It’s time to save Traditional Medicare. Join the fight against the privatization of Medicare, which the medical-industrial complex is attempting wholesale and by a thousand cuts. Please urge President Biden, and Secretary of Health and Human Services Xavier Becerra to: 1. save Medicare from further privatization and restore the original intent of Medicare to serve all Americans aged 65 and older (and disabled Americans) equally and without discrepancy in service, cost, or provider reimbursement; and 2. rescind the 20% co-pay requirement for Traditional Medicare that lures or forces many Medicare recipients into Medicare Advantage because of its lower or no premiums; and 3. require the Centers for Medicare and Medicaid Services (CMS) to monitor and end fraud in the existing privatized Medicare programs; and 4. cap administrative costs and profits in the Medicare Advantage and ACO-REACH programs at no more than that of Traditional Medicare. Please then make permanent the changes above by approving HR 1976, S 4204, and enable states to create universal health care systems with legislation such as HR 3775.

If trends hold, more than half of Medicare recipients will be in a private Medicare Advantage plan next year. We should be deeply concerned by the recent New York Times article by Reed Abelson and Margo Sanger-Katz. The study revealed dozens of fraud lawsuits, inspector general audits, and watchdog investigations showing that major health insurers exploited the M.A. program to inflate their profits by billions of dollars. Oversight has been ineffective as major insurers involved in fraud-related lawsuits remain M.A. participants. According to federal audits, eight of the ten biggest Medicare Advantage insurers — representing more than two-thirds of the market — have submitted inflated bills. And four of the five most prominent players — UnitedHealth, Humana, Elevance, and Kaiser — have faced federal lawsuits alleging that efforts to overdiagnose their customers crossed the line into fraud. The fifth company, CVS Health, which owns Aetna, told investors the Department of Justice was investigating its practices. In dubious statements, most insurers disputed the allegations in the lawsuits and said the federal audits were flawed. They said their aim in documenting more conditions was to improve care by accurately describing their patients’ health. Many of the accusations reflect missing documentation rather than any willful attempt to inflate diagnoses, said Mark Hamelburg, an executive at AHIP, an industry trade group. “Professionals can look at the same medical record differently,” he said. Some critics say the lack of oversight has encouraged the industry to compete over who can most effectively game the system rather than provide the best care. “Even when they’re playing the game legally, we are lining the pockets of very wealthy corporations that are not improving patient care,” said Dr. Donald Berwick. Dr. Berwick, a C.M.S. administrator under the Obama administration, recently published a series of blog posts on the industry. “When you skate to the edge of the ice, sometimes you’re going to fall in.” The government spends nearly as much on Medicare Advantage’s 29 million beneficiaries as on the Army and Navy combined. It’s enough money that even a slight increase in the average patient’s bill adds up: The additional diagnoses led to $12 billion in overpayments in 2020, according to an estimate from the group that advises Medicare on payment policies — enough to cover hearing and vision care for every American over 65. Another estimate from a former top government health official suggested the overpayments in 2020 were double that, more than $25 billion. The increased privatization has come as Medicare’s finances have been strained by the aging of baby boomers. Still, the program is strikingly lucrative for insurers that already dominate health care for workers. A study from the Kaiser Family Foundation, a research group unaffiliated with the insurer Kaiser, found the companies typically earn twice as much gross profit from their Medicare Advantage plans as from other types of insurance. Traditional Medicare is clearly under attack as profiteers are increasingly raiding the Medicare Trust Fund. It is critical that Congress immediately act to protect Medicare against further losses. We need to eliminate Medicare Advantage and other private programs or, at the very least, impose stringent regulations and oversight. Any insurer charged with fraud should be blocked from future participation. We should consider extending Medicare to all Americans and expanding coverage to include all services and prescriptions. A single-payer health care system would cover everyone at far less cost nationally, and our healthcare reforms should move in that direction. Medicare Advantage (M.A.) is popular because it offers “extras” such as vision, hearing, and dental care, low or no premiums, and even gym memberships; however, when people are in Medicare Advantage: 1) Their choice of doctors and services is confined to only those allowed by the M.A. network, 2) They and their doctors are more likely to face delays and struggles with insurance companies over pre-authorizations and payment for services, and 3) If you develop chronic diseases, the chances are greater that you will be unable to find the services you need within your M.A. network. Many