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I wonder: would this level of fraud occur if the US had universal healthcare, or its effective equivalent? Asking out of genuine intellectual curiosity, not wi

I wonder: would this level of fraud occur if the US had universal healthcare, or its effective equivalent? Asking out of genuine intellectual curiosity, not with political or other overtones (even with the highly political character of the news today).

davidw 2y ago
The biggest scam in US health care is the insurance industry. Most of the 'fraud' that doctors complained about where I lived in Italy was old people coming in with mostly imagined complaints because they're lonely and don't have anyone and a doctor visit is free. Which is kind of sad, but... not the same level of problematic.
- Aurornis 2y ago
  > Most of the 'fraud' that doctors complained about where I lived in Italy was old people coming in with mostly imagined complaints because they're lonely and don't have anyone and a doctor visit is free. Which is kind of sad, but... not the same level of problematic. I don't think that's a relevant analogy at all. In this case, the doctors were the ones perpetuating the fraud. Not the patients, not the insurance company.
LeonB 2y ago
There would still be some fraud, but since the prices of basic medical care would be considerably lower (as demonstrated everywhere else in the world) the amount of money made from fraud would be considerably smaller thus creating less incentives.
glzone1 2y ago
This level of fraud is almost non-existent when there is NO insurance and NO universal healthcare. Anytime the person paying is not the one receiving service, the appeal of fraud goes up. When the person paying is not paying with their own money the appeal goes up and a TON of incentives argue against finding fraud. At least in govt, there is sometimes a willful blind eye because finding fraud causes a huge headache and you don't benefit or get paid more. In fact, if you are taking an administrative fee to manage the program, reducing expenditures can hurt your own budget. I have traveled internationally where folks paid cash for services. It was a bit crazy - they would basically hold you hostage until you paid a bill / impound your car etc. BUT you could buy many drugs OTC (no DR visit even required) and the layers of things like approvals, pre-approvals, billing and billing codes etc simply didn't exist.
- svachalek 2y ago
  Yeah I've wondered about a system where health insurance is for major events like injury accidents and cancer, and typical office visits are handled as a consumer product. Insurance companies may want to pay for basic checkups and the like to reduce their risk of high ticket items -- or not, however the math works out. Seems like this has at least some of the benefits of a market system, for those who insist that nationalized health care is not something we can stomach in the US.
jcjkrigii 2y ago
This was Medicare fraud, which I imagine you’d see more of if universal healthcare was implemented as single payer “Medicare for all.”
- ceejayoz 2y ago
  Likely a net overall drop. Private insurers get defrauded just like Medicare does. They just don’t care; it means they can raise premiums. https://www.propublica.org/article/we-asked-prosecutors-if-health-insurance-companies-care-about-fraud-they-laughed-at-us https://www.propublica.org/article/we-asked-prosecutors-if-h...
Aurornis 2y ago
> I wonder: would this level of fraud occur if the US had universal healthcare, or its effective equivalent? The fraud was perpetuated against Medicare, which is the US-run insurance plan for people 65 and older and people with disabilities. Nearly 20% of the population is on Medicare. Universally letting everyone on to the plan would have actually allowed them to run the fraud on everyone, not just people on Medicare.
- ajross 2y ago
  This is one of those moments where you realize how frustrating the discourse is that Everyone Just Knows the US doesn't have government-run health insurance. The US invented government-run health insurance. And Medicare has its warts, but works extremely well on the whole.
  - silverquiet 2y ago
    The US has multiple government run single-payers. I remember being told six, but I remember Medicare, Medicaid, and the VA. What the US does not have is universal healthcare, though I think we spend something like as much of a percentage of GDP on our non-universal government systems as other countries do on their universal healthcare, and then again we spend more GDP on private. All for worse outcomes than those other countries (though we can do some really impressive stuff if you're rich). It's quite a racket for sure.
    - vharuck 2y ago
      1. Medicaid, 2. Medicare, 3. Military, 4. VA, 5. Indian Health Services Maybe 6 is Medicaid through a managed care plan.
      - WarOnPrivacy 2y ago
        > Maybe 6 is Medicaid through a managed care plan. House of Representatives and Senate offices will provide health coverage to Members of Congress and designated staff through the Small Business Health Options Program (SHOP). https://www.opm.gov/frequently-asked-questions/insure-faq/health/how-will-members-of-congress-and-designated-staff-obtain-health-coverage/ https://www.opm.gov/frequently-asked-questions/insure-faq/he...
canucker2016 2y ago
from Dec 2016, https://www.thestar.com/politics/provincial/ontario-s-top-billing-doctors-overcharged-ohip-health-ministry-audit-suggests/article_34b99dd2-4044-57d5-b670-96b55eaeb6a3.html https://www.thestar.com/politics/provincial/ontario-s-top-bi... ==== The province’s 12 top-billing doctors — who received payments of between $2 million and $7 million in one year — are overcharging the Ontario Health Insurance Plan, documents obtained by the Star suggest. [stuff deleted] Among additional “concerns” alleged in the report: - Three specialists “inappropriately delegated” duties — for which they billed OHIP and which were supposed to perform themselves — to unqualified individuals to undertake. - Six claimed to have worked between 356 and 364 days of the year. - Eight recorded notably high volumes of claims and/or patients. One radiologist, who worked 332 days, billed for 100,000 patients, indicating that more than 300 scans were interpreted per day, the report stated. - Eleven billed OHIP incorrectly. - An obstetrician/gynecologist billed for seeing male patients. ====

