9 ms·

Western medicine has turned into a ponzi scheme. The verifiable proof of this is to have an elderly family member in a nursing home who goes through the usual m

Western medicine has turned into a ponzi scheme. The verifiable proof of this is to have an elderly family member in a nursing home who goes through the usual monthly trips to the hospital from 'falling'. While Medicare covers almost all of it, it became so nauseating to read the outrageous EOB totals that I tried to put a end to it - I requested that unless the on call nurse (after hours) or physician (during business hours) deems the fall to be a life threatening emergency, they are to be kept in the facility. They found a workaround for that real quick - it's nearly always deemed life threatening because they are 1) unable to determine internal bleeding 2) unable to determine if a bone was fractured/broken. The obvious solution to this is to have an xray machine on site, because since everyone in the chain gets paid huge $, and it removes the liability from the nursing home to ship them off to the hospital, the merry-go-round of insanity continues. We have two family members in an assisted care facility for almost eight years now, and between the two of them, they've tapped Medicare for just under $700K. Together, the sum of both their incomes throughout their entire working lives never totaled that amount. This is why I call it a ponzi scheme.

rayiner 9y ago
Everything is really easy if you hand-wave away the facts: https://www.cdc.gov/media/releases/2016/p0922-older-adult-falls.html https://www.cdc.gov/media/releases/2016/p0922-older-adult-fa.... Elderly Americans experience about 29 million falls per year, which costs Medicare $31 billion. At about $1,000 per fall that seems quite reasonable. 27,000 older Americans die from falls each year. In an institutional setting like a nursing home, the rate of death per fall is even higher. $700,000 for two people in assisted living for eight years is about $43,000 per year. That's not unreasonable for the cost of assisted care plus medical expenses.
- maxerickson 9y ago
  Medicare wouldn't be paying for the assisted care: https://www.medicare.gov/what-medicare-covers/part-a/paying-for-nursing-home-care.html https://www.medicare.gov/what-medicare-covers/part-a/paying-... A facility generating large numbers of fall investigations that don't lead to ongoing medical care seems like it would be pretty easy (potential) fraud to go after though.
- Retric 9y ago
  29,000,000 / 27,000 = ~1,074 falls per death. ~At 1,000$ per fall that's ~1,000,000$ per death which seems reasonable on average. However, medical expenses are top heavy. Some of those falls probably cost 200,000+$ because they cause long term medial issues. If a faculty is spending ~1,000+$ on an a median fall their average is going to be much higher than that. Which is a sign they really are providing unnecessary procedures.
nkurz 9y ago
We have two family members in an assisted car facility for almost eight years now, and between the two of them, they've tapped Medicare for just under $700K. Together, the sum of both their incomes throughout their entire working lives never totaled that amount. Oh, but it gets worse. It's bad enough that the government is being bilked for hundreds of thousands of dollars on behalf of those without the ability to pay, but even for those with significant assets, there are "perfectly legal" tax dodges that can be set up for $XX,XXX so that Medicaid pays the $XXX,XXX bills while the family inherits the $X,XXX,XXX estate. And if you pay the lawyers a little more, they can probably even figure out how to avoid paying capital gains on the distributed assets if they are below $10 million. I don't see much hope for the insurance reform in the US until we can get end-of-life costs under control. I don't if "Ponzi" is quite the right term, but it's definitely a system rife with fraud. More generally, "House of God" is a stunning inside look on how the US medical system actual works: http://slatestarcodex.com/2016/11/10/book-review-house-of-god/ http://slatestarcodex.com/2016/11/10/book-review-house-of-go...
- wighty 9y ago
  House of God is indeed an interesting book and a good read. I read it during second year of my residency, and it is incredibly sad how the stuff that is talked about in the book has gotten worse in some ways, though better in others. I'm actively against the "bowel run" mentality. I do my best to avoid even the CYA test ordering, though I'm not in the ED where this can be the most rife. I see first hand the "ponzi scheme" (though IMO it is not the correct term) of the system and I chose to go into primary care because I actively want to fix this in any way I can, and being a specialist was not the way I thought would be best to do this.
  - ownagefool 9y ago
    I think the term is "gravy train".
- hkmurakami 9y ago
  > And if you pay the lawyers a little more, they can probably even figure out how to avoid paying capital gains on the distributed assets if they are below $10 million. Capital gains costs bases are currently "stepped up" during the estate transfer. No need to pay anything to lawyers. If your estate is below $10.5M (or thereabouts, I forget what the exact number is since it's now inflation adjusted), you won't be liable for any of that capital gains, nor will you owe any estate tax since you're within the exemption.
hkmurakami 9y ago
Since Medicare is largely funded by payroll taxes, would you say that this is a wealth transfer from non-healthcare industry workers to the various participants in "the chain" of the healthcare industry? https://www.medicare.gov/about-us/how-medicare-is-funded/medicare-funding.html https://www.medicare.gov/about-us/how-medicare-is-funded/med...
PickledJesus 9y ago
This is what horrifies a lot of us (British) about the NHS being further privatised. You create perverse incentives, beyond just providing the healthcare required.
- abfan1127 9y ago
  Medicare isn't private. If it were, the premiums would be so high, that people would be forced to choose...
  - specialist 9y ago
    As I understand these things... Medicare is single payer and NHS is single payer & single provider. Which would make the British NHS more akin to USA's Veteran's Administration. FWIW: I advocate single payer (Medicare for All), but not single (sole) provider.
mfukar 9y ago
I think you mean medical care in the USA. The schemes health providers resort to over there are world-renowned.

