As an investigative reporter covering the Medicare privatization crisis for over two years, I’ve examined the stakes and the potential consequences of the rapid expansion of Medicare Advantage. Medicare, the country’s largest and most successful healthcare program, is under threat from decades of relentless efforts by insurance companies to privatize it.
The growing Medicare Advantage market, now covering 52% of Medicare beneficiaries, up from 37% in 2018, is controlled by powerful corporations that have rigged the system to maximize payments from the government. This has led to overpayments of between $88 billion and $140 billion annually, threatening to drain the trust fund and eliminate Medicare’s ability to set prices.
If the current trend continues, all seniors and disabled people who depend on Medicare could be moved to a managed care model with limited networks, prior authorization requirements, and restricted drug formularies. This would sacrifice the promise of a humane healthcare system for all at the altar of insurer profits.
However, there are signs of resistance. Medicare Advantage enrollment growth slowed in 2023, and support within the Democratic Party for Medicare Advantage is dwindling. The Biden administration cut Medicare Advantage base payments for the second year in a row, despite fierce opposition from the insurance lobby.
Experts like Dr. Rick Gilfillan, a medical doctor and former director of the Center for Medicare and Medicaid Innovation, warn of the dangers of Medicare privatization. “The overpayments are based on medical diagnoses that may or may not be meaningful from a patient care standpoint,” he said. “Insurers are using chart reviews, nurse home visits, and AI software to find as many diagnoses as possible and thereby inflate the health risks of the patients and the premium they get from Medicare.”
Hayden Rooke-Ley, an Oregon-based lawyer and healthcare consultant, notes that Medicare Advantage is fueling vertical consolidation in the insurance business. “Insurance companies are restructuring themselves as vertically integrated conglomerates to become even more profitable, especially in Medicare Advantage,” he said. This consolidation allows insurers to manipulate risk scores and increase payments from the government.
There are two possible futures for Medicare: one where profiteers are eliminated, and funds are diverted to patient care, or one where the business practices of Medicare Advantage plans continue unchecked, leading to a polarized healthcare system
There are two possible futures for Medicare: one where profiteers are eliminated, and funds are diverted to patient care, or one where the business practices of Medicare Advantage plans continue unchecked, leading to a polarized healthcare system that caters to the wealthy and privileged.
The choice is ours. We can’t attack a problem if we don’t know how to diagnose it. It’s time to take a closer look at the rapid expansion of Medicare privatization and its consequences for the American public.
