Organizations like the American Association of Retired Persons
commonly known as AARP were in theory designed to look out for
the best interests of elderly Americans and
protect them against predatory schemes in this country of which there are many.
In reality, though, the AARP is aiding in abetting the privatization
of Medicare and most people are completely in the dark about it.
So, this piece was written in Jacobin and I think it's an excellent piece.
I hope that people become increasingly privy to what's going on, but
it has to do with Medicare advantage, okay?
Medicare Advantage is basically something that was put in place in January of 1999,
and it is a private alternative to Medicare.
And it was designed to work like this, so,
if private insurers with Medicare Advantage are able to provide care
at a lower cost than what the federal government pays them,
then they get to keep some of that federal money as profit.
Which, I mean, that is insane.
It is insane that it works that way, okay?
Thereby incentivizing these insurers to keep their costs down, okay?
At least that's what the lawmakers claimed the program was supposed to do.
But let's see what actually happened, okay?
In the years since the creation of Medicare Advantage,
providers have repeatedly told medical professionals to exaggerate
the severity of their patient's medical conditions, thereby allowing
these insurers to collect more federal money, meaning our taxpayer money.
So, let's just call it what it is, they're committing fraud.
They're committing fraud to rip off the government of our taxpayer money.
That's what's happening.
Okay, so, let's take a quick look at this chart,
which I think is very helpful in helping us determine which of these
private insurers that have the Medicare Advantage program,
which ones are actually engaged in some pretty questionable activity.
So, with UnitedHealth Group, they were accused of fraud by a whistleblower.
They were also accused of fraud by the US government and
they also overbuild according to the Inspector General.
With Humana, they were accused of fraud by a whistleblower.
They were also accused of overbilling according to the General Inspector.
So, all of these groups with the exception of Centene,
which I've never heard of in my life, have at least one violation.
But UnitedHealth Group has all three, okay?
Now that blatant fraud has huge consequences for us, the taxpayer, okay?
The additional diagnoses lead to $12 billion in overpayment in 2020
according to an estimate from the group that advises Medicare on payment policies,
which is enough to cover hearing and vision care for every American over 65.
Another estimate from a former top government health official suggested
the overpayments in 2020 were actually double that, more than $25 billion.
Regulators at the Centers for Medicare and Medicaid Services, they're supposed
to have a kinda serve like a watchdog group that cracks down on this fraud.
But they haven't, which is really interesting.
Apparently, Congress gave the agency the power to reduce the insurers'
rates in response to evidence of systematic overbilling, but CMS,
that Centers for Medicare and Medicaid Services, has never chosen to do so.
A regulation proposed in the Trump administration to force
the plans to refund the government for
more of the incorrect payments has not been finalized four years later.
Several top officials have swapped jobs between the industry and the agency.
So, the revolving door is happening, the industry meaning the private
insurance companies that's corrupt and should not be allowed.
But it is.
And as a result,
this so-called watchdog group is not doing any of the watchdog at all.
So, John, I'm gonna get to how AARP is involved in just a moment, but
I wanted to give you an opportunity to comment on what we've learned so far.
>> Well, first of all,
I've learned that watch-dogging used in that way is hilarious.
I've never heard [INAUDIBLE] used in that fashion.
I think that we really need to normalize it.
But anyway, so first of all, I'm glad that you were talking about the story,
outside of this show I had not heard anything about this and
it's not really difficult to figure out why.
Basically, every aspect of this story is something that the media would either be
disincentivized to actively talk about.
And there, I'm talking mostly about the way that a lobby is functioning,
how it might be changing,
that's not the sort of topic that they're generally gonna dive into.
It's also about generally the concerns of much older people draws less attention.
It's easy for people to be bored by a story like this.
But it is obviously important because they do represent a lot of people and
this it's a massively important organization has been for a long time.
This really cuts to one of what should be the core policy-based
concerns or certainly,
it would be of the most interest to the people that this lobby represents.
And it's also easy to imagine that people who might even
be active participants might not know that this sort of shift is
happening in terms of the position that AARP is taking on this.
We've seen this in some other areas.
I mean, there can be huge lobbies like the NRA that in one era
represent a certain sort of thing.
And then gradually leadership changes and
financial incentives changing can represent a totally different thing.
The membership doesn't necessarily get that.
They're not necessarily following what the leadership of the organization is doing.
I'm glad that you're pointing out the fraud.
My worry would be that again, because of how big an organization this is,
that there might be less incentive for
legislators to actually take it seriously to get involved, that's-.
>> That mean, John, it's not just that.
I mean, sure that might have some impact on why Congress
is refusing to act on this.
I mean, they're stealing from the federal government.
That's what's happening.
It's fraud.
I mean, authorities pat themselves on the back
anytime they bust a Medicare fraud ring.
