Sen. Warren Helpfully Identifies Medicare Trustee Nominee's Glaring Conflict Of Interest For Him

[muriel_volestrangler]

Now, sure, Demetrios Kouzoukas is a Biden nominee, but there are reasons why we have these hearings in the first place and don’t just go straight to a vote. Things are revealed that might not have come up previously.

For instance, in the personal testimony offered by Kouzoukas, he neglected to mention that he has a paid seat on the board of Clover Health, a for-profit health insurance company that insures seniors as part of Medicare Advantage. Warren brought this up, pointing out that “a big factor influencing Medicare solvency today is the growth of Medicare Advantage, a program that allows for-profit insurance companies to sell Medicare coverage that experts say is on target this year to charge —overcharge the government by $75 billion.” For-profit insurance companies like Clover Health.

Warren then asked Kouzoukas how much he was paid to sit on Clover’s board, and after several attempts to answer the very direct question in a very roundabout way, he finally settled on $100,000 as the number. She then asked him if he planned to quit the board if nominated — but after four straight attempts to not answer that question either, Sen. Warren said she could probably assume that he did not, in fact, plan to quit his paid position on the board.

It was at this point that she very helpfully explained that this would create a massive conflict of interest, because no matter what he chose to do about addressing the problem of Medicare fraud, with regard to Medicare Advantage, he would either be screwing over the people of this country or screwing over the company he works for and the legal obligation he has to maximize its profits.

https://www.wonkette.com/p/elizabeth-warren-helpfully-identifies

Don't know what the administration were thinking, nominating him if he doesn't feel like giving up his conflicting post. You'd think that'd be the first things they make sure of.

[Silent Type]

1. Yeah, why listen to anyone with Medicare Advantage connections? Just 51% of beneficiaries choose MA.

I don't have MA nor do I want it, but I know people who can't afford a supplement and drug plan under tradtional Medicare. I suspect Biden looked at the facts, people are gravitating toward MA. Unfortunately, it's because they can't afford traditional Medicare.


In 2023, 30.8 million people are enrolled in a Medicare Advantage plan, accounting for more than half, or 51 percent, of the eligible Medicare population, and $454 billion (or 54%) of total federal Medicare spending (net of premiums).Aug 9, 2023

https://www.google.com/search?q=percentage+of+beneficiaries+selectin+medicare+advantage&rlz=1C1CHBF_enUS916US916&oq=percentage+of+beneficiaries+selectin+medicare+advantage&aqs=chrome..69i57j33i10i160j33i299j33i22i29i30.21583j1j7&sourceid=chrome&ie=UTF-8

[muriel_volestrangler]

2. I'm really not sure what you're saying.

It doesn't seem to be about the conflict of interest. Instead, you seem to be saying it's an OK program for participants. This is about the conflict of interest between the government and the companies it buys things from.

[Silent Type]

4. I'm saying MA was passed by Congress. 51% of beneficiaries voluntarily choose it.

And it will keep increasing. Like it or not, it has surpassed traditional Medicare.

I think Biden knows what he is doing, again like it or not.

[muriel_volestrangler]

8. OK, only the last sentence is relevant to this thread.

You're saying he nominated a man with a conflict of interest for a reason? What reason, do you think?

[Silent Type]

12. Like it or not, Medicare Advantage is likely the future of Medicare. Why not appoint someone with

experience to make it better. He worked for CMS too.


Here's his background:


Demetrios L. Kouzoukas is the Director of Paragon Health Institute’s Medicare Initiative. From 2017 to 2021, Kouzoukas served as the Chief Executive of the Medicare program at the Centers for Medicare and Medicaid Services (CMS). In that role, he worked with patients, policymakers, providers, insurers, and manufacturers to improve health care in the United States. He developed and operationalized a vision to enhance patient-driven health care nationwide, testifying about it before Congress.

As manager of the largest health care payor in the United States, Kouzoukas delivered successively lower payment error rates year over year, brought about extraordinary reductions in Medicare Advantage premiums, and rewired policies and operations across the board in response to the COVID pandemic. Under his leadership, Medicare revolutionized payment for telehealth. His strategic vision maximized access for patients to medical technology innovations, expanded Medicare Advantage supplemental benefits to address chronic diseases and social determinants of health, instituted landmark price transparency reforms, and overhauled the skilled nursing facility and home health payment systems.

Prior to joining CMS, Kouzoukas was a senior executive at UnitedHealthcare’s Medicare business. He has also served as Principal Associate Deputy Secretary and as Deputy General Counsel of the U.S. Department of Health and Human Services, working with every part of the Department's broad portfolio. Kouzoukas has built innovative health law practices in the private sector, working with health care providers and life science innovators on new regulations and business models. In addition, Kouzoukas has represented the public as an expert in public administration and health benefits as an appointee to the Administrative Conference of the United States.

Kouzoukas is currently a Board Member an and Advisor to entities leading the transformation of health care. He holds a B.A. in political science from George Washington University and a J.D. from the University of Illinois College of Law.

https://www.google.com/search?q=Demetrios+Kouzo&rlz=1C1CHBF_enUS916US916&oq=Demetrios+Kouzo&aqs=chrome..69i57j0i131i433i512.1076j0j7&sourceid=chrome&ie=UTF-8

[muriel_volestrangler]

14. Because he intends to take money from people making a profit from it

while being responsible for it.

