Politics and Religion

I'm sorry, isn't single payer a form of universal health care? Or am I missing something? e
vamikey 73 Reviews 476 reads


St. Croix1563 reads

To all the liberals on the board, which one is your preference? If it's the former, i.e. Medicare for all, how do you propose eliminating, or at least dramatically reducing Medicare fraud.

I just read another Medicare fraud bust to the tune of $452M, which implicated 107 doctors, nurses, and social workers. Medicare fraud runs about $75B a year. It's a pay first, chase later system. Whereas the private insurers scrutinize the claim first before paying. Obviously they don't have the same level of fraud.

I'm not going to say that I will necessarily agree to a Single Payer System, but to get additional people to support, wouldn't a more efficient and effective system help convince the naysayers?

Medicare has been in place for over 40 years, and it just seems the fraud gets worse every year, and I'm thinking as a taxpayer why would I want to expand Medicare to all. Why would I want to expand a system that is flawed. I've not heard one decent idea on how to fix Medicare, and that's keeping me from having a willingness to at least consider it. Fair enough?

FistFullOfFifties611 reads

Fraud and corruption is worse in every area government. And even worse in the corporate sector. Not that there'a any real difference between government and corporate anymore. Why would Medicare be any different?

The only alternative seems to be the conservative idea of single prayer. Get sick, pray and die. And since there's no God, its really just get sick and die.

So, get well soon.

designed to combat Medicare fraud. Indeed, when they were trying to sell the bill, they helpfully added in the amount of fraud they said would be eliminated to cut the cost of the program.

      The anti-fraud features that I remember are some 400 million to prosecute offenders (good for attorneys), stricter penalties for offending doctors, the use of computer programs to detect improper billing patterns. There were a few others that I can't recall. Whether these measures are a "decent idea" remains to be seen; they haven't stopped the damn Scooter Store from bilking Medicare every day, that 's for sure. See there is a big part of the problem - companies that market diretly to medicare beneficairies and their sales pitch is - "you do not have not pay anything."

     But I'm pleased you focused on a measurable and remediable problem such as fraud rather than the absurd "defensive medicine" charges that Republicans love to toss around (it's 80 billion a year in defensive medicine costs). That's my pet peeve whenever the "let's fix medicare" topic comes up.

St. Croix300 reads

It seems like there are always new initiatives on curbing fraud since Medicare's inception. Again, Medicare is a "pay first" system, which means don't ask questions just pay the claim, and then we will investigate. Just the opposite of the private sector. Plus if I'm a provider, and I'm taking Medicare patients, and the reimbursements are low, I'm going to find a way to do more tests, whether or not they are really necessary. Go for volume in a way to offset low reimbursement. Just another example of fraud.

Now think about the reimbursement issue, and billing for things not necessary. The problem with health care, whether it's Medicare or the private sector, is the lack of consumer involvement. Name me any other product or service that consumers are not knowledgeable about what they get and how much it costs. As a patient or consumer, you are at the mercy of the providers. And go in and challenge a doctor on either the necessity of the procedure and the costs, and they will give a look of total disdain. How dare you question me on what I do, or how much I will charge?

You find a way to simplify the system, get the consumer educated, and costs will go down. Look at dental or eye care. They advertise, compete, have specials, so you know how much a crown costs, or contact lenses. You can shop.

The last thing that irks me to no end is the Explanation of Benefit form. Look at the so-called "retail or MSRP" charge by the provider, also labeled the amount billed. Then look at the member rate, or what Medicare or any private insurance will reimburse. The latter is like 20% of the amount billed. So I guess the amount billed is bogus. Does anyone pay it? I guess providers can make a living being reimbursed at only 20% of the member rate.

I realize liberals desperately want either single payer, or universal heath care. They view it as a right and should be made available to all irrespective of your ability to pay. Sounds laudable, but these ethereal views just don't cut it.

-- Modified on 5/3/2012 9:04:48 PM

and you ponder whether to order the ethereal roasted chestnut soup with shaved black truffles, do you –as an educated goumand - ask Wolfgang to leave off the shaved black truffles because they add about $30 to the cost of the soup?

    I’m guessing the answer is “no.” And the reason is because your employer is paying and you want to take full advantage of the best Wolfgang has to offer.

      So I can’t agree with your view that educating the consumer will reduce Medicare costs.  Because he just isn’t paying. He wants top of the line service, regardless of the cost. It’s just human nature.

        Aside from that you can’t compare health care “shopping” with shopping for a new car. When I wrecked my knee a couple of years ago I was in pain in the emergency room. I had no interest in discussing – do we really need to do an MRI? I just wanted the doctor to make the decisions for me at least until the pain medication took over and then I was pretty spaced out.

