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In May of 2023
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my mom was suffering from late stage
cancer and staying in a rehab nursing
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facility while we tried to figure out
what the next steps in her care plan were.
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We had a lot of very difficult choices
to make when one more got added:
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a billing administrator
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at the nursing facility approached me
to let me know that my mom's Aetna
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Medicare Advantage plan wouldn't cover her
stay anymore.
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Our only options were to bring her home...
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she could barely walk and was on an IV
drip, needing constant medical care...
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or to get rid of her Medicare Advantage
plan and switch back to regular Medicare:
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the basic public plan
would have paid for her continued stay.
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That didn't make sense to me.
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Medicare Advantage is a privatized
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add-on to Medicare
that was supposed to provide BETTER care.
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It ended up not mattering...
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She died before Aetna could throw her
on the street like they wanted to.
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Medicare Advantage is just one
part of our broken system.
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But I want to use it as an example of why
things are so broken.
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You might think you already get it.
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The American health care system sucks
and is far too expensive.
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But it's not just because it's not free.
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We're going to look at
where all this money is actually going,
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how a surprisingly influential vinyl
record dropped from an unexpected artist
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helped get us here, and who we're now
depending on to fix all of this.
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When you
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get old enough, 65, you're eligible
for Medicare.
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Medicare has four parts A, B, C, and D.
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All four parts
make up about 10% of the federal budget.
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Medicare Part A is completely free.
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It's what you paid for in taxes
for working all those years.
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It covers hospital visits.
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Medicare Part B is an optional add on.
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It costs around 175 bucks a month.
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It covers preventative care and necessary
procedures.
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A and B
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are fully administered by the government
and the vast majority of their budget-
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-that's taxpayer money
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and that monthly payment for part B-
are spent on actual care.
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98.6%.
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The other 1.4% goes towards
paying for the people
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who literally work for Medicare,
processing paperwork and whatnot.
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Then there's part C.
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Medicare Part C is also called
Medicare Advantage.
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It's an alternative
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to traditional Medicare
that replaces part A and B with one plan.
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Medicare Advantage is not administered
by the government.
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It's administered by everyone's
favorite entity.
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Private insurance companies
who get paid by the federal government,
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and a monthly fee from the elderly person
being insured.
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Medicare Advantage is heavily
advertised using all of the elderly s
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favorite celebrities.
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Hi William Shatner here with an important
message about your Medicare benefits.
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The ads use Medicare branding to convince
seniors these plans are more connected
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to real Medicare than they are
images of healthy, active seniors
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and promises of lower
out-of-pocket payments and more coverage.
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They don't include important information
like plan
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quality ratings
or the other hard facts about coverage.
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They even go further and offer gift cards
and other financial incentives
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to sign up, like a timeshare or something,
which the elderly also love.
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Since my mom's gone, I have to help
with a lot of my dad's health care.
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I've noticed that when I go
to refill his prescriptions at CVS,
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which owns Aetna, the insurer,
they have a little quiz like an evil
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BuzzFeed, where you can determine
what Medicare plan is right for you.
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And it seems like no matter what
I input, it always gives me
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an Aetna Medicare Advantage plan.
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That's the same one
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my mom had when she was denied comfort
and dignity in her final days
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care, which again, the basic part
A part B would have provided for her.
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And they want everyone on this plan.
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Imagine Medicare Advantage for all
where any hope of a more
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equitable plan is scrapped
to funnel more money to the insurers.
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It's not just my family, obviously,
since the advent of Medicare Advantage
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as we know it today, in 1986, the amount
the United States
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spends on health
care has more than quadrupled.
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Medicare Advantage.
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And much of our modern health
care problems exist because of not one,
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but two versions of Ronald Reagan.
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In the late 1950s, a fully government
funded health care plan for
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the elderly was actually a possibility.
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Congress
saw two bills that put forth plans
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for national insurance programs
for everyone receiving Social Security
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the elderly in exchange for a small
increase in Social Security payments.
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Early versions of the bills
saw the plan as mandatory.
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But an alliance between private insurers,
the American Medical Association
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and others
who profited off the existing system,
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which was already predatory,
did not want to see that happen.
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So they released a secret weapon
operation Coffee Cup.
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A key element of the campaign
was this vinyl record.
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The AMA drafted,
who was then just a young actor to record.
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Ronald Reagan
speaks out against socialized medicine.
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The record was sent out to doctors wives.
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It was 1961, okay
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to play for their friends,
to convince them not to support the health
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care bills like a Tupperware party
for predatory, privatized medicine.
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The record attacked the plans
for being controlling.
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And pretty soon
your son won't decide when he's in school
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where he will go or what
he will do for a living.
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He will wait for the government
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to tell him where he will go to work
and what he will do.
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And implored the wives to contact
their congressmen to fight the bill.
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If you don't this program, I promise
you will pass, just as surely as the sun
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will come up tomorrow, and behind
it will come other federal programs
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that will invade every area of freedom,
as we have known it in this country.
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Until one day, as Norman Thomas said,
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we will awake to find
that we have socialism.
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Reagan mocked advocates of the bill.
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They say, what would you do?
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Throw these poor old people out to die
with no medical attention?
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That's ridiculous.
And of course, no one has advocated it.
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I don't know, Romney.
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That sounds a lot
like what happened to my mom.
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A version of the health care bills
did pass, creating something
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similar to the Medicare we have today.
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But with an important change,
it wasn't mandatory.
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That left a lot of power
with private insurers.
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Then, as President, Reagan signed the Tax
Equity and Fiscal Responsibility Act,
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which made a few changes
to that existing Medicare program.
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Importantly, it made it legal
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for Medicare to contract
with private insurance companies.
