Before Medicare/Medicaid for all can even be discussed

[RB TexLa]

Fraud prevention has be stepped up, that 3% overhead comes with a cost. The cost is the amount of taxpayer money that doctors and facilities steal every year.

Increased enforcement and prison time is the only thing that works. These thieves will not stop until they see a doctor go to prison and know she is going to general population until she is dead.

[Agnosticsherbet]

1. So before we can expand medical care to all we must find the cure for greed?

I think it is more humane to get care to the poorest among us before we deal with a fundamental problem in the human mind that has always been with us.

[RB TexLa]

7. I don't support single payer or medicare for all, but we need to increase enforcement

anyway.

If expansion is discussed or not. Doctors and healthcare facilities give lot's of money to Congress to keep them from funding enforcement so they can steal as much as they can.

[MrsKirkley]

2. Single-payer controls costs.

That's why the cost of health care and prescription drugs in countries with single-payer is a fraction of what it costs in the US. Since we would save so much with single-payer wouldn't it make more sense to worry about fraud after single-payer is implemented not before?

[Hoyt]

5. Single Payer in countries where the government will say NO to patients and providers,

does work at lower cost. But here, the government knows patients and providers will whine like babies deprived of food. I honestly don't think the government has the will to be tough like other countries in terms of utilization control, amount providers can earn, drugs and services patients can demand, innovative payment schemes, etc.

[SickOfTheOnePct]

6. Single payer is not going to save money in the aggregate

While it may result in a lower per capita cost, with everyone being covered for everything, the overall cost will be more than what we spend on healthcare now.

That doesn't mean we shouldn't do it, but we have to into it with our eyes open to the realities.

[truebluegreen]

3. That's like saying we have to Secure the Borders!

before we deal with immigration issues.

[csziggy]

4. I'm all for Medicare/Medicaid fraud being prosecuted - start with Rick Scott!

And the other Republicans who have used the system to steal from the systems.

I suspect far more money is stolen by people like Rick Scott than by people who are just trying to get health care.

[Act_of_Reparation]

8. I've never met a doctor who did their own billing.

But whatever. Seems legit.

[Javaman]

9. ...

we are entirely capable of doing two things at the same time.

I really hate this bizarre meme.

[hunter]

10. You think the health insurance companies are better at dealing with fraud???

The ARE the fraud.

[RB TexLa]

12. They have a much lower rate of fraud committed against them

Loss prevention is very precise with them.

[hunter]

13. No, it's not.

The larger the money stream these insurance companies control, the more they can siphon off. Like all corporations, they measure their success in $$$ growth, not the overall health of the public they serve.

Furthermore, these same companies manage Medicare/Medicaid for the Federal government.

Yep, the work is contracted out to Cigna, Blue Cross, etc..

Hmmmmmm..... there might be some conflicts of interest here, don't you think?

There's a reason we have the most expensive medical care in the world, and a reason that care is so mediocre. For all the money we spend on medicine, we are not a healthy nation. Even wealthy people with good "platinum level" health insurance often get crappy, inappropriate care.

Yes, the system is corrupt.

I posted some thoughts in this thread:

http://www.democraticunderground.com/10027881003

[Recursion]

14. The big difference is they can't be lobbied and Congress can

Insurance companies would never have a 20-year-long "doctor fix" where they overpay doctors by 20% but can't bring themselves to cut that gravy train off.

US physicians make twice the OECD average, and -- surprise surprise -- we pay about twice the OECD average for health care, with the vast majority of it going to physicians.

[hunter]

15. Primary care physicians in the U.S.A. are making a little over $200,000 on average.

It's not a good job anymore, long hours, every day a new shit storm. One problem is they are forced to practice assembly line medicine, ten minutes with the patient, ten minutes (or more) to do the paperwork. In many ways they are "incentivized" to bounce patients up to more highly paid specialists. And they still work more than 40 hours a week, sometimes much more.

My doctor has done that to me, bounced me up to specialists making three times what he makes, with no better health outcomes for me, no new information or advice for my doctor. But them's the rules, all dictated by the insurance industries on all sides.

An "OECD average" doctor likely had their schooling paid for by the state and their billing isn't a shit blizzard, every patient with a different sort of insurance, all of it crappy and perverse in how it pays and doesn't pay, with many patients accumulating debts they can't pay. An OECD average doctor might even have an actual 35 hour work week.

In any case, my wife and I thought we had decent medical insurance, but we've been a smoldering crater of unpaid medical debts for many years now, and before Obamacare expired COBRAS and uninsurability. That wouldn't have been the case in any true "first world" nation.

The insurance industry, both health and medical malpractice, are not capable of measuring or determining what appropriate medical care is. All they are really counting is the $$$, and like any organization, they measure their success in $$$. But that's not a measure of public health, and that's not a measure of individual health.

[Recursion]

16. That's four times the median household income in the US

(The numbers I saw last had them at about $172, which is "only" 3 times the median household income, but obviously there's different ways people survey and measure this.)

An "OECD average" doctor likely had their schooling paid for by the state

Which is why I don't think we can realistically have single payer until we have free (or at least much cheaper) medical school -- it will crowd out literally all other social spending.

Their governments also don't kowtow to their national Medical Association and deliberately restrict the number of medical school slots available; doctors can command these prices because they are scarce in the US and their lobby makes sure they stay that way.

[hunter]

17. The AMA is a tool owned by the pharmaceutical industry; a shadow of what it once was.

Most doctors don't waste their money.

There is no strong physicians lobby, but there are many, many groups interested in keeping medical costs high, increasing the rivers of money they control.

A similar situation exists in the defense industry.

The people doing the lobbying that increases defense spending are not the skilled engineers and other professionals, they're not the sailors and soldiers, instead the high-power Congressional lobbying is done by the financial people, the Masters of Business Administration crowd, at the behest of those with million and multi-million dollar salaries.

Marillyn Hewson, CEO of Lockheed Martin, was paid 33.7 million dollars in 2014. Health insurance CEO's make similar amounts of money or more. Those are the people lobbying.

Medical slots in the U.S.A. are not "unfilled." Instead there is pressure to import non-citizen doctors largely educated in other nations because hospitals can pay them less and treat them poorly. In the Silicon Valley the situation is much the same with other professionals. The U.S.A. is, in effect, outsourcing rigorous technical education to other nations. The Silicon Valley engineer largely educated in India is likely to visit a Silicon Valley doctor largely educated in India.

[Recursion]

18. None of which single payer fixes, because it leaves the private provider system in place

I absolutely agree the situation is fucked, but I don't see how financing reform solves it; if anything it makes it worse because these incredibly rich hospitals (and a few incredibly rich private practices) can call up their Congresscritter and threaten to destroy them if they ever so much as touch reimbursements.

We need capitation budgeting, at which point I don't really care how we finance it because we'd go to having affordable health care prices like most of the world has. But that's going to take requiring providers to make a lot less money, which we don't seem to have the political will to do (I know this isn't GD-P, but even Sanders' plan is remarkably mum on this point).

[Iggo]

11. Always entertaining.