The Time Bomb Left by 45: Direct Contracting Entities (DCEs)

In this video Dr. Ana Malinow discusses DCEs. Very important video ( 15 minutes):

If there is one thing that makes Americans mad, it is being put into a situation without their consent and without any input. That pretty well describes America’s health care system for many Americans. America’s current health care is less a “system” and much more of a series of mazes without any real logical connections . 

Ours is the only illogical system like it in the world. Most other nations have a logical flow for their health care systems that make it so that the health of the user is the main goal of the system. In the US it appears that the main goal of the system is the financial status of the financial firms that have a stake in our health care infrastructure. The care of the patient is not the utmost concern.

As Thom Hartmann has noted many times, the US is the only country where people can go bankrupt seeking medical care.

One of the shining stars in the medical system has been what is now known as the traditional Medicare system. People pay into it all their lives and when they reach a certain age they are covered by a national insurance that covers illnesses without any consideration for prior conditions. If a person stays in the system, that remains true until they die.

Over the years Medicare has been hacked away at by a bastardized child known as Medicare Advantage which is nothing more than private insurance in a deceptive wrapper. From congress members Mark Pocan and Rho Khanna comes this clarification and warning:  

“The scheme is called Medicare Advantage. But in reality, so-called ‘Medicare Advantage’ is neither Medicare nor an advantage,” wrote the lawmakers, who earlier this year introduced legislation that, if passed, would ban private insurance plans from using the Medicare name.

“It’s actually just private insurance that uses the trusted Medicare name to trick seniors and people with disabilities into enrolling, then profits by denying coverage for necessary medical care,” Khanna and Pocan added. “It is long past time for Congress to end this scam and ensure that consumers get accurate information about their healthcare options.”

Before the end of the Trump presidency in 2021, Wall Street bankers added yet another twist to the bastardized system that is Medicare Advantage. That is an underhanded and deceptive way to get seniors who would in no way ever purposefully enroll into a Medicare Advantage program to be deceptively enrolled in one without their knowledge or consent. 

This deceptive practice is through a loophole built into the system at the end of the Trump presidency known as Direct Contracting Entities or DCEs. The loophole works like this: If a Medicare patient has seen a physician who is part of a direct contracting entity in the past two years, that patient may be switched without their knowledge or consent to a Medicare Advantage coverage.

As noted here it has even happened to professionals who were fully aware of the situation: 

The development represents a troubling new dimension in the fight by corporate interests to privatize Medicare, the federal health insurance program for people 65 or older. Medicare Advantage, which allows for-profit health insurers to offer privatized benefits through Medicare, already results in unexpected costs for routine procedures and wrongful denials of care. Private plans have cost Medicare an astonishing $143 billion since 2008, and are now driving some health insurers’ record profits.

The new Direct Contracting Entity (DCE) program similarly adds a private-sector third party between patients and Medicare services. Medicare allows these intermediary companies to offer unique benefits, like gym membership coverage. But as for-profit operations ranging from private insurers to publicly traded companies to private equity firms, these intermediaries are incentivized to limit the care that patients receive, especially when they are very sick.

While Medicare Advantage patients choose to sign up for private insurance plans, patients are being enrolled in these DCE health care plans without their informed consent. As Rep. Pramila Jayapal (D-Wash.) noted in a January op-ed, “Seniors in traditional Medicare may be ‘auto-aligned’ to a DCE if any primary care physician they’ve visited in the past two years is affiliated with that DCE. That means Medicare automatically searches two years of seniors’ claims history without their full consent to find any visits with a participating DCE provider as the basis for enrollment.”

Among those who unexpectedly found themselves caught up in one of these new DCE plans is Suzanne Gordon, a policy analyst based in Richmond, California. Gordon spent her entire professional career studying the U.S. health care system and advocating for Medicare for All. As a firm opponent of privatization in Medicare, she has never signed up for a for-profit Medicare Advantage plan.

I had called for these DCEs to be an issue in the recent election. But mine is a lonely voice when put up against a media that spends so much time on trivial issues and leaves real issues behind. I believe that real health care reform that creates a true Medicare for all system is something America wants and wants badly.

One of the Republicans chief weapons in the fight for real health care reform is the ignorance of the American consumer. There are only 2 years left before the next election and real health care reform in the manner of Medicare for all must be a top issue in that election.

About Dave Bradley

retired in West Liberty
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2 Responses to The Time Bomb Left by 45: Direct Contracting Entities (DCEs)

  1. Gena Hollis says:

    Please note DCEs are —not— Medicare Advantage plan though they share many of the same features.

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