Medicare Advantage Quotes

Well, this was predictable. House Republicans last week acceded to an extension of the Export-Import Bank for at least the next nine months. The Export-Import Bank is far from the worst example of government-business cronyism. I just completed a history of American political corruption and actually had to leave Ex-Im on the cutting room floor. Its cronies are pikers compared with the corporate moguls that take advantage of tax preferences like the G.E. and Apple loopholes. They also cannot hold a candle to the American Medical Association, which is basically free to write the reimbursement rates for Medicare Part B. And nothing compares to Fannie Mae and Freddie Mac from 1991-2008. The two mortgage giants kept the entire D.C. political class bent over a barrel for almost 20 years as its top executives reaped enormous bonuses while putting the broader economy at risk.

The freedom of choice provided by fee-for-service Original Medicare to beneficiaries comes at a financial cost. The reason is as obvious as the phrase. Fee-for-service means that health care providers get paid for the surgeries, care, and other health care services they provide. It says nothing about whether all this health care is needed or even in the best interest of the patient. Medicare Advantage health networks, by contrast, can be cheaper providers of care than can fee-for-service Medicare. Insurers can control costs more effectively by assembling their own groups of doctors, hospitals, and other service providers. Cheaper health care, not surprisingly, has its own downsides. Provider networks are so important to the present and future prospects of Medicare beneficiaries that they merit their own chapter (12) later in this book.

This semi-privatization of Medicare was called Medicare Part C, or Medicare Advantage. Although it has the name “Medicare,” it’s not Medicare. It’s private, for-profit insurance, with almost all of the costs paid for with funds extracted from the government’s Medicare trust fund.

I WOULD OFTEN think back to that Santelli clip, which foreshadowed so many of the political battles I’d face during my presidency. For there was at least one sideways truth in what he’d said: Our demands on the government had changed over the past two centuries, since the time the Founders had chartered it. Beyond the fundamentals of repelling enemies and conquering territory, enforcing property rights and policing issues that property-holding white men deemed necessary to maintain order, our early democracy had largely left each of us to our own devices. Then a bloody war was fought to decide whether property rights extended to treating Blacks as chattel. Movements were launched by workers, farmers, and women who had experienced firsthand how one man’s liberty too often involved their own subjugation. A depression came, and people learned that being left to your own devices could mean penury and shame. Which is how the United States and other advanced democracies came to create the modern social contract. As our society grew more complex, more and more of the government’s function took the form of social insurance, with each of us chipping in through our tax dollars to protect ourselves collectively—for disaster relief if our house was destroyed in a hurricane; unemployment insurance if we lost a job; Social Security and Medicare to lessen the indignities of old age; reliable electricity and phone service for those who lived in rural areas where utility companies wouldn’t otherwise make a profit; public schools and universities to make education more egalitarian. It worked, more or less. In the span of a generation and for a majority of Americans, life got better, safer, more prosperous, and more just. A broad middle class flourished. The rich remained rich, if maybe not quite as rich as they would have liked, and the poor were fewer in number, and not as poor as they’d otherwise have been. And if we sometimes debated whether taxes were too high or certain regulations were discouraging innovation, whether the “nanny state” was sapping individual initiative or this or that program was wasteful, we generally understood the advantages of a society that at least tried to offer a fair shake to everyone and built a floor beneath which nobody could sink.

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