Sign-up season for Medicare Advantage plans is just a month away. Over 34 million seniors or nearly 55% of Medicare beneficiaries enrolled in the privately-run health insurance plans this year, a number that will probably go higher next year given their enthusiastic endorsement of Dr. Mehmet Oz, the current administrator of the Centers for Medicare and Medicaid Services. Oz frequently touted MA plans on his television show prior to joining the Trump regime.
As regular readers of this Substack know, Medicare Advantage has come under withering criticism in recent years, echoing many of the complaints that people have with the broader health insurance industry. They include excessive use of prior authorization; narrow and inadequate physician networks; and, most significantly from a taxpayer point of view, the high insurance industry profits that come from excess government payments to many MA plans for diseases that are never treated.
Today, almost all Americans get their insurance through private plans, whether they are employer-sponsored plans, Medicare Advantage or Medicaid. But there are big differences among the operators. While most plans on the market are promoted by for-profit businesses, some are sold by non-profits.
They range from large organizations like Kaiser Permanente to small community-based plans like Scan Health, which is based in southern California. Others are run by unions like the building trades whose members are scattered among a large number of small employers. Do these non-profits do a better job?
This week, I invited onto the podcast the chief executive officer of one of these non-profits, the Scan Group. Dr. Sachin Jain trained as a physician and business leader at Harvard’s medical and business schools. During the Obama administration, he served as an adviser to the director of the CMS and in its Innovation Center. He went on to work for both a health delivery system and a drug company before joining the Scan Group at the start of this decade. Over the past five years, he helped Scan grow to a $5 billion-a-year enterprise, covering more than 300,000 members in five western states.
He is a trenchant critic of current industry practices. If you listen to this podcast, you’ll discover he has some interesting ideas about how his industry can live up to its unfulfilled promise of delivering better health at a lower cost.
