U.S. Health Care Reform Battle: You Ain’t Seen Nothin’ Yet!

I am one of the 10.2 million American seniors who benefit from a government initiative called Medicare Advantage. It was enacted by a Republican Congress in 2003 and it subsidizes managed care programs offered by private health insurance companies. I shopped around – there were a lot of choices – and chose a program called Quality Health Plans. And so far it has been the difference between getting by and not getting by.

noYou see, under Medicare, we geezers are liable for about 20 percent of our health care bills. With Medicare Advantage – at least with QHP – my contribution is a lot lower. There is no co-pay for visits to my primary care physician, and for specialists my co-pay is $5. For most prescriptions, my co-pay is zero. My highest co-pay is $30 for a month’s supply of glaucoma eye drops. And I don’t pay a monthly premium in addition to the money the government deducts from my Social Security payments- not one red cent.

True, I made some changes in my medications – from Humulin to Novolin and from Diovan to Lisinopril, for example – to get the best rates, but there have been no adverse effects to my health, and the benefits to my wallet have been considerable.

Now, it looks as if my lifeline might be taken away – or at least diminished – to help provide health insurance for the millions who can’t afford coverage.

OK, so I don’t completely understand how Medicare Advantage works, but it is working for me. And my ears tingled when I heard President Obama referring to “waste” in the Medicare program that would be trimmed to help provide insurance for Americans without health insurance. I suspected he was referring, among other things, to the Medicare Advantage subsidies. Yesterday, reading an article in the Los Angeles Times by Christi Parsons and Andrew Zaja, I realized my fears were justifiable.

Here are excerpts from the report:

Medicare Advantage pays insurance companies a hefty premium to enroll senior citizens and provide their medical services through managed-care networks. But whether the higher payments are worth it is a matter of dispute. Obama and many congressional Democrats see Advantage as a wasteful bonanza averaging about $17 billion a year for the companies, which critics say provide few benefits beyond regular Medicare. The companies and their supporters say they earn the extra payments by providing seniors – who pay nothing extra – with significant benefits, including freedom from government red tape. What lifts the disagreement above other points of contention on healthcare is its potential for spreading fear and outrage among Medicare recipients as a whole, much like the public outcry after Republicans accused Democrats of trying to create death panels to cut off care for severely ill seniors and the disabled.


The White House is counting on convincing seniors, with their powerful lobbying presence in Washington, that in order to fix the overall healthcare system, they have to cut the fat out. For the last few years, Medicare Advantage has been a sheltered corner of the national health plan. When congressional Republicans first began expanding private insurance options for Medicare in 1997, advocates argued that the plans would actually deliver services more efficiently and hence less expensively. But the spending on Advantage plans grew over time. The plans now cost the government about 14 percent more per person than does regular Medicare, according to a recent analysis by the Medicare Payment Advisory Commission, which recommends reimbursement rates to Congress.


Today, the sheer size of the program, which serves about 10.2 million seniors out of more than 45 million Medicare users, offers an opportunity for savings that the Office of Management and Budget puts at $177 billion over 10 years. Obama joined the Advantage critics in 2007 while campaigning in Iowa, when he cited the arrangement as an example of Medicare waste. Now his plan is to reduce payments to Advantage so that they are equal or comparable to the payments for regular Medicare. As part of their healthcare talks, lawmakers have suggested reducing the rates through competitive bidding or by fiat – perhaps setting payments at levels not to exceed traditional Medicare.


The Advantage plans seem headed for significant change.

And change is never easy. As that famous sage, Niccolo Machiavelli, said:

There is nothing more difficult to take in hand, more perilous to conduct, or more uncertain in its success, than to take the lead in the introduction of a new order of things.

Look, I know that there are a lot of people in America who are worse off than I am. I realize I might have to give up some of my Medicare benefits not just to help those who have no coverage at all but also to save the nation’s health care system – and the entire economy. It will mean more penny-pinching, of course, but I am not about to grab a magic marker and draw horns on the President’s head.

I can’t speak for my fellow geezers, though. As the Los Angeles Times article says, President Obama, “could face another emotionally charged obstacle” to health care reform. I suspect that’s putting it mildly.

Read the Los Angeles Times article here: