Medicare Advantage Denied My Dying Mom A Bed

In May of 2023 my mom was suffering from late stage cancer and staying in a rehab nursing facility while we tried to figure out what the next steps in her care plan were. We had a lot of very difficult choices to make when one more got added: a billing administrator at the nursing facility approached me to let me know that my mom's Aetna Medicare Advantage plan wouldn't cover her stay anymore. Our only options were to bring her home.

. . she could barely walk and was on an IV drip, needing constant medical care.

. . or to get rid of her Medicare Advantage plan and switch back to regular Medicare: the basic public plan would have paid for her continued stay.

That didn't make sense to me. Medicare Advantage is a privatized add-on to Medicare that was supposed to provide BETTER care. It ended up not mattering.

. . She died before Aetna could throw her on the street like they wanted to.

Medicare Advantage is just one part of our broken system. But I want to use it as an example of why things are so broken. You might think you already get it.

The American health care system sucks and is far too expensive. But it's not just because it's not free. We're going to look at where all this money is actually going, how a surprisingly influential vinyl record dropped from an unexpected artist helped get us here, and who we're now depending on to fix all of this.

When you get old enough, 65, you're eligible for Medicare. Medicare has four parts A, B, C, and D. All four parts make up about 10% of the federal budget.

Medicare Part A is completely free. It's what you paid for in taxes for working all those years. It covers hospital visits.

Medicare Part B is an optional add on. It costs around 175 bucks a month. It covers preventative care and necessary procedures.

A and B are fully administered by the government and the vast majority of their budget- -that's taxpayer money and that monthly payment for part B- are spent on actual care. 98. 6%.

The other 1. 4% goes towards paying for the people who literally work for Medicare, processing paperwork and whatnot. Then there's part C.

Medicare Part C is also called Medicare Advantage. It's an alternative to traditional Medicare that replaces part A and B with one plan. Medicare Advantage is not administered by the government.

It's administered by everyone's favorite entity. Private insurance companies who get paid by the federal government, and a monthly fee from the elderly person being insured. Medicare Advantage is heavily advertised using all of the elderly s favorite celebrities.

Hi William Shatner here with an important message about your Medicare benefits. The ads use Medicare branding to convince seniors these plans are more connected to real Medicare than they are images of healthy, active seniors and promises of lower out-of-pocket payments and more coverage. They don't include important information like plan quality ratings or the other hard facts about coverage.

They even go further and offer gift cards and other financial incentives to sign up, like a timeshare or something, which the elderly also love. Since my mom's gone, I have to help with a lot of my dad's health care. I've noticed that when I go to refill his prescriptions at CVS, which owns Aetna, the insurer, they have a little quiz like an evil BuzzFeed, where you can determine what Medicare plan is right for you.

And it seems like no matter what I input, it always gives me an Aetna Medicare Advantage plan. That's the same one my mom had when she was denied comfort and dignity in her final days care, which again, the basic part A part B would have provided for her. And they want everyone on this plan.

Imagine Medicare Advantage for all where any hope of a more equitable plan is scrapped to funnel more money to the insurers. It's not just my family, obviously, since the advent of Medicare Advantage as we know it today, in 1986, the amount the United States spends on health care has more than quadrupled. Medicare Advantage.

And much of our modern health care problems exist because of not one, but two versions of Ronald Reagan. In the late 1950s, a fully government funded health care plan for the elderly was actually a possibility. Congress saw two bills that put forth plans for national insurance programs for everyone receiving Social Security the elderly in exchange for a small increase in Social Security payments.

Early versions of the bills saw the plan as mandatory. But an alliance between private insurers, the American Medical Association and others who profited off the existing system, which was already predatory, did not want to see that happen. So they released a secret weapon operation Coffee Cup.

A key element of the campaign was this vinyl record. The AMA drafted, who was then just a young actor to record. Ronald Reagan speaks out against socialized medicine.

The record was sent out to doctors wives. It was 1961, okay to play for their friends, to convince them not to support the health care bills like a Tupperware party for predatory, privatized medicine. The record attacked the plans for being controlling.

And pretty soon your son won't decide when he's in school where he will go or what he will do for a living. He will wait for the government to tell him where he will go to work and what he will do. And implored the wives to contact their congressmen to fight the bill.

If you don't this program, I promise you will pass, just as surely as the sun will come up tomorrow, and behind it will come other federal programs that will invade every area of freedom, as we have known it in this country. Until one day, as Norman Thomas said, we will awake to find that we have socialism. Reagan mocked advocates of the bill.

They say, what would you do? Throw these poor old people out to die with no medical attention? That's ridiculous.

And of course, no one has advocated it. I don't know, Romney. That sounds a lot like what happened to my mom.

A version of the health care bills did pass, creating something similar to the Medicare we have today. But with an important change, it wasn't mandatory. That left a lot of power with private insurers.

