Progressives-- And The American People-- Want To Expand Medicare; Conservatives Want To Privatize It
Trump moved forward with a pilot program that would lead to privatizing Medicare. Shockingly, the Biden administration has continued it. Congress has been largely silent. Before we look at the piece on this that Jake Johnson wrote, I want to refer to a couple of questions about expanding Medicare that Data For Progress asked voters last week (and published yesterday):
Even Republican voters say they would be more likely to support the Build Back Better Act if it includes allowing Medicare to negotiate the cost of certain prescription drugs, something that is currently being blocked by corrupt Republicans plus corrupt Democrats Joe Manchin and Kyrsten Sinema. Johnson made the point last week that corrupt conservatives in thrall to Big PhRMA want to move the opposite direction... and already are. "A Trump-era pilot program," wrote Johnson, "that could result in the complete privatization of traditional Medicare in a matter of years is moving ahead under the Biden administration, a development that-- despite its potentially massive implications for patients across the U.S.-- has received scant attention from the national press or Congress.
Advocates have been publicly sounding the alarm about the DC program for months, warning that it could fully hand traditional Medicare over to Wall Street investors and other profit-seekers, resulting in higher costs for patients and lower-quality care.
"Everything we know about Direct Contracting should be cause to halt the pilot," Diane Archer, the founder of Just Care USA and the senior adviser on Medicare at Social Security Works, told Common Dreams in an email. "Direct Contracting effectively eliminates the more cost-effective traditional Medicare program designed to ensure that people with complex health conditions get the care they need."
"The Direct Contracting experiment is likely to be both a healthcare policy and a political nightmare," Archer argued. "We already know from the Medicare Advantage experiment that Direct Contracting won't save money, nor will it be able to show improved quality."
But healthcare campaigners' concerns have fallen largely on deaf ears in Congress and the Biden administration, which has allowed much of the pilot program to proceed as planned.
In a phone interview with Common Dreams ahead of Tuesday's demonstration at HHS headquarters, Dr. Ed Weisbart-- chair of the Missouri chapter of Physicians for a National Health Program (PNHP)-- said that Congress is largely "asleep at the switch" as Wall Street-backed startups and private insurance giants close in on traditional Medicare, a 56-year-old program that covers tens of millions of U.S. seniors.
"People don't know that it's happening," Weisbart, one of the physicians traveling to the nation's capital, said of the DC experiment. "Most people in Congress don't know that it's happening. We've started having some of these conversations with congressional staff, and we're hoping to have many more of them next week when we're there, but it's not on their radar either."
"That's the disturbing part," he added. "How radical the transformation of Medicare is becoming under this new model, how widespread it will be-- it'll be the entire book of business-- and yet that's occurring with neither the awareness nor consent of Congress."
The DC program was established by the Center for Medicare and Medicaid Innovation (CMMI) during the waning months of the Trump administration, which included former pharmaceutical industry executives, Wall Street bankers, and right-wing policy consultants notorious for gashing public health programs.
Under the DC model, so-called Direct Contracting Entities (DCEs) are paid monthly by the Centers for Medicare and Medicaid Services (CMS) to cover a specified portion of a patient's medical care—a significant shift from traditional Medicare's direct reimbursement of providers.
DCEs are allowed to pocket the funding they don't spend on care, an arrangement that critics believe will incentivize the private middlemen to skimp on Medicare patients-- many of whom could be auto-enrolled into DCEs without their knowledge or permission.
According to a policy brief released by PNHP, "Virtually any company can apply to be a DCE, including investor-backed startups that include primary care physicians, [Medicare Advantage] plans and other commercial insurers, accountable care organizations (ACOs) or ACO-like organizations, and for-profit hospital systems."
"Applicants are approved by CMS without input from Congress or other elected officials," the group notes.
At present, the pilot includes 53 DCEs in 38 states, Washington, D.C., and Puerto Rico. Drs. Richard Gilfillan and Donald Berwick pointed out in a September article for Health Affairs that 28 of the current DCEs are controlled by investors, not healthcare providers. A second tranche of DCEs is expected to debut in January 2022.
Dr. Ana Malinow, a physician from San Francisco who is taking part in Tuesday's petition delivery, said in a statement that "Medicare Advantage-- the first wave of Medicare privatization-- showed us that inserting a profit-seeking middleman into public coverage does not save money for taxpayers, but rather costs more money while also taking away care choices from seniors."
