You probably have seen Joe Namath on television hawking Medicare Advantage plans. Don’t be fooled! Joe was a decent quarterback, but a health insurance expert, he is not. Right now, there are two versions of Medicare: Original (federal) and Advantage (commercial). In addition, there is a new program called REACH which can switch your plan from Original to a commercial plan without your consent. Commercial insurance companies such as United Health Care, Cigna, and Aetna make huge profits if they can sell their Advantage plans. These insurers are overpaid middlemen. They spend your premium dollars on fat-cat executive salaries, lobbying, investor dividends, advertising, and political donations, not on your medical care. In addition, the government subsidizes Advantage plans using Original Medicare funds, thereby making the Advantage plans even more profitable and depleting the Medicare Trust Fund.
Advantage plans will limit your care if they can. They will insist that your doctor prescribe certain drugs and not others. You will be restricted to a certain panel of doctors, and they will make it difficult for you to go to anyone outside this panel. If your doctor orders a test, they might not pay for it unless you get prior approval. If you get really sick and you want to switch back to Original Medicare because it provides more options, you will do so at a greater cost. If you switch from one Advantage plan to another, you may have to switch doctors as well.
Don’t be fooled by Joe Namath’s slick but empty promises. Commercial insurers have turned our health care system into an expensive, poor performing mess. They are profit motivated not patient-care motivated. The only way out of this mess is a federally funded single payer system which would insure everyone from birth to death.
Richard Dundas, MD