Is Medicare Advantage for Suckers?

I guess I've insulted those on Medicare Advantage plans by calling them them suckers. Let me back out of this a little by saying that if you have a complete understanding of Medicare Advantage and still signed up for it, I am wrong to call you a sucker and I apologize!

Having said that, I am convinced that most people who have Medicare Advantage or are considering it have no real understanding of it because of the extremely deceptive advertising practices throughout the insurance industry.

In my opinion, if you really understood Medicare Advantage, you may well want to switch to Original Medicare (if possible) or avoid Medicare Advantage as an initial choice upon reaching 65. Indeed, there are those like liberal commentator Thom Hartmann who believe that Medicare Advantage Is a For-Profit Scam - Time to End It

Medicare Advantage is a massive, trillion-dollar rip-off, of the federal government and of taxpayers, and of many of the people buying the so-called Advantage plans.

It's also one of the most effective ways that insurance companies could try to kill Medicare For All, since about a third of all people who think they're on Medicare are actually on these privatized plans instead.

I have no financial interest in what you choose, but hope after reading on, you will make an informed decision whatever it is.

'Tis the season! Not just the holiday season but for the health insurance industry, something far more important - open enrollment season for Medicare Advantage, October 15 to December 7. The media is saturated with seemingly non-stop ads for Medicare Advantage. And just about all of them are deceptive in their own way. This is what pissed me off enough to do this blog posting.

It's important to note that there are no outright lies in any of the ads. That might get them in trouble! Instead, they are an endless stream of true but deliberately misleading messages.

Examples? Check these out!

Need help deciding on a Medicare plan? Call and talk to me, your [insert insurance company] Medicare advisor!

An advisor is understood as being a source of unbiased advice on selecting the right Medicare plan for that person. But this so-called advisor is paid to get you to sign up with the company that pays his salary. The word 'salesman' is a lot more honest.

[Here in the Pittsburgh area] If you sign up with the UPMC for Life [Medicare Advantage] plan, you get access to all of the world class UPMC doctors and hospitals!

True enough but misleading. Virtually all of the UPMC doctors along with most others accept all Medicare patients. So you don't have to enroll with the UPMC plan to get access to these same doctors.

The worst is all of the claims of what you can get for free from many Medicare Advantage companies. $0 monthly premiums. Free dental. Free vision. Free fitness club memberships. Free rides to the doctor. Some even promise to refund the $148.50 per month that is deducted from monthly Social Security benefits for all who have Medicare. Get all the benefits you have coming to you! Call today!

Everything for free? Unlimited benefits? Does this sound too good to be true? As they say, if it sounds too good to be true, it likely is. It's hard not to notice that these insurance companies are spending ad money by the bushel to get us as customers. Surely, they must be making enough money selling these policies to make them worthwhile. And they are. But how? They certainly don't say so in the ads.

One clue was provided by the UPMC 'advisor' trying to steer me toward one of his Medicare Advantage plans. As long as I stay healthy, I'm saving money with Medicare Advantage. Which is absolutely true! But again, utterly misleading!

The problem is that if you get sick and have to go to the hospital and possibly need surgery, there can be some nasty copays on the back end. They are going to get their pound of flesh one way or another! There is a usual annual out of pocket maximum of about $6,700. But if your illness lasts into a second calendar year, a new out of pocket maximum kicks in. Getting really sick can trigger some nasty bills. And unfortunately, as we get older, we are more likely to get sick.

I instead pay $120 per month for my selected Medicare supplemental insurance. (This will vary depending on your desired level of coverage.) In addition, I need to buy Medicare Part D prescription drug insurance for about $30 per month. Some of the brand name drugs can be pricey. Regrettably, Medicare is legally prohibited from negotiating drug prices with big pharma. It's not perfect. Medicare Advantage offers everything without requiring separate policies so it's one stop shopping. But despite what is claimed in some of the ads, that doesn't necessarily make it a better choice.

So the bottom line is that I pay more up front in premiums than those on Medicare Advantage. But the back end charges are minimal. I can't afford any financial calamities so this works for me. If the lower up front charges are more appealing and you can afford the possible back end billing, go for it! But make sure you understand how Medicare Advantage really works and don't sign up just based on the misleading ads.

Another major difference with Medicare Advantage is that it's managed healthcare. To keep costs down, patients are restricted to a network of providers and hospitals. Procedures and referrals to specialists beyond basic care can be subject to approval by the insurer. Visits to out of network providers may not be covered at all. Many retirees spend time away from home traveling or staying with friends, children and/or grandchildren. Getting sick while out of town may make covered in network providers inaccessible.

So how about going with the less upfront costly Medicare Advantage at age 65 and then moving to Original Medicare with the Medicare supplemental insurance later on when there is more of a chance of getting sick? Not so fast! In later years past age 65, getting the Medicare supplemental insurance runs into obstacles. There are higher premiums by age and health questions to navigate. Someone with too many health problems may be rejected. On the other hand, new Medicare applicants at age 65 get their choice of insurance plans with no questions asked.

