TRUE AMERICAN ADVANTAGE. Medicare is too expensive, encourages extraordinary spending, and needs to be modernized. Extending it, the way the Democrats are proposing will make it impossible for the United States to ever achieve a competitive Health Care GDP (NHC-GDP). Since Medicare Advantage is the most popular health plan in the United States, expanding it for All Americans should be more popular. A properly designed Medicare-Advantage-For-All plan could also reduce our NHC-GDP by $1.3 Trillion Dollars, to 12% of total GDP, by reducing or eliminating just half of our chronic illness. And, that would be just the beginning. The national value-based Wellness and Well Being program could be a catalyst for far greater reductions in the total national health care expenditure. We envision the need for a two-stage process. First, we need to pass the Medicare Advantage For All with an integrated value-based Wellness and Well Being program. And then, we need to use the Medicare Advantage For All program as a catalyst for a national effort to reduce our NHC-GDP to the lowest level of all the developed nations of the world.
THIS IS A TRUE AMERICAN PLAN. The Medicare Advantage program was made in America; it was created and operates in the true American way. We believe that our freedom comes from having a balance of countervailing powers that protect us from tyranny. This is certainly the case with our health care system, which is one of the most powerful industries on earth. Our health care industry is the sixth-largest employer in the United States and, it costs us Trillions of Dollars annually. Americans can not trust our government to have sole responsibility for our health care.
- We certainly can not trust the health care providers, whom we ultimately have to pay for their medical service.
- And, there is no way we are going to trust our health insurance companies, that Senators Bernie Sanders and Elizabeth Warren hate so much.
- We can't trust the federal or state governments because they have let our health status deteriorate to the point that we are ranked 37th in the world by the World Health Organization in terms of quality health care.
In fact, the ONLY ones we can trust are ourselves, as the consumers or health care. After all, we are the voters. We are the taxpayers that pay for it all, and we have the right to be in charge of our own health care.
We, the People, must increase our control over our health care and move into the driver's seat as the decision-makers for our own health. We must have as free a choice of doctors and hospitals and as free a choice of competing for health insurance plans as possible. Government programs like Obamacare should not cause us to have access to health care denied. We need to know how much things are going to cost. We need to know what we have to do to become True Americans for Healthy Living. We need to be able to lower our cost of health insurance and to improve our own health. A Trump Medicare-Advantage-For-All program will ensure that We the People can control our own health care.
WHAT IS THE TRUE "ADVANTAGE" OF A MEDICARE FOR ALL AMERICANS?
This is the way it is supposed to work. We must have doctors and hospitals that are committed to doing no harm and dedicated to finding the best and most effective way to allow us to take our health into our own hands. However, these doctors and hospitals that serve us must do their work in a cost-effective manner. They can not charge anything they want to charge, and they can not decide to pay themselves any amount of money. Private health insurance companies must keep that from happening. These health insurance companies must have customers in a free and open health insurance market that has real competition. We True Americans do not have this system today under Obamacare! In order for these insurance companies to be successful, they have to be able to attract new subscribers. In order to do that, they must be able to charge rates that customers can afford. In a free market, with real competition, this is possible. The government's role is to protect the consumer and make sure that all Americans have access to a fair system. If anyone of these roles gets exaggerated and out of sync with the other, we get what we have today, which is almost complete disfunction and severe suffering among the people.
The Medicare Advantage (MA) programs now ensures almost Twenty-five (25) Million Americans with comprehensive health insurance, at a lower federal cost than either "Traditional" Medicare or Obamacare/ACA. The affordability of health insurance is the last, and most important, piece of our Truly American health care system mosaic that we must complete. The Democrats call for "Medicare for All" is a testament to our collective failure to solve the problems with Obamacare (ACA). At Medicare-Advantage-For-All.com, we have a sincere desire is to finish this important work of art!
