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Don’t fall for Joe Namath’s ads

You probably have seen Joe Namath on television hawking Medicare Advantage plans. Don’t be fooled! Joe was a decent quarterback, but a health insurance expert, he is not. Right now, there are two versions of Medicare: Original (federal) and Advantage (commercial). In addition, there is a new program called REACH which can switch your plan from Original to a commercial plan without your consent. Commercial insurance companies such as United Health Care, Cigna, and Aetna make huge profits if they can sell their Advantage plans. These insurers are overpaid middlemen. They spend your premium dollars on fat-cat executive salaries, lobbying, investor dividends, advertising, and political donations, not on your medical care. In addition, the government subsidizes Advantage plans using Original Medicare funds, thereby making the Advantage plans even more profitable and depleting the Medicare Trust Fund.

Advantage plans will limit your care if they can. They will insist that your doctor prescribe certain drugs and not others. You will be restricted to a certain panel of doctors, and they will make it difficult for you to go to anyone outside this panel. If your doctor orders a test, they might not pay for it unless you get prior approval. If you get really sick and you want to switch back to Original Medicare because it provides more options, you will do so at a greater cost. If you switch from one Advantage plan to another, you may have to switch doctors as well.

Don’t be fooled by Joe Namath’s slick but empty promises. Commercial insurers have turned our health care system into an expensive, poor performing mess. They are profit motivated not patient-care motivated. The only way out of this mess is a federally funded single payer system which would insure everyone from birth to death.

G. Richard Dundas, MD


Medicare Advantage plans can improperly deny payment

When you opt for Medicare Advantage (MA) instead of traditional Medicare, you place decisions about your health in the hands of a big insurance company intent on making a profit. Three quarters of the MA business is currently in the hands of six huge insurers: Humana, CVS, Anthem, Kaiser Permanente, Centene, and Cigna.

Because of the “potential incentive for Medicare Advantage Organizations (MAOs) to deny beneficiary access to services and deny payments to providers in an attempt to increase profits,” the Health & Human Services agency Inspector General just reviewed the performance of MA insurers. The results were not good. Of the prior approval requests that MA insurers denied, 13 percent should have been approved. Of the payment denials by MA insurers, 18 percent were improper under both the rules of Medicare and the MA insurer’s own rules.

Some improper decisions were reversed by the MA insurer, but this often happened only after “a beneficiary or provider appealed or disputed the denial.” The three causes of these improper denials: Using clinical criteria that Medicare does not impose; requesting unnecessary documentation; and errors in the insurer’s manual review or system.

Since every improper denial is a money-saver for the insurance company, you have to wonder how intentional this rate of impropriety is. Since every improper denial is a hardship to a patient and/or medical provider, you have to wonder how the government can allow this kind of behavior, while also allowing MA insurers to tout the MA program as God’s gift to seniors. The government also knows that MA insurers are also manipulating the system to increase the amount of money they get from Medicare, a fiasco that is surely a testament to how much money these insurers devote to “shaping” regulators’ opinions.

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It will get worse. Ideas similar to those behind the Medicare Advantage program underlie Medicare’s new mania for “value based care.” The agency recently announced that all Medicare beneficiaries should be in value-based care programs by 2030.

Lee Russ


Another President Biden euphemism

President Biden recently said, “the MAGA crowd was the most extreme group in the Country.” I usually don’t believe in slogans but, in these trying times, how could make America great again be a bad goal for us. Then I asked myself the question did this Group burn down and loot our cities and kill and maim our citizens? The answer to this question is no. He must have been referring to ANTIFA and the gangs of losers and have-nots.

Is President Biden’s MAGA statement another one of his euphemisms, to be later clarified by his handlers? Did he realize that he was referring to 50 percent of our nation, and its leader, past Pres. Trump — who gave us so many successful plusses during his term that he in fact made America great again?

Let’s imagine getting back to energy independence, no budget busting inflation, full employment, respect from our allies as well as our enemies, stability in the Middle East, and too many other plusses to list here.

Let’s make it happen at the Polls this November, and at future elections.

Perry Green

Manchester Center


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