Editor's Note -
The following link will take you to the November 1, 2022 broadcast of the Maine Public show "Maine Calling":
https://bit.ly/3Dpk5IV
If the preceding link doesn't work for you, visit the "Maine Calling" Facebook page, or through the "Maine Public" app on your phone, and search for the November 1 "Maine Calling" show.
The episode was about how to choose a health plan, using the Maine-run ACA exchange, https://www.coverme.gov/.
It's worth listening to - lots of good information about what it's like trying to make your annual decision to enroll in a new plan, or keep your current choice.
The clearest message, based on the call-ins from Mainers was -
"this is really complicated - help!!"
It REALLY doesn't have to be this way!!
😱
-SPC
Commentary: Seven deadly universal health care misunderstandings
Although a signature-gathering campaign to put the question of universal
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by Michael P. Bacon - Portland Press Herald - November 2, 2022
There is increasing public awareness that our present health care system costs more and often delivers less than that of any other country, and there is growing support for single-payer, universal health care. The best-known plan is Sen. Bernie Sanders’ Medicare for All Act.
I recently participated in a signature-gathering campaign to put the question of universal health care before the Maine voters. While the campaign fell short, I learned some things. A healthy majority of those I met were supportive but had questions and concerns. I have gathered some of them here, along with my responses.
1. It’s Bernie’s idea, and I don’t like Bernie.
We may not embrace the senator’s entire agenda, but we should be willing to adopt the best ideas, whether from the left or the right, in making public policy. Slavish adherence to ideological imperatives closes minds and stifles creativity.
2. It is socialized medicine.
No, it isn’t. The whole delivery system – hospitals, physician practices, pharmacies, testing labs, etc. – remains under private ownership. It is just the social insurance function that the government performs and, as demonstrated with present Medicare, performs well.
3. It takes away our freedom to choose.
The only freedom we lose is that of struggling to choose from the confusing packages of benefits, prices, copays, deductibles and exclusions offered by private insurers. Those with employer-sponsored plans must accept what the employer offers. The freedom we care about most is choosing our providers, but private insurers have restrictive networks. Medicare doesn’t.
4. We should allow the invisible hand of the market to perform its magic to control costs, not the government.
I am a firm believer in free markets. For ordinary commerce, there is no better way to discover the price at which supply will meet demand. But when there is monopoly power and lack of transparency on the supply side, as is the case with health care, markets fail and government must intervene. And private insurers have a conflict of interest. They have interests in both profits and the health of their subscribers. When profits are down, we know what must be compromised. With ordinary goods and services, businesses can boost profits by cutting costs. Private insurers are tempted to do this by denying preapproval of tests and procedures or by rejecting claims after the fact.
5. We can’t afford it.
Many studies have demonstrated we can. One study, published in 2020 in The Lancet, a peer-reviewed medical journal, showed that the Sanders plan could guarantee coverage with generous benefits to everyone and still reduce the national health care expenditure by 13.1 percent, or $458 billion annually. It also showed that 68,500 American lives could be saved each year.
6. It will take jobs away from workers in the insurance industry.
Some proposals include plans for mitigating this, including funding for early retirement, retraining programs and relocation expenses. Any change in the economy that benefits society as a whole will inevitably displace some people. We must accept this but make provisions to assist them.
7. My taxes will go up.
It helps to think of deductions for health insurance premiums as taxes that we are already paying. These would be replaced by a tax/premium adjusted to the ability to pay. This would be instead of, not in addition to, what one is paying now.
A final thought: If I decided to oppose universal health care, I would have to identify the group of people to exclude. I could not do this and I don’t believe anyone could. Thus, we are all supporters of universal health care. Health care should be regarded as a public good, like fire protection, infrastructure, national defense, etc. We leave nobody out, not even those who, for whatever reason, don’t thrive in our highly competitive economy.
Republicans, Eyeing Majority, Float Changes to Social Security and Medicare
by Jim Tankersersley - NYT - December 3. 2022
WASHINGTON — Congressional Republicans, eyeing a midterm election victory that could hand them control of the House and the Senate, have embraced plans to reduce federal spending on Social Security and Medicare, including cutting benefits for some retirees and raising the retirement age for both safety net programs.
Prominent Republicans are billing the moves as necessary to rein in government spending, which grew under both Republican and Democratic presidents in recent decades and then spiked as the Trump and Biden administrations unleashed trillions of dollars in economic relief during the pandemic.
The Republican leaders who would decide what legislation the House and the Senate would consider if their party won control of Congress have not said specifically what, if anything, they would do to the programs.
