I’ve written before about how this works in the academic world, describing college and graduate school education as a classic pyramid scheme. Those who got in early got the big payoff — job security, a book-lined office, summers off, and a “sabbatical” every seven years (a concept rooted in the Jewish understanding of the sabbath as a holy time of rest). Those who came late to the party, however, have ended up in seemingly endless post-doctoral programs, if they’re lucky, and if not, as members of the part-time teaching corps.

Too Broke to Retire

For the most part, I’m sympathetic to Barton’s argument. There are too many people who are old and in the way at the top of various professional institutions — including our government (where an 81-year-old, under immense pressure, just reluctantly decided not to try for a second term as president, while a 77-year-old is still stubbornly running for that same office). But I think Barton misses an important point when he claims that “older workers are postponing retirement… because they simply don’t want to quit.” That may be true for high earners in white-collar jobs, but many other people continue working because they simply can’t afford to stop. Research described in Forbes magazine a few years ago showed that more than one-fifth of workers over age 55 were then among the working poor. The figure rose to 26% for women of that age, and 30% for women 65 and older. In other words, if you’re still working in your old age, the older you are, the more likely it is that you’re poor.

Older workers also tend to be over-represented in certain low-paying employment arenas like housecleaning and home and personal health care. As Teresa Ghilarducci reported in that Forbes article:

“Nearly one-third of home health and personal care workers are 55 or older. Another large category of workers employing a disproportionate share of older workers is maids and housekeeping cleaners, 29% of whom are 55 or older and 54% of whom are working poor. And older workers make up 34% of another hard job: janitorial services, about half of whom are working poor. (For a benchmark, 23% of all workers are 55 and up.)”

We used to worry about “children having children.” Maybe now we should be more concerned about old people taking care of old people.

Why are so many older workers struggling with poverty? It doesn’t take a doctorate in sociology to figure this one out. People who can afford to retire have that option for a couple of reasons. Either they’ve worked in high-salary, non-physical jobs that come with benefits like 401(k) accounts and gold-plated health insurance. Or they’ve been lucky enough to be represented by unions that fight for their members’ retirement benefits.

However, according to the Pension Rights Center, a non-profit organization working to expand financial security for retirees, just under half of those working in the private (non-governmental) sector have no employment-based retirement plan at all. They have only Social Security to depend on, which provides the average retiree with a measly $17,634 per year, or not much more than you’d earn working full-time at the current federal minimum wage, which has been stuck at $7.25 an hour since 2009. Worse yet, if you’ve worked at such low-paying jobs your entire life, you face multiple obstacles to a comfortable old age: pay too meager to allow you to save for retirement; lower Social Security benefits, because they’re based on your lifetime earnings; and, most likely, a body battered by decades of hard work.

Many millions of Americans in such situations work well past the retirement age, not because they “simply don’t want to quit,” but because they just can’t afford to do so.

On the Road Again

It’s autumn in an even-numbered year, which means I’m once again in Reno, Nevada, working on an electoral campaign, alongside canvassers from UNITE-HERE, the hospitality industry union. This is my fourth stint in Washoe County, this time as the training coordinator for folks from Seed the Vote, the volunteer wing of this year’s political campaign. It’s no exaggeration to say that, in 2022, UNITE-HERE and Seed the Vote saved the Senate for the Democrats, re-electing Catherine Cortez Masto by fewer than 8,000 votes — all of them here in Washoe County.

Buy the Book

This is a presidential year, so we’re door-knocking for Kamala Harris, along with Jacky Rosen, who’s running for reelection to Nevada’s other Senate seat.

When I agreed to return to Reno, it was with a heavy heart. In my household, we’d taken to calling the effort to reelect Joe Biden “the death march.” The prospect of a contest between two elderly white men, the oldest ever to run for president, both of whom would be well over 80 by the time they finished a four-year term, was deeply depressing. While defeating Donald Trump was — and remains — an existential fight, a Biden-Trump contest was going to be hard for me to face.

Despite his age, Joe Biden has been an effective president in the domestic arena. (His refusal to take any meaningful action to restrain the Israeli military in Gaza is another story.) He made good use of Democratic strength in Congress to pass important legislation like the Inflation Reduction Act. That kitchen-sink law achieved many things, including potentially reducing this country’s greenhouse gas emissions by 40% by 2030, allowing Medicare to negotiate drug prices directly with pharmaceutical companies (while putting a $2,000 annual cap on Medicare recipients’ outlays for drugs), and lowering the price of “Obamacare” premiums for many people.

Still, Biden’s advanced age made him a “terrible, horrible, no good, very bad” candidate for president. Admittedly, a win for 59-year-old Kamala Harris in Nevada won’t be a walk in the park, but neither will it be the death march I’d envisioned.

Old and In the Way?

Government, especially at the federal level, is clearly an arena where (to invert the pyramid metaphor) too many old people are clogging up the bottom of the funnel. Some of them, like House Speaker emerita Nancy Pelosi, remain in full possession of their considerable faculties. She’s also had the grace to pass the torch of Democratic leadership in the House to the very able (and much younger) Hakeem Jeffries, representing the 8th district of New York. Others, like former California Senator Dianne Feinstein, held on, to paraphrase Rudyard Kipling, long after they were gone. Had my own great heroine Ruth Bader Ginsberg had the grace to retire while Barack Obama was still president, we wouldn’t today be living under a Supreme Court with a six-to-three right-wing majority.

What about the situation closer to home? Have I also wedged myself into the bottom of the funnel, preventing the free flow of younger, more vigorous people? Or, to put the question differently, when is it my turn to retire?

I haven’t lived out the past three stints in Reno alone. My partner and I have always done them together, spending several months here working 18 hours a day, seven days a week. That’s what a campaign is, and it takes a lot out of you. I’m now 72 years old, while my partner is five years older. She was prepared to come to Reno again when we thought the contest would be Trump versus Biden. Once we knew that Harris would replace him, however, my partner felt enormous relief. Harris’s chances of beating Trump are — thank God — significantly better than Biden’s were. “I would have done it when it was the death march,” she told me, “but now I can be retired.”

Until Harris stepped up, neither of us could imagine avoiding the battle to keep Trump and his woman-hating, hard-right vice presidential pick out of office. We couldn’t face a Trump victory knowing we’d done nothing to prevent it. But now my 77-year-old partner feels differently. She’s at peace with retirement in a way that, I must admit, I still find hard to imagine for myself.

I haven’t taught a college class since the spring semester of 2021. For the last few years, I’ve been telling people, “I’m sort of retired.” The truth is that while you’re part of the vast army of contingent, part-time faculty who teach the majority of college courses, it’s hard to know when you’re retired. There’s no retirement party and no “emerita” status for part-timers. Your name simply disappears from the year’s teaching roster, while your employment status remains in a strange kind of limbo.

Admittedly, I’ve already passed a few landmarks on the road to retirement. At 65, I went on Medicare (thank you, LBJ!), though I held out until I reached 70 before maximizing my Social Security benefits. But I find it very hard to admit to anyone (even possibly myself) that I’m actually retired, at least when it comes to working for pay.

For almost two decades I could explain who I am this way: “I teach ethics at the University of San Francisco.” But now I have to tell people, “I’m not teaching anymore,” before rushing to add, “but I’m still working with my union.” And it’s true. I’m part of a “kitchen cabinet” that offers advice to the younger people leading my part-time faculty union. I also serve on our contract negotiations team and have a small gig with my statewide union, the California Federation of Teachers. But this year I chose not to run for the policy board (our local’s decision-making body), because I think those positions should go to people who are still actually teaching.

Those small pieces of work are almost enough to banish the shame I’d feel acknowledging that I’m already in some sense retired. I suspect my aversion to admitting that I don’t work for pay anymore has two sources: a family that prized professional work as a key to life satisfaction and — despite my well-developed critique of capitalism – a continuing infection with the productivity virus: the belief that a person’s value can only be measured in hours of “productive” labor.

Under capitalism, a person who has no work — compensated or otherwise — can easily end up marginalized and excluded from meaningful participation in society. The political philosopher Iris Marion Young considered marginalization one of the most ominous forms of oppression in a liberal society. “Marginals,” she wrote, “are people the system of labor cannot or will not use,” a dangerous condition under which a “whole category of people is expelled from useful participation in social life and thus potentially subjected to severe material deprivation and even extermination.”

Even when people’s material needs are met, as is the case for the luckiest retirees in this country, they can suffer profound loneliness and an unsettling disconnection from the social structures in which meaningful human activity takes place. I suspect it’s the fear of this kind of disconnection that keeps me from acknowledging that I might one day actually retire.

Jubilation and Passing the Torch

The other fear that keeps me working with my union, joining political campaigns, and writing articles like this one is the fear of the larger threats we humans face. We live in an age of catastrophes, present or potential. These include the possible annihilation of democratic systems in this country, the potential annihilation of whole peoples (Palestinians, for example, or Sudanese), or indeed, the annihilation of our species, whether quickly in a nuclear war or more slowly through the agonizing effects of climate change.

But even in such an age, I suspect that it’s time for many of my generation to trust those coming up behind us and pass the torch. They may not be ready, but neither were most of us when someone shoved that cone of flame into our hands.

