IN THIS EPISODE
What does it mean to “privatize” Medicare? What’s ACO-Reach? Why does it matter? Who’s for it, who’s against it, and why? Join host Brenda Gazzar and Ed Weisbart, MD, a retired family physician, former chief medical officer of Express Scripts and a national board member of Physicians for a National Health Program to get the low-down. Dr. Weisbart shines a revealing light on an issue that will impact the healthcare experience of almost every American aged 65 or older – the ongoing effort to give away Medicare to private, for-profit investors. Should health care be “just another way” for investors and shareholders to make money? Is a for-profit Fire Department just around the corner?
SHOW NOTES
WE DISCUSS
Could you briefly describe this latest threat to traditional Medicare?
In 2020, the Trump administration launched a new experiment to privatize traditional Medicare, turning everybody who is in traditional Medicare today over to a new entity that is invested in by Wall Street – run by the for-profit (healthcare) industry and…most able to make money by reducing how much care, how much people get. – Ed Weisbart, MD
How many Medicare beneficiaries will be affected?
“Medicare has announced that they plan to have 100% of people pulled out of traditional Medicare and pushed into one of these new programs by the year 2030. Technically, they’re still in traditional Medicare and can still go to any doctor that accepts traditional Medicare, but realistically, there’s now a for-profit entity that’s now focused on making profits rather than maximizing your health. I don’t want that involved in my health care.” – Ed Weisbart, MD
How would privatization impact Medicare costs and patient care?
“…traditional Medicare spends 98% out of 100% of the money they get…on health care and not on overhead or profit. The insurance industry spends more like 85% and keeps 15% for overhead and profit [from Medicare Advantage plans]. Whereas these new organizations [ACO Reach]…are allowed to spend as little as 60% on health care and keep 40% for overhead and profits. – Ed Weisbart, MD
What can we the people do about this?
“First is, learn more. There’s a lot of good high-level and in-depth information, if you go to our organization, Physicians for a National Health Program or pnhp.org.
…The second thing is, when you go there, sign the petition…Ask any organization you’re part of to sign the organizational petition, which is also on the website.
…Then the third thing is, call your member of Congress and just tell them, ‘Hey, I want you to know I’ve learned about the Reach program. I’ve heard about your trying to privatize Medicare. I’ve heard about these DCEs and I want you to stop it. I want you to become a Medicare protector, not a Medicare assaulter… and I’ll know if you do that and I’ll vote against you if you do that.” – Ed Weisbart, MD
Helpful Links
DCE’s: Handing Traditional Medicare to Wall Street, Physicians for a National Health Program
Medicare Direct Contracting: A Threat to Seniors and to Medicare’s Future Oral Testimony to the U.S. Senate by Dr. Susan Rogers, President, Physicians for a National Health Program
CMS redesigns controversial Medicare direct contracting model, Healthcare Dive
CMS Dumps DCEs … In Name Only, James G. Kahn, MD, MPH, Health Justice Monitor
House progressives push for CMS to end newly rebranded ACO REACH model, Fierce Healthcare
Episode Transcript
Read the full episode transcript.
Guest Biography
Ed Weisbart, MD, is a national board member of Physicians for a National Health Program and health policy advisor for Code WACK! He practiced family medicine for 20 years at Rush Medical Center in Chicago and spent seven years as chief medical officer of Express Scripts until retiring in 2010 to devote his time to advocating for healthcare justice. He is an author and popular speaker about single-payer health care, the ongoing attacks on today’s Medicare program, and how to find common ground across political chasms.
Get Involved / Take Action
Join Physicians for a National Health Program (PNHP) to support a national campaign to improve and expand Improved Medicare to all U.S. residents.
Subscribe to HEAL California for health policy news with a California focus
Join Healthy California Now – a coalition working toward a California single-payer system. Individual and organizational memberships available.
Join Health Care for All California to keep up with local actions to support California single-payer health care.
Find more Code WACK! episodes on ProgressiveVoices.com, on the PV App and on NurseTalk Media. You can also subscribe to Code WACK! wherever you find your podcasts. This podcast is powered by HEAL California, uplifting the voices of those fighting for health care reform around the country. I’m Brenda Gazzar.
_________________________________________________________________________________
HEAL California is an independent news and information hub focused on the Medicare for All movement.
With non-partisan news, views, podcasts and videos, we highlight the on-going injustices of our broken healthcare system and amplify the voices of those who are most impacted by it.
Our Podcasts shine a light on the failures of America’s healthcare system, while explaining how Medicare for All could help.
Our Media page offers connections to experts and additional resources including links to legislation and studies.
Keep up with the Medicare for All movement!
Follow us on Facebook, Twitter, and Instagram. Subscribe for email updates.
I have traditional Medicare and I recently received notice from the group my doctor belongs to, Health Partners located in Minnesota, tilted REQUIRED ANNUAL NOTICE: NO ACTION NEEDED. I first thought this is no big deal a required annual notice no action needed…. I continued to read on and it said my doctor
is now part of the HealthPartners ACO a Direct Contracting Entity!!!
Then in bold lettering– “Your Medicare benefits have not changed. The doctor, nurse practitioner, or physician’s assistant that you usually see has asked us to help see that you get the right care at the right time. You are not enrolled in any type of plan. You still have the freedom of choice to go to any doctor, hospital, or other healthcare provider of your choice that accepts Medicare.” The letter continued on with more sweet talk.
I already knew about DCE’s and did not want to be in one!! When I called the person who was handling the DCE part of Health Partners, she said there are 40,000 traditional medicare beneficiaries with Health Partners. I assume most of them will be switched over to the DCE plan. I told her I did not want to be connected to a DCE as I don’t want a third party between my doctor and myself and I am looking for a new PCP. Then she said the DCE will be ending Dec. 2022 and added that a new program, ACO REACH, will be starting in 2023. She said it in a way that if I didn’t like DCE, maybe I would like ACO REACH…..
When I told her what I knew about DCE’s, she said you have really done your research. Unfortunately the majority of people will see REQUIRED ANNUAL NOTICE: NO ACTION NEEDED and not question the changes.
I don’t think Health Partners DCE has a connection to Wall Street but it’s the idea that some one else may have a say in my health care besides my doctor. The money Medicare pays for beneficiary care should not go to for profit entities whether it’s Wall Street or Provider controlled.
Thank you for all the work you do to get the word out about DCEs and ACO REACH. These plans manage not to care for medicare beneficiaries and reach in taxpayers’ pockets to line their own pockets.
Thanks so much for writing, Catherine, and for sharing your clear-sighted perspective on the attempted takeover of traditional Medicare, an effective, life-saving public health insurance program! Keep us up with your story. I fear that it’s only a matter of time before all physicians are sucked into these arrangement that benefit no one except private equity shareholders and CEOs.