Humana CEO Signals Industry Plans to Hijack the Medicare for All Movement

[Nanjeanne]

https://businessinitiative.org/humana-ceo-signals-industry-plans-to-hijack-the-medicare-for-all-movement/

Wendell Potter has been my hero since he left the insurance industry and became an advocate for care. Worth reading the whole article.

My old colleagues in the insurance industry are up to their old tricks. Bruce Broussard, the CEO of my former employer, Humana, referred to Medicare for All as “a great opportunity” on Tuesday.

It is a great opportunity! Finally, we can have comprehensive universal healthcare.

We can remove the burden of providing health insurance from employers, who—once Medicare is improved and expanded to cover all of us—can raise wages, invest in new markets, create new jobs, and be more competitive internationally.

Medical professionals will no longer be drowning in paperwork. We won’t have to hear any more horrifying stories of people dying while rationing their insulin or losing their life savings from a cancer diagnosis. Or not being able to get the care they need because of the ever-increasing barriers insurance companies are erecting between patients and their doctors.

Of course, these aren’t the opportunities he’s referring to. You see, Humana ostensibly exists to sell health insurance that protects their customers from financial disaster when they need healthcare. But in reality, Mr. Broussard’s top priority is to further enrich Humana’s shareholders (including himself). And he’s doing a very good job of that by soaking taxpayers through the company’s Medicare Advantage plans.

[Wellstone ruled]

1. You just knew this

story was just waiting in the wings. When you can put a hundred Lobbyist in a Congressional Hearing Room,gee,what outcomes are these Lobbyist hoping for.

[octoberlib]

2. Wendell Potter founded a new investigative reporting site called tarbell.org.

Lots of good reports on there. From what I've heard Medicare Advantage is crap.

[Nanjeanne]

3. Yes. I subscribe. And he's on the board of this website Business Initiative health Policy where

this article comes from. Many great articles on the site.

[scarytomcat]

9. Medicare Advantage is confusing because people think it is Medicare from the government

it is a pure scam on the name

[msongs]

4. insurers are just parasites and provide no actual health care. they do not wish to disappear tho

and will sabotage any attempts to kill them using willing dems and repubs as tools in their efforts

[appal_jack]

5. Beto appears to be one of their willing pawns. k&r, nt

[SharonClark]

6. Of course they don't provide health care.

They provide insurance.
Only health care providers provide health care.

[erronis]

12. Agree with view on insurance. However a lot of providers are in it for big profits.

I've witnessed several of my small practices being subsumed or put out of business by mega HealthCare Providers.

And prices have gone up even thought one of the rationale was that there would be more "efficiency". Efficiency in putting $$$s in their banks.

In my state, every hospital is non-profit. But the top-level C-suite and admins make sure that there are no profits to be distributed.

[Nanjeanne]

22. They provide no service or make any product. They write a check (sometimes) to a

provider. I’d prefer the government write that check.

[ancianita]

7. Hilarious.

[Nanjeanne]

17. Not to me or my husband who battles multiple myeloma and needs ongoing

treatment to stay alive. Thank God when we got on Medicare and didn’t have to fight for his infusions or stem cell transplant.

But so glad to know you find healthcare hilarious.

[ancianita]

53. Of course I don't, either. It IS hilarious to me that these assholes think they'll be able to

take over the BIG government health care system of the third largest country on the planet. And that anyone but corporatists who want to end government and take over everything under the libertarian rubric of "free markets."

Watch them privatize Medicare and then start their a la carte charging old folks for every little treatment. I'm glad you both have Medicare -- I do, too -- but there is no for-profit health giant that can or will do what it does nearly as thoroughly or well as our government now does.

Never trust this gambit. It's real intent is to end Social Security, which runs Medicare -- that is where this terrible, horrible, no good idea is headed.

We have to keep voting for those who will protect both Social Security and Medicare. They're counting on people not knowing that the two are related, so if they can convince people to end Medicare, they've got their camel nose under the tent of stealing our huge pool of money.

Perhaps you might have asked what I meant. It was about this OP gambit, not how I find health care.

All the best.

[zaj]

8. Who here would choose...

... the status quo to a world with a Medicare Option?

Or Medicare For All that left room for private insurance alternatives like Humana?

In comparison to the alternative of going backwards or standing still, getting a Medicare Option that kept private insurance in the equation, would seem to be another huge step forward.

