GOP Should Stay Clear of Medicare Advantage Model When Reforming Health Care System

In tomorrow night's debate, 2020 Democratic Presidential hopefuls will pit their leftist policies against each other -- each one proposing some form of socialized medicine for America.

Republicans are scrambling to provide an alternative to the proposed far-left overhaul of our health care system that retains free-markets in care and coverage. Unfortunately, some suggest a system similar to the federal Medicare Advantage (MA) program.
 
This is the wrong direction. Medicare Advantage plans frequently deny patient access to care and
forces patients and doctors into a burdensome and bureaucratic appeals process. Thus, most denials are never being appealed. 
 
This disturbing trend was reported by the U.S. Department of Health and Human Services Office of Inspector General (OIG). While 75 percent of denials are overturned by the Medicare Advantage plans when appealed, only 1 percent of denials are appealed.
 
These MA managed care plans (prepaid health plans) aren’t what they seem. Like single-payer systems, they control the dollars, the data, and in many cases, the doctor’s decisions. 
 
Health plans are not the “private market.” They are not a free-market concept that bubbled up independently. They've been imposed by the government since President Nixon first funded 110 HMO pilot projects with nearly $26 million, and U.S. Sen. Ted Kennedy’s 1973 HMO Act gave $375M for the development of HMOs and forced companies with 25 or more employees to offer the HMO. The Affordable Care Act (ACA) then mandated “qualified health plans” for all.
 
Thus, Medicare Advantage plans are not a free-market American solution for patients, doctors, or taxpayers. For real free-market ideas, consider these:

  • Take the federal government out of health care and send it back to the States and the American people.
  • Repeal the ACA prohibition on catastrophic insurance and its restrictive health-plan-only definition.
  • Allow seniors to opt out of Medicare and keep or buy private indemnity medical insurance, without losing their Social Security benefits.
  • Disconnect HSAs from insurance, and allow seniors to continue to contribute to HSAs.
  • Encourage pre-birth insurance (insurers to sell, and parents to buy, an individual indemnity insurance policy for each child before birth) to move toward individually-owned, lifelong insurance and virtually eliminate the pre-existing condition problem.
  • End the federal EHR mandate that forces small and rural hospitals to close or merge, and leaves physicians burned-out and moral low.
  • Give the same tax deduction to individuals or end tax-deductibility altogether to move away from employer-sponsored coverage and toward individual portable, see-anyone, go-anywhere, catastrophic indemnity insurance that puts the dollars in the hands of patients, ends restrictive third-party controls, and reduces costs related to third-party payment.

To advance free markets and a system of affordable care and coverage, we started the patient-centered Wedge of Health Freedom (JointheWedge.com). With nearly 350 direct-pay practices nationwide and growing, this model, coupled with indemnity insurance for catastrophic and chronic conditions and the gift of medical charity, should be our goal.

In freedom,

Twila Brase, RN, PHN
President and Co-founder