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Sunday, October 22, 2023

Bad Moon Rising Part 94 - Sitting Ducks

image: aircraft carrier

The people that run the U.S. are posturing for something really big on the world stage.

IF IT WEREN’T FOR US, the Russian/Ukraine war would probably be over.  We’re messing with CHINA over Taiwan and computer chips. And now, we’re backing up Israel in their show show of horrible brutality of genocide against the Palestinian people.  And since we’re talking about the Holy Land - God.

I read Tom Clancy’s book RED STORM RISING in the 80s.

One of the best parts was pages detailing bombing US aircraft carriers like sitting ducks.

Red Storm, an audacious, four-month master plan of elaborate diplomatic trickery and crash military buildup designed to keep the West off-balance—and ready it for the knockout blow.

Soviet Navy achieves a decisive early victory against a combined U.S. Navy carrier battle group consisting of USS Nimitz, USS Saratoga, the French carrier Foch, USS Saipan, and their escorts resulting in Foch and Saipan being sunk, while Nimitz is forced to spend weeks in drydock undergoing repairs.

How/where does he get his INFORMATION?

Tom Clancy’s expertise was contagious. He knew how sonar could be defeated, how rubber bullets could kill, how the Secret Service could respond to a passenger jet nose-diving into the Capitol building, and myriad other ways the United States government could and likely would respond to threats at home and abroad. He knew all of this with a chilling degree of accuracy. And if you read Clancy’s novels, you knew it, too.

Why does it matter that Clancy workshopped best-selling novels by sitting around a table with friends, pushing fake fleets and squadrons across make-believe warzones in the military dork’s equivalent of Dungeons and Dragons? Because Harpoon, which was developed by civilians, is still used to this day by Navy instructors to train officer cadets. Its numerical models of both American and then-Soviet vehicles and weapon systems were so detailed that, as legend has it, the Department of Defense paid a none-too-friendly visit to Harpoon’s creator, Larry Bond (who co-wrote Red Storm Rising with Clancy), demanding to see his classified materials, only to find that Bond had culled all the information from non-classified sources. Apocryphal or not, that is Harpoon’s legacy - a naval simulation so good, it borders on illegal

There’s a new war going on in the Middle East - Hamas vs Israel.

AlJazeera REPORTS:

A surprise attack by Palestinian group Hamas on Israel combining gunmen breaching security barriers and a barrage of rockets fired from Gaza - was launched at dawn during the Jewish holiday of Simchat Torah.

Saturday’s attack came 50 years and a day after Egyptian and Syrian forces launched an assault during the Jewish holiday of Yom Kippur in an effort to retrieve territory Israel had taken during a brief conflict in 1967.

Check out the Real New Network show with Chris Hedges and Norman Finkelstein on OCTOBER 18:

On October 7, Hamas fighters broke through the security barrier separating Gaza from Israel. They attacked army outposts, villages, and outdoor concert venues, and kibbutz. Some 1300 Israelis, many of them civilians, were killed. Almost 200 Israelis, including women, children, and the elderly, were taken as hostages and transported back to Gaza. Israel says 1,500 Hamas militants, most young men who most likely had never been out of Gaza, were killed. Israel has now ordered some 1.1 million Palestinians in northern Gaza to evacuate. The north includes Gaza City, the most densely populated part of the strip, with 750,000 residents. It also includes Gaza’s main hospital, the Jabalia, and Al-Shati refugee camps. Gaza is one of the most heavily populated spots on the planet.  Its borders are sealed by Egypt and Israel.

There is no sanctuary; With a tiny landmass, 25 miles long, and only about five miles wide. Israel has cut off food, fuel, water, and electricity, provoking an appalling humanitarian crisis.

Israel has unleashed a horrific war of collective punishment against the people of Gaza, the latest in a long history of anti-Palestinian oppression. As corporate media shamelessly provides cover for what is undoubtedly a genocide unfolding in real time, the need to ground our understanding of the conflict in its proper history is more important than ever. Norman Finkelstein joins The Chris Hedges Report to discuss Israel’s 17 year blockade of Gaza and its crucial significance to understanding the events of the past two weeks.

It only took the United States a few days to stick it’s nose in:

CNN OCTOBER 20:

A US warship that intercepted drones and missiles near the coast of Yemen on Thursday encountered a larger and more sustained barrage than was previously known, shooting down 4 cruise missiles and 15 drones over a period of 9 hours, according to a US official familiar with the situation.

Today, we have two aircraft carriers ready to join in whatever happens next.

CNN AGAIN:

The Pentagon has ordered a second carrier strike group to the eastern Mediterranean Sea and is sending Air Force fighter jets to the region as Israel prepares to expand its Gaza operations, US Defense Secretary Lloyd Austin said in a statement Saturday.

The first carrier strike group, led by the USS Gerald R. Ford, arrived off the coast of Israel last week.

Now the USS Dwight D. Eisenhower strike group, which deployed from Norfolk, Virginia, on Friday, is headed to the eastern Mediterranean.

Over on Substack, Gilbert Doctorow writes:

My unfinished sentence about the Russian aircraft now on permanent patrol of the Black Sea and carrying Russias hypersonic Kinzhal missiles would have ended in the following: the Russian missiles can strike the U.S. aircraft carrier task force off Israeli shores and two of them are sufficient to send the Gerald Ford to the bottom of the sea.

