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New Study Gives Medicare Advantage Edge in Quality of Care

Medicare Advantage is the best bet for seniors looking at their options as the open enrollment period begins, according to a new study published by the “Journal of the American Medical Association (JAMA) Health Forum.”Medicare Advantage, also known as Medicare Part C, gives seniors a choice about how to get their medical services delivered over the traditional fee-for-service Medicare plan. According to the JAMA study, that choice also gives seniors better value and better care.

Examining data from nearly two million Medicare beneficiaries, the JAMA-published study concluded that “those enrolled in MA had lower rates of hospital stays, emergency department visits, and 30-day readmissions.” Additionally, the study noted that “[a]mong Medicare beneficiaries with complex care needs, those enrolled in MA had lower rates of acute care utilization, suggesting that managed care activities in MA may influence the nature and quality of care provided to these beneficiaries.”

Medicare Advantage provides health care plans offered by approved private coverage providers. Unlike government-run fee-for-service Medicare, Medicare Advantage plans can cover additional services that seniors rely on and depend upon, such as prescription drugs and routine eye and dental care.

The option currently enjoys broad backing in the halls of Congress, with 63 members of the U.S. Senate signing a letter on the program’s behalf.

“We write to express bipartisan support for the Medicare Advantage program and the high-quality, affordable care it provides to over 27 million older adults and people with disabilities,” the letter read, signed by members as ideologically diverse as Sens. Mazie Hirono (D-Hawaii) and Tommy Tuberville (R-Ala.)

In September, the House of Representatives passed a bill on a voice vote to make it easier for seniors using MA to get approval for treatment and prescriptions.

Traditional fee-for-service Medicare does not limit seniors’ out-of-pocket costs and copays. As a result, beneficiaries pay nearly $2,000 more per year in total healthcare-related costs than those enrolled in Medicare Advantage plans.

Because Medicare Advantage relies on the private sector, some more progressive politicians oppose the option and have tried to limit its expansion or even kill it entirely. The progressive magazine “The American Prospect” wrote about Medicare advantage, and their opposition to it, in a piece headlined “The Dark History of Medicare Privatization.”

Some members of Congress have urged the Centers for Medicare and Medicaid (CMS) to protect eligible Medicare beneficiaries who might be subject to aggressive and potentially predatory marketing tactics related to the sale of Medicare Advantage plans or other insurance products.

However, based on the data, it appears seniors are satisfied with both the coverage and the quality of care received.

According to the non-partisan Kaiser Family Foundation, Medicare Advantage enrollment has doubled over the last 15 years. Currently, 32 percent of Medicare-eligible Granite State seniors choose Medicare Advantage over traditional fee-for-service Medicare.

Reports from the Better Medicare Alliance, a research and advocacy group, indicate 95 percent of Medicare Advantage beneficiaries are satisfied with their network of care and a full 88 percent say Medicare Advantage gives them more flexibility and choice.

A separate study published by JAMA found Medicare Advantage beneficiaries received 9.2 percent fewer “costly, potentially harmful” low-value services than fee-for-service Medicare enrollees. In other words, Medicare Advantage beneficiaries received better-quality care.

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GOLDBERG: Medicare Will Use Death Panels to Set Drug Prices

Under the Inflation Reduction Act, death panels will determine what medicines Medicare should pay for to free up money for other government spending.

That’s not hyperbole. Under the Inflation Reduction Act (IRA), seniors still pay retail prices. (And only the 3 percent of Medicare beneficiaries who spend more than $2,000 out of pocket will see costs capped.) Medicare will determine the cost-effectiveness of medicine to generate discounts in the form of $250 billion in cash rebates. Specifically, under IRA, Medicare will set prices based on how much a medicine costs to add an additional year of healthy living (called a quality-adjusted year, or QALY) compared to or on top of existing therapies.

While Medicare can’t use cost-effectiveness research (CER) to “treat extending the life of elderly, disabled or terminally ill individuals as less valuable,” it can be used to establish at what price a drug should be made available.

CER is already approved by states to limit access to new medicines under Medicaid.  The therapies include those for cystic fibrosis, rare cancers and sickle cell anemia; treatments that primarily help minorities, the disabled and the terminally ill. Pharmacy benefit managers who administer the Medicare drug benefit and the Veterans Health Administration already use CER to negotiate drug prices.

They all contract with a group called the Institute for Clinical and Economic Review (ICER) to carry out CER.  Since 2016, ICER has deemed only 3 medicines out of nearly 100 evaluated for rare and life-threatening diseases cost-effective at or near the average 20 percent rebated price. Most other drug prices would have to be cut by 50 percent to 100 percent. That includes medicines for multiple myeloma, sickle cell anemia, ALS and chronic kidney disease.

Indeed, ICER counts the ability of a new drug to improve well-being by extending life as a cost, not a benefit. ICER claimed a medicine to reduce anemia from chronic kidney disease was not cost-effective “because more people will live longer, more people will be at risk of needing care for end-organ damage, increasing the cost of keeping people alive.”

Similarly, it noted that new sickle cell anemia drugs reduce the “risk of death from these chronic conditions,” making them “less cost-effective.” Incredibly ICER “chose to use the highest estimates of the risk of death to give an optimistic estimate of the (cost-effectiveness) of the treatment effect.”

Further, ICER claims that new medicines for rare diseases, especially those afflicting children, are too costly at any price. As ICER president Steve Pearson wrote, orphan drug spending places an “undue burden … on others for the sake of a few.” Specifically, ICER asserts, “The opportunity cost of supporting the use of ultra-orphan drugs necessitates that patients with a more common disease, for which a cost-effective treatment is available, are denied treatment.”

Most drugs for rare diseases also reduce the risk and severity of common diseases. While curative gene and cell therapies may cost hundreds of thousands of dollars, new methods of hedging financial risk and paying for treatments over time make their cost affordable. And in any event, since we can save $800 billion by eliminating wasteful health spending, why do ICER and CER target dying children to save money?

Because it’s a quick way to generate lots of money for other government programs.

Indeed, in 2016 ICER asserted:  “When we’re paying for drugs and don’t know the drug’s value, we will be “siphoning off resources for other things we need like better schools and more resources for local police, roads and bridges.”  Or, in the case of the IRA, siphoning money for 87,000 IRS agents and $249 billion in climate change tax credits for corporations. Ultimately, ICER and other comparative effectiveness firms are de facto death panels deployed by the Democrats to turn dying patients into cash cows for corporate welfare.

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