Before I turned 65, I imagined that once I got on Medicare, my health insurance needs would be met and I would no longer have to worry about private insurance. That turned out to be a fantasy. When Congress created Medicare back in the 60s, they made sure that private insurance companies would not be totally left out of the party. Original Medicare covers a lot but the coverage gaps make it an unsuitable risk on its own without either private Medicare supplemental insurance (aka Medigap) or the leap to Medicare Advantage which turns everything over to private insurance with Uncle Sam paying the insurer to take over its coverage.

Negotiating the jungle of private insurance options can be daunting. A site like medicare.gov allows individuals to research and eventually directly sign up with a chosen insurer. But finding a (hopefully trustworthy) insurance agency that works with health insurance is an easier way to go. The cost to the end customer is the same either way.

In closing, I would like to offer the reader the following link: Medicare Advantage Is Cheaper for a Reason - Beware!

Take This Job and Shove It!

Of course, I didn’t make up this title. It was a 1977 hit song by Johnny Paycheck. It is still well known today and has generated countless memes like this one.

Take this job and shove it

I ain't working here no more

Songs of grievance about the workplace are nothing new. Despite some who have all of a sudden discovered that the American labor market really sucks (especially compared to other countries), others will tell you that it’s been very bad for a long time, especially for those on the bottom of the food chain.

There are an uncountable number of workplace grievance songs. But let me share a couple of songs from the past that are my favorites.

Natural Man - Lou Rawls 1971

I don't want no gold watch for working fifty years from nine till five

While the boss is guzzling champagne and I'm belting beer in some dive

'Cause I want to be

Happy and free

Living and loving for me

I want to be

Happy and free

Living and loving for me

Like a natural man

The last song is about coal miners. For those in rural America, it paid well compared to other jobs. But it was a dirty and dangerous job so whether these workers were fairly paid is open to question. One part of living in a remote coal town was the company store.

Company stores have had a reputation as monopolistic institutions, funneling workers' incomes back to the owners of the company. This is because company stores often faced little or no competition for workers' earnings on account of their geographical remoteness the inability and/or unwillingness of other nearby merchants (if any existed) to accept company scrip, or both. [Of course, this was long before Amazon!] Prices, therefore, were typically high. Allowing purchases on credit enforced a kind of debt slavery, obligating employees to remain with the company until the debt was cleared.

So now you can better understand…

Sixteen Tons - Tennessee Ernie Ford 1946 

(Introduction by Dinah Shore)

You load 16 tons, what do you get?

Another day older and deeper in debt

St. Peter, don't you call me 'cause I can't go

I owe my soul to the company store

It is a phenomenon going on all over the US. ‘HELP WANTED’ signs everywhere but seemingly not enough applicants to fill these jobs. The restaurant/hospitality industry has been hit especially hard with many fast food restaurants doing drive-thru only while closing their dining rooms (long after covid lockdowns ended). In addition, a number of full service restaurants that have stayed open through the pandemic are now closing several days a week because of their labor shortages.

What the hell is going on? Labor shortages are affecting many industries for various reasons - too many to discuss here. One of the largest and most important employers in the US is the restaurant industry. So now, let’s focus the discussion here while noting their problems also apply to other industries, most notably retail.

Much has been written on what makes restaurant employment so problematic for many so I will only mention these in passing:

• The pay sucks
• Working hours are inconsistent
• Working conditions can be both physically and mentally stressful
• Often no benefits like health insurance, vacation, or sick days
• Notorious for sexual harassment

Because of those reasons among many, people left these jobs during the pandemic to retrain for others, vowing to never return to restaurant work for any wage!

Much of this is a symptom of American exceptionalism - but not in a good way!

Americans are paid far less than equivalent workers in other countries.

I have heard restaurant owners say that if they decided to pay their workers a living wage they would then be placed at a competitive disadvantage. That may well be true. But that’s why we need effective minimum wage laws! If all employers were forced to pay a higher minimum, the workers would get more and no employer would be at a competitive disadvantage.

Of course there are naysayers about a minimum wage, most of a conservative bent. Raise the wage and people will be put out of work? If we raised the minimum wage to $1 million an hour, that would effectively destroy everything. But the present national minimum wage of $7.25 an hour is ridiculously low. Some may say that $15 an hour is too much. Certainly, there is a reasonable compromise here.

The price of goods and services will go sky high. A Big Mac will cost $10! Most of the cost of an article you buy does not go to labor but to other overhead. It varies but according to this article labor costs are around 20 to 35 percent of gross sales. So what about that Big Mac? Where I live in the land of the $7.25 minimum wage, a Big Mac costs about $4. In Seattle with a $16 minimum wage, a Big Mac goes for about $6. Two things to say about this. I love a bargain as much as anybody - but not relying on slave wages. If a modest price increase means that workers are paid more fairly, count me in! Also, if everyone were getting paid at least $16 an hour, a $6 Big Mac wouldn’t be a hardship for anybody, would it?

