Young Americans deserve our support
February 10, 2023 at 5:00 a.m.
Our national nightmare of never-ending presidential campaigns has already begun. So, it's a good time to raise awareness among young voters about the confusing intricacies of Medicare.
Traditional Medicare had its genesis thanks to two presidents. On July 30, 1965, Lyndon Johnson traveled to the Truman Library in Independence, Missouri, to sign Medicare into law. He chose that venue to draw attention to the fact it took 20 years for Congress to enact government health insurance for senior citizens after Harry Truman had proposed it.
How many young people ever thought that Roe vs. Wade would be overturned? It is unlikely that Medicare will be "overturned" — but it is being "looted" and diluted through privatization via Medicare Advantage (MA) plans.
Medicare is at the forefront of political discourse, yet we largely ignore young people in this discussion under the assumption they are not interested and are not affected by Medicare's future and its impact on them.
By one estimate, more than 10 million young Americans are family caregivers, most of them caring for loved ones who depend on Medicare for financial security. According to Politico, 69% of young Americans support a Medicare For All government-funded program.
However, MA plans are growing exponentially. MA is a lucrative private insurance product masquerading as Medicare. Traditional Medicare is the most popular, most efficient and most cost-effective medical coverage program in the U.S.
MA enrollment has grown so fast that more than 29 million Americans were in MA plans this year, accounting for $427 billion of Medicare spending, according to the Kaiser Family Foundation.
One reason for this rapid growth may be that the Centers for Medicare and Medicaid Services (CMS) sets higher commission rates for insurance agents selling MA plans when compared with the rates set for agents selling plans to those who choose traditional Medicare with supplemental plans.
When an insurance agent enrolls a newly eligible 65-year-old client from New Jersey or California into an MA plan, she will earn a $750 commission for that year. But, if that same client chooses traditional Medicare and buys a Medigap policy as their supplement, the agent gets a $259.80 commission.
Additionally, brokers reap payments in subsequent years if their client stays in the same plan. Although rates vary depending on the plan and the region, a common commission for each renewing MA enrollee is about $375 per year, which continues annually as long as the beneficiary stays in that plan. Another reason for the MA growth is the aggressive, often misleading, advertising for these for-profit plans.
Some MA plans are managed by hedge funds and private equity firms — investors with no medical experience decide which medical procedures it will cover and will put profits first.
Tampering with traditional Medicare puts the health and financial future of young Americans and their families at risk. They have paid into the Medicare system for most of their adult lives, so it is only fair that they should expect to receive the same benefits — or better — as their parents have.
In January, JAMA published an essay by Donald Berwick, MD, MPP, titled "Salve Lucrum: The Existential Threat of Greed in US Health Care." Dr. Berwick notes that according to health services research, MA will cost Medicare over $600 billion more in the next 8 years than would have been the case if the same enrollees had been in traditional Medicare.
Dr. Berwick also questions the real value of MA — the value of MA depends on your location, healthcare needs, budget and preferences. Initially, an MA plan could be a good financial investment, if you are relatively healthy. When more serious health issues arise, audits by the Office of the Inspector General find that private MA plans deny necessary care that should be covered under the program.
In a coincidence of timing with Dr. Berwick's article, CMS released a rule for health insurers that operate MA plans, stipulating they will be subject to return overpayments to MA plans to the tune of billions of dollars in fraudulent billings.
As these problems with MA roiled to a boil, Sen. Patty Murray responded to constituents' growing concerns about MA plans with a boilerplate letter that completely ignored their worries, stating "Like you, I strongly believe our seniors deserve a health care system that works for them and puts their needs first. That is why I have long fought to defend the Medicare program, including by providing seniors the option of enrolling in Medicare Advantage ... I remain committed to working to ensure all beneficiaries have a choice between Medicare Advantage and the traditional Medicare program."
Sen. Murray's tone-deaf response is a reminder that democracy is not a spectator sport. If citizens want their voices heard, they must speak truth to power.
We must support our young people to keep traditional Medicare strong. We also must let presidential wannabees — and members of Congress — know we're mad as hell and we're not going to take it any longer!
The authors are longtime advocates for equity and justice in health care, who collaborate and volunteer with a variety of local, regional and national organizations.