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be a hero
Ady Barkan’s Legacy: Reclaiming Medicare From For-Profit Corporations
Ady recognized that so-called “Medicare Advantage” plans threaten our cherished public benefit.
Mar 28, 2024
Ady Barkan, my dear friend and former colleague, spent the last years of his life fighting to give everyone in America the right to high-quality healthcare. He knew that he was dying, and used his own story to shine a light on why “the richest country in the history of the world” could figure out how to provide it. He evangelized the virtues of Medicare For All, yet came to understand that a powerful force stood in the way: So-called “Medicare Advantage” (MA) plans. These plans are not Medicare. They are privatized alternatives run by for-profit insurance corporations.
As Ady wrote a little over a year ago, these privatized plans threaten our cherished public benefit of Medicare. They siphon up our public dollars, overcharging the government to the tune of billions a year. Then, they delay and deny the care the patients need. Their goal is to generate profit by charging as much as possible to provide as little healthcare as possible.
The government allows privatized plans to offer benefits Traditional Medicare is barred from covering, including dental, vision, hearing, and an out-of-pocket cap. This makes them an attractive option, particularly to younger and healthier patients. It is only once people get sick, and need to use their coverage, they realize these plans are a scam.
The government needs to hold these plans accountable for their greed, not give them a raise.
With Traditional Medicare, you can use the doctor and hospital of your choice, and they provide the care that you need. Medicare Advantage restricts your choice of doctors and hospitals, as well as what type of care they can provide. These might seem like minor nuisances when you’re relatively healthy, but can mean the difference between life and death when you’re sick.
That’s not an exaggeration. A recent study found that Medicare Advantage patients are 1.5 times more likely to die in the month after complex cancer surgery than Traditional Medicare patients. Another study found that if the government canceled contracts with the worst performing 5% of MA plans, it would save 10,000 lives a year.
Yet despite Medicare Advantage plans providing worse care than Traditional Medicare, they cost the government more money—an average of 6% per patient—despite the fact that Medicare Advantage patients are generally younger and healthier than those with Traditional Medicare. They are overcharging the government by up to $140 billion a year. This is money that comes out of the Medicare trust fund, endangering the future of the entire program. Yet it still isn’t enough for health insurance corporations offering these plans.
The government is proposing a 3.7% increase in payments to Medicare Advantage plans for next year. They plan to finalize that amount at the beginning of April. The health insurance corporations and their lobbyists are pressuring the government to increase that amount. They are even insisting that a 3.7% increase is a cut, just because it’s not as much as they want!
This is outrageous. The government needs to hold these plans accountable for their greed, not give them a raise. Over 25,000 Americans are calling on President Joe Biden to do just that. As their petition says, these plans should be paying us back, not the other way around.
Be A Hero, the organization Ady founded, is one of the organizations at the forefront of this fight. Hundreds of our grassroots supporters have shared their painful stories of being delayed or denied care by faceless, cruel insurance companies. Others reveal feeling tricked or even forced onto a Medicare Advantage plan and then being stuck in the “Hotel California.” Their heartbreaking stories called Ady and now call all of us to take action.
We are joined by doctors, patients and experts from across the country who see the existential threat posed to Medicare by insurance corporations. Reclaiming Medicare from corporate greed is an essential part of Ady’s legacy. It is the only way we can move towards Ady’s vision of Medicare for All—guaranteed high-quality healthcare for everyone.
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Patients, Advocates Push Biden to 'Reclaim Medicare' From Privatized Medicare Advantage
"If Medicare Advantage has it their way, they're going to deny me care and delay me care until I'm dead," said one patient.
Mar 15, 2024
Patients on Medicare Advantage spoke out against the privatized plans this week as part of a coordinated campaign to shed light on the program's care denials, treatment delays, and overbilling—and to pressure U.S. President Joe Biden to rein in the insurance giants raking in huge profits from such abuses.
"These corporations do nothing to increase positive outcomes in medical care. So don't fall for their bullshit," Jenn Coffey, a retired EMT from New Hampshire, said during a livestream hosted by People's Action on Wednesday night.
