Fight over Medicare cuts ignore patients-as usual!

Implications: Congress is looking at making cuts to Medicare especially the privately administered Medicare Advantage plans. America's Health Insurance Plans (AHIP) the advocacy group is concerned solely with preserving the healthy margins enjoyed by its members, while Congress is interested in reducing Medicare spending at all costs. Where is the patient in all this?

Analysis:  There is no doubt that this government -like most before it- has been concerned with reducing Medicare spending even as demands on the government program continue to grow. Gaining particular scrutiny is Medicare Advantage, the privately administered HMO-like Medicare plans. The concept sounds great in principle-greater access, more consumer choice, improved services etc. However the reality has been more harsh.


While the plans-especially the private fee for service (PFFS) variety -cost the government more than regular Medicare and the plan administrators line their pockets with healthy margins , patients dont always benefit.

In recent testimony before the House Ways and Means Committee, the AMA claimed their own study showed that patients on the Medicare Advantage received fewer benefits or end up being denied for more services than those under regular Medicare. Further, doctors often get paid less than they would under regular Medicare for the same service. Medicare has a huge price tag (an estimated $77billion will be spent on Medicare Advantage alone this year). Under PFFS plans alone there are over 1.3 million enrollees in 47 plans at a price tag of over $13billion. It is no wonder AHIP wants to campaign for continued payments at the current level!!

Congress is concerned with the overall price tag to the taxpayer, reports of unethical advertising, lax control and almost no oversight by CMS. Plus there is the traditional historical and continuing suspicion about Medicare fraud and uncontrolled spending.

AHIP might be reaching into its deep pockets to run highpriced advertising campaigns, but the motivation has nothing to do with patient care and everything to do with the profit motive. With Congress on one side and groups like AHIP on the other the patient is bound to get squeezed.