The Future of Medicare
http://thedianerehmshow.org/shows/2012-03-01/future-medicare
Federal prosecutors in Texas and New York announced this week they had uncovered two massive health care fraud schemes. In the Texas case, they've charged a doctor and six others with cheating the government out of more than a quarter of a billion dollars in Medicare and Medicaid fees. For many critics of the government health programs, fraud allegations underscore their belief that radical restructuring is needed. Others say proposals to overhaul the programs don't address the critical need to contain costs throughout the medical system. Diane and her guests will talk about the future of Medicare and Medicaid.
Guests
John Rother
president and CEO, National Coalition on Health Care.
Mary Agnes Carey
senior correspondent,Kaiser Health News.
Grace-Marie Turner
president of the Galen Institute, a research group focusing on free-market health care reform and tax policy.
Comments
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Those opposed to Medicare want to perpetuate the idea that it, exclusively, is riddled with fraud. Would they possibly be surprised to learn that the private health insurance industry is just as riddled with fraud?
Yes, the program needs radical restructuring, but not in the way your guests are going to suggest. The program needs to be restructured into Medicare-for-All, with no age eligibility restrictions and a pool of 300+ million patients, with a single payer replacing the 1300+ unethical, corrupt private health insurance companies.
Every single day we hear new stories about how the private health insurance industry is finding new ways to rip off the patient. Sooner or later the government and the public will come to the realization that we need to discard our “American exceptionalism” nonsense and heed the success of other countries with a nationalized system, so we can similarly provide every American with needed health care without the threat of financial ruin. This is the best, and the only, way to solve our inhumane health care crisis.
I am all for keeping Medicare for those age 65 and up, but changes do have to be made. Not only are seniors getting much more care than was even an option when it started, but no one receiving Medicare paid into the system what they are now taking out in procedures, etc. What are AARP and our seniors willing to give up (or contribute) now that our population has changed and the available medical services has multiplied?
December 3, 2011
The official in charge of Medicare and Medicaid for the last 17 months says that 20 percent to 30 percent of health spending is “waste” that yields no benefit to patients, and that some of the needless spending is a result of onerous, archaic regulations enforced by his agency.
Dr. Donald M. Berwick testifying before the Senate Finance Committee in November 2010.
The official, Dr. Donald M. Berwick, listed five reasons for what he described as the “extremely high level of waste.” They are over-treatment of patients, the failure to coordinate care, the administrative complexity of the health care system, burdensome rules and fraud.
“Much is done that does not help patients at all,” Dr. Berwick said, “and many physicians know it.”
Dr. Berwick was Obama's appointed guy.
If anyone has information regarding private health care insurance companies "waste fraud and abuse" anywhere near these figures, POST IT!
foxy wrote:
"Those opposed to Medicare want to perpetuate the idea that it, exclusively, is riddled with fraud. Would they possibly be surprised to learn that the private health insurance industry is just as riddled with fraud?"
Do you have any proof to back this up?
Consider an average-wage two-earner couple together earning $89,000 a year. Upon retiring in 2011, they would have paid $114,000 in Medicare payroll taxes during their careers. But they can expect to receive medical services - including prescriptions and hospital care - worth $355,000, or about three times what they put in.
http://www.washingtonpost.com/wp-dyn/content/article/2011/01/02/AR201101...
The news media fails to state the progressive solutions to Medicare/Medicaid reform which include making the institutions and people responsible for the shortcomings pay to strenghten the program.
We all know that trillions of dollars have been lost to fraud over decades while the government eliminated oversight, allowing fraud to flourish. We know that almost all that time the fraud was committed by the healthcare institutions of hospitals, doctors, and medical/pharma supply. Only lately have gangs joined the feeding. So the obvious thing to do is tax these institutions a surcharge that retroactively seeks to recover past abuses and anticipates future abuses. All retail businesses have a theft surcharge and the government should have had one protecting the taxpayers/entitlement recipients, but chose instead to protect the industry from tax. Is it fair to charge this tax for current members for the sins of the past......yes! the current players benefited financially from the ill-gotten profits of the past.
Secondly, those who say that not enough was paid into the program, especially given the expensive medical advances, there is this:
Baby boomers worked for lower wages to assure that they would have the retirement benefits that were sold as compensation packages, we paid into all thes medical advances through the use of taxpayer money used to finance all the research and development.....all these advances were paid for by the boomer generation...that is our contribution to receiving services now.
The boomers are telling politicians this: tax the industry for as long as it takes to recoup the trillions stolen and make the federal government subsidize the program for all the taxpayer contributions to government grants for medical research.....trillions of dollars over decades. This is the solution.....not cuts.