Still, if I can bring myself to let go and trust those coming after me, then maybe I’ll be ready to embrace the idea behind one of my favorite Spanish words. In that language, you can say, “I’m retired” (“retirada”), and it literally means “pulled back” from life. But in Spanish, I can also joyfully call myself “jubilada,” a usage that (like “sabbatical”) also draws on a practice found in the Hebrew scriptures, the tradition of the jubilee, the sabbath of sabbaths, the time of emancipation of the enslaved, of debt relief, and the return of the land to those who work it.

Maybe it’s time to proudly accept not my retirement, but my future jubilation. But not quite yet. We still have an election to win.

Copyright 2024 Rebecca Gordon

Via Tomdispatch.com

If we want to build on the promise of Medicare, then we’re going to have to grapple directly with the power of corporate health insurance: That starts with taking on the so-called “Medicare Advantage” program.

Ed Weisbart

( Commondreams.org ) – Fifty-nine years ago today, President Lyndon Johnson signed Medicare into law—a high-water mark in the fight for universal healthcare that had started decades before and that continues to this day.

Ever since Medicare became law, it has been a shining example of what is possible in U.S. healthcare: a truly public, truly universal program that has saved countless lives and prevented untold financial ruin among America’s seniors. But alongside this success, corporate health interests have also grown immeasurably more powerful. Insurers like UnitedHealthcare and Blue Cross Blue Shield have erected cruel barriers to care and are laughing all the way to the bank.

If we want to build on the promise of Medicare—and win the best possible version of Medicare for All—then we’re going to have to grapple directly with the power of corporate health insurance. That starts with taking on the so-called “Medicare Advantage” program.

The Strategic Importance of Medicare Advantage

Single-payer advocates understand that there can’t be “Medicare for All” if there is no “Medicare.” And no, Medicare Advantage (MA) doesn’t count as Medicare. The health insurance corporations that run these plans have a business imperative to prioritize profits above all else; this is anathema to any public health program.

Physicians for a National Health Program (PNHP) has compiled overwhelming evidence that MA insurers are harming patients, physicians, and hospitals by delaying and denying care—harms that are virtually unseen in Traditional Medicare. Nor is this cruelty even a trade-off for lowering the cost of healthcare. In fact, these corporations are paid far more than what is spent for similar patients in Traditional Medicare—up to $140 billion per year, or as much as 35% above the funding levels of Traditional Medicare.

There is no road to Medicare for All that ignores this existential threat.

Where we see middlemen standing between patients and the care they need, we should remove them. Where we see limited provider networks, we should expand them. Where we see piles of pre-authorization paperwork, we should shred them.

Thankfully, support for eliminating overpayments to MA extends far beyond those who are already committed to single payer. This fight builds our movement by mobilizing a wide range of people who understand, or can be educated about, the damage insurance companies are doing to patients. When we find common ground, we should walk together.

For that reason, PNHP is exposing MA overpayments and demanding a more fiscally responsible approach from policymakers. We are working closely with several organizations to change the national conversation and provide a badly needed counterweight to the lobbying might of big insurance.

When MA was created, way back in 2003, corporate insurers promised to reduce the cost of healthcare by improving care coordination and health outcomes. A healthier population, they claimed, would be less expensive. We should demand that MA corporations live up to these lofty promises without billions of dollars in overpayments.

We’d like to see them try.

Improved Medicare… for ALL

Winning back $140 billion in annual overpayments begs a tantalizing question: How can we use those funds to improve Medicare for all seniors?

Instead of the paltry benefits that MA plans offer, those funds would help us add robust hearing, vision, and dental benefits; totally eliminate Medicare Part B premiums; and fold in the Medicare Part D prescription drug benefit. Imagine the relief a senior on Medicare Advantage would feel when enrolling in a plan that actually covers the full range of dental care, while also freeing themselves from the narrow provider networks and prior authorization requirements imposed by MA plans.

Most critically, we need to establish a low out-of-pocket maximum for Medicare. Insurance corporations lure seniors and people with disabilities into the MA trap by selling lower up-front costs while hiding substantial barriers to care. It’s a classic bait and switch. Eliminating the need to purchase Medigap would level the playing field and allow everybody to remain in Traditional Medicare.

Let’s work to build a movement of seniors, physicians, students, people with disabilities, and everybody else who cares about Medicare.

Well, not everybody—but that’s our ultimate goal. PNHP advocates for a national single-payer health insurance program, and what better way to get there than through an improved version of the already popular Medicare program?

Where we see middlemen standing between patients and the care they need, we should remove them. Where we see limited provider networks, we should expand them. Where we see piles of pre-authorization paperwork, we should shred them.

We should also expand benefits to include all medically necessary care, and ultimately eliminate out-of-pocket costs that deter people from seeing a doctor. Once these improvements are in place, we will have a program that’s truly worthy of the name Medicare for All.

The advocacy work for these priorities—ending MA overpayments, improving Traditional Medicare, and realizing our vision for single payer—overlap and build on one another.

Let’s work to build a movement of seniors, physicians, students, people with disabilities, and everybody else who cares about Medicare. Together, we can take on the corporate insurers that are wreaking so much havoc in our lives and lay the groundwork for winning a single-payer program that brings everybody in and leaves nobody out

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Licensed under Creative Commons (CC BY-NC-ND 3.0.

On July 30, 1965, at the Harry S. Truman Presidential Library in Independence, Missouri, former President Harry S. Truman and his wife, former First Lady Bess Truman, became the first recipients of the new Medicare health insurance program. President Lyndon Johnson and the U.S. Congress enacted Medicare under Title XVIII of the Social Security Act to provide health insurance to people age 65 and older, regardless of income or medical history and Medicaid for those whose incomes were below specific levels.

Medicare was a momentous act because it provided new health insurance for people ages 65 and older and the disabled regardless of income or medical history. In the 59 years since, Medicare has become living proof that public, universal health insurance is superior to private insurance in every way. Medicare is more efficient than private health insurance and is administered at a cost of 3 percent to 4 percent, as opposed to private, for-profit health insurance, which has administrative costs above 15 percent.

Following the successful 1965 grassroots campaign to enact Medicare, many believed that the dream of a full national, single-payer health insurance system that included all age groups, “Medicare for All”, was right around the corner. Unfortunately five decades later, Medicare still has not been expanded. Most of the changes have been contractions with higher out-of-pocket costs for beneficiaries and repeated attempts at privatization by Big Pharma, Big health insurance industry companies/oligarchs/profiteers and their champions in the White House and Congress.

Big insurance and Big Pharma continue opposing legislation for the new Medicare for All because these resistant, self-serving industries have the most to lose if their huge profits are redirected to direct patient care for all. Individual and corporate predators regard democracy, government and community as obstacles to their greed and avarice, always placing profits over individual patients, families and public health. It’s no wonder so many beholden members of Congress want to protect the interests of Big Insurance and Big Pharma.

WEALTH ADDICTION OF BIG HEALTH INSURANCE/BIG PHARMA/CONGRESSIONAL PROFITEERING COMPLEX:

“Money is like salt water. The more you drink, the thirstier you get”. Roman proverbs say that the more money a rich man has, the more driven he is to accumulate more. Limitless greed for money the Greek dramatists said, becomes a disease of the psyche. In the 388 B.C. play, “Ploutos”, Aristophanes writes that a person may become over-saturated with food….but no one ever has enough wealth. Wealth addiction is a greedy compulsion to obtain more and more wealth, and specifically obtain what belongs to others. The net effect is to injure others because it is adversarial/harmful to society as a whole.

Although health insurance affordability for the majority of US citizens still remains elusive, President Biden’s health insurance plan still wants to shift many more dollars into private, Wall Street insurance industry hands. The takeover of public health insurance, as with Medicare Advantage plans and others, by private Wall Street entities continues apace as Democrats/Biden propose to increase taxes and give it to the private profit insurance industry—the basic source of our profound administrative waste, along with the costly administrative burdens they place on the delivery system that requires large profits. Profiteering continues unabated as private insurance sells us services we don’t need/want , such as deductibles and other cost sharing, maintenance of narrow networks, requiring prior authorization with increased administrative costs, excessive ongoing paperwork/documentation requirements, all while avoiding paying for surprise bills and other denied benefits.

ABC News Video: “What to know about Project 2025”

PROFITEERING SURVEY FROM GOVERNMENT PROGRAMS: (data from ” BIG INSURANCE 2022: Revenues reached $1.25 trillion thanks to sucking billions out of the pharmacy supply chain – and taxpayers’ pockets”, Wendall Potter,HEALTH CARE-uncovered,02/23/2023)

1). Big Insurance revenues and profits have increased by 300% and 287% respectively since 2012 due to explosive growth in the companies’ pharmacy benefit management (PBM) businesses and the Medicare replacement plans called Medicare Advantage.

2). The for-profits now control more than 80% of the national PBM market and more than 70% of the Medicare Advantage market.

3). In 2022, Big Insurance revenues reached $1.25 trillion and profits soared to $69.3 billion.

4). That’s a 300% increase in revenue and a 287% increase in profits from 2012, when revenue was $412.9 billion and profits were $24 billion

5). More than 90% of health-plan revenues at three of the companies come from government programs as they continue to privatize both Medicare and Medicaid, through Medicare Advantage in particular.