That last point is not my own interpretation: it was stated clearly on a live broadcast of Russia’s premier talk show hosted by Vladimir Solovyov two days ago.  To that I add here a very important additional note that highlights how close we are coming to the war to end all wars:  Putin made his statement about the Kinzhals not from his Kremlin offices but from the guest house in Beijing where he spent two days this week and met for several hours with Chinese president Xi Jinping.  As a veteran Kremlinologist, I can say with confidence that Putin’s readiness to finish off the American aircraft carrier task force in the Mediterranean if necessary had been discussed with and approved by Xi, who surely has his own concerns about the U.S. navy operating most provocatively in the South China Sea.  It also aligns with the threat by North Korean leader Kim one week ago that he is ready to sink the U.S. aircraft carrier that loiters in the vicinity of the Korean peninsula.  What we have before us is the prospect of Pearl Harbor all over again, but in three seas.

These separate facts are in the public domain.  I remain surprised that no one is drawing the dots to the obvious conclusion: that we are on the cusp of a very great war for which the Mideast crisis is just the detonator.

Nonetheless, it does not have to end this way. Unless attacked, it is unlikely that Iran will enter the conflict directly. Hezbollah can do a good enough job of bloodying the Israelis nose without the intervention of their friends in Teheran.  And the Russians are certain to hold their fire unless Iran and/or Syria are attacked by the U.S. warplanes based on the fleet.

This is not the Grand Chessboard that Zbigniew Brzezinski had in mind when he published his book on the global power outlook in 1997. Nor did he reckon that the U.S. team of strategists in office would not have progressed beyond Chinese checkers.

I watched MEET THE PRESS and FACE THE NATION this morning.

Nobody from the U.S. is talking peace.  After President BIDEN’S SPEECH the other day that sounded more like NAZI PROPAGANDA to me THAN ANYTHING ELSE - Blinken, Biden, and the rest of the warmongers may be getting ready to lead the world into the heart of the Holy Land in war.

Presidents Putin of Russia and Xi JinPing of China held their own meetings.

The Guardian REPORTS

Although Beijing has tried to position itself as a PEACEMAKER in Ukraine, China’s continuing economic and political SUPPORT for Russia has made its commitment to Moscow clear.

Xi cast China as a leader in fostering international cooperation through its BRI PROJECTS, which has involved more than 150 countries and 30 international businesses since its launch a decade ago.

Although China is not thought to have provided Russia with lethal weapons, it has provided key technology and hardware that have been a lifeline for the Russian economy - and military efforts.

Last month the US Commerce Department imposed trade restrictions on 11 Chinese companies, accusing some of them of supplying drone-making equipment to Russia.

Will the first U.S. aircraft carrier get sunk off the China coast, the Mediterranean, or maybe the Persion gulf??

Then what?

Seventeen years ago I though President Bush was going to NUKE IRAN.

His successors may be so crazy and so power hungry, that they may believe a nuclear exchange is survivable, and may do anything to protect their own self interests, rationalize it by talking themselves into believing they’re doing God’s work - like the PROSPERITY GOSPEL loving crowd of our own REPUBLICAN PARTY.

Over at AMERICAN MILITARY NEWS:

According to a Pentagon PRESS RELEASE, the military working toward a modern variant of the B61 nuclear gravity bomb, called the B61-13, but the initiative is awaiting congressional authorization and appropriation.

From the PRESS RELEASE:

The B61-13 would be deliverable by modern aircraft, strengthening deterrence of adversaries and assurance of allies and partners by providing the President with additional options against certain harder and large-area military targets. It would replace some of the B61-7s in the current nuclear stockpile and have a yield similar to the B61-7, which is higher than that of the B61-12.

We’re now involved in two important wars - Russia vs Ukraine, and Israel vs Hamas. 

We’re looking down Iran’s and China’s throats off their boarders, while the GEOPOLITICAL arena makes tectonic shifts.

We’re sitting ducks.

Posted by Elvis on 10/22/23 •
Section Bad Moon Rising • Section Dying America • Section Fascism
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Wednesday, October 18, 2023

22 Years of Blowback from the USA Patriot Act

image: patriot act

“Voice or no voice, the people can always be brought to the bidding of the leaders. All you have to do is tell them they are being attacked and denounce the pacifists for lack of patriotism and exposing the country to danger. It works the same in any country.”
- Hermann Goering, German military commander and Hitler’s designated successor

Postcards from a Police State: 22 Years of Blowback from the USA Patriot Act

By John & Nisha Whitehead
Rutherford Institute
October 16, 2023

Reprinted with permission

For those who remember the days and months that followed 9/11, there is an unnerving feeling of deja vu about the Hamas attacks on Israel.

The same shocking images of carnage and grief dominating the news. The same disbelief that anyone could be so hateful, so monstrous, so evil as to do this to another human being. The same outpourings of support and unity from around the world. The same shared fear that this could easily have happened to us or our loved ones.

Now once again the drums of war are sounding on the world stage, not that they ever really stopped. Israel is preparing to invade Gaza, the Palestinians are nearing a humanitarian crisis, and the rest of the world is bracing for whatever blowback comes next.

Here in the United States, as we approach the 22nd anniversary of the USA Patriot Act on October 26, were still grappling with the blowback that arises from allowing one’s freedoms to be eviscerated in exchange for the phantom promise of security.

Here are a few lessons that we never learned or learned too late.

Mammoth legislation that expands the governments powers at the citizenry’s expense will not make anyone safer. Rushed through Congress a mere 45 days after the 9/11 attacks, the USA PATRIOT ACT DROVE A STAKE THROUGH THE HEART OF THE BILL OF RIGHTS, undermined civil liberties, expanded the governments powers and opened the door to far-reaching surveillance by the government on American citizens.

