BIG F..king LIE: "Medicare pays over 95% of dollars collected back out in benefit cla

Discussion in 'Politics' started by healthmyths, Dec 7, 2011.

  1. healthmyths
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    healthmyths Gold Member Supporting Member

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    Why do people insist on being so IGNORANT---
    when the Internet PROVES them so wrong!!!

    Common MYTH statement:

    "Medicare pays over 95% of dollars collected back out in benefit claims.
    The best private health insurance bureaucracies can boast is 80%,
    most are closer to 70%."

    MYTH!!!

    FACT is Medicare spent in 2010 $37 billion more then they collected!

    FROM the people that would know:
    2011 Annual report of the Boards of Trustees for Medicare
    which you can download from:
    https://www.cms.gov/reportstrustfunds/downloads/tr2011.pdf

    Page 10 of the report shows in 2010:
    income $486 billion (to you means money coming in!!!)
    expenditures $523 billion (of which $516 billion were for claims)
    Means there was $37 billion MORE going out then came in!

    Which to almost everyone

    MEANS Medicare spend $37 billion more then there is income..

    MEANS MEDICARE IS BROKE!

    NO health insurance company would BE allowed to exist by any state insurance regulations if they spent more then their income!

    Medicare by definition is BANKRUPT.
    Medicare's expenses are greater then income .. BROKE!!

    Then this OTHER MYTH!!!
    The best private health insurance bureaucracies can boast is 80%, most are closer to 70%."

    FACTS why are people so ignorant when the Internet provides this!
    1) % of premiums spent on Claims:
    % of Premium 2009 paid in claims
    • UnitedHealth Group 82.30%
    • WellPoint 80.60%
    • Aetna 76.90%
    • Humana 83.20%
    • Cigna 82.30%
    • Health Net 83.90%

    AVERAGE % of Premiums paid in claims: 81.53%!!!

    Fortune 500 2009: Industry: Health Care: Insurance and Managed Care

    2) Percent of DENIALS!!!
    To the evidently IGNORANT Medicare DENIES a higher % then
    private insurance!

    Payer % of claim lines Denied
    • Medicare 6.85%
    • Aetna 6.80%
    • Anthem 4.62%
    • Health Net 3.88%
    • Cigna 3.44%
    • Humana 2.90%
    • Coventry 2.88%

    "Denied Claims Page 5 of 2008 National Health Insurer Report Card The Type of claims denied:"


    http://www.ama-assn.org/ama1/pub/upload/mm/368/reportcard.pdf
     
    Last edited: Dec 7, 2011
  2. 8537
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    8537 Senior Member

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    So you're saying that Medicare pays MORE than 95% of money collected in benefits?

    Somehow I doubt that's what you meant to stress.
     
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  3. Steelplate
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    Steelplate Bluesman

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    No... he's talking about "for Profit" doctors and hospitals OVERCHARGING Medicare for Services.

    If anything, the doctors and hospitals ought to be audited with a fine tooth comb and retrieve our taxpayer money back.

    I love the way people blame government for the sins of the private sector. Same with the thread on the rebuilding of the WTC, same with the bullshit that went on in the Banking industry that damn near killed us.

    Yes the government can be an "easy mark" for greedy assholes, but make no mistake... the sin is directly on the greedy asshole.
     
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  4. healthmyths
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    healthmyths Gold Member Supporting Member

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    Well let's see how that works out!
    If Medicare takes in $486 billion

    Pays out $523 billion that would be 107% of what they take IN!

    AND THAT would NEVER happen with private health insurance because state regulators would CLOSE THEM!

    AND YES Medicare is OK with paying out 107% of what they take IN!

    Again I think you are totally UNAWARE of what the MAJOR contributor to
    health costs occurred as an "unintended consequence of a good intention"!
    It was called in 1986 EMTALA!

    "In 1986, Congress enacted the Emergency Medical Treatment & Labor Act (EMTALA) to ensure public access to emergency services regardless of ability to pay."

    So Medicare KNOWS when they see a claim with a 6,000% markup that's because the hospital is "padding and passing" on the costs of EMTALA!

    Medicare is OK with paying 6,000% mark up because Medicare KNOWS that the providers are passing on to Medicare the $600 billion in defensive medicine costs! Again proof was Obamacare was very quick to tax tanning salons BUT tort reform that would reduce the $600 billion in fear of lawsuits?
     
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  5. 8537
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    8537 Senior Member

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    Really? An insurance company with a few hundred billion in reserves would be shut down because during one fiscal year they had losses equal to 7% of total revenue?

    Really?

    indeed, here in the United States we don't let people die outside Emergency Room doors because they can't pay the price of admission.
     
  6. Bfgrn
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    Bfgrn Gold Member

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    Hey Healthmyths, I appreciate that your user name is honest, you DO post health myths.

    You're confused. What the 95% signifies is called medical loss ratio.

    Let's have a 20 year Executive VP at CIGNA explain:

    BILL MOYERS: Why is public insurance, a public option, so fiercely opposed by the industry?

    WENDELL POTTER: The industry doesn't want to have any competitor. In fact, over the course of the last few years, has been shrinking the number of competitors through a lot of acquisitions and mergers. So first of all, they don't want any more competition period. They certainly don't want it from a government plan that might be operating more efficiently than they are, that they operate. The Medicare program that we have here is a government-run program that has administrative expenses that are like three percent or so.

