Medicare Disadvantage

While there has been a lot of attention paid to the ways in which George Bush’s changes to Medicare have benefited insurance companies, such as by not allowing negotiations over price, the benefits to insurance companies from Medicare Advantage plans has received less attention. Besides the political implications of the manner in which Bush has used his Medicare plans as a tremendous corporate welfare program to benefit his major contributors, there are aspects of the plan which health care consumers need to better understand. The Argus provided such warnings yesterday:

Targeted by aggressive marketers, some East Bay seniors are switching to Medicare Advantage plans they don’t fully understand, only to discover they can no longer see their longtime doctors and have severely limited their choice of specialists.

The plans are beneficial for some people. But consumer advocates advise seniors to proceed with caution and to seek free counseling before making a decision.

Limited choice of doctors? It is certainly ironic that the Republicans have devised a plan which suffers from one of the problems conservatives usually complain about in foreign plans.

While those who shop carefully might receive advantages, many do not as a consequence of dishonest marketing of Medicare Advantage plans. Private insurance companies receive twelve percent more to care for Medicare patients than those covered under the government’s Medicare program despite often cherry picking the healthier patients. So much for Republicans trusting the free market to provide services more economically. Rather than being used to provide benefits to beneficiaries as mandated by law, the money is largely used to increase corporate profits at the taxpayers’ expense. This provides considerable motivation to deceive seniors into joining the plans, with many plans paying salespeople a bounty for each person they sign up, without caring what they do to make the sale.

The New York Times reviewed the improper sales tactics used last spring, and last fall the Times reviewed audits reports on the Medicare Advantage plans. In an editorial last month they called on Congress “to eliminate the unjustified subsidies that give private plans a competitive advantage over traditional Medicare.” The editorial outlined some of the problems:

As Robert Pear reported in The Times last week, unscrupulous insurance agents have tricked people into dropping traditional Medicare coverage and enrolling instead in private plans that do not meet their needs. Agents typically receive $350 to $600 for each patient they enroll in a private plan. Some try to boost sales by pretending to be Medicare officials, forging signatures or hiding the fact that a patient’s doctor will not be part of the private plan. Others barge into homes and use high-pressure tactics to push poor, semiliterate people into a private plan.

The American Medical Association has also called for fiscal neutrality between Medicare Advantage and traditional Medicare. CBS News reported on the deceptive sales practices being used to sell the plans last summer. Barack Obama spoke out against the plans while campaigning in Iowa.

While anecdotal evidence might not be representative, I’ve found that the vast majority of patients enrolled in Medicare Advantage plans have no understanding of what they are signed up for. The Oklahoma insurance commissioner provides just one example of a state investigating and finding the same problems. The insurance commissioner found that many who thought they were signing up for simply a drug plan were being signed up by Humana into their Medicare Advantage plan.

Many patients have told me that salespeople tell them the plan is only a supplement to their regular Medicare. Sometimes salespeople bribe the residents of a senior citizen complex to attend a meeting with meals or other incentives, and then use hard sell tactics to get the bulk of them to sign up without understanding what they are signing. I’ve even seen patients enrolled in Medicare Advantage plans who do not recall ever signing anything. Possibly they did sign something, but who know what they were led to believe they were signing at the time.

As The Argus warns above, those who sign up in plans could find that their physician does not accept their plan. This month I had one patient have to postpone surgery until she could get out of a plan that wasn’t accepted. I’ve also seen a number of patients wind up with higher copays or a higher deductible than they had under Medicare. Sometimes the plans offer benefits not included in the usual Medicare program, but there could be a catch. I have one patient who signed up for a plan that includes dental coverage, but not a single local dentist accepts the plan. The plans are also a nuisance for physician offices when patients do not realize their plan has changed. Even Medicare does not realize when patients have switched for a while. Quite often I’ve seen letters from Medicare requesting money back which they paid on patients months earlier, but Medicare. the patient, and the physician were all unaware of this at the time.

Sometimes patients might benefit from Medicare Advantage plans if they have the opportunity to investigate their options and receive honest information as to what is covered. Those who benefit the most are generally those who choose to purchase higher priced plans as opposed to the plans people are typically placed into without their knowledge. Greater effort needs to be taken to weed out the deceptive sales tactics, and when Medicare is strapped for money their is no justification for paying these plans an extra twelve percent to care for patients.