In 2015, the basic annual Per Member cost of the ACA was $10,538 and with various add on $13,198, not counting the expenses associated with the Market Places. The comparative cost of Medicare Advantage (MA) programs was $9,719 Per Member. Check out our "Finance" page for the full explanation. There was not only a huge difference in cost; the Medicare Advantage health insurance plans were generally more comprehensive than the Obamacare / ACA benefit plans. MA benefit plans generally exceed Traditional Medicare benefits. Please see more detailed benefit descriptions on the Learn More Benefits Page. They are required by law to be equivalent comprehensive benefits with RX and wellness benefits, reasonable deductibles, and in most jurisdictional US counties have a zero dollar ($0.00) out-of-pocket premium for the beneficiaries. The affordable ACA health plans are generally the exact opposite, with multiple thousand-dollar deductibles, high out of pocket expenses, and generally expensive and inflationary premiums for those who do not qualify for federal subsidies. Most Americans have more than 18 MA Plan Choices where they live. This contrasts with only One or No ACA Plan choices available in 52% of the jurisdictional counties in the US. This is an ugly truth. Most Americans would not even believe it, because they have comprehensive health insurance coverage through their employer and are not affected by it!
We believe that CMS can effectively contain the wildfire of health care costs by initiating unified national Medicare payment reforms that will allow Medicare Advantage plans to collectively use their buying power and the massive influence of the federal government to impact the providers market power and effectively increase control and reduce the cost of health care and RX. We believe that we need to commit ourselves as a nation to the goal of achieving the lowest national health Care GDP of all the developed nations in the world by 2030. We believe the way to effectively reach that goal is the design of a new Defined Contribution Medicare Advantage plans that incorporate the knowledge and experience we have gained from Medicare, Obamacare, CMS, the AMC's and employer Health and Wellness programs. Like with did with Apollo 11, we need to pull the technology and expertise that we have developed into the health insurance programs of the future.
REPUBLICAN FAILURE
Even though the United States has generally fewer uninsured than at any other time in our history, the failure of the Republican Party to come up with a viable alternative to the ACA, and the fact that we have 33 Million Americans uninsured, has exacerbated this national crisis and thwarted the efforts of our health insurance carriers and health care providers to further extend their services to All Americans. What we need to see is more practicality and creative leadership devoted to this problem. The Mercatus Center at Georgetown University just released a comprehensive study showing that “Medicare for All” would cost them $32.6 Trillion Dollars over the first ten (10) years. Our country currently has a total national debt of approximately $21.7 Trillion Dollars. Based on these numbers, conservatives will successfully oppose “Medicare for All” so long as Republicans maintain control of the Senate. The taxpayers are not going to let them remain in office and spend that much money, no matter what improvements it may make in our health care!
We DO NOT want Congress to FAIL in its effort to successfully deliver the best possible medical care to All Americans at the lowest possible cost. It has been twenty-five years since Hillary Clinton brought us this close to fixing the system, and what is happening now, is setting us for failure once again! We are at a definite tipping point. What We (The People) need NOW is a True American politically BIPARTISAN effort focused on a more practical way of achieving this vital goal. We cannot afford to FAIL this time because, unlike 25 years ago, our national health condition has deteriorated to the point that we are on the verge of some real suffering! And, this is NOT caused by greedy health insurance companies and not having good health insurance! This is NOT entirely from a failure of medical care for our people. Our Medicare-Advantage-For-All.Com reform movement is THE ANSWER! Our membership consists of Democrats and Republicans (True Americans) who support a Medicare-Advantage-For-All plan for every U.S. resident as the very best and the most responsible way to accomplish the “Medicare for All” goals in the most cost-effective manner. We can NOT afford to let our politicians dash this plan on the rocks of partisan identity politics or sink because of insurance company profits! If WE Truly care about our economic viability and our health and about fixing the health care system, then we have to do some work!