[Nanjeanne]

11. Not me. If we are looking to bring down costs we must fight for a Medicare For All system

that everyone is in. Then private insurance companies can offer ancillary services for people to choose like cosmetic surgery or seeing a naturopath. Or expensive special policies for the very wealthy that will always want some kind of private everything. But that would be in addition to — not instead of paying for Medicare For All That’s all I want Humana to offer.

We must start with all in. We will never achieve lowering the cost of healthcare if it’s not a shared risk like insurance has to be and not just something for older and sicker people to “choose”. It’s the starting point. If we have to negotiate from there to some kind of option, so be it. But it is not the policy that should be discussed as a policy position.

For a much more coherent argument against Medicare For Some read this article by Dylan Dussault at Business Initiatve for Health Policy.


https://businessinitiative.org/wecannotbackoffonmedicareforall/

[zaj]

13. Incremental moves of the Overton Window

Each step moves the window further toward reform.

Obamacare, was flawed, but transformative... even without a Medicare Option.

It pushed the window forward.

Obamacare + Medicare Option (Medicare for America, it seems) moves even further.

When Hillary tried Medicare for All, we lost 40 years or transformation, because it was too big of a leap.

As an activist, you need to keep pushing for the end goal, but along the way, let's be sure the champion those taking big steps toward the goal, and accept victory in stages.

[Nanjeanne]

15. Read my post. You don't start with some kind of complicated hybrid that does nothing to

bring down costs and might actually increase them if Ony sick and older people are first in. The changes proposed to the Medicare For All plans in the house and Senate are greatly expanded on Medicare. Not feasible as an option that still allows insurance agencies to deny care to appease shareholders and give CEOs multi million dollar raises each year.

In addition, if doctors still have hundreds of different healthcare policies to administer to, there is no decrease in admin costs to doctors either.

You simply do not start there as a policy. When elected, you ay have to give a little to get the whole, but you have to start with an intelligent policy that cut costs and takes the profit motive out of healthCARE.

[alwaysinasnit]

10. K&R Great post, thanks.

[RicROC]

14. salary for Mr. CEO Humana

Mr. CEO Humana makes an income of $100+ Million per year so his interest is NOT having a Medicare for All plan.

[Nanjeanne]

16. Yup. And Blue Cross CEO got a 47% raise in one year. Thats a helluva lot of people who had

to be denied care for that many more millions!

[WillowTree]

33. Which Blue Cross was that?

[Celerity]

43. 43%, but still, outrageous

Blues CEO's compensation rises 43 percent to $19.2 million

https://www.crainsdetroit.com/health-care/blues-ceos-compensation-rises-43-percent-192-million

Daniel Loepp, president and CEO of Blue Cross Blue Shield of Michigan, earned total compensation of $19.2 million in 2018, a 43 percent increase from $13.42 million in 2017. Loepp, who has been CEO at Blue Cross since 2005, is one of the highest-compensated health insurance CEOs in the nation. Most local publicly traded companies haven't reported 2018 compensation yet, but Loepp's compensation would have put him second on Crain's list of highest-paid CEOs in 2017 behind General Motors Co.'s Mary Barra, who earned about $21.9 million.

Over his 14-year tenure at Blue Cross, Loepp's compensation has steadily risen, especially the last six years. His total compensation has increased 397 percent from $3.86 million in 2012 to $19.2 million in 2018, primarily by reaping bonus payments due to Blue Cross' steady financial improvements since the Affordable Care Act of 2010 went into full effect in 2014.


In 2018, Loepp's total compensation included a base salary of $1.54 million, which has remained the same over the past five years; a bonus of $16.24 million and other compensation of $1.44 million that includes car allowance, health insurance premiums and retirement contributions.


The Michigan Blues reported net income of $580 million in 2018 on $29.3 billion in revenue, according to its annual financial statement released Friday. It was the second-highest net income figure the health insurer has posted in the past decade after a record 2017.

snip

[WillowTree]

45. I just asked because you said "Blue Cross CEO got a 47% raise" as if there's one Blue Cross CEO.

There are actually 36 separate health insurers in the BCBS Association and I was just wondering which one you were referring to. Thanks for the info.

[Celerity]

46. you have the wrong poster

I did not post the first reply (the 47% one) that you responded to.