Do you understand what "conflict of interest" means?

[Silent Type]

20. No, I don't. Neither does Biden.

[2naSalit]

77. I suspect that...

Biden does, just because you don't, you can't claim someone else doesn't.

[progressoid]

16. Great, he has experience. So we should just turn a blind eye to his conflict of interest?

There are lots of people who have experience and DON'T have such conflicts.

The previous president had dozens of people working in his administration who had conflicts of interest. We rightfully criticized those appointments. Why should we turn a blind eye to this one?

[Silent Type]

21. Do you know anything about boards for companies that contract with Medicare? They include patients,

former government officials, nurses, doctors, etc., as well as company officials.

[progressoid]

31. So if appointed, where will his allegiance lie?

With the board of a for-profit health insurance company or Medicare?

Or as Senator Warren asks:

So, my question is, you are on the board of Clover, you are legally obligated to try to help Clover, to improve its profitability over time or at least sustain its profits. That’s corporate law 101, right? So, if you are also serving as a Medicare trustee, I just wanna be clear here. If the focus in the Medicare program is on the amount of fraud that is currently in the Medicare Advantage program, I think it’s reasonable to assume that could lead to reducing the amount of money that we put into Medicare Advantage, to putting more restrictions on Medicare Advantage, to saying we’ve gotta put a cop on the beat, maybe cut it out altogether.

What I’m asking you is, would that injure Clover? That is, would it reduce Clover’s profitability?

...It’s a question that’s a straight financial question. You know, Mr. Kouzoukas, I think you think you’re gonna get away with this by just not answering the question and not having any clip that admits how much money you’re taking from a private insurance company that makes its money through Medicare Advantage, at the same moment that you’re trying to take a public role that will influence whether we focus on the fraud in Medicare Advantage, or whether we turn a blind eye to it.

Let’s be clear. If Mr. Kouzoukas ignores the fraud, he helps Clover. If he focuses on the fraud, he hurts Clover. The conflict of interest here is so big and so pervasive that there is no action that Mr. Kouzoukas can take that doesn’t either help or hurt Clover, the company that pays him $100,000 a year to sit on its board and watch out for the company. And there is no waiver that can change that fact. This kind of conflict is shocking and it is deeply unethical. Not a single other trustee has ever received compensation from an insurance company while acting as a Medicare trustee.

And if you won’t step down from the Clover board, then you should withdraw your nomination. And if you do not withdraw, given the clear conflicts posed by your board service, I will strongly oppose your nomination and I will encourage every other senator in this body to do so as well.

[Silent Type]

35. Senator Warren should talk to Biden and CMS head, rather than doing a hit job like she did in 2016

on Obama and Clinton over foreign trade. That was one thing that helped give us trump.

[progressoid]

52. Or Biden could appoint someone WITHOUT a blatant conflict of interest

[kacekwl]

61. Exactly, we have to watch our own

harder than the obvious Republican criminals. This nomination should be pulled immediately. There is altogether to much of this crap in government an I applaud Sen. Warren for pointing it out. This is why the " both sides do it" reports exist. I'm disappointed with the Democratic nomination here.

[progressoid]

76. Yep.

We need to hold ourselves up to the standards we espouse even if they don't.

[eggplant]

53. You really seem to have an axe to grind here.

Are you pissed at Warren, or Biden, or the people here pointing out that the nominee has a clear conflict of interest and is seemingly unwilling to give up his board seat if given this role?

You seem uninterested in the actual topic of the OP.

[progressoid]

66. If they (Biden?) can make him give up his board seat, they should have talked to him about it.

In the questioning, he made no indication that he would. In fact, he goes out of the way to avoid the question.

WARREN: Is that a yes or a no? Do you plan to quit the job for which you were paid $100,000 a year?

KOUZOUKAS: Senator, I’m grateful to the president and his team for the review of my credentials and qualifications–

WARREN: I mean, really?! You know you’re gonna have to answer this question. Is it yes or is it no? Are you planning to resign the job that pays you $100,000 a year while you are a trustee for Medicare?

KOUZOUKAS: Senator, the review of my current activities and my credentials and qualifications is one that all nominees undergo and that’s one that led to the president putting my nomination before this body. I’m grateful for that and if given the opportunity —

WARREN: I’m not gonna get into why the president nominated you. What I wanna know is, are you gonna keep a job where you get paid by a for-profit outfit somewhere in the neighborhood of $100,000 a year while you keep your government trustee job? Can you answer that question?

KOUZOUKAS: Senator, the role of the trustees —

WARREN: Ok, I’m gonna take that as a “yes” because I’m gonna assume that if you were gonna quit that job, you would be really happy to tell me that right now before we go into the question of what it means for you to keep this job.

[Phoenix61]

90. She doesn't need to talk to anyone. He nominee needs to

decide whose team he wants to play on. Both is not an acceptable answer. I wouldn’t be at all surprised if he allowed others to assume he would step down from the board leading to his nomination.