patients with chronic diseases were forced to leave their M.A. plan to find needed care, and then, because they had “pre-existing conditions,” they could not find affordable supplemental insurance plans for the 20% balance that Traditional Medicare would not cover. If they had chosen Traditional Medicare, to begin with, their pre-existing conditions would have been covered. By next year, half of Medicare beneficiaries will have a private Medicare Advantage plan, but most large insurers in the program have been in court accused of fraud: • The health system Kaiser Permanente called doctors in during lunch and after work and urged them to add other illnesses to the medical records of patients they hadn’t seen in weeks. Doctors who found enough new diagnoses could earn bottles of Champagne or a bonus in their paycheck. • Anthem, a large insurer called Elevance Health, paid more to doctors who said their patients were sicker. And executives at UnitedHealth Group, the country’s largest insurer, told their workers to mine old medical records for more illnesses — and when they couldn’t find enough, sent them back to try again. The fraudulent strategies described by the Justice Department in the lawsuits led to the diagnoses of serious diseases that never even existed for specific individual patients. As a result, insurers collected more money from the federal government’s Medicare Advantage program. Medicare Advantage was originally designed by Congress two decades ago to encourage health insurers to find innovative ways to provide better care at a lower cost. Instead, they have resorted to fraud in order to increase private revenues and profits. Despite the Justice Department’s lawsuits, they continue to participate in the Medicare Advantage program at a much greater cost. We need to end Medicare Advantage and any other for-profit programs that will fail to produce improved results, only increased incentives to commit fraud under a system of weak oversight and enforcement. We should instead beef up our Traditional Medicare system to expand coverage of medical services, hospitalization, and prescriptions to include all Americans under a single-payer system.

Medicare Advantage is on track to enroll more than half of Medicare’s beneficiaries by next year. The government pays Medicare Advantage insurers a set amount for each person who enrolls, with higher rates for sicker patients. Unfortunately, the insurers, among the largest and most profitable American companies, have developed elaborate systems to make their patients appear as ill as possible, often without providing additional treatment, according to lawsuits by the Justice Department. As a result, the M.A. program, which was to help lower healthcare spending, has become substantially more costly than the traditional government program it was intended to improve. For people choosing between traditional Medicare and Medicare Advantage, there are trade-offs. M.A. plans can limit patients’ choice of doctors and sometimes require jumping through extra hoops to get certain types of expensive care. M.A. plans often have lower premiums or perks like dental benefits — extras that draw beneficiaries to the programs. The more that Medicare overpays M.A. plans, the more generous to customers they can afford to be. “Medicare Advantage is an important option for America’s seniors, but as it adds more patients and spends billions of dollars of taxpayer money, aggressive oversight is needed,” said Senator Charles Grassley of Iowa, who has investigated the industry. The efforts to make patients look sicker and other abuses of the program have “resulted in billions of dollars in improper payments,” he said. Former employees initially brought many fraud lawsuits under a federal whistle-blower law that allows them to get a percentage of any money repaid to the government if their suits prevail. But most have been joined by the Justice Department, a step the government takes only if it believes the fraud allegations have merit. Last year, the department’s civil division listed Medicare Advantage as one of its top areas of fraud recovery. “It’s an extremely high priority for us,” said Michael Granston, a deputy assistant attorney general for the civil division. In contrast, regulators overseeing the plans at the Centers for Medicare and Medicaid Services, or C.M.S., have been inattentive. Gross overpayments have been reported in inspector general investigations, academic research, Government Accountability Office studies, MedPAC reports, and numerous news articles throughout four presidential administrations. Congress gave the agency the power to reduce the insurers’ rates in response to evidence of systematic overbilling, but C.M.S. has never chosen to do so. A regulation proposed by the Trump administration to force the plans to refund the government for more of the incorrect payments has not been finalized four years later. Several top officials have swapped jobs between the industry and the agency. C.M.S. officials have declined interview requests. In a statement, the C.M.S. administrator, Chiquita Brooks-LaSure, said the agency recently sought feedback on improving the program. “We are committed to making sure that Medicare dollars are used efficiently and effectively in Medicare Advantage,” she said. The popularity of Medicare Advantage plans has helped them to avoid legislative reforms. The