The end of public Medicare.

In 1965 when Medicare was established it was a government, that is, public system of limited coverage.

In the years since it has become an expanded system of mostly privatized health insurance with huge profits for the insurance industry.

The Biden administration is making it more private. That doesn’t serve the interests of the patients it is intended to serve.

When I turned 65 I received my red, white and blue medicare card.

But when I joined the state subsidized retired teacher health insurance card I was told I didn’t need my Medicare card anymore. I would be covered under a Medicare Advantage program under United Healthcare and it would be “seamless” with Medicare.

It wasn’t really seamless. It was basically Medicare Advantage and United Healthcare.

It was private and for profit.

It contained a lot of moving parts. I was manager of my medical care and my coverage, requiring constant monitoring of what was going on, who was doing what and what my costs would be.

When Medicare Advantage was conceived of 35 years ago it was supposed to be a cheaper, better Medicare.

Instead it has saved no money and is not not patient-centered.

What the current administration wants to do is to move the rest of traditional Medicare into a totally private system that mirrors MA.

The goal is called direct contracting with the creation of Direct Contracting Entities (DCEs). They would act as middle men between traditional Medicare beneficiaries and the care providers.

The DCE would receive payment similar to MA. It would make deals with networks of providers, “manage” beneficiary care and costs, and pay the bills, while keeping the difference. Keeping the difference is not about the patient.

Medicare’s only role would be as banker.

Fifty-three bidders have been designated in the first class of DCEs. They include 28 investor-controlled plans, six insurers, and 19 health care provider–owned companies. The investor and insurer DCEs will be operating in 38 states and have access to 84 percent of all beneficiaries.

Wall Street is overjoyed.