[JoseBalow]

56. Warren nails it, as usual

[whathehell]

91. Yes. She and Katie Porter are terrific.

[JanMichael]

63. Fiduciary responsibilities, one is loyalty

The others of course obedience and care. Not sure this guy fits any of those.

[Envirogal]

33. Medicare Advantage is a scam

First of all, you don’t see regular, Medicare advertising all the time but you do see it with Medicare advantage, and a slew of has been senior spokes models. I used to be an advertising and I know how that does affect peoples mentality in selecting services. That’s why they do it.

Second of all, I sit on a board of a nonprofit and I don’t get paid a dime. In fact, I have to donate to them to help support them. Getting $100,000 paycheck is an exact conflict of interest and Senator Warren did her job pointing that out. And if it wasn’t uncomfortable, the nominee would’ve answered the question, truthfully, and transparently.

Third, Congress did pass Medicare advantage, but it was also done in a really, sneaky way. Just because Congress passes something doesn’t mean it was a good thing for the American people or these entitlement programs. I believe legislator leading the charge, went to go work for Eli Lilly after he “suddenly retired”. I can’t verify that but there was something shady.

Fourth, you seem to gloss over the fact that Senator Warren was also pointing out how much Medicare “advantage”, and the private insurers are doing to over charge the American government.

Finally, this is a blatant attempt to privatize Medicare. Be careful what you advocate for.

https://prospect.org/health/medicare-advantage-is-a-massive-scam/

[Silent Type]

41. Yeah, Medicare Advantage originally signed by President Clinton was "sneaky." It was called Part C.

When did Medicare Advantage start?
Managed care programs administered by private health insurers have been available to Medicare beneficiaries since the 1970s, but these programs have grown significantly since the Balanced Budget Act – signed into law by President Bill Clinton in 1997 – created the Medicare+Choice program.

The Medicare Modernization Act of 2003 changed the name to Medicare Advantage, but the concept is still the same: beneficiaries receive their Medicare benefits through a private health insurance plan, and the health insurance carrier receives payments from the Medicare program to cover beneficiaries’ medical costs.

https://www.medicareresources.org/medicare-benefits/medicare-advantage/

[Envirogal]

86. Medicare Modernization Act of 2003

was indeed sneaky in how it came about. It was the longest a vote was held open and it passed by the skin of its teeth at 6am by lying to sway the holdout votes. Look it up.

One of its biggest provisions was not to negotiate drug prices….. then the bills Architect, Rep. Billy Tauzin soon left Congress and the chair of the powerful Energy and Commerce committee to become the CEO of lobbying group PhRMA. What a gift he served his future employer!!

And well yes, Medicare part C was passed in 1997 the modernization act of 2003, stripped away many of the few decent parts of Medicare part C that helped people and save the government money as what was intended to do. This was all a huge giveaway to private insurance and the pharmaceutical industry. Even more was stripped back during the affordable care act passage.

And here you are still defending it, so vociferously.

Pro-Pública did a piece in 2009 how 25 of those “modernization” act champions in Congress went to work for the healthcare industry as LOBBYISTS. I wonder how many there are now?

Privatization is not sustainable. Doctors HATE MA. It is costing so much money and providing opportunities for Republicans to point out how inefficient Medicare and our social safety nets are. If we cut out the private industry This would save billions.

But again, I noticed you didn’t comment on the other things I had written earlier. But glad we have the historical account addressed.

[moniss]

95. First of all you are not receiving your Medicare benefits

"through" the MA company. It is not a pass through or just an "administered situation. MA plans are separate private insurance plans that have coverage and benefits equal to or greater than Medicare. In theory if they are charging less for a premium than your Medicare it is a saving. But, and it is a huge one, the experience of denial of coverage, refusal to pay benefits etc. is huge with MA compared to Medicare. So if the patient is left hanging with big bills what did they really save?

Any company can promise big expansive coverage and benefits but the real story is will they pay when it comes time and can you go to any doctor facility in the country anytime you want without a hassle or having less of the bill paid.

The man strikes me as a weasel in his interaction with Senator Warren and he was obviously acting like he was giving a PR statement on a subject for a corporation. If you can't get a straight answer now you certainly won't get one later and you certainly can expect that a man who gives you the weasel routine now will be a weasel in his position.

[ancianita]

64. Yes, it is. And word is getting out. People are leaving MA.

Just because it promotes "choice," doesn't mean it's better than current Medicare supplements. I got out of MA over ten years ago.

In 2019, Medicare Advantage Organizations denied 13% of prior authorization requests that would have been accepted if the beneficiaries were in original Medicare.[16]

In 2019 alone, Medicare Advantage plans cost tax-payers $9 billion more dollars than if beneficiaries were in original Medicare.[17]

This is due to a financial incentive for physicians associated with these plans to manipulate diagnosis codes.[17]

In addition, while original Medicare allows for beneficiaries to visit any provider that accepts Medicare, Medicare Advantage plans restrict the number of providers and hospitals that beneficiaries can visit.[18]

As a result of labeling beneficiaries with more severe diagnoses as a way to generate profit, many companies that participate in MA plans such as UnitedHealth, Humana, Elevance, and Kaiser have or are facing federal fraud lawsuits from the Department of Justice.

https://en.wikipedia.org/wiki/Medicare_Advantage

[airplaneman]

82. The most obvious thing I know about Medicare Advantage:

The maximum broker compensation for Medicare Advantage sales in California and New Jersey for 2023 is:

Initial sales: $750 per member annually
Renewals: $375 per member annually
For all other states, the maximum broker compensation for Medicare Advantage sales in 2023 is:

Initial sales: $678 per member annually
Renewals: $339 per member annually

The compensation for traditional Medicare is $0.

