About Dick Conoboy

Dick Conoboy is a recovering civilian federal worker and military officer who was offered and accepted an all-expense paid, one year trip to Vietnam in 1968. He is a former Army Foreign Area Specialist for Western Europe and Southeast Asia, counter-terrorism intelligence analyst and information/security manager at the Defense Department. Dick also worked as a resource manager at various government offices to include then VP Al Gore’s National Partnership for Re-inventing Government, now recognized as having been a shamefully neo-liberal “think tank”. He speaks fluent French and a passable English learned through many years of elementary school experience diagramming sentences. Dick owes his writing ability to consuming large amounts of chemical laden and fried fresh water pike and perch fished from Lake Erie in the 40s and 50s near his native Cleveland whose Cuyahoga River regularly catches on fire.

By: Dick Conoboy (315)

Medicare (Dis)Advantage - Even Hospitals Don’t Like It.

If the hospitals are smelling a rat, so should Medicare (Dis)Advantage victims (AKA enrollees).

If the hospitals are smelling a rat, so should Medicare (Dis)Advantage victims (AKA enrollees).

By

“We hear every day, from our hospitals and health systems across the country, about challenges they experience with Medicare Advantage [MA] plans,” said Michelle Millerick, senior associate director for health insurance and coverage policy at the American Hospital Association, which represents about 5,000 hospitals. The hurdles include prior authorization restrictions, late or low payments, and “inappropriate denials of medically necessary covered services,” she said. (Kaiser Family Foundation (KFF) Health News March 29, 2024)

I have already described in many previous articles the horror show that Medicare (Dis)Advantage has become for those unfortunate enough to have opted for one (see articles in Related Links below). MA eats away at the Medicare Trust Fund at the rate of $80-$140 BILLION a year, money that could have gone directly for the care of the Medicare insureds but that is re-routed into the coffers of hedge funds and insurance companies. It is unarmed robbery, but robbery nonetheless. This video, prepared by Students for a National Health Plan (SNaHP) recaps in 30 minutes the present situation with MA.  

I am not, however, crying crocodile tears for hospitals who take advantage of the system even as some complain about prior authorization, late payments, or denial of service. The hospital won't die because of shitty insurance. People do. Some hospitals grab onto the MA gravy train with eager abandon by entering into programs such as ACOReach, a form of the scheme previously known as Direct Contracting Entities. Our own monopolizing PeaceHealth (PH) hospital behemoth moved thousands of it clients with primary care doctors at PH, without their consent or knowledge, from Traditional Medicare (TM) to its “special money extraction unit” (ACOReach) that they blandly call Cascadia Community Care Alliance, which has little to do with community or care but much to do with sucking dollars from the teat of the Medicare Trust Fund. No doubt you will soon see comments below from their corporate office trying to defend the indefensible, their very own ACOReach, as they did with one of my previous articles, “Growth of Medicare’s ACO Reach Scam Halted”.  

What then to do?

I recently received an email from Physicians for a National Heatlh Plan (PNHP) reporting that 60 members of the U.S. House of Representatives sent a letter to Medicare administrators indicating the ways MA harms those enrolled in Medicare. The letter can be read in its entirety here. Meanwhile, let me direct you to this part: 

Supporters of MA claim the program reduces costs. Unfortunately, the MA program has never saved the government money.

1. In fact, spending per beneficiary is growing faster in MA than in TM, and the Medicare Payment Advisory Commission (MedPAC) estimates that CMS pays MA plans 6 percent more per enrollee than what it would cost to cover the same enrollee in TM.

2. Despite these higher costs, the data demonstrates that MA often provides worse coverage than TM. For example, a recent study found that people in MA are significantly more likely to die in the month following surgery for stomach, pancreatic, or liver cancer compared to people in TM.

3. Other recent data has shown that the bottom 5 percent of MA plans are responsible for 10,000 preventable deaths every year.

