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Articles by Donald E. L. Johnson

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Today is Friday, April 18, 2014

Fraud and Abuse

Poverty traps: Medicaid, food stamps, unemployment compensation, Social Security disability benefits

ObamaCare is what Rep. Paul Ryan (D-Wis.) accurately calls a "Poverty Trap".

Until ObamaCare (ACA) law is changed, it can’t be “fixed”
"Glitches" aren't #ObamaCare's biggest problems. 
The biggest problem is that the law is unworkable, mandates worthless preventive care and wellness benefits, offers free primary care to the lonely well, and implements community rating instantly rather than over an acceptable transition period of several years. 
Make deductibles workable and affordable for the low income people who ObamaCare supposedly is intended to help. Create payment plans so that the deductibles can be paid off over three to five years. As now structured, the high deductibles, which I support for those who can afford them, will force more medical bankruptcies, not fewer.
Make it very difficult and expensive to defraud ObamaCare, Medicare and Medicaid. Think jail, huge fines. Maybe we need a special court and prosecutors/public defenders for health care fraudsters.
Breakup healthcare provider and insurer monopolies and oligopolies so that consumers will have real choices on the exchanges. Let private enterprises other than insurers or insurance brokers create, run and profit from health care exchanges. Get the incompetent, politically driven bureaucrats and politicians out of the health care exchange business.
Fix the law so that it will work for consumers and so that it can be sold on the Web. If you're not willing to admit mistakes and keep doing the same dumb things over and over, you're insane.

Who do we blame for ObamaCare, the unAffordable Care Act? Big Government corrupts

Who do we blame for soaring health insurance premiums?

You can blame AARP, health insurers, doctors and hospitals and the politicians that they paid with campaign contributions to distort the health insurance and health care markets.

And you can blame uninformed, unorganized and powerless voters for letting the Henry Waxmans of Congress and every president since JFK for making it all go wrong.

Health care is big money and big government.

Big government spends big money.

Big money in the hands of Big Government corrupts. 

Big government corrupts politicians, campaign contributors, drug companies, hospital administrators, physicians and regulators who have anything to do with distorting our health insurance and health care markets.

That's why America's huge government is and looks so corrupt. We're a third world country now.

How to cut Medicare, Medicaid entitlement costs, expenditures

Congress and the Obama administration are fighting over how to fix entitlements, especially Medicare and Medicaid. Even Democrats disagree among themselves, according to today's Wall Street Journal. Some Democrats want no cuts, others want cosmetic cuts. Republicans want real reforms, but good luck with that.

Here are some ideas for fixing Medicare and Medicaid that I've made over the years and are even more relevant today: 

1. Take free physician office visits out of ObamCare. They waste physicians' time and create tremendous wait times for sick Medicare/Medicaid beneficiaries, which increases costs.

2. Require patients with minor symptoms to see nurse practitioners and other allied providers before wasting the time of the shrinking number of primary care physicians.

3. Eliminate coverage of the most wasteful primary care and allied providers."">

4. Get hospitals out of the doctor business. Their overhead is too high, and they demotivate physicians with all of their rules, red tape, etc.

5. Breakup so called integrated health care systems that are local monopolies and horribly distort local provider and health insurance markets.

6. Eliminated incentives for physicians/hospitals to practice very expensive defensive medicine.

7. Raise premiums for Medicare beneficiaries by 25% on coverage of primary care and drugs, and allow them to spend what they want on the kind of supplementary care they want.

8. Repeal the laws that keep Medicare beneficiaries from opting out of Medicare, especially the primary care coverage, which is a waste of money most of the time.

9. Invest in real fraud and abuse law enforcement.

10. Hire private insurers whose administrative costs per patient, not per enrollee, are 20% to 30% of the administrative costs of Medicare and Medicaid.

None of these reforms will be attempted because AARP, health workers' unions, HCA, the American Hospital Assn., the Catholic Health Assn. and the Federation of American Hospitals will fight them.


13 ways to cut Medicare costs, by Donald E. L. Johnson, 8. 3.2011

Cutting physicians’ incomes wrong way to cut Medicare costs and expenditures, By Donald E. L. Johnson 8.2.2011

Posted by Donald E. L. Johnson on 11/20/12 at 05:50 AM
Health insuranceFraud and AbuseMedicaidMedicarePermalink

13 ways to cut Medicare costs

Over the last 35 years, there have been a lot of attempts to slow the growth in Medicare expenditures, which have continued to soar unabated because of poor policy making by both parties. 

Although the Budget Control Act of 2011 (S. 365) says the Joint Budget Committee that will try to agree on the next round of budget cuts won't be allowed to change Medicare's benefits, I think it should.

Here are some ideas for changing Medicare that would give consumers and providers strong financial incentives to increase access to care and higher quality care at lower costs per patient and per enrollee:

Ethics: How do you feel when a company you owned is fined $75 million?

Medtronic (MDT) is paying a $75 million fine to settle a Medicare fraud and abuse claim against Kyphon Inc., which it acquired last November from me and a bunch of other happy Kyphon shareholders.

Of course, Medtronic didn’t commit the fraud and abuse, so its integrity can’t be challenged because of the claim, which it knew about when it bought the company.

And none of us outside shareholders were involved in the fraud and abuse, but we sure made a lot of money when Medtronic acquired Kyphon. We might have made a bit more if the company hadn’t been the subject of a fraud and abuse claim at the time of the acquisition.

So, how do I feel about having made money on a stock when the company wasn’t operating ethically?

Yucky. Disgusted. And frustrated that some of the people who were running a successful company like Kyphon felt they had to be unethical or didn’t care if they were.

As a ethical businessman and a taxpayer, I’m glad that a whistle blower had the integrity and courage to alert the government about the fraud and abuse and that whoever was involved in committing the crime will live with their personal shame for a long time.


Posted by Donald E. L. Johnson on 05/22/08 at 01:07 PM
EthicsHealth insuranceFraud and AbuseMedicareStocksStocks MedicalPermalink
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