Today's Alphabet Soup: DCEs-- Your Enemy, My Enemy. Everyone's Enemy But Wall Street's

Dr. Mark Neumann is the progressive candidate for the western Wisconsin congressional seat that New Dem Ron Kind is giving up. A La Crosse pediatrician, he is a compassionate progressive who is campaigning on Medicare for All, free higher education, the Green New Deal, protecting family farms, getting corporate money out of elections, marijuana legalization, equal justice, etc. A couple of weeks ago we talked about an issue he feels very strongly about-- DCEs (Direct Contracting Entities).

I'll come back to Mark Neumann in a moment but let me reminder everyone that Bernie announced on Sunday that plans to reintroduce Medicare-For-All. (Not just Mark, but every Blue America House candidate backs him on that.) As Jake Johnson reported for Common Dreams yesterday, Bernie is moving forward even as the Biden administration is moving in the opposite direction, a direction that Trump steered the health care system in, a Medicare privatization scheme that puts millions of Americans in imminent risk of losing their insurance. "Biden's Centers for Medicare and Medicaid Services (CMS) said that instead of terminating a Medicare privatization experiment hatched under the Trump administration, it would rebrand the pilot program and make minor changes that critics-- including physicians and Medicare for All advocates-- say would leave the scheme's most dangerous components intact."

This is what makes Mark Neumann's perspective on this so very salient. He explained that "A lot goes into being a healthcare worker. Knowledge base, technical skills, team building, and communication skills are all important. These experiences make it possible for successful health outcomes desired by patients and their care providers whether guiding health maintenance or treating illness and injury. The experience that is by far the most important is trust. We all have a belief, a hope, an expectation that as a patient, we can disclose deeply private worries or concerns, and that we will not be taken advantage of. There is an expectation that the intimate relationship of a sick person trusting their healthcare provider will be protected and cherished. We expect for our healthcare providers to have our personal best interest as their first concern. As a pediatric critical care doctor, I had that experience of trusting relationship with worried families at the bedside of ill or injured children as a daily occurrence. It was special. The rancor of divisive social noise that is all too familiar in our lives was left outside the room. In the presence of an ill child-patient, we were all simply people, concerned and trusting, focused on the wellbeing of our patient. This experience at the bedside or in the clinic or in our homes is called the doctor-patient relationship. I taught medical students that it was that relationship, that experience, that was the precious pearl of our healing profession that made all the work and grind of study and practice to be worthwhile. I remember the excitement and hopefulness that I and my classmates felt on our first days of medical school. We were taking first steps into a professional career where we would bring together our love for science with our desire to serve the wellbeing of neighbors. I once shared these memories with a medical colleague who responded back to my revery with a sad but true statement. He said, 'Yes, but they beat it out of us.' This is the part that we often miss when we discuss the shortcomings of our American healthcare system. What is it about our system that causes a doctor or a nurse or a therapist to feel that the dream that brought them into their profession was 'beat out of them?' How has the system where they work caused their dream to die? What is being taken advantage of to the detriment of the trusting relationship that we all need when we are worried about illness or even death?"

Our American healthcare system has been co-opted by selfishness and greed of investors who see a golden market of worried people that will buy stuff they can sell. Unfortunately, what they are selling, or rather, selling out, is the relationship of trust between healthcare workers and their patients. Their system tries to sell the human experience of trust as if it were a commodity. The system takes what is profoundly humane, the caring of a doctor, nurse, or therapist for their patient, and tries to sell it as an object to be bought and sold in a cornered market. No wonder healthcare workers are experiencing burn-out. No wonder my medical colleague was able to say, “Yes, but they beat it out of us.”

There is a new ploy of the healthcare financing system to squeeze more profits out of the good will of care providers with their patients. It is called Direct Contracting Entities (DCEs). For over 55 years Medicare has functioned as a successful public healthcare payment method for elders. That national healthcare insurance program made it possible for generations of seniors to go to their care providers to receive understanding, compassion, and relief from their worries within the humanity of a healing relationship. This was too much for the greed and selfishness of investors to tolerate. We all need healthcare. That need creates a demand and therefore a market for investors. There are profits to be made in that market. The trick is to somehow get positioned in between the demand and the supply.

This is exactly what has happened with DCEs. DCEs: Handing Traditional Medicare to Wall Street-- PNHP The program comes out of a provision of the Accountable Care Act of 2010. That law created the Center for Medicare and Medicaid Innovation (CMMI). This entity, contained within the Center for Medicare and Medicaid Services (CMS), was charged with the mission of evaluating pilot programs that might make the Medicare payment system more efficient. The CMMI was designed to look for ways to improve Medicare services without increasing cost or to reduce cost while maintaining the same level and quality of service. It’s a reasonable goal until it gets mixed with bad intentions of drawing out huge profits from the Medicare Trust Fund by inserting a middleman between the physician and their patients. The first step is to drum up accusations that the current Medicare payment system is not working and then promise to rectify those presumed failings by inserting private industry and investors who will handle the money for the Medicare Fund and make it more efficient.

The middlemen come between the physicians and their patients, and the process of compromising that relationship of trust for the sake of profit is established. The middlemen seek to encourage physicians to exaggerate the description of chronic illness of their patients in their medical records so that the middlemen will receive more money from the Medicare Fund to provide care for those patients. Nothing changes for the patient. No new services are provided. Only the description of their chronic illness is made to appear more severe by a process called “up coding.” Then the DCE middlemen go to work on the patients’ options for care by introducing subtle mechanisms for paying out less of the money received from the Medicare Fund. It is a simple business plan. Work to take more money in and then work to find ways to pay less money out. The difference is profit. Investors love DCE middlemen. There is gold to be got in that market.

The big problem that we are not recognizing here is that the critical relationship of trust contained in the doctor – patient relationship gets exploited by a mechanism of profit taking for the money handling middlemen.

The DCE program was conceived and approved by the Trump administration. The pilot project was launched on April 1st, 2021, under the Biden administration. There was no fanfare and very little public notice because the CMMI project was part of established law under the Accountable Care Act. If allowed to continue, the CMMI pilot project can expand to involve all of the Traditional Medicare program. There is no need for Congressional action for this to happen. There is no need for public debate for this to happen. Traditional Medicare will simply become privatized as the pilot project becomes the standard project. Huge profits will be made by the unneeded middlemen DCEs that do more harm than good without a whimper of public protest until it is too late.

The healing relationship with healthcare workers, the trust implicit in the doctor-- patient relationship is not a commodity to be bought and sold like a sack of potatoes. Let Medicare continue to support that relationship like it has done for over 55 years and keep the middlemen profiteers out.

Feel like contributing to Dr. Neumann's campaign? You can do it here or by clicking on the ActBlue Blue America 2022 congressional Medicare-For-All thermometer above.