Direct conversations are something everyone wants, but rarely gets.
At a meeting of medical scientists in Las Vegas earlier this month, I had the opportunity to have a fire health chat with Sachin Jain, CEO of Scan Health Programs, to talk about the current situation of Medicare. Although he praised the benefits of Medicare Advantage, he did not shy away from the thorny questions about the program and even agreed that the program needed to change.
Scan is a nonprofit health insurance advantage health program with annual revenue of $5.5 billion and a member base of 301,000 seniors. Watch the full video below:
I'm the first to call my baby ugly (Video timestamp 22:01)
Medicare Advantage is considered a way to reduce health insurance costs and provide more options for older people. However, the program is on the explosive popularity of explosives – more than 54% of the eligible Medicare population has been included in the MA program but has not yet fulfilled its initial task of reducing federal government costs.
The Medicare Payment Advisory Committee (MEDPAC), an independent congressional body, predicts that in 2025, the federal government will spend about $84 billion on MA participants, who are being recruited for traditional health insurance. This means that spending on MA plans has increased by 20%. Therefore, from this fact alone, the reason why the Rai son d'ê terre or became a horse seems to be wrong.
Additionally, KFF (Kaiser Family Foundation) conducted an analysis in 2022, and since 2016, it has been analyzed in 62 studies on MA and Medicare and concluded that there are few major differences between the two plans. Of all quality measures, MA and traditional Medicare have not performed consistently than others.
When asked about this, Jain initially took a defensive tackle and provided economic reasons to refute the data and the question.
“I actually care about people’s affordability,” Jaen retorted. “In fact, there’s nothing to talk about people’s out-of-pocket expenses.”
As the audience burst into applause, he continued:
“At the end of the day, we have to consider beneficiaries, we have to consider what they can pay and what they can afford.”
In the interview, Jain described the affordability crisis of traditional health insurance. He described a married couple with an average income of about $54,000 and eligible for Medicare, who had to pay a B premium of $184 per person per month and then had them pay D Part Perferscribe drug coverage and supplemental benefits.
“So, they spent their entire lives paying Medicare taxes … at the end of their lives, they were lucky enough to pay $12,000 of their $54,000 in revenue to pay for their health,” Jain explained. “So, it's a fundamentally broken system that doesn't look like Harry Truman initially imagined when he imagined Medicare's plan.”
He said that it is precisely in the absence of affordability that MA should be compared with Medicare. But at the same time, Jah's believers did not hide the practical problems within MA – the cost and the “evil practice” of cheating the elderly. These even led to calls for the removal of the term Medicare from the Medicare Advantage.
“I think the program is expensive, I think we need to address every aspect of it, and there are some bad actors who run away with the risk adjustment, and we need to address that. Evaluating the game at home is out of control. We offer a lot of supplemental benefits that people don't use. Ugly.”
He later added that MA “maybe the cost may be higher, but it may also be because it does more, it's just something we're talking about, that's what we should do more for the elderly in this country.”
Dr. Oz's opinion on Medicare Advantage broker (Time stamp: 26:59)
When a medical staff meeting was held in early April, the Senate has not confirmed Mehmet Oz's leadership of the Center for Medicare and Medicaid Services. Many conference participants don’t know the fact that Oz is one of them – The New York Times reported in February that Oz is a licensed broker capable of selling MA plans in more than 20 states.
Jack Ma’s theme was raised by Oz himself at the end of the Senate confirmation hearing. When Senator Ron Wyden (D-oregon) asked Oz that he believed that “the biggest abuse is now the biggest abuse in the private insurance sector”, Oz responded to “the sales of Medicare Advantage.”
Oz went on to add that the sale of insurance brokers with different policies so that older people can continually switch from one MA plan to another – should be studied. He noted that if older people don’t have to choose a plan every year, then maybe they can save some money from their current broker’s pockets. He added that there may be too many MA agents, some are good and some are bad.
When asked to respond to this, Jain returned to the same way there were good brokers and bad brokers, good journalists, bad journalists, good CEOs and bad CEOs. He did admit that some bad brokers gave the industry a bad name and then decided to call for action to hundreds of brokers in the audience.
“I’ve been this suggestion for a while…this is the idea that we should recast the broker’s
– Because I think brokers just mean that all you do is sell things – as a community health worker. Because what you are doing can really help people navigate a truly complex healthcare system. So, I do think we need cultural change in this industry.