"If left unchecked, the Direct Contracting program will hand traditional Medicare off to Wall Street investors, without input from seniors, doctors, or even members of Congress," said Malinow. "Health and Human Services Secretary Xavier Becerra has the power to stop this Trump-era program in its tracks, and must do so now."
The DC experiment was launched by the Trump administration but actually has its roots in the Affordable Care Act (ACA), which established CMMI with the stated goal of identifying "ways to improve healthcare quality and reduce costs in the Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) programs."
The ACA granted CMMI, also known as the Innovation Center, the authority to test alternative payment and service delivery models on a national scale without congressional approval-- latitude that, in the hands of the Trump administration, ultimately spawned the DC pilot program.
CMMI is currently headed by Elizabeth Fowler, who previously served as vice president of public policy and external affairs for WellPoint, Inc.-- a health insurance giant that later became Anthem. Fowler also worked as chief health counsel to former Senate Finance Committee Chair Max Baucus, a right-wing Democrat who infamously had single-payer proponents arrested in 2009 and helped ensure that the ACA did not include a public option.
Weisbart told Common Dreams that while the creation of CMMI may have been well-intentioned, the body's ability to "so fundamentally and radically transform a public health program that so many Americans rely on" without congressional approval or oversight is a real danger that lawmakers must take seriously.
"Someplace there needs to be congressional oversight," Weisbart said. "When the public does finally find out that [lawmakers] were asleep at the switch, they're not going to be happy. This is your chance to do what democracy is intended to do."
The Biden administration paused the most extreme form of Direct Contracting-- known as the Geographic (GEO) model-- in March, but it is allowing the Global and Professional Direct Contracting (GPDC) pilot to move forward. According to CMS, the GPDC pilot is expected to play out over a six-year period.
While lawmakers have largely been quiet about the Medicare experiment, a handful of Democratic members of Congress have echoed grassroots demands for an immediate end to the DC program in recent months.
"We appreciate that you paused implementation of the Geographic model," Reps. Lloyd Doggett (D-TX), Bill Pascrell (D-NJ), Mark Pocan (D-WI), and Katie Porter (D-CA) wrote in a May letter to Becerra and then-Acting CMS Administrator Elizabeth Richter. "However, we remain worried that the 53 DCEs participating in the GPDC model, a policy launched under the Trump administration, lacks oversight to protect Medicare beneficiaries' care."
"As members of Congress committed to protecting Medicare beneficiaries," the lawmakers continued, "we ask that CMS immediately freeze the harmful CMMI DCE pilot program including the Geographic model and the Global and Professional Direct Contracting Model and evaluate the impact to beneficiaries."
In September, Porter took part in a PNHP-hosted webinar that spotlighted the potentially far-reaching harms of the DC pilot.
"This program was supposed to make Medicare more efficient," said Porter. "But actually it does just the opposite. Rather than allowing patients to go to providers directly under traditional Medicare, DCEs invite insurers and investors to step in and interfere with the care that Americans get."
"This Direct Contracting Entity model is just one more example of the Trump administration's many attempts to wreck a functioning, successful, popular government program for the sake of lining the pockets of its corporate donors," Porter added. "The bottom line for Direct Contracting Entities is not to improve the quality of care. They drive up costs for patients to maximize their profits."
In a column earlier this month, the Houston Chronicle's Chris Tomlinson argued that the Biden administration's decision to allow the DC program to continue "reflects for-profit health companies and investors' power over both political parties."
"Direct Contracting is also likely to kill any chance for progressive Democrats to make Medicare an option for any American who wants to enroll," Tomlinson added. "If the government puts private companies in charge of all Medicare patients, it will eliminate any opportunity to overhaul our healthcare system truly."
"Next year," he added, "millions more Americans will find themselves in privatized Medicare, and most will never know what happened."
