Government provided Health Care

[toomuchtime_]

Since all healthcare is rationed, the question for me is do I want those decisions to rest with corporations whose sole reason for existence is to make a profit --- profits which depend upon insuring the healthiest among us, and denying coverage for those whom they may have to pay claims? Corporations where profits are dependent on NOT providing the services I pay for? That can at any point in time decide to cancel my policy, leaving me without any coverage at all and no prospects of obtaining coverage on my own? That spend 1/3 of their revenue in administrative overhead?

No thanks.

Nonsense. Health care is not rationed in the US by either private plans or, as yet, by our public plans, but it is rationed by public plans in countries like Canada and the UK where some medications and procedures are simply not available through the public plan because the expense of providing them might strain the budget.

Your rant about insurance companies denying services to their customers is without basis is fact or logic. An insurance policy is a legal contract enforceable in court, so if you entered into that contract in good faith - told the truth about your medical history in the application - and pay your premiums the insurance company cannot deny you any services the policy says are covered or cancel your policy. Not so with a government plan like our Medicare or the Canadian Medicare system or the UK's NHS, which can change your benefits at any time and you have no legal recourse.

That is the case in principle against the claim private insurance companies are free not to live up to their obligations, and the facts also disprove your claim. First, the AMA has shown that Medicare denies a larger percentage of claims than private insurers do.

http://www.ama-assn.org/ama1/pub/upload/mm/368/reportcard.pdf (See metric 12)

Additionally, when Obama tried to make the same case you are making against insurance companies in his speech before a joint session of Congress, even with all the resources at the disposal of the WH, he was forced to lie in order to present to supposed examples of abuses by insurance companies.

To highlight abusive practices, Mr. Obama referred to an Illinois man who "lost his coverage in the middle of chemotherapy because his insurer found he hadn't reported gallstones that he didn't even know about." The president continued: "They delayed his treatment, and he died because of it."

Although the president has used this example previously, his conclusion is contradicted by the transcript of a June 16 hearing on industry practices before the Subcommittee of Oversight and Investigation of the House Committee on Energy and Commerce. The deceased's sister testified that the insurer reinstated her brother's coverage following intervention by the Illinois Attorney General's Office. She testified that her brother received a prescribed stem-cell transplant within the desired three- to four-week "window of opportunity" from "one of the most renowned doctors in the whole world on the specific routine," that the procedure "was extremely successful," and that "it extended his life nearly three and a half years."

The president's second example was a Texas woman "about to get a double mastectomy when her insurance company canceled her policy because she forgot to declare a case of acne." He said that "By the time she had her insurance reinstated, her breast cancer more than doubled in size."

The woman's testimony at the June 16 hearing confirms that her surgery was delayed several months. It also suggests that the dermatologist's chart may have described her skin condition as precancerous, that the insurer also took issue with an apparent failure to disclose an earlier problem with an irregular heartbeat, and that she knowingly underreported her weight on the application.

Scott Harrington: Fact-Checking the President on Health Insurance - WSJ.com

As to the question of administrative costs, Medicare has higher per beneficiary administrative costs than the average private insurance plan, in 2005, $509 per person for Medicare and $453 for the average private plan. Because Medicare beneficiaries, the elderly and disabled, incur much higher medical expenses than the average private plan beneficiary does, expressing administrative costs as a percentage of total expenditures makes them seem deceptively low for Medicare in comparison with private plans, which is why advocates of government run health insurance like to use that statistic, but the per person administrative cost shows that even including profits, executive pay, taxes and sales commissions, private insurance plans on average are more efficient and have lower administrative costs than Medicare.

Medicare Administrative Costs Are Higher, Not Lower, Than for Private Insurance

That means that if a new public plan for the non elderly were run the way Medicare is, it, too, would have higher per person administrative costs than private health insurance plans and since both public and private plans would be dealing with the same populations, the public plan's higher per person administrative costs would translate into higher premiums. Moreover, according to the CBO, the public plan proposed in the current House bill would be less effective in managing fraud and waste than private plans are, translating into even higher premiums for the public plan.

http://www.cbo.gov/ftpdocs/106xx/doc10688/hr3962Rangel.pdf Page 6.

So, putting the facts together, a public health insurance plan for the non elderly would be less efficiently run than private health insurance plans, would have higher premiums than private health insurance plans and would deny more claims than private health insurance plans. That means if you want to pay more and have fewer of your medical bills paid, you want a government run health insurance plan.

Your post exemplifies the extent to which Obama's and Pelosi's blatant lies and misrepresentations on the issue of private and public health insurance have degraded the level of political discourse so that so many seemingly intelligent and well intentioned people repeat their statements with no apparent interest in whether they are true or not.