6). Enrollment in government-funded programs increased by 261% in 10 years; by contrast commercial enrollment increased by just 10% over the past decade.

7). Commercial enrollment actually declined at both UnitedHealth and Humana.

8). 85% of Humana’s health-plan members are in government-funded programs; at Centene, it is 88%, and at Molina, it is 94%.

9). The big insurers now manage most states’ Medicaid programs – and make billions of dollars for shareholders doing so – but most of the insurers have found that selling their privately operated Medicare replacement plans is even more financially rewarding for their shareholders.

10). This is especially apparent when you see that the Big Seven’s combined revenues from taxpayer-supported programs grew 500%, from $116.3 billion in 2012 to $577 billion in 2022.

11). Changes in health-plan enrollment over the past decade show how dramatic this shift has been. Between 2012 and 2022
enrollment in the companies’ private commercial plans increased by 10%, from 85.1 million in 2012 to 93.8 million in 2022.

12). By comparison, growth in enrollment in taxpayer-supported government programs increased 261%, from 27 million in 2012 to 70.4 million in 2022.

13). Within that category, Medicare Advantage enrollment among the Big Seven increased 252%, from 7.8 million in 2012 to 19.7 million in 2022.

14). Nationwide, enrollment in Medicare Advantage plans increased to 28.4 million in 2022 (and to 30 million this year). That means that the Big Seven for-profit companies control more than 70% of the Medicare Advantage market.

MEANWHILE, AS BIG INSURANCE THRIVES:(data from Potter)

**27.5 million people remain uninsured in the United States. Up to 14 million more will lose their Medicaid coverage once the pandemic emergency period ends later this year.

**100 million of us – almost one of every three people in this country – now have medical debt.

**In 2023, U.S. families can be on the hook for up to $18,200 in out-of-pocket requirements before their coverage kicks in, up 43% since 2014 when it was $12,700.

**44% of people in the United States who purchased coverage through the individual market and (ACA) marketplaces were underinsured or functionally uninsured.

**46% of those surveyed said they had skipped or delayed care because of the cost.

**42% said they had problems paying medical bills or were paying off medical debt.

**Half (49%) said they would be unable to pay an unexpected medical bill within 30 days, including 68% of adults with low income,

**69% of Black adults, and 63% of Latino/Hispanic adults.

**In 2021, about $650 million, or about one-third of all funds raised by GoFundMe, went to medical campaigns. That’s not surprising when you realize that in the United States, even people with insurance all too often feel they have no choice but to beg for money from strangers to get the care they or a loved one needs.

**62% of bankruptcies are related to medical costs.

**Even as we spend about $4.5 trillion on health care a year, Americans are now dying younger than people in other wealthy countries.

**Life expectancy in the United States actually decreased by 2.8 years between 2014 and 2021, erasing all gains since 1996, according to the Centers for Disease Control and Prevention.

WENDALL POTTER CONCLUDES:
“The companies that comprise Big Insurance are vastly different from what they were just 10 years ago, but policymakers, regulators, employers, and the media have so far shown scant interest in putting their business practices under the microscope. Changes in federal law, including the Medicare Modernization Act of 2003, which created the lucrative Medicare Advantage market, and the Affordable Care Act of 2010, which gave insurers the green light to increase out-of-pocket requirements annually and restrict access to care in other ways, opened the Treasury and Medicare Trust Fund to Big Insurance. In addition, regulators have allowed almost all of their proposed acquisitions to go forward, which has created the behemoths they are today. CVS/Health is now the 4th largest company on the Fortune 500 list of American companies. UnitedHealth Group is now No. 5 – and all the others are climbing toward the top 10”

OPPOSING MEDICARE BY PRIVATIZING PUBLIC SERVICES:

The U.S. Congress/government permits private health insurance companies to exact large profit from its cItizens, Wall Street banks and investors who back Big Insurance turn public money into a bonanza of private riches. High health insurance costs are the result of a political decision to essentially allow Big Insurance to do what they want and charge whatever they want.

Fully backed by Wall Street, the for- profit, private insurance industry thoroughly dominates our national health insurance system and defines the basic concept and purpose of health insurance . The U.S. subscribes to a private business model of health insurance that defines insurers as commercial entities. Private insurers maximize profits by mainly limiting benefits, maximizing health policy premiums or by not covering people with health problems. Like all businesses, their goal is to make money. Under the addictive business model, the greed of casual inhumanity is built in and the common good of the citizens and nation is ignored; excluding the poor, the aged, the disabled and the mentally ill is sound business policy, since it maximizes profit .

INCREASED CORPORATE POWER/PRIVATIZATION OVER PUBLIC RESOURCES:

A new report from OXFAM, 01/24/24, “Inequality. Inc.”, describes how “around the world, corporate power is relentlessly pushing into the public sector, commodifying and segregating access to vital services such as education, water and healthcare, often while enjoying massive, taxpayer- backed profits.This can gut governments’ ability to deliver the type of high-quality, universal public services that can reduce inequality.

The stakes are huge. Essential services constitute trillion- dollar industries and immense opportunities for generating profit and wealth for rich shareholders. The World Bank and other development finance actors have prioritized private service provision, effectively treating basic services as asset classes and using public money to guarantee corporate returns rather than human rights. Private equity firms are snapping up everything from water systems to healthcare providers and nursing homes, amid a litany of concerns about poor and even tragic outcomes”.

OXFAMS “inequality Inc.” report further warns that ”privatization often entails giving corporations control over significant areas of policymaking, as well as access to public resources and capacity that could otherwise be dedicated to providing universal services and reducing inequality. Despite the promotion of privatization as a cost-saving measure, many contemporary arrangements such as PPPs and outsourcing can be highly costly to the state and require taxpayers to guarantee private sector profits. The fiscal risks of PPPs are particularly extreme, earning them the nickname ‘budgetary timebombs’. That such arrangements often place a high burden on public coffers and routinely cost more than public delivery undermines arguments that privatization is necessary because the public sector lacks sufficient resources.

Institutional investors are turning to PPPs and other forms, (eg., Medicare Advantage, ACOs) of privatized services to generate stable returns. Major development agencies and institutions, many of which have adopted policies that prioritize private provision of services, have found common ground with investors by embracing approaches that ‘de-risk’ such arrangements by shifting financial risk from the private to the public sector. This new ‘Wall Street Consensus’ reframes the ‘Washington Consensus’ in the language of contemporary development speak, and envisions the transformation of basic services such as education, healthcare and water into financial assets backed by public resources”.

STRATEGY OF PRIVATE INSURANCE INDUSTRY:

To protect and enhance high profits by opposing improved Medicare for All 2024, the private health insurance industry has mounted a huge campaign using myths, scare and fear tactics ever since ‘Obamacare’, the Affordable Care Act (ACA), was enacted in March, 2010. The U.S. health insurance industry lobbied Congress hard at that time to enact a requirement that most non-elderly Americans become compulsory customers of the private insurance industry and approve taxpayer financing of massive subsidies for that industry. The private insurance industry is very happy that with ACA, Americans are forced to purchase the product of their private industry plus give huge tax-financed subsidies to their industry in the amount of a half-trillion dollars per decade.

FEAR: The expedient health insurance industry seeks to protect high profits using scare/fear tactics against new and improved Medicare for All 2024 legislation. One tactic deliberately confuses the public by not telling individuals what would change if their private insurance is replaced by the new Medicare for All health insurance program. Lack of specificity and avoidance behavior promotes confusion, misunderstanding and great fear because it conflates loss of private health insurance with loss of their own physicians, other health professionals and hospitals. The for-profit health insurance industry knows full well that people are most interested in keeping their own doctors and that the new Medicare for All 2024 does not interfere with that. By conflating private health insurance with the direct provision of medical treatment itself, many patients are mislead into thinking they could lose all their health professionals. Fortunately, once folks understand that losing their expensive, for-profit private insurance plans is the only thing that will change, support for Medicare for All sharply increases. The huge profits of Big Insurance and Big Pharma are threatened once folks become aware of this tactic.

SOCIALIZED MEDICINE: Another industry scare tactic is to stoke public fear and confusion by conflating the “socialized medicine” label with single-payer, “socialized (public) health insurance”. Socialized medicine is a system in which doctors and hospitals work for and draw salaries from the government. The U.S. Veterans Administration is an example. In contrast, most European countries, Canada, Australia and Japan have ‘socialized health insurance’, not ‘socialized medicine’. The term “socialized medicine” is often used by the private insurance industry and politicians to manufacture frightening images of government bureaucratic interference in medical care. In countries with socialized health insurance, health and mental health professionals and patients often have more clinical freedom. This is in sharp contrast to the U.S., where private health insurance bureaucrats attempt to direct/interfere with care .

Manufactured confusion and fear of socialism by the health insurance industry and their political spokesmen impede the public’s ability to differentiate and thereby reduce support for Medicare for All . This allows the private health industry to successfully maintain control of the U.S. health care system for its own profitable purposes.

SEE “PLAYING THE ACE OF FEAR CARD” IN MMT SECTION BELOW: Playing “as if we can’t afford” M4A with the “ace of fear” card, opponents of M4A 2024 use the scary myth that large, confiscatory tax hikes will be needed to “pay for” M4A.

