1. Improved Medicare for All? -- or -- Medicare Advantage for All?

2. What’s So Great
About Medicare?

3. Go to any doctor or hospital Anywhere in the United States
Medicare Means
Freedom of Choice
Physicians in practice in USA
Physicians opting out of Medicare
Medicare’s “directory”
685,000
9,539
98%
of practicing physicians
Go to any doctor or hospital
Anywhere in the United States
You’re back in control.
2013 data from Fiscal Times
Accessed July 16, 2017

4. Waste Less Money on Bureaucracy
Medicare Means
Waste Less Money on Bureaucracy
Insurance Overhead
Q1 2016
Medicare
Parts
C and D
Source: Day, Himmelstein, Broder, Woolhandler – Int. J Health Serv 2014
Updated data from firms’ SEC filings (Q12016)
Overhead = (Premium revenue – Medical Expenses) / Premium Revenues
Medicare updated with 2016 Medicare Trustee Report 2012 data as cited by Kip Sullivan, Journal of Health Politics, Policy, and Law. Vol 38, No. 3, June 2013 DOI / available at .

5. Medicare Means Healthier Americans Age 65 USA Rank Women Men Age 1 3 57 9 11 13 15 17
USA
Rank
Age 65
Women
Men
0-1
1-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85-89
90-94
95-99
Institute of Medicine. Shorter Lives, Poorer Health.
Fig 1-9: Ranking of US mortality rates by age group among 17 peer countries,
Peer nations are Australia, Austria, Canada, Denmark, Finland, France, Germany, Italy, Japan, Norway, Portugal, Spain, Sweden, Switzerland, Netherlands, United Kingdom
Age

6. Medicare for All? NHI? Single Payer?
Also known as
“National Health
Insurance”
also known as
“Medicare for All”
“Single Payer”

7. Medicare for All Makes Economic Sense
25 independent studies,
at the state and federal level, confirm that the
savings would fund full coverage.
Accessed 2/25/2017

8. Medicare for All Makes Economic Sense
$ Billions
Increased market power (better pricing on
drugs and devices)
Admin costs to providers (hospitals and physicians)
Increased utilization
(home health, dental, etc.)
Covering the uninsured
Health insurance admin
Medicaid Rate Adjustment
Gov. admin ($23B)
New Costs
New Savings
Analysis of HR676
Friedman, G. Dollars & Sense. March/April 2012

9. “All Americans should have
Medicare Advantage.”
Erin Solaro, SeattlePi, June
Accessed Aug

10. Medicare Part C Sounds Pretty Good
100% Coverage
More Affordable Than Medigap
Extra Perks
No copays
No deductibles
No out-of- pocket
Very little (or zero) fee above Traditional Medicare
Gym clubs
In-home medical evaluation
Some include a drug benefit
Too good to be true?

11. “People over 70 hold onto that red, white, and blue card
“People retiring now
are likely to pick a Medicare Advantage plan.
They're used to those kinds of networks….
“People over 70
hold onto that
red, white, and blue card
for dear life.”
Mark Bertolini
Aetna CEO
Jan. 23, 2014
Accessed Aug. 20, Excerpts taken in context.

12. Medicare Advantage Now Has 31% of Medicare Beneficiaries
Insurers are not required
to sell a Medigap policy to anyone
leaving a Medicare Advantage plan
after one year.
Millions of Americans in an MA plan
Kaiser Family Foundation, as quoted at medicare-advantage (accessed Aug )

13. It’s Complicated Part C Part D “Single Payer” (Medicare Advantage)
(Drug Benefit)

14. It’s Complicated, and Complexity Wastes Our Money
Medicare for All
Privatized Medicare

15. MA Plans Market to Healthy Seniors
The healthiest members
make the healthiest profits.

16. Health Insurance Whack-a-Mole
MA plans try to attract the healthiest seniors away from traditional Medicare.
CMS responded by “risk adjusting” what they pay MA plans.
Makes sense…

17. Medicare pays MA plans ~$4,000 more for every heart failure patient
MA Plans Are Paid More for “Sicker” Patients… Free Screening Echocardiograms
Medicare pays MA plans ~$4,000 more for every heart failure patient
$4,000
MedPAC data for 2008

18. MA Plans Are Paid More for “Sicker” Patients… Free Screening Echocardiograms

19. Medicare Overpays Medicare Advantage
Total overpayments :
$174 Billion
Overpayments ($ Billions)
Source: MedPAC and Geruso and Layton, 2015 (updated)

20. We Should Require Private Insurance to be As Efficient As Medicare
ACA today requires
Medical Loss Ratios of 80-85%.
Build on that and
transition all payers to Medicare’s 98.6%
Insurance Overhead
Q1 2016
Source: Day, Himmelstein, Broder, Woolhandler – Int. J Health Serv 2014
Updated data from firms’ SEC filings (Q12016)
Overhead = (Premium revenue – Medical Expenses) / Premium Revenues
Medicare updated with 2016 Medicare Trustee Report 2012 data as cited by Kip Sullivan, Journal of Health Politics, Policy, and Law. Vol 38, No. 3, June 2013 DOI / available at .

21. MA Patients Get Less Healthcare
Traditional Medicare
minus
Medicare Advantage
NBER Working Paper #23090, January 2017

22. Medicare Advantage Eliminates Choice
Insurers that include the best hospitals
attract the sickest patients.
Sickness becomes a liability
for health insurers in the “free market”.
NYC Medicare Advantage Plans including Sloan-Kettering Cancer Institute in network?
FL Medicare Advantage Plans including BJC in network?
STL area Medicare Advantage Plans including Mayo Clinic in network?

23. Truly Sicker Patients Leave MA Plans
Similar results with
hospital or home care use
Patient left:
Health Affairs 2015;34: data.
Similar results for patients with hospital or home care use

24. Truly Sicker Patients Leave MA Plans Because They Can’t Get Healthcare
Patient reasons for disenrolling from MA plans with relatively high health-biased disenrollment rates
41%
27%
Disenrollment reasons for 126 Medicare Advantage contracts with relatively high disenrollment, 2014
GAO Report April 2017
Accessed Aug

25. Disappears when you need it
Medicare “Advantage”
Loss of choice
and control
Wastes our
tax dollars
Disappears when you need it
Directories of doctors and hospitals
Little out-of- network coverage
Marketing
Bureaucracy
Highly compensated executives
Attracts the healthiest seniors
Sickest seniors often decide to go back to Traditional Medicare

26. The Best Way to Protect Medicare
Improve and Expand Medicare for
All Americans!