Pre-emptive strikes will only lead to further blowback. Not content to wage war against Afghanistan, which served as the base for Osama bin Laden, the U.S. embarked on a PRE-EMPTIVE WAR AGAINST IRAQ in order to “stop any adversary challenging Americas military superiority and adopt a strike-first policy against terrorist threats ‘before they’re fully formed.’” We are still suffering the COUNSEQUENCES OF THIS FAILED POLICY, which resulted in lives lost, taxpayer dollars wasted, the fomenting of hatred against the U.S. and the further RADICALIZATION OF TERRORIST CELLS.

War is costly. There are many reasons to go to war, but those who have advocated that the U.S. remain at war, year after year, are the very entities that have profited most from these endless military occupations and exercises. Thus far, the U.S. taxpayer has been made to shell out more than $8 TRILLION TO WAGE WARS ABROAD, including the LIFETIME PRICE OF HEALTH CARE FOR DISABLED VETERANS and interest on the national debt. That also does not include the more than hundreds of thousands of civilians killed, or the millions displaced from their homes as a result of endless drone strikes and violence.

The tactics and weapons of war, once deployed abroad, will eventually be used against the citizenry at home. The horrors that took place at Abu Ghraib, the American-run prison in Iraq, involved “US military personnel humiliating, hurting and abusing Iraqi prisoners in a myriad of perverse ways. WHILE AMERICAN SERVICEMEN AND WOMEN SMILED AND GAVE THUMBS UP, NAKED MEN WERE THREATENED BY DOGS, OR WERE HOODED, FORCED INTO SEXUAL POSITIONS, PLACED STANDING WITH WIRES ATTACHED TO THEIR BODIES, OR LEFT BLEEDING ON PRISION FLOORS.” Adding to the descent into moral depravity, the United States government legalized the use of torture, including waterboarding, in violation of international law and in the so-called pursuit of national security. The ramifications have been far-reaching, with domestic police mirroring a battlefield mindset in their encounters with American citizens, including the use of torture tactics at secret locations such as HOMAN SQUARE IN CHIGAGO.

Allowing the government to spy on the citizenry will not reduce acts of terrorism, but it will result in a watched, submissive, surveillance society. Not only did the USA Patriot Act normalize the governments mass surveillance powers, but it also dramatically expanded the government’s authority to spy on its own citizens without much of any oversight. Thus, a byproduct of this post 9/11-age in which we live, whether youre walking through a store, driving your car, checking email, or talking to friends and family on the phone, you can be sure that some government agency is listening in and tracking your behavior. This doesn’t even begin to touch on the corporate trackers that monitor your purchases, web browsing, Facebook posts and other activities taking place in the cyber sphere. We have all become data collected in government files.

News cycle distractions are calibrated to ensure that you lose sight of what the government is doing. The average American has a hard time keeping up with and remembering all of the “events,” manufactured or otherwise, which occur like clockwork and keep us distracted, deluded, amused, and insulated from the reality of the American police state. Whether these events are critical or unimportant, when were being bombarded with wall-to-wall news coverage and news cycles that change every few days, it’s difficult to stay focused on one thing - namely, holding the government accountable to abiding by the rule of law - and the powers-that-be understand this. In this way, regularly scheduled trivia and/or distractions that keep the citizenry tuned into the various breaking news headlines and entertainment spectacles also keep them tuned out to the governments steady encroachments on their freedoms.

If you stop holding the government accountable to the rule of law, the only laws it abides by will be the ones used to clamp down on the citizenry. Having failed to hold government officials accountable to abiding by the rule of law, the American people have found themselves saddled with A GOVERNMENT THAT SKIRTS, FLOUTS, AND VIOLATES THE CONSTITUTION with little consequence. Overcriminalization, asset forfeiture schemes, police brutality, profit-driven prisons, warrantless surveillance, SWAT team raids, indefinite detentions, covert agencies, and secret courts are just a few of the egregious practices carried out by a government that operates beyond the reach of the law.

Do not turn your country into a battlefield, your citizens into enemy combatants, and your law enforcement officers into extensions of the military. A standing army - something that propelled the early colonists into revolutionstrips the citizenry of any vestige of freedom. How can there be any semblance of freedom when there are tanks in the streets, military encampments in cities, Blackhawk helicopters and armed drones patrolling overhead? It was for this reason that those who established America vested control of the military in a civilian government, with a civilian commander-in-chief. They did not want a military government, ruled by force. Rather, they opted for a republic bound by the rule of law: the U.S. Constitution. Unfortunately, we in America now find ourselves struggling to retain some semblance of freedom in the face of police and law enforcement agencies that look and act like the military and have just as little regard for the Fourth Amendment, laws such as the NDAA that allow the military to arrest and indefinitely detain American citizens, and military drills that acclimate the American people to the sight of armored tanks in the streets, military encampments in cities, and combat aircraft patrolling overhead.

As long as you remain fearful and distrustful of each other, you will be incapable of standing united against any threats posed by a power-hungry government. Early on, U.S. officials solved the problem of how to implement their authoritarian policies without incurring a citizen uprising: fear. The powers-that-be want us to feel threatened by forces beyond our control (terrorists, shooters, bombers). They want us afraid and dependent on the government and its militarized armies for our safety and well-being. Most of all, they want us distrustful of each other, divided by our prejudices, and at each otherגs throats.

Once you trade your freedom for security, the terrorists win. We’ve walked a strange and harrowing road since September 11, 2001, littered with the debris of our once-vaunted liberties. We have gone from a nation that took great pride in being a model of a representative democracy to being a model of how to persuade a freedom-loving people to march in lockstep with a police state. And in so doing, we have proven Osama Bin Laden right. He warned that FREEDOM AND HUMAN RIGHTS IN AMERICA ARE DOOMED. The U.S. government will lead the American people in and the West in general - into an unbearable hell and a choking life.