PREJUDICE AGAINST GOVERNMENT: Opposition to Medicare for All is also based on irrational fears, folklore/myth and general prejudice against government programs. Fear-mongering about waiting lists, bankrupt doctors and hospitals, and socialism is exactly the same fearful/false rhetoric used in the campaign to block LBJ’s original Medicare program in the mid-1960s. The Wall Street Journal then warned about “patient pileups,” and the American Medical Association mounted a campaign featuring Ronald Reagan that smeared Medicare as creeping socialism that would rob Americans’ freedom.

Unfortunately many government leaders from both political parties share the same ‘profits over public health’ ideology, even though the Covid-19 pandemic clearly showed how our economic system failed to serve our citizens by allowing these groups to privatize, sabotage, fragment and cripple our health, public health and other social services. No greater disconnect exists between the public good and private interests than in the U.S. system of for-profit health insurance. Using dark money, Big Insurance and Big Pharma are very powerful private interests that have shaped public policy in national health insurance and public health for the past 40 years.

U.S. SUPREME COURT: Strong support for the U.S.Supreme Court, ‘Citizens United’ decision, by unaccountable/unregulated large Big Insurance and Big Pharma corporations and ultra-wealthy individuals/families. is based on their Machiavellian understanding of the purpose of dark money in politics: to use dark money to change political outcomes to favor themselves, the 001% oligarchs and becomes a threat to democracy because its source is not made public. Dark money is corruption that erodes confidence and trust in local, state and national government and in both major political parties. It’s used to throw referendums and elections from which can come many of today’s social, economic, public health, mental health and environmental problems. Dark money is used to hide conflicts of interests and further enhance self promotion with bogus scientific controversies, fake news and fake grassroots campaigns.

REDUCE GOVERNMENT CAPACITY TO RESPOND: To reduce governments capacity to respond to public health problems/environmental crises such as Covid-19, single-payer national health insurance and other social services, these companies fund right-wing think tanks to attack public health/social policy. By presenting government as a threat to freedom, the distinguished writer for The Guardian(U.K.),George Monbiot, described how right wing groups and big business create a narrative by reframing responsible government as the “nanny state”, the “health police” and “elf ‘n’ safety zealots”. They dismiss scientific findings and predictions as “unfounded fears”, “risk aversion” and “scaremongering”. Public protections are recast as “red tape”, “interference” and “state control”.

Although some have negative feelings toward government, and examples of government inefficiency exist, the record of private health insurers is far worse. The only thing that exceeds government inefficiency is the private health insurance industry itself. Dozens of financial profiteering scandals have wracked private insurers and HMOs in recent years. Everyone should categorically reject myths about ‘Medicare for All’ that try to frighten seniors and others by telling them they will lose Medicare benefits under a new M4A program, that pointy-headed government bureaucrats will make medical decisions, determine the cost vs benefits of procedures, including age and quality of life considerations and medical personnel will be in short supply.

TRADITIONAL MEDICARE THREATENED BY NEW PRIVATE PROFITEERS: Private profit “Medicare Advantage” present new threat to Traditional Medicare.

WHAT IS MEDICARE ADVANTAGE? Medicare Advantage is a managed care program offering private health insurance plans as options to replace traditional Medicare. Medicare Advantage plans differ from traditional Medicare in that they are paid with capitation (per member), they are required to limit enrollees’ out-of-pocket spending and can offer extra benefits (e.g. gym memberships, $900 worth of groceries, dental benefits). They almost always offer prescription drug coverage and use a defined and often restricted network of providers that can require enrollees to pay more for out-of-network care. Utilization management techniques are used ,such as prior authorization, and they can also fund special programs such as rewards for beneficiaries to encourage healthy behaviors. The deceptively innocent hope is that these differences will lead to improved care at lower cost compared to Traditional Medicare.

In reality, “Medicare Disadvantage”is a better, more accurate name for the programs however, as insurance companies push Congress to corporatize all of Medicare, yet keep the name for the purposes of marketing, deception, and confusion.

Dismantling Medicare with Medicare Advantage: Over 50% of Medicare beneficiaries now have for-profit corporations in charge of their care through Medicare Advantage (MA). Insurance companies are paid handsomely for these plans, and much of that money goes to corporate profits instead of care. The companies running MA plans want to take over Medicare entirely, leaving patients with no option but to give their money to private insurers.

Denying Treatment: Investigations into claim denials in MA found that insurers were inappropriately denying treatments and tests that should be covered under Medicare. Physician surveys show that these practices often cause patients to suffer unnecessarily, and can even be life-threatening. In some cases, MA insurers were found to spend just seconds on each claim, and even denied claims using artificial intelligence instead of medical experts.

Deceiving Patients and Taxpayers: Reports from journalists, researchers, and government agencies have shown that health insurance companies like UnitedHealth and Cigna overcharge Medicare by giving patients exaggerated or entirely false diagnoses. Several companies have been fined, or sued, and agreed to large settlements. MA insurers are taking citizens tax dollars for conditions they aren’t even treating.

Bottom Line: Medicare Advantage is not the same Medicare program that Americans have come to know and love. The private insurance industry has spend millions on advertising in order to hide the ugly truth: their MA plans raid taxpayer funds and routinely fail to deliver the care that patients expect and deserve.

Terminate Medicare Advantage: Physicians for a National Health Program (PNHP), concludes tnat the Center for Medicare Services (CMS) should terminate the Medicare Advantage program. It would be far more cost-effective for CMS to improve traditional Medicare by capping out-of-pocket costs and adding improved benefits within the Medicare fee-for-service system than to try to indirectly offer these improvements through private plans that require much higher overhead and introduce profiteers and perverse incentives into Medicare, enabling corporate fraud and abuse, raising cost to the Medicare Trust Fund, and worsening disparities in care. These problems are not correctable within the competitive private insurance business model, and the Medicare Advantage program should be terminated.

MODERN MONETARY THEORY- MMT AND MEDICARE FOR ALL:

The US healthcare system is notorious for its high costs and below par outcomes. We already spend 18 percent of GDP on healthcare, and that is projected to reach 20 percent soon. This is approximately twice as much as our peers, other rich, developed, capitalist countries with no discernably better health outcomes (and even worse on a number of measures). Our excessive spending when compared to that of our peers can be attributed to the use of for-profit private insurance to pay for healthcare, higher pharmaceutical and provider costs, and higher administrative costs. Study after study has confirmed that prices and administrative costs in the US are out of line with those in the rest of the developed world, and especially compared to countries that have some type of a single-payer.

The Ace of Fear Card: Playing “as if we can’t afford” M4A with the “ace of fear” card, opponents of M4A 2024 use the scary myth that large, confiscatory tax hikes will be needed to “pay for” M4A. Economists at the Levy Institute of Economics of Bard College alert us how opponents of M4A typically warn of the high financial costs, and hence of prospective dangerously high government deficits. From the perspective of Modern Money Theory (MMT) however, these fear mongering arguments are beside the point and are a myth. A sovereign government’s finances are not like the budgeting by households and firms; the government uses the monetary system to mobilize the nation’s real resources and to move some of them to pursuit of public purposes, such as social welfare programs, public health, public health insurances, Medicare for All, etc. Whatever the financial costs, we already have a financial system that can handle them.

Distinguished Professor of Economics L. Randall Wray, Levy Economic Institute of Bard College and Yeva Nersisyan, Associate Professor of Economics at Franklin and Marshall College, Lancaster, PA, maintain that :“a sovereign government like the USA is not financially constrained; it spends by fiat, i.e., printing money, and/or through creating electronic computer entries in bank accounts and can neither run out of them nor save them for the future. What should constrain the spending of a sovereign government is the nation’s available real resources. Excessive spending, therefore, creates problems not in terms of higher government deficits and debt, but in terms of true inflation. Similarly, taxes are used not to finance government spending, but to withdraw demand from the economy, creating space for government spending to move resources to the public sector without causing inflation”.

Professor Wray notes that“the adoption of a single-payer system (replacing for-profit private insurers) would significantly reduce the resources devoted to our unusual way of paying for healthcare. It would eliminate the private insurance sector’s participation, reduce employers’ costs of administering healthcare plans, reduce the costs incurred by doctors and hospitals due to billing insurers as well as pursuing patients for uncovered costs, lower the costs of appealing denials, and cut costs associated with patients avoiding early treatment of diseases (because of the actual or expected out-of-pocket costs) that become chronic and expensive maladies. If M4A could control prices and lower administrative costs, we could spend significantly less on healthcare than we do currently, while expanding coverage to everyone. All else equal, if we were able to reduce our spending on healthcare to the level of our peers, we would be creating deflationary pressures, not inflation”.

Nersisyan and Wray estimate that “in the short term M4A could save about 3.7 percent of GDP while providing healthcare to the whole population. Even if we lowered healthcare spending by 3.7 percent of GDP, we would still be spending more on healthcare than all of our peers. “We believe our estimates are just the savings possible in the short term. In the long term, increased use of healthcare could reduce spending on chronic diseases. With universal access, cost controls, and elimination of a highly inefficient private insurance system, the single-payer system could shrink US spending on healthcare by much more, bringing us in line with other rich countries at about 10 percent of GDP.”