 

[Douger]

RGS...what medical treatment have you been denied?

They denied his brain IMPLANT........
Retired and sergeant is like working at Winn Dixie for 30 years to attain the title of shelf stocker.

RetiredCoffeePickerGuy.

 

[Care4all]

Since all healthcare is rationed, the question for me is do I want those decisions to rest with corporations whose sole reason for existence is to make a profit --- profits which depend upon insuring the healthiest among us, and denying coverage for those whom they may have to pay claims? Corporations where profits are dependent on NOT providing the services I pay for? That can at any point in time decide to cancel my policy, leaving me without any coverage at all and no prospects of obtaining coverage on my own? That spend 1/3 of their revenue in administrative overhead?

No thanks.

Nonsense. Health care is not rationed in the US by either private plans or, as yet, by our public plans, but it is rationed by public plans in countries like Canada and the UK where some medications and procedures are simply not available through the public plan because the expense of providing them might strain the budget.

Your rant about insurance companies denying services to their customers is without basis is fact or logic. An insurance policy is a legal contract enforceable in court, so if you entered into that contract in good faith - told the truth about your medical history in the application - and pay your premiums the insurance company cannot deny you any services the policy says are covered or cancel your policy. Not so with a government plan like our Medicare or the Canadian Medicare system or the UK's NHS, which can change your benefits at any time and you have no legal recourse.

That is the case in principle against the claim private insurance companies are free not to live up to their obligations, and the facts also disprove your claim. First, the AMA has shown that Medicare denies a larger percentage of claims than private insurers do.

http://www.ama-assn.org/ama1/pub/upload/mm/368/reportcard.pdf (See metric 12)

Additionally, when Obama tried to make the same case you are making against insurance companies in his speech before a joint session of Congress, even with all the resources at the disposal of the WH, he was forced to lie in order to present to supposed examples of abuses by insurance companies.

To highlight abusive practices, Mr. Obama referred to an Illinois man who "lost his coverage in the middle of chemotherapy because his insurer found he hadn't reported gallstones that he didn't even know about." The president continued: "They delayed his treatment, and he died because of it."

Although the president has used this example previously, his conclusion is contradicted by the transcript of a June 16 hearing on industry practices before the Subcommittee of Oversight and Investigation of the House Committee on Energy and Commerce. The deceased's sister testified that the insurer reinstated her brother's coverage following intervention by the Illinois Attorney General's Office. She testified that her brother received a prescribed stem-cell transplant within the desired three- to four-week "window of opportunity" from "one of the most renowned doctors in the whole world on the specific routine," that the procedure "was extremely successful," and that "it extended his life nearly three and a half years."

The president's second example was a Texas woman "about to get a double mastectomy when her insurance company canceled her policy because she forgot to declare a case of acne." He said that "By the time she had her insurance reinstated, her breast cancer more than doubled in size."

The woman's testimony at the June 16 hearing confirms that her surgery was delayed several months. It also suggests that the dermatologist's chart may have described her skin condition as precancerous, that the insurer also took issue with an apparent failure to disclose an earlier problem with an irregular heartbeat, and that she knowingly underreported her weight on the application.

Scott Harrington: Fact-Checking the President on Health Insurance - WSJ.com

As to the question of administrative costs, Medicare has higher per beneficiary administrative costs than the average private insurance plan, in 2005, $509 per person for Medicare and $453 for the average private plan. Because Medicare beneficiaries, the elderly and disabled, incur much higher medical expenses than the average private plan beneficiary does, expressing administrative costs as a percentage of total expenditures makes them seem deceptively low for Medicare in comparison with private plans, which is why advocates of government run health insurance like to use that statistic, but the per person administrative cost shows that even including profits, executive pay, taxes and sales commissions, private insurance plans on average are more efficient and have lower administrative costs than Medicare.

Medicare Administrative Costs Are Higher, Not Lower, Than for Private Insurance

That means that if a new public plan for the non elderly were run the way Medicare is, it, too, would have higher per person administrative costs than private health insurance plans and since both public and private plans would be dealing with the same populations, the public plan's higher per person administrative costs would translate into higher premiums. Moreover, according to the CBO, the public plan proposed in the current House bill would be less effective in managing fraud and waste than private plans are, translating into even higher premiums for the public plan.

http://www.cbo.gov/ftpdocs/106xx/doc10688/hr3962Rangel.pdf Page 6.

