UNNEEDED ADVANTAGE

One of President Bush’s reasons for threatening to veto the expansion of the State Children’s Health Insurance Program, known as SCHIP, is that it would be financed partly by a cutback in something called “Medicare Advantage.”

If you don’t know about Medicare Advantage, that’s no surprise. It is popular in California, Florida, New York, Ohio and Pennsylvania, where more than 30 percent of Medicare beneficiaries have signed up for it. But in Maine, New Hampshire and Vermont, fewer than 3 percent belong, and some doctors have never heard of it.

Medicare Advantage, heavily promoted by the Bush administration as an alternative to “socialized medicine,” is a program that pays various private health plans to provide service less available under ordinary Medicare. Critics see it as an administration wedge intended to privatize Medicare, which now serves 44 million elderly and disabled people. About 8.7 million of them, 20 percent, get expanded Medicare benefits through these private plans.

Mainers are well off to avoid these Medicare Advantage plans, as shown by a chorus of criticism and condemnation. The American Medical Association reported in May that its survey “paints a bleak picture of physicians’ experience with Medicare Advantage plans.” More than half of the physicians surveyed said their patients had been denied coverage of services covered by the traditional, government run, Medicare plan. Eighty-four percent said their patients couldn’t understand how the private plans worked.

AMA’s board chairman, Dr. Cecil Wilson, said: “The private health plans were supposed to inject competition into the Medicare program, but instead we’ve ended up with a federal handout to the insurance industry.” He quoted government figures to show that eliminating overpayments to insurance companies will save Medicare $65 million over five years.

The Kaiser Family Foundation, which reports regularly on health programs, raised a fairness issue in June, questioning whether the mixed private-public Medicare system “distributes extra benefits equitably across the Medicare population.” It says the current payment system increases Medicare expenditures over the long run, cuts short the life of the Part A trust fund by two years, and increases Part B premiums by $2 per person per month.

The U.S. Government Accountability Office, in a blistering report last month, complained about the administration of the private plans by the U.S. Centers for Medicare and Medicaid Services. It said CMS had been slow to conduct required audits and had failed to pursue financial recoveries based on audit results. It disputed officials’ excuse that they lacked necessary authority to recover misspent funds.

Just this month, the Johns Hopkins University School of Medicine said it was “proceeding very cautiously with Medicare Advantage plans” because reimbursements are too low, it is costly to administer, it is little used, and its “longevity is in question.”

So whatever else may be said about the pending SCHIP bills and the threatened Bush veto, there should be no objection to cutting back funding for Medicare Advantage. It is a misconceived and mismanaged program that needs fixing or total abandonment.