Every year, Medicare Advantage saves American taxpayers Millions of Dollars over the cost of our traditional fee-for-service Medicare. It has been saving taxpayers money every year now for over 20 years. Numerous studies demonstrate that Medicare Advantage programs save money by reducing the cost of hospital admissions and medical treatments and, most notably, for our more costly seniors, who are at higher health risk levels. Obamacare (ACA), on the other hand, can make NO such claim! The ACA has caused us double-digit premium increases and severe headaches in Congress and amongst the American people. The withdrawal of health insurance carriers from over half of the jurisdictional county marketplaces has left Millions of our Americans dependent on just one health insurance carrier and NO competitive, cost-effective health insurance choices. The ACA has been a nightmare, and it is the most expensive federal health insurance program serving the fewest number of people in the history of our Country. Unlike the ACA, there is broad BIPARTISAN support in Congress for Medicare Advantage. Medicare Advantage is the MOST POPULAR INSURANCE PROGRAM IN AMERICA. We advocate re-engineering this successful health insurance program to include an integral health and wellness program and making it available to All Americans immediately!
Our health care system is our largest employer. We spend 18% of GDP on health care. The health care industry is our most abundant source of employment. Warren Buffet says, “health care is the tapeworm of the American economy” because the cost of it is going to eat us alive! If we, as a nation, are to successfully pass a Medicare for All program, which would potentially solve all our uninsured health care access problems, we will have to do it in a much more practical and cost-effective manner. The Democrat proposal to extend the Traditional Medicare fee-for-service program for All (even gradually) is way too expensive, unsustainable, and quite frankly not in the best interests of the nation. We can do better, and this web site is dedicated to showing everybody how we can improve our health and lower the cost of health care at the same time.
Despite its failures, the ACA has been, by far, the most expensive federal insurance program (per capita) in the history of American. This is true, over and above the cost of the 3R’s: risk corridor, risk adjustment, and reinsurance funding, the CSR payments, and the cost of the federal and state Marketplace exchanges. NOT including all of that stuff, the annual per member cost of the ACA program exceeded the cost of the traditional fee-for-service Medicare program, which is an almost inconceivable feat and simply astounding to realize.
MAA volunteer Mary delivering the "The Best Bipartisan Solution" Document to Congress in August 2017.
Despite these numbers, most Americans are under the impression that Obamacare is a step in the right direction. Obamacare / ACA's goals were a step in the RIGHT direction. However, the Obamacare program itself has proved to be a costly failure. We have very few government-sponsored programs that run well. Consider the Garn - St. Germain Depository Institutions Act. this congressional Act brought on the saving and loan crisis. The Community Reinvestment Act forced our banks into lending that almost crippled the economy. And, there was the Federal Family Education Loan Program, which has continued the student loan debt crisis, etc. We all know we have failures but the often get swept under the rug or doubled down on. The current administration seeks to double down on the ACA.
THE TRUTH
The ACA was an inflationary program from the start. In 2014, the Bureau of Economic Research documented a 24.4% increase in non-group health insurance premiums that would NOT have happened without the ACA. Between 2013 and 2017, ACA exchange premiums increased, on average, 105%, and in 2018, the annual cost of Silver-tier plans, which are used to calculate the federal subsidies, was up again by 32%. This increase was of great concern to Republicans running for re-election in the midterms. The ACA has NOT increased health plan affordability, competition in the marketplace, or documented any remarkable cost containment. Medicare Advantage programs, on the other hand, have demonstrated substantial savings over the cost and quality of Traditional fee-for-service Medicare. And, this is the fee-for-service Medicare is the program that Democrats would like to extend to everybody?
In 1982, Congress had two simple goals when they created Medicare Advantage plans:
1. Expand Medicare beneficiary choices, and
2. Save money by taking advantage of the efficiencies that managed care was producing for employers in the private sector.
It took the government over five years to act to take advantage of the success HMO’s and managed care programs saving money in the early eighties. At that time, there was widespread agreement among politicians and experts in the health care field, that the competing managed care providers were the KEY to reducing the cost of Medicare. This is still true today. In 2011, the highly respected Milbank Memorial Fund published, “An Economic History of Medicare Part C,” and it concluded that “MA Plans can most effectively bargain for rates in competitive provider markets, whereas when setting rates, Traditional Medicare ignores the degree of competition in local markets. By (the federal government) sending Medicare money to Medicare Advantage plans and letting the plans negotiate with providers, the MA program continues to be able to reduce overpayments to providers …”. The “Journal of Managed Care,” has reported that Medicare Advantage plans to deliver higher quality care by reducing the number of hospitalizations, re-admissions, and other complex care that are among the highest cost drivers in our health care system. Medicare Advantage plans have pioneered many of the innovations that health policy experts say our health care system needs, including integrated delivery systems, coordination of care, an emphasis on primary care, and value-based approaches to paying doctors, hospitals, and other health care professionals. Humana programs have documented 6% fewer hospitalizations, a 40% reduction in overall hospital costs, and a 44% reduction in admissions for those seniors at the highest risk. These are the facts, and the truth is our congressional representatives, provider communities, and our insurance companies are not making these facts clear to the American people.
