Eliminating Fraud And Waste In Medicare

The lack of action in this area has (and will continue to have) a big impact on the overall cost of health care to small business. This is a low hanging fruit that doesn't get the attention it needs.

The President told the American people that he could pay for a large portion of Health Care Reform by reducing the fraud and waste in Medicare. If that is the case why is he waiting for Health Care reform legislation? Why not begin the eliminate it last February when he first said it?

This is not the first time rhetoric is followed up with maintaining the status quo in the health care debate. It's much easier to first lock people into an expensive health care bill and then go about cutting waste and fraud. We could always say, "Well, we have a budget for it (the Health Care bill with or without a public option) and we tried to cut waste but we didn't find that much, really..."

For example, in 2002 a biotech in St. Louis, MO, published a peer-reviewed study showing that 90% of kidney dialysis patients wouldn't need the treatment, potentially saving a substantial portion of the $35 billion and growing budget currently spent on this often fatal treatment in the US alone. The NHS refused to acknowledge the scientific results. A more recent study by AstraZeneca confirmed the 2002 findings. Again, nobody cared. This year, legislation in Congress noted that kidney disease and associated treatment options is the largest and also the fastest growing cost component of MediCare, yet nobody cared to look for a cost-cutting solution. Rather, Congress focused on increasing the budget to allow for the cost increase.

Now that the President has proposed to cut MediCare and shift the funds to a different part of the budget, you are right, there is again no solution. Of course, vested interests have a lot to lose, yet change is inevitable. The quality of health care in this country is declining rapidly. The model we have now doesn't focus on results (healthy people), instead it rewards doctors and pharma companies who keep people coming back for more.

We need more competitive health care options, not fewer. Deborah Williams, Dir. of Policy at Baxter wrote "We as the health care community should begin with building incentives for the right care at the right place. If we can't do it in an area where the answers and data are readily available and relatively robust, it points to a serious societal problem." Note her choice of words, "relatively," not "absolute." She acknowledges that nobody is perfect, but she does stress that we need to focus on the right care for patients.

In the January 2008 Congressional Budget Office (CBO) report on Technological Change and Healthcare Spending, CBO points to development of dialysis of patients with kidney failure as increasing costs. The development of renal dialysis therapy and the many improvements made to it over the past several decades have vastly improved the ability of providers to care for these patients, but at the same time this led to higher costs because patients stayed in treatment longer. In other words, no effort was made to prevent the onset of kidney disease... It further noted that the costs will continue to increase as the prevalence of patients with end stage renal disease has been estimated to increase by 62% by 2020 (Gilbertson and Collins, USRDS (the NIH US Renal Data System)). Whatever happened to prevention...don't we need an SEC type body for health care?

To answer the question in the post title ..... I can give you two reasons:

1. The Congress (both Republican and Democrat controlled) has consistently failed to fund staff and technology in order to do so. (For every $1 spent on exam of suspicious claims $50 comes back to Medicare, yet Congress keeps cutting the exam and technology budget)

2. The President has little influence on the process beyond the selection of an Administrator who will focus on the issue.

Congress micro-manages Medicare and Medicaid, that micro-management is single largest contributor to the 9% of each year’s payments, which constitute Fraud, Waste and Abuse. Yes, that is roughly $22 billion and over the last 20 years the only impact made on fixing that problem was in the first term of the GWB administration when the number went from 11% to the current 9% number.

However, remember, the currently Democratic controlled Congress is telling us they will add millions of people to Medicare and Medicaid and yet it will cost us less than it does today.

I guess they really think we are just that stupid, and from the look of the current polling and who we elected maybe they are correct.

Musings On Health Care Reform And The Affect On Small Business

I could go on forever...so much information to consider and opine upon. Who says the system is broken? The US has the quality AND level of care that nearly everyone in the world looks to with envy.

The problem is not CARE ... it is COST. So why is the proposed "solution" labeled Health CARE Reform.

Because it is care that will be affected ... not cost. Unless you consider higher costs as the outcome of the "reform" you were looking for.

HALF the reason our costs are so high is because of the quality AND level of care that (nearly) everyone gets. No other country pays for such aggressive cancer-fighting treatments, heart transplants, quadruple-bypass etc in the "average Joe" -- even if you're 80 years old or 100 pounds over-weight. In the US, it's joint-replacement surgury for everyone!

The other HALF of the reason our costs are so high is because someone will pay the price. The health companies would not charge such high rates if someone would not pay them (with government collected taxes, or by forcing businesses to pay). The critics say that already no one can afford health care. Well that is not true or the companies providing the services would not provide them, or they will lower their costs.

Is it just me, or is the plan to have the government throw more money at the problem the wrong way to go? Stop subsidizing health care with so much tax money and prices will come down. Stop increasing the burden on businesses and the prices will come down. Stop encouraging everyone to have an MRI every time they have a headache and the prices will come down.

Only problem: Perhaps the health-care industry will not be able to employ 11% of the entire work-force. But then, is it really necessary for one in every fifteen people (6.8% of the total US population) to be working full time to care for the rest of us? Then again...maybe we wouldn't need 10% of the entire population (15% of the work-force) employed in government either. That's right! Fully 25% of everyone working in the US is employed in either health care or government. What are the chances of "right-sizing" that mess without a full-blown default?

there are many people (perhaps a majority?) that feel entitled to get more of a share of the national wealth than the fair market value of the work they do, or capital they can invest, in return. They feel that the well off should be obligated to pay for the not-so well off. Government as "Robin Hood" -- take from the rich and give to the poor. Whether it's health care, unemployment insurance, social security, or food stamps -- the majority want more than they can afford. It amounts to welfare. And most have no concept of what it takes to pay for it, or the social costs.

Of course Dear Leader (sic Obama) and his cronies will push forward an agenda that will give some people subsidized health insurance with what appears to be lower premiums .... as a big portion of the premiums are paid not by the policy holders themselves, but by the rest of us. Private health care does not have that option of taxpayer subsidized premiums, so of course the playing field is not level. In doing this, more people will be lured to government programs and when private insurance cannot stay in business any longer ..... we will all either have no insurance or government insurance with few actual benefits, not because medical care isn't covered in theory, but because there is no incentive anymore to provide quality health care since doctors and nurses will become government employees.

Here a few simple solutions I think should be part of any reform plan .....

First, shut off access to taxpayer subsidized health care to illegal aliens.

Second, limit the payout on malpractice lawsuits.

Third, everyone has only a major medical policy, meaning everyone pays out of pocket all basic doctors and prescription costs, causing a market shift in doctor visit prices and cost of prescription drugs based on what the market will bear.

Fourth, elect small government members of congress in 2010 and elect a President in 2012 who believes in capitalism.

We just can't fiscally sustain this huge ramp-up in government programs and expanded control from the Democrats; it'll bring the country to where we are now in the state of CA, on the brink of financial ruin. And once these Federal programs are passed, they never go away. They only grow and inefficiently spend more & more money as time goes on as Congress approves additional programs requiring higher taxes.

This administration is not about fixing the economy; it's about expanding government control of our everyday lives and raising taxes to redistribute to the general populace to increase dependency on the gov't. They know how to grow the economy, and they're intent on doing just the opposite.

I agree that something needs to be done to fix healthcare (err costs) .... and I'm hopeful that 2010 will be an election year when it becomes clearly understood that the kind of change we've gotten in Washington D.C. ..... is not the change that we wanted.