It took a long time to clear away the rubble from the 9/11 attacks.

Yet as I make clear in my book BATTLEFIELD AMERICA : THE WAR ON THE AMERICAN PEOPLE and in its fictional counterpart THE ERIC BLAIR DIARIES, 22 years after the USA Patriot Act was unleashed on a vulnerable nation, we are still reeling from the destruction it has wrought on our freedoms.

About John W. Whitehead

Constitutional attorney and author John W. Whitehead is founder and president of The Rutherford Institute. His most recent books are the best-selling Battlefield America: The War on the American People, the award-winning A Government of Wolves: The Emerging American Police State, and a debut dystopian fiction novel, The Erik Blair Diaries. Whitehead can be contacted at staff[at]rutherford.org. Nisha Whitehead is the Executive Director of The Rutherford Institute. Information about The Rutherford Institute is available HERE.

Publication Guidelines / Reprint Permission

John W. Whitehead’s weekly commentaries are available for publication to newspapers and web publications at no charge. Please contact staff[@]rutherford.org to obtain reprint permission.

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Posted by Elvis on 10/18/23 •
Section Privacy And Rights • Section Dying America
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Thursday, October 05, 2023

Medicare News

image: medigap vs medicare advantage
 
It’s easy to see THE APPEAL: Original Medicare requires piecing together care from what’s called Part A, for in-patient hospital and skilled nursing care, and Part B, for doctor services. That typically costs about $165 a month (with the cost deducted from your Social Security check). Plus, many people pay extra for Medigap, to cover copays and other out-of-pocket costs, as well as a Part D plan for drugs.
 
Advantage plans (also called Part C), on the other hand, provide the benefits of Parts A, B, and often D, usually for about the same amount, with lower copays, so theres no need for Medigap. Some also offer benefits not in Original Medicare, such as fitness classes or some vision and dental care.
 
Sounds good - but be wary. Choosing between the two requires careful consideration of your finances and health needs. And Advantage plans can carry hidden risks, especially for people with major health issues.
 
“Some people in Medicare Advantage end up paying unexpectedly high costs when they become ill or find their network lacks the providers they need,” says Tricia Neuman, senior vice president at Kaiser.
- The Pros and Cons of Medicare Advantage, Consumer Reports, 2022

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Medicare Advantage Coverage is Rising for the Declining Share of Medicare Beneficiaries with Retiree Health Benefits

By Meredith Freed, Tricia Neuman, Matthew Rae, and Jeannie Fuglesten Biniek
KFF
December 1, 2022

Employer and union-sponsored retiree health plans can play an important role in providing supplemental benefits to people with Medicare, but just 13 PERCENT of large employers currently offer retiree health benefits to Medicare-age retirees, according to the KFF Employer Health Benefit Survey. Concerns about costs associated with retiree health benefits have led employers and unions to IMPLEMENT CHANGES TO LIMIT THEIR FINANCIAL LIABILITY while continuing to offer retiree health benefits, including establishing financial caps on their liability, shifting toward defined contribution approaches, increasing retirees premium contribution, and more recently, by offering their Medicare-eligible retirees coverage through Medicare Advantage plans.

This analysis uses data from the 2022 KFF EMPLOYER HEALTH EMPLOYER HEALTH BENEFITS SURVEY to examine the extent to which large private and non-federal public employers that offer retiree health benefits are turning to Medicare Advantage and why they are making this shift. However, the Survey does not include information about union-administered benefits. For additional information about methods, see Survey Design and Methods.

Based on the Survey, we find:

Half (50%) of large employers offering retiree health benefits to Medicare-age retirees offer coverage to at least some retirees through a contract with a Medicare Advantage plan, nearly double the share in 2017 (26%).

About 44% of large employers that offer Medicare Advantage coverage to their retirees do not give retirees a choice in coverage options.

Among larger employers with 1,000 or more workers that offer retiree health benefits through a Medicare Advantage plan, the most commonly cited reason they elected this option was the lower cost.

Background

THE SHARE OF MEDICARE BENEFICIARIES OFFERED RETIREE HEALTH BENEFITS HAS BEEN ERODING OVER TIME. For people with Medicare, employer or union-sponsored retiree health benefits can help to make Medicare more affordable, by helping to cover deductibles and cost sharing and by providing supplemental benefits that are not covered by traditional Medicare. Until fairly recently, employer and union-sponsored retiree health coverage was typically designed to coordinate or wrap around traditional Medicare. More recently, employers with retiree health obligations have turned to Medicare Advantage, an approach that could have implications for retirees core Medicare benefits, particularly if the only option for retirees is a Medicare Advantage plan, which may impose restrictions, such as more limited provider networks and prior authorization requirements.

Medicare Advantage plans, which are mainly HMOs and PPOs, provide all Medicare-covered benefits, OFTEN FOR NO ADDITIONAL PREMIUM FOR PLANS OPEN FOR GENERAL ENROLLMENT (OTHER THAN PART B PREMIUM), typically include Part D drug coverage, and may cover other benefits such as vision, dental, and hearing benefits. In 2022, OVER FIVE MILLION MEDICARE BENEFICIARIES RECEIVE THEIR MEDICARE-COVERED BENEFITS AND SUPPLEMENTAL RETIREE HEALTH BENEFITS THROUGH AN EMPLOYER GROUP WAVER PLAN (EGWP). While group enrollment has accounted for roughly the same share of total Medicare Advantage enrollment since 2010 (18%), the actual number of group enrollees has increased from 1.8 million in 2010 to over 5 million in 2022 as MEDICARE ADVANTAGE ENROLLMENT OVERALL HAS GROWN.