The Democrats earnest calls for "Medicare for All" is an acknowledgment that they, with or without the Republicans, cannot enable universal coverage by promoting Obamacare/ACA. It is absolutely of paramount importance that we, as True Americans, all likewise recognize that our Nation cannot afford the traditional Medicare fee-for-service for All. We can't "just pay for it," and We can't just afford it either!
Traditional Medicare, like the traditional pension plan, is not sustainable for everybody. And, we can not afford "to just pay for it." The Social Security Trustees project that in 2018, the US Social Security Administration will have started to spend more money than it collects, for the first time since 1982. According to the Medicare Board of Trustees, the Medicare Part A Trust fund will run out of money in just seven (7) short years from now (2026). And, that is three (3) years earlier than they projected in 2017. And, the SSI Trust Fund with $2.89 Trillion Dollars in current assets will be completely broke by 2034. The unfunded liability for the Traditional Medicare fee-for-service program (the Defined Benefit Health plan) is in the Trillions of Dollars and just like the dinosaur traditional Defined Benefit Pension Plans, Medicare, as it is today, can NEVER be adequately funded out of our current economic GDP. Most people do not realize that our Medicare Advantage programs do NOT participate in, nor do they contribute to, this unfunded Medicare liability. Medicare Advantage Plans are generally administered by managed care providers that take 100% of the underwriting risk associated with their programs! The health insurance companies and the medical providers bare 100% (ALL) of the responsibility for the cost and financial outcomes of the Medicare Advantage programs that they manage. When True Americans consider the overarching, imperative question, which is how we fix, refinance, and revitalize our Medicare Programs, the promotion of our Medicare Advantage programs is a vital part of the answer. This is a no brainer, which is why we may never get it!
I am sure there must be other reasonable solutions to all of these problems with health insurance, and reasonable people can certainly disagree. But rather than wasting time trying to figure them all out, We at Medicare-Advantage-For-All take a simpler and more direct approach. We believe, if the system ain't broke, don't fix it! Medicare Advantage IS THE MOST POPULAR PROGRAM IN AMERICA. It works! The obvious solution to reducing the number of uninsured Americans is the expansion of the Medicare Advantage program we all know and love.
The imperative thing to do is pass legislation to de-regulate the non-group health insurance market and authorize the Department of Health and Human Services to immediately develop and report back to Congress with ONE legislative proposal for the expansion of the popular Medicare Advantage program to ALL Americans. Congress is already ready for a debate on this issue. Please see the Fifth Edition of the True American for further details. Taking a page out of the Obamacare playbook, the proposal should crank up a variety of Gold, Silver, and Bronze - MA Public Option plan choices that will be attractive and more affordable and affordable for young and middle-aged Americans. As we all know, Medicare Advantage is a tremendously successful program. It already covers Thirty-Eight percent (38%) of our elderly citizens (22.6 Million beneficiaries) and is hailed as the key to reducing the cost of traditional Medicare. MA is growing like a weed, even with the reductions federal funding spending planned by the Obama Administration to pay for the ACA. Of the 11,000 Americans that age into eligibility for the Medicare daily; 50% choose MA plans within their first year of eligibility. It does not take a rocket scientist to see that our Medicare Advantage Program is far more successful than Obamacare Care program that covers only 8.5 Million, mostly low-wage Americans. ACA enrollment has declined in each of the last three (3) years. And, even as we currently enjoy almost the lowest uninsured rate ever in US history, the ACA is steadily moving us in the WRONG DIRECTION!