Yet several influential Republicans have signaled a new willingness to push for Medicare and Social Security spending cuts as part of future budget negotiations with President Biden. Their ideas include raising the age for collecting Social Security benefits to 70 from 67 and requiring many older Americans to pay higher premiums for their health coverage. The ideas are being floated as a way to narrow government spending on programs that are set to consume a growing share of the federal budget in the decades ahead.
The fact that Republicans are openly talking about cutting the programs has galvanized Democrats in the final weeks of the midterm campaign. Mr. Biden has made securing Social Security and Medicare a late addition to his closing economic messaging, and Democratic candidates have barraged voters with a flurry of advertisements claiming Republicans would dismantle the programs and deny older adults benefits they have counted on for retirement.
Mr. Biden has repeatedly said he will not agree to cuts to Social Security, which provides retirement and disability pay to 66 million Americans, or Medicare, which provides health insurance to about 64 million people. He has also accused all Republicans of putting both programs on the chopping block, based on the possible outcomes of proposals put forth by two Republican senators, which party leaders have not embraced.
“You’ve been paying into Social Security your whole life. You earned it. Now these guys want to take it away,” Mr. Biden said during a visit to Hallandale Beach, Fla., on Tuesday. “Who in the hell do they think they are? Excuse my language.”
Former President Barack Obama, who campaigned last week in Wisconsin for the state’s Democratic candidate for Senate, Mandela Barnes, excoriated Senator Ron Johnson, the incumbent Republican, over his plans for the legacy programs. Mr. Obama faulted Mr. Johnson for supporting tax breaks for the wealthy that were included in Republicans’ 2017 tax cut legislation, along with spending proposals that Mr. Obama said jeopardized Social Security’s future.
American retirees “had long hours and sore backs and bad knees to get that Social Security,” Mr. Obama said. “And if Ron Johnson does not understand that — if he understands giving tax breaks for private planes more than he understands making sure that seniors who have worked all their lives are able to retire with dignity and respect — he’s not the person who’s thinking about you and knows you and sees you, and he should not be your senator from Wisconsin.”
Mr. Johnson has proposed subjecting Social Security and Medicare to annual congressional spending bills instead of operating essentially on autopilot as they do now. That would leave the programs susceptible to Washington’s frequent and fraught debates over funding the government, making it more difficult for retirees to count on a steady stream of benefits.
Still, Mr. Johnson does not hold a leadership position, and it is unclear whether his ideas — or any of the more aggressive proposals presented by those in his party — would find purchase with Republican leaders. This week, he said that Mr. Obama had “lied” about his proposal and that he had never called for Social Security cuts.
Mr. Biden and other Democrats have also criticized a plan from Senator Rick Scott of Florida, the chairman of the Senate Republicans’ campaign arm, who has proposed subjecting nearly all federal spending programs to a renewal vote every five years. Like Mr. Johnson’s plan, that would make Medicare and Social Security more vulnerable to budget cuts.
Senator Mitch McConnell of Kentucky, the Republican leader, said this year that a bill to sunset those programs every five years “will not be part of a Republican Senate majority agenda.”
Still, the fact that key Republicans are openly broaching spending cuts to Social Security and Medicare — or declining to rule them out — is a break from former President Donald J. Trump, who campaigned on a promise to leave the programs intact.
Several conservative Republicans vying to lead key economic committees in the House have suggested publicly that they would back efforts to change eligibility for the safety net programs. The conservative Republican Study Committee in the House, which is poised to assume a position of influence if the party claims the majority, has issued a detailed plan that would raise the retirement age for both programs and reduce Social Security benefits for some higher-earning retirees. The plan would increase premiums for many older adults and create a new marketplace where a government Medicare plan competes with a private alternative, in what many Democrats call partial privatization of the program.
Representative Kevin McCarthy of California, who is in line to be House speaker if his party wins control, told Punchbowl News last month he would not “predetermine” whether Social Security and Medicare cuts would be part of debt-limit negotiations. Those comments suggested that, unlike in past negotiations, Republicans could demand future cuts to the programs in order to raise America’s borrowing limit and avoid a default on government debt. Mr. McCarthy later told CNBC that he had not brought up the programs and was committed to “strengthening” them, though he did not provide details.
Asked whether Mr. McConnell would support any changes to the programs should Republicans capture the majority, aides pointed only to his specific comments about Mr. Scott’s plan.
With Mr. Biden in the White House, Republicans have little chance of securing changes to either program.