It has been pointed out by many that when an employer doesn’t pay a living wage or provide health insurance, the worker often needs public assistance to get by. But instead of criticizing the worker as being a sponger off the system, why not call it like it is - corporate welfare. This public assistance allows the employer to get away with substandard pay and benefits.

As is well known, America is the only industrialized country without universal health insurance for its citizens. There are all too many who cling to a job they may well hate because they don’t want to lose their health insurance. Obamacare has helped somewhat but it’s still too expensive for many. You would think that corporate America would love Medicare for All, relieving them of administration and expenses associated with health insurance. But for the most part, they don’t knowing that the health insurance they provide helps to keep employees from straying away to greener pastures.

The minimum wage can act as a union for low wage workers. But many others need the leverage that a union provides so that a worker can have a fighting chance in negotiating wages and benefits with an employer. If the American worker ever had it good it was during the 50s through the 70s when unions were far stronger than they are now. When President Ronald Reagan, former president of the Screen Actors Guild fired the air traffic controllers, he likely had no clue of what this would do to destroy the union movement in America. Union membership has fallen drastically since then. So instead of workers getting the raises they deserved, the money gets sucked upwards to the executives and large stockholders. Most economists believe this is a major contributor to the wage and wealth inequality that is dogging America.

Regrettably, anti-union sentiment has predominated much of the public discourse. Unions are greedy, corrupt and just plain useless in the eyes of most conservatives. Former Wisconsin Governor Scott Walker had an obsession against unions. To big businesses like Walmart and Amazon, unions are a mortal enemy to destroy. States with Republican legislatures are passing something with an Orwellian description, Right-to-Work Laws. With this, workers are no longer required to pay unions who are representing them. If there are enough free riders, the union may well be starved out of existence - which is the point of the legislation.

On the other hand, CEOs and other large stockholders who walk away with most of the money are worshiped on the right as ‘Job Creators’. But truth be known, the real job creators are consumers like you and me. When we want to buy stuff, people must go to work to produce and sell those goods. Here’s another truth. Corporations only hire and expand capacity when they can’t meet demand for their products. When money is thrown at corporations to entice them to hire and expand like the Trump tax cuts, the corporations pocket the money and say thank you followed by buying their own stock back to increase its value. Workers get zilch, nada, nothing!

There are other areas where American workers are pitifully behind the rest of the industrialized world like vacation time, sick pay, and maternity leave for example. But that is a discussion for another time.

In fairness to the employers, there are problems that are beyond their control in enabling them to hire the people they need.

One is a mainly conservative narrative that since President Biden was paying people to stay home during the pandemic, people no longer want to go back to work. This sounds plausible, but in many states the benefits have expired. There wasn’t the expected big rush of new job applicants. So this explanation appears inadequate.

Perhaps the biggest obstacle to more hiring is childcare. Many of the women laid off during the pandemic had jobs on the lower end of the labor scale that could not be done remotely. These women then had to do full time childcare and perhaps help tutor their children who may have been struggling in their exclusively online education.

So now what do they do? Assuming they feel safe upon returning to work and feel the children will be safe going back to school, two big ifs, there is the problem of finding affordable childcare. A lower income woman getting a job and spending most of the additional income on childcare obviously makes no sense. So most of these women thus far are staying home instead of reentering the workplace. President Biden wants to offer government benefits to assist with childcare for these people. But you know there will be yells of Socialism! Socialism! to make this a challenge to achieve. For readers who want to explore this more in depth, please check out this excellent background article for more info.

Before the pandemic, there were many American workers who were stuck in jobs that made them miserable but they stayed because they saw no other alternative. The pandemic has taught us that life is too short and too fragile to live this way. Many of us have decided to hold out for the right job at the right pay. Some households have cut back from a two earners to a one earner standard of living in the hope of a better quality of life at home. Employers are slowly starting to respond by finally raising pay. But inflation is eating up any of those gains so it’s not so easy to resolve this standoff between employers and potential workers.

During the height of the pandemic there were workers who had to do the stuff we needed in order to eat while the lucky among us could work remotely. We saluted these ‘Essential Workers’ and promised that once the pandemic ended, they would be recognized and paid accordingly. They’re still waiting.

As Rodney Dangerfield would say, the workers of America for the most part don’t get no respect. No respect at all! That has to change. There is a positive sign in the near future. A group of about 60,000 members of a union known as IATSE are fed up with their miserable pay and working conditions and are threatening to go on strike this Monday if they don’t get a deal. A work stoppage would shut down film and television production across the US.

Whether they will succeed is unclear at the time of this posting. But it’s nice that the American worker is finally flexing his muscles. It’s about time that the American worker finally shouts out, I'm mad as Hell and I'm not going to take this anymore!