The commercials are extremely deceptive: Giving money back to Social Security only means they are paying for part or all of coverage B. You can't see a specialist without approval even if you are still paying all of B under Advantage.

The biggest danger under Advantage is if you have cancer and need doctor assisted Chemotherapy pharmacy treatment. Under Advantage you are stuck with the 20% copay but if you have traditional Medicare and a Medigap policy you are 100% covered.

There are many other reasons I would never accept Advantage.

-Airplane

[peppertree]

34. Hear, hear

Plus - as a Greek liquor store owner (and a Republican) once bellowed to me - "I don't see why I have to pay all these TAXES!"

This has bad idea written all over it, and I hope Biden reconsiders.

[muriel_volestrangler]

99. According to a Washington Post reporter, the trustee appointments are traditionally bipartisan

Link to tweet

"Biden nominates DEMETRIOS KOUZOUKAS, a key Trump health official, to help oversee Medicare and Social Security trust funds.

The role has been vacant since 2015.

Traditionally a pair of bipartisan trustees help oversee funds. Biden previously nom’d @tricia_neuman last year."

So that may explain why Kouzoukas thought he could get away with it - he's from the Trump swamp. It's poor that the Biden administration didn't get a promise from him to give up the conflicting paid position.

[progressoid]

100. Oh good. A Trump guy.

[onecaliberal]

79. Because his loyalty is to his company. Do you see what is happening to working people?

We need someone loyal to THE AMERICAN PEOPLE.

[SouthernDem4ever]

94. Not addressing the relevance to the thread

I would like to comment that if MA programs are over-charging Medicare, it won't be able to last that way much longer unless Mr. Conflict-of-Interest can get his loathsome behind in a cushy position of authority over Medicare. Liz is right and I hope the rest of the Senate realizes this.

[LymphocyteLover]

15. it's not simple connections-- he appears to have a major conflict of interest

[Silent Type]

23. Call up Biden. Apparently, he sees the writing on the wall.

[erronis]

27. Deflection is a favorite tool. First address the issues that are raised by Sen. Warren.

[Silent Type]

71. I did. To improve MA -- chosen by over half Medicare beneficiaries -- you have to have people who

don't hate it.

I'd be fine with the Clintons in this position, after all President Clinton signed it Part C into law in 1997. But I assume he's not applying.

[Hermit-The-Prog]

101. You still avoid addressing the conflict of interest while promoting MA.

[Silent Type]

72. Yet, people think there is something wrong with you. I get. Take care.

PS. There are lots of other DUers with Medicare Advantage too.

[pazzyanne]

97. "There are lots of other DUers with Medicare Advantage too."

Like me. I can't afford Medicare and a medigap/ supplement plan. Most people don't understand there are two types of Medicare Advantage plans: HMOs and PPOs. Stay away from HMOs because they are very restrictive. I have a Blue Cross/ Blue Shield PPO plan that I pay an additional $80.90. The plan covers drugs, dental, and eye care/ glasses plus Medicare services with lower co-pays. I have no bad feelings about my Medicare Advantage plan.

[whathehell]

89. A very slim majority..

attained by an aggresive marketing plan.

[whathehell]

98. For a campaign, perhaps

for a policy, not as much.

The only reason Clinton signed off on MA is that he was facing a Republican congress who wanted to undermine Medicare. He agreed to the Republican-designed Medicare Advantage as part of some necessary deal-making to protect Medicare.

That said, I'd guess almost any health insurance is better than none, so if MA is what you can afford now, you may as well go with it.

[Srkdqltr]

3. I don't understand. Medicare Advantage is in place of Medicare? I thought it was a supplement?

[Silent Type]

6. Medicare beneficiaries can choose traditional Medicare or Medicare Advantage. 51% selected MA

as of 2023.

[ProfessorGAC]

11. It's A Replacement

There are really just 3 options. Medicare only, Medicare with a supplemental, or Medicare Advantage. (Also called Part C Medicare.)
You use Advantage as a substitute for Medicare, although it's still all underwritten by the government.
We have traditional Medicare with a supplemental & a Part D plan. I just didn't see the "advantages" of Advantage. A bit cheaper, but with more conditions.

[Srkdqltr]

13. Thank you. I have Medicare and Blue Cross. That is how it worked when I retired in the last

Century.

[gristy]

38. Me too. Medicare and a Blue Cross Supplemental Plan G

Working great so far.

[Silent Type]

26. Professor, I suspect you can afford the $300/month for a supplement and drug plan. Believe it or not

a lot of Medicare beneficiaries can't. And, they actually use the dental and vision benefits, food cards, etc., even if small to you.