Democratic candidates and outside groups supporting them have spent $100 million nationwide this election cycle on ads mentioning Social Security or Medicare, according to data from AdImpact. Nearly half of that spending has come since the start of October.
“Far-right extremists are gutting retirement benefits,” a narrator says in an advertisement targeting Cassy Garcia, a Republican seeking to unseat Representative Henry Cuellar, a Democrat, in a fiercely contested Texas district. “They’ll slash Medicare and Social Security — benefits we paid for with every paycheck.”
Republicans have campaigned far less on the programs, spending about $12 million this cycle on ads mentioning them. Republican candidates have largely embraced repealing the Inflation Reduction Act, which Mr. Biden signed in August and which reduces prescription drug costs for seniors on Medicare. Some candidates have begun pushing back against Democratic attacks about Social Security and Medicare.
In a recent ad, Don Bolduc, a Republican challenging Senator Maggie Hassan, Democrat of New Hampshire, says he will not “cut Social Security and Medicare for older Americans,” though it remains unclear if he would reduce benefits for future retirees. Mr. Bolduc spoke in favor of privatizing Medicare in August, Politico reported this fall.
Democrats and Republicans largely agree Congress will need to ensure the solvency of the programs in the decade to come. Spending for the programs is projected to balloon in the coming decade as more baby boomers retire. The trustees of the Social Security and Medicare trust funds estimate that a key Medicare trust fund will run out of money in 2028 and the main Social Security Trust Fund will be insolvent in 2034, potentially forcing cuts in benefits if Congress does not act to avoid them.
In the 2020 campaign, Mr. Biden proposed raising payroll taxes on high earners to help fund Social Security, while also making the program’s benefits more generous for many workers. He put that plan on the back burner in his first two years in office, as he pushed a sweeping economic agenda that included new spending on infrastructure, low-emission energy, health care and advanced manufacturing. Republicans largely oppose Mr. Biden’s tax increases.
This week in Florida, Mr. Biden boasted that “on our watch, for the first time in 10 years, seniors are getting the biggest increase in Social Security checks, period.”
It was a curious bragging point. That increase is an adjustment for cost of living — and it is the result of prices rising faster on Mr. Biden’s watch than they have in four decades, an inflation rate that has hurt Democrats in the midterms.
Fiscal hawks said this week that Mr. Biden’s attempts to wield Social Security and Medicare against Republicans in the midterms would only set back efforts to shore up the programs.
“This is clearly election-time pot stirring,” said Maya MacGuineas, the president of the Committee for a Responsible Federal Budget in Washington. “Changes desperately need to be made to the programs to ensure solvency — politicians can disagree about what changes to make, but not whether they need to be made. It’s highly disappointing to hear the president, who knows better, resort to fearmongering rather than using his platform to help enact needed changes.”
Emily Cochrane, Margot Sanger-Katz and Peter Baker contributed reporting.
https://www.nytimes.com/2022/11/02/us/politics/republicans-social-security-medicare.html
Private Medicare Plans Misled Customers Into Signing Up, Senate Report Says
The report by Senate Democrats points to widespread misbehavior by the plans and the marketing firms they hire.
by Reed Abelson and Margot Sanger-Katz - NYT - November 3, 2022
Companies selling private Medicare plans to older adults have posed as the Internal Revenue Service and other government agencies, misled customers about the size of their networks and preyed on vulnerable people with dementia and cognitive impairment, according to a new investigation of deceptive marketing practices in the industry released Thursday by Democrats on the Senate Finance Committee.
Many individuals say they were enrolled in plans without realizing it.
The report catalogs complaints from 14 states, and a multitude of marketing materials generated by the insurers and the companies they hire to help sell the private plans.
The plans are part of a program called Medicare Advantage that now enrolls nearly half of all Medicare beneficiaries. The committee says people both in traditional Medicare and those already in a private plan have been inappropriately switched.
“It is unacceptable for this magnitude of fraudsters and scam artists to be running amok in Medicare, and I will be working closely with C.M.S. to ensure this dramatic increase in marketing complaints is addressed,” said Ron Wyden, a Democratic senator from Oregon and the committee’s chairman, referring to the Centers for Medicare and Medicaid Services, the agency that oversees Medicare. “Medicare Advantage offers valuable plan options and extra benefits to many seniors but it is critical to stop any tactics or actors that harm seniors or undermine their confidence in the program.”
Medicare Advantage has become a highly lucrative market for health insurers. But many of the insurers selling such plans have been accused of overstating how sick their customers are, according to a New York Times review last month that found four of the five largest insurers have faced federal lawsuits accusing them of fraud.