THE RIGHT DIRECTION
De-regulation will make these Medicare Advantage Public Option plans even more affordable by preserving the competition between the managed care plans, as was originally intended by the legislation that created MA. What the Socialists don't get is the fact that Competitive free-market health plans lower costs. Health plans have natural incentives to use risk-based capitation arrangements that encourage healthcare providers to integrate care, operate efficiently, improve wellness, keep their members healthy and out of the hospital. Pre-existing medical conditions can, should, and will be covered. But to be affordable, We at Medicare-Advantage-For-All believe that confirmed Pre-X (that is NOT completely under control) should be covered by special Medicaid cost plus risk pools.
The necessary premium subsidies and tax credits can be funded under a re-structuring the Medicare Trust Funds, which must be done almost immediately. We started Medicare in 1965 after years of in-depth planning and with a firmly identified funding base. It was easier in those days because the total premium for Medicare Part B was just $3.00 a month. In 1980, four (4) workers funded the employer payroll taxes that supported each one (1) Medicare beneficiary. Today, our current Medicare fee-for-service program has only three (3) workers funding the employer payroll taxes supporting each beneficiary, and for the remainder of this millennium, we are projected to have even fewer workers supporting the program. It will be bankrupt in seven years. How much clearer does this point need to be made?
So, with our Congress facing some very tough decisions refinancing Medicare, which probably will require higher monthly premiums, across the board employer taxes, fewer income exemptions, and additional scaled high-income tax responsibility; Our enhancing the popularity of Medicare Part C, the less costly Medicare Advantage program alternative for All Americans should be a very high priority, RIGHT? In fact, the Medicare Trust Fund refinancing may prove to be just the enormously important catalyst we need to get this program Right! The promotion of the Public Options of "Medicare Advantage for All" (MAA) should peacefully co-exist with Obamacare/ACA and any necessary Medicaid modernization and expansion plans. Americans should be able to choose the program that is best for them. We can make it possible for the United States to achieve a near 100% insurability for All American citizens in a Truly great American way. Consequently, Republicans do not need to repeal Obamacare, and Congress does not need to stabilize its markets. Market stabilization is a dog whistle for health insurance company subsidies that can be used to cover up bad product design and over-regulation. The Obamacare/ACA may or may not naturally die of chronic in-viability or be ruled unconstitutional, but in our humble opinion, we reap NO benefit from going out of our way to save it.
AFFORDABILITY AND COST CONTAINMENT
In the real world, affordability and cost containment go hand in hand. In a recent issue of the “Journal of the American Medical Society,” JAMA predicted that the biggest health care cost drivers in 2018 were physician salaries, high drug prices, and excessive provider overhead. I am sure CMS and our health care providers are still working assiduously on all three of these issues. But the bottom line is not going to cut it! Unless and until we make a sizable dent in the health conditions suffered by our citizens, which are the very oxygen wildly enflaming the rising cost of health care, we are not going to appreciably lower the cost of health care in the United States of America.
We believe that CMS can effectively contain this health care wildfire by initiating unified national Medicare payment reforms that will allow Medicare Advantage plans to collectively use their buying power and the massive influence of the federal government to impact the providers market power and effectively increase control and reduce the cost of health care and RX. this can be our PUBLIC OPTION! This strategy is modeled on how health insurers negotiate drug prices for Medicare’s Part D programs. In addition, CMS is using its own risk-based capitation reimbursement with dedicated plans, promoting member wellness and working together with an integrated network of health care providers to reduce our health care costs to a level that everyone can afford and a GDP that our businesses are willing to support.
