Letter: Question your doctor about Medicare alignment

Graphic by Lori Deaton

As a retired RN, a traditional Medicare consumer and member of HealthCare for All WNC, I contacted my local doctor about the practice working with an ACO REACH program.

A little history first. During Trump’s presidency, the Centers for Medicare & Medicaid Services started a DCE (Direct Contracting Entity) pilot program. In it, Medicare automatically assigned beneficiaries to a DCE if their primary care physician or the physician practice joined a DCE. The only way beneficiaries could opt out was to find a different primary care doctor.

This year, CMS responded to criticism of DCEs with a name change: ACO REACH. ACO stands for Accountable Care Organization and REACH stands for Realizing Equity, Access and Community Health. These are great names that disguise their true intent, which is to privatize Medicare by 2030. I am entitled to the Medicare I receive because for the 50-plus years I worked, I have been paying into it. By privatizing Medicare, the Congress and President Biden are stealing the money I (we) put aside for health care in our aging years!

Here is how it is happening:
• Instead of paying doctors and hospitals directly, Medicare will give third-party REACH middlemen a monthly payment to cover some or all of each senior’s medical expenses, allowing these entities to keep as profit what they don’t spend on care. This establishes a dangerous financial incentive to restrict and ration care.
• Under this program, up to 30 million seniors who actively chose traditional Medicare may be automatically “aligned” with a REACH entity without their full knowledge or consent.

When I reached out to the Asheville practice, I was told they were independent and that it is not possible to change a beneficiary’s Medicare without their consent. Clearly, I was educating the billing person and will contact the board of directors, as I don’t know what the independent practice’s plans are.

I quit working with my orthopedic surgeon when his independent practice joined Mission/HCA. I hope that my primary provider’s practice doesn’t go in that direction.

I am hoping others in our community question their doctors. We really need a single-payer system. A transparent system where the patient chooses who they work with based upon their needs, not employer or insurance company decisions. Health care decisions belong between the patient and the doctor, not the insurance industry. The federal government would pay for the services through our taxes. Just like our taxes fund the fire department, libraries, roads, public schools and police departments. It will save us money and be equitable.

— Padma Dyvine
Bat Cave


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2 thoughts on “Letter: Question your doctor about Medicare alignment

  1. Susie-Danzen

    While I understand your sentiments, we won’t have a single payer system in this country for several reasons. The biggest reason is because the government wants (needs, insists..) individuals to remain in the workforce for as long as possible. The biggest driver of this is privatized insurance, paid for and made “reasonably” affordable by one’s employer. In fact, this is why many doctors don’t accept Medicare: because they can’t bill high enough. There’s an enormous difference in what a hospital charges for a medicare patient (let’s say in their 70’s) versus a working professional in their 40’s with private insurance. Jaw-dropping in fact.
    Let me state this another way: if we had a single payer system as many envision, I would retire in 5 years. Because insurance is privatized and so expensive, I will remain in the workforce for 15 more years at least, paying in my “fair share”. And 15 years from now, the eligible age for Medicare won’t be what it is now either. It’ll probably be bumped two more times by then!
    Then, for shucks sake, let’s go ahead and tack on the cost of healthcare for the immense influx of people into this country who don’t have insurance but require healthcare and receive it.
    So at the end of the day, only you can decide what your time is worth and if you want to spend it petitioning for a single payer system, well, best of luck!

    • kw

      And let’s bill the hell out of obese smokers, destroyers of our natural world and other miscreants who do not even attempt to lead a healthy lifestyle.

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