Can Medicare Advantage Cure America’s Healthcare Crisis?

The face of America is changing. Race relations are evolving. Social interaction has been altered, perhaps forever. The economy is transforming. And our healthcare crisis is ripe for disruption. Is this revolution going to be painful or painless, bloody or bloodless? Are you prepared for seismic shifts in the way our country provides healthcare?

Forbes Media published a recent article by George Halvorson, CEO, Institute for InterGroup Understanding and former CEO of Kaiser Permanente, and Dr. Mehmet Oz, Attending Physician, New York Presbyterian/Columbia, and host of The Dr. Oz Show. Their collaboration promotes a revolutionary new model for health insurance they call “Medical Advantage”. They differentiate their proposal from a government-based Medicare for All model by using the existing private insurance companies’ Medicare Advantage payment rates and care networks to transition to a system that offers subsidized care for everyone.

The Halvorson/Oz article focuses on the crisis of the COVID-19 pandemic and the strains it has put on the existing system as a stimulus for change, but innovation in the industry has already been underway. For example, Telehealth–online doctor/patient visits–vastly expanded during the pandemic and is likely to remain a major new form of healthcare. A recent story on virtual healthcare in The New Yorker magazine documents this changing aspect of healthcare.

As the Halvorson/Oz article says “We should be on the cusp of a golden age in health-care delivery that uses all of the best patient-support tools to deliver continuously improved care.” The two authors strongly recommend a departure from the “fee-for-service model, which has created dysfunctional and expensive incentives in health-care for decades, also suffocated their cash flow when the pandemic limited lucrative medical procedures.” They advocate “buying health-care coverage for every American who is not on Medicaid through the Medicare Advantage program, which a third of Medicare beneficiaries already use very successfully,” and funding the program through a payroll tax. All Americans would be covered by this program, one way or another.

The advantage of this approach is using “tools that are already in place”. Instead of driving the private health insurance companies out of business and sending even more people to the unemployment lines, the government would partner with them like they do today. In addition to payment rates and care networks, private insurers have an army of highly trained staff with  years of experience. CODY supports the proposed Halvorson/Oz model as a way to effect major change without completely reinventing the healthcare system we proudly serve.

About CODY: CODY works with more than 60 government-funded, commercial and ACA health plans across 45 states and Puerto Rico. We help health plans maximize efficiencies and strategically integrate operations by streamlining marketing communications and improving regulatory compliance. Our proprietary suite of software, CodySoft®, is specifically designed for health plans.