Two Questions I Would Ask

[Guest]

If I were to battle my way thru a crowd and attend one or more of the town hall meetings being held this month, I'd ask two simple questions.

I think everyone will agree that the cost of healthcare is growing at a rate that cannot be sustained by our economy. Experts say that 1/6 of the total GDP is now spent on healthcare and that within a decade or so, that number will grow to 1/3 of our total GDP. Right now we spend a little more than $7,000 per person per year for healthcare; that will grow to about $14,000 in a decade or so. About 40% of that spending is by Medicare. COST is the problem that has drawn so many people into the partisan and disagreeable debates on reform measures being considered by Congress.

While I haven't really decided on what the truth is regarding reforms being proposed and partisan allegations being made, I haven't heard either of the following two questions being addressed at all.

First, if I understand what's being spent per year on healthcare, it's around $3 trillion this year. I've heard estimates that 20% of all Medicare reimbursements are fraudulent. So if Medicare fraud could be eliminated, savings in the range of $240 billion could be achieved with no change whatsoever in any other healthcare factor. (Medicare expenditures are about 40% of the total in the U.S. per year and growing as more Boomers reach Medicare age.) My question: Why doesn't any of the proposed reform legislation include criminal penalties against doctors, hospitals and other Medicare providers? Such penalties could provide for both both jail time, stiff fines and permanent loss of rights to bill Medicare in the future. (It would be nice if the medical licenses could be withdrawn from convicted doctor/perpetrators, or severe licensing penalties be imposed against hospitals, but those are state issues.)

Second, I've seen estimates that medical tort reform in the form of caps on awards, "loser pays", that sort of thing, would result in savings of $150 billion per year. My second question: Why has medical tort reform been ignored in any version of the proposed legislation?

If these two issues were addressed by new laws, nothing else would have to be changed to achieve what has been estimated as almost $400 billion per year in savings. That's a 13% reduction in healthcare expenditures without changing any other factor now being debated in the proposed legislation. There are other savings to be achieved, of course, the cost curve has to be "bent" as the experts propose. But just these two new laws would cut costs about 13% with nothing else being changed.

Would I get a direct answer from any of the 435 whose town hall meetings I might attend? Doubtful. Why? Again, just two answers to match the two question: the powerful American Medical Association and hospital lobbies, and the even more powerful trial lawyers lobby.

Government FOR the people? Pfisssh!

[Guest]

If I were to battle my way thru a crowd and attend one or more of the town hall meetings being held this month, I'd ask two simple questions.

I think everyone will agree that the cost of healthcare is growing at a rate that cannot be sustained by our economy. Experts say that 1/6 of the total GDP is now spent on healthcare and that within a decade or so, that number will grow to 1/3 of our total GDP. Right now we spend a little more than $7,000 per person per year for healthcare; that will grow to about $14,000 in a decade or so. About 40% of that spending is by Medicare. COST is the problem that has drawn so many people into the partisan and disagreeable debates on reform measures being considered by Congress.

While I haven't really decided on what the truth is regarding reforms being proposed and partisan allegations being made, I haven't heard either of the following two questions being addressed at all.

First, if I understand what's being spent per year on healthcare, it's around $3 trillion this year. I've heard estimates that 20% of all Medicare reimbursements are fraudulent. So if Medicare fraud could be eliminated, savings in the range of $240 billion could be achieved with no change whatsoever in any other healthcare factor. (Medicare expenditures are about 40% of the total in the U.S. per year and growing as more Boomers reach Medicare age.) My question: Why doesn't any of the proposed reform legislation include criminal penalties against doctors, hospitals and other Medicare providers? Such penalties could provide for both both jail time, stiff fines and permanent loss of rights to bill Medicare in the future. (It would be nice if the medical licenses could be withdrawn from convicted doctor/perpetrators, or severe licensing penalties be imposed against hospitals, but those are state issues.)

Second, I've seen estimates that medical tort reform in the form of caps on awards, "loser pays", that sort of thing, would result in savings of $150 billion per year. My second question: Why has medical tort reform been ignored in any version of the proposed legislation?

