June 23, 2009
Reforming Healthcare means fighting systemic fraud
Our Scrooge-McDucks on the right would have you believe that squeezing out malpractice claims, fighting individual medicaid fraud, or Individual Medical Savings accounts would solve our problems. They would have you believe that paying attention to Christmas Future, Christmas Present, and Christmas Past, would cost more money and be "socialism" -- but all of that is a pack of lies and deceptions. Still it might work. GOP analyst Frank Luntz wrote up an article that has been a source for goose-stepping attack ads, columns, and orchestrated attacks on health care reform, designed to keep the corrupt in line, scare the moderately corrupt (the real meaning of "moderate") and make it difficult for the majority of the people of the country to get the kind of basic health care that they need and deserve. It's simple really, he advises using scare words, and seizing on the language used by liberals in such a way as to make them scare words.
The idea is to divide the people up into a "us versus them" mentality. Those who have lousy health insurance, to be convinced they'd lose that to even worse insurance. Corporations who might actually benefit from a Federalized Single payer program to be convinced that they'd lose money from their insurance investments. Those who have good insurance, to be convinced that they'd have to pay more. And those who have no insurance to be painted as evil, lazy scofflaws. Result? People voting against their own best interests convinced that they are protecting their pocket books.
http://wonkroom.thinkprogress.org/2009/05/06/luntz-memo/
Basically the liars and Tazmanian spin devils of the far right will tell you "I'm all for reform, but not for the Gubbornment taking away people's insurance and making them go to a State Run system." The idea is to scare people into thinking that the Government is going to "Socialism."
As Igor Volksy of the "Wonk Room" writes:
"The memo is titled “The Language of Health Care 2009″ and it lays out the argument for “stopping the Washington takeover” of health care.” But if fully implemented it may very well stop health care reform."
And he quotes:
"This document is based on polling results and Instant Response dial sessions conducted in April 2009. It captures not just what Americans want to see but exactly what they want to hear. The Words That Work boxes that follow are already being used by a few Congressional and Senatorial Republicans. From today forward, they should be used by everyone."
"Luntz warns that “if the dynamic becomes ‘President Obama is on the side of reform and Republicans are against it,’ then the battle is lost and every word in this document is useless.’” The trouble is, it already is useless. Because rather than challenging the tenets of American reform proposals, Luntz establishes a straw man argument against a non-existent health plan."
"Buried amongst the usual rhetoric about government-run health care is Luntz’s predictable contradiction: he instructs Republicans to “be vocally and passionately on the side of REFORM” but then urges GOP lawmakers to misrepresent and obstruct any real chance of passing comprehensive legislation. "
So the idea is to either defeat health care reform. Or if that doesn't work, to take over the language and turn it into anti health care reform; as they did with Medicaid, welfare, "right to life" and other issues. It could work. Which is why the rest of us need to wake up and pay attention so we "won't get fooled again!"
First, most of the medicaid fraud we are seeing is systemic. It is designed to ad to the profits of the giant megacompanies that currently run our Health Care system as a series of fiefdoms in which our employers
Second, we no longer have large numbers of medical providers unless you count all their shell companies, subsidiaries and offshore subsidiaries. We are down to a few megagiants.
Third: We have rationing with the system we have now:
http://www.medicalnewstoday.com/articles/119471.php
Fourth: Medical Malpractice insurance rates have more to do with bad investments on wall street and insurance greed than with Medical Malpractice Claims. Universal Medical protection availability would reduce the volume and severity of those claims. Having health care reform with defined best practices would also help reduce malpractice. Capping claims won't do anything except provide impunity to bad doctors.
Fifth: Medical Savings Accounts seems like a good idea until one realizes that it is simply a scam on employers. If the money doesn't get spent by the end of the year the "account" vanishes. If one relies on it to pay large medical bills one will soon go bankrupt.
As the right has learned to do. They don't need to listen to the three Ghosts of Christmas at all. All they need to do is to pretend they've had a change of heart. The kid with the crutches will still die, but everybody else will be convinced that they made a major change for the better.
