Archive for the ‘Medicare’ Category

Feds make $125 billion in “improper payments” … whoa, Nellie.

March 18, 2015

In these days of Moneyball and Team Obama’s campaign technology apparatus that could pin down the ice cream flavor that somebody eats, this shouldn’t happen.

But, it does.

The GAO just issued a report saying that the Feds made an estimated $125 billion (that’s billion with a “b”) in so-called “improper payments” in 2014

 

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 Here are some of the ugly details …

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Symptoms & causes: Why diabetes strips are $18 on a hospital bill and less than a buck on Amazon.

February 25, 2013

On Sunday, Business Insider ran a piece called The Most Infuriating Paragraph You Might Ever Read About The Healthcare System

It referenced rants on “Steven Brill’s epic cover story for Time on why healthcare costs so much.”

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The paragraph that set them off from the Brill article should – according to Business Insider — “legitimately get anyone’s blood boiling.”

By the time Steven D. died at his home in Northern California the following November, he had lived for an additional 11 months. And Alice had collected bills totaling $902,452. The family’s first bill — for $348,000 — which arrived when Steven got home from the Seton Medical Center in Daly City, Calif., was full of all the usual chargemaster profit grabs: $18 each for 88 diabetes-test strips that Amazon sells in boxes of 50 for $27.85; $24 each for 19 niacin pills that are sold in drugstores for about a nickel apiece.

There were also four boxes of sterile gauze pads for $77 each. None of that was considered part of what was provided in return for Seton’s facility charge for the intensive-care unit for two days at $13,225 a day, 12 days in the critical unit at $7,315 a day and one day in a standard room (all of which totaled $120,116 over 15 days). There was also $20,886 for CT scans and $24,251 for lab work.

As for why we can have a system where diabetes-test strips are sold for $18/each in one place, while Amazon sells a box of 50 for $27.85, see this, great piece by Sarah Kliff on the lack of price controls in the US.

My opinion: Apparently these guys have never heard of “absorption costing” or bothered to really ask “why is healthcare so costly?”

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$$$: The Federal budget on the head of a pin …

January 15, 2013

Nice recap courtesy of JP Morgan Wealth Management …

Easy facts to remember:

  • Feds take in about $2.5 trillion in taxes
  • Deficit is just over $1.1 trillion
  • Spending is over $3.6 trillion

Note that Social Security & Medicare spending is about twice what’s taken in via “Social Insurance” … aka. “payroll taxes”.

Also note how big that dashed Borrowing box is.

We don’t have a spending problem.

Yeah, right.

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Chart Tip: Being picky, but they should have put Social Insurance at the bottom of the sources’ stack so that it lined up with Social Security and Medicare.

Every list should have a logical order … and that order is rarely the order that you thought of things.

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Background: Here’s a way to raise tax revenues & create jobs.

December 20, 2012

In the fiscal cliff talks, I think that the Feds – both Obama & Congress – are demonstrating “no brain” thinking – working ineffectively on the wrong stuff.

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Specifically, in the fiscal cliff talks, practically all of the focus has been on jacking up the marginal tax rates for millionaires and billionaires making more than $250,000
.

Payroll taxes – for Social Security & Medicare – have been largely pushed off-stage.

That’s because both Dems & the GOP seem to agree that the 2% payroll “tax holiday” should be allowed to expire.

That may be true, but I think the payroll tax structure may be the key to hitting the seemingly conflicting objectives of raising tax revenues and creating jobs.

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Let’s lay out some basics:

What happens to whom if the current payroll tax holiday expires?

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Electronic medical records cut costs … oops, make that raise costs.

October 17, 2012

Interesting expose In the NY Times of all places.

Punch line:

When the federal government began providing billions of dollars in incentives to push hospitals and physicians to use electronic medical and billing records, the goal was not only to improve efficiency and patient safety, but also to reduce health care costs.

But, in reality, the move to electronic health records may be contributing to billions of dollars in higher costs for Medicare, private insurers and patients by making it easier for hospitals and physicians to bill more for their services.

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How can this be?

