In light of the fraud going on in Minnesota, I’ve been thinking a lot about taxes. I wonder what percentage of our taxes pay for fraudulent programs? In my mind there is hard fraud, as in the Somali Minnesota fraud debacle, but there is what I call soft fraud as well. An example of this is the healthcare system. The ACA and other unconstitutional laws like the Stark Law consolidate healthcare spending a significant portion of which is funded by taxes. It’s all just so demoralizing. What is to be done?
The US will spend $1.4 trillion on welfare this year. The government says there are 19.8 million Americans living in poverty. If we simply split up the money to each family, they’d each get $70,000 per year. But they get nowhere near that. It’s going to fraud and inefficiency.
It’s idiotic, and republicans are NO BETTER than democrats on spending. It’s really just about 5 republicans that actually have any real backbone in stopping the spending spree.
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The consolidation of
Money and Power is a big result of all of this. Fight at the local level where you can make a difference to some degree while this is happening at the large scale level. Like in 2020 many rural areas didn’t have the ridiculous rules big cities did. And it was because people said no
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Unfortunately, there is plenty of direct (hard) fraud in government paid healthcare programs. As just one example of many, see this story from last month https://www.justice.gov/opa/pr/four-california-residents-sentenced-prison-connection-16m-hospice-fraud-and-money-laundering
As for the rest of the healthcare system, a significant percent (up to 25% of total expenditures) goes to errors, waste and regulatory compliance. https://www.amjmed.com/article/S0002-9343(23)00396-0/fulltext
Some degree of quality assurance, generally the purported purpose of government regulation, is appropriate in healthcare, but the cost of regulatory compliance alone for hospitals is estimated at $39 billion per year. AHA study: Rising regulatory burden diverting providers from patient care | AHA News To make it worse, there is often little connection between the compliance efforts and actually improving patient care.
Sadly, @backfire is right. The Republicans are no better than the Democrats on spending, save a handful, both in healthcare and the rest of the welfare system. So, what could we do? First deal with the waste, fraud, and over-regulation, but even if waste, fraud, and over-regulation were contained, there are other isues. Modern medical treatments (MRI, surgery, cancer care, ICU, etc.) would be unaffordable to most, if they had to pay 100% out of pocket. Most people actually pay for health insurance not health care. We have to get rid of the ACA mandates for what must be covered under health insurance plans. A young, health, single male has to pay for maternity and newborn care, cancer screenings, and chronic disease management because the ACA requires all plans to cover these services. People should be able to buy a health insurance product that matches their needs and circumstances. Allow for what used to be called catastrophic insurance plans. You will pay more out of pocket for office visits, routine lab work, etc, with a significantly lower premium, but are covered in the event of a serious injury or illness. We should go back to risk based insurance with state based high-risk pools covering those with pre-existing conditions. Allow insurance plans to be sold across state lines, allowing for a larger national market for insurance coverage. Competition is always the best way to drive down the price of a product or service.
There is also an ongoing and sustained shortage of physicians in the United States. Shortages drive prices up. In my opinion, this is a structural issue and intentional, but related to the extreme increase in the cost of university education in general. There are only 200 or so medical schools in the US that graduate approximately 25,000 new doctors each year. Many qualified candiates for medical school are turned away every year. Roughly 10,000 practicing physicians retire each year. It is estimated that another 3-5% leave the practice for a variety of reasons. Using the number of licensed physicians as a proxy (though not all are practicing), there are a little over 1 million doctors in the US. With that attrition rate, conservatively, that suggests another 30,000 doctors leave the practice. Given the supply and demand, one might ask why aren’t new medical schools opening across the country? On a broader level, one must ask why college costs so much, both for undergraduate and graduate and professional schools? Addressing the issues of cost and access in our higher education system, including medical school is also part of the solution.
Though I hesitate to end on a negative note, I see few in Washington, DC doing anything substantive to address these issues.
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What is to be done? I have been thinking about this as well. Here is what I think the path COULD look like, but it would take some organization and political action (maybe we should start our own PAC?)
- We need to draft a “Citizen’s Bill” or “Anti-corruption Bill” that would require the government to find and remove fraud, this would also include things like ending corporate lobbyists in DC, ending any and all inside trading and imposing HUGE penalties for violation, putting up hard firewalls between government agencies and big corporate America to prevent rotating doors, etc, etc. and I would throw in term limits for congress.
- Once we have this bill drafted, which would be HUGELY popular on both left and right, then we need candidates in every state who are running in primaries who will commit in advance to passing this bill. If a candidate does not support it, they can be assumed to be “on the take” and not “for the people.”
- Replace enough incumbents in the next big general election (2028 OR 2032) to get the bill passed quickly in the first term following election (2029 or 2033).
- Once we have accomplished that we might actually have the first representative government in more than 100 years (at least that long since Corp. America has captured government, and used it to defraud taxpayers and solidify their stranglehold/monopolies on the marketplace)
(note: the bipartisan nature of this bill is key–doesn’t matter if you vote R or D, as long as your candidate supports the anti-corruption bill–so we would need to leave all more partisan issues alone until that first bill is passed)
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When it comes to health care costs ask who is really to blame. Ask yourself what do insurance companies provide? What would the cost of xyz service be if there were no 3rd party payer?
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For routine healthcare, cough, cold, sore knee, about the same, maybe a little less. For a major injury or illness requiring surgery, ICU, long stay in the hospital, chemotherapy, etc, completely impossible for most people to pay out of pocket, even if there were no 3rd party payor.
This is similar to the answers I hear the most, but if there were no 3rd party payer would there still be ICU, MRI, etc…. My argument is yes and the cost would be what the market could bear.
Insurance provides nothing but an income for themselves ! Biggest scam of all time.
If people had to pay they also might be more conscious of their habits and health.
There are the questions of major issues like solid organ transplants etc. That could be a function of the teaching hospitals perhaps.
I totally agree, if people had to bear more of the cost of their choices related to health and fitness, they likely would have better habits. However, there is no way the average person could bear the cost of advanced health care. Without insurance things would default to a two tier system with the ultra rich able to afford it, and the rest, who could not. An MRI machine is needed often enough that a mid sized hospital will need one or two, but not frequently enough that you can leverge economy of scale to significanlty drive down price. Maybe new tech that does what an MRI can in a hand held device, but we are very far off from that.
I think the solutions are very apparent to anyone with common sense and a desire for freedom. I think the harder question to answer is how do we hold public leaders and bureaucrats who have gone astray accountable? And then get the legislators to do the right thing for the American people and the future of the country instead of for their lobbyists and donors.
In terms of healthcare, the number one thing to do is repeal the ACA. It is an anticompetitive bill designed to consolidate the healthcare “marketplace” into the hands of people who’s goal is to extract as much money as possible from the American people. And that is effectively what it has accomplished. They might as well call “healthcare” the oligarchic extortion scheme, bc that is what it has become. But my question is, why does it still exist? Republicans control the house, senate and the executive branch. I don’t understand why they haven’t repealed it unless they too are bought off by big insurance and the hospital systems?
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Short answer it’s because we are an immoral people who value money over all else.
The stupid thing about that is that money loses money every day!
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