Gaming our Healthcare System by Ripping of the US Public
Tonight, our guest Dr James G. Kahn, emeritus professor of health policy, University of California San Francisco & leading researcher in the cost and effectiveness of health intervention programs, and in US health care financing reform joins
Show Outline: our guest addresses and/or explicates the following:
- Medicare, a medical insurance program for people over 65 and younger disabled people and those on dialysis and Medicaid, the government assistance program for low income patients’ medical expenses are billed by providers. Rates are based on diagnosis by providers. If providers are not properly supervised they can upcode diagnoses and charge the goverment for unneeded and/or unprovided services. The result is a fraudulent one in which the Center for Medicare &Medicaid Services (CMS) which funds Medicare & Medicaid and also has the functional authority to monitor the amounts paid from an insurer to a provider has not been doing its job of protecting US taxpayers from profiteering and fraudulent charges resulting in the lining the pockets of insurance companies and providers.
- According to our guest , as a result he estimates that we are spending in excess of $25B a year in extra payments because CMS has failed to adjust for this overcoding And this money will increase to about $600B over the next ten years in overpayments if CMS is not reformed. Our guest details how because of ourincredibly complicated and inefficient system another 600B per year is overpaid to providers and insurance companies
- The result is an enormous wealth transfer from the public sector, namely our taxpaying dollars, to the wealthy. We have the most egregious levels of wealth inequality of advanced nations to begin with and this is a just another ‘legal’ mechanism built into a system that defrauds the majority population on behalf of the one tenth of one percent.
- We spend 2x as much than other wealthy nations on our healthcare system yet we are do much worse than our peer countries by every possible metric particularly ‘process measures’ including: 1) access to care; 2) How likely people are to have a doctor; 3) How quickly can people be seen when they get sick; 4) The rates of people in the US in postponing or skipping medications or healthcare because of financial barriers. As a result of a broken health system that allows profiteering to the health deficits of the majority population our guest points out that US life expectancy compared to other advanced nations is shameful and has has dropped some 3yrs in the past two years . Our guest was a co author of a 2022 study that found if we had a single payer healthcare sstem like our peer countries we could have saved some 338,000 US lives from Covid alone. Tonight he details how Medicare Advantage is a rip off from US taxpayers.