[WillowTree]

47. So I do. Sorry 'bout that.

[Celerity]

48. all good!, cheers n/t

[DirtEdonE]

18. I gotta' tell you, I've been dealing with "health care" companies

like Humana for many years and they are the among the worst criminals in the nation. I could tell you stories that would make a bald man's head curl. They are interested in nothing more than "earning" their year-end bonus by denying people their life-saving medical care.

They, the "health care insurers" are the REAL death panels. IMO and in truth.

[Nanjeanne]

21. Amen. Couldn't agree more b

[PeeJ52]

19. I wonder how much the insurance companies are ripping off the government with their supplement plans

It's hard for me to believe I'm only paying $138 a month for all the coverage I get with my AARP plan. All my meds are no cost if I get them mail order. Medicare is cheaper for me than the $400 a month I was paying for insurance when I was working and the coverage is the same except a little max out of pocket on big ticket procedures.

[WillowTree]

28. How would insurers "[rip] off the government" with Medicare supplement plans?

How does that work?

[PeeJ52]

30. Can they allow the doctor to run up all kinds of charges that the government has to pay.

Maybe splitting them with the doctors? Having the doctors over prescribe medications that are free to the patient, like me, but when the government gets the bills from the insurance warehouse they have to get the meds from, they are twice what I would pay at the local drug store if I paid my $3 deductible. Things like that. We don't see what the insurance company is charging the government for the services we receive. I haven't even seen a statement of services from the doctors since I've been on Medicare. For all I know he's been charging for 20 or 30 procedures when all he's been doing is taking my weight, blood pressure, pressing on my stomach, and asking me how I'm feeling.

[WillowTree]

34. Lots of supposition there without facts.

It's apparent that you really don't know how Advantange plans work.

[PeeJ52]

35. Well, do you want to explain them to me since you are so pro insurance?

I understood Medicare to pick up about 80% of the major medical such as hospital costs and the supplemental plans cover your doctor visits, prescriptions, and more, depending on how high you want your premiums to be. If you'd like to give an in depth lesson, I'd be more than glad to read your words of wisdom.

I do know that insurance companies can submit claims for more services than the patient received, as I live in Florida and our Governor was famous for that when he was at Columbia/HCA. I also know doctors can prescribe drugs that favor one drug company over another.

Now, tell me what you know about the healthcare industry.

[WillowTree]

36. Thanks for the snotty response.

Did it occur to you to do even a little a bit of research to see how Medicare Advantage plans work before getting all snarky and further displaying what you don't know about it? Obviously not.

Advantage plans are not the same thing as supplemental plans and neither of them "submit claims for...….services". They pay claims. Supplemental plans pay the providers of services for amounts not paid by Medicare.

Advantage plans, on the other hand, are what are called "capitated" insurance plans, meaning that they are not "fee for service" plans but instead Medicare pays the plan a contracted flat monthly amount for each person enrolled in the plan and the insurer has to pay for covered expenses out of that pool, which is also how most HMOs work. In most cases, the insurance company, in turn, negotiates a flat (capitated) amount per patient with doctors and hospitals. But there is no mechanism for a Medicare Advantage insurer to "submit claims for more services than the patient received" to anyone, including Medicare because, as I said before, they pay claims, they don't submit them.

By the way, the same thing applies to regular insurance. They pay...….or don't pay...….but they don't submit. Honest. You can look it up.

And the 47 years that I worked in the industry kind of does give me a bit of knowledge on the subject.

[PeeJ52]

39. Well then, there is no way in hell capitated plans are getting by on my $138 a month.

Every insurance company is losing money then. When I had to pay $400 a month when I was working and I never used that damn insurance except to have one child, a broken leg, a bout with lung cancer, and a hip. And now that I'm retired I only pay $138 a month and I have regular checkups and will probably use doctors a lot more because of being older... something tells me we need to get rid of the insurance industry altogether then.

Oh, my "snotty" response was just a mirror of your "It's apparent that you really don't know how Advantange plans work". Instead of saying that to someone, maybe you should consider telling them what you told me after I had to give you my snotty response. You telling me I don't know what I'm talking about doesn't really do much good.

[WillowTree]

40. It WAS apparent that you didn't know how Advantage plans work. Still is.

But you have a real nice evening.