“Some will object that the savings largely accrue to the private sector, while the government will face additional costs. While it is true that the distribution of spending between the private and public sectors would change”, economist Wray assures us that. “there is nothing about government spending that necessarily makes it more inflationary than private spending. If private spending on healthcare costs falls by more than the increased government spending, the movement to single payer will be deflationary, not inflationary. Only a net increase in demand for resources would be inflationary.”

CONCLUSIONS:
The common good of our nation is ignored because the U.S. subscribes to a private business model for health insurance that defines insurers as commercial entities. Private health insurers maximize profits by limiting benefits or by not covering people with health problems. Like all businesses, their goal is to make money. Under this business model of health insurance, the greed of casual inhumanity is built in and the common good of the citizens and nation is ignored. Excluding many in the middle class, the poor, the aged, the disabled and the mentally ill is sound business practice policy since it maximizes profit.

Today we still have tens of millions of individuals without insurance, many more who are underinsured, many who have impaired access to their physicians and other health/mental health professionals because of insurer network restrictions, many who face financial hardship when health needs arise, and an outrageously expensive system due to the profound administrative waste of the insurers and the burden they place on the health care delivery system when immense profit is required. For example, statistics show that nearly 41% of adults (or nearly 100 million) are forced to get a medical loan to cover their health-care debt because they don’t have enough savings, and nearly 12% of them owe more than $10,000. Also, these data don’t take into account such forms of debt like credit cards or installments offered. When millions lost their jobs due to Covid-19, the dangers of connecting health insurance to employment also became painfully clear. Health insurance must not be tied to employment.

Almost none of these problems would exist if the government, instead of the private insurers, served us as a single-payer, health insurance financing authority. It is inhumane to allow consumer-directed, moral-hazard based private health policies to erect barriers to health care for millions of citizens with minimal or modest resources.

We now have several decades of experience with the conversion of health/mental health care into a business. Our health care is being rationed, with care guidelines determined by profitability and secrecy decided in private Wall Street corporate boardrooms. To realize large profits demanded by Wall Street investors, our health system must attract the healthy and turn away the sick, disabled, the poor, many of the old, and the mentally ill.

To maintain corporate control of U.S. health care insurance, our system is privatized and unregulated. Private, big insurance companies are in the business of making money, not providing full health care, and when they undertake the latter, it is likely not to be in the best interests of patients or to be efficient. Administrative costs (and immense profiteering ) are greater in the private health care insurance system, and even Medicare itself is weakened by having to work through the private system.

The USA is a country where health insurance for medical and mental health care is a function of socio-economic status. Everyone knows that this inhumane system should have been corrected long ago, but the death and illness ravages of the pandemic crisis makes it impossible to any longer avoid reality. We must immediately end our moral crime of having one of the the greatest health systems in the world, but only for those who can afford it. We must support the common principles that health care is a human right, must be free from corporate profit, and must be achieved through national legislation.

Let’s never forget that universal Medicare for All is a solid investment, not an expense, in and for our country by simply promoting a social service for universal access to affordable health care insurance for all. Aren’t we a society that cares enough to see that everyone receive the health care they need? That’s the basic purpose of Medicare for All. The 59 year history of our most successful national health insurance program, Medicare, provides one of the best arguments for expanding the program to cover everyone. It’s time to end inadequate and dangerous health insurance programs. Insist on real health insurance reform essential for all individuals and families.

American history is filled with examples of fundamental, democratic change brought about by successful mass action and public pressure against the counseling of the wealth addicted, neoliberal, privatization, 1% self-serving oligarchs/vested interest/profiteering/crowd. Professor of Economics L. Randall Wray notes that the US healthcare system still has significant gaps in coverage—all while facing the highest healthcare bill in the world. Dr. Wray convincingly argues that the underlying challenge for a system based on private, for-profit insurance is that basic healthcare is not an insurable expense. He concludes that It is time to abandon the current, overly complex and expensive payments system and reconsider single payer for all. Social Security and Medicare provide a model for reform.

Today, the very best way forward is, without ambivalence, avoidance behavior or any further delay, to immediately implement new legislation now filed in Congress, “The Medicare for All Act of 2023” House Bill (H.R. 3421) and Senate Bill (S. 1655) that would establish this long overdue reform.

President Harry S. Truman once said,”There is nothing new in the world except the history you do not know”. Attempts to transfer ownership and control of economic programs/services/financial resources from the government into private, greedy hands have existed in many societies for thousands of years. Father Lactantius, c.250-c.326, an early Christian author and advisor to the Roman Emperor Constantine I, wrote in “ The Divine Institute”, a timely piece about Roman society that well applies to 21st century USA society:

In order to enslave the many, the greedy began to appropriate and accumulate the necessities of life and keep them tightly closed up so that they might keep these bounties for themselves. They did this not for humanity’s sake which was not in them at all but to rake up all things and products of their greed and avarice. In the name of justice, they made unfair and unjust laws to sanction their thefts and avarice against the power of the multitude. In this way they ruled as much by authority as by strength of arms and overt evil.

LINKS: Full text U.S.House of Representatives – H.R. 3421

Full text U.S. Senate – S. 1655

1). Medicare Advantage (MA), the privately-administered version of Traditional Medicare (TM), is causing significant harm to America’s patients, providers, and health

2). Political support for the private health insurance industry and Medicare Advantage exists because our government permits private health insurance companies to exact large profit from its citizens as Wall Street banks and investors who back Big Insurance turn public money into a bonanza of private riches.

3). High health insurance costs are the result of a political decision to essentially allow Big Insurance to do what they want and charge whatever they want.

4). The recent JAMA IM article, “Less Care at Higher Cost — The Medicare Advantage Paradox,” details how private insurers have exploited loopholes in Medicare’s complex payment rules for decades to extract overpayments.

5). The federal government pays insurance companies a lump sum for each patient its Medicare Advantage plans sign up, with the amount of the lump sum based on enrollees’ “risk scores,” which the government calculates from diagnosis codes that the plans submit. The risk scores are meant to predict how much care enrollees will need.

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6). Research has repeatedly shown that the private plans game the system by cherry-picking the healthiest seniors to enroll, and then exaggerating how sick they are by so-called “upcoding,” i.e. padding enrollees’ medical charts with long lists of diagnosis codes that do not require specific treatment, jacking-up the risk score and hence the government’s lump-sum payment to the plan.

7). According to the JAMA IM article, privatized Medicare plans often refuse to cover providers that high-cost patients need, such as specialized cancer hospitals, mental health professionals and psychiatrists; restrict access to drugs and treatments; and pressure patients and doctors to curtail expensive care.

8). As a result, the privatized plans spend, on average, 9% less on medical services (including the extra benefits they promise) than traditional Medicare spends for comparable patients.

9).“Medicare Advantage plans have, in effect, stolen hundreds of billions from taxpayers,” says David Himmelstein, a study co-author who is a Distinguished Professor at CUNY’s Hunter College, a lecturer at Harvard Medical School, and a Research Associate at Public Citizen. “And the private plans’ schemes also raise seniors’ Part B Medicare premiums. Even seniors who don’t choose to enroll in Medicare Advantage are subsidizing the private plans’ profits.”

10). Medicare was created to serve the people, and MA betrays that promise. We must rein in the abuses of MA insurers, eliminate profit-seeking in Medicare and put an end to these egregious harms.

( Commondreams.org) – They’re competing unfairly with Medicare, and you and I are paying for it. It’s obscene.

When former U.S. President George W. Bush and congressional Republicans (and a handful of bought-off Democrats) created Medicare Advantage in 2003, it was the fulfillment of half of Bush’s goal of privatizing Social Security and Medicare, dating all the way back to his unsuccessful run for Congress in 1978 and a main theme of his second term in office.

Medicare Advantage is not Medicare. These plans are private health insurance provided by private corporations, who are then fully reimbursed by the Medicare trust fund regardless of how much their customers use their insurance. Thus, the more they can screw their customers and us taxpayers by withholding healthcare, the more money they make.

These giant insurance companies ripped off our tax dollars last year to the tune of an estimated $140 billion over and above what it would’ve caused us if people had simply been on real Medicare.

With real Medicare, if your doctor says you need a test, procedure, scan, or any other medical intervention you simply get it done and real Medicare pays the bill. No muss, no fuss, no permission needed. Real Medicare always pays, and if they think something’s not kosher, they follow up after the payment’s been made so as not to slow down the delivery of your healthcare.

With Medicare Advantage, however, you’re subject to “pre-clearance,” meaning that the insurance company inserts itself between you and your doctor: You can’t get the medical help you need until or unless the insurance company pre-clears you for payment.

These companies thus make much of their profit by routinely denying claims—1.5 million, or 18% of all claims, were turned down in one year alone—leaving Advantage policy holders with the horrible choice of not getting the tests or procedures they need or paying for them out-of-pocket.

Given this, you’d think that most people would stay as far away from these private Medicare Advantage plans as they could. But Congress also authorized these plans to compete unfairly with real Medicare by offering things real Medicare can’t (yet). These include free or discounted dental, hearing, eyeglasses, gym memberships, groceries, rides to the doctor, and even cash rebates.

You and I pay for those freebies, but that’s only half of the horror story.

