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First Cut the Abusers, the Bureaucrats, and Useless Interventions!
Obama is challenged to come up with ways to pay for a health insurance plan that will cover most, if not all, Americans. Many call for cutting services and reducing fees for doctors and for hospitals. Others favor raising taxes one way or another. I say first cut out the crooks. You may say this is an often-used gambit; that people who do not want to face the tough choices that must be made claim that you can pay for what must be covered by curbing fraud and abuse. However, in this case, there is strong data that show that scores upon scores of billions could be saved in this way.
I served as a staff director of a commission that investigated abuses in nursing homes in the state of New York. We found that the owners cheated their patients and used the funds to buy themselves expensive paintings, mansions, fancy cars and numerous other goodies. When they were caught, which was rare, all that Medicaid did was to ask them to pay back the money, either with no penalty or with only a very minor one. Moreover, those who abused the elderly and the tax payers were not disbarred from receiving still more public funds in the future. Throughout the health sector, according to estimates from the federal government and the National Health Care Anti-Fraud Association, more than $100 billion are lost each year to fraud, abuse and waste in the health care system.
Another major source of savings, well known but still true, can be found in those who administer health care. According to Consumer Reports, the US spends three times more money on administering health care per capita than many other industrialized nations, Canada for instance. Physicians for a National Health Program find that more than 30% of U.S. health spending -- $294 billion -- goes to paper work and administration, compared to only around 17 percent in Canada. This large sum is due to a crazy system that tries to check every transaction, every medication, every x-ray, every procedure provided to most patients, instead of paying doctors and hospitals a flat fee (known as capitation). If we shifted to a Canadian-like system, we would save approximately 13% off our total health care bill: in 2008 that would have amounted to a savings of $312 billion.
Computerizing health care records would save another bundle, by reducing the staggering number of medical errors and doctor and hospital induced illness from such simple problems as illegible handwriting and prescriptions that conflict with those previously prescribed. And these saving pale in comparison to the savings we could gain if the government would stop reimbursing for medical interventions that have not been proven to actually help patients. Even if we could just cut these interventions by half, we still would be ahead by some $350 billion a year.
It is possible that even if all this is done, we will still be short. However it is morally repugnant to claim that we cannot afford to provide beneficial medications and services to patients while so much money is being lost due to abuse, poor administration, and interventions that have no proven benefit.
**I will respond to the comments of those persons who are willing to identify themselves, because I hold this essential for a civilized dialogue.
Amitai Etzioni is a professor of sociology at The George Washington University and the author of The New Golden Rule (Basic Books, 1998). For more, please visit http://www.gwu.edu/~ccps/securityfirst.html. Etzioni can be contacted at icps@gwu.edu.
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What we have is unsustainable, and it is URGENT to reform the grotesque health non-system we live with. The idea that health care is "for profit" (beyond fair and just renumeration for doctors, nurses, health professionals) is immoral.
After hearing decades of conservative hype about the superiority of the "magic of the marketplace" I find it interesting and disgusting that private insurance companies should be blowing so much money on administrative expenses in contrast to Medicare which spends a much lower percentage.
I also find it disgusting and rather pitiful that the American public is so easily scared by the thought of "socialized" medicine when police departments, fire departments, the military, ect are publicly funded. The American public seems to have a lamentable tendency to become scared and hysterical when hearing certain words.
JJ, I simply don't believe your assertion that medicare is administerted more cheaply than private health care. If you have data to support that, I'd be delighted to see it.
The government has legitimate functions in our society: the military is part of my social contract with the federal government, and is a constitutional obligation. Socialism is a situation in which government controls the means of production, i.e. the private sector, e.g. General Motors. Police and fire are local functions. None of those are examples of socialism.
GOOD MORNING!!! MY FELLOW HOMO SAPIENS WHICH MEANS THE SPECIES WHO IS WISE.
There are to many Democrats in the U.S. Congress that are refusing to support a public health care plan and that means these so called Democrats are working for the Robber Barons (their campaign contributors) in other words they are not Democrats but Robber Baron stooges and should join the Republican party which makes no secret about the fact that they are working for the Robber Barons.
