CBS News Exposes Medicare Advantage Plans

I’ve posted many times on the problems of the Medicare Advantage plans, as recently as this morning. CBS News is doing an investigative report on these plans. Medicare Advantage plans are private plans which treat Medicare patients, but receive more money per patient than is spent by the government’s Medicare program. Among other findings, CBS News found that more money is going to the insurance companies than is required by law:

But how much of that money is going back into the pockets of the insurance companies?

“Well, it’s required by law: 25 percent goes back to the federal treasury, 75 percent goes back to the beneficiary,” Norwalk said.

So the insurance companies are doing this, what, out of the kindness of their hearts, asked Keteyian?

“There, there would be, I’m sure, some small amount to administer the additional benefits,” Norwalk said.

But CBS News has found that’s not always the case. An independent report found when it comes to the fastest-growing plans, known as private fee-for-service, half of that extra money goes back to the insurance companies. All these private Medicare plans are expected to cost taxpayers an additional $54 billion over the next five years.

“Taxpayers are losing; people in Medicare are losing,” Hayes said. “And the structure of Medicare as a national treasure that we need to rely on moving forward, is being undermined.”

So much so that key Congressional Democrats now want to cut payments to private plans. The insurance industry is fighting back with a direct mail campaign urging seniors to contact their representatives.

Ron Paul and Military Contributions

We’ve heard that Ron Paul has been beating expectations with regards to fund raising, but what type of person is contributing to him? It looks like active duty military personel and veterans are contributing heavily to him–more than the other Republican candidates combined. Maybe they all aren’t so fond of the war after all.

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Bill Richardson Predicted to Win Iowa Caucus

It must be a sign of dissatisfaction with the major candidates that Bill Richardson seems to be getting most of the favorable news and comments the last couple of days beyond Joseph Wilson’s endorsement of Hillary Clinton. Yesterday I reported that Polls Suggest Richardson May Replace Edwards As Number Three in Race as well as Richardson receiving key endorsements in Utah and favorable press in South Carolina and New Hampshire. USA Election Polls goes further out on a limb in predicting that Richardson will win the Iowa caucus.

We are going to go out on a limb six months in advance of the Iowa Caucus to predict that Bill Richardson will win the state of Iowa in this election cycle.

Bill Richardson was at 1.0% in both Iowa and New Hampshire six months ago. Now he is hovering around double digits…

Richardson has been able to make consistent gains in Iowa. A Fairbank Maslin Maullin and Associates poll showed that Bill Richardson had 18% support among the most likely voters in Iowa, 13% among all likely voters. Their determination of who is the most likely voter is unknown to us but was some fraction of all likely voters. With 18%, he edged Barack Obama by 2%…

Before the Iowa Caucus in 2004, it was generally believed that Howard Dean and Dick Gephardt were the front runners. But they came in third and fourth in the state respectively. John Kerry and John Edwards were voted in #1 and #2. Iowa voters do not look to the polls to help them to determine who to vote for. They vote based on the issues and the candidates themselves.

Needless to say, such an upset would probably knock Edwards out of the race, and position Richardson as a front runner going into the subsequent contests.

Richardson’s major problem so far has been mediocre performances in the debates and televised interviews, but supporters feel this is a skill he can improve upon. In the short run Richardson might have benefited by the fact that few were paying attention to him, but ultimately he will need more coverage to succeed. In addition to the recent coverage I noted above, he is discussed both at Swampland and The Fix today. Chris Cillizza writes:

With the focus on the “top tier” New Mexico Gov. Bill Richardson may be overlooked. But Richardson is as well-positioned financially as he could possibly have hoped for when he announced his candidacy for president earlier this year.

Between April 1 and June 30, Richardson raised $7.1 million, bringing his year-to-date fundraising total to more than $13 million. Richardson, like Obama, raised more money in the second quarter of the year than in the first…

Seeking to show that the ads, the first flight of which we raved about earlier this year, have worked, Richardson’s campaign released a poll of the “likeliest” of Iowa caucus-goers that showed Edwards leading with 31 percent followed by Clinton at 23 percent, Richardson at 18 percent and Obama at 16 percent. (Among “likely” caucus goers in the Richardson poll, Edwards led with 31 percent followed by Clinton at 24 percent, Obama at 17 percent and Richardson at 13 percent.)