Then, as President, Reagan signed the Tax Equity and Fiscal Responsibility Act, which made a few changes to that existing Medicare program. Importantly, it made it legal for Medicare to contract with private insurance companies. So in the 60s, after Reagan gave the industry the gift of making Medicare optional, and then in the 80s, President Reagan gave them access to even the folks who were on the government plan.

That bill allowed for the creation of Medicare Part C, which eventually became Medicare Advantage in 1996. Since then, we see a lot of the same arguments about why privatize insurance and health care is better than public. They said a government plan would be more expensive.

They said it would destroy choice and give worse quality of care. And they dropped. What was the scariest word of that century?

Communism. Universal health care would be using your tax dollars to support other people, they warned. Medicare Advantage specifically shows why.

Each of those arguments is total bullshit. One is the expense. Does Medicare Advantage adding privatization to a public plan save anyone money?

Well, no. It's costing taxpayers way more. Most estimates find that Medicare Advantage plans cost the taxpayer between 300 and $1400 more per patient than traditional Medicare.

And that's when the plan's working as intended. One study found that just the amount of corrupt overcharges that Medicare Advantage charges the system cost taxpayers more money than all normal Medicare programs combined. In the next few years, Americans are expected to pay nearly $1 trillion in taxpayer money for overpayments.

That brings us to choice and quality of care. If it's that expensive, it must be better, right? No Medicare Advantage denied more prior authorization requests and more necessary care than Medicare, especially in rural hospitals.

And this study reads nearly 15% of the 5. 6 million denials. That's a full $150 million into nine spending was attributed to Medicare Advantage policies that were more restrictive than traditional Medicare coverage rules.

Medicare Advantage provided demonstrably less care than normal Medicare. That's exactly what I saw with my mom. She needed a place to stay with medical assistance while we planned for her cancer care, Aetna Medicare Advantage said no.

Whereas normal Medicare would have said yes. And they're also more restrictive and where you get your care. Medicare Advantage plans often have a much smaller network of in-network doctors than regular.

And the government control thing, well, guess which health system in the United States has the best customer satisfaction? Veterans affairs that's are very satisfied with their VA health care. And that's a totally government run program.

They deserve great care. But it's proof that even in America, government care can work. And then there's the whole communism thing.

The critics ask, why should my tax dollars go to support someone else? Well, with Medicare Advantage they are supporting someone else. Remember that stat from earlier that the actual administration of Medicare is only 1.

4% of the cost for Medicare Advantage? It's ten times that 15%. And that's in large part due to executive salaries and profit margins, because this is a for profit business that needs to make a profit.

Sure. Government programs can see corruption or incompetence, but if everything works as it's meant to, their purpose is to serve you. The purpose of private insurers is to profit off of you.

That can come at the cost of providing you less care or overcharging you, either through premiums or tax dollars. Medicare Advantage isn't the only problem in our health care system, obviously, but the many failures of the program are emblematic of what a privatized system looks like. Compared to a public one.

Costs aren't rising because of any technological or other medical advances that are saving lives. Between 1999 and 2021, the average cost of a hospital stay in America increased 161. 7%, far outpacing inflation without any significant increase in life expectancy.

And that's for all the same reasons. Medicare Advantage is broken. For profit companies have devised ways to skim more and more money off of the ill and the taxpayer.

We have a new administration coming in, led by a man who is supposedly the master of negotiation. But as of now, regular Medicare can't negotiate with health care providers, while the for profit version can. If President Trump really wants to help Americans and has the power of the art of the deal, shouldn't he be getting us deals where we the people, pay less for our health care, both as patient and as taxpayer?

And then there's Elon Musk's new Department of Government Efficiency that promises to cut trillions of dollars in government spending. Senator Rick Scott is one of the congressmembers who's sitting on a new Senate caucus that's going to be advising Jones. Sorry, I can't say that with a straight face on where to make trims.

What sort of cuts would someone like Scott, whose company had to pay a $1. 7 billion fine for defrauding Medicare and Medicaid, possibly recommend. And wouldn't the best way to save taxpayer money be to cut out the corporate profiteers transferring your money to their pockets?

Contractor profits are the tax that we spend the most on, and get the least out of replacing Medicare Advantage with a fully nationalized program for everyone, not just the elderly who opt in, would help pay for all of this. It would take negotiating power away from the health care companies, as they'd only have one customer, and it would cut out the opportunities for corporate profit to siphon money away from taxpayers and people who need health care. But so far, it's not looking good.

President Trump's pick for running Medicare doctor, Mehmet Oz, has long been a proponent of Medicare Advantage for all. Taking the popular language of real health care access advocates and using it to push for a fully for profit system. With all of those problems outlined above.

Enriching Ingredient serves at the cost of everyone else. My mom wouldn't have survived even if Medicare Advantage were better. She was far too sick when she first went to the hospital.

I don't blame her death on their greed, but seeing how easily they denied her care on the supposedly better plan when the normal government plan would have taken care of her. Made me very angry. And that's a rage that the incoming administration needs to take straight to the insurers, to the health care providers, and to all of the profiteers if they aim to keep the promises they made to all of us.