Editorial/opinion
As a primary care doctor, I believe Alaskans must understand that a critical portion of our Medicare dollars is bleeding away into privately held corporations, which inherently value profits over people.
Recently, Direct Contracting Entities (DCEs) have been tapping into the Medicare trust. This is money held in trust by the federal government, which in 2020 was valued at $937 billion. During the Trump administration, the Centers for Medicare & Medicaid Innovation (CMMI) vowed to pass all Medicare “risk” to “management” plans. “Risk” in this case is a misleading term: It refers to the healthcare costs of the beneficiaries – that is, paying for beneficiaries’ healthcare. “Management” involves more layers of middlemen tapping into the pot, rarely improving services and often denying care. After all, unlike Medicare itself, corporations like DCEs exist to make a profit, so DCEs have every reason to pay as little as possible.
Today, the Biden administration is allowing the continuation of so-called “demonstration projects”, which are moving 30 million of Medicare’s 38 million beneficiaries into the DCE plans without our consent or knowledge. This is occurring via several large corporations in the health arena, such as Anthem, Cigna, CVS, Humana and United Health Services, and smaller private equity firms that are wooing physician groups with the promise of higher reimbursements and less Medicare paperwork.
The catch? Toward the end of patients’ lives, when healthcare can get very expensive, many claims get denied. Yes, that is the “management” model, and it should shock us all.
Here is a 14-minute YouTube video by a past-president of Physicians for a National Health Plan explaining the problem. https://www.youtube.com/watch?v=L27IqMLr934
I recommend watching it twice, since the issue is complex. Please go to PNHP.org, sign the petition to stop DCEs, and spread the word. Our health, and healthcare benefits, depend on being aware and taking action.
Emily Kane is a naturopathic doctor and licensed acupuncturist living in Juneau.
