Problems with Medicare

Medicare as we know it has evolved substantially since its inception to cover more people in an increasingly comprehensive manner. This has of course led to increases in program cost. Private alternatives to medicare tend to be more efficient relative to cost secondary to their ability to make arbitrary coverage decisions. Medicare however, has always sought to pool risks; that is no enrollee can ever lose their coverage due to ill health.

Concerns with medicare include improving benefits, legitimate prescription drug coverage and cost-sharing issues. Also, I have been advised that there are often significant delays in making payments to providers. One of the primary goals of medicare has been to achieve some equality in service delivery without regard to economic status.

Medigap plans have evolved to assist patients in managing so-called gaps in medicare coverage. These plans have changed from community rated premium model, to a system whereby premiums rise with age, thus becoming increasingly unaffordable for those with average incomes.

Medicare "Advantage" Plans...

A Poor Substitute for Your Medicare!

It is amazing how easily most Americans merely take for granted the limitations on care available to them accorded them by their insurance companies. These inequities in my opinion as a health care provider, should not exist. If you have been a good law abiding citizen you should not have limitations on your access to quality health care spanning the full spectrum. The most outrageous aspect of the entire issue of financing access to health care in America is the charade that so many Americans at every socio-economic level have perpetrated upon them by shady insurance sales people.

People often believe erroneously that they have "good coverage" until they become ill with a serious disease such as cancer. The most nefarious aspect of this entire charade is that when signing up to trade their Medicare for an Advantage plan, the customer is not even aware of the differences in coverage between Medicare and the replacement plan that may well come back to harm them later both physically and financially.

While the warnings to Medicare beneficiaries are outlined in their manual of benefits, many continue to be lured away from their secure Medicare health care plan to the privately sponsored for profit Medicare Advantage (REPLACEMENT PLANS) by slick advertising both in print and paid television programming.

While the content of the advertising features healthy active seniors boasting about how much cash they are saving in monthly premiums and freebies, nary a mention is made about what seniors are giving up in return for the freebies.

Never does one hear about whether or not a given plan includes 100 days of skilled nursing facility in-patient rehabilitation coverage as does Basic Medicare. No mention of exhorbitant co-pays... or the need to use in-network doctors which may exclude the patient from important specialty care without additional costs and most importantly, delays in treatment related to the need acquire approval from the Insurer.

As a provider of health care, I have witnessed the shenanigans associated with Advantage coverage where in my mind as a provider of care, the ONLY "advantage" associated with Medicare Advantage plans... accrues to the Insurer. Additionally, the choice of physicians is often limited to these unwitting Advantage clients, due to the fact that many of the best providers do not accept certain plans due to low/delayed reimbursement and/or circuitous and complicated claims processes.

As I have navigated the approval process working with families and patients to secure vital diagnostic/treatment services through the system put in place by corporate insurers via policies facilitated by corporate-owned politicians, I have characterized this phenomenon as "The Lawyering of Health Care."

Meanwhile, as with private health care coverage, provider reimbursement levels have not kept pace with cost, increasingly leading to providers declining to accept medicare patients. Access to a full range of providers is therefore limited in some cases by a patient's coverage and inability to pay for medical services.

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