[Sorry I have 4 years of Scrooge sermons to do before Christmas to make up for holding back]
Posted by cholte at June 23, 2009 02:12 PM
>>>Medical Savings Accounts seems like a good idea until one realizes that it is simply a scam on employers. If the money doesn't get spent by the end of the year the "account" vanishes.
Talk about a straw man. I think you are conflating HSAs with pre-tax Cafeteria Flex-comp plan, called a (FSA), or Flexible Spending Account? Those suck.
Who told you that?
"Do unused funds in a Health Savings Account roll over year after year?"
"Yes, the unused balance in a Health Savings Account automatically rolls over year after year. You won’t lose your money if you don’t spend it within the year."
U.S. Treasury - HSA Frequently Asked Questions
http://www.ustreas.gov/offices/public-affairs/hsa/faq_using.shtml
BTW, the FSA is a good way to reduce payroll tax and pay fixed medical costs pre-tax. An FSA can also be typically used for child care costs. But it is "use it lose it" on an annual basis.
The MSA/HSA is better in that it rolls over and works just like an IRA, except that pre-65, it can be used tax free to pay QMEs. Also, an MSA must be paired with a qualified high deductible Major Medical Policy.
The trouble with getting fighting mad is that anger clouds the mind, and causes mental errors. I already make enough of those just due to old age.
I wrote:
"Medical Savings Accounts seems like a good idea until one realizes that it is simply a scam on employers. If the money doesn't get spent by the end of the year the "account" vanishes."
Robin: "Talk about a straw man. I think you are conflating HSAs with pre-tax Cafeteria Flex-comp plan, called a (FSA), or Flexible Spending Account? Those suck."
You could be right, but it doesn't matter. Medical Savings Accounts might be useful for people who have a good job, but supposedly such people have good insurance in the first place. If the private for profit insurance companies were so good, why would anyone need them? They won't cover emergencies. If they were pre-tax they'd only be good to help with deductables on a real medical plan -- they could never substitute it.
I'm all for replacing FSA's with Medical Savings Accounts, but this is not going to solve the underlying problem. I usually have a small FSA and it really sucks to either use it up or to have to schedule appointments late in the year to make sure I use it up.
I'll concede that one point could be useful in moderating the current FUBARed (Effed up beyond all Recognition) system but it won't cure anything. A single unplanned illness or hospital stay can wipe out years worth of Medical Savings Account in less than a week.
It also doesn't address the profiteering problem.
Bottom line, any "reform" that doesn't;
a; Cover everybody in the country either directly or through State and local agency providing:
----- Wellness care (preventive medicine)
----- Basic Care
b; Eliminate the current profiteering in the system.
---- Appropriate profiteering; facelifts
---- Inappropriate profiteering: medicaid fraud such as Medicaid part D.
One thing. The HSA/MSA is always paired with a Major Medical Insurance Policy with a high deductible. It can even be arranged so the policy premium is funded by the HSA. Also, ideally, the annual deductible = the HSA acount value on the anniversary date. If I were dictator, I would subsidize HSAs.
Heath Care should be divided into:
** Wellness Care / check ups / vaccinations
** Screening of suspected emergencies.
** Treatment of non-emergency sickness & injury.
** Emergency Treatment
** Treatment of chronic conditions, inherited or acquired.
** Long term care {home health care / nursing home}
The first two should be paid for in cash, or by a welfare voucher, or provided at free clinics / sliding scale clinics.
The next two should be financed by Major Medical insurance.
The 5th one is problematic. Some separate kind of long term treatment insurance, or a single payor pool. Those are people that wind up either losing or paying through the nose for insurance. They might lose the job, and COBRA is too high to afford. Or pool closing leaves them stuck in a high risk pool. They increase the costs for all if left in a general pool. I would lean toward a public pool funded perhaps by payroll taxes. We all pay in, most of us never need it.
Long Term Care for boomers is the sound of once distant thunder at a picnic. Policies for this are on the market; but ...
What's that called again, Oh yeah "Occam's razor". It means that if someone has to spin and parse things into insane complexity while someone else has a relatively simple explanation for the same phenomenom, the simpler explanation is more likely to be true.
