Miriam,
I write my US Rep., and both my Senators, all three are Democrats, and
health care appears to not be an issue with them.
As long as we are under the thumb of the American Corporate Empire we
will be pressured into consumers at best an at worst, slaves.
Carl Jarvis
On 12/17/21, Miriam Vieni <miriamvieni@xxxxxxxxxxxxx> wrote:
The problem is that I've read at least five articles warning that we will be
forced into a privatized Medicare plan which costs the government more and
provides fewer to us, benefits at a higher cost unless this experimental
program of direct contracting entities is discontinued. We will have no
choice about whether or not we are in traditional Medicare.
Miriam
-----Original Message-----
From: blind-democracy-bounce@xxxxxxxxxxxxx
<blind-democracy-bounce@xxxxxxxxxxxxx> On Behalf Of Carl Jarvis
Sent: Friday, December 17, 2021 1:11 PM
To: blind-democracy@xxxxxxxxxxxxx
Subject: [blind-democracy] Re: MEDICARE PRIVATIZATION SCHEME FACED LEGAL
QUESTIONS ABOUT PROFITEERING
This sounds like the old American Corporate Socialist Party. Once your
membership has been approved you are eligible to grab as much of the US
treasury as you can.
Carl Jarvis
On 12/16/21, Miriam Vieni <miriamvieni@xxxxxxxxxxxxx> wrote:
MEDICARE PRIVATIZATION SCHEME FACED LEGAL QUESTIONS ABOUT PROFITEERING
Government attorneys expressed concerns that the Medicare direct
contracting model - begun by Trump and continued under Biden - was
geared to benefit specific companies.
Ryan Grim, Austin Ahlman The Intercept December 14 2021, 7:46 a.m.
Center for Medicare and Medicaid Innovation director Adam Boehler
speaks during a news conference on Feb. 14, 2019, in Washington, D.C.
Photo: Kevin Wolf/AP IN THE FINAL stretch of the Trump administration,
government attorneys expressed ethics concerns about a Medicare
privatization scheme being set up by Adam Boehler, a former dorm-mate
of Jared Kushner's who was made director of the Center for Medicare
and Medicaid Innovation, also known as CMMI or the Innovation Center.
In January 2019, ahead of the launch of a new direct contracting
model, the Office of the General Counsel for the Health and Human
Services Department warned, in comments on a draft of the proposal,
that it appeared as if the new project was being set up to benefit
specific companies.
"We are concerned based on [Centers for Medicare and Medicaid
Services]'s regular references to organizations like Chen Med, Oak
Street Health, and Verily in the comments and otherwise, that this
model has been designed with specific private sector entities in mind.
If accurate, this could create ethics concerns, as the creation of
this model would give those entities a leg up in the market," read the
guidance, a copy of which was obtained by The Intercept.
The direct contracting model was announced publicly in April 2019 and
began its implementation phase in October 2020. The project pays
private companies a predetermined but individualized amount per year,
per patient, regardless of what the company spends on care, and has
persisted and grown under the Biden administration.
Boehler, prior to working in the Trump administration, ran a startup
called Landmark Health, which was backed by venture capital money,
including the firm Oxeon. Multiple Oxeon-funded health companies, such
as Oak Street Health, were directly referenced in the documents
setting up the new project, which drew scrutiny from the Office of the
General Counsel. Under Boehler, CMMI contracted with Oxeon to recruit
the noncareer staff for CMMI, who then went on to design the program.
Once the project was set up, Landmark Health announced it would be
contracting with CMMI to become a direct contracting entity - meaning
Boehler's model was shoveling money to the firm he had left. Boehler
is now CEO of Rubicon Founders, a venture capital and private equity
firm operating in the health care industry.
(Before taking his position in the administration, he had divested
from any Landmark, along with other healthcare-related investments.)
In May 2019, a calendar alert went out to staff reading "discussion
with Landmark on the direct contracting model." Career staff were
appalled.
"This
shit is so fucking gross," wrote one in a group text with other aides
which was shared with The Intercept. "Ugh. What the fuck," replied
another, with a third sending a link to the Office of the Inspector
General, suggesting it be reported. (It does not appear to have been
reported.)
