Letters from North
America
Everyone
in the country seems to
have their panties in a
wad over the current
healthcare issue. It’s
hard to go an hour of
the day without someone
speaking out for or
against it. What you
hear is pretty well
determined by where you
happen to be standing at
any given time. Move ten
feet in any direction
and you are fairly
certain to hear an
opposing viewpoint.
Now, I follow the news
about as close as anyone
in this country. I
believe it’s just part
of getting older. I
remember my grandfather
sitting in front of a
radio every night
listening to the news of
the day. He read the
paper in the morning and
listened to the same
news each night. I do
almost the same thing.
While I will not take up
your time trying to
change your mind about
whatever position you
happen to have that is
contrary to mine, it
should suffice to say
that I think you are
wrong. I’ll let it go at
that.
What I do want to do is
throw out some comments
I feel are mostly common
sense and which all of
us need to think about
as we go along in trying
to solve this very
complex and thorny
problem.
The President came out
the other day and told
us that he intends to
pay for the healthcare
plan by eliminating
fraud and waste in the
Medicare and Medicaid
system. This has got me
puzzled. First off I
think we have had these
two programs for a
number of years and
hardly a week goes by
that we don’t read about
some doctor or medical
company somewhere in the
country being charged
with crimes relating to
medical fraud. So, I
guess my problem is
simply this…if the
system has been in
existence for over forty
years and we haven’t
cleaned up the fraud and
waste by now, how can we
expect it to improve in
the coming years? Why
hasn’t the government
eliminated the fraud and
waste long before now,
instead of just now
looking at it and
determining that it’s a
problem that could be
solved and thus freeing
up enough revenue to
provide healthcare to
millions of people in
this country? Seems to
me they should have done
this years ago.
You may recall that I
had a total knee
replacement just over
three months ago. I am
covered by Medicare and
have no complaints about
the doctors or the
hospital. What does yank
my chain is the fact
that after I got home,
some person showed up at
my door with a walker
and a potty chair. I
explained that I did not
need either one, but
they left them anyway. I
used the walker for
about a week, but never
had need for the potty
chair and called the
company to tell them we
wanted them picked up.
They refused and said
they were mine and there
was nothing they could
do about it. How many
times does this occur
over the face of this
county each and every
day?
When my mother died
several years ago, I
found that a company had
been getting paid for a
wheelchair and home
health care visits for
over a year after she
went into the nursing
home. She never had a
wheelchair of her own
and the home health care
people certainly did not
visit her in the nursing
home. I wrote to
Medicare and reported
this. I received a form
letter back, no phone
number, no contact
information, no file or
case number on a piece
of paper that had been
copied so many times it
was hard to read.
Obviously they don’t
seem to appreciate this
type of information.
In my former life I
owned an investigative
company that worked on
insurance fraud cases. I
was at a conference one
day and overheard two
insurance executives
discussing the so-called
‘cut-off’ point which as
I recall was around
$7500. I asked them if
this was the upper limit
for them to start a
fraud investigation.
They advised that this
was the lower limit. Any
claim below $7500 was
accepted and nothing
would cause them to be
suspicious unless it was
over this figure. I told
them that they could
lose a lot of money with
people filing claims
under $7500 and they
told me they were aware
of it, but that was
their policy. Stupid
policy in my opinion.
I suppose the bottom
line for this week is
that if the system is
broke now and hasn’t
been fixed in over forty
years at either the
government or insurance
company levels, how is
making the system bigger
going to help us?
Shouldn’t we take some
time out, cure the
problems we have already
incurred and then see if
we can afford to move
forward?
Comments go to pperry@austin.rr.com