Sure medical care can be described as:
"Heath Care should be divided into:
** Wellness Care / check ups / vaccinations
** Screening of suspected emergencies.
** Treatment of non-emergency sickness & injury.
** Emergency Treatment
** Treatment of chronic conditions, inherited or acquired.
** Long term care {home health care / nursing home}"
But your complex explanation has a cost to society and a matter of justice attached to it.
"The first two should be paid for in cash, or by a welfare voucher, or provided at free clinics / sliding scale clinics."
Or paid for by a single payer system that covers all US Citizens and legal resident aliens as a matter of citizenship or legal residence. See simple. Occam's razor. How that system is administered is where the devil is, but the principle is simple.
Welfare vouchers? Expensive complicated.
Free clinics? Creates a two tiered system that provides minimal (abysimal in some cases) care for the poor and is abhored by the wealthy. Cash? leaves out our ever increasing numbers of working poor or definitional outlaws (the homeless and desperately poor) who have no cash for wellness care.
Compensate Doctors for taking patients from 9-5 every day, and pay them piecework if they take patients off hours. People who are working should pay for some of this, and the rest should be paid for by employers. Simple, easy. No complex vouchers. No two tiered system. Nobody dying of cancer because an executive prefers to own a million dollar yacht to keeping his promises.
As for keeping costs down for long term care. We have examples in other countries where that is already being done successfully. That is where the actuaries come in. Our problem is that we prefer to set money aside and then let Wall Street Gamble with it. Hard to make good actuarial calculations if 2 trillion dollars "disappears" overnight because somebody made bad bets on the housing market.
Chris
Dumbing Down and Occam's Razor are not the same thing. Unqualified people trying to discuss policy leads to a mess. I do not want you running health care, as you do not seem to understand it. I do not want me launching rockets or running nuclear reactors. There are different levels of care that call for different approaches and different funding mechanisms. It is not simple.
Do you really think 6 levels od care is insane complexity? Wow!
>>> Welfare vouchers? Expensive complicated
Food stamps are done that way. TANF is done that way. FSAs and MSAs work that. Most people have a bank account and are able to somehow manage to their bills. Most have a debit card. It is actually simple and cheap. Algore designed it for food stamps and TANF. You give them a medical expense card with an annual cash balance. They use it to pay qualified medical expenses. That is much easier and less complex than saving up receipts and filing claims.
>>> Free clinics? Creates a two tiered system
I know, one size fits no one, equal distribution of mediocrity is so much better. Free clinics are also the only way you are going to cover a significant chunk of the uninsured.
>>> Cash? leaves out
Obviously, that is for people who can pay out of pocket. Not everyone's situation is the same.
>>> Compensate Doctors for taking patients from 9-5 every day, and pay them piecework if they take patients off hours.
Are you serious? I think they are going to be paid per patient, and based in levels of care. A physical costs X. An EKG costs a little more. And so on. You want to turn doctors into assembly line workers?
>>> long term care. We have examples in other countries
Where? The move here in my country is toward de-institutionalizing; going to home health care and assisted living. I am curious what models you are thinking of.
>>>Cash? leaves out our ever increasing numbers of working poor or definitional outlaws (the homeless and desperately poor) who have no cash for wellness care.
The poor who qualify for a subsidy would get an HSA debit card; just like the debit card for TANF & Food Stamps. FSAs and HSAs often work just like that.
The homeless {and poor immigrants who will not sign up for government plans like S Chip} would go to the free / sliding scale clinic.
Obama's mandatory insurance and public option plan does nothing to help the homeless or government shy immigrants, except to criminalize
them.
I assume it would provide a subsidy for the working poor who have a home. He could get the same result simply by eliminating the childless adult exclusion from Medicaid.
The big problem I run into are people with high cost conditions who are stuck in high risk or assigned risk pools. They pay through the nose for insurance. Most of their premium is just marked up prepayment for services. They can not afford to keep it, but can not afford to drop it. So they hang on until they can get Medicare. Then they can still get hung out to dry by Part D gaps; if there is a high cost uncovered prescription.
I wrote:
>Cash? leaves out our ever increasing numbers
> of working poor or definitional outlaws (the
> homeless and desperately poor) who have no
> cash for wellness care.