The payment model is designed to be lucrative for firms contracting
with the
government: The government pays a set amount of money annually per
patient based on a risk score that is easily gamed by the health care
company, and there is no requirement that a minimum percentage of the
money be spent on care, a requirement known as a "medical loss ratio"
that is typically used to constrain insurance firms or providers from
eating the bulk of the funding.
Brad Smith, a recruit of Boehler's who briefly served as director of
CMMI after Boehler was appointed to an unrelated position by President
Donald Trump, wrote an article for the New England Journal of Medicine
in February of this year that was highly critical of similar payment
models the organization was rolling out, noting with unusual frankness
that "the vast majority of the Center's models have not saved money,
with several on pace to lose billions of dollars. Similarly, the
majority of models do not show significant improvements in quality."
Smith identified "inflated benchmarks"
- in which providers wildly overestimate what they expect a patient
will cost - and providers' ability to "game" the payment models as key
drivers of losses for the government. Smith expressed hope for direct
contracting as a fix, though the project's critics note it has the
same elements.
Smith, able to spot a good business opportunity, launched a health
care company, Russell Street Ventures, in June. That company is now
directly contracting with Medicare. Smith did not respond to a request for
comment.
In October 2020, when the direct contracting program was in its early
implementation phase, Smith indicated on a panel with Boehler and
another former CMMI head, Patrick Conway, that in the program's early
stages the firms that had "come into that space that [were] running
the program" were mostly "new and mid-stage companies" - like his firm
and those founded by Boehler. Conway noted that he had recruited
Boehler to the job, just as Boehler had recruited Smith. As Boehler
added during the panel, the trend is bipartisan. Andy Slavitt, Obama's
head of CMS and an outspoken resistance Democrat, has now linked up
with Oxeon - the same VC firm that was funding Boehler - for his own
direct contracting enterprise.
THE LATEST PRIVATIZATION scheme echoes the Medicare Advantage system,
the private-insurer-run version of Medicare currently used by over 40
percent of enrollees.
Direct contracting uses a model that, in theory, pays firms for
maintaining the overall health of a patient rather than billing
Medicare for individual medical services. Critics argue that the
latter model, which is currently used for standard Medicare enrollees,
incentivizes unnecessary hospital visits and treatments. But the
former model, which is referred to as value-based contracting,
requires complex bureaucratic oversight to ensure that providers are
not juking the system by unreasonably inflating the cost and difficulty of
caring for a patient.
Related
In New York City, Retirees Brace for Switch to Privatized Health Care
Medicare Advantage also currently uses a version of the value-based
contracting model, but the design failures of the program have led to
significantly higher costs than under the traditional Medicare
fee-for-service model - with little evidence to support the claim that
patients are receiving better care. This is because of the insurer
payment formula for Medicare Advantage, which largely depends on the
number of diagnoses each patient has received, or their "risk score."
An entire cottage industry has popped up to help insurers and
providers increase a patient's risk score by scouring for potential
diagnoses before patients enroll in Medicare Advantage plans. By
finding more diagnoses, whether treatable or not, the annual
reimbursement rate under the value-based contracting model increases.
Experts have estimated that the resulting overpayments will lead to
hundreds of billions of dollars in cost overruns over the next several
years. While technocratic fixes to the formula could fix many of the
problems plaguing the Medicare Advantage program, Congress and
executive branch appointees have so far been unwilling to stomach the
political risks posed by large-scale interruptions to the care of
Medicare enrollees that would be necessary to combat the wasteful
spending generated by privatization.
In a paper published in September, Richard Gilfillan, the head of CMMI
from
2010 to 2013, and Donald Berwick, a former head of Centers for
Medicare and Medicaid Services, or CMS, during the Obama
administration, warned that many of the waste-generating elements of
Medicare Advantage programs would carry over to direct contracting.
While the direct contracting pilot adjusts the formula for payments to
blunt the impact of risk-score gaming, it is unclear whether these
adjustments are sufficient to end the practice. Adjusting each firm's
scoring downward by an equal amount punishes firms behaving honestly,
they argued, and rewards the firms who hire consultants to game the
coding exercise. That puts the government's thumb on the scale of the
most aggressive coders.