Warren Buffett believes that the cost of our health care system is the biggest issue facing American businesses competing around the world. Spending Eighteen percent (18%) of our NHC-GDP in 2018, he sees this level of expenditure as a huge disadvantage for American employers. Putting his savvy midwestern business acumen to work, he and his partner Charlie Munger have recently pioneered a Berkshire Hathaway partnership with Jeff Bezos of Amazon and Jamie Diamond of J.P. Morgan Chase. The three parent companies said in January 2019 that they would leverage their combined scale and expertise to develop technological solutions to provide employees and their families, "simplified, high-quality and transparent healthcare at a reasonable cost." This partnership is simply named the Haven. They are doing something creative about the spiraling cost of their employer's health insurance plans. These men are among the most brilliant minds in the American business world today. They hired one of the most thoughtful health practitioners, Dr. Atul Gawande to head up this new venture. Dr. Gawande is the Deepak Chopra of the health care world. He wrote an influential article in the New Yorker magazine on health care cost drivers, which caught the eye of Charlie Munger (Warren Buffet's partner). Dr. Gawande said in a recent statement that the company wants "to change the way people experience healthcare so that it is simpler, better, and lower cost." Amazon, in particular, is pioneering uses of Alexa to help families make health care appointments and provide other helpful information. Although we haven't seen any earth shattering results from this investment, we are hopeful.
In an interview recently, Warren Buffet proclaimed that the United States is a "rich country, and we can get along doing the wrong thing for some time, but we can't get along doing the wrong thing indefinitely." The next lowest comparable country's health care GDP is Switzerland at 13%, and all the other nations of the world are lower; in some cases, much lower. We think Warren would like to see a 10% health care share of GDP (an 8% reduction from the current level) and with the approach to value-based health care, health & wellness programs, competition in the market place and the use of superior technology, we can do it!
HOW DO WE LOWER THE HEALTH CARE GDP?
We spend about $1.1 Trillion dollars annually, about 5.8% of that health care GDP on the treatment of chronic disease. An informed consensus of medical opinion holds that over 80% of these chronic diseases are preventable or almost completely reversible with the right combination of health and wellness promotion and medical intervention. As a nation, if we had been able to eliminate 80% of the cost of treating chronic illnesses in 2016, which is reasonable; our health care GDP would have been 13%, five percentage points (-5%) less than our actual GDP, and just about equal to our nearest competitor, Switzerland. Did you know that over 48% of our population suffers from chronic illness? Did you know that 2 out of 3 (66%) of Americans are overweight, and almost 40% (124.4 Million) are considered obese? Of course, you knew that because you are either part of the obese club or you see members of the obese club every-day, everywhere you go. It is getting to the point that we will need separate admission lines for motor scooters for the less ambulatory. Did you also know that our Health and Human Services Department has had the premier Preventative Services Task Force since 1984? Are their recommendations considered the Gold Standard for clinical health preventative services in the world? Still, according to the “New England Journal of Medicine,” by the year 2023, seven chronic diseases will have a total annual impact of $4.2 Trillion dollars on our economy.
No True American alive today does NOT know that we are too fat. This is the indisputable truth, and it is causing us a lot of problems and a lot of money. Every day it is in our face! We all go out to eat at restaurants, shopping, and other events, and we All love to people watch. Obesity-related health conditions include heart disease, stroke, Type 2 diabetes, and certain types of cancers, which are the leading causes of preventable and premature death. The savings from the improved treatment of chronic illness and the restructuring of the health insurance market should easily exceed 8% of GDP. To make a long story short, it should be abundantly clear to everyone reading this commentary. It is within our power to substantially reduce the cost of our health care in the United States. We have the skills and expertise to simultaneously reduce our health care NHC-GDP to a competitive world market level, secure our exceptional and unique health care financing system and improve the health, productivity, and insurability of the American people. And, properly designed, competitive, expertly administered, and adequately regulated Medicare Advantage plans can be a meaningful start and will make an important contribution to the health and well being of our people and our nation. After MAA, we will need to invent the next generation Defined Contribution Health plan that tangibly will reward participants for improvements in their behavior and incentivize medical practitioners to deliver effective Preventive Predictive Personal Medical care that will prevent illness, improve health and maintain improvements over the long term. We call this the Apollo Medicare Advantage plans, but they are NOT rocket science.
But first, that is NOT going to happen, unless we get together and until we all get brutally honest with ourselves. The truth is the ACA’s government regulation created rapidly increasing health insurance premiums and restricted health insurance markets. This accelerated the rise in health care GDP and priced Millions of unsubsidized Americans out of the market. Continuing to throw money at the ACA program will only make matters worse, and these conditions may become terminal. The ACA is too expensive, but it is NOT too big to Fail!