“Because it’s such a profitable line of business, they have an incentive to do more marketing,” said Tricia Neuman, a senior vice president at the Kaiser Family Foundation, who is working on a review of television advertisements by the plans. “And they have more money to do marketing, which increases revenue.”
Most of the behavior documented in the report came from insurance brokers or third-party marketing firms hired by the companies, not the insurers themselves.
The Senate report did not say which insurers benefited from the behaviors described. But it identified similar misleading behavior across multiple states, and an escalating number of complaints, suggesting that the tactics were not limited to a small group of bad actors.
Industry trade groups denounced the practices.
“America’s seniors and people with disabilities deserve Medicare Advantage (MA) plans that continue to deliver better services, better access to care, and better value,” Kristine Grow, a spokeswoman for AHIP, an industry trade group, said in a statement. “Health insurance providers are clear: Americans should be protected from bad actors who engage in misleading advertising and marketing tactics.”
She emphasized the federal government’s strict oversight of the industry’s marketing, including new rules that will require brokers to record their calls with potential customers and offer greater supervision of the third-party marketing groups enrolling new customers.
The Senate report pointed to several aggressive practices that it said amounted to fraud.
Five states said they were aware of brokers that had targeted people with cognitive impairment, and six states indicated people were signed up for a Medicare Advantage plan without even knowing it.
Marketing firms in several states sent mailers to Medicare beneficiaries made to look like correspondence from the Internal Revenue Service, the Social Security Administration or Medicare itself, the report said.
The mailings are designed to generate leads for insurance brokers. Federal rules prevent cold-calling of Medicare beneficiaries. But once respondents call, click or mail back a form, the companies are allowed to call them repeatedly. The investigation found similar forms from several states that looked like tax documents, using the font and layouts of an I.R.S. form. One Utah mailing declared: “IMPORTANT-COMPLETE & RETURN POSTAGE-PAID CARD WITHIN 5 DAYS.”
The report also said that a frequent refrain in television commercials and mailings was the idea that switching to Medicare Advantage would increase beneficiaries’ Social Security benefits. Some plans do charge lower premiums than traditional Medicare, but not most. Only 7 percent of beneficiaries this year were enrolled in a plan that offered such a premium discount, according to research from the Medicare Payment Advisory Committee.
The report described an Oregon man who enrolled in a Medicare Advantage plan after hearing that switching would increase his Social Security check by $135 a month. It turned out that his new plan did not cover prescription drugs, and his Social Security income was unchanged because Medicaid already paid his Medicare premiums. “He was astonished and very stressed out when he went to the pharmacy,” according to a complaint cited in the Senate report. “He says he was never told that and would never have enrolled in a plan” without drug coverage.
Ten of the 14 states said people were confused about whether their doctors or the drugs they were being prescribed were covered under a plan. In Oregon, a patient was switched from traditional Medicare and a Medicare supplemental policy to a Medicare Advantage plan by an agent who came to her house. The new plan did not include her mental health provider as part of its network. Her claims, previously covered, were denied.
A 94-year-old woman with dementia in Missouri was sold a plan that did not include the hospital or doctors she saw in her rural area, according to another complaint. She was forced to travel significantly farther for her medical care.
Medicare Advantage plans have become increasingly popular. They are required to offer similar benefits to traditional Medicare, and many include extras like dental benefits, gym memberships or lower premiums. But the plans typically come with limited provider networks, which means that switching plans could mean losing access to doctors or coverage for certain prescriptions. Most Medicare beneficiaries are allowed to switch plans once a year, during a period known as open enrollment, which this year started Oct. 15 and ends Dec. 7.
That’s the time of year when the advertisements, mailers and telemarketers are most pervasive. Medicare has recently promised to increase its oversight this year and next, but the increasing popularity of the program and looser regulation under the Trump administration appear to have led to an increase in complaints to Medicare.
The report says that complaints to the Centers for Medicare and Medicaid Services more than doubled, from 15,497 complaints in 2020 to 39,617 in 2021. Several state insurance regulators have also seen an increase.
“In some areas of the country, confused and embarrassed seniors have fallen victim to improper marketing practices,” said Ceci Connolly, the chief executive of the Alliance of Community Health Plans, who wrote last month to Senator Wyden about concerns that people were being misled into changing plans.
“It is very clear from the on-the-ground experience of our members that it has grown significantly,” she said in an interview. Plans say members are being switched to competing insurers without their knowledge, including one plan in which a beneficiary was disenrolled four times before ultimately being allowed to stay.