      So I don’t think you can use the same reasoning for health care services as would clearly apply to other services where we bargain from an arms length position.

      Medicare is social insurance where we spread the risk of health care costs over the broadest class of eventual users. That is so different from what private insurers that you can't take the exemplary practices they employ and super- impose them on this very different kind of insurance system.

St. Croix474 reads

Re education - I said Medicare AND the private sector. The obvious reason you have no consumer involvement is that the consumer has no VESTED ($$$) reason, and that is even more apparent in Medicare.

Look mari, if you are in the emergency room because of your weak knees, obviously you just want the pain to go away. You just want the doctor to do anything and everything. Emergency room, surgery, I get it, but a portion of health care is done at the doctor's office, or outpatient procedures.

I assume you have private insurance. Does your plan have a "estimated" pricing tool? This is where you can look at a procedure, and get different prices. I've seen MRI prices range from $500 to $5000. If the consumer is INVOLVED, then naturally the price comes down.

Medicare is a single payer system. It's just one big insurance company. They take in premiums and pay out claims. That's it. They could put in incentives, but like fraud, the government is not designed to be cost effective. Plus add the fact that half of our population goes through life fat, drunk and stupid, I kinda have a problem of just paying and paying and paying for that behavior.

And to think you used a Spago example to make your point. That's pretty weak. And if I did go to Spago's, it better be with a client that is about to sign a multi-million dollar contract, otherwise I'm hustling money from slow, white, asthma inhaling can't shoot losers like you (lmao).

...I dunno how workable this is, but I figure I'd toss this idea out there.

What if we went to a Medicare for all system, and we took out the incentives to make a profit. To combat fraud, everyone pays into the system, and you have someone who knows something about finance invest revenues not used in something that is low risk. At the end of every quarter, or year, if the system uses less money than it takes in, everyone gets a check.

Wouldn't this give everyone in the system the incentive to reduce fraud?

St. Croix490 reads

I have no idea what you just wrote. If just want a Universal Health Care system vs a Single Payer, then just say it. Make all providers, doctors, nurses, hospitals, anybody remotely involved in health care, government employees or government health centers.

If you still want a Single Payer System, then you can do a few things to reduce fraud.

1. Make the system more consumer friendly. Get the consumers educated.
2. Change Medicare from a pay first chase later system, to investigate claims first, then pay.
3. Employ better processes and better technology. If private insurance companies have lower fraud rates, fucking buy there software and systems.
4. Make the punishment for fraud so horrific, doctors, nurses, lawyers, and roving ethnic bands you hear about will think twice about committing fraud.

Let's try this idea out on ya Saint. Who OWNS the federal government? The People do. Therefore, Federal lands, and Federal institutions are OWNED by the People too. If the Federal Government leases land to an oil company, that is my land that they're leasing. Why am I not getting a royalty check?

They do this sort of thing in Alaska. It seems to work for them.

All I'm suggesting, is to try the idea with Federal institutions as a way to reduce fraud.

I think your ideas are well....stupid. Do you really want gov't bureaucrats trying to figure out if you're frauding the gov't when your in an emergency room suffering chest pains?

Make punishment for fraud extraordinarily draconian. There's an idea that never fucking works. Texas gleefully executes people regularly, yet they still have one of the highest homicide rates in the nation. Maybe if we could only execute people twice, maybe that would deter them, eh?

Just take the profit out of health care. You get rid of the incentive to commit fraud. You get rid of skyrocketing prices. You financially reward people for reducing costs.

Instead of looking at private insurance as a model for anything in a Single Payer System, why not look at what other nations are doing to administer their health care?

you have zero ownership interest in federal lands, and I hope you are not waiting for that royalty check. The Alaska Permanent Fund was established by a constitutional amendment to the Alaska Constitution - there is no comparable provision in the US Constitution. and even in Alaska, the citizens do not get royalties from oil production - they get a dividend depending on fund performance.

      St. Croix's ideas are not stupid but simply impractical which is why the latest, best thinking in this area -The Affordable Care Act - does not incorporate those ideas to combat fraud. The private market model that he so dearly loves simply does not work when applied to a social insurance system based on nationwide risk spreading, and his educating the consumer rationale which works so well in other contexts does not work when there is a third party payer.

    But your pure socialist "take out the profit motive" from health care is the worse possible idea to float. One day, when you covertly order your first bottle of Viagra from that on line pharmacist, I want you to stop and think "gee, why do we have this wonderous drug?" I wonder if it was developed in the Soviet Union?"

...but I imagine if you take the profit motive out of health care you could eliminate most of the fraud. Just sayin...

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