So, putting the facts together, a public health insurance plan for the non elderly would be less efficiently run than private health insurance plans, would have higher premiums than private health insurance plans and would deny more claims than private health insurance plans. That means if you want to pay more and have fewer of your medical bills paid, you want a government run health insurance plan.

Your post exemplifies the extent to which Obama's and Pelosi's blatant lies and misrepresentations on the issue of private and public health insurance have degraded the level of political discourse so that so many seemingly intelligent and well intentioned people repeat their statements with no apparent interest in whether they are true or not.

Just utterly ridiculous and as i have told you before very wrong in the heritage foundations assumptions.

Healthcare administration costs for the elderly should be much much much much higher than the administrative costs for someone HEALTHY, who does not use the services that require the administration of such.

The private insurance industry runs about 20% higher than Medicare and this is with primarily an healthy group of people that they are insuring, who do not even use their health care services for other than a routine check up and routine labs.

To even THINK that health care administration costs for the primarily sick and elderly should be on par with a nonsickly person who receives no care to even cost anything administratively is absurd too much time.

And if the private sector felt that they could insure the elderly so much better and cheaper, then why in the heck did they REFUSE to cover them in the FIRST PLACE which lead our government IN TO CREATING medicare coverage for the elderly.

THE INSURANCE COMPANIES DO NOT WANT THEM To much time, why is that?

We will just have to agree to disagree on this....logic and statistics, are wih me on it, imo...but believe what you wish.

Care

 

[Zona]

If the Government provides Health Care, whether spelled out in this bill or not, it will RATION the care. That is how it works.

The Government can not afford to pay for everything for everyone, even if they took all our money. And in fact the research that backs up this health care bill out of the House spells it out clearly. Specifically it identifies the elderly and those under the age of 2 as being less important and so they will be the first to suffer from reduced services.

Knowing that the Government can not efficiently run anything, I can promise it won't end there.

Then ask them to stop your tricare. Ask them to stop your retirement check as well since they are doomed and will fail.


Dumb ass E-7.

 

[American Horse]

The primary reasons why Medicare runs in the red is the majority of those covered by medicare subsidized by payroll taxes aren't paying premiums. Only $2.9 billion of its income of nearly $231 billion comes from its client base --- which are statistically the sickest demographic (seniors and disabled) and with a larger healthier client base, that means more money in revenue vs expenditures.

Cover everyone with Medicare, and the size and overall health of their client base goes up along with the revenue income from premiums.

EVERYONE that works pays into medicare. EVERYONE. There is no other way to put it. Medicare is already subsidized by OUR TAXES from every person in this country that works. And it fails miserably.

I'm not sure that is true. those who make their income, their living, through investments do NOT PAY MEDICARE taxes.

And it does not fail miserably, if we had NO medicare at all, then look at it...you will KNOW what failure is.

Medicare, as originally conceived, and if adequately supported by those who would eventually draw from it was a good idea and a necessity. As with almost all government programs, it has been piled onto and been insufficiently paid into by those who would draw from it.

That is a political problem, one of a lack of courage to pay for all the new things larded on, while at the same time there was a resistance to forcing competition into it (like Medicare Advantage accounts or Health Savings accounts - those things were adamantly resisted).

Means testing should've made it just a hospitalization-policy for those who could afford to insure for all the rest and things like knee and hip replacement also should've only been provided for by an insurance regime, openly selected by enrollees just like the current supplemental policies are now. (The above mentioned improvements helped in that regard) Those too poor to buy those policies would need to have been provided for by Medicare (or a tax credit to provide for inurance) as established by some form of means testing; in other words, anything to bring competition by forcing those able make their medical choices to actually do so. That would have helped keep it solvent. Even the problem of fraud and waste, ten percent of expenditures, imbedded in it is seems to be too complicated to take on by the bureaucracy. The politicians will never really succeed in eliminating that. They will instead only reduce costs by reducing services to those who are truly sick and most in need of medical services.
.

 

[toomuchtime_]

Since all healthcare is rationed, the question for me is do I want those decisions to rest with corporations whose sole reason for existence is to make a profit --- profits which depend upon insuring the healthiest among us, and denying coverage for those whom they may have to pay claims? Corporations where profits are dependent on NOT providing the services I pay for? That can at any point in time decide to cancel my policy, leaving me without any coverage at all and no prospects of obtaining coverage on my own? That spend 1/3 of their revenue in administrative overhead?

No thanks.

Nonsense. Health care is not rationed in the US by either private plans or, as yet, by our public plans, but it is rationed by public plans in countries like Canada and the UK where some medications and procedures are simply not available through the public plan because the expense of providing them might strain the budget.

