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DeLauro, Blumenthal Seek Medicare Fix

by Thomas MacMillan | Jul 28, 2014 2:01 pm

(12) Comments | Commenting has been closed | E-mail the Author

Posted to: Health, Fair Haven

Thomas MacMillan Photo After a Medicare Advantage plan abruptly dropped him and hundreds of other physicians, Dr. Steven Wolfson tearfully said goodbye to patients of 30 years and offered some final advice: Don’t get sick.

Wolfson (pictured), a cardiologist at the Yale School of Medicine, shared his experience Monday morning at a “roundtable” discussion of a new bill designed to protect Medicare Advantage beneficiaries from “bait and switch” maneuvers by health care plans.

That’s how U.S. Sen. Dick Blumenthal described a recent move by United Healthcare Group, which had dropped hundreds of doctors from its Medicare Advantage plans. That move forced senior citizens to lose physicians they may have had for decades and find new doctors who may be a significant distance from their homes.

Blumenthal was joined for Monday’s event, at Atwater Senior Center in Fair Haven, by U.S. Rep. Rosa DeLauro, New Haven Mayor Toni Harp, and representatives from medical associations.

Blumenthal and DeLauro are proposing bills that would prevent Medicare Advantage plans from dropping doctors without cause except during open enrollment periods. Plans would have to finalize their provider networks 60 days before the annual open enrollment period begins.

“This bill arises from a hugely wrong and exploitative practice by United Healthcare,” Blumenthal said. He said the company dropped 2,250 doctors across the state, affected some 32,000 patients. Doctors sued and won an injunction.

Wolfson said United Healthcare dropped all Yale medical school doctors, as well as all doctors with admitting privileges at Yale-New Haven Hospital, and the hospital itself.

The “bait and switch” happened after people signed up for plans, then found they couldn’t access the doctors they had been promised, Blumenthal said.

“It affected most particularly our elderly and frail,” he said. “It was morally wrong. We need to make it legally wrong.”

“If you buy a car, you don’t expect to have a bicycle delivered,” said Judy Stein, head of the Center for Medicare Advocacy.

United Healthcare’s market share in Connecticut dropped from 45 to 36 percent, said Mark Thompson, head of the Fairfiled County Medical Association. Because United Healthcare gets a flat-rate reimbursement from the federal government, it was able to increase its profits even as it lost doctors. It got rid of the specialists with the patients who require the most expensive care.

“Normally, losing customers is a bad thing,” Blumenthal said. But United Healthcare wanted to lose customers—to increase revenue.

“This is their business model,” said U.S. Rep. DeLauro (pictured).

“We continue to offer Medicare Advantage enrollees a broad choice of primary care physicians and specialists in Connecticut and elsewhere, and are committed to ensuring Medicare beneficiaries have access to quality, affordable care,” said United Healthcare spokeswoman Maria Gordon Shydlo.

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posted by: robn on July 28, 2014  2:19pm

Just plain wrong. People should never be forcefully separated from their long time physicians.

posted by: JustAnotherTaxPayer on July 28, 2014  2:26pm

If there is any way to measure who is speaking the truth to the events involved in United Healthcare’s negligence towards their clients, it is in statements expressed by Dr. Wolfson and Judy Stein. The fact that they sent a spokesperson to this event has nothing to do with their concern for those that they take money from, to insure them. No, their statement and method of operation has everything to do with trying to maintain a public image that is a fallacy. Those that are responsible for their actions in dropping some 2200 doctors, several hospitals and primary care centers, and especially the 33,000 seniors that are affected, lack a conscience, and are most certainly an example of some of the people in these corporate monsters, that have lost their souls, and their judgment. All for the price of a dollar. It is a shame that anyone involved in the actions on United Healthcare can actually believe what has occurred is not a disgrace, and even worse, an abomination as they did it to maintain a profit margin that will be the reason for bonuses to the very largest of the large executives at the top of the food chain at United. They are disgusting human beings, shameless, soulless, and comparable to those that would knock down seniors on the street and rob them of their money. These folks are worse as they believe the respectability of wearing a suit and tie puts them above the behaviors of criminals on the street. No, it makes them far worse, as they will look at their parents, grandparents, children, spouses, friends, fellow parishioners, and tell them that they did not have control of these actions. The best way to judge this is for them to honestly ask themselves would they partake in this type of behavior if their parents or grandparents were to be the victims. If the answer is no, then why do they continue to fail to accept their reprehensible behavior.

posted by: N'Zinga Shani on July 28, 2014  2:31pm

I am PLEASED to see this action being taken.  United Health Care has been Unscrupulous and Unethical in its conduct.  I am one of the people who wrote to Congresswoman DeLauro about the bait and switch policy being practiced by United Health Care. This company takes our premiums and we have no access to specialists or physicians of our choice.  They have removed every physician from my network with no replacement; yet, they are getting monthly premiums. This is an OUTRAGE!
It is straightforward thievery!