[ProfessorGAC]

28. Not Sure Your Point

I know how to read & I'm good at math. When we chose the difference in cost was small.
Not sure what your point is.

[Silent Type]

32. How much are you spending for supplement and drugs? Is that amount the difference in you having a

roof over your head or food? That is the case for people I know who are among the majority of Medicare beneficiaries selecting MA.

I'd much rather have Medicare-for-All with no copays, etc. But until we get this, poor beneficiaries have little choice.

[ProfessorGAC]

37. That's None Of Your Business

What the heck is wrong with you?
You do understand that everyone here is on the sane side, don't you?

[Silent Type]

43. Not on this issue, and the misinformation is staggering.

[ProfessorGAC]

65. And, You're One Of The Sources

Because you are suggesting that everybody here who chose other than Advantage is misinformed.
You are totally wrong about that, and you're spreading that same disinformation again.

[Silent Type]

67. Professor, no I'm saying until we get something better, Med Advantage is the best poor people are

going to get right now, unless they are on Medicaid. In that case, they are likely assigned to a Managed Care Plan.

You can afford the $300/month. Others can't.

Maybe you should call Biden and tell him he's wrong and see how he responds.

[Desert grandma]

85. Not necessarily so

We have regular Medicare, a supplement plan and a drug plan. My supplement plan is a $160 per month and I just got word that my drug plan will be $0 next year. My supplement plan will ONLY increase if the cost of medical care in my region increases. It is as an AGE ISSUED plan as opposed to most that are AGE ATTAINED plans and increase yearly on your birthday. Age issued plans will NOT increase on a members birthday. I am 75. Ten years ago when I first got on Medicare and this plan, the premium was $150 per month. It is now $160 per month. It does take a lot of research to find the best fit. MA plans for the most part have restrictive provider networks and large co-pays, especially for hospital stays. My medical supplement plan G covers the entire 20 percent that medicare does not cover. In addition, I could be seen at the Mayo or Cleveland Clinics or ANY provider that accepts Medicare.If original Medicare advertised the way the MA plans do, I am not certain they would have 51 % of the medicare eligible population.

[Rebl2]

42. Well the

Blue Cross/Shield plan we have costs much more than $300 a month and our drug plan is part of it. It’s through the postal service. It’s definitely over 300 a month. I was warned not to get MA by my rheumatologist because they won’t pay for my biologic medicine or not pay very well. United Health told me the same. I have multiple medical issues, so MA definitely would not work for us. It’s great if you are healthy, but not so much if you aren’t.

[ProfessorGAC]

69. You're Agreeing With Me

Again, we chose against MA. The restrictions were not worth the difference in cost.
I'm not understanding how anyone thinks I'm promoting MA.
We don't have an Advantage plan. Did the same as you.

[Wonder Why]

55. Let me make it clearer

Medicare covers most health things (no dental, no eye) with very clear rules. You can pick any doctor and go to a specialist without having to get a referral from your doctor. Most of them accept what Medicare say is the value of their services. Some don't so you are responsible for their higher charges above the Medicare approved amount. Medicare covers all but a fraction of hospital payments and 80% of outpatient plus there is a deductible.

Medigap policies are an optional supplement to Medicare as they cover some or all of the deductibles and co-payments (your 20%). They are strictly regulated in that they must gall into one of about 6 categories based on what is covered. Every company in a category must cover the same things and can't decide they won't do it. You can pay a pretty high price for Medigap depending on the category but the best ones mean you pay no doctor or hospital costs (if they accept Medicare) approved amount.

Medicare Part D covers drugs. They are not covered by Medicare. They can be in any category decided by the insurer and you pay a small monthly charge plus the co-payments for the drugs which can be high for some drugs or those drugs may not be covered at all.

Medicare Advantage is an alternative to Medicare as it includes hospital, doctor, usually drugs, and often other extras. Medicare pays for the basic cost but your co-payments can be higher, you must use an "in-network" doctor who may or may not stay "in network" or pay higher co-payment to go out of network; you must get a referral to see a specialist; there are lots of other rules. Basically, it's just ordinary insurance with a private company with Medicare providing the monthly insurance charge vs you and your employer sharing the charges before you stopped working. Every service has to be approved by the company. You save paying the monthly fee for Medicare and the Part D monthly fee but you are at much higher risk of being turned down for treatment or paying lots of $$ for co-payments.

[ProfessorGAC]

62. And?

I know all that. I suspect 99.9% of everyone here over 55 knows all that.
This thread is off the rails with all the pointless hectoring & lecturing.
What part of "I made the choice..." did you not understand? How the heck did I make a choice without knowing the particulars?

[Wonder Why]

74. I didn't question your decision, your, intelligence or your knowledge but calling

it Medicare with or without a supplement is kind of misleading. The "supplement" you are referring to can be another policy (like a retiree policy) that may or may not pay anything (mine never did because its deductible was so high) or Medigap which is a specifically designed policy to cover deductibles and co-pays, not just ordinary insurance.