Your rant about insurance companies denying services to their customers is without basis is fact or logic. An insurance policy is a legal contract enforceable in court, so if you entered into that contract in good faith - told the truth about your medical history in the application - and pay your premiums the insurance company cannot deny you any services the policy says are covered or cancel your policy. Not so with a government plan like our Medicare or the Canadian Medicare system or the UK's NHS, which can change your benefits at any time and you have no legal recourse.

That is the case in principle against the claim private insurance companies are free not to live up to their obligations, and the facts also disprove your claim. First, the AMA has shown that Medicare denies a larger percentage of claims than private insurers do.

http://www.ama-assn.org/ama1/pub/upload/mm/368/reportcard.pdf (See metric 12)

Additionally, when Obama tried to make the same case you are making against insurance companies in his speech before a joint session of Congress, even with all the resources at the disposal of the WH, he was forced to lie in order to present to supposed examples of abuses by insurance companies.

To highlight abusive practices, Mr. Obama referred to an Illinois man who "lost his coverage in the middle of chemotherapy because his insurer found he hadn't reported gallstones that he didn't even know about." The president continued: "They delayed his treatment, and he died because of it."

Although the president has used this example previously, his conclusion is contradicted by the transcript of a June 16 hearing on industry practices before the Subcommittee of Oversight and Investigation of the House Committee on Energy and Commerce. The deceased's sister testified that the insurer reinstated her brother's coverage following intervention by the Illinois Attorney General's Office. She testified that her brother received a prescribed stem-cell transplant within the desired three- to four-week "window of opportunity" from "one of the most renowned doctors in the whole world on the specific routine," that the procedure "was extremely successful," and that "it extended his life nearly three and a half years."

The president's second example was a Texas woman "about to get a double mastectomy when her insurance company canceled her policy because she forgot to declare a case of acne." He said that "By the time she had her insurance reinstated, her breast cancer more than doubled in size."

The woman's testimony at the June 16 hearing confirms that her surgery was delayed several months. It also suggests that the dermatologist's chart may have described her skin condition as precancerous, that the insurer also took issue with an apparent failure to disclose an earlier problem with an irregular heartbeat, and that she knowingly underreported her weight on the application.

Scott Harrington: Fact-Checking the President on Health Insurance - WSJ.com

As to the question of administrative costs, Medicare has higher per beneficiary administrative costs than the average private insurance plan, in 2005, $509 per person for Medicare and $453 for the average private plan. Because Medicare beneficiaries, the elderly and disabled, incur much higher medical expenses than the average private plan beneficiary does, expressing administrative costs as a percentage of total expenditures makes them seem deceptively low for Medicare in comparison with private plans, which is why advocates of government run health insurance like to use that statistic, but the per person administrative cost shows that even including profits, executive pay, taxes and sales commissions, private insurance plans on average are more efficient and have lower administrative costs than Medicare.

Medicare Administrative Costs Are Higher, Not Lower, Than for Private Insurance

That means that if a new public plan for the non elderly were run the way Medicare is, it, too, would have higher per person administrative costs than private health insurance plans and since both public and private plans would be dealing with the same populations, the public plan's higher per person administrative costs would translate into higher premiums. Moreover, according to the CBO, the public plan proposed in the current House bill would be less effective in managing fraud and waste than private plans are, translating into even higher premiums for the public plan.

http://www.cbo.gov/ftpdocs/106xx/doc10688/hr3962Rangel.pdf Page 6.

So, putting the facts together, a public health insurance plan for the non elderly would be less efficiently run than private health insurance plans, would have higher premiums than private health insurance plans and would deny more claims than private health insurance plans. That means if you want to pay more and have fewer of your medical bills paid, you want a government run health insurance plan.

Your post exemplifies the extent to which Obama's and Pelosi's blatant lies and misrepresentations on the issue of private and public health insurance have degraded the level of political discourse so that so many seemingly intelligent and well intentioned people repeat their statements with no apparent interest in whether they are true or not.

Just utterly ridiculous and as i have told you before very wrong in the heritage foundations assumptions.

Healthcare administration costs for the elderly should be much much much much higher than the administrative costs for someone HEALTHY, who does not use the services that require the administration of such.

The private insurance industry runs about 20% higher than Medicare and this is with primarily an healthy group of people that they are insuring, who do not even use their health care services for other than a routine check up and routine labs.

To even THINK that health care administration costs for the primarily sick and elderly should be on par with a nonsickly person who receives no care to even cost anything administratively is absurd too much time.

And if the private sector felt that they could insure the elderly so much better and cheaper, then why in the heck did they REFUSE to cover them in the FIRST PLACE which lead our government IN TO CREATING medicare coverage for the elderly.

