Vermont Standard


If I started the column with the title, “Medicare Disadvantage declares open season on seniors,” I don’t know about you, but I’d be moving on to something else to read. I’m sick and tired of the direct mail, ceaseless television commercials, and the phone calls. Does anyone fear the “Do not call list” anymore? The jackals that are promoting the Medicare Advantage plans are halfway through moving seniors from traditional Medicare to for-profit private sector plans. Just so you know, this will ultimately turn out badly. Why? Because it already has!

As you might expect, there was growing clout through the years of the insurance industry. Fast forward to the 1960s, and the medical industrial complex started complaining about two classes of people that the insurance companies hated: Poor people couldn’t pay for insurance, and old folks used too much healthcare. Both of these groups just cost too much to care for — there was no profit in it. So in response, the federal government created Medicare for seniors and Medicaid for those who can’t afford insurance, two of the most efficient and cost-effective programs we’ve ever created when compared to the for-profit free-for-all that goes on in the private sector.

The healthcare industry represents almost 20% of our entire economy and 14% of the workforce. With so many people profiting off the status quo and with profits in the billions, the only changes that have happened in our healthcare system during the last 70 years were all schemes to tweak profits upwards, which brings us to Medicare Advantage (MA) and Obamacare: The no insurance company left behind Act requiring insurance for all.

Created in 2003 without much fanfare, the insurance industry convinced the federal government that they should get a share of the potential profits from Medicare. Just so you know, Medicare administration costs around two percent, while private sector plans suck up to 20 cents of every dollar for running the plans. The Republican dream of privatizing Medicare was launched, and 20 years later, we’ve reached the tipping point of half of all seniors now on a private sector MA plan. Read that as half of Medicare has been privatized. I’ve been asking myself, is it even possible at this point to put the greedy genie back in the bottle?

We’ve all heard it said, “If it’s too good to be true, then it probably isn’t.” So knowing how much extra it costs to run MA plans, and with the promised extra bennies like dental, eye health, hearing, meals, rides to appointments, and gym memberships, well, you might think it doesn’t add up. How can the insurance industry offer all these extras and still make money? You already know the answer: massive fraud, and denying claims as a standard operating procedure. reports, “The rate of denials has tripled since 2019, as Advantage plans use artificial intelligence to make decisions.” Let that sink in: denials made by machines.

Meanwhile, there’s a growing movement within provider networks and hospitals to refuse to do business with MA providers. Every day there’s another hospital chain that complains of being underpaid, or, when they do get paid, having to wait months for the check. Even after the MA fraud was discovered, the insurance companies fought tooth and nail to keep their ill-gotten gains. After they were caught, they negotiated with Medicare to keep some of the money and promised to keep the fraud to a dull roar in the future. Wait — they stole from We the People, kept a piece of the action, and made a deal for future fraud? Someone want to tell me why these companies are still eligible to participate in MA plans? According to the Medicare Trust Fund, MA plans charge the government 25 to 30% more than traditional Medicare would charge for the same service — that’s after you’ve been denied.

The bad news is that, eventually, the insurance industry will suck all the money from the trust fund, and there will be no Medicare for anyone. Without the political will to fix this, Republicans will fulfill their dream to eliminate one of our cherished social programs — one down, next up Medicaid and, finally, Social Security. Do you remember why Medicare was created in the first place: Because here in the richest country in history we decided our elders should have proper medical care. During the open enrollment period, reject MA plans and the systematic destruction of our eldercare system as we know it. Instead of screwing it up, we should try making Medicare better.

Contact Kurt Staudter at