Most veterans get their healthcare through the Veterans Affairs healthcare system or VA. But what if they have a Medicare Advantage program funded by the taxpayers as well?

Bruce Kitt is one of the Medicare Advantage industry’s most lucrative customers. The federal government pays his private Medicare Advantage insurer thousands of dollars a year to cover the cost of doctor visits, hospitalizations and other medical care that the 74-year-old retired aircraft mechanic might need.

But Kitt, an Air Force veteran who served in Thailand during the Vietnam War, gets almost all of his healthcare outside the Medicare system, through the Minneapolis VA Medical Center. The taxpayer-funded Department of Veterans Affairs health system provides low-cost or free care to Kitt and about nine million other qualifying veterans.

Mark Maremont, Christopher Weaver, and Tom McGinty expose this scandal in The Wall Street Journal.  They tell us Kitt’s Medicare Advantage insurer, an affiliate of CVS Health’s Aetna unit, pays for almost nothing other than a $100 monthly cash-like rebate to Kitt as an incentive to keep him on its rolls. The government paid the insurer at least $6,000 to cover him in 2022, the year he joined the plan.

“I don’t think I’ve used my Medicare in years,” said Kitt, who lives in Eden Prairie, Minn. When he needed some eye tests, the VA, not his Medicare Advantage plan, paid for him to go to an outside clinic. “I’m pretty happy with the VA,” he said. “I look at the Medicare plan as a backup.”

A Wall Street Journal analysis of Medicare and VA data found that Medicare Advantage insurers collected billions of dollars a year in premiums to provide medical coverage for about one million veterans like Kitt, even though they go to the VA for some or all of their healthcare needs. The analysis found the insurers paid far fewer medical bills for those veterans than for typical members. About one in five members of Medicare Advantage plans that enroll lots of veterans didn’t use a single Medicare service in 2021, the Journal found. That compares with 3.4% of members of other Medicare Advantage plans.

The federal government paid insurers an estimated $44 billion from 2018 through 2021 to cover Medicare Advantage-plan members who were also users of VA services, based on average payments for all members of those plans. The VA spent $46 billion on the same group’s medical care, according to VA data reviewed by the Journal. The figures exclude pharmacy costs, which many Medicare Advantage plans focused on veterans don’t cover.

Under the decades-old law that created Medicare, the VA can’t bill Medicare Advantage insurers for services it provides their members. The result is that the federal government sometimes effectively pays twice to cover the health needs of veterans—once in premiums for their Medicare Advantage insurers, then again for the VA to provide actual healthcare services.

The VA encourages veterans to sign up for some form of Medicare, even if they have access to VA health, in part because Medicare gives them the choice of going to a non-VA doctor or hospital. Medicare Advantage plans are attractive to many veterans because they offer perks that go beyond what Medicare requires, ranging from the dental benefits to gym memberships.

Medicare Advantage, the privatized form of the federal health program for seniors and disabled people, was expanded about two decades ago in an effort to deliver care more efficiently. The insurers get paid a lump sum every month to cover members’ healthcare, with higher payments for patients diagnosed with more serious health conditions. The private plans now cover more than half of Medicare recipients. The program has proved popular, but also has cost taxpayers far more than traditional Medicare coverage, according to the Medicare Payment Advisory Commission, a congressional agency. One reason for this I discussed in a series of earlier posts, Home Nursing Visits Bilking Medicare for Billions – Parts I and II.

In a rare case of political irony, President-elect Trump has just named Dr. Jay Bhattacharya of Stanford University to head the National Institutes of Health (NIH). After nearly five years of disparaging scientists who disagreed with the policy of Covid lockdowns, the true scientists have emerged.

Allysia Finley, writing for The Wall Street Journal, calls it “the revenge of the Covid lockdown skeptics.” Francis Collins, the NIH chief between 2009-21, derided Dr. Bhattacharya as a “fringe” scientist for urging the government to focus on protecting the vulnerable while letting others go about their lives. Dr. Bhattacharya, Martin Kulldorff, then at Harvard, and Oxford’s Sunetra Gupta formally expounded this idea in the Great Barrington Declaration in October 2020.

It was far from fringe. Tens of thousands of doctors and scientists around the world signed the document. Before the Covid pandemic, the World Health Organization had opposed lockdowns to control disease outbreaks. Yet after the declaration’s publication, Dr. Collins urged a “quick and devastating published take down of its premises” in an email to Anthony Fauci. I was one of those doctors who signed that document.

In a Washington Post interview, Dr. Collins decried the declaration as a “fringe component of epidemiology.” “This is not mainstream science,” he added. “It’s dangerous” and “fits into the political views of certain parts of our confused political establishment.” Dr. Collins had it backward. We all now know this is true.

Lockdowns endangered democracy, the economy and children’s learning. The confused public-health establishment nonetheless embraced them. Mr. Trump initially went along but reversed course after Scott Atlas, a Covid adviser, arranged for Dr. Bhattacharya and other lockdown critics to educate Mr. Trump about the damage. Mr. Trump proved more open-minded than the mainstream experts, who continue to insist that lockdowns and school closings saved lives despite the evidence to the contrary. Such small-minded zealots again showed their authoritarian side by pressuring social-media companies to suppress lockdown contrarians.

Twitter blacklisted Dr. Bhattacharya in 2021 after he tweeted an article he had written on age-based risks, noting that “mass testing is lockdown by stealth.” He was right. Many school districts later dropped their mandatory Covid testing policies because so many kids with mild or no symptoms were forced to stay home.

Finley tells us Dr. Bhattacharya didn’t deliberately court controversy. People who know him describe him as apolitical and unassuming. Over two decades in academia, he published dozens of wonky papers, such as “Provider visit frequency and vascular access interventions in hemodialysis” and “Heterogeneity in healthy aging.”

Two relate to the NIH and help explain the public-health establishment’s lockstep support for lockdowns. Scientists respond to incentives as much as anyone, and they have a strong incentive to follow public-health leaders if they want to advance professionally and win government grants. These incentives evidently can influence scientific judgment.

In a 2018 working paper published by the National Bureau of Economic Research, Dr. Bhattacharya raised the question: “Does the NIH fund edge science?” The answer is yes, though less so than in the past. Dr. Bhattacharya found that the NIH increasingly funds researchers who seek to build on more-established ideas rather than those pursuing novel ones.

In a February 2020 paper, Dr. Bhattacharya analyzed why pharmaceutical advances are slowing. The phenomenon has been called Eroom’s law, a reverse spelling of Moore’s law, which observes an acceleration in computer-chip advancements over time. Dr. Bhattacharya concluded that career incentives encouraged “me-too research.” Citations by other scientists “have become the dominant way to evaluate scientific contributions and scientists.” That in turn has shifted research “toward incremental science and away from exploratory projects that are more likely to fail, but which are the fuel for future breakthroughs.”

Might similar incentives explain conformist behavior during Covid? A young scientist without a secure job might have been reluctant to contradict Drs. Collins and Fauci, lest doing so jeopardize NIH funding for her research. Scientific journals rarely published Covid studies with conclusions that ran against the grain. Research echoing the public-health orthodoxy yielded more citations in the press and journals.

Dr. Bhattacharya’s top charge at the NIH will be returning the agency to its original mission of funding innovation rather than political science masquerading as real science. It’s about time the real scientists were in charge; not just those who want to play the system. Too many lives are depending on our scientists to get it right.