THE INSURANCE COMPANIES DO NOT WANT THEM To much time, why is that?

We will just have to agree to disagree on this....logic and statistics, are wih me on it, imo...but believe what you wish.

Care

Administrative costs per person are basically the same regardless of the amount of medical expense per person. The only difference in administrative expense is in the cost of claims processing, which is relative to the number of claims processed not the size of the claims, and since claims processing accounts for less than .0025% of Medicare's costs, the difference in the number of claims processed cannot account for Medicare's almost 12.5% higher per person costs. Since total per person administrative costs are only slightly related to the number of claims processed and not at all related to the dollar amounts of the claims, expressing administrative costs as a percentage of total expenditures is obviously deceptive and misleading.

Moreover, even this analysis from the Heritage Foundation, which you seem to be regarding as a part of a "vast right wing conspiracy," is biased in favor of Medicare. As the AMA points out in an analysis of administrative costs of public and private health insurance plans:

Perhaps the most obvious shortcoming of many
estimates is that they ignore unreported spending on administration
of government programs. Such uncounted administrative
costs are especially evident in the Medicare program
and include:
• Tax collection to fund Medicare—this is analogous to
premium collection by private insurers, but whereas
premium collection expenses of private insurers are rightly
counted as administrative costs, tax collection expenses
incurred by employers and the Internal Revenue Service
do not appear in the official Medicare or NHE accounting
systems, and so are usually overlooked
• Medicare program marketing, outreach and education
• Medicare program customer service
• Medicare program auditing by the Office of the
Inspector General
• Medicare program contract negotiation
• Building costs of the Centers for Medicare & Medicaid
Services (CMS) dedicated to the Medicare program
• Staff salaries for CMS personnel with Medicare
program responsibilities
• Congressional resources exhausted each year on setting
Medicare payment rates for services

A pair of studies
of Medicare administrative costs that included unreported
expenditures on the program made by numerous government
agencies concluded that Medicare administrative expenditures
were at least three times the amount reported in the federal
budget in 2003—$15.0 billion vs. $5.2 billion.

http://www.voicefortheuninsured.org/pdf/admincosts.pdf

So if all of these unreported Medicare administrative expenses were included, Medicare's per person administrative costs would be much, much, much higher than the Heritage Foundation study claims and if Medicare's true administrative costs are three times higher than what the federal government carries on its books, as the studies cited by the AMA claims they are, then even the deceptive and misleading statistic of administrative costs as a percentage of total expenditures would show Medicare to be less efficient than private health insurance plans.

 

[Emma]

We can not afford socialized medicine. We already can not afford medicare. Yet by adding MILLIONS more suddenly all will be fine?

The primary reasons why Medicare runs in the red is the majority of those covered by medicare subsidized by payroll taxes aren't paying premiums. Only $2.9 billion of its income of nearly $231 billion comes from its client base --- which are statistically the sickest demographic (seniors and disabled) and with a larger healthier client base, that means more money in revenue vs expenditures.

Cover everyone with Medicare, and the size and overall health of their client base goes up along with the revenue income from premiums.

EVERYONE that works pays into medicare. EVERYONE. There is no other way to put it. Medicare is already subsidized by OUR TAXES from every person in this country that works. And it fails miserably.

Payroll tax for Medicare is less than 1 1/2 %.

 

[Emma]

Since all healthcare is rationed, the question for me is do I want those decisions to rest with corporations whose sole reason for existence is to make a profit --- profits which depend upon insuring the healthiest among us, and denying coverage for those whom they may have to pay claims? Corporations where profits are dependent on NOT providing the services I pay for? That can at any point in time decide to cancel my policy, leaving me without any coverage at all and no prospects of obtaining coverage on my own? That spend 1/3 of their revenue in administrative overhead?

No thanks.

Nonsense. Health care is not rationed in the US by either private plans or, as yet, by our public plans

Yes, it is. Healthcare is NOT an infinite resource.

 

[Care4all]

most plans have a lifetime 2 million cap

 

[Care4all]

The primary reasons why Medicare runs in the red is the majority of those covered by medicare subsidized by payroll taxes aren't paying premiums. Only $2.9 billion of its income of nearly $231 billion comes from its client base --- which are statistically the sickest demographic (seniors and disabled) and with a larger healthier client base, that means more money in revenue vs expenditures.

Cover everyone with Medicare, and the size and overall health of their client base goes up along with the revenue income from premiums.

EVERYONE that works pays into medicare. EVERYONE. There is no other way to put it. Medicare is already subsidized by OUR TAXES from every person in this country that works. And it fails miserably.