And, no, lots of people don't understand the differences between Medicare and Medicare Advantages and the big difference in risk, potential costs, and restrictions. They just look at the ads that say you don't pay for Medicare and you "may" be entitled to dental, eyeglass, OTC drugs and all sorts of other things.

[Lonestarblue]

18. No, it's essentially replacing Medicare and is a stealth attack by the insurance industry to

to privatize Medicare. Once they accomplish a significant percentage of enrollees, original Medicare will be gone and insurance companies, as private entities, can then raise premiums, deny healthcare, and essentially do whatever they want to insert themselves between patients and doctors. With MA you’re limited to the doctors you can see and you need referrals to see specialists. If you see a doctor out of network, you will pay extra.

I understand that people look at MA as good because it offers benefits, like eyeglasses, that original Medicare does not. But I spent my working life in an insurance-controlled plan being forced to go to doctors chosen by insurance executives for their costs rather than their quality. Original Medicare accepts everyone. If insurance companies eventually take it all over, company executives who want to increase shareholder profits will be rejecting patients who cost too much. At that point, there will be no fallback because Medicare will be gone.

Here’s an example. If you have cancer and your doctor recommends a form of treatment that costs more than the lowest-cost treatment, the insurance companies can force you to undergo the cheaper, less effective treatment first. Your doctor may know that the treatment will not work, but you have no choice. You have to go through all the lower-cost options until you can get to the one that works—or you die first and save the insurance companies money. People not in Medicare but still on employer-sponsored health insurance plans are denied treatment every day. I know some of them, and it is a battle to get effective healthcare. I would hate to see our real Medicare program turned over to for-profit insurance companies where health coverage and treatment decisions are made by insurance executives, not doctors.

[Srkdqltr]

22. The worst thing ever was allowing insurance to be for profit.

[erronis]

36. Well, the insurance "industry" by definition is for profit. I think you mean health insurance.

Which started when companies needed to add benefits to augment workers wages since the wages were frozen during WW-II. Thus began the behemoth medical insurance industry.

Of course we all know life insurance is for profit, as all other types.

When the US tried to ease into health insurance for all, they started with the Medicaid and Medicare programs. These programs weren't "for all" but they tried to get around the lobbying of the monied healthcare insurance models for a bit.

Of course the capitalists couldn't stand not getting their filthy hands on the funds transferred by the workers and employers directly to the providers using the government programs, so they convinced CMS to add "Medicare Advantage" to the mix. Along with false advertising and poor services, these corporate types have tapped into this source of more money.

And then, look at how most civilized countries take care of their populations. Much better and much cheaper. Difference? US capitalist greed.

[ProfessorGAC]

30. Another Reply Having Nothing To Do With What I Wrote

Did I post in a different language?
I chose AGAINST advantage. I didn't think the cost benefit was worth the strictures of the policy.
Since I chose against what you criticize, I'd think you'd consider me an ally, not the target of a needless screed.

[Deuxcents]

5. MA is a scam, imo

Its enrollment time and I’m doing my research and it does not include MA. I think some have been pressured or misinformed and once they’re in, they can’t get out. I wish the elected would finally get serious about this issue and thanks to Senator Warren for being on top of this

[Silent Type]

7. They just did get serious by appointing this guy. Like it or not, MA is not going away.

[Deuxcents]

9. I know it's not going away

But it needs oversight or some regulations as to the overcharges and dissatisfaction with doctors and patients. Thankfully, we still have choices

[Celerity]

10. yes it is: Medicare Advantage Is a Massive Scam

The program rips off both the taxpayer and its own enrollees.

https://prospect.org/health/medicare-advantage-is-a-massive-scam/



If you’ve ever watched cable news, where the average viewer is in their late sixties, you’ve probably seen an advertisement for a Medicare Advantage plan. They usually star some washed-up celebrity whose career peaked right around when today’s retirees were young adults (think Jimmy Walker or Joe Namath). And they always make a lot of big promises about how great Medicare Advantage coverage is. There’s just one problem: The sales pitch is an abject lie. Medicare Advantage is much worse than traditional Medicare for people on the program and costs a great deal more to boot. But unless the Biden administration changes course, private companies will soon devour the rest of the program.

Medicare Advantage plans are typically a combination of “Medigap” plans, which cover services not included in the government plan like vision and dental, plus a privatized version of traditional Medicare. About 28 million American seniors are now on Advantage plans, or about 40 percent of the whole program. As Barbara Caress explains in the Prospect, it was set up back in the late 1990s as a way for those wonderful private insurance companies we all know and love to work their free-market magic on one corner of the system America carved out as publicly run. Once we got business involved, surely the quality of coverage would improve and costs would go down, right?

The problem with this logic, as people realized even back in the glory days of neoliberalism, is that there are a lot of perverse financial incentives in health insurance, particularly when it comes to seniors. Half the reason the government set up Medicare in the first place was that as people reach the end of life, they tend to become sick and require more treatment than they can personally afford. In the pre-Medicare days, private companies did all they could to keep them off the insurance rolls.

