Who is really cutting Medicare Advantage?

This Wall Street Journal editorial is misguided and directly conflicts with a major investigative report on Medicare Advantage (MA) plans done by the paper in August. While it is true that Medicare is making it more difficult for MA plans to overcharge Medicare, these plans are still making tremendous profits while harming providers with low payments and hurting patients by denying coverage. The best evidence of this point is the massive advertising push by MA plans during this fall's open enrollment. 

As the WSJ’s own Investigative Report clarifies, MA plans manipulate the coding system to increase their payments. This editorial describes Medicare's efforts to reduce that coding manipulation as Kamala Harris making cuts to Medicare. The real problem that all these stories have in common is that coding is exceedingly complex and, therefore, open to manipulation. The only reform that will meaningfully address these problems is to stop using coding for payment to providers or insurers. There are alternative solutions - go to www.thejourneys-end.org for information on those solutions.

My health wish list for the next administration

A new health reform movement is on the rise, led by two Stanford surgeons, Casey and Calley Means, and a Johns Hopkins surgeon, Marty Makary. They both have authored best-selling books which detail their research (the Means' book isn’t #1 on the NYT list). Ironically, their research powerfully illustrates that the US food system, the overuse of drugs and the health systems’ economic incentives are the primary cause of our health system crisis. 

For example, the US food system adds up to 10,000 different chemicals to our food - often designed to create addiction/overeating. Compare this system to Europe, where only 400 chemicals are allowed in the food system. These experts argue that food toxins are a more significant issue impacting health than smoking!

Or let’s look at our healthcare economic incentives. The “quality and merit” criteria used by Medicare for physicians in MIPS and QQP and also used for Medicare Advantage Plans and ACOs have all the wrong incentives. These specific quality metrics are primarily based on whether doctors prescribed drugs regularly or did more interventions. Yet there is no evidence that these practices have improved health outcomes. These measures are process measures - not outcome measures. This criticism applies to hundreds of metrics for a multitude of conditions 

Not only does this “quality and merit system” not work, it costs billions in terms of administrative cost. The worst impact of this system is that doctors spend more time completing administrative work than they do seeing their patients. No wonder we have a physician morale problem.

Or let’s look at drug utilization. The only countries in the world that allow pharma to advertise directly to the public are the US and New Zealand. The average American sees nine drug ads a day. Pharma is the largest media advertiser so a media investigation into this problem is unlikely. These ads allegedly inform consumers, but evidence suggests they mislead consumers and interfere with the physician-patient relationship.

My book www.thejourneys-end.org has a similar focus, essentially that healthcare has medicalized death by over treating the elderly. This over treatment is heavily related to the health systems' economic incentives and the overuse of pharma. 

Combining the Means’ wish list for the next administration with the wish list in my book would be both feasible and a powerfully positive approach to reforming healthcare.

Why improving primary care matters

Here's another compelling argument that describes how improving primary care is the key to improving healthcare.