David Lipschutz, the associate director of the Center for Medicare Advocacy, which favors stronger regulation of the plans, said Medicare could be substantially more aggressive about enforcing the rules against deceptive marketing.
“Plans might try to distance themselves from this marketing misconduct and say we have no control over these agents and brokers or their brokerage firms, but C.M.S. has been pretty clear that plans are liable for the conduct of these downstream entities,” he said.
Medicare has told plans it will begin policing marketing materials more closely. Starting next open enrollment, Medicare will review and approve television advertisements before they air to make sure celebrities accurately describe the plans’ benefits. (One heavily shown ad that featured Joe Namath, the former star football quarterback, was changed to comply with regulations, according to the report.)
“C.M.S. remains committed to the shared goal of protecting people with Medicare from confusing and potentially misleading marketing while also ensuring they have the accurate and necessary information to make the coverage choices that best fit their needs,” said Chiquita Brooks-LaSure, the C.M.S. administrator, in a statement thanking the committee for the report.
Reed Abelson covers the business of health care, focusing on health insurance and how financial incentives affect the delivery of medical care. She has been a reporter for The Times since 1995. @ReedAbelson
Margot Sanger-Katz is a domestic correspondent and writes about health care for The Upshot. She was previously a reporter at National Journal and The Concord Monitor and an editor at Legal Affairs and the Yale Alumni Magazine. @sangerkatz • Facebook
A version of this article appears in print on Nov. 4, 2022, Section B, Page 6 of the New York edition with the headline: Some Medicare Insurers Mislead Older Adults, Senate Report Says. Order Reprints | Today’s Paper | Subscribe
Alleviating Canada’s Acute Shortage of Family Doctors
by Ian Austen - NYT Canada Letter - November 5, 2022
In British Columbia this week, the provincial government took a bold, and costly, step that it hopes will help recruit family doctors for about 1 million people. Adrian Dix, the minister of health, outlined a new plan that could see a typical family doctor’s gross income rise by 135,000 Canadian dollars a year, to about 385,000 dollars.
It’s a problem that resonates in other provinces. This week I’ve been in Nova Scotia for an upcoming climate article. In casual conversations, the province’s shortage of family physicians kept coming up. |
Nova Scotia’s latest monthly tally, released in mid-October, showed that 110,640 people, or 11 percent of the population, were on the wait list for a family doctor. |
Nova Scotia and British Columbia are not alone. The recently re-elected Coalition Avenir Québec government dropped its promise to ensure that everyone has a family doctor. More than 800,000 Quebecers are without one. In Ontario, the provincial advocacy group for family physicians estimates that 1.8 million residents do not have a family doctor and another 1.7 million people are under the care of physicians older than 65 who are nearing retirement. |
The desperation to secure a physician pushed Janet Mort in British Columbia to drastic measures. She took out an ad in a local newspaper in search of a physician to fill her 82-year-old husband’s prescriptions after his physician retired, as reported by Global News. Her strategy was successful. |
For others, the process to find a family doctor has meant working the phones to call individual clinics or to join growing provincial wait lists. Those who turn to the services of walk-in family doctors find longer wait room times and no continuity of care. And some people add to the congestion in overburdened hospital emergency departments. |
While British Columbia’s new plan would increase the income of family physicians, it’s not a simple raise. Rather than just increase payments, the province is completely changing how family doctors bill the government. Under the current fee-for-service model, physicians in British Columbia and most provinces are paid about 30 to 40 Canadian dollars each time they see a patient, regardless of how much time they spend or how complex the patient’s medical issues. |
The system was first set up to end a strike by doctors in 1962 after Saskatchewan became the first province to introduce public health care. But critics say it encourages medical students to seek out other specialties where the government’s fees better reflect the time and skill needed for treatments and that bring higher earnings generally. |
Under British Columbia’s new plan, a physician’s income will increase depending on a number of factors, including how much time a doctor spends with a patient, how many patients the doctor sees each day, the number of patients in their practice and the complexity of the patient’s medical condition. The new system will also pay for some of the costs of running and staffing offices, a move that address a longstanding grievance of many family doctors. |
In an interview with The Vancouver Sun, Dr. Ramneek Dosanjh, president of Doctors of B.C., described the new system as “a seismic shift.” The province estimates that it will increase health care costs by 708 million Canadian dollars in its first three years.I spoke with Katherine Stringer, the head of the Department of Family Medicine at Dalhousie University in Halifax, about the department’s efforts to increase the number of family doctors in Nova Scotia.
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