    BILL MOYERS: Compared to the industry's--

    WENDELL POTTER: They spend about 20 cents of every premium dollar on overhead, which is administrative expense or profit. So they don't want to compete against a more efficient competitor.

    BILL MOYERS: You told Congress that the industry has hijacked our health care system and turned it into a giant ATM for Wall Street. You said, "I saw how they confuse their customers and dump the sick, all so they can satisfy their Wall Street investors." How do they satisfy their Wall Street investors?

    WENDELL POTTER: Well, there's a measure of profitability that investors look to, and it's called a medical loss ratio. And it's unique to the health insurance industry. And by medical loss ratio, I mean that it's a measure that tells investors or anyone else how much of a premium dollar is used by the insurance company to actually pay medical claims. And that has been shrinking, over the years, since the industry's been dominated by, or become dominated by for-profit insurance companies. Back in the early '90s, or back during the time that the Clinton plan was being debated, 95 cents out of every dollar was sent, you know, on average was used by the insurance companies to pay claims. Last year, it was down to just slightly above 80 percent.

    So, investors want that to keep shrinking. And if they see that an insurance company has not done what they think meets their expectations with the medical loss ratio, they'll punish them. Investors will start leaving in droves.

    I've seen a company stock price fall 20 percent in a single day, when it did not meet Wall Street's expectations with this medical loss ratio.

    BILL MOYERS: And they do what to make sure that they keep diminishing the medical loss ratio?

    WENDELL POTTER: Rescission is one thing. Denying claims is another. Being, you know, really careful as they review claims, particularly for things like liver transplants, to make sure, from their point of view, that it really is medically necessary and not experimental. That's one thing. And that was that issue in the Nataline Sarkisyan case.

    But another way is to purge employer accounts, that-- if a small business has an employee, for example, who suddenly has have a lot of treatment, or is in an accident. And medical bills are piling up, and this employee is filing claims with the insurance company. That'll be noticed by the insurance company.

    And when that business is up for renewal, and it typically is up, once a year, up for renewal, the underwriters will look at that. And they'll say, "We need to jack up the rates here, because the experience was," when I say experience, the claim experience, the number of claims filed was more than we anticipated. So we need to jack up the price. Jack up the premiums. Often they'll do this, knowing that the employer will have no alternative but to leave. And that happens all the time.

    BILL MOYERS: So, the more of my premium that goes to my health claims, pays for my medical coverage, the less money the company makes.

    WENDELL POTTER: That's right. Exactly right.

    BILL MOYERS: So they want to reverse that. They don't want my premium to go for my health care, right?

    WENDELL POTTER: Exactly right. They--

    BILL MOYERS: Where does it go?

    WENDELL POTTER: Well, a big chunk of it goes into shareholders' pockets. It's returned to them as part of the investment to them. It goes into the exorbitant salaries that a lot of the executives make. It goes into paying sales, marketing, and underwriting expenses. So a lot of it goes to pay those kinds of administrative functions. Overhead.

    Bill Moyers Journal . Wendell Potter on Profits Before Patients | PBS
     
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  7. Steelplate
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    Steelplate Bluesman

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    cue the "Wendell Potter is a Marxist" mantra in 3....2.....1....
     
  8. Mr. Shaman
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    Mr. Shaman Senior Member

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    Wendell Potter;
    American HERO!!!!

    [ame=http://www.youtube.com/watch?v=7QwX_soZ1GI]BILL MOYERS JOURNAL | Wendell Potter | PBS - YouTube[/ame]​

    [​IMG]
     
  9. Bfgrn
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    Bfgrn Gold Member

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    New measures gearing up to fight Medicare fraud

    The Affordable Care Act aims to stop criminals from defrauding taxpayers billions of dollars every year


    Federal health officials announced new security measures to combat Medicare fraud, including tougher screenings for providers and the ability to withhold payments during investigations.

    Authorities recovered $2.5 billion in health care fraud judgments last year -- a record high up 50 percent from 2009 -- according to a new report.

    Authorities have long said the solution to solving the nation's estimated $60 billion to $90 billion a year Medicare fraud problem lies in vigorously screening providers and stopping payment to suspicious ones, ending the antiquated "pay and chase" system authorities say has kept them one step behind criminals.

    Health and Human Services Secretary Kathleen Sebelius touted the Affordable Care Act as one of the toughest anti-fraud laws in history.

    More...
     
  10. healthmyths
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    healthmyths Gold Member Supporting Member

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    Wendell Potter and Bill Moyers are frauds!
    Again I'm not confused! THE insurance companies average 80% of their premiums going out in claims! THAT is a fact under penalty of prison when CEOs sign false Sarbanes- Oxley that state false expenses, i.e. how much spent on claims!
    And any idiot then should know when you divide claim expenses by
    premiums the average reported health insurance medical ratio is 80%!

    Reed Abelson of the New York Times reports that in 2008, the for-profit average medical loss ratio was 84 percent in policies offered to large employers and 80 percent in policies offered to small businesses. In the individual market, there was an average medical loss ratio of 74 percent. Rockefeller specifically accuses CIGNA of breaking the law and inaccurately reporting information to the NAIC -- they had claimed a medical loss ratio of 93 percent.

    HEALTH REFORM: Medical Loss Ratio or Just Medical Loss? | New America Blogs
     

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