A collection of other independent polling in Iowa seems to show a positive trend line for Richardson, although the independent polls are not as rosy as the governor’s own surveys.

Organizationally, Richardson is in surprisingly good shape in Iowa. He has 11 field offices in the state just one less than Clinton and four fewer than Edwards. (Obama has a whopping 28 field offices.) And, according to’s “Campaign Tracker” — bookmark it if you haven’t already done so — Richardson has done 25 events in the Hawkeye State since the start of the year.

Expect Richardson to attempt to gain more traction in the coming weeks with his plan to remove all American troops from Iraq by the end of this year. That agressive position is sure to play well with Democratic base both nationally and in Iowa, where anti-war sentiment runs high…

Richardson continues to build the kind of candidacy — both financially and organizationally — that will allow him to be a serious presence in the first four caucus and primary states. He remains far behind Clinton and Obama in fundraising and there seems little reason to expect that he will be able to compete with those two candidates when it comes to money.

But, Richardson is doing everything he needs to do to ensure that if the race takes an unforeseen turn, be it a stumble by a frontrunner or some other unpredictable event, he is in position to take advantage of it.

Clinton and Obama have been receiving the most coverage–just like Howard Dean received most of the coverage in 2003. It certainly is possible that, once again, voters in Iowa and New Hampshire will ignore what the media is saying and make completely different decisions.

Gritting Teeth and Removing W-Stickers


I think that Peggy Noonan might have started a new trend among conservatives with her op-ed in Friday’s Wall Street Journal. Noonan helped make what was once “Bush Derangement Syndrome” acceptable conservative thought. Noonan wrote of Republicans removing W-stickers from their car, and now the idea has hit You Tube per the above video. (Hat tip to National Review, where apparently W-sticker removal is also in vogue.) Noonan wrote:

It’s been a slow week in a hot era. I found myself Thursday watching President Bush’s news conference and thinking about what it is about him, real or perceived, that makes people who used to smile at the mention of his name now grit their teeth. I mean what it is apart from the huge and obvious issues on which they might disagree with him.

I’m not referring to what used to be called Bush Derangement Syndrome. That phrase suggested that to passionately dislike the president was to be somewhat unhinged. No one thinks that anymore. I received an email before the news conference from as rock-ribbed a Republican as you can find, a Georgia woman (middle-aged, entrepreneurial) who’d previously supported him. She said she’d had it. “I don’t believe a word that comes out of his mouth.” I was startled by her vehemence only because she is, as I said, rock-ribbed. Her email reminded me of another, one a friend received some months ago: “I took the W off my car today,” it said on the subject line. It sounded like a country western song, like a great lament.

As I watched the news conference, it occurred to me that one of the things that might leave people feeling somewhat disoriented is the president’s seemingly effortless high spirits. He’s in a good mood. There was the usual teasing, the partly aggressive, partly joshing humor, the certitude. He doesn’t seem to be suffering, which is jarring. Presidents in great enterprises that are going badly suffer: Lincoln, LBJ with his head in his hands. Why doesn’t Mr. Bush? Every major domestic initiative of his second term has been ill thought through and ended in failure. His Iraq leadership has failed. His standing is lower than any previous president’s since polling began. He’s in a good mood. Discuss.

Is it defiance? Denial? Is it that he’s right and you’re wrong, which is your problem? Is he faking a certain steely good cheer to show his foes from Washington to Baghdad that the American president is neither beaten nor bowed? Fair enough: Presidents can’t sit around and moan. But it doesn’t look like an act. People would feel better to know his lack of success sometimes gets to him. It gets to them.

His stock answer is that of course he feels the sadness of the families who’ve lost someone in Iraq. And of course he must. Beyond that his good humor seems to me disorienting, and strange.

After writing more about Bush, Noonan concludes, “Americans can’t fire the president right now, so they’re waiting it out. They can tell a pollster how they feel, and they do, and they can tell friends, and they do that too. They also watch the news conference, and grit their teeth a bit.”

They grit their teeth, and remove the W stickers. As for me, the No-W sticker will remain on my car until he’s out of office.

