Ritter Insurance Marketing

Just a quick hit here, but it’s quite odd to me that 2 things never get mentioned in the Healthcare Reform Debate.  Further, I never even see these things questioned.

1.  The $177 Billion in Medicare Advantage cuts over 10 years will impact the 11 million Medicare Beneficiaries in Medicare Advantage to a FAR greater extent than it will affect the profits of the insurance companies who offer the plans.  You hear on almost a daily basis that MA plans are paid 114% of Traditional Medicare.  The basis of this number is the March 2009 Medpac report on Medicare Payments.  What’s ironic is THAT VERY SAME REPORT will tell you on Page 260 (you can read this in black and white) that while MA plans are paid $103/member/month more than traditional Medicare, $79/member/month goes to the Medicare Beneficiary (76.7% of the total) mainly in the form of reduced cost sharing.  Based on this, if we plan to cut $177 Billion out of Medicare Advantage, $136 Billion will come directly out of the pockets  of the 11 million Medicare Beneficiaries on Medicare Advantage.  Additionally, even these numbers are wildly skewed by Private Fee for Service which has, for the most part, has been legislated away by MIPPA 2008 (and to a lesser extent the massive overfunding of Puerto Rician MA plans which get 180% of Traditional Medicare, but that’s a whole other story and that’s NOT a typo!).

One could honestly argue that it’s not “fair” that MA members get these additional benefits, but let’s at least be HONEST about who’s going to be paying the vast majority of the $177 Billion in MA cuts to “fund” care for the uninsured–It’s the 11 million (mostly Seniors) on MA plans!  I cringe every time I hear “It’s going to the insurance companies and it’s not making anyone healthier.”  A more accurate statement is, “It’s going to Medicare Beneficiaries and it’s making them wealthier.”

2.  I hear over and over again that we have the “incentives” for Medical Providers misaligned because we pay for “volume of care” and not “quality of care”.  The implication is that Doctors order tests and procedures to build their revenues.  I have yet to hear mentioned that perhaps the Doctors might be doing this to, not to enrich themselves, but because they are practicing “Defensive Medicine” and fear being sued.  It seems to me that EVERYONE is being asked to accept less:  Medicare Beneficiaries, Hospitals, Insurance Companies, Physicians, Drug Companies, Medical Equipment Providers, etc., etc., but I’ve yet to hear ANY TALK of trial lawyers having to “accept less”.  I’m not saying that tort reform would, in and of itself, solve the Healthcare “Crisis”, however, I’m shocked that it is NEVER EVEN MENTIONED as something we might want to, at least, take a look at.