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<\/a>Fed\u00ader\u00adal agents storm a Los Ange\u00adles hos\u00adpi\u00adtal engaged in a scheme to defraud Medicare. Such fraud is ram\u00adpant, rais\u00ading the ques\u00adtion of whether \u201cMedicare for All\u201d is a good idea. [Cred\u00adit: LA<\/span> Times]<\/p><\/div>Estill Mitts, a 68-year-old from Los Ange\u00adles, came up with an enter\u00adpris\u00ading idea<\/a> some years back that made him mil\u00adlions: pay home\u00adless peo\u00adple from the city\u2019s \u201cSkid Row\u201d dis\u00adtrict who were eli\u00adgi\u00adble for Medicare or Med\u00adic\u00adaid to check into local hos\u00adpi\u00adtals, even if they didn\u2019t need to be there.\n Set\u00adting up shop at a faux med\u00adical facil\u00adi\u00adty that he dubbed the \u201dAssess\u00adment Cen\u00adter,\u201d Mitts hired what he called \u201cstringers\u201d to pay home\u00adless peo\u00adple small sums of mon\u00adey to go to one of three med\u00adical facil\u00adi\u00adties that were in on the scam \u2013 City of Angels, LA<\/span> Met\u00adro\u00adpol\u00adi\u00adtan and Tustin Hos\u00adpi\u00adtal and Med\u00adical Cen\u00adter \u2013 where they were admit\u00adted whether or not they actu\u00adal\u00adly required care. The hos\u00adpi\u00adtals billed Medicare or Med\u00adic\u00adaid for the inpa\u00adtient stays and made kick\u00adback pay\u00adments to Mitts.<\/p>\n What makes Mitts and his accom\u00adplices unusu\u00adal is that, unlike so many peo\u00adple who per\u00adpe\u00adtrate fraud against gov\u00adern\u00adment-run health pro\u00adgrams, they were caught. Police observed that a large num\u00adber of patients dis\u00adcharged from those hos\u00adpi\u00adtals were being dumped on Skid Row, some still wear\u00ading med\u00adical gowns<\/a>. When ques\u00adtioned, the dis\u00adcharged patients told police that they\u2019d been paid to go to the hos\u00adpi\u00adtal, lead\u00ading to Mitts\u2019 undoing.<\/p>\n A cau\u00adtion\u00adary tale for those who think that Oba\u00admacare should evolve into \u201cMedicare for All,\u201d a sin\u00adgle-pay\u00ader sys\u00adtem that is the tal\u00adis\u00adman for the Amer\u00adi\u00adcan Left.<\/p>\n In 2012, state, local and fed\u00ader\u00adal gov\u00adern\u00adments spent a total of $1.23 tril\u00adlion on health care<\/a>,<\/span> which trans\u00adlates to near\u00adly $3.4 bil\u00adlion per day. No insti\u00adtu\u00adtion can pos\u00adsi\u00adbly keep track of all that mon\u00adey, much less ensure that it is appro\u00adpri\u00adate\u00adly spent.<\/p>\n Which cre\u00adates a world of oppor\u00adtu\u00adni\u00adties for peo\u00adple like Mitts. Judge George H. King sen\u00adtenced Mitts to 18 months in prison and ordered him to make $9.8 mil\u00adlion in resti\u00adtu\u00adtion pay\u00adments. Mitts\u2019 ill-got\u00adten gains rep\u00adre\u00adsent less than 5 min\u00adutes of gov\u00adern\u00adment health spend\u00ading, a pit\u00adtance that would nev\u00ader have been noticed had his home\u00adless part\u00adners been less forth\u00adcom\u00ading with the authorities.<\/p>\n Oth\u00ader fraud\u00adsters are more cir\u00adcum\u00adspect and suc\u00adcess\u00adful. Rel\u00ada\u00adtive\u00adly sim\u00adple schemes pro\u00adduce easy mon\u00adey with lit\u00adtle chance of being caught. The mon\u00adey flows so fast and in such vol\u00adume as to escape detection.<\/p>\n Still, there are those who are con\u00advinced in their bones that gov\u00adern\u00adment can allo\u00adcate med\u00adical goods and ser\u00advices more fair\u00adly and effi\u00adcient\u00adly than can mar\u00adkets. Ver\u00admont Gov\u00ader\u00adnor Peter Shum\u00adlin is one. Tak\u00ading advan\u00adtage of an Oba\u00admacare pro\u00advi\u00adsion<\/a> that allows states to imple\u00adment a sin\u00adgle-pay\u00ader sys\u00adtem begin\u00adning in 2017, Shum\u00adlin has laid the ground\u00adwork for a gov\u00adern\u00adment-run sys\u00adtem in his state to be known as Green Moun\u00adtain Care (GMC<\/span>).