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Is Medicare An Effective Bureaucracy? Part 1

Posted Sep 22 2008 4:36pm

 

Stanley Feld M.D.,FACP,MACE

Barack Obama's medical plan wants to guarantee universal insurance coverage similar to that offered through the Federal Employee Health Benefits Program. (Medicare Part C)

“The benefit package will be similar to that offered through Federal Employees Health Benefits Program (FEHBP),

the plan members of Congress have. The plan will cover all essential medical services, including preventive, maternity and mental health care.”

I stated that forming a new bureaucracy to improve medical care is not the answer. Bureaucracies are inefficient and at time wasteful.

The answer is not Mr. Obama’s proposed National Health Insurance Exchange . I think a new bureaucracy will make things worse.

“· National Health Insurance Exchange: The Obama plan will create a National Health Insurance Exchangeto help individuals who wish to purchase a private insurance plan. The Exchange will act as a watchdog group and help reform the private insurance market by creating rules and standards for participating insurance plans to ensure fairness and to make individual coverage more affordable and accessible. Insurers would have to issue every applicant a policy, and charge fair and stable premiums that will not depend upon health status. The Exchange will require that all the plans offered are at least as generous as the new public plan and have the same standards for quality and efficiency. The Exchange would evaluate plans and make the differences among the plans, including cost of services, public.”

Medicare has been proud to advertise that it is an efficient bureaucracy. It has declared that its overhead is only 2.5%. We now know this is not true. Medicare outsources most of its administration services to the healthcare insurance industry. The healthcare insurance industry builds in its administrative fees to the cost of care. The New York Times obtained a draft of a report prior to being made public. The inspector general is studying the report before it is released and might change it.

Medicare’s top officials said in 2006 that they had reduced the number of fraudulent and improper claims paid by the agency, keeping billions of dollars out of the hands of people trying to game the system.”“But according to a confidential draft of a federal inspector general’s report, those claims of success, which earned Medicare wide praise from lawmakers, were misleading.”

Medicare told outside auditors to ignore government policies that would have accurately measured fraud.

“For example, auditors were told not to compare invoices from salespeople against doctors’ records, as required by law, to make sure that medical equipment went to actual patients.”

“As a result, Medicare did not detect that more than one-third of spending for wheelchairs, oxygen supplies and other medical equipment in its 2006 fiscal year was improper, according to the report. Based on data in other Medicare reports, that would be about $2.8 billion in improper spending.”

This miscalculation does not represent direct patient care. These supplies are essential to manage chronic disease. However the abuse of responsible sales these supplies by secondary stakeholders is not controlled by Medicare. 

I campaigned to have Medicare pay for home glucose monitoring strips. It is an essential part of diabetes care. To my astonishment, private companies were formed to refill glucose strips automatically. Patients would not need strips because they were not compliant with physicians’ orders. Compliance rate for home glucose monitoring is only 50%. Medicare is spending twice as much as they would if the patient was responsible for buying the glucose strips.

The extra money paid could be directed to paying for disease management. Patients could be taught the importance of measuring their blood sugars three times a day. Instead the private companies are profiting from the sales extra glucose strips.

“That same year Medicare officials told Congress that they had succeeded in driving down the cost of fraud in medical equipment to $700 million.”

Pete Stark claimed, “We're speechless”. Mr. Stark and his ilk consistently claim that Medicare is a model for government-run "universal" health care because it spends less on overhead than the private sector.”

" To look better to the public, you cook the books," Mr. Stark continued. "This agency is incompetent."

The report points out a basic problem of bureaucracies. The goal always seems to be to look good rather than perform its job efficiently. The people must force our leaders to face reality. Congress and the administration must begin to trust citizens to be responsible for their own Medicare dollars rather than have a bureaucracy or healthcare insurance company in charge of their needs.

“Some lawmakers and Congressional staff members say the irregularities that the inspector general found were tantamount to corruption and raise broader questions about the credibility of other Medicare figures.

Senator Grassley who has praised Centers for Medicare and Medicaid Services for efficiency in the past has demanded that heads roll.

“Congressional staff said the Centers for Medicare and Medicaid Services — the agency overseeing Medicare — was lobbying the inspector to play down the report’s conclusions.”

This response is only natural and to be expected when bureaucracies are challenged and exposed.

“A spokesman for Medicare said that the agency agreed with the inspector general that the agency’s reported level of improper billing for durable medical equipment, or D.M.E., should have been higher. But Medicare says the $2.8 billion figure is unsupported.”

The media is the message in our sound byte society. Once the day of the reporting has passed the story is forgotten. Unfortunately the implications of the story are profound

"Fraudulent and improper payments have long bedeviled Medicare, a $466 billion program. In particular, payments for durable medical equipment, like power wheelchairs and diabetic test kits, are ripe for fraud."

There is a simple plan for Barack Obama to adopt. It is my ideal Medical Savings Account. Medicare patients should be responsible for spending the first $6,000.00 dollars. They would be careful to not waste their Medicare insurance money. Maybe they would not get the best wheelchair in the world or let companies send them diabetes kits they do not use.

A government bureaucracy should make the rules. If vendors break the rules patients should report them. The government bureaucracy should act quickly to enforce the rules. With my ideal medical savings account you create an enormous policing agency. People will not tolerate waste when their money being wasted. This will eliminate fraud and the waste of the peoples money.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

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