(Cross posted at The Carpetbagger Report)

John Kerry Boosts Obama Campaign and Helps Debunk Clinton Attacks

While individual endorsements probably have minimal impact on primary races, the cumulative effect of several high profile endorsements might help Obama overcome one of the disadvantages typically faced by insurgent candidates going up against an establishment candidate who has an advantage in party support. Recently Obama has received endorsements from Gary Hart, Ned Lamont, Tim Johnson, George Miller, Janet Napolitano and Senators Ben Nelson and Claire McCaskill. Obama has even received the support of the woman who asked Hillary Clinton the question in New Hampshire which might have led to her comeback in the state. The New York Times reports that Congressman James E. Clyburn of South Carolina, the highest-ranking African-American in Congress, is considering an endorsement of Obama. Last week Obama had John Kerry come to South Carolina to appear at a campaign event after his endorsement. Kerry also appeared today on This Week to support Obama (video here).

Kerry’s endorsement is helping some voters overcome reservations about Obama’s youth and experience. The Washington Post noted this, including a comment from one voter:

“I’ve been on the fence between Hillary and Obama, but I just went over to him” she said. “I had this idea that he had to be more experienced, but what hit me is if you can bring people together like this, and inspire people, then you can make change from a fresh perspective. You just don’t see this in South Carolina.”

Kerry also discussed Obama’s experience on This Week, noting that Obama has more legislative experience than Clinton. Obama’s experience as a professor of Constitutional law and a community organizer are also of significance. Other topics discussed in posts this weekend came up during the interview, including the ability of candidates to respond to attacks and their pre-war positions on Iraq.

One reason I respect Kerry is that he is generally right, and when he is wrong he admits it learns from his mistakes. Nobody knows better than Kerry the dangers of inadequately responding to attacks, and he will certain advise any Democratic nominee to handle things differently than he did against the Swift Boat Liars. In Kerry’s defense it should be noted that many myths have been spread regarding the attacks, even among liberal bloggers who should know better. While Kerry didn’t respond as forcibly as he should have in retrospect, his campaign did rapidly respond to the attacks with the facts. Unfortunately, in this case, the facts were not enough.

Looking back we must remember that things looked different at the time from how they do in retrospect. The Swift Boat Liars made their claims both in the spring of 2004 and again in August. The spring attacks did no harm, perhaps leading Kerry’s campaign to underestimate their harm when they returned in August.

The old conventional wisdom, before the days of the internet and twenty-four hour cable news, was that responding to an attack often backfires by giving more coverage to the attack. Voters hearing the responses often wind up remembering the attack but not the defense. The Swift Boat Liars began with small ads which gradually increased in significance as they were picked up first by Fox, and then by legitimate news outlets. There was no single moment when it was clear at the time that the attacks were anything which would have a serious effect, making it more difficult to decide upon a response.

As Kerry noted today, his response was also limited by the campaign finance laws which left him with little money to spend in the period between the Democratic and Republican conventions. During this period Kerry was on a national tour to concentrate on his domestic policy proposals, and the campaign also felt that concentrating too much on responding to the attacks would have distracted from this. Obviously, in retrospect, they were wrong but their decisions were not totally absurd at the time.

Kerry also discussed how Clinton has taken Obama’s comments before the 2004 convention out of context to question his opposition to the war. Obama understandably toned down his criticism of voting for the Iraq War Resolution to avoid sounding critical of Kerry and Edwards. This might have been less necessary if people better understood Kerry’s actual position on the war and his reasons for voting for the IWR. While some didn’t say this until more recently, Kerry made it clear at the time of the vote that he was only voting yes based upon Bush’s claims that he would only go to war as a last resort. Kerry made his position clear in his Senate floor statement, and in articles published at the time in The New York Times and Foreign Affairs.


Obama Receives Additional Endorsements

The 2008 race is breaking the usual patterns. There have been races in the past where an insurgent candidate pulls an upset in Iowa but loses in New Hampshire. Typically the establishment candidate has money money and the advantages of the party machinery to ultimately beat the insurgent. While this year’s race is far more in doubt than immediately after Iowa, Obama is clearly not going to play the role of the typical insurgent and quickly disappear. Compared to past insurgency campaigns, Obama is better funded and is receiving endorsements which reduce Clinton’s advantages. He has received additional endorsements of significance from Arizona Gov. Janet Napolitano and Senators Ben Nelson and Claire McCaskill.