<\/p>\n GMC<\/span>\u2019s cov\u00ader\u00adage is quite gen\u00ader\u00adous rel\u00ada\u00adtive to that offered through Oba\u00admacare. It would pay, on aver\u00adage, 87 per\u00adcent<\/a> of med\u00adical costs, com\u00adpared with the 70 per\u00adcent that an Oba\u00admacare sil\u00adver plan cov\u00aders. Lav\u00adish ben\u00ade\u00adfits, of course, come at a cost. The Green Moun\u00adtain Care Board esti\u00admates that it will need to raise $1.61 bil\u00adlion<\/a> to pay for the plan in 2017, com\u00adpa\u00adra\u00adble to the total amount that the state col\u00adlects in tax\u00ades from all sources today. Dou\u00adbling people\u2019s tax\u00ades would not be ter\u00adri\u00adbly pop\u00adu\u00adlar even in a state with reli\u00adably left\u00adist sen\u00adsi\u00adbil\u00adi\u00adties, so the Gov\u00ader\u00adnor has yet to spec\u00adi\u00adfy pre\u00adcise\u00adly how he\u2019ll finance his project.<\/p>\n A study by health con\u00adsul\u00adtan\u00adcy Avalere<\/a> con\u00adclud\u00aded that $1.61 bil\u00adlion will not be enough in any event. They put GMC<\/span>\u2019s first-year cost some\u00adwhere between $1.9 and $2.2 bil\u00adlion (p. 2).<\/p>\n In pro\u00adduc\u00ading the esti\u00admates, the Avalere study chal\u00adlenged the most durable super\u00adsti\u00adtion among sin\u00adgle-pay\u00ader advo\u00adcates: that putting all of health care financ\u00ading in the hands of the gov\u00adern\u00adment will save enor\u00admous amounts of over\u00adhead costs. Elim\u00adi\u00adnat\u00ading pri\u00advate insur\u00aders, the argu\u00adment goes, means elim\u00adi\u00adnat\u00ading the por\u00adtion of pre\u00admi\u00adums that goes to prof\u00adit \u2013 prof\u00adit being under\u00adstood, not as a moti\u00adva\u00adtion to effi\u00adcien\u00adcy, but as a sort of obscen\u00adi\u00adty. A sin\u00adgle pay\u00ader sys\u00adtem also is thought to cut the admin\u00adis\u00adtra\u00adtive costs of doc\u00adtors and hos\u00adpi\u00adtals, since they won\u2019t have to deal with the paper\u00adwork demand\u00aded by com\u00adpet\u00ading insur\u00aders, only that required by the ten\u00adder touch of government.<\/p>\n The Avalere study ques\u00adtions both assump\u00adtions. It first under\u00adcuts the notion that GMC<\/span> would reduce admin\u00adis\u00adtra\u00adtive costs from 12 per\u00adcent to 7 per\u00adcent (p.3). The actu\u00adal cur\u00adrent aver\u00adage admin\u00adis\u00adtra\u00adtive cost incurred by com\u00admer\u00adcial insur\u00aders in Ver\u00admont is 6.7 per\u00adcent, accord\u00ading to Avalere, less than that pro\u00adject\u00aded for GMC<\/span> (p. 16). It also notes that Ver\u00admon\u00adters receive rough\u00adly 1\/3 of their inpa\u00adtient care and more than 1\/5 of their out\u00adpa\u00adtient care in oth\u00ader states (p. 19, Table 6). Ver\u00admont will incur the costs of nego\u00adti\u00adat\u00ading rates with out-of-state providers or sim\u00adply pay\u00ading them what they demand (pp. 19\u201320), since providers in those states won\u2019t be affect\u00aded by Vermont\u2019s price controls.<\/p>\n About those price con\u00adtrols: GMC<\/span> pro\u00adpos\u00ades to pay in-state med\u00adical providers a lot less than they receive now from pri\u00advate plans. One of the dirty lit\u00adtle secrets of gov\u00adern\u00adment pro\u00adgrams like Medicare and Med\u00adic\u00adaid is that they pay providers poor\u00adly, rely\u00ading on pri\u00advate insur\u00aders (and, more accu\u00adrate\u00adly, those who pay pre\u00admi\u00adums for pri\u00advate insur\u00adance) to make up the difference.<\/p>\n Avalere found that pri\u00advate insur\u00aders in Ver\u00admont cur\u00adrent\u00adly pay hos\u00adpi\u00adtals 55 per\u00adcent more than Medicare and near\u00adly 90 per\u00adcent more than Med\u00adic\u00adaid for inpa\u00adtient ser\u00advices (p. 10, Table 3). Hos\u00adpi\u00adtals need these high\u00ader pay\u00adments from pri\u00advate insur\u00aders to make up for their Medicare and Med\u00adic\u00adaid short\u00adfalls. Under the Governor\u2019s plan, GMC<\/span> would pay hos\u00adpi\u00adtals only 5 per\u00adcent more than Medicare. Since Medicare already pays hos\u00adpi\u00adtals less than it costs to pro\u00advide inpa\u00adtient care<\/a>,<\/span> par\u00ading com\u00admer\u00adcial rates to just above the Medicare lev\u00adel would cause some Ver\u00admont hos\u00adpi\u00adtals to \u201csuf\u00adfer grave\u00adly\u201d (p. 5), accord\u00ading to Avalere. Doc\u00adtors, too, could see a \u201cdra\u00admat\u00adic drop\u201d (p. 3) in reim\u00adburse\u00adment under GMC<\/span>, which \u201ccould cre\u00adate a sig\u00adnif\u00adi\u00adcant dis\u00adin\u00adcen\u00adtive for [them] to work in Ver\u00admont\u201d (p. 5).