There has been a lot of discussion about excessive CMS payments to the privatized Medicare Advantage plans. One area of special concern is the risk management adjustments that provide additional payments for the care of high risk patients. This leaves open a huge area for gaming the system by the insurance companies. Upcoding and adding new diagnoses (not those supplied by the attending physicians) seems to be on the increase. A recent article by Bob Herman in Modern Healthcare discusses this problem. Besides this chicanery of the insurance industry one of the most sordid aspects of the current debate is the overt buying of government by the same industry and the obvious bribery in the U.S. Senate. 53 Senators have sent a letter to CMS pressuring the agency to continue the overpayments. According to Open Secrets.org the two senators leading the pack have received more than $727,000 in campaign funds from the health insurance companies in the last 8 years; Mike Crapo $234,000, Charles Schumer $493,000. In the mind of Everyman this is unethical. But, then, we already know that our politicians are not answerable to Everyman.
Dr. John Geyman has published his latest book on the state and future of American health care.* He has written a series of books on this subject over the last 13 years.** His latest, “How Obamacare is Unsustainable” should be must reading for every congressmen, CMS employee and medical reporter and blogger as well as President Obama and his staff. It should be recommended reading for everyone else concerned about health care in the United States.
Dr. Geyman discusses the failure of the Affordable Care Act (ACA) to effectively address the four biggest challenges of health care reform: restricted access, increasing costs, increasing unaffordability even for people with insurance, and poor quality of care compared to the rest of the industrial world. He first reviews the history of the corporation led charade that created the byzantine ACA. Political corruption, lobby money, and media entanglements with corporate stakeholders (especially the pharmaceutical and insurance industries) disfigured the initial goals beyond recognition.
In Chapter 10, after reviewing where we stand now, 5 years into the ACA, he elaborates on the ten lessons we should have learned (and were predictable):
1) Health care “reform’ through the ACA was framed and hijacked by corporate stakeholders, themselves in large part responsible for system problems of health care and dedicated to perpetuating their self-interests in an unfettered health care marketplace.
2) You can’t contain health care costs by leaving for-profit health care industries to pursue their business “ethic” in a deregulated marketplace.
3) You can’t reform the delivery system without reforming the financing system.
4) The private insurance industry does not offer enough value to be bailed out by government.
5) It is futile to embark on unproven and disproven incremental tweaks to our present system while ignoring health policy and experience around the world.
6) In order to gain the most efficiency of insurance coverage we need the largest possible risk pool to spread the risk and avoid adverse selection.
7) The ACA is a massive bailout of private interests profiting on the backs of sick or injured Americans.
8) The single-payer alternative was considered “politically unfeasible” by being “too disruptive” to the existing system; instead, look at how disruptive the ACA has been compared to the simplified single-payer alternative.
9) The ACA is unaffordable for many patients and their families, is byzantine in its complexity, and is unsustainable in the long run.
10) We cannot trust many states to assure an adequate safety net for the insured and underinsured.
Dr. Geyman goes on to define the need for, and the barriers to the development of a single-payer system in the United States. He describes what a single-payer system would look like and what the political prospects are for developing such a system.
This evidence-based analysis of our health care non-system offers the most comprehensive, accurate, and functional map of the road to universal health care in the United States.
* Geyman, JP. How Obamacare is Unsustainable: Why We Need a Single-Payer Solution for All Americans. Friday Harbor, WA. Copernicus Healthcare, 2015.
**A list of books by Dr. John Geyman
- Health Care in America 2002
- The Corporate Transformation of Health Care 2004
- Falling Through the Safety Net 2005
- Shredding the Social Contract 2006
- The Corrosion of Medicine 2008
- Do Not Resuscitate 2008
- Hijacked 2010
- Breaking Point 2011
- The Cancer Generation 2012
- Health Care Wars 2012
- How Obamacare is Unsustainable 2015
To see Dr. Geyman’s biography and web site visit….…http://www.johngeymanmd.org/PNHP-profile-jgeyman-2007.html & http://www.johngeymanmd.org/