There is a great “tradition” in the U.S. regarding entrepreneurs [from the French entre (between) preneur (taker)]. Privatization of Medicare is bringing forth a host of what I have coined as entrevoleurs [from the French entre (between) voleur (thief)]. Direct Contracting Entities (DCEs) and their genetically modified sibling and newest scam, ACO Reach, are there to encourage and protect the entrevoleurs, while you are there to be had. We must not let this happen.
In an email to me and other constituents (see Files below), Representative Rick Larsen indicated that he has concerns about Medicare privatization. I had written to him to express my outrage at the imposition of a privatization of Medicare for beneficiaries under a Direct Contracting Entity at PeaceHealth. Larsen responded that he had written to Chiquita Brooks-LaSure, administrator of Centers for Medicare and Medicaid Services (CMMS) and asked her to address his concerns in these three areas:
• CMS is placing seniors into DCE care without beneficiary opt-in and with minimal or confusing notification
• Placing traditional Medicare plans in a contracted managed care system will incentivize DCEs to limit care in order to maximize profits
• In other parts of the country, DCEs have attracted bids from private companies without a history of health care management, which could lead to a reduction in quality of care
Although these are areas of the “Entities” that are cause for alarm, they are not the only ones. I would refer you to my previous articles (here, here and here) that contain more details about the privatization effort locally. At least Larsen has concerns, but much more needs to be done. My emails to Senators Cantwell and Murray went unanswered. However, a friend in town received a response from Cantwell that you can read in its entirety under Files below. The response did not specifically address DCE's and the activity taking place at PeaceHealth. Her generalized response was:
“Throughout my time in Congress, I have fought to protect Medicare. I oppose efforts to privatize, cut, or weaken Medicare. Medicare is a longstanding promise to seniors and individuals with disabilities and it has provided health and financial security for millions of Americans since its enactment.”
There is a lot of space for interpretation between Cantwell's words. More worrisome yet, in what appears to be a canned response that has gone out not only to constituents but to organizations opposing privatization, she goes on to say, :
“Instead of cutting Medicare benefits, we should be working to improve Medicare for patients while driving down costs. Under the current system, doctors and medical facilities are generally paid by the number of services they provide, without regard to the best outcome for the patient. That is why I authored a “value index” that puts the focus back on patient health, paying doctors more when they provide better care to their patients. It rewards quality over quantity. My value index is part of a new Medicare physician payment system that is beginning to move Medicare from a volume-based system to one that rewards high quality and high-value health care.”
Pardon me, but this language does not indicate that Cantwell is working to put the kibosh on privatization efforts. I am not the only one to see the holes in Cantwell's statement. Puget Sound Advocates for Retirement Action (PSARA) had this to say about this very paragraph in their March 2022 newsletter (scroll down to the newsletter). It was published following their attempts by letter to gain Cantwell's support for the fight.
“Does this mean she is supporting Direct Contracting? We intend to find out and at the same time we will let her know privatizing traditional Medicare is unacceptable and betrays the choice that 58 percent of Medicare beneficiaries made.”
Yup, Maria, it's pretty simple. And your response?
PSARA's newsletter goes on:
“Of the members who replied to us, all said they support Medicare and wanted us to know they will do their best to assure us access to the medical care we need. None of them committed to oppose Direct Contracting and some voiced support for the kind of privatizing programs we oppose. Clearly, we have a battle ahead of us to make sure no one privatizes our Medicare.”
DelBene’s legislative director replied to PSARA with this troubling remark:
“Rep. DelBene doesn’t like the [private equity] involvement and has been supportive of the Medicare Accountable Care Organization program which in simplest terms has the good parts of the DCE model but doing it in traditional Medicare not [Medicare Advantage] …”
Rep. Derek Kilmer wrote to PSARA's executive board members:
“The Center for Medicare and Medicaid Services has paused the Geographic Direct Contracting Model for further review and is no longer accepting applications for DCE. That said, like you, I understand the importance of ensuring that seniors have access to high quality, affordable health care. As the Direct Contracting pilot program is further considered by Congress, please know that I will keep your thoughts in mind.”
“Keep your thoughts in mind?" What is this pathetic response? Will he pray for us and Medicare too? Nothing but argle-bargle. And Derek, are you not aware that while the Center for Medicare and Medicaid Services was pausing the Geographic Direct Contract Model, they were creating a similar program called ACO Reach? This level of knowledge should be pretty basic for a member of Congress, or at least the staff who writes these nonsensical replies.
Unions for Single Payer Health Care has also answered the call to defeat privatization efforts. Their take on the PSARA newsletter article can be found here. Luckily, there is a resurgence in the U.S. in creating unions, many of which are supportive of Medicare and are also fighting for single payer health systems.
Our local legislators in Olympia ought to be brought up to speed on the attempt to rob from Medicare at the expense of its beneficiaries. Washington state law is not silent on Medicare related issues. (Chapter 48.66 RCW - MEDICARE SUPPLEMENTAL HEALTH INSURANCE ACT)
"CW 48.66.160 Federal law supersedes.
In any case where the provisions of this chapter conflict with provisions of the "Health Insurance For The Aged Act," Title XVIII of the Social Security Amendments of 1965, or any amendments thereto or regulations promulgated thereunder, regarding any contract between the secretary of health and human services and a health maintenance organization, the provisions of the "Health Insurance For The Aged Act" shall supersede and be paramount."
So any mucking about by the CMMS with their entrevoleurs and their privatization schemes du jour, all presumably has to be de-conflicted at the state level. Obey we must.