Introducing the profit motive into Medicare has led to considerable hoop-jumping just to prevent such cravenness. For instance, if the government were to calculate the average per-person cost of Medicare and pay private companies that much per enrollee, companies would scramble to snap up all the younger, healthier seniors with relatively few problems, and cream off some easy profits. As Matt Bruenig explains, that’s why the Centers for Medicare & Medicaid Services maintains a gigantic database of every single one of the roughly 64 million Medicare enrollees, and assigns them all a risk score based on their demographic and health characteristics. Advantage companies then get paid, in theory at least, according to how sick their risk pools are.

snip

[peppertree]

17. Those ads! They should hire Cheeto for their next one.

Would be right up his alley - and he'd cause more problems for his wingnut base while he was at it.

"Like nothing you've ever seen - believe me!"

[Celerity]

25. the new scam advert I just saw on the MSNBC stream I watch claims the MA may well pay a decent part

of your rent on top of everything else listed above, and you may get all of it perhaps for free, zero monthly premium.

I could so see Trump shilling for that shite.

[peppertree]

39. Oh, boy - it's like a race to the bottom between them, and the Reverse Mortgage fraudsters

Tom Selleck had better watch out - because Trump might be gunning for his job any second now.

[progressoid]

19. I hate those fucking commercials. EOM.

[Silent Type]

49. Scam started by President Clinton. I enjoy you insights Celerity, but you live where people don't

have to chose between original Medicare and Medicare Advantage in the hopes of saving $300 and month and getting some extra benefits.

I'm for redesigning Medicare and health financing in USA, but for now this is what poor folks have.

[whathehell]

92. No one here is badmouthing Clinton or Biden..

Even the best people make mistakes, and no one's judgement is beyond question. Besides, the major issue here is conflict of interest, not MA's value or lack of such.

[rurallib]

24. Thanks so much for posting

I can't understand how Biden fucked this one up so badly. talk about putting the fox in the chicken house!

Thank goodness Warren caught it and exposed it. Repugs are doing their damnedest to destroy Medicare while defrauding it.

MA is nothing more than private insurance. Once it is the preponderance of senior insurance then Medicare will be killed with little more than a whimper because Americans were hoodwinked once more by the insurance companies.

[Silent Type]

29. He didn't screw it up. He knew what he was doing.

[rurallib]

40. I read your posts above. You make it seem like

there is a full out push to move to Medicare Advantage. I so hope that is wrong.

Medicare Advantage is a slightly wrapped version of private insurance. If it becomes Medicare we will be really sorry. We will see a return to the days of the elderly dying in their homes because they can't afford insurance.

I would hope that Biden is smarter than that.

[Silent Type]

45. Well over half Medicare beneficiaries have chosen it. Glad people think they are smarter than those

beneficiaries and Biden.

[erronis]

48. Shill much?

[Silent Type]

51. Facts. I don't have MA, but if I lived in a big city, I'd sure consider it.

[rurallib]

57. Nice shot.

I think many of those people were bamboozled and now can't get out of their choice.
Some no doubt chose MA because they feel it is better, but as they age I think they will be sorry.
Plus, as more and more are lured into MA it will give the MAGAs an opening to end traditional Medicare.

Once they have MA as the only choice, watch the changes to raise prices and cut services. Somehow I have seen this movie before. I expect it to end the same once more.

No I am not saying that I am smarter than Biden and half the country. I am saying once again the far right has bamboozled the public. When the public figures it out that will have been totally screwed.

The real answer is for the greatest country in the world to dump its Rube Goldberg medical system that costs twice as much as any other country for half the services. Way pas time to join the world in some form of a one payer system with all services from pregnancy to nursing homes available including dental and optical.

Other countries do much more for much less. MA is another step in the wrong direction.

[Silent Type]

59. Actually, as I age I will probably have to go to MA. Again, it amazes me that over half Medicare

beneficiaries are just not as smart as those posting here.

I agree 100% that our system sucks. But right now -- and for the foreseeable future -- MA is what over half beneficiaries have. Until we can change that, why not make it better?

[rurallib]

68. But it won't get better for the customer

but it will get better for the corporation while they suck the money dry. Expect the Medicare pot to be under severe strain as MA drains it faster than it grows. Right wing legislators will not raise taxes thus leading to crises that they manufactured.

Answer? End medicare except for the very poorest and everyone else reverts to some form of private insurance.
These folks play a long game.

Folks think MA is a hell of a deal today, but in 10 to 15 years when they are much older, MA will be refusing to pay for many services. And there will be no other option. It is a very old trick - suck them in and then change the rules.

You my want to poke around here a bit.
https://socialsecurityworks.org

[erronis]

46. Please explain your point a bit better.

Are you inferring that Biden put someone up for nomination who was known by Biden to have financial interests in the scam Medicare Advantage programs?

Or are you just stirring up the mud?

[Silent Type]

50. I'm saying, Biden knows what he is doing. Improving Medicare Adv will do more good for the poor

than all bashing, hearings, etc.

[Envirogal]

87. Privatization helps the poor???

Since I’ve been reading you schill throughout this entire thread, I thought I would ask for your extensive knowledge base of how privatization in the case of MA is able to undercut traditional, Medicare’s monthly premiums as you have cited ad nauseam?