"...When they were caught, which was rare, all that Medicaid did was to ask them to pay back the money, either with no penalty or with only a very minor one...."
Oops, you can't use logic in an issue emotionalized by rethugs. Besides, in our system of legalized bribery, where are bent politicans gonna get their campaign donations?
One fear of health care providers is this; they are scared someone will match up what they claim they did for their patients and what really happened. When a person is in the hospital, who but the doctor keeps track of each time they see the patient?
If I stop by my doctors office to pay on my bill and he says "Hi, how are you" and I reply, does that mean he can claim an office visit? Who would know if he did?
This whole exercise in this so called health care debate is a total waste of time because the entire structure, the whole system in American health care is flawed, wasteful, inefficient and unfair. So why tinker with the flawed monster?
Obama care will only TINKER with this mess. All the problems are well known and well studied.
The problem is how to fix them. The conservatives are adamant that private insurance based more choice and more competition will cut costs and improve quality, AND THEY MIGHT BE RIGHT.
The liberals say that a government ran single payer system will lower costs and improve quality and efficiency. THEY MIGHT BE RIGHT.
Obama care gives us the WORST of both worlds, that is to say we get gigantic inefficient and poorly managed programs (Medicaid has been documented to pay out at least 10% of its budget on fraudulent claims) and we get private insurance companys that have such a dominant position in the market place that they really dictate prices instead of competing on price.
I have no faith that Obama care and the congress will EVER lower spending and run a tight ship regarding these new programs Obama care will bring us.
If you think health care is expensive now, YOU AINT SEEN NOTHIN BABY>
The Rosetta stone in all of this is the public option. The REAL reason conventional heath insurance companies don't want it has nothing to do with taxpayer subsidies. It has to do with the fact that a new health care provider designed from the ground up to keep its customers healthy rather than their stock value terrifies the crap out of them. The public system will do to the present heath insurance companies what the Japanese auto companies did to the big three. It's just that simple.
And look at how well that worked for Detroit!
Don't forget the lawsuits. Those add up.
I think our discussion about health care--like so many of our political discussion--is a@$backwards. We should first be asking what constitutes a good health care system, what steps are required to get there, then what will it cost. So long as cost continues to be the primary goal of reform efforts, improvement in actual health care is bound to fail.
As a former health care giver, I am shocked and saddened to see what has become of health care in America. $ 1. 4 million is being spent per day in DC by the health care lobbyists so your elected representative is getting taken care of and has quality health care we pay for and can't afford ourselves for our families, I know what is deemed, defended and supported in Tennessee and Virginia as quality health care and clearly profit care comes ahead of patient care. http://www.wisecountyissues.com/?p=62 MRSA ( methicillin resistant staphylococcus aureas ) is infesting our communities because filthy, uncaring hospitals and emergency rooms are breeding them and spreading them into our schools, homes, restaurants. How many more Americans' will be diseased or die while 74 % of Americans' are begging for health care reform ? More people died in America last year from MRSA complications than AIDS. When MRSA and a flu bug start mixing, it won't be pretty and we are being infected by the very health care system we depend on and trust to keep us safe and healthy.
Sadly, we have gotten to the point that those that have profited are spending over 1 million/day to keep the status quo.
With 91 percent of talk radio scaring the American public every day the truth is obscured. I have never seen even 1 Doctor that represents the Single Payer program (16,000 have signed onto) on network or cable news. Is it because millions of advertising dollars are spent on Pharmaceutical commercials? Or what is it?
Lynne Gillooly
That WAS a rhetorical question, right??
agredd! Also, we waste huge amounts on futile and painful measures near the end of life instead of providing p[alliative care which is better for patients and way cheaper. We also waste huge amounts of money on keeping the MD monopoly on well care-we should be using alot more NPs to do the critical work of health teaching, check-ups and chronic disease management. Sue, RN
Yeah, just cuz my aunt, dying of cancer, spent her last 48 hours alternately begging ti live and (due to pain) begging to die, we need to follow your lead: Let'em die.
Bet your position will change when it's your turn....
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