Payroll tax for Medicare is less than 1 1/2 %.

it's a little more than that with the employer match...

but besides that ONLY the wealthiest that pay themselves a salary pay medicare tax....if they do not take a salary and only live off of their dividends of their company stock, then they do not pay any medicare pay roll tax...Buffet, Gates, Hilton, Heinz are just a few, who pay NO MEDICARE tax.

 

[toomuchtime_]

Since all healthcare is rationed, the question for me is do I want those decisions to rest with corporations whose sole reason for existence is to make a profit --- profits which depend upon insuring the healthiest among us, and denying coverage for those whom they may have to pay claims? Corporations where profits are dependent on NOT providing the services I pay for? That can at any point in time decide to cancel my policy, leaving me without any coverage at all and no prospects of obtaining coverage on my own? That spend 1/3 of their revenue in administrative overhead?

No thanks.

Nonsense. Health care is not rationed in the US by either private plans or, as yet, by our public plans

Yes, it is. Healthcare is NOT an infinite resource.

And the demand is not infinite so there has been no need to ration health care services in the US by either our public or private plans, however in countries like Canada and the UK, because governments are reluctant to raise taxes, rationing of health care services is a normal response to budget constraints. Here in the US, Medicare may soon have to choose between raising the Medicare payroll tax from its present 2.9% to close to 8% to keep Medicare solvent through the next decade or to begin to ration health care services. Private insurers, of course, are bound by the contract obligations defined in the policies and do not have the freedom Medicare has to cut services, and they are less reluctant to increase premiums to cover rising costs than Congress is to raise Medicare payroll taxes, so we may soon be coming to a time when people under 65 find themselves with higher and higher payroll taxes or people over 65 find themselves with health insurance that is increasingly inferior to what they had had from their private insurers.

 

[DiamondDave]

Govt: Medicare paid $47 billion in suspect claims - Yahoo! News

More behind one of the major reasons besides against what the country was set up to be... our government is a pit of corruption with a propensity for allowing programs to be susceptible to corruption

 

[Emma]

Govt: Medicare paid $47 billion in suspect claims - Yahoo! News

More behind one of the major reasons besides against what the country was set up to be... our government is a pit of corruption with a propensity for allowing programs to be susceptible to corruption

It's not clear whether Medicare fraud is actually worsening. Much of the increase in the last year is attributed to a change in the Health and Human Services Department's methodology that imposes stricter documentation requirements and includes more improper payments — part of a data-collection effort being ordered government-wide by President Barack Obama next week to promote "honest budgeting" and accurate statistics.

The Obama administration is cracking down. That's why you're seeing an increase in improper payments.

 

[Care4all]

in addition to this the private insurance industry is plagued by the same problem and is one reason why we pay higher rates for our own health insurance policies.

This is NOT a copyrighted article and is old, from 1998 talking about the problem....back then they said it was $100 billion a year in total and $12 billion of it was Medicare, so the private industry is filled with it.

Mostly private businesses are the ones committing the crimes against medicare and the insurance industry.

Insurance Fraud and Abuse:
A Very Serious Problem
Stephen Barrett, M.D.

Fraud and abuse are widespread and very costly to America's health-care system. Fraud involves intentional deception or misrepresentation intended to result in an unauthorized benefit. An example would be billing for services that are not rendered. Abuse involves charging for services that are not medically necessary, do not conform to professionally recognized standards, or are unfairly priced. An example would be performing a laboratory test on large numbers of patients when only a few should have it. Abuse may be similar to fraud except that it is not possible to establish that the abusive acts were done with an intent to deceive the insurer.

Although no precise dollar amount can be determined, some authorities contend that insurance fraud constitutes a $100-billion-a-year problem. The United States Goverment Accountability Office (GAO) estimates that $1 out of every $7 spent on Medicare is lost to fraud and abuse and that in 1998 alone, Medicare lost nearly $12 billion to fraudulent or unnecessary claims [1].
Type of Fraud and Abuse

False claim schemes are the most common type of health insurance fraud. The goal in these schemes is to obtain undeserved payment for a claim or series of claims [2]. Such schemes include any of the following when done deliberately for financial gain:

* Billing for services, procedures, and/or supplies that were not provided.
* Misrepresentation of what was provided; when it was provided; the condition or diagnosis; the charges involved; and/or the identity of the provider recipient.
* Providing unnecessary services or ordering unnecessary tests [3].