Is it because they can cherry pick and take younger and less sick patients that lead to less of a risk pool? Could it be that when a patient does need coverage especially catastrophic, they can overbill the US taxpayer? That is a bait and switch scheme, especially when they’ve got the good ol’ US American taxpayer to take care of their risk. They lure people with lower upfront premiums (as you say the poor) through extensive brainwashing with commercials, then make sure they leave the sickest people to Medicare.

That is why the health industry did not fight too much when Medicare started in the late 60’s because it was taking the biggest risk customers out of their pool—seniors. Then a few decades later they were able to convince current Conservadems and Republicans that they wanted in on that biz, but still mandating they needed to cherry pick customer and make huge profits.

[Fiendish Thingy]

54. He might know what he is doing

But I don’t agree with it - hiring an MA fox to guard the Medicare chickens is like hiring a private parcel shipping magnate to be postmaster general…and we know how that turned out.

Privatizing Medicare will be as dramatic of a shift as the shift from most folks having defined benefit pensions to most having 401k’s. Big profits for the profiteers, and reduced benefits for seniors.

I trust Warren on this one. I hope she blocks his nomination from getting out of committee.

[Silent Type]

60. He worked with CMS/Medicare before getting on the Board. If he doesn't resign, they can make him.

I doubt I'd ever trust Warren over Biden. H Clinton trusted her too, right up until Warren undercut her and Obama leading up to trump's victory in 2016.

[gratuitous]

44. Kouzoukas is on the board of Clover Health

During his personal testimony about his experience and background, Kouzoukas neglected to mention that. When asked by Sen. Warren what he's paid by Clover Health to sit on their board, he dodged, dissembled and ducked before finally, grudgingly, admitting that he gets $100,000 a year from Clover.

Warren then asked Kouzoukas if he was going to resign from Clover. More dodging, dissembling and ducking ensued, and Warren finally just said that it didn't sound like Kouzoukas was going to resign his $100,000 a year post.

Warren then pointed out that being a trustee of Medicare Advantage that Kouzoukas would be making decisions about all kinds of things that would affect Clover Health and its bottom line. Kouzoukas tried more dodging, dissembling and ducking with a good bit of willful ignorance thrown in for good measure, but Warren wasn't having it:

Let’s be clear. If Mr. Kouzoukas ignores the fraud, he helps Clover. If he focuses on the fraud, he hurts Clover. The conflict of interest here is so big and so pervasive that there is no action that Mr. Kouzoukas can take that doesn’t either help or hurt Clover, the company that pays him $100,000 a year to sit on its board and watch out for the company. And there is no waiver that can change that fact. This kind of conflict is shocking and it is deeply unethical. Not a single other trustee has ever received compensation from an insurance company while acting as a Medicare trustee.

This nomination needs to be voted down.

[jaxexpat]

47. MA is the juncture of taxpayer funding and corporate monetization of healthcare.

The subject, then, is profit. Ultimately, profit is when wealth is funneled to an ever shrinking group of receivers who are dependent upon their placement to maintain their status.

Where could a focus of profit take our already desperate healthcare system? Oh......just kidding, it would take us exactly to our current healthcare location with our current uncertainties.

[Silent Type]

73. As is traditional Medicare. It's locally administered by insurance companies, private insurers make

Last edited Fri Sep 29, 2023, 08:04 PM - Edit history (1)

money off supplements and drug plans.

If you have a question about your traditional Medicare, you call a private insurance company.

If you don’t believe me, look it up. Tell me what state you are in, and I’ll give you the name of the MAC (Medicare Administrative Contractor) for your area. It’s a subsidiary of an insurance company like BCBS, CIGNA, etc. They credential providers, pay doctor claims, they answer beneficiary questions, they audit doctors and hospitals.

Feds set standards just like they do for MA. But private insurance companies administer the program.

[erronis]

81. What the hell are you talking about. Medicare is not administered by insurance companies.

You sound almost robotic. Has BC/BS, Anthem, UHC started using the GPTs to write posts?

[jaxexpat]

83. How could there possibly be any confusion about Medicare with all the facts we have, eh?

[bringthePaine]

75. can't be trusted during testimony?🤨sure as fuck can't be trusted with our best imterests!🖕

[Warpy]

78. Yes, they should have done a better job vetting this guy

who obviously knew there was a gigantic conflict of interest but wanted to pretend no one else did.

Somebody didn't do his job.

[Tom Yossarian Joad]

80. Hat tip to Sen. Warren

[mountain grammy]

84. The Senator is doing her job

He should just answer the questions and the administration should be prepared for this.
I did learn a lot on this thread. Thanks everyone.

[UTUSN]

88. K&R for, perfect Subject title

[SleeplessinSoCal]

93. We were directed to Medicare Advantage after losing our PPO Medicare coverage through SAG.

The Covid years did enormous harm in many ways. SAG couldn't honor its obligation to provide top tier medical coverage to its many non-working actors. Via Benefits has been provided by SAG to manage our choices. We got calls this week to expect to engage with them over the coming months of open enrollment. Think I'll look into the difference in costs. It has been more affordable with the Medicare Advantage HMO. But.....