programs have become popular in urban areas and have been increasingly embraced by Democrats and Republicans. Nearly 80 percent of U.S. House members signed a letter this year saying they were “ready to protect the program from policies that would undermine” its stability. “You have a powerful insurance lobby, and their lobbyists have built strong support for this in Congress,” said Representative Lloyd Doggett, a Texas Democrat who chairs the House Ways and Means Health subcommittee. The original promise of the M.A. program has fallen by the wayside. Congress’s first attempt to design a privatized Medicare plan paid insurers the same amount for every patient with similar demographic characteristics. In theory, if the insurers could do better than traditional Medicare — by better managing patients’ care or improving their health — their patients would cost less, and the insurers would make more money. But some insurers engaged in strategies — like locating their enrollment offices upstairs or offering gym memberships — to entice only the healthiest seniors, who would require less care, to join. To deter such tactics, Congress decided to pay more for sicker patients. Almost immediately, companies saw ways to exploit that system. Privatized alternatives to Traditional Medicare do not work. Profit incentives should have no place in health care insurance. Costs generated by hospitals, doctors, and various other providers should be controlled under a single-payer system. Study after study has proven that a single-payer system substantially reduces national healthcare costs. Eliminate the Medicare Advantage and other private programs to prevent bad actors from abusing the system.

If trends hold, more than half of Medicare recipients will be in a private Medicare Advantage plan next year. We should be deeply concerned by the recent New York Times article by Reed Abelson and Margo Sanger-Katz. The study revealed dozens of fraud lawsuits, inspector general audits, and watchdog investigations showing that major health insurers exploited the M.A. program to inflate their profits by billions of dollars. Oversight has been ineffective as major insurers involved in fraud-related lawsuits remain M.A. participants. According to federal audits, eight of the ten biggest Medicare Advantage insurers — representing more than two-thirds of the market — have submitted inflated bills. And four of the five most prominent players — UnitedHealth, Humana, Elevance, and Kaiser — have faced federal lawsuits alleging that efforts to overdiagnose their customers crossed the line into fraud. The fifth company, CVS Health, which owns Aetna, told investors the Department of Justice was investigating its practices. In dubious statements, most insurers disputed the allegations in the lawsuits and said the federal audits were flawed. They said their aim in documenting more conditions was to improve care by accurately describing their patients’ health. Many of the accusations reflect missing documentation rather than any willful attempt to inflate diagnoses, said Mark Hamelburg, an executive at AHIP, an industry trade group. “Professionals can look at the same medical record differently,” he said. Some critics say the lack of oversight has encouraged the industry to compete over who can most effectively game the system rather than provide the best care. “Even when they’re playing the game legally, we are lining the pockets of very wealthy corporations that are not improving patient care,” said Dr. Donald Berwick. Dr. Berwick, a C.M.S. administrator under the Obama administration, recently published a series of blog posts on the industry. “When you skate to the edge of the ice, sometimes you’re going to fall in.” The government spends nearly as much on Medicare Advantage’s 29 million beneficiaries as on the Army and Navy combined. It’s enough money that even a slight increase in the average patient’s bill adds up: The additional diagnoses led to $12 billion in overpayments in 2020, according to an estimate from the group that advises Medicare on payment policies — enough to cover hearing and vision care for every American over 65. Another estimate from a former top government health official suggested the overpayments in 2020 were double that, more than $25 billion. The increased privatization has come as Medicare’s finances have been strained by the aging of baby boomers. Still, the program is strikingly lucrative for insurers that already dominate health care for workers. A study from the Kaiser Family Foundation, a research group unaffiliated with the insurer Kaiser, found the companies typically earn twice as much gross profit from their Medicare Advantage plans as from other types of insurance. Traditional Medicare is clearly under attack as profiteers are increasingly raiding the Medicare Trust Fund. It is critical that Congress immediately act to protect Medicare against further losses. We need to eliminate Medicare Advantage and other private programs or, at the very least, impose stringent regulations and oversight. Any insurer charged with fraud should be blocked from future participation. We should consider extending Medicare to all Americans and expanding coverage to include all services and prescriptions. A single-payer health care system would cover everyone at far less cost nationally, and our healthcare reforms should move in that direction.