BASED ON ITS OPERATING RECORD, UNITED HEALTH CARE SHOULD NOT BE ALLOWED TO JOIN THE CT HEALTH EXCHANGE IN OCTOBER 2014. THAT WOULD BE EQUIVALENT TO THE STATE COLLUDING WITH AN ORGANIZATION THAT HAS ALREADY PROVED ITSELF UNWORTHY OF THE PEOPLE’S TRUST.

posted by: Walt on July 28, 2014  3:48pm

I’m one of the victims of these United Healthcare changes,  and support these proposed new laws but Blumenthal and DeLauro are not the great defenders of those on Medicare that they try to claim.


United Healthcare was my insurer thru their Medicare   Advantage Plan for at least 15 years and in my opinion did   an excellent job.

When Obamacare passed Congress took 3/4 of a   TRILLION (NOT BILLION)  dollars from Medicare to enable Obamacare to start,

Part of the deal supported by all CT national legislators was to remove the subsidies to Medicare Advantage Plans which had served old   folks very well for many years.

The final reduction for Medicare Advantage Plans was to have occurred this year but   was recently delayed (Obama Executive action) until after   the November House and Senate elections so that old folk would not vote out   the Dem congresspeople who   had caused this messup of their previously good Medicare coverage

United Healthcare was good,I say but is not anymore

I will flee United this Fall during the open-enrollment period, but they   and other Medicare Advantage Plans   should not get all the blame-

-DeLauro and Blumenthal and our other federal legislators,  by their votes,  started this mess for all senior citizens,  and should share a major portion of the blame ,not be falsely portrayed as saviors of the old via their current misleading claims

posted by: Threefifths on July 28, 2014  4:10pm

This is why you need single-payer national health insurance.

Physicians for a National Health Program.

http://www.pnhp.org/

posted by: TheMadcap on July 28, 2014  6:26pm

The cuts to Medicare Advantage in the ACA are a good thing. Medicare Advantage was predicated on the continuously spouted idea the market will make everything cheaper, and shockingly, the for-profit health care companies did not, just like they didn’t when states privatized Medicaid coverage. MA spending by the feds was averaging 12% more than traditional Medicare
http://www.commonwealthfund.org/Publications/Issue-Briefs/2008/Sep/The-Continuing-Cost-of-Privatization—Extra-Payments-to-Medicare-Advantage.aspx
The cuts in Obamacare make it so the costs must come down to the levels of Medicare, but it doesn’t even make a difference. The cuts should go through, but they haven’t yet, they were supposed to start and they have been delayed and reversed, so the cuts don’t exist even exist yet to complain about
http://healthworkscollective.com/linda-ringquist/158706/medicare-advantage-cuts-not-only-delayed-reversed

posted by: LookOut on July 28, 2014  10:31pm

Come on folks - this is just part of the plan that has been in place since 2010;

Since the public won’t stand for a single payer healthcare system, we’ll put together a partial socialization that is messy, expensive, and doomed to fail (when insurers such as United Healthcare see that playing by the new rules results in big losses).  Once the system fails, the only ‘logical’ fix will be the single payer system that no one wants. 

Then, the gov’t will take control of the industry that is 1/6 of our GDP and everyone other than the rich will have massively long waiting periods for even the most basic of services. 

We’re on the way….

posted by: robn on July 29, 2014  8:03am

LO,

According to Forbes (reported by Ezra Kline), the Med-Insurance Industry generates a 2% profit while Pharma and Med-Equipment generates 20% and 16% profit respectively. In other words, the latter is the problem.

http://www.washingtonpost.com/blogs/wonkblog/wp/2014/01/13/what-liberals-get-wrong-about-single-payer/

And according to the Incidental Economist, average wait times are elective and not a product of the insurance system we choose.

http://theincidentaleconomist.com/wordpress/single-payer-does-not-equal-increased-wait-times/

posted by: Dwightstreeter on July 29, 2014  8:18am

Lookout claims Americans don’t want a single payer health care system, but Medicare is universally popular and no politician dares tinker with it.