The letter goes on to say that to improve patient health, reforms are needed to:

1. Ensure that insurance companies do not prevent older adults and people with disabilities from getting care by putting up obstacles, including onerous prior authorizations, Artificial Intelligence (AI) algorithms [sets of computer procedures], or limited networks;

2. Strengthen provider encounter and patient data collection and transparency to improve public understanding of the effects of insurer-run MA plans on patients and the Medicare program;

3. Rein in overpayments to insurers in MA by adjusting benchmarks to compensate for favorable selection and cracking down on deceptive tactics by private insurance companies, including upcoding; and

4. Strengthen Medicare for everyone through administrative action, such as by lowering Medicare premiums, and support legislative efforts to expand Medicare benefits, cap out-of-pocket (OOP) costs in TM, and adjust the physician fee schedule to account for increases in provider costs.

Locally, the Whatcom Democrats have gone further and unanimously passed (70-0) a resolution* asking the Biden administration to:

1.Phase out all MA programs and return all Medicare insureds to Traditional through a
detailed transition process.

2.Move to a single payer national health plan: Medicare (TM) for All.

3.Add vision, hearing, and dental coverage to Medicare for All.

4.Eliminate the 20% co-pay
 

The Whatcom Democrat's platform now contains these planks. 

1.Federal Government: Terminate efforts to privatize original Medicare (Medicare “Advantage” is already privatized) through Direct Contracting Entities (DCE) or anything similar, and prohibit the practice of assigning original Medicare recipients to these entities without their prior consent.

2.PeaceHealth: Cancel the Medicare DCE contract. [AKA Cascadia Community Care Alliance]

3.Federal Government: Phase out so-called Medicare Advantage, which, despite its misleading name, is privatized, and costs the government more per person than traditional Medicare. That difference could fund vision, dental, and hearing benefits.

4.Congress: Expand Medicare to include vision, dental, and hearing benefits.

5.Congress: Pass a single-payer health care system such as Medicare for All.

In short, we should immediately stop the bleed caused by MA and ACOReach, while moving quickly to a nation-wide single payer system for delivery of healthcare. All else is lipstick on the pig and polishing the proverbial turd.

*Full Disclosure - I drafted the original version of this resolution.

 

 

Related Links

About Dick Conoboy

Citizen Journalist and Editor • Member since Jan 26, 2008

Dick Conoboy is a recovering civilian federal worker and military officer who was offered and accepted an all-expense paid, one year trip to Vietnam in 1968. He is a former Army [...]

M. Lynda Hanscome

Mar 31, 2024

BRAVO to Dick Conoboy!!!!

I am one of the 2.1 million TM beneficiaries who was dumped in an ACO-REACH for-profit Medicare Scam WITHOUT MY KNOWLEDGE OR CONSENT—PeaceHealth, I’m lookin’ at you….   It is ALL about Upcoding on the front-end by exaggerating medical prognosis and once the for-profit gets the money-in-pocket to “manage” the paitent, they subsequently delay or deny necessary treatment.  Don’t get me started about PeaceHealth, medical crooks of Bellingham.  I am in the process of cutting off PeaceHealth from ever receiving any future Medicare information about me; I have begun travelling outside of Bellingham for my minimal medical needs.

These Medicare Scams will ONLY stop when ALL beneficiaries (including future beneficiaries) stand up and demand the raiding of the Medicare Trust Funds stop.

Thank you, Dick, for your outstanding coverage of this issue.

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Medicare (Dis)Advantage - Even Hospitals Don’t Like It.

By Dick ConoboyOn Mar 31, 2024

If the hospitals are smelling a rat, so should Medicare (Dis)Advantage victims (AKA enrollees).

1 comment, most recent 2 weeks ago

The $5 Trillion National Infrastructure Bank Is Looking Better Every Day

By Dick ConoboyOn Mar 27, 2024

With such a bank in place, we would likely not be scrambling around and asking Congress for rebuild monies, as we are now with the catastrophic event involving the Francis Scott Key bridge on March 26, 2024.