[PeeJ52]

50. and it's apparent you would rather just tell people they are stupid than educate them...

go ahead and feel good about yourself...

[WillowTree]

42. Oh, and by the way.......

HCA isn't an insurance company, another little fact you seem to have confused with something else, even if you do live in Florida.

[Celerity]

44. How Private Insurers Rip Off Medicare Advantage for Billions of Dollars

http://www.thefiscaltimes.com/2017/05/16/How-Private-Insurers-Rip-Medicare-Advantage-Billions-Dollars

Despite its successes in diversifying government health care coverage for seniors over the past 15 years, the Medicare Advantage managed-care program increasingly has come under attack for excessive and unscrupulous billing practices that are costing taxpayers billions of dollars.

The Government Accountability Office (GAO), the premier non-partisan watchdog, has repeatedly complained of inadequate auditing by the Centers for Medicare & Medicaid Services (CMS) to ferret out wrongdoing or inaccurate billings by scores of for-profit health care insurers that take part in the program.

In 2014, Medicare paid about $160 billion to Medicare Advantage organizations to provide health care services for about 16 million beneficiaries, according to GAO. CMS, which administers the program, estimates that about 9.5 percent of its payments to Medicare Advantage organizations were improper, owing largely to unsupported diagnoses submitted by the private insurers.

That works out to roughly $15.2 billion a year in overbilling or bogus patient diagnoses by the insurance companies providing coverage through health maintenance organizations and other private medical practices.

snip

[PeeJ52]

51. I thought that's what I "guessed" how they could do it... I must be Jon Snow though..

I know nothing...

[Initech]

20. Can't have universal health care, there's billions to be made!

[DirtEdonE]

23. Yep.

Where would the money come from?

From the extra 25 percent or so the "health insurance" companies rip-off for the top for their own bonuses, for starters.

[nitpicker]

24. Retire from the Federal government

And carry the FEHB insurance into retirement.

Then Medicare Part B, "Medicare Advantage", etc. plans aren't needed.

[Maru Kitteh]

25. Humana commercials NEVER STOP. They go on forever and they're EVERYWHERE.

Any company doing that much advertising is running a racket.

[Cracklin Charlie]

26. Insurance industry execs deserve extinction.

Their greedy fingers are in every pocket. Just go away.

Congress needs to make that happen.

[Hoyt]

27. Since we don't have M4All, I wonder how many DUers -- with Medicare Advantage -- feel it's a scam?

Over 30% of Medicare beneficiaries voluntarily choose to sign on with Medicare Advantage because it saves most of them money and provides coverage that traditional Medicare does not, such as: drugs, limit on out-of-pocket costs, is often better coordinated care that promotes preventive care, etc.

I've been for Medicare-for-All, actually Medicaid-for-All, since the very early 1980s. But it ain't happening any time soon. A Medicare Public Option might happen sooner, but it won't be as inexpensive as people think.

While Wendell Potter has his views -- some right, some not -- he did make a lot of money from the insurance industry he now makes money bashing.

[WillowTree]

29. I'm very happy with my Advantage plan.

No co-pays for .regular office visits small ones for visits with specialists, small co-pays for lab and x-rays and out-patient surgery. The Rx coverage is roughly equivalent to what I had when I was working plus excellent vision care coverage, limited dental care and even $300/year for OTC items, all with no additional premium above the regular Part B monthly premium. So no. I don't at all think it's a scam

[Hoyt]

31. I agree with you. I think most of the criticism of M-Advantage are from people who have no idea

what they are talking about, and likely aren't even old enough to have to make the decision to go traditional Medicare (with 20% co-insurance and no out-of-pocket limit), pay $100-$200 for a supplement and drug coverage vs. M-Advantage with low or no additional premium, etc.

I get some people don't like being locked into a panel of physicians, but when I had Kaiser MAdvantage I liked them taking care of all that and actually trying to keep me well.

Now, I'd like everyone to have that choice, including those younger than Medicare. But that's a different issue.

[WillowTree]

32. I was under an HMO at work and loved my medical group.

So that was important when choosing a Medicare plan and was glad to see them associated with this one.

I was talking with a good friend last week who's really happy with her Med supplement which, she says, picks up literally everything above what Parts A & B pay. But, of course, there's an additional premium for that which I can avoid with the one I found for myself. Interestingly, she said that virtually no doctors where she lives are affiliated with any Advantage plans. She didn't know why.

