Conway MacLean, DPM, Journal Columnist
America's health care system is in crisis. Many Americans don't have health insurance, and one injury could leave them homeless. Medical debt often leads to bankruptcy or worse. Although many factors are at play, many experts believe a profit-driven health care system is a contributing factor.
For more than 50 years, we've been providing seniors with Medicare. This program has provided medical care to millions of Americans. Although there are many problems with this system, older people who are usually no longer working have received reliable medical care.
After extensive lobbying, legislation was passed nearly 20 years ago to allow large insurance companies to provide insurance to seniors. This effectively allowed them to compete with Medicare. These plans were called “Advantage” plans, and they were sold in such a way that advanced users had no idea what they were getting or who was offering it. The answers to important questions like these are always buried in slogans and fine print.
There are many tactics used by major insurance companies, including pre-authorization, outright denials, delaying treatment, and various obfuscation techniques to deny or withhold payment. One of the most successful ways they increase their profits is by refusing to pay for services provided. A recent federal audit found that tens of millions of denials are improperly issued each year.
Prior authorization is another method, requiring the prescribing physician to contact a nurse by phone and lobby for the treatment prescribed by the physician. Everyone is working to get more coins into the safe. Additionally, they lobbied for government subsidies to be written into their contracts to give them an advantage over Medicare.
The marketing tactics employed by private health insurance companies are ruthless but highly effective. Seniors are signing up for Advantage plans in droves. Unfortunately, most consumers who choose this “advantage” The plan has no idea that there is no Medicare. However, the general public is completely ignorant about this issue, which suits the big insurance companies.
Advantage Plans has used millions of dollars of advertising, misleading claims, and malicious marketing to attract this age group. Private insurance benefit plans have no interest in educating consumers about the differences between Medicare and these plans. The term itself is misleading. “Medicare Advantage” It has the word “Medicare” in the title. These plans loudly advertise that they offer the same coverage, but as we all know, there is no truth in advertising.
The methods used by insurance companies have been a huge success, resulting in record profits for major insurance companies, which some estimates put at nearly $60 billion. The data reveals an ugly truth. People enrolled in Advantage plans are receiving lower quality medical care. It is clear to industry members, healthcare professionals, or those involved in healthcare management that Advantage plans do not promote health.
But the dangers of this approach are finally being exposed. Major multi-billion dollar lawsuits have been filed against several major insurance companies. This is due to the fact that insurance companies are actually abusing the system, a technique that clearly benefits their bottom line. Several major health systems have removed these plans from their list of options. Experts in the field are calling for curbs or changes to the way these programs are managed. Unfortunately, the public has been slow to learn of these concerns.
It's true that if you don't need medical care, you can save money with these private management plans. But which age groups are most likely to need medical care than those targeted by these deceptive practices? Investigators agree that the care provided by the Advantage Plan was inadequate. But this is more than just a big company. This is huge business.
If your insurance card says “ADVANTAGE” anywhere, you are not enrolled in Medicare. Also, be wary of ads for Advantage plans. You have a product to sell and you don't have to be honest. As the cliché goes, the devil is in the details, and this clearly applies to insurance contracts. If you switch to an Advantage plan, whether voluntarily or not, your health care will be controlled by an organization whose sole purpose is to make money. Become a better informed consumer of health care. After all, health is an important part of life.
Editor's note: Dr. Conway McLean is a podiatrist who has taken over the practice of Dr. Ken Taber and currently practices foot and ankle medicine in the Upper Peninsula. MacLean lectures internationally in surgery and wound care and holds certification in both as a subspecialty in orthopedic therapy. Dr. MacLean welcomes questions, comments, and suggestions at drcmclean@penmed.com.
