Vol. 73/No. 42      November 2, 2009

As reader David Wilder points out, Medicare Advantage “is itself a wedge driven into Medicare” by opening it up to “private insurance schemes.”

Medicare Advantage has been used by the U.S. rulers in their efforts to privatize Medicare, a process that is inevitable under the workings of capitalism. However, many Medicare recipients have joined Medicare Advantage because of added benefits it offers, though with built-in limitations.

Under this program the government contracts with private insurers for policies like those under standard Medicare that cover doctor visits and hospitalization. Medicare Advantage also provides additional benefits like vision, dental care, and often prescription drug coverage.

It offers lower copayments and deductibles than standard Medicare coverage, but includes limitations on which doctors and hospitals a patient may visit. Medicare Advantage plans cover nearly 11 million people, 23 percent of all Medicare beneficiaries.

Medicare covers 80 percent of doctors’ bills and medical procedures. Some turn to Medicare Advantage to cover the difference. Others take out “Medigap” insurance policies. About 90 percent of Medicare recipients have some form of supplemental insurance to cover the gap.

Basic Medicare provides no drug coverage. Seniors must use private insurers for prescriptions.

The “health reform” bills circulating in the Senate and House of Representatives project cutting more than half a trillion dollars from Medicare over 10 years, based on the claim that the Medicare trust fund will probably be out of funds within eight years.

This includes a proposal in the bill being promoted by Sen. Max Baucus to cut government payments to Medicare Advantage by more than $100 billion. President Obama initially called for cuts of $175 billion, arguing that the government is spending too much for those on Medicare Advantage that could instead go toward regular Medicare.

However, their plans are not to expand basic Medicare, but to make much deeper cuts. Proposals include raising premiums for some in higher-income brackets, cutting payments to hospitals and nursing homes, and reducing “overvalued services” by doctors. For the 45 million people covered by Medicare this translates into less available health care, rising premiums and copayments, and hospital closures.

Medicare was enacted in 1965 as a result of victories won during the two-decade-long working-class mobilization for Black civil rights. At that time more than 50 percent of those 65 and older had no health coverage. The Medicare program soon covered 95 percent of all seniors. In 1972 the program was expanded to individuals with significant disabilities, adding 2 million to its rolls.

The Democrats and Republicans have been steadily whittling away at Medicare since. Seven years after its enactment, Congress passed legislation allowing private health maintenance organizations to provide coverage for Medicare beneficiaries. In 1997 the Balanced Budget Act added more private insurers to the Medicare program. Medicare Advantage was then set up, resulting in the highest enrollment in private health plans in Medicare history.

All moves to slash Medicare should be opposed. Medicare, like Social Security, was won as a result of mass social struggles by working people. That is the only way it can be defended—a fight that starts from the point of view of health care as a right that is guaranteed everyone free of charge for a lifetime.
 
 
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