Many insurance policies cover a percentage of the physician's "usual" fee. Some physicians charge insured patients more than uninsured ones but represent to the insurance companies that the higher fee is the usual one. This practice is illegal. It is also illegal to routinely excuse patients from copayments and deductibles. (A copayment is a fixed dollar amount paid whenever an insured person receives specified health-care services. A deductible is the amount that must be paid before the insurance company starts paying.) It is legal to waive a fee for people with a genuine financial hardship, but it is not legal to provide completely free care or discounts to all patients or to collect only from those who have insurance. Studies have shown that if patients are required to pay for even a small portion of their care they will be better consumers and select items or services because they are medically needed rather than because they are free. Routine waivers thus raise overall health costs. They are considered fraudulent because averaging them with the doctor's full fees would make the "usual" fees lower than the amounts actually billed for.

Other illegal procedures include:

* Charging for a service that was not performed.
* Unbundling of claims: Billing separately for procedures that normally are covered by a single fee. An example would be a podiatrist who operates on three toes and submits claims for three separate operations.
* Double billing: Charging more than once for the same service.
* Upcoding: Charging for a more complex service than was performed. This usually involves billing for longer or more complex office visits (for example, charging for a comprehensive visit when the patient was seen only briefly), but it also can involve charging for a more complex procedure than was performed or for more expensive equipment than was delivered. Medicare documentation guidelines describe what the various levels of service should involve [4].
* Miscoding: Using a code number that does not apply to the procedure.
* Kickbacks: Receiving payment or other benefit for making a referral. Indirect kickbacks can involve overpayment for something of value. For example, a supplier whose business depends on physician referrals may pay excessive rent to physicians who own the premises and refer patients. Another example would be a mobile testing service that performs diagnostic tests in a doctor's office. Kickbacks can distort medical decision-making, cause overutilization, increase costs, and result in unfair competition by freezing out competitors who are unwilling to pay kickbacks. They can also adversely affect the quality of patient care by encouraging physicians to order services or recommend supplies based on profit rather than the patients' best medical interests. In 2000, the Office of the Inspector General issued a fraud alert warning against kickbacks disguised as rental payments [5].

Criminals sometimes obtain Medicare numbers for fraudulent billing by conducting a health survey, offering a free "health screening" test, paying beneficiaries for their number, obtaining beneficiary lists from nursing homes or boarding facilities, or offering "free" services, food, or supplies to beneficiaries.
Excessive or Inappropriate Testing

Many standard tests can be useful in some situations but not in others. The key question in judging whether a diagnostic test is necessary is whether the results will influence the management of the patient. Billing for inappropriate tests—both standard and nonstandard—appears to be much more common among chiropractors and joint chiropractic/medical practices than among other health-care providers. The commonly abused tests include:

continued at:Insurance Fraud and Abuse: A Very Serious Problem

 

[Zona]

Can you believe there are dumb asses in here so partisan, they are actually defending the insurance companies.

here is a hint, if you like paying that much money per month, with no end in sight, PAY IT.

Leave the rest of american alone. Dont touch your insurance...they wont. Dont touch the rest of america's choice.

 

[AllieBaba]

If the Government provides Health Care, whether spelled out in this bill or not, it will RATION the care. That is how it works.

The Government can not afford to pay for everything for everyone, even if they took all our money. And in fact the research that backs up this health care bill out of the House spells it out clearly. Specifically it identifies the elderly and those under the age of 2 as being less important and so they will be the first to suffer from reduced services.

Knowing that the Government can not efficiently run anything, I can promise it won't end there.

Is your health care rationed?

Absolutely it's rationed. Medicare won't pay for flu shots, and there is a whole book about procedures, medications and treatments it will not fund.

Try to keep up.

 

[AllieBaba]

Since all healthcare is rationed, the question for me is do I want those decisions to rest with corporations whose sole reason for existence is to make a profit --- profits which depend upon insuring the healthiest among us, and denying coverage for those whom they may have to pay claims? Corporations where profits are dependent on NOT providing the services I pay for? That can at any point in time decide to cancel my policy, leaving me without any coverage at all and no prospects of obtaining coverage on my own? That spend 1/3 of their revenue in administrative overhead?

No thanks.

Nonsense. Health care is not rationed in the US by either private plans or, as yet, by our public plans

What planet do you live on?

Medicare will not cover dental procedures...even when those dental procedures are needed to prevent or halt life-threatening infections.

I have a book on what is covered and what isn't covered by medicare.

OHP is rationed in that it closed, despite the fact that people were eligible for it, years ago. It opened for one month last year to allow a small handful of people to qualify, then closed again. Now it's opening again...it works as a lottery. People sign up for a reservation list, if their name is drawn (and they are talking 6000 people a month, which doesn't come close to meeting the demand) AND they are eligible, they can get OHP. For 6 months. In 6 months, they are re-evaluated. If no longer income eligible, they lose their coverage.