Under this approach, employers and unions contract with a Medicare Advantage private insurer to provide all Medicare-covered benefits as well as SUPPLEMENTAL BENEFITS. The employer (or union) and/or private insurer (acting on behalf of an employer) receives a payment from the federal government (Medicare) and agrees to cover all Medicare-covered benefits, along with a package of supplemental benefits for retirees in their group. Payments are based on the bids of other Medicare Advantage plans available to individual (non-group) enrollees, adjusted for geography and risk. While Medicare pays for retirees in group plans, there is very little data on the premiums, cost sharing, supplemental benefits, and provider networks in these plans.

Employer plans are eligible to receive rebates and bonus payments from Medicare, both of which help cover the costs associated with supplemental benefits for their retirees. Bonus payments are based on a plans quality rating, using a system of STARS. Bonus payments for group Medicare Advantage plans REACHED $2 BILLION IN 2022. On average, bonuses for group plans ($396 per enrollee in 2022) are higher than for Medicare Advantage plans open for general enrollment ($358).

MEDPAC ESTIMATES that Medicare Advantage payments to employer plans will average 102 percent of FFS spending in 2022, which contributes to higher Medicare spending that ultimately affects the solvency of the Medicare Trust Fund and higher Medicare premiums paid by all beneficiaries. In other words, Medicare spends more per retiree in group Medicare Advantage plans, on average, than it pays for similar people in traditional Medicare.

Findings

Among all large firms (firms with 200 or more workers) that offer retiree health benefits to Medicare-age retirees, 50% provide these benefits through a Medicare Advantage plan in 2022, almost double the share in 2017.

Among firms with 5,000 or more workers offering retiree benefits, 60% offer retiree health benefits through a Medicare Advantage plan in 2022, a share that has doubled over the same time period (29%).

Among large firms (200 or more workers) offering retiree benefits through a contract with a Medicare Advantage plan, more than 4 in 10 (44%) provide at least some retirees no choice but to receive their retiree health benefits through a Medicare Advantage plan.

Retirees in firms that offer Medicare Advantage exclusively are unable to choose traditional Medicare for their core Medicare benefits, rather than a Medicare Advantage plan, unless they are willing to give up their retiree health benefits.

Among firms with 1,000 or more workers offering retiree benefits through a contract with a Medicare Advantage plan, the primary reason the firm elected this option is the lower cost.

Among employers with 1,000 or more workers that offer retiree benefits through a Medicare Advantage plan, about four in ten employers (42%) said the primary reason they selected this option was due to the lower cost. Nearly a quarter (23%) said they don’t know, while fourteen percent said it provides flexibility for enrollees, eight percent said it has better coverage options, seven percent said it is administratively simpler, and five percent selected it for another reason.

More than four in ten large employers (200 or more workers) offering retiree benefits through Medicare Advantage (41%) said they don’t know why they selected Medicare Advantage for their retiree benefits. This is primarily due to smaller firms (those with 200-999 workers) who disproportionately dont know why their firms provide their retiree health benefits through a Medicare Advantage plan (49%) compared to those with 1,000 or more workers (23%).

Discussion

As the share of large employers offering retiree health benefits to Medicare-eligible retirees continues to decline, firms that still offer these benefits are increasingly turning to Medicare Advantage, often to lower their own financial liability, which raises questions about the implications for retirees, employers and the Medicare program.

For some large employers, the shift to Medicare Advantage appears to be a strategy to maintain benefits for their retirees, without terminating coverage or adopting other changes that more directly shift costs onto retirees. However, the shift to Medicare Advantage has implications for retirees that extend beyond supplemental benefits. This approach has the potential to restrict retirees’ access to doctors and hospitals, depending on the plans provider network, and subject retirees to cost management tools, such as prior authorization, that may limit access to Medicare-covered services. Limited provider networks was a major area of concern when New York City recently tried to move its city worker retirees into a Medicare Advantage plan to save an estimated $600 MILLION PER YEAR year in health care costs (and may explain why THE IMPLEMENTATION OF THIS PLAN IS ON HOLD DUE TO LITIGATION AND THE WITHDRAWAL OF THE INSURER WHO WAS SET TO RUN THE PLAN). If retirees are dissatisfied with their network, their only option may be to give up retiree benefits altogether, although they would retain Medicare, and have the option to choose traditional Medicare (potentially with a Medigap supplement) or a Medicare Advantage plan (including zero-premium plans).

The rising number of Medicare-eligible retirees into Medicare Advantage plans raises questions about the impact on Medicare spending, particularly because MEDICARE PAYS MORE FOR ENROLEES IN MEDICARE ADVANTAGE plans (including in group plans) THAN FOR TRADITIONAL MEDICARE, on average. Further, the rising number of Medicare Advantage enrollees in group plans highlights the lack of transparency about these plans, including information about which employers are offering Medicare Advantage, and makes it difficult to assess the extent to which Medicare overpayments may be offsetting employersҒ liability for retiree health coverage, the scope of coverage under group plans, such as provider networks for Medicare-covered and other benefits, the scope of extra benefits, and premium and cost-sharing requirements.

SOURCE

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Insurers Are Gaming Medicare - To The Tune Of $140 Billion
Private health insurers are systematically taking advantage of Medicare while denying care to seniors, a new report shows.

Healthcare News
The Lever
October 4, 2023

The federal government is losing as much as $140 billion per year by subsidizing private Medicare Advantage plans, according to a bombshell new report. In the groundbreaking investigation, health care researchers identified the four major ways that private insurers systematically exploit the taxpayer-funded national health insurance program while denying care to the nations most vulnerable patients.

