The Medicare program exists for the beneficiaries, but decisions are not made with the beneficiaries best interests at heart. The main players are the government, the HMOs which are mostly publicly held companies, the medical profession, and last but not least, the beneficiaries. The government is a political entity subject to many influences which effect its performance and decision making. HMOs are interested in getting as many enrollees as possible and holding down costs. I know there should be a balance here and perhaps the reason I think there isn't is that my experience included Florida, famous for the ping-ponging of enrollees.
Medical practitioners are in a catch twenty-two.
I believe that most want to give good quality care, but they are often limited when they practice in the HMO setting. There are two major problems with marketing. The biggest is the marketing representative. This is the man or woman who sells the plan to the beneficiary. Unless things have changed, and I do not think they have, they are paid on commission.