Half the Democrats in Congress (and any running for office - can we say NY26?) are saying:
"We will NOT touch Medicare - it's SAFE and this is NON-NEGOTIABLE."
The other half have another piece of the Medicare puzzle, namely reforming the system in order to do away with insurance fraud and abuse. BUT - they've been unable to adequately express the fact that:
A) they have no intention of doing away with Medicare, while-
B) recognizing the need to "clean it up" and end the waste and fraud.
They're afraid to use the word, "Change" in the same sentence as Medicare; afraid it will scare us as much as Ryan's 'voucher' program (which is, to put it bluntly, a privatized and, thus, a "for profit" system). What they need to do is dump the word "Change" and replace it with the more positive and unimpeachable word: "Improve".
In other words: "DON'T TOUCH MY MEDICARE BUT FEEL FREE TO IMPROVE IT!"
So, Democrats and President Obama, listen up. As a Medicare recipient, I actually know how to do the above. No, really, I do. *g*
First of all, for the next year and a half, ALL Democrats MUST be united in saying over and over again that they will NOT touch Medicare as WE KNOW IT, that they will not put Medicare on the table for negotiation with the Republicans ever. That must be their primary message. Medicare for today and tomorrow will remain SAFE.
In other words: "DON'T TOUCH MY MEDICARE BUT FEEL FREE TO IMPROVE IT!"
So, Democrats and President Obama, listen up. As a Medicare recipient, I actually know how to do the above. No, really, I do. *g*
First of all, for the next year and a half, ALL Democrats MUST be united in saying over and over again that they will NOT touch Medicare as WE KNOW IT, that they will not put Medicare on the table for negotiation with the Republicans ever. That must be their primary message. Medicare for today and tomorrow will remain SAFE.
But - at the same time - they must find a way to easily explain the intention to IMPROVE Medicare; to improve the care seniors receive by ensuring that insurance companies don't continue to cheat the government.
That's their problem.
One of the biggest fraud issues is with the health care providers. When you go on Medicare, you can go to any doctor you choose (for now, we'll leave Medicare Advantage out of the equation although the system outlined below applies to MA as well) so most seniors spend a great deal of time trying to choose the right provider - the one that will have the lowest costs (as in co-payments, etc.).
NOTE: When I say "Health Care Providers", I mean providers like Kaiser, Cigna, Aetna, Monarch, Blue Shield, Health Net, Well Care, etc.
As it can work now, when you visit your doctor, what he does, what he orders, what actually ends up happening, isn't necessarily what the doctor reports to your health care provider and definitely not always what the provider reports to Medicare for reimbursement. Your doctor may do nothing but take your blood pressure, but the provider may send in a bill for a test you never received. This is a big chunk of what is costing our government so much money within the Medicare system. There are other abuses as well, obviously, but that's the largest. It's also the easiest to fix.
So, to President Obama and Congress, well, listen up. *G*
Right now, I receive a quarterly statement that shows the prescriptions I 'purchased' in the previous three months. It reports what I paid (if anything) and what portion my provider paid. I check it religiously to ensure it's correct and then I file it. This same 'statement' process could be expanded to include the actual care I received. A process used by Medicare, the physician and the provider - in order to establish an easy 'check and balance' system.
It should work something like this: When you visit your physician, at the conclusion, you would receive a 'receipt' (generated via codes) that shows what was ordered, what was done, etc. If your doctor took blood, then your 'receipt' would show how many tests were ordered and which ones. Then your doctor would naturally send the same info to your provider (they already do this, of course and the provider sends their report to Medicare for reimbursement). But this is where we'd add the now missing - but vital - step: Whether monthly or quarterly, Medicare would send each member a statement showing what was reported by the health provider regarding your care; a report that you would compare with your 'receipts' to ensure everything was reported correctly and thus paid/reimbursed properly.
Can you see how this could and would help stop the fraud and abuse?
"Wait, this statement says I had an MRI in May - I haven't had an MRI in over five years!"
"Hey, this statement says that four different tests were run on the vial of blood taken last month, but my doctor was checking my TSH levels as it says right here on my receipt!"
"Cool, it matches perfectly!"
If you find a problem, the Medicare website would have a section for reporting the discrepancy (or for those without computers, a phone number), and Medicare would then take over by dealing directly with either (or both) the doctor/provider to correct the report and, if necessary, ensure the provider refunds the Medicare bank. *g*
With a system like that in place, one that would be both easy and cost effective. I know this because I instituted a similar process in my business of contracting to transport school children. I had to report things like miles driven and students transported to my customers; the school districts. And, btw, for the same reason: so the districts could receive their government transportation funds. Without such a system, which was completely automated, it would have been very easy for:
NOTE: When I say "Health Care Providers", I mean providers like Kaiser, Cigna, Aetna, Monarch, Blue Shield, Health Net, Well Care, etc.
As it can work now, when you visit your doctor, what he does, what he orders, what actually ends up happening, isn't necessarily what the doctor reports to your health care provider and definitely not always what the provider reports to Medicare for reimbursement. Your doctor may do nothing but take your blood pressure, but the provider may send in a bill for a test you never received. This is a big chunk of what is costing our government so much money within the Medicare system. There are other abuses as well, obviously, but that's the largest. It's also the easiest to fix.
So, to President Obama and Congress, well, listen up. *G*
Right now, I receive a quarterly statement that shows the prescriptions I 'purchased' in the previous three months. It reports what I paid (if anything) and what portion my provider paid. I check it religiously to ensure it's correct and then I file it. This same 'statement' process could be expanded to include the actual care I received. A process used by Medicare, the physician and the provider - in order to establish an easy 'check and balance' system.
It should work something like this: When you visit your physician, at the conclusion, you would receive a 'receipt' (generated via codes) that shows what was ordered, what was done, etc. If your doctor took blood, then your 'receipt' would show how many tests were ordered and which ones. Then your doctor would naturally send the same info to your provider (they already do this, of course and the provider sends their report to Medicare for reimbursement). But this is where we'd add the now missing - but vital - step: Whether monthly or quarterly, Medicare would send each member a statement showing what was reported by the health provider regarding your care; a report that you would compare with your 'receipts' to ensure everything was reported correctly and thus paid/reimbursed properly.
Can you see how this could and would help stop the fraud and abuse?
"Wait, this statement says I had an MRI in May - I haven't had an MRI in over five years!"
"Hey, this statement says that four different tests were run on the vial of blood taken last month, but my doctor was checking my TSH levels as it says right here on my receipt!"
"Cool, it matches perfectly!"
If you find a problem, the Medicare website would have a section for reporting the discrepancy (or for those without computers, a phone number), and Medicare would then take over by dealing directly with either (or both) the doctor/provider to correct the report and, if necessary, ensure the provider refunds the Medicare bank. *g*
With a system like that in place, one that would be both easy and cost effective. I know this because I instituted a similar process in my business of contracting to transport school children. I had to report things like miles driven and students transported to my customers; the school districts. And, btw, for the same reason: so the districts could receive their government transportation funds. Without such a system, which was completely automated, it would have been very easy for:
- my drivers to cheat me in order to pad their time and increase their pay
- for me to 'enhance' mileage and pupil count in order to increase my receivables from each customer
- and for the district to 'enhance' their numbers in order to receive a larger chunk of Federal Transportation money and ensure their yearly transportation budget either stayed the same or was increased