This year, as Matthew Cunningham-Cook pointed out in Wendell Potter’s brilliant Healthcare Un-covered Substack newsletter this week, we’re ponying up an additional $64 billion to give to these private insurance companies to reimburse them for the freebies they relentlessly advertise on television, online, and in print.

And here’s the most obscene part of the whole thing: The companies won’t tell the government how much of that $64 billion they’ve actually spent. They just take the money and say, “Thank you very much.” And then, presumably, throw a few extra million into the pockets of each of their already very-well-paid senior executives.

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For example, the former CEO of the nation’s largest Medicare Advantage provider, UnitedHealth, walked away with over a billion dollars in total compensation. With a “B.” One guy. His successor made off with over a half-billion dollars in pay and stock.

Good work if you can get it: All you need do is buy off a hundred or so members of Congress, courtesy of Clarence Thomas’ tie-breaking vote on Citizens United, and threaten the rest with massive advertising campaigns for their opponents if they try to stop you.

Project 2025 and candidate Trump both promise to end real Medicare “immediately” if Trump or when another Republican becomes president.

And while the companies refuse to tell us how much of the $64 billion that we’re throwing at them this year to offer “free” dental, etc. is actually used, what we do know is that most of that money is not going to pay for the freebies they advertise. As Cunningham-Cook noted, in one study only 11% of Advantage policyholders who’d signed up with plans offering dental care used that benefit.

Another study showed over-the-counter-drug freebies were used only a third of the time, leaving $5 billion in the insurance companies’ money bins just for that goodie. A later study found that at least a quarter of all Advantage policyholders failed to use any of the freebies they’d been offered when they signed up.

That’s an enormous amount of what the industry calls “breakage;” benefits offered but not used. Billions of dollars left over every month. And, used or not, you and I sure paid for them.

In my book The Hidden History of American Healthcare: Why Sickness Bankrupts You and Makes Others Insanely Rich, I lay out the story of this scam and how badly so many American seniors—and all American taxpayers, regardless of age—get ripped off by it.

When he was president, Donald Trump substantially expanded Medicare Advantage, calling real Medicare “socialism.” Project 2025 and candidate Trump both promise to end real Medicare “immediately” if Trump or when another Republican becomes president.

These giant insurance companies ripped off our tax dollars last year to the tune of an estimated $140 billion over and above what it would’ve caused us if people had simply been on real Medicare, according to a report from Physicians for a National Health Program (PNHP). If there was no Medicare Advantage scam bleeding off all that cash to pay for executives’ private jets, real Medicare could be expanded to cover dental, vision, and hearing and even end the need for Medigap plans.

But for now, the privatization gravy train continues to roll along. The insurance giants use some of that money to buy legislators and some of it for expensive advertising to dupe seniors into joining their programs. The company (Benefytt) that hires Joe Namath to pitch Medicare Advantage, for example, was recently hit with huge fines by the Federal Trade Commission for deceptive advertising.

The FTC news release laid it out:

“Benefytt pocketed millions selling sham insurance to seniors and other consumers looking for health coverage,” said Samuel Levine, director of the FTC’s Bureau of Consumer Protection. “The company is being ordered to pay $100 million, and we’re holding its executives accountable for this fraud.”

And what was it that the Federal Trade Commission called “sham insurance”? Medicare Advantage. Nonetheless, the Centers for Medicare Services continues to let Benefytt and Namath market these products: Welcome to the power of organized money.

And it’s huge organized money. Medicare Advantage plans are massive cash cows for the companies that run them. As Cigna prepares for a merger, for example, they’re being forced to sell off their Medicare Advantage division: It’s scheduled to go for $3.7 billion. Nobody pays that kind of money unless they expect enormous returns.

Traditional Medicare has been serving Americans well since 1965: it’s one of the most efficient single-payer systems to fund healthcare that’s ever been devised. But nobody was making a buck off it, so nobody could share those profits with greedy politicians. Enter Medicare Advantage, courtesy of George W. Bush and the GOP.

While several bills have been offered in Congress to do something about this—including Reps. Mark Pocan’s (D-Wis.) and Ro Khanna’s (D-Calif.) Save Medicare Act that would end these companies’ ability to use the word “Medicare” in their policy names and advertising—the amounts of money sloshing around D.C. in the healthcare space now are almost unfathomable.

So far this year, according to opensecrets.org, the insurance industry has spent $45,173,132 showering gifts and persuasion on our federal lawmakers to keep their obscene profits flowing.

It’s all one more example of how five corrupt Republicans on the U.S. Supreme Court legalizing political bribery with Citizens Unitedhave screwed average Americans and made a handful of industry executives and investors fabulously rich.

Thus, here we are, handing billions of dollars a month to insurance industry executives so they can buy new Swiss chalets, private jets, and luxury yachts. And compete—unfairly—with Medicare itself, driving LBJ’s most proud achievement into debt and crisis.

Enough is enough. Let your members of Congress know it’s beyond time to fix the court and Medicare, so scams like Medicare Advantage can no longer rip off America’s seniors while making industry executives richer than Midas.

Thom Hartmann

( Tomdispatch.com ) – On April 22nd, the Supreme Court heard oral arguments for Grants Pass v. Johnson, a case that focuses on whether unhoused — the term that has generally replaced “homeless” — people with no indoor shelter options can even pull a blanket around themselves outdoors without being subject to criminal punishment.

Before making its way to the Supreme Court on appeal, the Ninth Circuit Court held that municipalities can’t punish involuntarily homeless people for merely living in the place where they are. This is exactly what the city of Grants Pass, Oregon, did when it outlawed resting or sleeping anywhere on public property with so much as a blanket to survive in cold weather, even when no beds in shelters were available. The law makes it impossible for unhoused residents to stay in Grants Pass, effectively forcing them to either move to another city or face endless rounds of punishment. In Grants Pass, the punishment starts with a $295 fine that, if unpaid, goes up to $500, and can escalate from there to criminal trespass charges, penalties of up to 30 days in jail, and a $1,250 fine.

The issue before the court is whether such a law violates the Eighth Amendment’s restrictions against cruel and unusual punishment. The city is asking the court to decide that the Eighth Amendment doesn’t impose any substantive limit on what can be criminalized, so long as the punishment itself isn’t considered cruel and unusual. If so, municipalities across the nation would be free to make involuntary homelessness unlawful.

In response, more than 40 amicus briefs with over 1,100 signatories were filed against the city’s case, representing millions of people concerned about or potentially affected by the far-reaching consequences of such a decision. The Kairos Center for Religions, Rights & Social Justice — to which the two authors of this piece belong — submitted one such brief together with more than a dozen religious denominations, historic houses of worship, and interfaith networks. Along with the 13 official signatories of that brief, many more clergy, faith leaders, and institutions support its core assertion: that the Grants Pass ordinance violates our interfaith tradition’s directives on the moral treatment of poor and unhoused people. Indeed, the Supreme Court’s decision could dramatically criminalize poverty and homelessness nationwide, especially if cities near Grants Pass, in the state of Oregon, and across the country, put in place similar restrictions.

Sadly, such a scenario is anything but far-fetched, given not just this Supreme Court but all too much of this country. Since the early 2000s, our nation has regularly turned to policing and “law and order” responses to social crises. Often wielded against poor and low-income communities in the form of fines, fees, and risks of jail time, such threats are regularly backed up by police in full body armor, using tactical gear and, in this century so far, hundreds of millions of dollars of military equipment transferred directly from the Pentagon to thousands of police departments nationwide.

All of this has made the possibility of using violence and brute force more likely in relation to many situations, including the world of the unhoused. Most recently, of course, militarized police have swarmed campuses to help quell largely peaceful student protests over the war on Gaza. Consider it anything but ironic that when Northeastern University students were arrested for their Gaza encampment, they were taken to the same facilities where unhoused people were being processed during homeless encampment sweeps, as local contacts in Boston have told us.

Poverty and Housing Insecurity

The homelessness and housing crises unfolding today reflect a broader national crisis of economic insecurity. In 2023, after all, approximately 135 million people or more than 40% of the nation, were considered poor or low-income and just one crisis away from becoming homeless. In a dramatic return to pre-pandemic conditions, this included 60% of Latinos (38.9 million), 59% of Native Americans (2.3 million), 55% of Blacks (22.5million), 36% of Asian people (8 million) and 32% of Whites (61.8 million).

Among those tens of millions of Americans, housing insecurity is alarmingly widespread. Before the pandemic, there were approximately 8 to 11 million people who were homeless or on the verge of becoming so, relying on a crumbling shelter system and a growing constellation of informal encampments on America’s streets, or trapped in a rotating series of sleeping places, including cars and couches, or doubled or tripled up in apartments. Worse yet, even those numbers were likely an underestimate: when the pandemic hit in 2020 and millions of people lost their jobs, 30 to 40 million people suddenly found themselves at risk of becoming homeless.

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In a nation once known as “the home of the brave” and “the land of the free,” there are untold numbers of brave souls who are without homes or on the verge of homelessness. Today, there is not a single state or county where someone earning the federal minimum wage can afford a two-bedroom apartment.

