Paying More, Getting Less: Just Where Do America's Health Care Dollars Go?

Mijourney · Jul 12, 2008

Thanks HM2Viking for the article. Even though it's one-sided in my opinion, it does provide some very useful points that can serve as food for thought.

I have read where Medicare pays 98% of its claims. Yet, some of the hidden activities behind this near payment of all claims is the fact that so much fraud, waste, and abuse occurs within the Medicare system. This has nothing to do with the private insurers but it has everything to do with the provision of services and the high cost of utilizing those services.

CseMgr1, ASN, RN · Jul 12, 2008

I have read where Medicare pays 98% of its claims. Yet, some of the hidden activities behind this near payment of all claims is the fact that so much fraud, waste, and abuse occurs within the Medicare system.

You got THAT right:

http://www.usdoj.gov/opa/health/hcf2.htm

HM2VikingRN, RN · Jul 12, 2008

Eventually the miscreants are caught. If we can reduce administrative costs on the demand end eventually we will achieve cost containment on the supply end. (Demand=Doctors, nurses and patients, Supply= Insurance companies and FFS medicare.)

Another place that we can cut costs is to put medicare advantage plans on the exact same reimbursement as traditional FFS medicare. MA (Private plans) cost 17% more than traditional FFS Medicare (government administered.)

Katie82, RN · Jul 20, 2008

Another place that we can cut costs is to put medicare advantage plans on the exact same reimbursement as traditional FFS medicare. MA (Private plans) cost 17% more than traditional FFS Medicare (government administered.)

There is a lot of waste and abuse in government administered medicine - Medicare and Medicaid. CMS is outsourcing so much now - administration, billing, case management, utilization review - that it is costing us a fortune. I would love to see the figures that justify this outsourcing - are we really saving money? There is also a huge CMS bureaucracy to monitor the outsourcing. I work in this enviornment as a case manager. This is my biggest argument against Universal Healthcare. The infrastructure that the government would have to create to manage it would double our taxes...

HM2VikingRN, RN · Jul 20, 2008

EXCEPT that the experience we have shows that Government does a pretty good job of paying money on a transfer payment basis efficiently. (Administrative costs for SS are well under 1%. FFS medicare is administered at between 3-5% for administrative costs.)

Medicare Advantage plans (Those administered by the allegedly efficient private sector) cost about 15-20% in administrative fees.

By your own post you acknowledge that outsourcing of governmental functions is more expensive than keeping the duties inhouse.

RN4MERCY · Jul 21, 2008

You got THAT right:
http://www.usdoj.gov/opa/health/hcf2.htm

Of course there will always be corporate cheaters who belly up to the public trough to feed their greed! We have to have the political will to stop the influence of dirty money that favors corporate interests over the public health and benefit infrastructure.

The fraud and abuse perpetrated on the sick and injured, (who thought they had insurance), by insurers who take their premiums, and then look for reasons to deny care, or delay it "til death do us part,"is the most shocking and offensive abuse and fraud.

http://www.latimes.com/news/local/la-fi-insure23feb23,0,187355.story

http://abcnews.go.com/GMA/story?id=3289308&page=1

http://losangeles.bizjournals.com/losangeles/stories/2008/04/14/daily28.html

http://www.cbsnews.com/stories/2007/11/09/eveningnews/main3482856.shtml?source=search_story

http://www.latimes.com/features/health/la-fi-bluecross5mar05,1,5799673.story

We've had enough. Single Payer Now: No excuses!

Neveranurseagain, RN · Jul 21, 2008

The money goes to profit. In the US, a large part of our healthcare is profit driven. In many of the countries we are compared to healthcare is a not for profit business.

Katie82, RN · Jul 27, 2008

Medicare Advantage plans (Those administered by the allegedly efficient private sector) cost about 15-20% in administrative fees.
By your own post you acknowledge that outsourcing of governmental functions is more expensive than keeping the duties inhouse.

I agree 100%, but the governmant is in the outsource mode. They do not want to become healthcare administrators beyond regulation. They would most certainly outsource UHC - big time. And I would be surprised if they could keep costs between 3-5%.

Katie82, RN · Jul 27, 2008

Another place that we can cut costs is to put medicare advantage plans on the exact same reimbursement as traditional FFS medicare. MA (Private plans) cost 17% more than traditional FFS Medicare (government administered.)

The advantage plans would not stay in. They offer coverages beyond straight Medicare, like dental, vision, hearing aids, and drug coverages. As I see it, part of the problem with Medicare is that it was set in place to keep people alive, not to be full coverage. I think the founding fathers of Medicare believed the aging population would pay for the extras out of pocket - just as Social Security was never intended to be anyone's sole source of income in retirement. THere are a lot of folks out there who are bitter because they think the government should be "taking care of me" in old age. Medicare should go back to the purpose for which it was intended - to pay for hospital and doctor, not all the frills in the advantage plans. Having worked with the Medicare Population, I can tell you there is a sense of entitlement that has arisen from a population that prided itself on not taking handouts. Many beneficiaries are bitter that they should have to pay even one penny out of pocket, even though many can afford it.

allnurses Guide · Jul 27, 2008

We the people can and should ensure that improved Medicare is NOT an outsourced system.

Basic Medicare is far better than the various "advantage" plans that cost taxpayers more and deny care that would be covered by regulat traditional Medicare.

I think people whose eye and dental care will be covered by the improved Medicare will not choose a for profit plan.

The recent vote by a veto proof majority shows the beginning of the end of outsourcing.

Let's stop corporate welfare.

Simplepleasures · Jul 27, 2008

I am on Medicare, its a lot better than a free clinic.I couldn't afford Cobra while waiting for SSDI approval. The problem that does exist with Medicare is the rate in which the doctors and clinics are reimbursed. Plus the deductibles , which forces those with Medicare to either buy a Supplemental insurance or buy an Advantage Plan. The Supplemental Plan costs another $100 a month on top of the almost $100. Medicare premium, so that is $200, out of the Social Security monthly payment. Oh almost forgot about the added 35 or 40 bucks a month for Medicare part D.

Those who have been disabled and have gone through their savings to pay for medical debt , now have to rely on living on SS alone. I am grateful to have it and I am thrilled to have Medicare, but the doctors and clinics charges keep going up, Medicare cannot continue to pay for those increased costs year after year. Those costs MUST be kept to a reasonable level, as they are in other countries that have universal health care, it can be done. I would much prefer keeping private health insurance out of the system altogether, that and the outrageous health care costs will bankrupt Medicare if something isn't done soon.

I do not have an entitlement attitude, I am grateful for what there is in place now, but as a civilized intelligent nation, I think we could do better.