Diagnosis for Democracy
Insights into the State of Our Union
A Blog by Rob Tenery, MD


April 30, 2014: The Reverend Jessie Jackson and Geronimo

By Rob Tenery, MD on April 30, 2014

What would be the response be from the Muslim community if a health care insurer decided that it would decrease the reimbursement for hospital care of their Muslim policyholders, if they were readmitted for the same diagnosis within thirty days of their last discharge? Incidentally, the insurer did not apply that same rule to their Christian patients. Would not the Muslim clerics loudly protest or worse?

What if only black patients, and not any other patients, who were admitted to hospitals for observation and limited diagnostic studies, had to comply with the ‘two-midnight’ rule for their health care insurance to cover their stay? Would the Reverend Jessie Jackson and other leaders in the black community stage a protest march in Washington?

Would the leaders in the ‘gay’ community be silent if practitioners were reimbursed 25% less when they treated gay patients?

Would the women’s lib contingency stand idly by if health plans that specifically targeted medical issues in females faced disproportionate funding decreases while other plans went untouched?

Finally, what if the patients of the Indian Health Service were forced to use preferred pharmacy networks even though their out of pocket costs would be significantly higher? Do you wonder if the leaders of the Native American Community might consider closing all the roads, including the Interstate highways, through their reservations to public transportation in protest?

Although each of these examples seems farfetched, they are close to the truth. The only difference is that these individuals from the Muslim, black, gay, female and Native American communities are limited to the seniors in their community--- the seniors who are enrolled in the Medicare program. For each of them, all of these five scenarios are potentially real. The difference is their needs go almost unnoticed, not because of their religious preference, color of their skin, gender or ethic background, but because they are over 65.

For most senior citizens the Medicaid, Medicare and Medicare Advantage programs are single-payer models that are run by the federal and state bureaucrats under the auspices of the administration through the Centers of Medicare and Medicaid Services (CMS). As the ‘only game in town’, they promulgate these discriminatory rules, because they can.

 Where is the outcry on behalf of the seniors? Where is the Reverend Jessie Jackson, a Gloria Steinem or a Geronimo to come to their rescue?

It’s not AARP! Their members were thrown ‘under the bus’ when AARP’s Board of Directors threw their support behind President Obama’s health care plan. They didn’t seem to care that over $700 billion would be diverted away from projected Medicare funding over the next ten years. To the Board of Directors of AARP, it has always been about the money. Through its subsidiary company, AARP was one of the main suppliers of Medi-gap insurance, a privately purchased coverage that picked up where Medicare benefits left off. The George W. Bush administration passed the Medicare Advantage program that was a lower-cost alternative to the Medi-gap coverage. More than 11 million seniors took advantage of the program that significantly cut into the AARP Medi-gap revenues. President Obama eliminated subsidies for the Medicare Advantage program that made the more-expensive Medi-gap coverage more competitive.

What about the American Medical Association (AMA) and the American College of Physicians (ACP)? Current AMA policy supports adequate funding for the Medicare program and opposes further reductions of current Medicare limiting charges.  However, it seems that both of these influential organizations felt that achieving a permanent fix to the Sustainable Growth Rate (SGR) was more important than fighting to block this diversion of projected Medicare funding away from the seniors and to the ‘newly’ insured under Affordable Care Act. As a side note, have these organizations achieved their goal of a permanent fix for the SGR by throwing their support behind the President’s health care plan? No!

So who fights for the seniors’ interests? The answer is the seniors themselves, who really have no effective organizational model after AARP traded their best interests for company profits. They do have the representatives that they elected to their statehouses and Washington DC--- these same representatives that were also elected by and are also beholding to many other interests in the community.

These discriminatory regulations by CMS and mandates under the authority of the ACA are examples of how sectors of underrepresented populations fall prey to the dictates of a few when competition is eliminated from the marketplace. Today, it is the seniors.

Tomorrow, who knows?




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