The researchers additionally found that seniors could save over $1,800 in annual fees taken from their Social Security checks if the government redirected what it spends subsidizing Medicare Advantage plans to instead reduce premium costs. Under the current ARRANGEMENT, “traditional Medicare pays about $12,000 a year to private Medicare Advantage insurers for every patient whose care they “manage. “

Medicare Advantage insurers - which include UnitedHealth Group, Humana, Cigna, and Blue Cross Blue Shield are profiting at the expense of ordinary seniors, 40 PERCENT of whom are completely dependent on their Social Security benefits, which average about $1,600 per month after Medicare premiums are taken out.

“Insurers are quietly plundering the Medicare trust fund for their own profits and compromising the health of senior citizens and [people with] disabilities,” said Ed Weisbart, a family medicine physician who is the secretary of Physicians for a National Healthcare Program (PNHP), a single-payer advocacy group that produced the report.

Medicare, the public health insurance for seniors and people with disabilities, is one of the most popular and effective social programs in the country. The program is funded by TAXPAYER MONEY and keeps costs low by setting fixed prices with health care providers.

Medicare Advantage lets private insurance plans step in as a middle man. When the program was established in its current form in 2003, its proponents argued it would help save the government money on Medicare spending. However, RESEARCH from the Medicare Payment Advisory Commission (MedPAC), an independent agency that advises Congress on Medicare, shows that the program has not yielded savings in the two decades since it was established.

Medicare Advantage plans receive a flat payment for the care they provide, strongly incentivizing the insurers sponsoring the plans to RATION CARE - leading to high rates of wrongful claim denials, worse health outcomes, and costly administrative headaches for providers.

These private plans have been under fire for the rate at which they deny patient care. As The Lever REPORTED, these claims have a devastating cost to health outcomes but frequently save insurance companies money as patients forgo treatments they cannot afford.

Since then, claim denials have only increased. A report from the KFF (formerly known as the Kaiser Family Foundation), a major foundation that studies health policy issues, found that TWO MILLION prior authorization requests were denied by Medicare Advantage in 2021 - significantly higher than the rates for traditional Medicare.

Since 2007, the share of beneficiaries enrolled in Medicare Advantage plans has tripled, far outpacing the growth of traditional Medicare enrollment.

Many people leave traditional Medicare for private plans, and once they do, an ADMINISTRATIVE BARRIER makes it difficult to return. That’s because while Medicare covers 80 percent of patients’ health care costs, the last 20 percent are usually covered by the individual or a supplementary plan called Medigap. But in most states, when someone leaves Medicare Advantage, often due to illness necessitating broader coverage networks, Medigap insurers can deny future coverage effectively making their return to traditional Medicare impossible.

As of this year, Medicare has reached a turning point: Medicare Advantage now MANAGES care for over half of all eligible beneficiaries.

As patients are joining these for-profit plans, providers are leaving. Scripps Health, a major health care provider in San Diego, announced in late September that it would decline most Medicare Advantage plans moving forward, because of their practices.

Scripps CEO Chris Van Gorder TOLD MEDPAGE TODAY, “We are a patient care organization and not a patient denial organization and, in many ways, the model of managed care has always been about denying or delaying care - at least economically.”

Van Gorder explained that the private plans routine denials forced Scripps’ medical groups to operate at a $75 million annual loss, adding: “That is why denials, [prior] authorizations, and administrative processes have become a very big issue for physicians and hospitals.”

Scripps is one of MANY health care groups around the country dropping Medicare Advantage plans. In the last month, medical groups in Ohio, Virginia, Oregon, Missouri, Oklahoma, and South Dakota have all terminated or partially terminated their contracts with Medicare Advantage plans, citing delayed reimbursements and administrative conflicts.

In August, Humana, which controls 18 percent of the Medicare Advantage market,POSTED a 38 percent increase in its profit from the same quarter in 2022, earning $957 million in one quarter alone. UnitedHealth - the largest Medicare Advantage insurer, CONTROLLING 29 percent of the market - POSTED $8.1 billion in profits, up $1 billion, or 14 percent, from the same period the prior year. Theenormous profits are driven by the substantial subsidies that Medicare Advantage offers the insurers.

Taking Advantage

The REPORT from PNHP is among the first to fully categorize the predatory costs that the private insurance plans impose on Medicare. It spells out four key ways that Medicare Advantage games the Medicare system for profit.

Favorable selection and deselection:

Researchers found that Medicare Advantage plans actively seek out healthier patients, targeting their marketing towards a healthier demographic in a process called “favorable selection” and “favorable deselection.”

While traditional Medicare accepts anyone who is eligible, private plans aggressively market to a healthier population and when high-need patients find that their Medicare Advantage plans won’t cover their health care costs, they often try to return to traditional Medicare.

This means that low-needs patients turn to Medicare Advantage, taking Medicare funding with them, while high-needs patients further strain the traditional Medicare system with elevated care costs.

The flat rates that the government pays to Medicare Advantage insurers is based on the costs of traditional Medicare participants, but traditional Medicare participants tend to be sicker. Research SHOWS that patients tend to switch to traditional Medicare as they get sicker due to Medicare Advantage plans narrow provider networks and restrictions on care.

The PNHP report CITES a 2019 study from KFF, finding that similarly situated seniors who switched to Medicare Advantage plans received $1,253 in less care in a given year than those who had stayed in traditional Medicare.

MedPAC FOUND in June that favorable selection for a healthier Medicare Advantage population resulted in 11 percent lower costs for Medicare Advantage plans, even as insurers get paid on the basis of the traditional, higher-need Medicare population. The report estimates that these overpayments cost Medicare $44-56 billion annually.