If these two issues were addressed by new laws, nothing else would have to be changed to achieve what has been estimated as almost $400 billion per year in savings. That's a 13% reduction in healthcare expenditures without changing any other factor now being debated in the proposed legislation. There are other savings to be achieved, of course, the cost curve has to be "bent" as the experts propose. But just these two new laws would cut costs about 13% with nothing else being changed.

Would I get a direct answer from any of the 435 whose town hall meetings I might attend? Doubtful. Why? Again, just two answers to match the two question: the powerful American Medical Association and hospital lobbies, and the even more powerful trial lawyers lobby.

Government FOR the people? Pfisssh!

Regarding Question One, criminal law exists already. 18 USC Section 1035 (http://caselaw.lp.findlaw.com/scripts/ts_search.pl?title=18&sec=1035) is on the books at the federal level. Calls for fines and/or up to five years' imprisonment.

Regarding Question Two, we've discussed this one many times. Damages caps have not alleviated the "defensive medicine" problem anywhere where caps are law.

I would also add this compound question, As almost every elected official touting this plan has no: 1) experience in ever running any kind of business, 2) training or experience in delivery of services at the local or national level, or 3) credentials of any kind in health care; what gives them the confidence to believe HR 3200 will work, and that any US government agency has the wherewithal to provide the management and oversight detailed in HR 3200?

[Guest]

The fact that laws already exist against fraud in the Medicare field and that fraud is still rampant is what makes me very nervous about the Obama plan for health "reform". By expanding government health insurance to potentially everyone (medicare on steroids), we will be exposing ourselves to fraud on steroids. Yet Obama claims that he will pay for 2/3 of his program by savings in Medicare including elimination of fraud. If government can not run a medical insurance program for a subset of the population without rampant waste and fraud, how can we expect it to run a program that encompasses the broad population without even greater fraud?

His promise to find savings in Medicare rings a bit hollow when he also said that we was going to wring savings out of every government agency. His efforts resulted in savings so small that they are lost in rounding.

[Guest]

The fact that laws already exist against fraud in the Medicare field and that fraud is still rampant is what makes me very nervous about the Obama plan for health "reform". By expanding government health insurance to potentially everyone (medicare on steroids), we will be exposing ourselves to fraud on steroids. Yet Obama claims that he will pay for 2/3 of his program be savings in Medicare including elimination of fraud. If government can not run a medical insurance program for a subset of the population without rampant waste and fraud, how can we expect it to run a program that encompasses the broad population without even greater fraud?

His promise to find savings in Medicare rings a bit hollow when he also said that we was going to wring savings out of every government agency. His efforts resulted in savings so small that they are lost in rounding.

None of the health care plans provide for any increases the staffing or funding of the Department of Justice entities (FBI and US Attorney's Office) which would tackle the criminal investigation and prosecution of those committing fraud. Who's going to do the increased investigating, case-building and prosecution to go after Medicare fraud as a priority?

[Guest]

All anybody has to do, either party, is ready VK and Steve's posts above.
Add to the information that Obama has in fact confirmed the waste and abuse. In addition he has some what put a price tag on it.

So if Americans want to get angry, forget all the mis-information real or alleged.


I would use for future town hall meetings, with angry Americans, another question:
Mr. President, how could you even talk about the abuse without addressing something needs to be done....using the Obama/Rahm approach...ASAP!

The impact on ALL Americans, both parties by such abuse, KNOWINGLY, being allowed to continue to be tolerated is approaching incompetence (both parties)
and insulting to the intelligence of we the people.

This thread boils the problem down to a very discussable two (or three) very fundamental issues.....that nothing is being done about, except validating that it exists and is the bait for health care reform.

I would love to hear an opposing view of why the above questions are not compelling enough to make the party loyalists angry ....too!
Just once!

Excellent VK and Steve.

btk

[Guest]

Regarding Question One, criminal law exists already....Calls for fines and/or up to five years' imprisonment....Regarding Question Two, we've discussed this one many times....

Question One Redux:

Thanks for the legal reference, Steve. I guess I would re-phrase my question to be "If Medicare fraud is so rampant, how come so few doctors and other providers are prosecuted under 18 USC Section 1035?" (There may be some, but very, very few such prosecutions are ever reported on, leaving me to believe that only the most egregious and high profile cases lead to action by the U.S. Attorney.)