We are skeptical that CMS will be able to meaningfully reduce the cost of health care under this Graham-Cassidy (Heritage Foundation) hybrid style State Block Grant financing approach (creating solutions that may cause more problems) which purport to get the money out of Washington D.C.! However, at Medicare-Advantage-For-All, we trust and believe that our President was serious when he promised to come up with a health plan that will make it better for everybody!
The most important piece of this program is the Health & Wellness part of it! A States Rights program might very well be the direction in which we need to go in order to accomplish this goal. However, we will be going NO-WHERE if we do not REQUIRE HEALTH AND HUMAN SERVICES TO ADMINISTER A THOROUGH HEALTH & WELLNESS PROGRAM FOR ALL AMERICANS! We appreciate our able HHS Secrtary Xavier Becerra and his choices to head up CMS and other Departments. The Centers for Medicare and Medicaid Services is doing a phenomenal job on a staggering number of issues, including holding the states accountable for medical outcomes and other things they are doing with our federal tax dollars. We are painfully aware of the state Medicaid systems have little uniformity of administration or benefits. There is virtually no meaningful federal influence over their cost containment programs that We are aware of. There appear to be virtually no uniform state-wide Wellness Programs. There are no shared criteria for Medicaid eligibility, even as this is a potentially life-saving program for low-income Americans. This program is responsible for most of the annual births in this country. If Medicaid were a national program, it would be the largest federal health care program, covering almost Eighty-Two (82) Million Americans. 1332 waivers aside, the status and variance among these programs nationally is a HUGE HUGE problem.
And, if that were not enough, the last time the Graham-Cassidy Bill (which would have implemented a Medicaid capitation reimbursement system) came up for a vote in the Senate, not only was there ZERO support from anybody, the bill had to be withdrawn from the Senate floor without a vote. The last nail in the coffin was when most state officials running their Medicaid programs incredulously had to admit in writing that two years was NOT enough time for them to properly implement the legislation? That is unbelievable! And, in this, we are only talking about saving a little bit of money, NOT about saving any real money, saving lives and or improving the health of the people covered by these programs? SAD. The Graham-Cassidy Bill was primarily a straightforward effort to force the states to accept the same type of capitation reimbursement that the federal government uses to control the cost of health care with the managed care companies that deliver the Medicare Advantage plans. It is not rocket science. That right there should tell you why it is so important for us, as taxpayers, to support Medicare-Advantage-For-All and a leading role for the Department of Health and Human Services in the program.
THE ELEPHANT IN THE ROOM
We can not pretend, for political expediency, that we can afford Medicare for all. And, we will not be able to improve the health and well-being of the American people unless and until we change the focus of practice patterns and the incentives we give to our physicians. The new CEO of Haven, Dr. Atul Gawande, advocated the creation of Accountable Care Organizations (ACO) to change the incentives in medical care. ACO's actually saved the federal government $954 Million Dollars over a three-year period. That is NOT a lot of money for a program of such magnitude and intensity. The problem is you can't force or pass legislation that makes physicians address the cost drivers that can make a meaningful risk reduction and impact on medical costs. Integrated multi-disciplinary medical practices, like the Mayo and Lahey Clinics, do this by their very nature. These institutions were created using practice patterns that are successful in delivering high-quality care at the lowest possible cost. We should use them as the model. We have to change physician practice patterns and reduce utilization, especially for patients with complex chronic illnesses. Assuming the risk for these Clinics goes without saying.