The stream featured testimony from several patients who have experienced the kinds of delays and denials for which Medicare Advantage is notorious.
Rick Timmins of Puget Sound Advocates for Retirement Action said it took five months and "multiple calls and emails" for his insurance company to approve his referral to a dermatologist for a suspicious lump on his earlobe that turned out to be malignant melanoma. The delay stemmed from a byzantine process known as prior authorization, whereby doctors are required to prove a treatment is necessary before an insurer will cover it.
By the time his referral to a specialist was approved, Timmins said, the previously tiny lump "had tripled in size" and was "quite painful."
MA insurance companies find it financially beneficial to delay essential care to patients.
Medicare (Dis)Advantage plans take the problems of private health insurance and import them into Medicare. @PplsAction #CareOverCost pic.twitter.com/V21nKlkyLj
— Social Security Works (@SSWorks) March 14, 2024
Coffey, for her part,
ended up on a UnitedHealth Medicare Advantage plan after she was diagnosed with breast cancer in 2013. She later developed two rare diseases—including complex regional pain syndrome—and required expensive treatments that her Medicare Advantage plan refused to cover.
"If Medicare Advantage has it their way, they're going to deny me care and delay me care until I'm dead," Coffey, a healthcare advocate, said in a video published Thursday by the advocacy group Be A Hero as part of a social media day of action against the for-profit plans.
"They only make money when they don't have to spend it on you," said Coffey.
Once enrolled in a Medicare Advantage plan, patients often find it difficult to get out.
"They like to tell you: 'Medicare Advantage numbers are so high, can't you tell people love it?'" said Coffey, alluding to the fact that more than half of all eligible Medicare beneficiaries are now enrolled in a Medicare Advantage plan. "No, we don't. We're stuck. It's the Hotel California: You can check in, but you can't get the hell out."
“If Medicare Advantage has it their way, they’re going to deny me care and delay me care until I’m dead.” — Jenn
The greedy health insurance corporations that run Medicare (Dis)Advantage will always put profits above patients. That’s why we’ve got to #ReclaimMedicare. pic.twitter.com/0ED1iHBu0u
— Be a Hero (@BeaHero) March 14, 2024
Next month, the Biden administration is expected to finalize 2025 payment rates for Medicare Advantage, which is funded by the federal government. Medicare Advantage plans frequently overbill the government by making patients appear sicker than they are.
An analysis released last year by Physicians for a National Health Program estimated that Medicare Advantage plans are overcharging U.S. taxpayers by as much as $140 billion per year—an amount that could be used to completely eliminate Medicare Part B premiums or fully fund Medicare's prescription drug program.
Patients and advocacy groups are calling on Biden to "not fork over more money for insurance companies like UnitedHealthcare," as Coffey put it during Wednesday's livestream.
A petition sponsored by Social Security Works urges Biden to "reclaim Medicare" from Medicare Advantage providers, which "have delayed and denied care to millions of Americans in order to turn a massive profit."
"Medicare Advantage isn't really Medicare, and it isn't an advantage to the seniors and people with disabilities who rely on the program," reads the petition, which has over 22,800 signatures as of this writing. "In the 25 years that it has existed, it’s clear that Medicare Advantage is riddled with the same problems as the rest of private insurance: Opaque bureaucracy and extraordinary fees. Seniors who enroll in these for-profit plans are being price-gouged by massive corporations."
The Biden administration has proposed a 3.7% payment increase for Medicare Advantage in 2025—a change that insurers have portrayed as a cut. But Social Security Works noted in response to the industry's complaints that "MA companies are not hurting for profits."
"In 2022 alone, seven healthcare companies that comprise 70% of the MA market brought in over $1 trillion in total revenue and over $69 billion in profits, and spent $26.2 billion on stock buybacks," the group observed. "These same companies claim that if the government doesn't increase their already bloated payment rates, they will have no choice but to slash benefits for patients. This is false, and should be seen for what it is—MA plans holding patients hostage to extort the government for profits."
In an op-ed for STAT last month, former insurance industry insider Wendell Potter—who is now an outspoken critic of private insurers—and John A. Burns School of Medicine professor professor Philip Verhoef wrote that "private plans have no business administering Medicare benefits."
