Who do you trust with your healthcare?
A private/for-profit insurance company?
Had a rather interesting conversation with a neighbor about Medicare, the election, and he and his wife’s Medicare coverage. They are really nice folks and enthusiastic Trump supporters, but were not aware of Trump’s plans for Medicare as outlined in Project 2025 (written by over 100 former Trump administration officials and campaign supporters).
In a nutshell, Medicare would be turned over to private and for-profit insurance companies.
There are a whole lot of problems with this.
First, unlike traditional Medicare, MA members have little control over their health care…MA members have to:
go through hoops to get needed care…the insurer decides if the care is necessary and if they will pay for it,
In 2021, patients and their providers had to file 35 million PA (Prior Authorization) requests in order to receive medical care... Eighty percent reported that PAs caused the abandonment of recommended treatment, and 33% reported that they caused a serious adverse event for their patients.
go only to those hospitals, health systems, doctors and other healthcare providers that are in the insurance company’s network. So, if the Mayo Clinic or Cedars Sinai or Sloan Kettering isn’t in your network, you can’t get care there, and
make sure their medications are approved by the insurer, or pay out of pocket,
and keep up with changes to their insurer’s network of providers…there’s been a lot of provides leaving MA plans due to the vey low reimbursement.
Incentivized to spend as little as possible, MA plans pay healthcare providers less than Traditional Medicare. As a result, an increasing number of doctors and providers are declining to accept MA patients, further restricting MA networks and access to care. Additionally, lower payments can prevent doctors from providing the best quality care. In comparison, around 99% of non-pediatric physicians accept Traditional Medicare.
Second, MA is pretty darn expensive for taxpayers mostly because it has generated gargantuan profits for insurers. In 2021, MA companies had a gross profit margin of $1,730 per enrollee, which is more than double their profit margin on the individual market ($745).
Third, Medicare would not be allowed to negotiate drug prices.
This would dramatically increase both seniors’ and taxpayers costs. Estimates are the average Medicare member would pay about $400 more per year out of pocket.
What does this mean for you?
If you want insurance companies to control the care you can get and where you can get it, you’ll love a Trump Administration.
Joe, Interesting observations. Did you notice that your description of the Medicare system's medical care "restrictions" and claims management, strikingly resemble the work comp system? Certainly the private equity/for-profit comp health care management/claims adjudication programs fit that description. As restrictive as your descriptions sound, my personal experience with Kaiser's Medicare Advantage program here in northern California is medically and financially outstanding.