There are strong isolated signs that meaningful change is making its way into the American health care system. Paul Markovich, CEO of Blue Shield of California (with $17 Billion Dollars in Annual Revenue) recently reported that they have an exclusive network of ACO providers and that over the course of its existence it has shown about a 3% compound annual healthcare trend as compared to a more than 6% to 7% cost trend for the rest of their business. Dr. Jason Mitchell, Chief Medical Officer for Presbyterian Healthcare Services in Albuquerque, NM, has an integrated system that includes a health plan, medical group practices, and a delivery system that is 70% capitated. They manage the healthcare needs for over 100,000 fully capitated individuals, delivering high-quality care while carefully managing the cost of that care. In the last four years, cost trends for this population have been consistently lower than national averages and lower than local non-capitated NM patient populations. In a letter to Modern Healthcare Magazine (April 8th Edition), he stated, "This arrangement has allowed us to invest in a multi-disciplinary team that works together to support each other and our patients in order to improve health and reduce costs. It is the kind of approach that would be difficult to provide in a purely fee-for-service model."
THE DOCTORS ARE IN! What Dr. Mitchell writes about is possible in every single state in the United States, and it is happening now in New Mexico, California, Massachusetts, Maryland, and Minnesota. This is the New Paradigm. This is the future of medical care in the United States, and, in the long run, it will reduce our health care GDP!
CMS is currently re-thinking the ACO program because many providers in the program refuse to accept financial risk for their patients. Dr. Gawande has recognized the need for discipline and teamwork in the physician practice patterns in America, where our doctors have traditionally practiced medicine with fierce independence, self-sufficiency, and virtually complete autonomy. His mentor, Charlie Munger, puts the matter more succinctly, "If the incentives are wrong, the behavior will be wrong." We have to fix the incentives not only with provider risk-taking but more immediately with health insurance risk-taking and the Affordable Care Act.
The national health insurance solution that will work best in the United States is honest, healthy, and fair competition in the health care markets. The most important ingredient is the natural incentives and motivations of competition amongst providers and between insurance companies, which does not exist under the ACA/ Obamacare program, nor under the Medicare fee-for-service or single-payer systems. What we need to do first is have the courage to forcefully establish a fair and competitive non-group health insurance market, put Medicare back on a sure financial footing, and design and build a vibrant Public Option of "Medicare Advantage Plans for All Americans."
This Medicare beneficiary, Betsy, is 101 years old. We need to make sure traditional Medicare is around for her when she is 106.
In 1973, Medicare HMO contracting was authorized by the HMO Act, which was sponsored by Senator Edward M. Kennedy and signed by Richard M. Nixon with the goal of saving money. In 1982, TEFRA was signed by Ronald Reagan, creating Medicare + Choice demonstration programs, which later blossomed into full flower as Medicare Advantage plans with the 1997 Balanced Budget Act, signed by Bill Clinton. All these Acts were created with broad bipartisan support. The Medicare Advantage program still benefits from strong allegiances on both sides of the aisle. The challenge is to use the Four (4) Parts of our successful Medicare program (how many parts do we really need?) to re-engineer affordable universal Medicare-Advantage-Plans-For-All Americans. This is the last and greatest piece of our Truly great American health care system mosaic that should be the burning desire of our congressional representatives, of both political parties, to complete.
The Medicare program is of enormous importance to the elderly in the United States. It profoundly affects their health, financial status, and their overall welfare. It is also of enormous importance to the federal government, American businesses, and the American people because of its huge cost and impact on the national budget. Medicare Advantage (MA) is the ONLY federally sponsored health plan, besides the Federal Employee Health Plan, that relies upon a free health insurance market with incentives for the health insurance companies to actually compete with one another on price and service. In 1999, CBO Director Dan Crippen observed in the National Bipartisan Commission report on the future of Medicare, "We believe that introducing competition into the Medicare program could help reduce costs in both the short and the long run." In testimony before the Senate Budget Committee in 2007, Peter Orszag, then director of the Congressional Budget Office (CBO) famously made the follow observations, "the nation's long-term fiscal balance will be determined primarily by the future rate of health care cost growth. And, a Medicare Advantage program that is able to thread the policy needle and offer high-quality health plans while saving money has the potential to improve the performance and sustainability of the Medicare program overall." Peter was right when he said this in 2007, and his statement is still true today. The extension of Medicare Advantage to All Americans will improve the health, well-being, and competitiveness of the United States of America. As Dr. Gawande would say, if we do this, that will be our future. And he is RIGHT!
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