As reported this May, between 2019 and 2023, rents rose by more than 30% nationally. Despite a number of local and state increases in the minimum wage this year, a living wage adequate to cover housing and other basic needs would often have to be at least twice as high as what those hourly increases add up to. In California, where the minimum wage rose to $16 an hour, single parents would need to earn at least $47 an hour to meet their basic needs, whereas a household with two working adults and two children would need close to $50 an hour. In Alabama, where the minimum wage is just $7.25, a single parent would need an hourly wage more than four times as high to meet basic household needs.

This, of course, means that tens of millions of people of every race, age, and gender identity, in every state and county in the country, are facing multiple forms of deprivation daily and will do so for years to come.

Although the depths of this crisis are hard to fathom, it can be measured in death. In 2023, researchers from the University of California, Riverside, found that poverty is the fourth-leading cause of death nationally, claiming 183,000 of us in 2019. Their research also showed that cumulative or long-term poverty was associated with 295,000 deaths annually, or 800 deaths a day. During the pandemic crisis, poor and low-income counties experienced Covid death rates that were three to five times higher than wealthier counties, while the mortality rate among renters facing eviction was 2.6 times higher than that of the general population. Housing insecurity led to increased death by Covid and had negative health impacts more generally.

Underestimating the Crisis

The extent of the (un)housing crisis is so much greater than the systems and structures that exist to respond to it. In part, this is because, as with poverty, measures of housing insecurity generally underestimate the need at hand. The most commonly used reference point on housing is the point-in-time (PIT) homeless count. The “PIT count” includes both the number of the unhoused who are in shelters and a street count of unsheltered homeless people. However, it only deals with those it can reach and so literally count. It also leaves out some forms of homelessness, including the millions of people who are living “doubled up” or “tripled up” with friends, family members, or even strangers.

In the pre-pandemic years, the PIT count was often around half a million people, but didn’t include the 2.5-3.5 million people living in temporary homeless shelters, transitional housing centers, and informal encampments or tent cities, or the estimated seven million people who had lost their own homes and moved in with others. In other words, the PIT count was short by about 9 to 11 million people (and that was before the pandemic caused greater homelessness and housing insecurity).

Although grossly inadequate, the PIT count remains the measure used to allocate federal resources toward homelessness. Unfortunately, when a housing program is designed for tens or even hundreds of thousands rather than millions of people, it will fail. For this reason, housing organizers and advocates have for years been pushing alternatives and urging the consideration of housing solutions that could actually respond to this crisis at scale. The Housing First model is one of those solutions, prioritizing access to permanent and stable housing, alongside wraparound services for employment, recovery, and greater housing stability for those in need. The use of this model has been shown to result in higher rates of housing retention among previously unhoused people, with (not surprisingly) an improved quality of life as well.

In fact, some pandemic policies did temporarily (even if unintentionally) implement and expand on the Housing First model. They moved people into hotels or other available, unused rental units, stopping all evictions and foreclosures; distributed economic stimulus payments; and built up this country’s decrepit social welfare system by expanding unemployment insurance and food security programs, while issuing monthly payments to households with children. All of this did, in fact, prevent massive dislocations of millions of people between 2020 and 2022, while providing more housing and keeping at least 20 million people above the poverty line.

A common thread of these programs was that they prioritized financially vulnerable households over Wall Street, real estate tycoons, and corporate landlords. Years later, a majority of Americans continue to support many of these policies, which were put in place alongside breakthrough organizing among poor, unhoused, and housing-insecure people.

During the early weeks of the pandemic, unhoused people living in encampments also fought to become certified as “essential workers” so that they could get protective equipment for their community members. Around the same time, low-income housing organizers and tenant associations became acutely aware of the vulnerabilities of low-income tenants who couldn’t then afford to pay their rent and feed their families. Despite fears of eviction, rent strikes broke out in March and April 2020, as tenants decided to withhold their limited resources to ensure that they could provide food to their families. This happened weeks before the federal eviction moratorium was enacted. When it expired months later, communities blocked eviction hearings to make sure as many people as possible could stay in their homes.

Despite widespread support for a more robust right to housing, it didn’t take long for powerful interests to begin pushing back. The real estate industry spent upwards of $100 million lobbying against pandemic eviction moratoriums at both the federal and state levels. In 2022, the Cicero Institute created a template for state legislation that would criminalize unhoused people. That model legislation would have banned encampments on public land and diverted funds from Housing First programs to short-term shelter programs, while forcing unhoused people into state-run encampments. Versions of this bill have been introduced in half a dozen states and passed in Missouri, Tennessee, and Texas.

Recently, in New York (where we live), Governor Kathy Hochul enacted a budget that prioritized the state’s wealthy residents over its poor and low-income ones. Not only did she refuse to increase taxes on the wealthiest New Yorkers and corporations, losing billions of dollars in new revenue, but her housing policies provided tax incentives to developers rather than focusing on creating stable housing for housing-insecure and homeless New Yorkers.

According to the New York Labor-Religion Coalition and the Housing Justice for All Coalition, at least 3.4 million tenants will be excluded from good-cause eviction protections, among them all upstate municipalities, while those who are eligible may not be able to exercise their rights unless they have adequate legal representation in housing court. That budget also rolls back rent-stabilization measures, making elderly tenants in particular more vulnerable to eviction, while failing to allocate a single dollar to move homeless New Yorkers into stable housing. And in all of this, New York is anything but out of the ordinary.

What You Do to the Least of These, You Do Unto Me

Although America’s political leadership is generally failing to respond to the need at hand, millennia of religious teachings have helped shape society’s views on our responsibility to care for, not punish, poor and unhoused people.

Indeed, there are over 2,000 Biblical passages that address poverty — most of them focusing on those made poor by a society that fails to provide for all our needs. As Jesus says to his followers in Matthew 25:

“[F]or I was hungry and you gave me no food, I was thirsty and you gave me nothing to drink, I was a stranger and you did not welcome me, naked and you did not give me clothing, sick and in prison and you did not visit me. Then [the nations] also will answer, Lord, when was it that we saw you hungry or thirsty or a stranger or naked or sick or in prison and did not take care of you? Then [Jesus] will answer them, Truly I tell you, just as you did not do it to one of the least of these, you did not do it to me.”

This responsibility rests not only on individuals, but those in positions of authority in society. As Isaiah 10:2 puts it: “Woe to those who make iniquitous decrees, who write oppressive statutes, to turn aside the needy from justice and to rob the poor of my people of their right.” Instead, Isaiah 3:15 instructs those who make the laws and issue decrees not to “grind the face[s] of the poor,” making their already difficult conditions worse. Such teachings are consistent not just with the Abrahamic tradition but other belief systems like Hinduism, which prioritizes non-violence and non-injury as a core moral responsibility.

A law like the one now before the Supreme Court in Grants Pass v. Johnson that would punish unhoused people for simply living departs from such moral wisdom in a radical fashion. As Justice Elena Kagan pointed out during oral arguments over the case, “For a homeless person who has no place to go, sleeping in public is kind of like breathing in public.” How true! If only four other justices would see the situation similarly.

Our faith traditions and constitutional values certainly should be clear enough that it is cruel and unusual punishment to treat the homeless the way Grants Pass wants to do. The court and the nation should respond to this moral crisis with care and compassion, with housing, not handcuffs.

May it be so.

Copyright 2024 Liz Theoharis and Shailly Gupta Barnes

Via Tomdispatch.com

Jake Johnson

( Commondreams.org ) – Patients on Medicare Advantage spoke out against the privatized plans this week as part of a coordinated campaign to shed light on the program’s care denials, treatment delays, and overbilling—and to pressure U.S. President Joe Biden to rein in the insurance giants raking in huge profits from such abuses.

“These corporations do nothing to increase positive outcomes in medical care. So don’t fall for their bullshit,” Jenn Coffey, a retired EMT from New Hampshire, said during a livestream hosted by People’s Action on Wednesday night.

The stream featured testimony from several patients who have experienced the kinds of delays and denials for which Medicare Advantage is notorious.

Rick Timmins of Puget Sound Advocates for Retirement Action said it took five months and “multiple calls and emails” for his insurance company to approve his referral to a dermatologist for a suspicious lump on his earlobe that turned out to be malignant melanoma. The delay stemmed from a byzantine process known as prior authorization, whereby doctors are required to prove a treatment is necessary before an insurer will cover it.

By the time his referral to a specialist was approved, Timmins said, the previously tiny lump “had tripled in size” and was “quite painful.”

Coffey, for her part, ended up on a UnitedHealth Medicare Advantage plan after she was diagnosed with breast cancer in 2013. She later developed two rare diseases—including complex regional pain syndrome—and required expensive treatments that her Medicare Advantage plan refused to cover.

“If Medicare Advantage has it their way, they’re going to deny me care and delay me care until I’m dead,” Coffey, a healthcare advocate, said in a video published Thursday by the advocacy group Be A Hero as part of a social media day of action against the for-profit plans.

Image by Steve Buissinne from Pixabay

“They only make money when they don’t have to spend it on you,” said Coffey.

Once enrolled in a Medicare Advantage plan, patients often find it difficult to get out.

“They like to tell you: ‘Medicare Advantage numbers are so high, can’t you tell people love it?'” said Coffey, alluding to the fact that more than half of all eligible Medicare beneficiaries are now enrolled in a Medicare Advantage plan. “No, we don’t. We’re stuck. It’s the Hotel California: You can check in, but you can’t get the hell out.”