In my opinion, Obama’s failure to effectively reform the health payment system will be among his biggest failures (support for domestic spying as Senator and President will also not be forgotten) as President. He had a majority in Congress for 2 years, but lacked the vision and the guts to get it done. The NY Times reported on the deal cutting at the White House that led to this hybrid system that works on alternate days.

I can only hope we are headed for single payer. It works.

posted by: LookOut on July 29, 2014  8:39am

To those who think they want single payer healthcare, google the term - the list of failures in countries and states that use it is staggering.  Read an article such as this;

http://heartland.org/sites/all/modules/custom/heartland_migration/files/pdfs/8303.pdf

Yes - those with Medicare benefits will fight hard to keep them.  That does not mean that the service is good and it certainly doesn’t mean that the program is financially solvent.  (depending upon which economist you believe, the system will be bankrupt in 8-25 years.

Finally, ask someone who lives in or has lived in a place where socialized medicine and care has taken hold.  I’ve spoken to people at various ends of the income spectrum.  Those at the low end have huge wait times for service and care and then receive cookie cutter care (fast, cheap).  Those who can afford it but private medical insurance and avoid the entire system.  (rather ironic)

posted by: TheMadcap on July 29, 2014  10:16am

“Finally, ask someone who lives in or has lived in a place where socialized medicine and care has taken hold. “

The response is quite always “Sure the system has a lot of problem but lmao if you think we want some kind of American system. Guaranteed free/low cost health care to everyone is pretty great”

I mean my god the Brits love the NHS so much despite how much they simultaneously like complaining about it that there was a tribute performance to it during the opening games of the London Olympics.

“Those who can afford it but private medical insurance and avoid the entire system”

Yes, much like they do now. I mean it’s hilarious Americans defend health care they have absolutely no access to. The wait times in the US really aren’t that spectacular when compared to the OECD
http://www.oecd-ilibrary.org/sites/health_glance-2011-en/06/08/index.html;jsessionid=2nxd58kpl8y72.x-oecd-live-01?itemId=/content/chapter/health_glance-2011-59-en&_csp_=484d3d91b843a9804bc912701c46682d
While we were quite below nations with single payer systems like the UK/Canada, we were on par with nations like Germany, Switzerland and Holland that use a system of highly regulated and subsidized non profit insurers as the main vehicle to provide insurance. What the chart leaves out though is the fact those were our numbers with throwing 15-20% of the nation uninsured at any given time, and the fact Americans see a doctor on average less than their counterparts
http://www.oecd-ilibrary.org/sites/health_glance-2011-en/04/01/index.html;jsessionid=cglsg3b4phjf.x-oecd-live-01?contentType=&itemId;=/content/chapter/health_glance-2011-29-en&mimeType=text/html&containerItemId;=/content/serial/19991312&accessItemIds;=/content/book/health_glance-2011-en

There is nothing defensible about the US health care system, we get meh results that at best are on par with many other OECD nations and spend a huge amount of money to get them while leaving a signicant minority to literally die.

posted by: Threefifths on July 29, 2014  10:23am

posted by: LookOut on July 29, 2014 9:39am

To those who think they want single payer healthcare, google the term - the list of failures in countries and states that use it is staggering.  Read an article such as this;

I read this.

21 Ways the Canadian Health Care System is Better than Obamacare
by RALPH NADER

http://www.counterpunch.org/2013/11/22/21-ways-the-canadian-health-care-system-is-better-than-obamacare/


The Canadian system is government controlled, but not government owned. Doctors and facilities are privately operated and paid for through taxes.The current Canadian system was established in 1984.From birth to death, a Canadian citizen’s basic health care is provided at virtually no out-of-pocket cost.Ever wonder why prescription drugs are so much cheaper in Canada? The government buys them in bulk and passes on the savings.

The French health care system.

http://about-france.com/health-care.htm


What American Healthcare Can Learn From Germany
Under Obamacare, the U.S. healthcare system is starting to look more like Germany’s. Here’s what Germans do right—and how Americans could do even better.


http://www.theatlantic.com/health/archive/2014/04/what-american-healthcare-can-learn-from-germany/360133/

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