Upcoding:

Even though beneficiaries enrolled in Medicare Advantage plans tend to be healthier, the private plans systematically make their patients appear sicker to juice more profits out of Medicare.

As part of a complex formula, Medicare Advantage insurers receive “risk adjustment” payments when their patients have more severe conditions, strongly incentivizing the private plans to create records that indicate having sicker patients, a practice known as “upcoding.”

As The Lever COVERED in May, this fraudulent practice leads to $20 billion in additional spending per year - and generates more profits for insurers. The PNHP report cites a 2021 STUDY showing that risk adjustment payments are 20 percent higher in Medicare Advantage than traditional Medicare.

Quality benchmarks and county bonuses:

Currently, Medicare provides bonuses to Medicare Advantage plans based on the locations they cover, supposedly to ensure equal geographic access to coverage. But as MedPAC NOTED in its 2023 report, these payments “are not necessary for maintaining affordable supplemental coverage” and “fail to capture savings for the Medicare program.”

These payments are combined with bonuses that Medicare Advantage insurers receive for being higher “QUALITY.” Over half of all plans currently receive over four stars out of five, making them eligible for “quality” payments and the rating system is plagued with limited information, making it a poor performance measure.

A June 2023 REPORT from the Urban Institute found that “after weighting, about two-thirds of a contracts star rating is determined by beneficiary experience and administrative effectiveness,” and that “measures of beneficiary experience do not permit meaningful distinctions across [Medicare Advantage] contracts.” The report added, “Administrative effectiveness measures do not target important deficiencies regulators have identified within [Medicare Advantage] organizations.”

The PNHP report estimates that quality benchmarks and county bonuses may amount to $24-28 billion in annual overspending.

Induced utilization:

In traditional Medicare plans, only 80 percent of health care costs are covered - and 86 percent of traditional Medicare beneficiaries have some type of supplemental coverage, whether from a Medigap plan, an employer-sponsored health plan for retirees, or another form of supplementary coverage to cover the last 20 percent.

Medicare Advantage participants do not need supplementary coverage. This is an essential feature of the marketing of Medicare Advantage plans: Seniors accept the costs of narrow networks and managed care in exchange for not needing to pay the cost of supplementary coverage.

But Medicare makes spending assumptions for Medicare Advantage on the basis of significantly more comprehensive coverage than what the plans actually offer. That means that Medicare Advantage plans are paid using assumptions that they provide more care than they actually do.

The report estimates that these costs amount to $36 billion per year.

Experts say that the $140 billion these predatory practices are costing the government could instead go to reducing costs for seniors.

“Medicare Advantage overpayments could be rediverted into paying everybody’s [traditional Medicare] premiums, the money they’re paying every month out of Social Security,” said Weisbart, from PNHP.  It’s going directly into the profit lines of the Medicare Advantage companies without any additional health value.

He added, “If seniors understood that the $165 coming out of their monthly Social Security checks was going essentially dollar for dollar into profiteering of Medicare Advantage, they would and should be angry about that. We think that we pay premiums to fund Medicare. The only reason we have to do that is because we’re letting Medicare Advantage take that money from us.”

Analysts from Moodys Investor Service, a bond credit rating agency, suggested in March that they could expect slower growth in the overall insurance industry compared to 2022, but that they “expect continued growth in Medicare Advantage.”

SOURCE

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Another year of Medicare physician pay cuts is unconscionable

AMA News Wire
October 4, 2023

Whats the news: The AMA is making loud and clear that the 3.36% cut in the proposed 2024 Medicare physician pay schedule is bad policy that threatens access to high-quality physician care for the over 50 million older adults enrolled in Medicare.

“With higher costs for everything associated with practicing medicine, another year of Medicare payment cuts jeopardizes patient access and imperils the physician practices on which communities rely,” said AMA President JESSEE M. EHRENFELDT, MD, MPH. “These cuts are unsustainable and unconscionable.”

In a 120-page COMMENT LETTER (PDF) to the Centers for Medicare & Medicaid Services (CMS) concerning the Medicare physician payment schedule, the AMA noted that physicians are facing a triple whammy as pay reductions are pending on several fronts.

The proposed 3.36% cut is attributable to two factors. One is a 1.25% reduction stemming from a temporary legislative update and the other is a negative budget-neutrality adjustment linked to the introduction of a CMS-developed office visit add-on code.

Why its important: Even before rampant inflation and an epidemic, physicians were facing an unsustainable trend. When adjusted for inflation, Medicare physician payment already has effectively DECLINED (PDF) 26% from 2001 to 2023 before additional inflation and these cuts are factored in. Additionally, physicians saw a 2% pay cut in 2023. Physicians are one of the only providers without an automatic increase to account for inflation.

SOURCE

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If You Don’t Know Medicare Advantage Is a Scam, You’re Not Paying Attention

Were on the edge of the open enrollment period for Medicare, and the Advantage scammers will be carpet-bombing America with advertisements over the next few months. Don’t be fooled about what it is - and who is profiting.

By Thom Hartmann
Common Dreams
October 7, 2023

President George W. Bush and Republicans (and a handful of on-the-take Democrats) in Congress created the MEDICARE ADVANTAGE scam in 2003 as a way of routing hundreds of billions of taxpayer dollars into the pockets of for-profit insurance companies.

Those companies, and their executives, then recycle some of that profit back into politicians’ pockets via the CITIZENS UNITED legalized bribery loophole created by five corrupt Republicans on the Supreme Court.

Just the overcharges happening right now in that scam are costing Americans over $140 billion a year: more than the entire budget for the Medicare Part B or Part D programs. These ripoffs - that our federal government seems to have no interest in stopping - are draining the Medicare trust fund while ensnaring gullible seniors in private insurance programs where they’re often denied life-saving care.