Next month, the Biden administration is expected to finalize 2025 payment rates for Medicare Advantage, which is funded by the federal government. Medicare Advantage plans frequently overbill the government by making patients appear sicker than they are.

An analysis released last year by Physicians for a National Health Program estimated that Medicare Advantage plans are overcharging U.S. taxpayers by as much as $140 billion per year—an amount that could be used to completely eliminate Medicare Part B premiums or fully fund Medicare’s prescription drug program.

Patients and advocacy groups are calling on Biden to “not fork over more money for insurance companies like UnitedHealthcare,” as Coffey put it during Wednesday’s livestream.

A petition sponsored by Social Security Works urges Biden to “reclaim Medicare” from Medicare Advantage providers, which “have delayed and denied care to millions of Americans in order to turn a massive profit.”

“Medicare Advantage isn’t really Medicare, and it isn’t an advantage to the seniors and people with disabilities who rely on the program,” reads the petition, which has over 22,800 signatures as of this writing. “In the 25 years that it has existed, it’s clear that Medicare Advantage is riddled with the same problems as the rest of private insurance: Opaque bureaucracy and extraordinary fees. Seniors who enroll in these for-profit plans are being price-gouged by massive corporations.”

The Biden administration has proposed a 3.7% payment increase for Medicare Advantage in 2025—a change that insurers have portrayed as a cut. But Social Security Works noted in response to the industry’s complaints that “MA companies are not hurting for profits.”

“In 2022 alone, seven healthcare companies that comprise 70% of the MA market brought in over $1 trillion in total revenue and over $69 billion in profits, and spent $26.2 billion on stock buybacks,” the group observed. “These same companies claim that if the government doesn’t increase their already bloated payment rates, they will have no choice but to slash benefits for patients. This is false, and should be seen for what it is—MA plans holding patients hostage to extort the government for profits.”

In an op-ed for STAT last month, former insurance industry insider Wendell Potter—who is now an outspoken critic of private insurers—and John A. Burns School of Medicine professor professor Philip Verhoef wrote that “private plans have no business administering Medicare benefits.”

“Traditional Medicare is already more efficient than its private counterpart, in large part because the approval process is much simpler and there aren’t the same incentives to upcode,” the pair wrote. “Traditional Medicare spends far less of its funds on administrative overhead, and overall it spends less money per patient than Medicare Advantage while providing far superior access to doctors, hospitals, and treatments.”

“Medicare Advantage isn’t working for any group: the government, patients, taxpayers, and now even investors,” they added. “It’s time to turn to what we already know works. We need to support and strengthen traditional Medicare.”

( Commondreams.org ) – The United States health care system—more costly than any on earth—will become ever more so as Wall Street increasingly extracts money from it.

Private equity funds own approximately 9% of all private hospitals and 30% of all proprietary for-profit hospitals, including 34% that serve rural populations. They’ve also bought up nursing homes and doctors’ practices and are investing more year by year. The net impact? Medical costs to the government and to patients have gone up while patients have suffered more adverse medical results, according to two current studies.

The Journal of the American Medical Association (JAMA) recently published a paper which found:

Private equity acquisition was associated with increased hospital-acquired adverse events, including falls and central line–associated bloodstream infections, along with a larger but less statistically precise increase in surgical site infections.

This should not come as a surprise. Private equity firms in general operate as follows: They raise funds from investors to purchase enterprises using as much borrowed money as possible. That debt does not fall on the private equity firm or its investors, however. Instead, all of it is placed on the books of the purchased entity. If a private equity firm borrows money and buys up a nursing home or hospital chain, the debt goes on the books of these healthcare facilities in what is called a leveraged buyout.

To service the debt, the enterprise’s management, directed by their private equity ownership, must reduce costs, and increase its cash flow. The first and easiest way to reduce costs is by reducing the number of staff and by decreasing services. Of course, the quality of care then suffers. Meanwhile, the private equity firm charges the company fees in order to secure its own profits.

With so much taxpayer money sloshing around in the system, hedge funds also are cashing in.

An even larger study of private equity and health was completed this summer and published in the British Medical Journal (BMJ). After reviewing 1,778 studies it concluded that after private equity firms purchased healthcare facilities, health outcomes deteriorated, costs to patients or payers increased, and overall quality declined.

Photo by Towfiqu barbhuiya on Unsplash

One former executive at a private equity firm that owns an assisted-living facility near Boulder, Colorado, candidly described why the firm was refusing to hire and retain high-quality caregivers: “Their position was: We are trying to increase our profitability. Care is an ancillary part of the conversation.”

Medicare Advantage Creates Wall Street Advantages

Congress passed the Medicare Advantage program in 2003. Its proponents claimed it would encourage competition and greater efficiency in the provision of health insurance for seniors. At the time, privatization was all the rage as the Democratic and Republican parties competed to please Wall Street donors. It was argued that Medicare, which was actually much more efficient than private insurance companies, needed the iron fist of profit-making to improve its services. These new private plans were permitted to compete with Medicare Part C (Medigap) supplemental insurance.

In 2007, 19% of Medicare recipients enrolled in Medicare Advantage plans. By 2023 enrollment had risen to 51%. These heavily marketed plans are attractive because many don’t charge additional monthly premiums, and they often include dental, vision, and hearing coverage, which Medicare does not. And in some plans, other perks get thrown in, like gym memberships and preloaded over-the-counter debit cards for use in pharmacies for health items.

How is it possible for Medical Advantage to do all this and still make a profit?

According to a report by the Physicians for a National Health Program, it’s very simple—they overcharge the government, that is we, the taxpayers, “by a minimum of $88 billion per year.” The report says it could be as much as $140 billion.

In addition to inflating their bills to the government, these HMO plans don’t pay doctors outside of their networks, deny or slow needed coverage to patients, and delay legitimate payments. As Dr. Kenneth Williams, CEO of Alliance HealthCare, said of Medicare Advantage plans, “They don’t want to reimburse for anything — deny, deny, deny. They are taking over Medicare and they are taking advantage of elderly patients.”

Enter Hedge Funds

With so much taxpayer money sloshing around in the system, hedge funds also are cashing in. They have bought large quantities of stock in the healthcare companies that are milking the government through their Medicare Advantage programs. They then insist that these healthcare companies initiate stock buybacks, inflating the price of their stock and the financial return to the hedge funds. Stock buybacks are a simple way to transfer corporate money to the largest stock-sellers.

(A stock buyback is when a corporation repurchases its own stock. The stock price invariably goes up because the company’s earnings are spread over a smaller number of shares. Until they were deregulated in 1982, stock buybacks were essentially outlawed because they were considered a form of stock price manipulation.)

United Healthcare, for example, is the largest player in the Medicare Advantage market, accounting for 29% of all enrollments in 2023. It also has handsomely rewarded its hedge fund stock-sellers to the tune of $45 billion in stock buybacks since 2007, with a third of that coming since March 2020. Cigna, another big Medicare Advantage player, just announced a $10 billion stock buyback.

These repurchases are also extremely lucrative for United Healthcare’s top executives, who receive most of their compensation through stock incentives. CEO Andrew Witty, for example, hauled in $20.9 million in 2022 compensation, of which $16.4 million came from stock and stock option awards.

Those of us fighting for Medicare for All have much in common with every worker who is losing his or her job as a result of leveraged buyouts and stock buybacks.

A look at the pharmaceutical industry shows where all this is heading. Between 2012 and 2021, fourteen of the largest publicly traded pharmaceutical companies spent $747 billion on stock buybacks and dividends, more than the $660 billion they spent on research and development, according to a report by economists William Lazonick and Öner Tulum. Little wonder that drug prices are astronomically high in the U.S.

And so, the gravy train is loaded and rolling, delivering our tax dollars via Medicare Advantage reimbursements to companies like United Healthcare and Big Pharma, which pass it on to Wall Street private equity firms and hedge funds.

It’s Not Just Healthcare

In researching my book, Wall Street’s War on Workers, we found that private equity firms and hedge funds are undermining the working class through leveraged buyouts and stock buybacks. When private equity moves in, mass layoffs (just like healthcare staff cuts and shortages) almost always follow so that the companies can service their debt and private equity can extract profits. When hedge funds insist on stock repurchases, mass layoffs are used to free up cash in order to buy back their shares. As a result, between 1996 and today, we estimate that more than 30 million workers have gone through mass layoffs.

Meanwhile, stock buybacks have metastasized throughout the economy. In 1982, before deregulation, only about 2% of all corporate profits went to stock buybacks. Today, it is nearly 70%.

Those of us fighting for Medicare for All, therefore, have much in common with every worker who is losing his or her job as a result of leveraged buyouts and stock buybacks. Every fight to stop a mass layoff is a fight against the same Wall Street forces that are attacking Medicare and trying to privatize it. Creating a sane healthcare system, therefore, will depend on building a massive common movement to free our economy from Wall Street’s wealth extraction.

To take the wind out of Medicare Advantage and Wall Street’s rapacious sail through our healthcare system, we don’t need more studies. It’s time to outlaw leveraged buyouts and stock buybacks.