Simple, Watson.

First, a system can provide docs with a checklist of separately billable procedures that they might perform … ensuring a complete check-up and making sure that no billing stone is left unturned.

Second, an e-system can make it easier for doctors to “upcode” a procedure in a way to maximize reimbursement rates.

For example, when a doctor enters a billing code, the system can present him with alternative codes for very similar procedures that get higher reimbursement payments … and tell the doctor what addition work needs to be done to qualify for the higher paying code.

So, maybe just asking the patient a couple of more specific questions  may upgrade an examination from ‘simple’ to ‘ complex.  The doc can then ask the questions (or not) and check the higher paying box.

Third, an e-system makes it easy for docs to “clone” common ‘boiierplate’ findings from one patients chart to another patient’s chart … saving time and, perhaps, implying a more detailed examination.

The Times says:

As software vendors race to sell their systems to physician groups and hospitals, many are straightforward in extolling the benefits  of those systems in helping doctors increase their revenue.

In an online demonstration, one vendor promises that it “plays the level-of-service game on your behalf and beats them at their own game using their own rules.”

An expert says “What’s happening is just the problem we feared” … unintended consequences.

For the record, I think that cutting healthcare costs by reducing doctors’ pay is nuts … there is lots of waste, fraud and unnecessary expense in a grossly inefficient system.

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Back to the Clinton years? … Dems: Be careful what you wish for.

September 27, 2012

Lots of articles have been written about how the the bottom 50% pays no Federal income taxes and the very top tiers pay vast shares.

The usual cry from the Dems: what about payroll taxes?

Then, they holler: go back to the rates in effect during the glorious Clinton years.

Well, the Independent Review pulled together Federal tax burdens back to 1980 … including payroll taxes

The key findings:

Since 1980, the bottom 40%’s share of total Federal taxes has almost halved … from about 9% to to 5%.

The top 10%’s share has grown about 15% … from 40% to almost 55%.

Most of the top 10%’s share  increase has landed where?

You guessed it … among the evil 1-percenters.

Geez.

If we could only get the wealthy to pay their fair share, we’d be out of this fiscal mess, right?

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A good day for Team R&R …

August 16, 2012

On Monday, I laid out the Brer Rabbit strategy that I thought Team Romney was implementing.

Note: Pundits are now calling it “Political Jujitsu”

The essence: name Ryan and lure Team Obama into the Medicare trap … get them to repeat their claim that Ryan wants to throw granny off a cliff … and then bang …  counter attack and put ObamaCare on the table.

Team Romney probably didn’t expect help from others , it got some.

First, a video of Erskine Bowles – you know, of Simpson-Bowles fame – went viral.

The video shows Bowles (a Democrat) praising Ryan and his budget.

“Have any of you all met Paul Ryan? We should get him to come to the university. I’m telling you this guy is amazing. … He is honest, he is straightforward, he is sincere. And the budget that he came forward with is just like Paul Ryan. It is a sensible, straightforward, serious budget and it cut the budget deficit just like we did, by $4 trillion. … The president as you remember, came out with a budget and I don’t think anybody took that budget very seriously. The Senate voted against it 97 to nothing.”

click to view vid
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On cue, the Dem talkers started ripping on Ryan.

As soon as they did, Team Romney launched the counter-attack …  reminding folks that Medicare funds were being raided to pay for ObamaCare … taking Medicare funds away from seniors and sprinkling them to others.

click to view vid

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On cue, the Dem talkers denied that Obama would ever consider raiding Medicare.

Oops.

Tape on file shows Pres. Obama telling Jake Tapper of ABC that he would, he did, and he’d make it stick.”

TAPPER: One of the concerns about health care and how you pay for it — one third of the funding comes from cuts to Medicare.
PRESIDENT BARACK OBAMA: “Right.”

TAPPER: Are you willing to pledge that whatever cuts in Medicare are being made to fund health insurance, one third of it, that you will veto anything that tries to undo that?
OBAMA: Yes.

click to view vid

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That’s called “hoisting yourself by your own petards.”

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