Some people's objections may have to do with dealing only with "in network" doctors. Either just don't like the idea out-of-hand or may have had a less-than-optimal experience with an HMO somewhere down the line. I am fortunate that I never had any problem with the HMO that I had for about 11 years and my primary doc is part of a massive, well-regarded group in this area which includes virtually any specialty I might ever need. Very fortunate, and I know it.

[Blue_true]

38. I was in an HMO all my corporate working career.

I preferred that. I have to evaluate insurance coverage now and it is a bear. A person ends up having to FIND an insurance broker to help and hope that person is on the up and up. Any way it is more expensive now.

[SoCalDem]

37. I am actually thankful for our Kaiser medicare advantage.. My husband died in Oct

and From Oct 23 to 26th he was at two hospitals, had a very expensive ambulance ride to a major stroke centered hospital and intensive care for most of the time..

Our share of the TOTAL care $215.00..


The outcome sucked, but it would have anyway, and at least I did not have to empty bank accounts & go into debt..

[Hoyt]

49. Sorry about your husband. I had Kaiser too, and liked it. Moved out of their coverage

region, but it’s getting closer. Take care.

[Blue_true]

41. Where were you during the Capitalism fight?

Some people dislike anything that has profit associated with it, regardless of whether it is effective or not.

I don't plan to retire, but I really wish that someone like you would do an OP laying out the ins and outs of Medicare for people that are nearing that age. Coinsurance, Advantage Plans, when and how people choose would be valuable.

I have to deal directly with picking through healthcare plans, it is a PITA. In the end things get thrown in the lap of an insurance broker, with a prayer about whether I am doing the right thing.

Insurance, even under Medicare can be confusing. A person like you that has some insight writing a detailed OP Nedicare and related healthcare coverage and on the how to's would help some people.

[procon]

54. I have no complaints with my Medicare Advantage plan thru Kaiser

I switched after first signing up with regular medicare and a supplemental plan to cover some of the unpaid charges. Everything was a confusing hazzle with too many variables between plans to make any sort of comparison shopping. There was lots of paperwork, OOP bills to pay, and it took up a great deal of my time and energy, but I always felt my decision was flawed because I couldn't make an informed choice.

With Medicare Advantage everything is seamless, easy-peasy, and almost everything is covered with many free services. They offer health education classes for chronic disease, there are weight loss meetings, free vaccines, every sort of specialty service, and almost everything is located in their local facility. Their support staff is polite and I've never had any problem getting what I want in a prompt time.

I don't have a problem with Kaiser making a reasonable profit from the services they provide as long as the govt is doing oversight and regulate insurance providers to avoid scammers. If we ever get a universal health plan, Medicare Advantage would be a good place to start.

[Nanjeanne]

57. Our dear friends had an Advantage policy while we had decided on a Medigap policy.

When my husband was diagnosed with multiple myeloma we were thrilled we had decided on the N policy as we were able to go to Boston and have a myeloma specialist at Dana Farber lead my husband’s team at Yale with no problem. And we had no issue when we did his stem cell transplant at Dana Farber either.

We would have conversations with our friends about the extra cost versus the Advantage plan and they were happy paying less. Fast forward 2 years and my girlfriend was diagnosed with aggressive brain tumor. Then they found out how limited their choices were. One hospital in NY for treatment, they couldn’t go to any specialist they wanted or travel out of state. When time came for hospice, they had one choice in the Village that had only a few beds. They wanted to go to Cavalry, a well respected hospice. Their doctor fought to get them in here but because it would only be covered by Medicare, and not covered by their Advantage plan, they would have to be responsible for the additional 20%. That is what Gene chose and she had excellent care until she passed at Cavalry. Unfortunately, the medical bills by going outside his limited Advantage plan, are still burdening Gene.

Anecdotal- yes. But as we are heavily involved with cancer treatments for my husband now going on our 6th year - we have dozens of these stories. People “like” their insurance much more when they don’t actually have to use it.

[Turbineguy]

52. Well, they have to protect themselves.

After all, what kind of country would not allow you to loot a system based on profiting from those who suffer?

[FakeNoose]

55. K & R bookmarked

Thanks for posting this! I plan to read more articles by Wendell Potter.

[ck4829]

56. Nasty