"In Direct Contracting, CMS established a stated aim of bringing
'organizations that currently operate exclusively in Medicare Advantage'
into traditional Medicare, targeting the very MA insurers and
investor-controlled provider firms that are driving the MA overpayments,"
Gilfillan and Berwick noted, specifically mentioning Oak Street Health
and Landmark Health, which Boehler previously ran, as examples of
investor-controlled provider firms. (Gilfillan himself is CEO of
Trinity Health, a major player in the healthcare industry.)
Diane Archer, founder of Just Care and a health policy expert,
described a similar scenario in an email to The Intercept. "The way
they make money is by spending as little as possible on patient care,
while ensuring as best they can that they have all diagnoses possible
for their enrollees in order to maximize government payments. The more
diagnoses, the higher the government payments. Government payments are
set upfront and unrelated to the cost or number of services people
receive."
"The incentive is to deny as much care as possible."
"And, yes, the incentive is to deny as much care as possible," she
continued, "it's also to delay as much care as possible and to create
administrative and financial barriers that make it hard for enrollees
to get care, even if the DCE does not delay or deny care," she said,
referring to direct contracting entities approved to participate in
the program.
Aside from the looting of public funds and the depreciation of care,
the shift toward privatization has profound implications for the
political economy of health care. Every new private equity or venture
capital-backed firm that grabs a bigger piece of the health care
market becomes an incumbent corporate stakeholder and a well-funded
obstacle to public-minded reform efforts.
THROUGHOUT THE MEDICAL INDUSTRY, physician practices, hospitals, and
groups of specialists are being bought up by investors and
consolidated. In the direct contracting space, much of the funding is
coming from venture capitalists, but private equity has gotten involved as
well.
CanoHealth, a private-equity backed firm, told investors in a
presentation that as of April 2021 it had added direct contracting to
its existing Medicare Advantage business model. More than half of
Medicare recipients have declined to opt in to the privatized Medicare
Advantage model, and CanoHealth noted that becoming a direct
contracting entity massively expands the company's potential pool of
customers, saying it "triples the addressable market opportunity."
(More recent estimates put the number of Medicare Advantage enrollees
higher, at 42 percent.)
Cano-Health_Investor-and-Analyst-Day-Presentation_vFF
77 pages
The entrance of big private money can be damaging to patient health. A
recent study of private equity influence in nursing homes found that
residents under the care of a private equity-owned facility were a
startling
10 percent more likely to die.
Related
Nursing Home Magnate Cozied Up to Trump as Deaths Rose in His
Facilities At the center of this privatization project now that Joe
Biden is in the White House is Liz Fowler, who was previously the lead
health care staffer for former Sen. Max Baucus, D-Mont., who drafted
massive chunks of the Affordable Care Act. Fowler was in the trenches
battling progressives over the shape and construction of Obamacare,
and before that, she had been a top lobbyist for the insurance company
WellPoint. After that, she went on to work for Johnson & Johnson. Now
she's back in government, as the deputy administrator and director of
CMMI, the innovation agency created by the law she helped write, and
people involved in the fight over this project say she's a strong
backer of direct contracting. Fowler did not respond to a request for
comment.
In May, four Democrats in Congress - Reps. Bill Pascrell, Mark Pocan,
Katie Porter, and Lloyd Doggett - sent a letter to CMMI and to Health
and Human Services Secretary Xavier Becerra, who is himself a
supporter of Medicare for All, asking for the program to be frozen due
to concerns that "funneling people into Medicare Advantage-like plans
not only eliminates beneficiary choice, but also erects more barriers
and provides fewer consumer protections for beneficiaries."
In a sign of how big direct contracting has gotten, it has its own
lobby now. The Direct Contracting Coalition, which operates as part of
America's Physician Groups, sent a letter in response, arguing that
the critics don't understand how much it can help beneficiaries and
cut costs for the government.
The Biden administration paused implementation of two of the three
models for direct contracting earlier this year, but there is no
indication the administration intends to halt the program altogether.
Archer, the health policy expert, said that the path toward a full
privatization of Medicare is now apparent if the Biden administration
doesn't change course. "The private equity takeover is short term,"
she predicted. "PE will sell their DCEs to insurers. We'll get fully
privatized Medicare, unaccountable and far less cost-effective.
Traditional Medicare will wither on the vine."