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So in the 60s,
after Reagan gave the industry
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the gift of making Medicare optional,
and then in the 80s, President
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Reagan gave them access to even the folks
who were on the government plan.
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That bill allowed
for the creation of Medicare Part C,
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which eventually
became Medicare Advantage in 1996.
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Since then, we see
a lot of the same arguments about why
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privatize insurance
and health care is better than public.
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They said a government
plan would be more expensive.
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They said it would destroy choice
and give worse quality of care.
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And they dropped.
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What was the scariest word
of that century?
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Communism.
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Universal health care would be using
your tax dollars to support other people,
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they warned.
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Medicare Advantage specifically shows why.
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Each of those arguments is total bullshit.
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One is the expense.
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Does Medicare Advantage
adding privatization to a public plan
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save anyone money?
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Well, no.
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It's costing taxpayers way more.
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Most estimates find that Medicare
Advantage plans cost the taxpayer
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between 300 and $1400 more per patient
than traditional Medicare.
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And that's when the plan's
working as intended.
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One study found that
just the amount of corrupt overcharges
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that Medicare Advantage charges
the system cost taxpayers
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more money than all normal
Medicare programs combined.
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In the next few years,
Americans are expected to pay
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nearly $1 trillion in taxpayer money
for overpayments.
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That brings us to choice
and quality of care.
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If it's that expensive,
it must be better, right?
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No Medicare Advantage denied more prior
authorization requests
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and more necessary care than Medicare,
especially in rural hospitals.
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And this study reads nearly
15% of the 5.6 million denials.
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That's a full $150 million into nine
spending was attributed
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to Medicare Advantage
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policies that were more restrictive
than traditional Medicare coverage rules.
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Medicare Advantage provided demonstrably
less care than normal Medicare.
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That's exactly what I saw with my mom.
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She needed a place to stay
with medical assistance
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while we planned for her cancer care,
Aetna Medicare Advantage said no.
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Whereas normal Medicare
would have said yes.
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And they're also more restrictive
and where you get your care.
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Medicare Advantage plans often
have a much smaller
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network of in-network
doctors than regular.
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And the government control thing,
well, guess
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which health system in the United States
has the best customer satisfaction?
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Veterans affairs that's are very satisfied
with their VA health care.
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And that's a totally government
run program.
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They deserve great care.
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But it's proof that even in America,
government care can work.
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And then there's
the whole communism thing.
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The critics ask, why should my tax dollars
go to support someone else?
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Well, with Medicare Advantage
they are supporting someone else.
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Remember that stat from earlier
that the actual administration of Medicare
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is only 1.4% of the cost
for Medicare Advantage?
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It's ten times that 15%.
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And that's in large part due to executive
salaries and profit margins,
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because this is a for profit business
that needs to make a profit.
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Sure.
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Government programs
can see corruption or incompetence, but
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if everything works as it's meant to,
their purpose is to serve you.
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The purpose of private insurers
is to profit off of you.
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That can come at the cost of providing
you less care or overcharging you,
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either through premiums or tax dollars.
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Medicare Advantage isn't the only problem
in our health care system, obviously,
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but the many failures of the program
are emblematic of what a privatized system
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looks like. Compared to a public one.
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Costs
aren't rising because of any technological
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or other medical advances
that are saving lives.
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Between 1999 and 2021, the average
cost of a hospital stay in America
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increased 161.7%, far outpacing inflation
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without any significant increase
in life expectancy.
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And that's for all the same reasons.
Medicare Advantage is broken.
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For profit
companies have devised ways to skim
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more and more money off of the
ill and the taxpayer.
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We have a new administration coming
in, led by a man
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who is supposedly
the master of negotiation.
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But as of now, regular Medicare
can't negotiate
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with health care providers,
while the for profit version can.
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If President Trump really
wants to help Americans and has the power
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of the art of the deal,
shouldn't he be getting us deals where we
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the people, pay less for our health care,
both as patient and as taxpayer?
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And then there's Elon Musk's
new Department of Government Efficiency
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that promises to cut trillions of dollars
in government spending.
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Senator Rick
Scott is one of the congressmembers
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who's sitting on a new Senate caucus
that's going to be advising Jones.
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Sorry, I can't say that with a straight
face on where to make trims.
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What sort of cuts would someone like
Scott, whose company had to pay a $1.7
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billion fine for defrauding
Medicare and Medicaid, possibly recommend.
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And wouldn't the best way to save taxpayer
money be to cut out the corporate
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profiteers
transferring your money to their pockets?
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Contractor profits are the tax that we
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spend the most on, and get the least
out of replacing Medicare Advantage
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with a fully nationalized program
for everyone,
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not just the elderly who opt
in, would help pay for all of this.
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It would take negotiating power away
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from the health care companies,
as they'd only have one customer,
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and it would cut out the opportunities
for corporate profit
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to siphon money away from taxpayers
and people who need health care.
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But so far, it's not looking good.
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President Trump's
pick for running Medicare doctor, Mehmet
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Oz, has long been a proponent
of Medicare Advantage for all.
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Taking the popular language of real health
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care access advocates and using it to push
for a fully for profit system.
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With all of those problems outlined above.
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Enriching Ingredient serves
at the cost of everyone else.
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My mom wouldn't have survived
even if Medicare Advantage were better.
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She was far too sick
when she first went to the hospital.
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I don't blame her death on their greed,
but seeing how easily they denied her care
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on the supposedly better plan
when the normal government
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plan would have taken care of her.
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Made me very angry.
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And that's a rage that the incoming
administration needs to take straight
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to the insurers, to the health care
providers, and to all of the profiteers
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if they aim to keep the promises
they made to all of us.