Question Two Additional Comment:

I know we disagree on the potential for cost savings resultant from medical tort reform, but I continue to endorse enactment of such reforms based on the opinions of doctors that savings from a reduction of CYA tests and procedures could be achieved. The fact that the U.S. is the only country in the world that permits litigation with unlimited awards against the medical profession is enough reason for me to support such a change. Something needs to be done to "bend the curve" of seemingly out-of-control malpractice awards and the result they have on healthcare costs. Failing to enact tort reforms seems to fall into the category of "doing nothing", and we all know that hasn't worked to control healthcare costs. If not tort reform, then what will reduce both the frequency of malpractice lawsuits and the ramp-up of awards and out-of-court settlements? Doing nothing isn't working to achieve the needed improvement in doctor performance, which underlies any lawsuit, whether settled on behalf of the plaintiff or not. The Hippocratic Oath hasn't been enough to improve physician performance. We need something else.

[Guest]

I shared my feelings on tort reform and fraud prevention with a doctor friend of mine. He is a semi-retired emergency room physician, still practicing in The Villages area. Here's what he had to say...

"Tort reform would help eventually but not a great deal and then only very slowly. The amount of cover-your-ass tests and procedures would eventually be cut and smarter practice would result after a while. While it would be very welcome, the actual amount saved would not be that great.

Fraud detection could save big bucks and do it fairly quickly but would involve government (either Medicare itself or the U.S. Attorney investigators) looking into billing and using statistical snooping techniques to audit charges, etc. It could be done in a legal and appropriate way and SHOULD be done regardless of any reform changes."

[Guest]

Two thoughts come to mind:
1. Trial lawyers make lots of money from fees in medical malpractice suites. What is the profession of most of the members of Congress?
2. While I have no basis for this, I am of the opinion that many of the "excessive" malpractice awards are awarded by juries. If the juries stopped awarding such high damages, perhaps the cost of medical malpractice insurance would decline. I suggest that the high awards by the juries are the result of a desire to "teach the doctor a lession." Of course, it is the insurance company that pays.

[Guest]

Question One Redux:

Thanks for the legal reference, Steve. I guess I would re-phrase my question to be "If Medicare fraud is so rampant, how come so few doctors and other providers are prosecuted under 18 USC Section 1035?" (There may be some, but very, very few such prosecutions are ever reported on, leaving me to believe that only the most egregious and high profile cases lead to action by the U.S. Attorney.)
It's strictly a matter of assets and training. "White collar crime" like this requires investigators skilled in this kind of investigation, and the time to do it. These investigations can take many months and years, and the federal agencies which play in this arena (FBI, DEA to a degree, HHS/SSA IG, US Attorney's Office, and a couple others) have higher priority targets for the finite resources they have. As none of the health care plans proposed so far add any resources to the Department of Justice or HHS for such law enforcement efforts, what there is now is all there is.....

I shared my feelings on tort reform and fraud prevention with a doctor friend of mine. He is a semi-retired emergency room physician, still practicing in The Villages area. Here's what he had to say...

"Tort reform would help eventually but not a great deal and then only very slowly. The amount of cover-your-ass tests and procedures would eventually be cut and smarter practice would result after a while. While it would be very welcome, the actual amount saved would not be that great.

Fraud detection could save big bucks and do it fairly quickly but would involve government (either Medicare itself or the U.S. Attorney investigators) looking into billing and using statistical snooping techniques to audit charges, etc. It could be done in a legal and appropriate way and SHOULD be done regardless of any reform changes."

Changing a "business culture" is not the easiest of things to accomplish. Your friend understands this well. Whether any change occurs or not will basically require a new generation not already prejudiced by how things are currently done and how they have learned to conduct their business. In the meantime, it's the patients who absorb all the risk - not the insurance companies, practitioners or the lawyers and the courts.

And again, unless Congress funds the Department of Justice and others with more assets dedicated to Medicare malfeasance, what's being done now is all there is.....