But the private insurers are engaging in fraud and it's widespread and
it's well known, but they're not doing a damn thing about it.
In 2019, for instance, 70% of the House in Senate signed
a letter just to show their support for Medicare Advantage,
which again, is the privatized option for Medicare, okay?
And I should also note that look,
I don't think they're doing anything about it because why would they?
I mean, the reason why you see widespread support for
this privatized Medicare model and that of course includes Democrats, is because
they're controlled by the same corporate interest by the same healthcare lobby.
So, Democrats and Republicans are gonna keep providing cover for these
insurers who are defrauding the American people and stealing our resources.
That is what they're doing.
I also want to just quickly note that in 2019 the same year where
70% of Congress members signed that letter to show support for
Medicare Advantage, the Inspector General's Office reviewed
430 instances of Medicare Advantage denying care to patients.
And found that 13% of those requests should have been approved.
Now, 13 percent doesn't sound that bad, right?
But then you kind of break it down numbers-wise, based on its finding that
about 13 percent of the request denied should have been covered under Medicare,
the investigators estimated as many as 85,000 beneficiary requests for
prior authorization of medical care were potentially improperly denied in
2019 alone, in one year.
And thanks to this very manipulative, the manipulative
marketing tactics involved with promoting Medicare Advantage.
A growing number of Medicare beneficiaries are enrolled in this privatized model.
This graph will show you how, okay?
So, at the top of this graph, you see, Traditional Medicare at the bottom,
you see Medicare Advantage, and the number of people who have decided to
enroll in Medicare Advantage has increased significantly more than 50%,
by 2032 it'll be more than 50%.
In fact, by 2024 it will be more than 50% of retirees
enrolled in this privatized model.
And being enrolled in that privatized model means that they will have certain
medical needs denied because the insurance companies won't authorize them.
It means that these insurers will continue to defraud us and steal our money.
And it means that it will slowly and surely gut the Traditional Medicare model,
which is incredibly important to maintain and
protect because of what it does in providing health care to elderly
individuals who are no longer working in this country, because they're retired.
So, final thing I'll say,
John then I'll go to you is how the hell is AARP involved?
Why are they pushing for Medicare Advantage?
AARP has been reaping the financial benefits of its own Medicare Advantage
plan, which it has been offering in partnership with the for-profit
insurance giant UnitedHealthcare since 2003.
You guys remember UnitedHealthcare, right?
>> [INAUDIBLE] are they the one with-.
>> All three, let's bring that.
Let's bring that graph back up.
Let's bring it back up.
Let's take a look at that graph because the one prior to that,
that shows all of the violations.
Yeah, so you have the Inspector General.
So, UnitedHealthcare is the first on the list and
it's one of two private insurers that had a three-violation streak.
All three violations, they were guilty of overcharging
the government, fraud according to whistleblowers.
And I forget what the middle one is and
I can't read that because the screen is too small.
But you get what I'm saying, they're the ones who have-.
>> The government's claims of fraud.
>> That's right.
They defraud the government with their false claims
regarding their patient's needs.
So, this is what we're dealing with.
AARP is also not transparent with their seniors about the chance that they could
be denied.
The health care that they need,
should they choose the privatized model as opposed to the traditional model.
AARP had a chance to call out problems with Medicare Advantage denying
care to patients when CMS released a request for
comments about the program at the beginning of August.
What I'm about to read to you is now it's a tale as old as time.
I feel like this is always the game.
But in its resulting August 30th letter,
AARP hardly touched on care denials, instead recommending modest increases in
transparency on issues like racial equity and telehealth funding,
while championing the expansion of the privatized insurance program.
And look, there's a lot of money on the line for AARP because,
in 2021 alone, AARP earned $814 million in royalties for
its healthcare work, according to a recently released financial
statement review by the Lever, which of course, does wonderful work.
That figure is more than double what the organization collects in dues.
So, dues meant to represent the best interests of
the elderly folks who pay the dues or double the amount of
money by selling them crappie privatized Medicare.
We'll go with the privatized Medicare.
Disgusting.
>> And they don't really have to choose.
I mean, even if this was widespread knowledge,
they're not gonna lose all their members, they would lose a few people or whatever.
And I think they're perfectly willing to make that gamble.
It's, like with so
many stories just this is the direction of the financial incentives are pointing in.
And so, in theory, maybe Congress could do anything,
except there's a lot of reasons to believe that they're not going to.
Or in theory, maybe the membership should get more involved and try
to steer the organization in a different direction if that's even possible.
>> Well, knowledge is power.
So, if you have elderly folks in your family who are paying dues to AARP,
make sure they know about this.
And make sure that they're not led astray by enrolling in privatized Medicare that
will not only defraud us, but very likely deny them the health care they need.