QUOTE(Rene @ Jun 13 2006, 06:12 PM) [snapback]213108[/snapback]
Got some thought processes generating ideas there. Had to read it more than once to make sure I was understanding it, in between getting distracted.
If we were talking just coverage for those stuck with Medicaid/Medicare or the uninsured, the 10% abuse/fraud figure wouldn't hurt as much. Go universal with mandatory national enrollment and I'm outside of my comfort zone again for more than one reason. The percentage of acceptable fraud at 10% could equate to something around 3+ million people and hundreds of millions of dollars? I'm also leery of the mandatory forced enrollment in any universal/social plan with any possibility of someone, who's now not part of the uninsured problem and is paying for their own health insurance coverage they need, having that right or ability taken away or charged more for such service, than they do now.
Fraud could be kept below 3 million people because that's not where the fraud lies. Most of it is committed on the doctor/hospital/billing dept. end, which is made easy and compounded by our present sytem.
It's not, you know, that people are rushing out to have unnecessary angiograms or proctoscope exams. The bulk of the fraud lies in providers billing for procedures tests and services not performed at all. The money goes into the provider's pocket, sometimes with a kickback to the fake patient but usually without the patient's knowledge. The ease of this type of fraud comes from the billing process, which produces (a) bills that might as well be written in Greek for all that a patient can understand what's being billed for and say "no, I didn't receive that test." (

The use of no-claim-form-needed insurance plans that are marketed to consumers by touting as their primary benefit that patients DON'T have to review bills and sign that yes, they receieved that test; and © the use of emergency rooms and clinics by the poor, government-insured, (MediCaid, CHIPS, Indigent Medical Services) in lieu of a family doctor. This makes it difficult to detect docs/hospitals whose prescribing and ordering patterns would stand out as red flags under other circumstances.
As for your ref to 3 million people, I think you're confusing fraud in disability status and malingering, car insurance and worker's comp fraud, with general medical "fraud, waste and abuse". Those are separate issues from regular fraud, though they usually go hand in hand and are made easier, not harder, by our present system. As it is, someone who claims a work injury, fake disability, or staged car accident is directed to docs who specialize in such cases and work with sleazy attorneys, and the "victims" kickback usually comes in the form of SSI payments or worker's comp wage substitutes. Were coverage universal, such fraud would be reduced, not increased, because the "normal" pattern would be for regular family docs to be treating most of these cases, and a doc who seemed to have an unusually large number of such cases would stick out. Under our present system, with Medicaid, worker's comp etc. being the "insurance coverage" of last resort and being paid at lower rates than regular coverage, such patients are concentrated in the practices of certain docs/clinics who accept such lower fees, making a pattern of abuse harder to detect.
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But, you do make some very good observations and I would suggest that your requirement for mandatory enrollment in some form of health insurance, whether private or a pseudo-government universal plan is a reasonable one that should be pursued. At least some states are pursuing that requirement now and maybe the monies doled out to the states by the fed could be better served in such plans.
You might want to take note that Medicaid, Medicare and other govt-funded programs actually have LOWER fraud and abuse rates (and overhead) than private plans, simply because private plans can simply raise premiums to cover such costs, just as dept. stores raise overall prices to cover losses due to shoplifting. Since raising prices isn't an option for gubmint programs, the incentives are diff and efforts to detect fraud are somewhat more diligent.
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If there was a pseudo-government program along the lines of yours, I'd like to have it include allowing insurance providers to compete for individual or subsidized premiums, along the line of open seasons, and allowing for the individuals to pick from a list of provider which meet establish coverage guidelines, much as they do with the federal employees programs.
Probably the only way a universal basic program can be instituted. The private insurance industry is so powerful that the only way to GET universal coverage will be to let them pocket the booty. Even though the private "competative" system is the most expensive. One alternative that's been proposed is regional single-payer, with competitive bidding for a 5-year contract to admnister a region's program, but that's a nonstarter because it would reduce the insurance companies not bidding on those regional basic program administration contracts to competing for what would be, in effect, the crumbs left over--the folks willing to pay more, out of pocket, for cadillac coverage.
This is really the problem Canada is encountering in trying/considering allowing private additional coverage to reduce those waits: Not enough people willing to pay for the cadillac coverage when push comes to shove, and not enough demand to stimulate an actual, real, competitive market for that minority of the population willing and able to pay. That's how its come to happen that such Cadillac-desiring patients simply fly to the US, and pay out of pocket, for their Cadillac care.
It should be noted that Canada, Europe, Japan, etc. introduced their universal coverage back in the 1960s and 1970s, before the technology boom took off and the cost spiral began as new, effective and more expensive treatments became available. As a result, their citizens have come to expect universal coverage as a normal right. We, on the other hand, did not follow suit, and instead allowed OUR system, which is pretty much unique in the industrialized world, to develop our employer-as-payer system that is now becoming unravelled and contributing to our competitve disadvante vs. countries with such universal systems, or third world countries who simply don't provide medical care.
A retrofit is always harder.
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As for the costs associated with hospitals investing in high cost technologies, I support them. Although an argument can be made for increasing cost associated with hospitals investing in technologies to compete for clientele, the more of those machines and technologies, the better for a lot of us in the long run with shorter wait times to get at them. When it comes to costs, we should also look to see how much of an impact malpractice insurance rates and litigious settlements account for the fifty dollar q-tip charge. (deliberately exaggerated…slightly)
That $50-dollar Q-tip (or not absurd but real, $40 single dose of Tylenol or Advil, is a result of that cost-shifting I mentioned. The 50 buck Q-times are what covers the cost of the lose on the MRI machine.
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I am for finding a way to include those without health insurance now without lowering the bar of standards enjoyed by those already insured. Somewhere, in the middle ground there's a solution that meets everyone's needs. Besides, once everyone has some form of health insurance, we can then dismiss the lack of health insurance benefits as a reason not to work.
There is hope on that point. The majority of people are seeing the price of their coverage incrased, the "reliability" of their coverage dimiishing (lose job/change job, lose coverage), and increasingly finding themselves either actually uninsured, or anxious that they may be uninsured. That's the force behind the growing pressure for univeral coverage. We aready have a two-tiered system, but it's more and more becoming tiers of "cadillac" and "none", rather than basic and deluxe that would be more desirable and less costly overall.
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We can then discuss a flat tax? :
Don't tempt me. I'm a flat taxer of the most extreme sort, and the board will SCREAM if I once again launch into an explanation of my plan for complete conversion to flat tax based on all income, in lieu of all corporate taxes, excise taxes, sales taxes, inheritance taxes. and NOT exempting the poor frm the system, but rather giving them a disincentive to vote themselves generous benefits they don't have to pay for..
My pet project is doing away with deficit spendning and social engineering via tax code by putting tax rate on autopilot and removing Congress and deficits entirely. Whatever the gubmint spent last year would automatically determne the universal flat tax rate for the following year, thereby stripping government of its ability to game the system, and proving the average citizen with a direct an promp motivation to REALLY push for spending control. End the smoke and mirrors and accounting tricks that are feeding the runaway budgets.
It's nice to have an intelligent, detailed discussion on these issues, instead of the usual vapid rich against poor ranting.