Robin: "The poor who qualify for a subsidy would get an HSA debit card; just like the debit card for TANF & Food Stamps. FSAs and HSAs often work just like that."
This is a poison pill "solution" Robin. All it would do is to give propaganda points to future "cost cutters" who would campaign about "medical queens" and how the poor get better health care than working people. This is the "welfare" solution all over again.
"The homeless {and poor immigrants who will not sign up for government plans like S Chip} would go to the free / sliding scale clinic."
We already try to do this, and everytime the economy slips, or Republicans are elected, the first thing that goes on the chopping block are neighborhood clinics. The result, our working poor stand in lines that would horrify Brazilians when Doctors visit from "Doctors without Borders".
"Obama's mandatory insurance and public option plan does nothing to help the homeless or government shy immigrants, except to criminalize
them."
Well, we finally agree on something. I don't like the mandatory insurance provision either; because it does nothing to remove the profiteering, kleptocratic log-rolling, and corporate legislation steam-rolling from the system. This provision is coming from the Insurance companies as a way to ruin small business, enforce people's attachment to giant corporations, and derail the "public option." Daschle has (once again) disappointed me by selling out as a shill for the Insurance industry, and so have other mainstream Democrats who are both afraid of them and in their pockets. They put Single payer off the table, and now are planning to hollow out the rest of the proposal so it goes from being a genuinely cost effective and fair plan to becoming just another way to wring money from both Government and the rest of us. Mandatory Employer insurance is a poison pill too. I hope the small businesses in the Chamber of Commerce realize what they'll be doing to themselves if they don't see through this.
Companies should collect a National Health Insurance tax from payroll in the same way (or even by expanding) medicaid, and everyone should be covered regardless of who they work for for the same price. Like you said, this shouldn't be done with Insurance rules.
"I assume it would provide a subsidy for the working poor who have a home. He could get the same result simply by eliminating the childless adult exclusion from Medicaid."
I agree, this subsidy idea also sucks. All it will do is to allow the Insurance providers and for profit health providers to overcharge the government while providing minimal and inadequate medicine to the poor. I think we need to expand medicaid to cover everybody, increase the things covered to cover the basic categories we mentioned earlier, and leave the rest to the States and to supplemental insurance.
And the reason is the following, about which you are right:
"The big problem I run into are people with high cost conditions who are stuck in high risk or assigned risk pools. They pay through the nose for insurance. Most of their premium is just marked up prepayment for services. They can not afford to keep it, but can not afford to drop it. So they hang on until they can get Medicare. "
It is really ugly the way our Insurance companies are doing their rationing. Not only do they pay high premiums, but they get high copays followed by limits on those pays. What good is a 10,000 dollar limit to payment when a procedure is being billed at $50,000.00 dollars?
We have people going on Hospital vacations to India and other "poor countries", where they get excellent care at a reasonable cost. Often better care than they get here at 10 times the cost!
Then they can still get hung out to dry by Part D gaps; if there is a high cost uncovered prescription."
Part D was a poison pill when the Democrats and others acceded to "non-negotiability" clauses and subsidies for participating insurance companies. It was designed to be degrading, degenerate and destructive. A new law without genuine "Part D reform" will be hollow.
Of course this is all linked to our corrupt politics. As long as we have doctrines like "Corporate Personhood", "New Jersey rules" for corporations, and the best Government money can buy, we'll continue to be suckered into thinking the battle is between "socialism" and "free markets" when it is neither and we have neither. Health care is not a free market even if it is completely privatized -- and we wouldn't want it to be. The concept is absurd.
Chris
>>>>"Like you said, this shouldn't be done with Insurance rules." -- Chris
Elsewhere someone wrote: >>>Insurance is designed to assuage personal risk. Insurance is not designed to assume all costs. Until this is realized health care will be over-consumed in the United States, and costs will continue to spiral out of control.When the true cost of any good is borne by the consumer (insurance included), the consumption of that good goes down and the price of that good is normalized. When someone else pays for your care and you just have to pay a $10 copay, then you want the highest quality care regardless of cost. The doctor has no incentive to deny that care. If he did, he might be sued for malpractice later. Ultimately, your over-consumption will necessitate high inflation in that area of the economy.