Ben Nelson endorsed Obama saying, “Barack Obama, to me represents the best hope for our own political reconciliation and a future where the cogs of government are working smoothly for progress instead of being gummed up by partisanship.”

The St. Louis Post-Dispatch reports that Claire McCaskill endorsed Obama saying “only once in a generation” does a politician come along with Obama’s “particular gift” and argued that it would be “a terrible disappointment” if the country didn’t seize this moment. They also note that “McCaskill could help Obama win over women voters, a pivotal constituency in his contest with Clinton as she vies to become the nation’s first female president.”

Janet Napolitano endorsed Obama saying:

“This election is fundamentally about change,” she told Arizona reporters after the conference call. “It’s about a new vision in Washington, D.C. It’s about bringing people of different areas of the country together, it’s about bringing people of different parties together, people of different ages together. To me, Sen. Obama is evidence of that change that we need.”

The New York Times also reports that Congressman James E. Clyburn of South Carolina, the highest-ranking African-American in Congress, is considering an endorsement of Obama.

Josh Marshall noted the significance of these and other recent endorsements:

But that isn’t the biggest significance. The key is timing. You don’t hit a big time politician like Hillary Clinton when she’s down unless you’re really against her and you’re fairly confident she’s not getting back up. After winning in New Hampshire, albeit narrowly and after the clobbering in Iowa, there’s been a sense that Clinton may be back on track to consolidating her frontrunner status and perhaps following a modified version of the standard script in which the anointed frontrunner gets a scare in the early states before mopping up the competition as the race goes national. But these four clearly don’t want that to happen. In fact, they’re sticking their necks pretty far out to help make it not happen. And their endorsements, coming right now, tell me they have some confidence it won’t .

Teaching of Evolution Remains Under Attack

Despite the high profile victory for keeping creationism out of science classes in the Dover case, there are ongoing battles around the country to defend science. South Carolinians for Science Education reports on one victory as the State Board of Education reversed a December vote which would have led to dropping the use of a text teaching evolution. However the news isn’t as good in Florida where a former St. Petersburg City Council member and candidate for Mayor has repeated Tom DeLay’s theory linking the teaching of evolution to the Columbine shootings.

There is also controversy on a state wide level in Florida, where the word evolution is not used in science classes. One biology teacher defended the teaching of evolution explaining, “It’s very hard to teach good biological science without mentioning evolution. It’s one of the basic underpinnings of modern biological science.” He should explain this to Florida Governor Charlie Crist who, like many conservatives, confuses the scientific meaning of theory with its use in common language. Crist is quoted as saying:

I think the way it’s been handled historically in Florida is probably appropriate. It’s been introduced and discussed in terms of being a theory. I don’t know if there’s a need for a change in that. But I’ll leave the decision to the board.

I’ve frequently seen accounts of teachers having difficulty with teaching evolution regardless of the law due to pressure from religious groups. A teacher described these problems in an op-ed in FortBendNow:

I taught sixth grade in Texas for three years 2001-2004. During that time, I was absolutely warned to not begin to say the word “evolution” or we would have every preacher in the district, as well as the media, breathing down our necks, and then there would truly be no teaching or learning. Sadly, I needed the position, so I played the “hide the issue and hide the learning” game.

Every time I tell this story, usually at a dinner party, people look at me like I am reliving some ancient past. I remind them that this policy ruled only two years ago – and in their progressive community. Like many issues that are easier to disbelieve than to address, people inevitably choose disbelief.

It is more difficult for me to choose disbelief, but over time, even I can begin to question my experience. So several weeks ago, I decided to test the continued use of this policy. I interviewed with a high school in Fort Bend and asked if I could use current events in the English classroom to explore why real evolution education is often an inoculation against racism and eugenic posturing. The interviewer quickly replied, “We do not challenge the sensitive “beliefs” of our student community.”

These problems have extended beyond the public schools as last fall I reported on a community college instructor who was fired for calling the story of Adam and Eve a “fairy tale.” Even Bill Nye, the Science Guy has come under attack by the religious right for being an “evolution huckster.”

