Kay Tillow on the Downside of Medicare Advantage and the Upside of Single Payer

Almost 40 percent of all Medicare beneficiaries are now on private Medicare Advantage plans.

“It is true that a person may be able to lower monthly costs by enrolling in one of these plans,” Kay Tillow wrote last year in an article titled Beyond the Medicare Advantage Scam.

“That’s a powerful incentive in a time when the majority of seniors live on tight budgets, many just an inch from disaster.”

“The laws and regulations allow these insurance companies to lure seniors away from traditional Medicare, and members of Congress of both parties should be held responsible.”

“You may be okay for a time and save money monthly – as long as you don’t get sick.  Once you need to use the plan, you will discover the problems that come from being in a for-profit plan that makes more when it denies you care. Your choice of physicians will be restricted to a list. The specialist you need may not be anywhere near where you live.  The hospitals and rehabs centers will be limited. The post-hospitalization facility available to you is likely to be the one with the worst reputation. The drugs you need may now cost a fortune.”

Tillow points out that if the patient tries to escape these exorbitant costs by returning to traditional Medicare and a prescription plan, the patient will need a supplemental Medigap plan to handle the twenty percent in copays and deductibles.

But the patient now has a pre-existing condition. When seniors first sign up for a Medicare plan, they are protected by law against discrimination for pre-existing conditions in the purchase of a Medigap plan. But when a person tries to change back to traditional Medicare later, that protection is gone. Only four states have regulations to prohibit such practices.

Tillow is a labor and single payer organizer based in Louisville, Kentucky.

“Medicare Advantage plans are run by private for profit insurers,” Tillow told Corporate Crime Reporter in an interview last week. “And profits within the health care system work against patients. When you deny care, profits go up. We have the fox in the hen house. Those who are against the patients control how the patients are treated. They are very sharp at setting up systems. There are people who have lower monthly premiums because they are in Medicare Advantage. But what they will find is once they get sick that advantage goes away because the barriers go up to the care they need. They can’t see the doctor they need or get to the hospital that they need. Those things work against the patient’s care.”

“Patients then find themselves in a plan that doesn’t work for them and they go back to traditional Medicare. That’s how the private insurers want it. When you are in good health and we can just profit from you and don’t have to pay out for your care, we want you. But we want you to have incentives to leave once you get sick. That’s the way it works. We the public pay about $1,000 annually per person more for everybody in Medicare Advantage. And yet the patients in Medicare Advantage are the healthiest patients. We should be paying less for them.”

“You can’t regulate enough around these foxes. We just have to get them out of the house because they are going to eat the chickens as long as they are in there.”

Congresswoman Pramila Jayapal told The Intercept in January that her single payer bill would be introduced probably in the first week of February. It was not and still has not been introduced. Do you sense that the leaders of single payer in the House and Senate are not being aggressive enough?

“That’s definitely true,” Tillow said. “There is no question about it. We now have a lot of people who say they are for Medicare for All. And if you dig underneath, you find they are for lots of other steps between now and then. We have to change that idea that this is not urgent, that somehow we can do other things.”

“Many people say – I’m for Medicare for All, but that may be years down the road – so in the meantime let’s do the public option. The public option won’t help because it maintains the private insurance industry within the system. It doesn’t make it better and it deflects the pressure of the movement to get change. We are offered change. We are going to wait for the ACA to take effect over ten years and you are going to be really happy.”

“What we saw was the Democrats lost their majority and the ACA did not gain in popularity. For a long time, it was under fifty percent. And it is probably just barely above that now. It doesn’t fix the problem. It doesn’t cover everybody. It is unjust and unfair. Some people get subsidies, some people don’t. Some people get Medicaid, some people don’t. You get on Medicaid then you get a job and you lose your Medicaid. You get an employer based plan, the employer changes your plan and your deductible is $3,000. There is nothing that is stable about it.”

“We have to push for the plan that will solve the problem. This is nonsense to go to the public option or in an emergency cover all the bills. You leave the insurance industry in there and we will still have all of the problems. Inherent in profit is the discrimination we suffer. We have to get the profit out of the health care system. No one should make a business out of killing people. No one should make a business out of increasing the suffering. And that is precisely what they do. We have all of these mechanisms in our health care system for keeping people from getting care. They claim it will keep the costs down. You have a deductible that is high. It means you can’t afford it when your child needs emergency care and you don’t go to the emergency room because there is a thousand dollar deductible. And you think – maybe the kid can live without it because the family’s budget will be wrecked by it.”

“Even people on Medicare go into bankruptcy. We are the only country in the industrialized world where you go bankrupt over your medical bills. It’s a crime. It’s an abomination. People in the Congress can’t just say – oh well, the time isn’t right. We don’t yet have majority support. Well, work to get majority support. We need this.”

Some activists are pushing their states to pass single payer. Tillow calls state based single payer a diversion.

“We don’t need state plans that will bar you from getting care in another state. It’s too complex,” Tillow said. “It’s a diversion and it’s harmful to the movement. We can do this thing nationally. Canada had no national program when they did it one state at a time and then went national. We already have national programs – Medicare and the VA. You would have to bust all of those up to give the money to the states. And most states can’t run on a deficit. They have to balance their budgets. If they can’t raise the money, they are going to be cutting your health care. Nationally, we have a little more leeway.”

“It doesn’t make sense to do it state by state. I would encourage our friends who are working on state plans to come and help us push for a national plan.”

One of the more liberal members of Congress, Ro Khanna, has introduced a bill that would make it possible for California to pass a single payer bill. You call it a diversion. Is it a misguided diversion?

“I know people who sincerely want single payer and are working on state plans. But I wouldn’t doubt that there are forces in there somewhere that are working to divert and delay us from doing the national plan we need to do. I’ve looked at the Ro Khanna bill that was introduced in the last session. It turns over all the federal money to the state. If the state says – we are going to do a universal health care plan and we are going to cover everybody, they get the money. Your state would be in control of your Medicare. Think about what Louisiana might do with your Medicare money. It’s a terrible thing. I don’t know why Ro Khanna introduced that bill and why people continue to work on state plans.”

“I think it’s because of a lack of confidence that we can do this nationally. We have the people with us. If we have any democracy left, we ought to be able to have the democratic will to push the people’s Congress to do what it rightly ought to do for the welfare of the people.”