Real Medicare pays bills when they’re presented. Medicare Advantage insurance companies, on the other hand, get a fixed dollar amount every year for each of the people enrolled in their programs, regardless of how much they spent on each customer.

As a result, Medicare Advantage programs make the greatest profits for their CEOs and shareholders when they actively refuse to pay for care, something that happens frequently. It’s a safe bet that nearly 100 percent of the people who sign up for Advantage programs don’t know this and don’t have any idea how badly screwed they could be if they get seriously ill.

The doctors’ group Physicians for a National Health Program (PNHP) just published a shocking report on the extent of the Medicare Advantage ripoffs - both to individual customers and to Medicare itself - that every American should know about.

The report, titled OUR PAYMENTS, THEIR PROFITS, opens with this shocking expose:

Not only that, when people do figure out they’ve been duped and try to get back on real Medicare, the same insurance companies often punish them by refusing to write Medigap plans (that fill in the 20% hole in real Medicare). They can’t do that when you first sign up when you turn 65, but if you “leave” real Medicare for privatized Medicare Advantage, it can be damn hard to get back on it.

“By our estimate, and based on 2022 spending, Medicare Advantage overcharges taxpayers by a minimum of 22% or $88 billion per year, and potentially by up to 35% or $140 billion. By comparison, Part B premiums in 2022 totaled approximately $131 billion, and overall federal spending on Part D drug benefits cost approximately $126 billion. Either of these - or other crucial aspects of Medicare and Medicaid - could be funded entirely by eliminating overcharges in the Medicare Advantage program.

“Medicare Advantage, also known as MA or Medicare Part C, is a privately administered insurance program that uses a capitated payment structure, as opposed to the fee-for-service (FFS) structure of Traditional Medicare or TM. Instead of paying directly for the health care of beneficiaries, the federal government gives a lump sum of money to a third party (generally a commercial insurer) to ‘manage’ patient care.”

With real Medicare and a Medigap plan, you talk with your physician or hospital and decide on your treatment, they bill Medicare, and you never see or hear about the bill. There is nobody between you and your physician or hospital and Medicare only goes after the payment theyve made if they sniff out a fraud.

With Medicare Advantage, on the other hand, your insurance company gets a lump-sum payment from Medicare every year and keeps the difference between what they get and what they pay out. They then insert themselves between you and your doctor or hospital to avoid paying for whatever they can.

Whatever you decide on regarding treatment, many Advantage insurance company will regularly second-guess and do everything they can to intimidate you into paying yourself out-of-pocket. Often, they simply refuse payment and wait for you to file a complaint against them; for people seriously ill the cumbersome “appeals” process is often more than they can handle.

As a result, hospitals and doctor groups across the nation are beginning to refuse to take Medicare Advantage patients. California-based Scripps Health, for example, cares for around 30,000 people on Medicare Advantage and recently notified all of them that Scripps will no longer offer medical services to them unless they pay out-of-pocket or revert back to real Medicare.

Scripps CEO Chris Van Gorder told MEDPAGE TODAY:

“We are a patient care organization and not a patient denial organization and, in many ways, the model of managed care has always been about denying or delaying care - at least economically. That is why denials, [prior] authorizations and administrative processes have become a very big issue for physicians and hospitals...”

Similarly, the Mayo Clinic has warned its customers in Florida and Arizona that they wont accept Medicare Advantage any more, either. Increasing numbers of physician groups and hospitals are simply over being ripped off by Advantage insurance companies.

Not only is the Medicare Advantage scam a screw job for healthcare providers and people who are on the programs and are unfortunate enough to get sick, itҒs also preventing Americans from getting expanded benefits from real Medicare.

As the PNHP report notes, for real Medicare to provide comprehensive vision, dental, and hearing benefits to all Medicare recipients would cost the system around $84 billion a year, according to the Congressional Budget Office.

Instead, though, the Medicare system is burdened with at least that amount of money in over-payments to Medicare Advantage providers - over-payments that have no health benefit whatsoever and merely inflate the companies’ profits.

A hundred billion dollars in excess profits can be put to a lot of uses, and the health insurance industry is quite good at it. The former CEO of UnitedHealth, DollarӔ Bill McGuire, for example, made off with OVER 1.5 BILLION DOLLARS for his efforts.

And, because five corrupt Republicans on the Supreme Court legalized political bribery with their CITIZENS UNITED DECISIONS, some of these companies allocate millions every year (a mere drop in the bucket) to pay off loyal members of Congress and to dangle high-paying future jobs to high-level employees of CMS who have the power to keep the gravy train going and thwart prosecutions.

As PNHP NOTED:

“Medicare Advantage is just another example of the endless greed of the insurance industry poisoning American health care, siphoning money from vulnerable patients while delaying and denying necessary and often life-saving treatment. While there is obvious reason to fix these issues in MA and to expand Traditional Medicare for the sake of all beneficiaries, the deep structural problems with our health care system will only be fixed when we achieve improved Medicare For All.

Were on the edge of the open enrollment period for Medicare, and the Advantage scammers will be carpet-bombing America with advertisements over the next few months. Representatives Pocan, Khanna, and Schakowsky have introduced the “Save Medicare Act” that would ban Advantage companies from using the word Medicare in their advertising.

They made a VIDEO about it that’s well worth sharing with friends and family:

As Schakowsky, Khanna, and Pocan note, “Only Medicare is Medicare.” Dont be fooled by the Medicare Advantage scam.

SOURCE

Posted by Elvis on 10/05/23 •
Section Dying America
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