A short thread on a similar topic from 2005, “Is this illegal? Lying by Omission” centered around Antiques Roadshow-type stories: finding a bargain at a yard sale and such. The consensus was that capitalism is about buying cheap and selling dear, and the buyer is not obligated to tell the seller what an item is really worth.
I’m wondering about something different.
In the USA the Medicaid Enrollment Period is in full swing and anyone who sees any television at all knows that a number of companies are trying to get seniors (who are eligible for Medicare) to sign up for their particular “Medicare Advantage/Medicare Part C” plans. Of course this is a highly lucrative business, or the companies would not be spending so much to advertise. Medicare Advantage is elected by more than half of the (in 2024) 67 million seniors and disabled people who are on Medicare. Advertising is a big reason for this. And it’s incredibly profitable: a $450-billion/year system that
*see below for a link to the WSJ 2024 article that’s the source for this quote. I regret I don’t have a subscription (so can’t offer a gift). But it’s well worth trying to find for anyone interested in the topic.
Companies were permitted to offer this product as something of a political compromise: Democrats wanted Medicare and Republicans wanted corporations to be able to make profits off Medicare. In 1997 Congress created Part C and it’s been exploding in growth ever since—because it is, again, so damned profitable.
The profits come from two main sources: money paid by the senior electing a plan (various out-of-pocket costs and plan premiums, etc.), and—mostly—the federal government. It pays these private companies a monthly amount per beneficiary, in order for the company to pay for medical services that would otherwise be covered directly by the government (for those who don’t elect an Advantage plan and instead retain “Original Medicare”). A big part of the treasure chest of cash that taxpayers hand the MA companies comes from denying care: “In 2019, Medicare Advantage Organizations denied 13% of prior authorization requests that would have been accepted if the beneficiaries were in original Medicare.” (See Wikipedia link below.)
An even larger portion of the taxpayer-supplied treasure chest comes from the fact that Medicare pays these companies a base rate for each person who elects MA—but adds onto that sum for diagnoses of particular conditions. Extra money goes to Humana and the other companies for chest pain, kidney disease, atrial fibrillation, etc,–diagnoses that double and triple the per-enrollee pile of money paid to the company. (The WSJ article goes into detail about the fakery surrounding diabetic cataracts, one of the most lucrative diagnoses:
Again: collect the cash; provide no treatment = major profit!
But the “lying by omission” I’m asking about isn’t so much the lying these companies do by failing to disclose, in their ads, that
Instead I’m wondering about the lying-by-omission involved in this part of the Medicare Advantage advertising:
Insurers promise benefits that are also available to those who elect Original Medicare over Medicare Advantage, strongly implying that the only way to get these benefits is by electing their MA plan.
Low income seniors qualify for all the ‘goodies’ the commercials promise: rides to medical appointments; no co-pays; no monthly premiums; see any doctor who accepts Medicare; covered prescription drugs, and having your Part B premium paid for you each month. But you’d never know that from the commercials.
I realize that this post looks like I’m making a thread about Medicare Advantage, but it’s not really just about that. It’s about the entire phenomenon of deliberately misleading advertising. I’m just wondering if world-wide, this is as legally-acceptable as it is in the USA. Is it okay to mislead by failing to mention relevant facts (such as that MA is NOT providing anything that Original Medicare isn’t, and in many cases MA is providing far less)?
My guess is that the answer is that this is perfectly legal worldwide. But I’d love to hear I’m wrong about that.
https://www.wsj.com/health/healthcare/medicare-health-insurance-diagnosis-payments-b4d99a5d