 Medicare Advantage is great if you don't actually need it. I'm Eileen Appelbaum. I am the co-director at the Center for Economic and Policy Research. Medicare has decided that it wants seniors in value-based payments, which it believes will reduce cost and increase quality. But value-based payments are actually capitated payments. And what that means is that the health provider gets a flat fee. There's no payment for individual services, just that flat fee. And they spend whatever money they spend on the patient. If they spend less than the capitated payment, they get to keep the difference. We have seen nonprofit organizations that have taken those capitated payments, you get them in bulk, and have been able to use them to increase quality of care and to reduce costs of care by keeping people healthier. In the case of profit-motivated companies, what we see is that they find other ways to reduce the cost of patient care and keep the difference. If you're unscrupulous, you have the opportunity here to find ways to cut costs that are not related to improving quality. So Medicare Advantage is a huge problem because by now more than half of Medicare beneficiaries are in Medicare Advantage. Medicare Advantage is supposed to be saving Medicare money. That was the premise. But the Medicare Advantage plans are owned by insurance companies. They are not Medicare, they are insurance plans. People who go into Medicare generally are sicker. If you know that you're going to need healthcare, you are going to opt for traditional Medicare because you can pick your doctor, you can pick your nursing home, you can choose the facilities you want and get the quality that you want. So those patients are sicker. Medicare uses the cost of treating those patients as a benchmark and because the Medicare Advantage plans have a healthier population, they can always beat the benchmark. If they beat the benchmark, Medicare says, oh, yeah, you beat the benchmark here. Let us give you a subsidy or a kickback. In a capitated payment system, you get more for taking care of sicker patients and so they code their patients as sicker than they really are. Collect the higher capitated payment but these people are not as sick as they've been coded. They don't require the extra services. They just pocket that money for themselves. That's illegal. That's fraud. That's taking advantage of taxpayers. Your premiums are going to go up as a result. So this is taxpayer money and this is also draining the Medicare Trust Fund. So Medicare Advantage is not a benefit for taxpayers or for the Medicare system. If they are not providing the level of care that the patient requires because they are cutting costs, the quality of care a patient suffers. This is not good. What I would really like to see is Medicare put traditional Medicare on an even footing with Medicare Advantage. We need Medicare Part E. Part A, Part B, Part C is Medicare Advantage. Part D is the drug benefit. Medicare Part E should be an inexpensive wrap-around for everybody and they should provide the same kinds of benefits that you get now in Medicare Advantage. With the money they would save not overpaying Medicare Advantage. They could pay for hearing, eye care, all of this in the regular Medicare program. Most people who have studied it will agree they're overpaying and they're not getting the quality that they need for the people who actually get sick. But only if you get sick do you realize that you should have been in traditional Medicare.