You are forgetting lost wages in the compromise for retirement benefits and you are forgetting the huge amount of taxpayer money paid into medical research through grants ...trillions of dollars from boomers...lower and middle class. We have paid for those services and expect to get them.
"In 1997, Rick Scott was implicated in the biggest Medicare fraud case in US history, stepping down as CEO of Columbia/HCA after the hospital giant was fined $1.7 billion and found guilty of swindling the government. As Florida's new governor, Scott is now trying to kill off an anti-fraud database that would track the fraudulent distribution of addictive prescription drugs in Florida, over the protestations of law enforcement officials, Republican state lawmakers, and federal drug policy officials".
If you can`t beat em,steal from them.
THX I have spent the last four years helping take care of aging, ailing parents. Have been doing the assisted living, nursing home, medicare, medicaid dance with them. In their state of body and minds there is no way according to then that they could navigate the maze without their childrens help. I have never been up so close to these medical systems. As I go through my mothers two knee replacement bills and being very aware of all medications, therapy etc. I have been in shock about cost of therapy etc. When I reported fraud with charges by one private company...nothing done. Lots more examples.
Fraud waste and abuse is huge.
Listen to this one. A friend who voted for Republicans, had several million that she inherited from parents, lived on that interest and claimed that she was living off of her partners 15,000 dollar income from his massage business. She was able to get her kid, her partner and herself on medicaid coverage. Total fraud
So much fraud and abuse in this system. They really need to make it easier to turn people in.
THX, it happened to me, among many others. I went to a doctor for a shoulder problem. He wanted to give me a cortisone injection and I refused it. (The problem wasn't even in the joint space.) However, on the EOB I saw that they had charged the insurance company for it.
What are some of the ways that other countries deal with fraud and waste in government-administered healthcare?
This is an important issue for the future of healthcare in America. We need to learn from other successes and failures, so that we can ensure that such programs can be both effective and efficient.
I lived 17+ years in Europe under universal health care policies. In that time, I saw rampant abuse, fraud, inefficiencies, stupidities and waste. It's expensive, bloated and wasteful I wouldn't want anyone to ever live without it. Regardless the problems, you do not see in Europe what confronted me when returning to the U.S.: chronically ill people, untreated and unable to help themselves. There are some things more important than saving money or political philosophy.
LH
I've read many articles and opinions on the Ryan Medicare proposal. Have yet to hear how it would actually save any money anywhere. Insurance companies are not fools. They will price policies based on the expected costs so you will have low cost policies for the well and much, much higher cost policies for the sick. The insurance companies will make their profit in either case. You'll just need to be rich once you start to have long term illness.
Medicare fraud could be substantially reduced by placing payment approval with the patient first. Baby boomers must hold the "approval to pay" decision before the government issues funds to a qualified source.
The blame for monitoring health care fraud in Medicare should reside with the Private insurance companies who review the claims: Medicare contracts with regional insurance companies who process over one billion fee-for-service claims per year. These companies should be sophisticated enough to keep track of potential fraud or they would go out of business with their own products.
I think the biggest cost problem with the health care system is the overhead of the health insurance program. 60-minutes a year or so ago reported that the Duke Medical System had over 1000 people in their accounting department - more than the health professionals there.
How do doctors salaries in the us compared to those in europe?
I am for Obamacare, but it needs tweeking. Burned my hand, went to ER & very well treated, given a perscription for much too much med. What I got at the ER was sufficient. Given 4 extra bottles of salve and 24 pain killers which I never used?? Who pays for all that extra med. which I could not return? or should I not have filled the Perscription, but how was I to know??
I am a reporter from Dallas who covered the indictment this week in Dallas. And have spent much of the last year covering health care fraud.
It is embeded in the system. There are entire industries, known as practice management companies, designed to either overtly or obliquely evade regulations and maximize the take from taxpayers.
There are recruiters who either directly or indirectly sell patients to doctors and dentists.
Regulators rarely look at this on the granular level. They expect to solve it with computer programs. In this way the problem is similar to the mortgage crisis, where lenders never saw the properties they were buying, appraisals were nonexistent, and the entire process was commodified.
Your guests seem to advocate more "competition" in health care. My observation is that health care providers compete not by becoming more efficient or cheaper, but by promoting new services and treatments. Thus, too many cat scans, etc. Shopping for Medicare supplement insurance, I found no evidence of price competition among insurers whatsoever.
Doctors in Europe make considerably less than their counterparts here in the states.
Socialized Medicine!
http://economix.blogs.nytimes.com/2009/07/15/how-much-do-doctors-in-othe...