<\/p>\n As for non-physi\u00adcians who work in Ver\u00admont, GMC<\/span> pre\u00adsumes that 84 per\u00adcent of them will lose their employ\u00ader-spon\u00adsor cov\u00ader\u00adage (p. 4). Gov\u00ader\u00adnor Shum\u00adlin avoids the President\u2019s men\u00addac\u00adi\u00adty that you can keep your cov\u00ader\u00adage if you like it. The suc\u00adcess of GMC<\/span> depends on peo\u00adple los\u00ading their employ\u00ader-spon\u00adsored cov\u00ader\u00adage, forc\u00ading them into the state-run sys\u00adtem. Its authors say that GMC<\/span> will cost more if employ\u00aders don\u2019t<\/em> drop cov\u00ader\u00adage (p. 8).<\/p>\n Avalere isn\u2019t sure how employ\u00aders might react to Vermont\u2019s sin\u00adgle pay\u00ader pro\u00adgram. On the one hand, employ\u00aders are \u201chope\u00adful that GMC<\/span> might unbur\u00adden them of the ever-ris\u00ading expense of pro\u00advid\u00ading health care cov\u00ader\u00adage to their work\u00aders\u201d (p. 21); on the oth\u00ader, the Gov\u00ader\u00adnor has not said \u201cwhether employ\u00aders will be expect\u00aded to help with the fund\u00ading of GMC<\/span> through an employ\u00adment-based tax\u201d (p. 21). Busi\u00adness own\u00aders, being engaged in com\u00admerce, are not eas\u00adi\u00adly beguiled. They under\u00adstand that the Gov\u00ader\u00adnor must find his $1.6 (or $1.9 or $2.2) bil\u00adlion some\u00adwhere and that they are very like\u00adly marks.<\/p>\n The pic\u00adture is clear\u00ader for insur\u00aders. State offi\u00adcials con\u00adfirmed to Avalere that \u201cinsur\u00aders would not be need\u00aded\u201d under GMC<\/span>, though the gov\u00adern\u00adment \u201cintend[s] to explore alter\u00adna\u00adtive roles\u201d for them (p. 21). So they have that going for them.<\/p>\n Doc\u00adtors and hos\u00adpi\u00adtals prob\u00ada\u00adbly won\u2019t see much relief from admin\u00adis\u00adtra\u00adtive costs, accord\u00ading to Avalere (p. 21), but they will see low\u00ader reim\u00adburse\u00adment for the care they pro\u00advide, mak\u00ading it \u201cchal\u00adleng\u00ading for Ver\u00admont to retain a high\u00adly qual\u00adi\u00adfied and tal\u00adent\u00aded health care work\u00adforce and to attract new high\u00adly qual\u00adi\u00adfied health care pro\u00adfes\u00adsion\u00adals\u201d (p. 21).<\/p>\n All of which will adverse\u00adly affect con\u00adsumers, who \u201cmay expe\u00adri\u00adence longer wait times to receive health care ser\u00advices\u201d and who could see their \u201caccess to care con\u00adstrained fur\u00adther if the sup\u00adply of health care prac\u00adti\u00adtion\u00aders is dimin\u00adished as a result of reduced pay\u00adment\u201d (p. 22). At an 87 per\u00adcent actu\u00adar\u00adi\u00adal val\u00adue, though, they should pay less for ser\u00advices than under Oba\u00admacare, once they make it to the front of the line. Even those sav\u00adings could prove illu\u00adso\u00adry, how\u00adev\u00ader, if they are \u201caffect\u00aded by addi\u00adtion\u00adal tax\u00ades\u201d required to finance GMC<\/span> (p. 22).<\/p>\n Oba\u00admacare con\u00adtin\u00adues to hob\u00adble along, but seems more like\u00adly than not to sur\u00advive its con\u00adtin\u00adued stum\u00adbles. If it does, Ver\u00admont may offer a vision of the future it will bring. Though it may seem a drea\u00adry one, take heart. By 2017, Estill Mitts will be out of prison and per\u00adhaps look\u00ading for a new scam to run. Ver\u00admont beckons.<\/p>\n <\/p>\n","protected":false},"excerpt":{"rendered":" Estill Mitts, a 68-year-old from Los Ange\u00adles, came up with an enter\u00adpris\u00ading idea some years back that made him mil\u00adlions: pay home\u00adless peo\u00adple from the city\u2019s \u201cSkid Row\u201d dis\u00adtrict who were eli\u00adgi\u00adble for Medicare or Med\u00adic\u00adaid to check into local \u2026 Con\u00adtin\u00adue read\u00ading