Just What We Need - A Bank in Fairhaven

By Dick ConoboyOn Dec 05, 2023

Peoples Bank proposes to tear down the once popular Zane Burger restaurant to build a branch office.

3 comments, most recent 4 months ago

Chutzpah Redefined - Call For Citizen Policing of Medicare Advantage

By Dick ConoboyOn Dec 02, 2023

Biden administration is asking the public to report on bogus advertising claims of Medicare Advantage providers.

7 comments, most recent 4 months ago

Reference:  Swanson Note #1

By Dick ConoboyOn Nov 19, 2023

Click here to return to article.NOTE 1Starting with data, Georgetown University’s Center on Education and the ...

Scamming Our Veterans

By Dick ConoboyOn Nov 17, 2023

There seems to be no barrier to the depths to which scammers will go to steal money from the most vulnerable or deserving.

Some Thoughts on Veterans Day 2023

By Dick ConoboyOn Nov 10, 2023

Merely musing about soldiers.

4 comments, most recent 5 months ago

Retirees With Federal Employee Health Care - Beware Of Offers To Switch Drug Coverage

By Dick ConoboyOn Nov 04, 2023

Getting a letter that declares, “An exciting new prescription drug benefit for you!” should activate your BS detector.

7 comments, most recent 4 months ago

Memorial Event for Wendy Harris

By Dick ConoboyOn Oct 19, 2023

Wendy was an intrepid voice for the environment and the humane treatment of animals. May her memory be for a blessing.

3 comments, most recent 5 months ago

Signing On To Medicare Advantage?  Don’t!

By Dick ConoboyOn Oct 18, 2023

Or at least, take a moment to learn about the privatization of Medicare, commonly called Medicare [Dis]Advantage.

1 comment, most recent 5 months ago

Proposed Congressional Gold Medal For The Donut Dollies Gets a Boost

By Dick ConoboyOn Sep 24, 2023

The President of the American Red Cross has come out in support of the Gold Medal for the Dollies who served in Vietnam

Renewed Push for a National Infrastructure Bank

By Dick ConoboyOn Jul 28, 2023

This legislation calls for a $5 trillion National Infrastructure Bank that will finance the nation’s infrastructure needs without involving the budget or adding to the national debt.

4 comments, most recent 7 months ago

Support Russ Whidbee For City Council At-Large

By Dick ConoboyOn Jul 07, 2023

Experience counts.

3 comments, most recent 7 months ago

Flippin’ CityView

By Dick ConoboyOn Jun 29, 2023

The developer, who bought the property to build the private student dormitory, CityView, now has a very, very large white elephant on his hands.

3 comments, most recent 9 months ago

Donut Dollies In Vietnam - Three Did Not Come Home Alive

By Dick ConoboyOn May 22, 2023

They died in Vietnam supporting and entertaining the troops. Memorial Day is for them too. So is a Congressional Gold Medal.

National Infrastructure Bank…And The State Of Washington

By Dick ConoboyOn May 14, 2023

The state of Washington has much to gain by the passage of a bill that will provide for $5 trillion to finance infrastructure nationwide.

3 comments, most recent 10 months ago

Private Armed Guards in Bellingham

By Dick ConoboyOn May 10, 2023

This is not a new phenomenon in our city.

City Council Review of Rental Registration and Inspection Ordinance

By Dick ConoboyOn Apr 25, 2023

A review and update of Bellingham’s rental registration and inspection program is long overdue.

10 comments, most recent 11 months ago

Ban All Firearms

By Dick ConoboyOn Apr 10, 2023

Ban them all. Forever. Every single, solitary firearm in the U.S.

18 comments, most recent 11 months ago

Public Banking Bill Fails In Committee

By Dick ConoboyOn Mar 13, 2023

The Senate Committee on Business, Financial Services, Gaming & Trade failed to vote the bill out of committee, but it can be revived in the second year of the biennium.