rayiner 9y ago

Everything is really easy if you hand-wave away the facts: https://www.cdc.gov/media/releases/2016/p0922-older-adult-falls.html https://www.cdc.gov/media/releases/2016/p0922-older-adult-fa.... Elderly Americans experience about 29 million falls per year, which costs Medicare $31 billion. At about $1,000 per fall that seems quite reasonable. 27,000 older Americans die from falls each year. In an institutional setting like a nursing home, the rate of death per fall is even higher. $700,000 for two people in assisted living for eight years is about $43,000 per year. That's not unreasonable for the cost of assisted care plus medical expenses.

maxerickson 9y ago
Medicare wouldn't be paying for the assisted care: https://www.medicare.gov/what-medicare-covers/part-a/paying-for-nursing-home-care.html https://www.medicare.gov/what-medicare-covers/part-a/paying-... A facility generating large numbers of fall investigations that don't lead to ongoing medical care seems like it would be pretty easy (potential) fraud to go after though.
Retric 9y ago
29,000,000 / 27,000 = ~1,074 falls per death. ~At 1,000$ per fall that's ~1,000,000$ per death which seems reasonable on average. However, medical expenses are top heavy. Some of those falls probably cost 200,000+$ because they cause long term medial issues. If a faculty is spending ~1,000+$ on an a median fall their average is going to be much higher than that. Which is a sign they really are providing unnecessary procedures.

nkurz 9y ago

We have two family members in an assisted car facility for almost eight years now, and between the two of them, they've tapped Medicare for just under $700K. Together, the sum of both their incomes throughout their entire working lives never totaled that amount. Oh, but it gets worse. It's bad enough that the government is being bilked for hundreds of thousands of dollars on behalf of those without the ability to pay, but even for those with significant assets, there are "perfectly legal" tax dodges that can be set up for $XX,XXX so that Medicaid pays the $XXX,XXX bills while the family inherits the $X,XXX,XXX estate. And if you pay the lawyers a little more, they can probably even figure out how to avoid paying capital gains on the distributed assets if they are below $10 million. I don't see much hope for the insurance reform in the US until we can get end-of-life costs under control. I don't if "Ponzi" is quite the right term, but it's definitely a system rife with fraud. More generally, "House of God" is a stunning inside look on how the US medical system actual works: http://slatestarcodex.com/2016/11/10/book-review-house-of-god/ http://slatestarcodex.com/2016/11/10/book-review-house-of-go...

wighty 9y ago
House of God is indeed an interesting book and a good read. I read it during second year of my residency, and it is incredibly sad how the stuff that is talked about in the book has gotten worse in some ways, though better in others. I'm actively against the "bowel run" mentality. I do my best to avoid even the CYA test ordering, though I'm not in the ED where this can be the most rife. I see first hand the "ponzi scheme" (though IMO it is not the correct term) of the system and I chose to go into primary care because I actively want to fix this in any way I can, and being a specialist was not the way I thought would be best to do this.
- ownagefool 9y ago
  I think the term is "gravy train".
hkmurakami 9y ago
> And if you pay the lawyers a little more, they can probably even figure out how to avoid paying capital gains on the distributed assets if they are below $10 million. Capital gains costs bases are currently "stepped up" during the estate transfer. No need to pay anything to lawyers. If your estate is below $10.5M (or thereabouts, I forget what the exact number is since it's now inflation adjusted), you won't be liable for any of that capital gains, nor will you owe any estate tax since you're within the exemption.

hkmurakami 9y ago

Since Medicare is largely funded by payroll taxes, would you say that this is a wealth transfer from non-healthcare industry workers to the various participants in "the chain" of the healthcare industry? https://www.medicare.gov/about-us/how-medicare-is-funded/medicare-funding.html https://www.medicare.gov/about-us/how-medicare-is-funded/med...

PickledJesus 9y ago

This is what horrifies a lot of us (British) about the NHS being further privatised. You create perverse incentives, beyond just providing the healthcare required.

abfan1127 9y ago
Medicare isn't private. If it were, the premiums would be so high, that people would be forced to choose...
- specialist 9y ago
  As I understand these things... Medicare is single payer and NHS is single payer & single provider. Which would make the British NHS more akin to USA's Veteran's Administration. FWIW: I advocate single payer (Medicare for All), but not single (sole) provider.

mfukar 9y ago

I think you mean medical care in the USA. The schemes health providers resort to over there are world-renowned.