 

[Old Rocks]

By the way, all currently run Government Health care IS rationed also. That INCLUDES Military health Care. Active duty which gets the best treatment still does not have access to new procedures or medications until or unless the Government decides they should, a slow cumbersome process at the best of times. Medicare and Medicaid are also rationed.

The VA hospital is a good example of a reason to NOT have the government run health care. It has improved much over the last few years but its still not as good as it should be. A good friend of mine is a marine who got his knee all screwed up in AFG. They kept pushing him off and making him wait for the proper treatment. It took 2 months for him to get to see a doctor back home. Then it took 4 more months for the specialist. Another 2 months for the surgery, but they got him into physical therapy pretty fast.

Another good example is the poor handling of the H1N1 vaccine distribution.


Those who fail to learn from history are doomed to repeat it -Someone Smart

The European systems seem to have handled the H1N1 vaccine distribution far better than we have. Now why is that?

 

[Old Rocks]

Govt: Medicare paid $47 billion in suspect claims - Yahoo! News

More behind one of the major reasons besides against what the country was set up to be... our government is a pit of corruption with a propensity for allowing programs to be susceptible to corruption

Odd that most of the fraud seems to come from people like Rick Scott.


Once Forced to Resign in Massive Fraud Case, Rick Scott Reborn as Leader of Anti-Healthcare Reform Lobby | Crooks and Liars


From the Politico:

The Conservative Patients' Rights Action Fund -- the first group out of the box opposing Obama's healthcare plan -- has launched a second round of its campaign on the issue, a source involved in the group says.

The campaign focuses on Obama's proposal to set $634 billion in the federal budget aside for healthcare reform, and links the issue to the Congress's treatment of bonuses for AIG executives.

“Isn’t it amazing folks in Congress were shocked the plan THEY passed allowed those huge bonuses for AIG?" asks Rick Scott, the former healthcare executive who chairs the group, in a new television ad to be released tomorrow. "Now some in Congress want to raise taxes and spend $634 billion for the President’s healthcare overhaul - - WITHOUT even seeing all the details of his plan. They just never seem to learn."

Ah, yes, Rick Scott. Funny, the details the Politico leaves out of their stories! From Christopher Hayes in The Nation:

Having Scott lead the charge against healthcare reform is like tapping Bernie Madoff to campaign against tighter securities regulation. You see, the for-profit hospital chain Scott helped found--the one he ran and built his entire reputation on--was discovered to be in the habit of defrauding the government out of hundreds of millions of dollars.

This is the man who will be delivering what Politico called the "pro-free-market message."

A Texas lawyer who shared a business partner with George W. Bush, Scott started his health company, Columbia Hospital Corporation, in 1987. Its growth was meteoric, expanding from just a few hospitals to more than 1,000 facilities in thirty-eight states and three other countries in 1997. As his firm gobbled up chains, like the Frist family's Hospital Corporation of America (HCA), it became the largest for-profit hospital chain in the country. By 1994, Columbia/HCA was one of the forty largest corporations in America, and Scott had acquired a reputation as the Gordon Gecko of the healthcare world. "Whose patients are you stealing?" he would ask employees at his newly acquired hospitals.

He promised to put nonprofit hospitals--which he insisted on referring to as "nontaxpaying" hospitals--out of business and touted his company's single-minded pursuit of profit as a model for the nation's entire healthcare system. "What's happening in Washington is not healthcare reform," he told the New York Times in 1994. "Healthcare reform is happening in the marketplace."

 

[toomuchtime_]

Nonsense. Health care is not rationed in the US by either private plans or, as yet, by our public plans

What planet do you live on?

Medicare will not cover dental procedures...even when those dental procedures are needed to prevent or halt life-threatening infections.

I have a book on what is covered and what isn't covered by medicare.

OHP is rationed in that it closed, despite the fact that people were eligible for it, years ago. It opened for one month last year to allow a small handful of people to qualify, then closed again. Now it's opening again...it works as a lottery. People sign up for a reservation list, if their name is drawn (and they are talking 6000 people a month, which doesn't come close to meeting the demand) AND they are eligible, they can get OHP. For 6 months. In 6 months, they are re-evaluated. If no longer income eligible, they lose their coverage.

Medicare was never intended to cover all medical and dental services. It also does not cover cosmetic surgery or examinations for eye glasses except in certain cases, but for covered services, so far, Medicare does not ration health care in the way the Canadian and British public systems do.