Why a "Medicare for all" plan is necessary

Here is a great explanation for why a "Medicare for all" plan is necessary:

Video: Why Are American Health Care Costs So High?
YouTube URL: http://youtu.be/qSjGouBmo0M

Minute Rant: On Healthcare Executive Compensation

Did you know the total compensation paid to the top 25 executives of not-for-profit healthcare organizations in 2011 was about $100 million? Some of the guys at the bottom were only getting $3 million but the ones at the top made $8 million. Of course, the nonprofits aren’t paying the big bucks that the for-profits are paying.

Minute Rant: On Healthcare Insurance Company Profits

Healthcare insurance companies are making enormous profits this year and they are all forecasting good times in 2014—at the same moment in time when providers are laying off employees or closing. Why are none of the talking heads yelling about that on television and radio? Here are the second quarter PROFIT numbers for the big five insurance companies: Aetna $536 million; Cigna $505 million; Humana $420 million; United $1.436 billion; and Wellpoint $1.231 billion. I say we all have a drink and celebrate their good fortune and then get back to work trying not to lay off a few more employees.

Reform Rant

Want to fix the ACA? Harry Reid admitted recently that the long term goal should be a Medicare for all, single payor system. If we had done so back in 2008, I believe the backlash would have been no worse and we would have a system worth fighting to preserve.

I've included a study (click here to view PDF) analyzing the economic impact of a universal Medicare program. It is based on HR 676—the Expanded and Improved Medicare for All Act—a bill introduced by Rep. John Conyers Jr. (D-Mich.). The bill has been proposed for 11 straight years. The bill is a mess. It gets involved on the provider side too much and, for that reason, would never pass—not should we want it. Reform can be accomplished solely on the payor side. Payment reform will drive provider reform without draconian and “socialistic” re-engineering providers (e.g., the bill would convert all providers to nonprofits—as if that status makes the provider less susceptible to greed?).

According to the study, the expansion of Medicare would save the U.S. healthcare system $592 billion in 2014 alone. The main savings would come from slashing "administrative waste" (profit) in the private health insurance industry and by using the government’s bargaining power to obtain cheaper pharmaceuticals. Over the next decade, the study said savings could reach $1.8 trillion.

Under HR 676, a single-payer system would be financed through several factors: increasing the personal income tax on the top 5 percent of income earners, instituting a progressive tax on payroll and self-employment, taxing capital gains and other unearned income, instituting a 0.5 percent tax on stock trades and other "progressive tax" financing efforts, according to the study.

Single-payer healthcare bills have generally been opposed by Congress. According to a recent polling data, a majority of physicians now support a single-payer system.

RAC from HDI

This summer, Ozarks Community Hospital was forced to restructure its inpatient behavioral health services (originally known as OCH Resolutions) due to RAC audits. While the hospital is still actively combating these claims, OCH no longer has the resources to continue providing the service through Resolutions. OCH now provides care to geriatric patients through OCH Inpatient Services.

In light of what happened to Resolutions, our inpatient geriatric psych service, you may be asking yourself:

What is a RAC and who the hell is HDI? 

A RAC is a Recovery Audit Contractor, a private, for-profit company empowered by the federal government to “recover” funds paid by Medicare to healthcare providers in the event the RAC computer or RAC “auditor” (whose last job may have been phone solicitor or bank teller) decides there was something wrong with the claim. The RAC gets to keep a percentage of all the money it recovers. The thing you need to know is that hospitals are winning over 75% of the appeals when reviewed by a neutral administrative law judge—a percentage which might lead one to conclude that the RACs are recovering more money than they should.

HealthDataInsights (When did businesses first start running their names together into one name with interior capital letters? I assume it is an outgrowth of web site naming conventions that eliminate spaces between words. It just looks silly to me and I wish they would stop.) HDI is a wholly owned subsidiary of HMS Holdings Corp. HDI began life as an entrepreneurial venture-backed company. HDI investors included Redhills Ventures, GRP Partners and Ticonderoga Capital. In other words, a bunch of venture capitalists with political connections but ZERO healthcare expertise helped create a company for the sole purpose of getting a government contract to make millions of dollars by “recovering” it from healthcare providers. The “word on the street” back then was getting one of the RAC contracts would be a license to print money—there was literally no way to lose.

Once the venture capitalists got the bid to be a RAC, they got HDI up and running until it was printing money as expected and then they sold it to HMS.

Who the hell is HMS?

HMS Holdings Corp. (NASDAQ: HMSY) operates through its subsidiaries including Health Management Systems, Inc. (HMS), AMG-SIU, IntegriGuard LLC, Reimbursement Services Group, Inc. (RSG) and HealthDataInsights, Inc. (HDI). It is the nation's leader in cost containment, program integrity, and coordination of benefits solutions for government-funded, commercial, and private entities. HMS is focused exclusively on the healthcare industry.

For the first half of 2013, HMS reported revenue of $242.4 million, an increase of 6.6% compared to revenue of $227.4 million for the same period a year ago. Net income for the first half was $17.4 million. You can pretty much double those numbers to see what they make in a year.

As President and Chief Executive Officer at HMS HOLDINGS CORP, William C. Lucia made $1,860,000 in total compensation according to proxy statements filed for the 2012 fiscal year.

It is nice to know we are helping with someone’s bottom line.