"Traditional Medicare is already more efficient than its private counterpart, in large part because the approval process is much simpler and there aren’t the same incentives to upcode," the pair wrote. "Traditional Medicare spends far less of its funds on administrative overhead, and overall it spends less money per patient than Medicare Advantage while providing far superior access to doctors, hospitals, and treatments."
"Medicare Advantage isn't working for any group: the government, patients, taxpayers, and now even investors," they added. "It's time to turn to what we already know works. We need to support and strengthen traditional Medicare."
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'The Progressive Movement Has Lost a Hero': Ady Barkan, Medicare for All Champion, Dies at 39
"There are no words to capture Ady Barkan's brilliance, moral clarity, and immense capacity to imagine and fight for a new world."
Nov 02, 2023
Ady Barkan, a powerful moral force in the fight for a just healthcare system, died at the age of 39 on Wednesday from complications of amyotrophic lateral sclerosis, commonly known as ALS.
Following his terminal diagnosis in 2016—just months after the birth of his son, Carl—Barkan campaigned tirelessly for Medicare for All and other progressive causes, frequently taking part in Capitol Hill protests, congressional hearings, and conversations with prominent political figures even as he lost the ability to stand, walk, and speak on his own.
In 2020, Barkan delivered an address to the Democratic National Convention using a voice-generating device attached to his wheelchair.
"Like so many of you, I have experienced the ways our healthcare system is fundamentally broken. Enormous costs, denied claims, dehumanizing treatment when we are most in need," Barkan said. "Since my shocking diagnosis, I have traveled the country meeting countless patients like me, demanding more of our representatives and our democracy."
Barkan's death was announced Wednesday by his wife, Rachael.
"You probably knew Ady as a healthcare activist," she wrote. "But more importantly he was a wonderful dad and my life partner for 18 years."
Be a Hero—an advocacy organization that Barkan co-founded in 2018, the year before the birth of his daughter, Willow—said in a statement that Ady "inspired many of us to join the fight for universal access to life-saving and life-giving healthcare."
"Ady was a life-long activist and movement lawyer," said Jamila Headley, the group's co-executive director. "Before he co-founded Be a Hero in 2018, Ady spent years fighting to advance worker rights and economic justice at social justice organizations, including Make the Road New York and the Center for Popular Democracy, where he co-founded the Fed Up Campaign and Local Progress."
"Up until his death," Headley continued, "Ady spent his days working with the Be a Hero team of staff and volunteers to stop health insurance corporations from gouging Medicare and denying patients care, and fighting to make it possible for people with disabilities and older adults who need home and community-based services to get the care they need surrounded by the people they love."
News of Barkan's passing was met with an outpouring of tributes from those who worked alongside him for healthcare and economic justice.
"There are no words to capture Ady Barkan's brilliance, moral clarity, and immense capacity to imagine and fight for a new world," progressive activist Ana Maria Archila wrote on social media. "My dear friend, rest in power. Forever and always, your voice will guide us."
Rep. Pramila Jayapal (D-Wash.), chair of the Congressional Progressive Caucus and one of the lead sponsors of Medicare for All legislation in the House, said in a statement late Wednesday that "the progressive movement has lost a hero tonight."
"Ady Barkan accomplished more in his too-short time here than most do many lifetimes over. This country, and the lives of all of us who knew and loved him, are better for it," said Jayapal, whose Medicare for All bill now has the support of more than half of the House Democratic caucus. "I am devastated to lose a champion, a partner, and a friend. My Progressive Caucus colleagues and I are with all those mourning Ady tonight, and we send our deepest condolences to Rachael, Carl, and Willow."
Sen. Bernie Sanders (I-Vt.), the Senate's top Medicare for All proponent, wrote on social media that "Ady Barkan was an inspiration to all of us."
"There are very few people in this country who have done more to make healthcare a human right," Sanders added. "To honor his life, let us dedicate ourselves to completing his work."
A previous version of this story misspelled Jamila Headley's last name in the second mention.
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