The Onion Shows Why Edwards is Not Catching on With Voters

I could write endlessly as to why John Edwards’s message will not resonate with most voters but this is unnecessary for those who see this, and I doubt I could satisfactorily explain it for those who don’t. As Bill Clinton said, the era of big government is over. A majority of Americans will back increased government involvement at times, such as in providing affordable health care due to the failure of private systems, but for the most part they are more sympathetic to the unkept promises of Ronald Reagan and his successors to get government off our backs. Democrats lost repeated presidential races, as well as control of Congress, by failing to understand this. John Edwards, perhaps demonstrating that Robert Shrum was right in characterizing him as a lightweight, or as “a Clinton who hadn’t read the books,” has fallen back on tired campaign strategies of promising everything to everybody.

Sometimes satire does the best job of making an idea clear. The Onion does a superb job of capturing the flaws in the Edwards campaign when they “report” that Edwards Vows To End All Bad Things by 2011. In their satiric account, Edwards contrasts himself on bad things, similar to his failed to attempts to distinguish himself from the other candidates on Iraq, by arguing, “Other candidates have plans that would reduce some of the bad things, but I want all of them gone completely.” They claim Edwards has laid out a three step plan:

According to Edwards, his plan is composed of three steps. Everyday bad things, such as curse words and splinters, would be eradicated during his first six months in office. Next, very bad things, including child abduction, soil erosion, and resurgent diseases such as malaria and tuberculosis, would be ended by the the end of 2009. Finally, extremely bad things—plights such as genocide, species extinction, and virtually every form of cancer—would take a full two years to wipe out.

“Racism will soon be a thing of the past,” Edwards said. “Same goes for being picked last for playground athletics, AIDS, robbery, not having enough spending money, and murder. Because these things are bad and not good, I promise they will be eliminated.”

Other bad things the 2004 vice-presidential nominee vowed to end include the housing crisis, skinned knees, frowns, steep staircases, jailbreaks, water that is too cold to swim in, pain, traffic, being tired in the morning, sprained ankles, hunger, not having enough energy at night, teen pregnancy, cases of the blahs, thunder, the high cost of admission to events, type 2 diabetes, games of tic-tac-toe with no clear winner, the lack of parking in urban areas, forgetting birthdays, child prostitution, and confusion.

“Imagine a world free of procrastination, class disparity, and itchiness,” Edwards said. “It will only be possible if we try.”

The article also satirizes Daily Kos and Rudy Giuliani in reporting on their fictitious responses.

AMA Calls For End of Government Subsidies To Insurance Industry in Bush’s Medicare Plan

The funding provided in George Bush’s Medicare D plan for Medicare Advantage plans is an example of corporate welfare which does not benefit patient care. Under the program, insurance companies are provided more money than it costs to care for patients under the government’s Medicare program, despite the insurance companies cherry picking healthier patients. The American Medical Association has repeated their call to eliminate the additional funding provided to this program:

The American Medical Association renewed its call for fiscal neutrality between Medicare Advantage and traditional Medicare, pointing out the gross inequity in payments between the two Medicare programs.

“Right now the government is paying health insurance plans that administer Medicare Advantage, on average, 12 percent more per person than it spends on patients enrolled in traditional Medicare,” said AMA Board Member Cecil Wilson, MD. “With Medicare payments to doctors who care for seniors slated for a 10 percent cut next year, Congress must put the money used to subsidize the insurance industry to better use.”

At the AMA’s Annual Meeting late last month, America’s physicians sent a resounding message to Congress – eliminate the Medicare Advantage subsidy. AMA policy clearly states that subsidies to private plans offering alternative coverage to Medicare beneficiaries should be eliminated, and that these private Medicare plans should compete with the regular Medicare program on a fiscally neutral basis.

The financial motivation provided to the insurance companies also results in fraudulent sales tactics. I frequently see patients who have been signed up for these programs with no understanding of what they have signed. Often they say that they were only told that signing would result in lower health care costs, when in reality many of these plans carry copays which are higher than the governemnt’s Medicare copay. I’ve previously reported on investigations of fraudulent sales tactics in Oklahoma, and hope they are extended to additional states. While far less attention has been paid to the Medicare Advantage plans than other aspects of health care policy, Barack Obama did speak out against the plans in May.

