London Economist: Health-care fraud in America--

[eridani]

--That’s where the money is

How to hand over $272 billion a year to criminals

http://www.economist.com/node/21603026?fsrc=nlw|hig|29-05-2014|5356c587899249e1ccb62fe5|NA

Medical science is hazy about many things, but doctors agree that if a patient is losing pints of blood all over the carpet, it is a good idea to stanch his wounds. The same is true of a health-care system. If crooks are bleeding it of vast quantities of cash, it is time to tighten the safeguards.

In America the scale of medical embezzlement is extraordinary. According to Donald Berwick, the ex-boss of Medicare and Medicaid (the public health schemes for the old and poor), America lost between $82 billion and $272 billion in 2011 to medical fraud and abuse (see article). The higher figure is 10% of medical spending and a whopping 1.7% of GDP—as if robbers had made off with the entire output of Tennessee or nearly twice the budget of Britain’s National Health Service (NHS).

<snip>

But the broader point is that American health care needs to be simplified. Whatever its defects, Britain’s single-payer National Health Service is much simpler, much cheaper and relatively difficult to defraud. Doctors are paid to keep people well, not for every extra thing they do, so they don’t make more money by recommending unnecessary tests and operations—let alone billing for non-existent ones.

Too socialist for America? Then simplify what is left, scale back the health tax-perks for the rich and give people health accounts so they watch the dollars that are spent on their treatment. After all, Dr Berwick’s study found that administrative complexity and unnecessary treatment waste even more health dollars than fraud does. Perhaps that is the real crime.

[Leme]

1. Politically America won't do single payer and to

give people health accounts would just give lawmakers a way to provide companies an additional way to swindle people.

[TexasTowelie]

2. The problem with health accounts is what does the person do if they have exhausted the funds in that

account? Then, what happens to the funds in those accounts after a person dies?

Some people would be so afraid of trying to maintain a significant amount of funds in those accounts that they would forsake seeking medical treatment and end up with an ailment that is so severe that it is costlier than treating it in the first place. For example, diabetics wouldn't go for checkups and it would result in more kidney complications, amputations and blindness. That isn't a good trade-off IMO.

[dipsydoodle]

5. I don't understand that bit

which goes against allusions with our UK NHS.

The NHS is based on "national grouping" - those that pay provide cover for those unable or not eligible to pay. There are no limits whatsoever for expenditure on individuals.

[JDPriestly]

7. This is what is wrong with our system.

We pay our doctor to heal us when we are sick.

We should be paying our doctors to keep us from getting sick in the first place when possible.

The ACA is pointing us in the right direction.

Kaiser has a good system. You have a doctor. You pay a small co-pay per visit. But your doctor is not compensated more if he sees you more often. The doctor is paid a salary and sees a certain number of patients.

The doctor does not earn more if you are sick. He has an interest in keeping you well.

I go to Kaiser. When I see an allergist, he reminds me that I am supposed to be getting an examination that has been ordered by another doctor. The healthier I am, the more Kaiser gets to keep of what they are paid to treat me. They never refuse care for me. But they share my interest in keeping well.

That is the point of the article. Our system pays doctors to treat us when we are sick. The doctor makes more money if we are sick more often. What is sick is the way we compensate doctors.

And don't worry about incentives for doctors. I know one very well. She loves treating patients. It's who she is. Frankly, I don't want a doctor who doesn't do her work out of love for her profession and her patients. There are such people. It's their love of their work, their calling, that keeps them going through gross anatomy to the end of their residency. Many years, hard work even for the smartest people. That's what it takes to become a doctor. I have so much respect for them. They deserve to be paid in a system that let's them do what they want and are called to do -- care for patients -- and not worry about how they will pay their bills if their patients get well.

[SheilaT]

3. I am inclined to think that the ACA is going to lead us to a single payer system.

I make no predictions about when that will happen, but I feel reasonably sure it will. I do hope I'm right.

[eridani]

4. This will happen only when more people get serious about pushig for it at the state level n/t

[SheilaT]

9. I would think it would have to happen at the federal level.

Although, it's at the state level, under our current system, that Medicaid expansion did or did not take place recently.

[eridani]

10. I don't see how it can, as long as conservatives keep electing whackjobs

Red states prefer to be poor, sick and stupid, but that is no reason why the rest of the country can't move on.

[SheilaT]

11. My expectation is that

as more people are covered and at lower cost, those who initially opposed it will come around.

It would help enormously if every single Democrat running for office would openly support and praise the ACA, and too many of them are being wishy-washy about it.

[dipsydoodle]

6. The Dutch model , as opposed to full blown NHS , may have suited you better

as a step toward full socialised healthcare but see odd relevant notes too : http://en.wikipedia.org/wiki/Healthcare_in_the_Netherlands

Overall you , the USA , lack the concept that the population need to care for the entire population - not just individuals.

[eridani]

8. Their prices for dentistry sure suit me

Biking there in 1998, my husband had to have an emergency root canal. It cost is 100 guilders, or $25 American.