests these visits serve, it helps to tease out the roles of the players. Health insurance companies do not deliver health care. That’s what medical providers and groups do. The primary role of insurance companies is to pay the bills; they profit by taking in more money from beneficiaries than they pay for the medical care they need. To be sure, this distinction is getting murky: some health insurers have bought medical provider groups, and some health systems offer health insurance.
Health Insurers Have Indeed Bought Medical Provider Groups–One Big Insurer in Particular
As Becker’s (once again) is reporting:
The largest employer of physicians in the United States is not HCA, the VA, or Kaiser Permanente — it's UnitedHealth Group's Optum. With at least 60,000 employed or aligned physicians across 2,000 locations in 2023, Optum has cemented itself at the forefront of the quickly changing healthcare delivery landscape. For comparison, Bloomberg reported in 2021 that Ascension employs or is affiliated with 49,000 physicians, HCA has 47,000 and Kaiser has 24,000.
MA Plans Get a Very Special Award
MedPage Today is reporting that:
Medicare Advantage plans took the top spot in this year's Shkreli Awards, the annual list from the Lown Institute that calls attention to some of healthcare's most greedy and unethical behavior. The plans' penchant for defrauding or overbilling Medicare by an estimated $25 billion in 2020 alone by saying beneficiaries were much sicker than they actually were earned them their top marks, according to the Lown Institute.
Another Tool Big Insurance Uses to Boost Profits–Excessive Prior Authorization Demands
Prior authorization requirements are growing and have become a “massive source of administrative burden” for doctors and other clinicians. As Fierce Healthcare reports, CMS “might” try to do something about it:
Several provider groups pressed Medicare officials Tuesday to install several proposed reforms to prior authorization, including mandating an electronic process for plans to approve requests. Leadership with the Centers for Medicare & Medicaid Services (CMS) held a roundtable Tuesday with medical groups on reforming prior authorization in government programs such as Medicaid managed care, Medicare Advantage and the Affordable Care Act’s exchange plans. The roundtable comes roughly a month after three proposed rules that aim to reform the process physicians say is a massive source of administrative burden. “These proposed actions will significantly streamline the prior authorization process for clinicians, improve the healthcare experience for people we serve and ensure they can access the care they need,” said CMS Administrator Chiquita Brooks-LaSure during a call with reporters Tuesday.
Bernie Talks about Medical Debt, Caused in Large Part by Outrageous Deductibles
Democracy Now reported on Sen. Sanders’ national address Tuesday on the American working class, which is getting buried under mountains of medical debt because Big Insurance makes everybody pay often huge sums out-of-pocket before insurers will pay a dime. This is from the broadcast:
We hear from patients and discuss the fight to stop hospitals from suing patients, garnishing wages and putting liens on homes of people facing medical bills they can’t afford. We are joined by Elisabeth Benjamin, vice president of Health Initiatives at the Community Service Society of New York and co-founder of the Health Care for All New York campaign.
NOTE: This is why I lead the Lower Out-of-Pockets NOW Coalition. Check us out, support us and share your stories with us. We’ll share them with lawmakers and employers.
And I just re-read the inferno and wrote a thing on it. https://open.substack.com/pub/thefrontierpsychiatrists/p/the-inferno-by-chatcpt?utm_source=direct&r=1ct8f&utm_campaign=post&utm_medium=web