As Congress grapples with how to cut health care spending by $880 billion in the next budget, one move that could permanently bring down costs in both the public and private sectors is to decouple Medicare from Social Security, says Twila Brase, president, and co-founder of the Citizens Council for Health Freedom. Brase spoke with Health Care News contributor Ashley Bateman about how that can happen and why it should, now more than ever.
Health Care News: People can opt out of Medicare, but if they do, they lose their Social Security benefits. How did these two programs become attached in the first place?
Brase: The Social Security Administration’s (SSA) Program Operations Manual System says people were asking to exit Medicare because they preferred their private insurance. In 1993, the Clinton administration responded by tying Medicare Part A, the part that covers hospitalization, to access to Social Security benefits. If a person refuses to enroll in Medicare Part A, they are not allowed to receive Social Security benefits.
Health Care News: What law put this in place?
Brase: No law authorized the directive, and it’s not clear who gave the order. As one Medicare official once told me, it was an ‘executive instruction,’ written in. There was no debate, no public notice. It just appeared in the manual and has been followed ever since.
Despite discovery conducted for a lawsuit filed in 2008, the source of the order was never uncovered.
Health Care News: Who filed the lawsuit, and what was the result?
Brase: The lawsuit was filed by Americans who preferred their private insurance and didn’t want to [have to] exhaust all Medicare options for treatment before accessing private benefits. It went all the way to the U.S. Supreme Court, which refused to hear it.
Judge Brett Kavanaugh, at the D.C. Court of Appeals, wrote a very bad majority opinion on which SCOTUS likely relied. He ruled that Americans cannot choose to opt out of their eligibility for Medicare; they cannot “un-entitle” themselves. But that was never the question, as Judge Karen Henderson pointed out in her brilliant dissent. The plaintiffs were asking for the right to “disenroll” from Medicare, not “un-entitle” themselves, in a similar way to how people can choose to opt out of Medicaid.
Health Care News: How are people discouraged from disenrolling?
Brase: If a person enrolls and later chooses to disenroll from Medicare, the Clinton administration’s directive requires them to pay back all Medicare and Social Security benefits ever received.
Health Care News: Do you think tying these two programs together has caused spending in Medicare to soar, including the use of Social Security to pay for Medicare?
Brase: Yes: Medicare has facilitated the theft of Social Security benefits. The government automatically deducts the Part B fees from the monthly Social Security payment. Citizens have no choice. The higher Medicare Part B fees go, the lower the monthly Social Security payment.
Many older seniors have little left over each month after dollars for the Part B payment are taken from their account. Government may feel free to raise the fees because the money is there for the taking. It doesn’t have to ask for permission.
Health Care News: What else has contributed to the rise in costs?
Brase: There are many other reasons for the rise in Medicare costs. Most practitioners and institutions are essentially forced to game the system. Since Medicare cuts their charges by about 60 percent, they overcharge to try to cover actual costs and not get shorted.
Also, Obamacare regulations and the mandated government-approved version of the electronic health record have forced massive consolidation of the market, all but ending the lower prices caused by competitive forces. Health plans have little incentive to push for lower premium prices due to Obamacare’s “minimum loss ratio,” which requires them to spend 80-85 percent of premiums or pay back part of the premium.
Another result of Obamacare regulations and funding formulas is excessive funding to Medicare Advantage organizations. For health plans, Medicare Advantage is a cash cow, a profit center.
Health Care News: Are there enough choices on the market to make decoupling a viable solution, as Congress has dragged its feet on increasing limits on HSAs, for example?
Brase: Currently, because there is no real insurance market in the U.S., there are not enough choices if people are allowed to leave Medicare and keep their Social Security benefits.
We are pushing for a repeal of the Obamacare prohibition on catastrophic health insurance. Most people don’t realize that the Affordable Care Act unconstitutionally prohibits the sale of catastrophic coverage to anyone over the age of 29 years. ACA proponents want every American enrolled in a health plan, which we consider the corporate version of socialized medicine which controls the dollars, the data, the decisions, and the doctors.
We are working on a “Make Health Insurance REAL Again” bill in Congress, to not only bring back catastrophic coverage but to bring back real insurance, the kind of policy that pays the patient, who then uses [that money] to pay the doctor and the hospital. This will end third-party payments, third-party interference, third-party delays and denials, and the multitude of third-party fingers in health care that make medical care and coverage so unaffordable.
Health Care News: Is this more attainable with the current administration?
Brase: On October 3, 2019, we secured an executive order from President Trump requiring HHS and SSA to work together to decouple Medicare and Social Security. However, COVID intervened, and President Trump was not reelected. Now, we’re asking Congress to pass a bill to do the same thing by passing the Retirement Freedom Act (RFA).
We would like it on President Trump’s desk and signed within the next 18 months. Medicare needs an escape hatch, and Americans need this path back to health freedom.