This morning, I spoke with 5 progressive candidates for Congress about the conservative push to privatize Medicare. Please read their responses below and consider contributing to their campaigns if you would like to see any of their perspectives be part of the fierce debate in the next, possibly Republican-controlled, Congress. You can contribute to all of them or to any of them by clicking on the 2022 Blue America congressional thermometer on the left (or by clicking on this link). This isn't a drill; this is real... and it is NOT "moderates" or conservative Democrats who are going to protect Medicare. It's people like these:
Mike Ortega is running in a deep blue Orange County district currently held by a reactionary Blue Dog. Mike pointed out that "About 80% of Democrats and nearly 50% of Republicans know that we need an expanded and strengthened Medicare For *All*. That fight has strengthened in this last years, and I’m running to take it across the finish line. In the meantime, our current Medicare system, relied upon by millions, is being attacked right under our noses. I applaud the efforts of our neighboring district’s representative Katie Porter for her strong efforts to end this corporate takeover and ultimately assault of millions of patients’ quality of care. Our opponent here in CA-46, Lou Correa, continues to take tens of thousands from pharmaceutical and insurance corporations every cycle. He has already sold our nation down the river when it came to lowering prescription drug prices this year. He’s no fan of Medicare For All. In fact, his silence here shows his cards. He’s against our fight for single-payer and health care as a human right.”
Steve Holden would like to represent his neighbors in the Syracuse-centered Central New York district held by Republican John Katko. He told me that "The expansion of Medicare is something that is popular, even in red states. For example, in the state where I was raised, Oklahoma, voters passed Medicare expansion. This policy, which I support, is supported by 60% of Americans-- Democrats, Republicans, and Independents alike. As someone who has had to deal with privatization of mine and my wife’s health care (Tricare) once I retired from the Army, I can tell you, that it is fraught with more problems. Dealing with providers, copays, and long waiting lists are common. My father recently had double cancer surgery. Instead of being concerned about his upcoming surgery, he was more concerned with his monthly premium payment. If we choose to privatize, in the middle of a global pandemic, we will have more at-risk individuals, such as my father, in this predicament. My opponent, John Katko, gets large amounts of money from medical insurers and Big PhRMA. I oppose any sort of privatization and support Healthcare for All.
Jason Call, the progressive crusader in northwest Washington noted that "It’s an absolutely terrible idea to privatize Medicare, let’s start there. To take what is actually a pretty good healthcare system on paper (needs to be improved, hence National ‘Improved’ Medicare For All) and turn it over for profiteers is unconscionable. One of the reasons Medicare works well is because it is a public system that can put dollars into actual healthcare instead of CEO and shareholder profits. Healthcare is a terrible product for insurance because insurance is exclusionary. Insurance wants to keep the good risks and reject the bad risks. That is an automatic failed scenario for the tens of millions of people in this country who have health problems and need care. They are going to be denied or priced out because that’s literally what insurance does for bad risks. It’s why the insurance pool needs to be the whole country-- everyone in, nobody out. The incumbent I’m running against in WA-02 does not feel that way. He’s has hundreds of thousands of dollars thrown at him by the for profit health industry, and he’s stated numerous times that he won’t support a single payer system. He’s said he would support a public option, but here’s the problem with a public option-- it leaves the private insurers with a lot of profit making power (they can keep the good risks and their premiums), while shuffling the bad risks onto taxpayers. The bottom line is healthcare should not be a profit making venture, and there’s no inherent right of the health insurance to even exist as a private business sector. We could end it with the passage of Medicare For All, but damn if Biden isn’t going to take it in completely the wrong direction here, yet another abject failure of expectations.
Culver City mayor Daniel Lee is the progressive candidate for the open Karen Bass seat in Los Angeles-- and a Medicare-for-All advocate. Last night he told me that "It seems like the Biden administration is committed to going in the wrong direction when it comes to expanding or contracting healthcare. Our healthcare system already rations access and this privatization scheme hatched under the Trump administration and inexplicably extended by the Biden administration seeks to put that on overdrive. Rather than going in the opposite direction and extending high quality universal healthcare to all through Medicare for all. We need to reverse course immediately."
Virginia progressive Ally Dalsimer, who has a family member in an ICU and spoke to me from the hospital today, told me that "While I could say a lot about how our medical system is broken and corrupt, and how this new pilot program would only exacerbate the issue, the bottom line is that corporately-funded Dems, like my opponent, have a vested interested in maintaining the status quo and in making sure that profit is NOT removed from health care. It's perverse, and it's a major driver in why I'm running against an incumbent who just doesn't get it. He has said he will 'never' support universal healthcare; he thinks having profit-driven insurance companies at the helm is somehow a better option. Well, it's not. The vast majority of Americans support true Medicare for All-- let's hope we can get some folks elected who want to help make that happen, instead of pursuing failed and unpopular policies that only hurt Americans and their families.