Another closely kept secret is the number of primary care doctors in the DC area who either won't take new Medicare patients, or who just don't participate in the Medicare program, and most of these are the better, more in demand doctors
The secret is that it is a voluntary program for doctors. So if you cut funds to doctors, guess what happens? Doctors don't need Medicare in wealthy areas!
We could prevent a lot of the fraud in the present fee for service area by having patients pay at point of service and then be reimbursed or otherwise credited on their taxes. Believe me you could not overcharge most medicare participants if they had to write the check at point of service.
France limits unnecessary care by having patients pay every time they see a doctor at the point of care and they are reimbursed within a matter of days (without paperwork). Reid's book "Healing of America" describes this logical and efficient alternative.
Medical billing, payment and collection is ridiculously inefficient and a whole industry by itself. It is a huge waste which is only getting more inefficient with the absurd new coding being adopted. Make things simpler. Return payment to the point of care.
Also if it didn't cost so much to bill and collect from insurers, some of use older partially retired physicians would be able to continue doing what we love to do. My billing and collections before I went to work as an employee of a hospital was nearly 30% at times.
I had to fight for payment when even the patients were shocked how little I was being paid for my time as a neurologists. If patients paid doctors directly for their care, their care would be a lot better. No patient would leave the office without being asked, "Did we answer all your questions?"
oh please...the plan D is a huge mistake, it makes TOO MANY options w/little help for seniors to figure out which plan is best fit for their reality....to have Medicare do the same will only increase costs by creating confusion....
not only do my neighbors have to figure out what plan is best annually but are faced w/drugs that cost less individually instead of being combines...
also my sister, as she turned 65, didn't need Plan D & so didn't sign on...3years down the road, she did sign on to the program and had to pay an extra charge for the years she didn't sign on....
the biggest way to help Medicare is to drop the 'fee for service' & make MD's responsible for HEALTH not service....allopathic medicine is not always the best route, why not begin to include more non-allopathic paths, chiropractic, Chinese medicine etc
I believe Ms. Turner mentioned that increasing competition in Medicare would decrease costs. How would this work? Competition has been part of the problem with health care for non-Medicare eligible by pushing profit as the primary driver of the system and contributing to the increasing number of uninsured.
Please ask your guests to comment on existing barriers to utilizing nurse practitioners in primary care. What, if any, is the role/position of the American Medical Association in the erection of these barriers. What do you see as the future for utilization of NPs?
Thanks.
These people keep talking about people deciding and making choices during a time in people lives when they can not make those choices. By 75 my mom could not longer make health choices decisions and kept telling health care providers that she had diabietes and had had her neck broken in a car wreck, neither of which are true. Their thoughts are headed in the wrong direction.
as a recently retired physician, I'm very disappointed in this discussion - it's just a rehash of prior gyrations and not facing the needed discussion.
End of life care cannot be realistically discussed when the payment systems allows individuals to "choose" (one of the favorite words of the discussants) continued expensive measures of treatment without a discussion of expense, suffering, ethical considerations. Likewise with insurance comanies.
It is well established that physicians and their families use less care than others. Why not transfer that knowledge/judgment to the general population. It's a matter of education.
Insurance companies add red tape and bureacracy to the process and little else. They are the only industry that can figure out what their costs are by actuarian methods, then add the desired profit and set the fee.
The upcoming computer garnered info effort by the government is an anchor to physicians.
The fundamental problem with healthcare costs is Medicare is a system of price controls. Healthcare costs will never be optimal until the patients have a responsible virtual control of the money and the providers compete on price and quality. See our proposal at http://www.healthcareinc.net/
Great topic but where are the doctors in this program?
Points:
1. Americans have paid for Medicare via Payroll taxes over a lifetime. Most have in much more than taken out.
2. Why "penalize" the "caregivers" (i.e doctors, hospitals, etc) with diminishing reimbursements. They are the men & women & organizations that doing the hard work daily.
3. Why is the government "demonizing" healthcare providers: 99% of us are honest, caring & hardworking people. I personally work 70 hours a week caring for my patients: commercial & Medicare.
4. Pitting subspecialists against PCP is another method of demonizing doctors. PCP have very unque challenges & skill sets that should be appropriately compensated. Specialists are the "experts" in their respective fields. The should be compensated greater due to the extensive additional training required; special skill required; more complex medical issues, etc.
5. I agree with competition! Patient demand for better care will force hospitals & doctors to improve; Costs will fall if competition is entered into the equation. I recommend the book: "Who Killed Health Care" by Regina Herlinger for expansion of this point of view.
6.Finally, doctors, nurses, techs, hospitals really want to be efficient, profitable and centers of excellence for their patients...this can be done if the government doesn't dictate the terms.