Fox put in charge of hen house

To the editor:

It is concerning that our federal government is consistently working to privatize Medicare and Medicaid in spite of the many reports by attorneys general offices documenting private insurance refusing to pay claims and denying authorization for services that would be paid under Medicare, and overcharging the government for millions of dollars.

A Jan. 17 letter by Physicians for a National Health Plan uses attorney general records to document overcharges of $875 million. The Centers for Medicare & Medicaid Services actually suspended three UnitedHealthcare plans and one Anthem plan for not spending enough of their federal income on health care. 

Not dissuaded by increased costs, the administration is transferring patients to Medicare Advantage plans at an alarming rate, allowing the insurance company to retain 15 percent of the government money for administration and profit. Medicare administration costs 4 percent. Medicare Advantage plans are not decreasing medical costs for the government, the patient or the doctor.

The next step was to allow groups of doctors or hospitals — direct contracting entities — to administer medical benefits for their in-network patients. The doctors and hospitals are paid per patient by the government, and retain a set percent for administration expenses and profit.

The conversion to DCEs resulted in many patients losing their coverage for those doctors who were suddenly no longer in-network. Under Medicare, patients can see any doctor that accepts Medicare payment. Naturally, there is also incentive for doctors to order more tests, and upcode conditions for higher reimbursements. The cost of medical care continued to increase.

The latest privatization attempt by the government truly puts the fox in charge of the hen house. Private equity firms can now buy up smaller insurance companies and doctors networks, and be paid with our taxpayer dollars to administer health care. Wall Street, the slickest of the profit takers, is to be entrusted with lowering medical costs.

A recent article in Kaiser Health News warns “more orthopedic physicians sell out to private equity firms, raising alarms about costs and quality.”

The peer-reviewed Journal of the American Medical Association concluded in its study “the findings of this economic evaluation suggest that, among a large commercially insured population, private equity acquisitions of physician practices were associated with increased health care spending and several measures of utilization.”

Private equity has no interest in reducing the cost of medicine. The argument that privatization of government health care will lower costs is simply unfounded and absurd.

There is widespread concern about the high cost of medical care destroying our small businesses, employer-based care leaving our workers vulnerable to economic downturns and epidemics, and the enormous increase in bankruptcies resulting from medical debt.

The solution is not to expand profit-based health care, but to stop the privatization of Medicare.

Helen Krim