Health Care Reform Suggestions II — Isn’t There A Better Way? I Think There Is!
Health Care Reform Suggestions II — Isn’t There A Better Way? I Think There Is!
By
Ken Eliasberg
Moving right along in our consideration of appropriate alternatives for health care reform, let’s take a look at another area of abuse in the existing health care system — fraud.
Fraud.- Recently,60 Minutes devoted a substantial segment of their Sunday night coverage to the topic of health care fraud. They concluded that the cost of such was in the neighborhood of 50 billion dollars, a pricey neighborhood, to be sure, but, in my opinion, far short of the mark. Why do I say that? Because, in 1992, according to a cover story in U.S. News & World Report, the then cost of fraud was estimated to be “up to $80 billion,” see Special Investigation: HEALTH CARE FRAUD — Up to
$80 billion of your money disappears every year in the nation’s biggest unchecked scandal, U.S. News & World Report, 2/24/92, p.34. And the incidence of fraud has certainly has not gone down in the intervening 17 years. Why not? Because the tools for committing fraud have become more efficient and more effective. The internet was hardly the factor in 1992 that it is today in conducting business, and it offers a much easier and speedier method of accomplishing fraud. Also, since it does away with a great deal of the paper trail formerly used in record keeping, it is frequently more difficult to uncover. As a consequence, I would wager that the amount involved is two to three times estimated on the 60-minutes report or double the amount suggested by U.S. News & World Report, i.e. 150 to160 billion dollars.
How to deal with the problem? Obviously, a great deal more oversight in the area. Stress the significance of the area to the agency entrusted with oversight responsibility, hire more capable employees, incentivise them in whatever manner you can — i.e. by paying them better and rewarding them when they uncover fraud and secure the punishment of the violators — and, finally, by providing severe penalties for those who commit the crime. Lock up the criminals and throw away the key — enough of this Mr-nice-guy approach to criminals, particularly those that engage in White Collar crime. Why white collar crime? Because that is typically an assault on the community at large, e.g. health care fraud is a crime against all of us because all of us will have to pay the bill.
Insurance Industry Adjustments.- Another area of reform that will result in significant savings concerns the health insurance industry. It gives rise to two significant problems: The present arrangement (1) inhibits competition, which, in turn, increases costs, and (2) multiplies the burdens ofhealth care providers by imposing a paper-work burden that is both costly and unnecessary. How to deal with this area? Simple — (1) provide the same rules for acquiring health insurance as presently exist with respect to other forms of insurance — i.e. auto and home — by allowing sales across State lines, and (2) create a Health Insurance Industry committee whose main purpose is to simplify procedures imposed on health care practitioners. For example, unify the claim-reporting forms required of health care practitioners, thereby reducing their costs. Now a doctor has to have assistance — more than occasionally in the form of a staff — to wade through the paperwork. There is no reason why the Industry cannot produce and provide some measure of administrative uniformity.
Waste.-Perhaps trying to eliminate waste in government is an exercise in futility, but it’s worth a try. One of our not particularly astute readers — who regularly displays his limitations in these pages — informs us that we have been “brainwashed with the suggestion, ‘Government is bad’ yet we have allowed our U.S. Military, local Police, Fire Departments, Medicare and many other Departments of Government to do an adequate job of running government.” Now to this bit of brilliance I have but 2 thoughts: (1) Do we have a choice, and (2) they may be doing an “adequate” job (although this is certainly debatable), but they are certainly not doing it on a cost effective basis, i.e. almost every significant governmental agency is broke or well on their way to going broke. They are “adequate” because the first thought informs the second, i.e. we do not have a choice; we must have a military, police department, etc. This approach to “adequacy” bespeaks the thinking of the left — it’s only money, and we’re never going to run out of that because the good fairy will take care of us — and of government, i.e. it ain’t our money that we are spending. By way of example, recall the Pentagon expenditures of hundreds of dollars for a toilet seat and/ or a hammer (if you have any doubts re the cost consciousness of government agencies, just google the Pentagon and toilet seats and hammers, etc.). I realize how difficult it is to make government employees conscious of the money they are spending, but it is done in the private sector (only because it is imperative to do so; the alternative is bankruptcy, and, until recently, we never thought about governments going bankrupt — we are being forced to do so now). We just have to learn how to operate government more efficiently!
Tax Changes.- Another approach — one suggested by Charles Krauthammer, among others — would be to reverse the long standing tax treatment of employer-provided health insurance, i.e. tax the employee on the value of the insurance benefits provided. As Krauthammer observes: “This is an accrued inefficiency of 65 years, an accident of World War II wage controls. It creates a $250 billion annual loss of federal revenue - - the largest tax break for individuals in the entire federal budget.”
Krauthammer continues “This reform is the most difficult to enact, for two reasons. The unions oppose it. And the Obama campaign savaged the idea when John McCain proposed it during last year’s election.” Krauthammer, Kill the Bills. Do Health Reform Right, townhall.com, 11/27/09.
Krauthammer concludes on this note:
“Insuring the uninsured is a moral imperative. The problem is that the Democrats have chosen the worst possible method - - a $1 trillion new entitltement of stupefying arbitrariness and inefficiency.
The better choice is targeted measures that attack the inefficiencies of the current system one by one - - tort reform, interstate purchasing and taxing employee benefits. It would take 20 pages to write such a bill, not 2.000 - - and provide the funds to cover the uninsured without wrecking both U.S. health care and the U.S. Treasury.” Medical Savings Accounts might be a foot in the door approach to the employer-provided health benefit tax problem.
I strongly believe that if we could make progress in any of the areas discussed above — let alone all of them — we would go a long way (perhaps all the way) in covering the 15 or 16 million people who currently have no health care coverage but want it. These are the people who concern me — not the young folks who don’t want insurance and certainly not the illegals. At the very least, progress in these areas would certainly give us a much better idea of what sort of problem, if any, we need to solve. I fear that the price of making 15 million people relatively happy will be making over 200 million very unhappy. What we don’t want to do is penalize the 85% of our populace who are content with their current coverage to provide coverage for the currently uncovered — particularly since it would most assuredly be inadequate — both quantitatively and quantitatively — coverage. While I certainly cannot guarantee that the suggestions offered above would solve our health care problem, I can gurantee 2 things: (1) it’s a heck of a lot saner approach to the problem than the one we are taking, and (2) it would take us a long way down the road to a solution.
Of course there’s a better way. The way our Democratic friends have chosen is one that takes the position that since the current system doesn’t work for 20 to 30 million people, let’s fix it so that it doesn’t work for 300 million. Obviously, this approach is like trying to shoot a fly off the wall with a cannon. And, by the way, when it’s all over, the approach suggested by our Congress — you know, the one that covers over 2,000 pages and probably over 2 tirllion dollars, would still leave almost 20 million people uncovered. Now, if these 20 million are illegal aliens, I won’t shed any tears; if they’re not, I have to ask the question what have we accomplished here? And, the answer is simple — we have consolidated an enormous — a regrettably enormous — amount of authority over our economy in the hands of the federal government. What a coincidence, that’s what Obama always wanted to begin with; now he’s got it, and we’re screwed!!