Several organizations involved in the teaching of science in the United States and Europe have issued statements favoring the teaching of evolution and not creationism in the schools. These include the Association for Science Education, the California Academy of Sciences, the UK government (whose statement explains the scientific meaning of theory), and the Council on Europe.

We also must not forget that two Republican candidates still in the race, Mike Huckabee and Ron Paul, both deny evolution. Mike Huckabee has advocated teaching intelligent design in the schools, while Ron Paul simply does not believe in public schools. A panel of scientists recently warned how we are “doomed” should Huckabee be elected.

For those interested in reading more about evolution, an updated version of Science, Education, and Creationism, a book from the National Academy of Sciences, is available for free download in pdf format here.

(Cross posted at The Carpetbagger Report)

Update: There is tremendous amount of material available on line regarding evolution which debunks the nonsense promoted by supporters of intelligent design/creationism. On of the people commenting at The Carpetbagger Report pointed out yet one more excellent article from Stephen Jay Gould on Evolution as Fact and Theory.

Bill Clinton’s Own Fairy Tales on Obama’s Views on Iraq

Some of the posts on Saturday dealt with the inevitable attacks which the Democratic candidate will face and whether they will be prepared to respond. There was an example of a response to an attack from the Obama camp on Saturday night as Dick Durbin defended Obama against recent attacks from Bill Clinton.Bill Clinton has stated that Obama’s claims of opposing the war from the start were a fairy tale. The Politico reports on a call received from Durbin disputing this and defending Obama:

“I’m really troubled by his questioning the sincerity of Barack Obama’s opposition to the war in Iraq,” Durbin said. “I really think it is unfortunate to question Barack’s sincerity on the war. He has been there from the start, opposing this war.”

The unsolicited comments — in a phone call to Politico from Springfield, Ill. — were a sign that the Obama campaign is going to react aggressively to perceived attacks on the senator’s character…

Durbin suggested that the former president has been giving somewhat revisionist accounts on the way the Iraq war debate played out.

“It was not easy to be against that war back when we cast that vote in October of 2002,” Durbin said. “I was one of 23 who voted against the war. Barack was supportive — one of the few candidates speaking out strongly against it in Illinois.

“If President Clinton had opposed that war as strongly as Barack Obama at the time, it would have helped a lot of us who had voted against authorizing an invasion.”

Obama made his views on Iraq clear in a speech on October 2, 2002:

I don’t oppose all wars. What I am opposed to is a dumb war. What I am opposed to is a rash war. What I am opposed to is the cynical attempt by Richard Perle and Paul Wolfowitz and other armchair, weekend warriors in this administration to shove their own ideological agendas down our throats, irrespective of the costs in lives lost and in hardships borne.

What I am opposed to is the attempt by political hacks like Karl Rove to distract us from a rise in the uninsured, a rise in the poverty rate, a drop in the median income, to distract us from corporate scandals and a stock market that has just gone through the worst month since the Great Depression.

That’s what I’m opposed to. A dumb war. A rash war. A war based not on reason but on passion, not on principle but on politics.

Clinton based his attacks on Obama on statements in which Obama avoided criticism of Kerry and Edwards for their votes in favor of the Iraq War Resolution before the 2004 convention, but Obama never wavered in his opposition to going to war. Bill Clinton made similar claims last March which were debunked by The New York Times:

In 2002, in the weeks before and after the Senate voted on the war resolution, Mr. Obama, then a state senator, took a strong antiwar line, popular in his liberal Chicago district, and repeatedly said President Bush ”has not made his case for going into Iraq.”

Bill Sargent at TPM Election Central also reviewed the statements by Obama that Bill Clinton took out of context to make his claims and concluded:

It’s perfectly clear that Obama was in fact against the war at the time. His position then — as now — was that the case for war had not been made and that the invasion wasn’t justified.

Bill Clinton has not only been telling fairy tales of his own with regards to Obama’s position on the war, but has also told fairy tales about his own views. In November The Washington Post questioned Clinton’s claims that he had “opposed Iraq from the beginning.” Hillary Clinton’s record isn’t very good either. Last month Foreign Policy in Focus reviewed her views on the war dating back to the pre-war days, which show a stark contrast from the anti-war views expressed by Obama above. Reviewing Hillary’s record shows why Bill Clinton might want to revise history, but his fairy tales do not change the past.

(Cross posted from The Carpetbagger Report)