Fraud & Bureaucracy

Fraud

The beneficiaries of America’s gluttonous epidemic depend on a steady stream of unhealthy patients, which the insurance industry pays for. They collect enormous premiums from these patients and then try to wiggle out of paying for the tests, procedures and treatments ordered by their doctor. They deny claims based on one or more technicalities or interfere in the administration of care by offering alternatives.

 

Health insurance companies and their lobbyists would like everyone to believe they are on the side of patients. That their medical review team’s purpose is to ensure quality of care.  The fact is, they issue denial letters for pre-existing condition, inaccuracies, untruthfulness and undisclosed ailments in the initial application, even when they know the underlying basis is a lie. Other technical denials include rejecting treatments as needless, failure to follow established protocols, or treatments involving experimental and unproven therapies, even though they were recommended, performed or prescribed by qualified medical experts.

The insurance industry doesn’t conceal the fact that they reward medical reviewers who deny claims and fire those who don’t.

 

The purpose of an insurance company’s medical review team is to deny, limit or save money.

 

Insurance companies along with the drug, hospital and managed care industry, have perpetuated a fraud on the American public. Together with the food, entertainment, and gaming industries that feeds them their stream of patients, The multinationals have reaped a financial windfall from sedentary life and the addiction to foods, drugs and inactivity that it produced. Someone must be held accountable for the disastrous results that this has produced. The best way to do that is to require these companies to pay for the treatment that their products and practices caused.

While it may be true that the contents and products of these companies are inspected and regulated for safety and efficacy, their marketing practices are not.

The behavior of these companies’ executives is both unethical and immoral. They are able to use their power to influence and sway consumers through neuromarketing and the power of addiction. They are held accountable only to the fiscal rules of good conduct. As corporate citizens, their behavior is unregulated so long as they remain profitable.

 

The freedom corporate executives enjoy, to hide behind the corporate veil, emboldens them in their strategies. They know  shareholders will pay them millions in bonuses for their efforts.  They lie before Congress, make misleading claims of safety before regulators and sign false declarations. Executives are thus free to act without any fear of consequences to themselves or any concern for the toll and pain they inflict on others.

 

Fraud is woven into the fabric of healthcare. Insurance companies depend on it and everyone pays for it. Fraud by doctors, hospitals, pharmacies and patients.

But the biggest fraud of all, the one that boasts that because of our doctor’s have the most expertise, that we have the greatest healthcare system in the world. Along with this deception is the debate on how to pay for it.

While we are able to extend life, treat life-threatening emergencies, manage acute infections, and provide prosthetic replacements, we are unable to stem the tide of nutritional diseases. These illnesses are fueling a pandemic in this country. They are driving a monumental shift in the health of Americans.

Our healthcare system has ceased to educate patients on preventing illness. So instead of devoting energy and resources to preventing disease, we are grappling with how to pay for an inferior system and insure an increasingly unhealthy population.

Bureaucracy

Our healthcare system is a mess. In its first ever assessment of healthcare systems around the world, the World Health Organization, ranked the United States  37th out of the 191 countries it surveyed. Just ahead of those bastions of good health, Lithuania and Cuba.

The two countries that led the survey in delivering medical care to its citizens were Italy and France, two Mediterranean diet based nations.

Statistics can be interpreted differently. The countries rated higher by WHO don’t have better doctors and hospitals, they have healthier patients and taxes allocated for healthcare. This allows their governments to insure everyone regardless of occupational status. The lack of nutritional disease among their citizens also allows their governments to allocate more funds for prevention.

Compared to their single payer systems, our for-profit healthcare system spends, double per capita, ($6,000) than the Italians or the French and yet we have 50 million uninsured while they don’t have any.  In fact, we spend more money on healthcare than every other nation on Earth. Based on those numbers it seems we are already paying for national health insurance, we just aren’t getting it.

 

The massive, inefficient bureaucracy that feeds off the countless number of claim forms, special requests, prior approval and a host of regulations and billing requirements. They were all created by the insurance industry. It is their monstrous creation that is swallowing, up to a third of healthcare costs in the administration and profits of the various insurance plans.

 

Why do we have a second rate system, and what can do we do about it?  For a start, we need to reestablish the priorities for our country. We need leaders who are willing to offend the interests that benefit from the inefficiency in health care.

The present debate on healthcare is focused on how to pay the cost of insuring all Americans. A generational credit card is one solution, let the children pick-up the tab.

Of course politicians can’t admit to that so they speak of removing corruption, eliminating double billing, and removing waste and incompetence. They claim they can insure everyone and still improve the quality of care.

 

They plan to create a massive new federal bureaucracy to reduce costs, inspect facilities, correct violations and prosecute offenders. This new entity is supposed to oversee care and transform a bureaucracy bloated health care system, into a streamlined, efficient and dynamic one.

We have a government that can’t even buy a hammer yet these lawmakers think that divine wisdom is going to help manage our nation’s health! Who do they think they are kidding?

 

America spends close to 10% of its gross domestic product on healthcare, with the government picking up two thirds of the cost. Their two thirds, only covers one third of the population. Private insurers on the other hand, cover two thirds of the population but only shell out, one third of the cost.

The government guarantees coverage for the elderly through Medicare, and the poor via Medicaid. Since these groups require more care, they consume a disproportionately large share of the expenses. By cherry picking its customers, private insurers have been able to spend much less per capita, and profit much more.

The situation will get worse as the population ages, since the number of Medicare recipients will climb and drag the government’s proportion of healthcare expenses along with it.

 

We as a nation must begin to focus on preventing future generations from needing this amount of care and suffering the

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