Richardson Receives Key Endorsements in Utah

I’ve recently mentioned the improvements in the polls, fund raising, and favorable media coverage in New Hampshire and South Carolina as reasons that Bill Richardson may be on the verge of replacing John Edwards as the third place contender for the Democratic nomination. He’s also picked up another valuable endorsement in one of the early primary states. The Salt Lake Tribune reports:

Democratic presidential candidate Bill Richardson swooped into Utah on Friday to scoop up cash and endorsements from Mayors Rocky Anderson and Peter Corroon…

Utah has joined with New Mexico and Arizona to hold the Western States Primary on Feb. 5.

Earlier Friday, Anderson and Corroon, mayors of Salt Lake City and Salt Lake County, held a news conference to endorse Richardson.

Richardson’s experience as a congressman, United Nations ambassador and Energy secretary under President Clinton gives him the experience needed to deal with the nation’s problems, Corroon said. “These are serious times that need serious leadership.”

“He is a man who believes in diplomacy,” Anderson said. “We wouldn’t be in the midst of this debacle in Iraq if we had President Bill Richardson.”

Former Utah Rep. Bill Orton agreed that Richardson’s knack for diplomacy, which included negotiating hostage releases in North Korea, Sudan and Iraq, is needed. “Our country is in desperate need of someone to take us forward and improve our status worldwide.”

Anderson is known as a firery liberal who has backed the impeachment of George Bush.

While Clinton and Obama are holding steady, Edwards has been collapsing, and the other second tier candidates are going nowhere, Richardson is currently showing the most momentum. It remains to be seen whether this will be enough to be competitive with Clinton and Obama.

Paul Krugman on Delays in Health Care

Paul Krugman discussed health care, starting with a statement which is surprising in its stupidity, even coming from George Bush:

Being without health insurance is no big deal. Just ask President Bush. “I mean, people have access to health care in America,” he said last week. “After all, you just go to an emergency room.”

Sure, anyone can go to an Emergency Room and they will receive treatment–for emergencies. They will not receive treatment for chronic medical problems or preventative care. They will also wind up with a big bill for using an ER. Use of Emergency Rooms for primary care services is also not very cost effective. Krugman continues:

This is what you might call callousness with consequences. The White House has announced that Mr. Bush will veto a bipartisan plan that would extend health insurance, and with it such essentials as regular checkups and preventive medical care, to an estimated 4.1 million currently uninsured children. After all, it’s not as if those kids really need insurance — they can just go to emergency rooms, right?

O.K., it’s not news that Mr. Bush has no empathy for people less fortunate than himself. But his willful ignorance here is part of a larger picture: by and large, opponents of universal health care paint a glowing portrait of the American system that bears as little resemblance to reality as the scare stories they tell about health care in France, Britain, and Canada.

The claim that the uninsured can get all the care they need in emergency rooms is just the beginning. Beyond that is the myth that Americans who are lucky enough to have insurance never face long waits for medical care.

Actually, the persistence of that myth puzzles me. I can understand how people like Mr. Bush or Fred Thompson, who declared recently that “the poorest Americans are getting far better service” than Canadians or the British, can wave away the desperation of uninsured Americans, who are often poor and voiceless. But how can they get away with pretending that insured Americans always get prompt care, when most of us can testify otherwise?

A recent article in Business Week put it bluntly: “In reality, both data and anecdotes show that the American people are already waiting as long or longer than patients living with universal health-care systems.”

Krugman debunks many of the claims about delays in health care coming from opponents of universal health care. He finds delays under both systems, but there are differences. “In Canada and Britain, delays are caused by doctors trying to devote limited medical resources to the most urgent cases. In the United States, they’re often caused by insurance companies trying to save money.” Krugman concludes with the frequently heard claims about hip replacements:

On the other hand, it’s true that Americans get hip replacements faster than Canadians. But there’s a funny thing about that example, which is used constantly as an argument for the superiority of private health insurance over a government-run system: the large majority of hip replacements in the United States are paid for by, um, Medicare.

That’s right: the hip-replacement gap is actually a comparison of two government health insurance systems. American Medicare has shorter waits than Canadian Medicare (yes, that’s what they call their system) because it has more lavish funding — end of story. The alleged virtues of private insurance have nothing to do with it.

The bottom line is that the opponents of universal health care appear to have run out of honest arguments. All they have left are fantasies: horror fiction about health care in other countries, and fairy tales about health care here in America.