davidw 2y ago

The biggest scam in US health care is the insurance industry. Most of the 'fraud' that doctors complained about where I lived in Italy was old people coming in with mostly imagined complaints because they're lonely and don't have anyone and a doctor visit is free. Which is kind of sad, but... not the same level of problematic.

Aurornis 2y ago
> Most of the 'fraud' that doctors complained about where I lived in Italy was old people coming in with mostly imagined complaints because they're lonely and don't have anyone and a doctor visit is free. Which is kind of sad, but... not the same level of problematic. I don't think that's a relevant analogy at all. In this case, the doctors were the ones perpetuating the fraud. Not the patients, not the insurance company.

LeonB 2y ago

There would still be some fraud, but since the prices of basic medical care would be considerably lower (as demonstrated everywhere else in the world) the amount of money made from fraud would be considerably smaller thus creating less incentives.

glzone1 2y ago

This level of fraud is almost non-existent when there is NO insurance and NO universal healthcare. Anytime the person paying is not the one receiving service, the appeal of fraud goes up. When the person paying is not paying with their own money the appeal goes up and a TON of incentives argue against finding fraud. At least in govt, there is sometimes a willful blind eye because finding fraud causes a huge headache and you don't benefit or get paid more. In fact, if you are taking an administrative fee to manage the program, reducing expenditures can hurt your own budget. I have traveled internationally where folks paid cash for services. It was a bit crazy - they would basically hold you hostage until you paid a bill / impound your car etc. BUT you could buy many drugs OTC (no DR visit even required) and the layers of things like approvals, pre-approvals, billing and billing codes etc simply didn't exist.

svachalek 2y ago
Yeah I've wondered about a system where health insurance is for major events like injury accidents and cancer, and typical office visits are handled as a consumer product. Insurance companies may want to pay for basic checkups and the like to reduce their risk of high ticket items -- or not, however the math works out. Seems like this has at least some of the benefits of a market system, for those who insist that nationalized health care is not something we can stomach in the US.

jcjkrigii 2y ago

This was Medicare fraud, which I imagine you’d see more of if universal healthcare was implemented as single payer “Medicare for all.”

ceejayoz 2y ago
Likely a net overall drop. Private insurers get defrauded just like Medicare does. They just don’t care; it means they can raise premiums. https://www.propublica.org/article/we-asked-prosecutors-if-health-insurance-companies-care-about-fraud-they-laughed-at-us https://www.propublica.org/article/we-asked-prosecutors-if-h...

Aurornis 2y ago

> I wonder: would this level of fraud occur if the US had universal healthcare, or its effective equivalent? The fraud was perpetuated against Medicare, which is the US-run insurance plan for people 65 and older and people with disabilities. Nearly 20% of the population is on Medicare. Universally letting everyone on to the plan would have actually allowed them to run the fraud on everyone, not just people on Medicare.

ajross 2y ago
This is one of those moments where you realize how frustrating the discourse is that Everyone Just Knows the US doesn't have government-run health insurance. The US invented government-run health insurance. And Medicare has its warts, but works extremely well on the whole.
- silverquiet 2y ago
  The US has multiple government run single-payers. I remember being told six, but I remember Medicare, Medicaid, and the VA. What the US does not have is universal healthcare, though I think we spend something like as much of a percentage of GDP on our non-universal government systems as other countries do on their universal healthcare, and then again we spend more GDP on private. All for worse outcomes than those other countries (though we can do some really impressive stuff if you're rich). It's quite a racket for sure.
  - vharuck 2y ago
    1. Medicaid, 2. Medicare, 3. Military, 4. VA, 5. Indian Health Services Maybe 6 is Medicaid through a managed care plan.
    - WarOnPrivacy 2y ago
      > Maybe 6 is Medicaid through a managed care plan. House of Representatives and Senate offices will provide health coverage to Members of Congress and designated staff through the Small Business Health Options Program (SHOP). https://www.opm.gov/frequently-asked-questions/insure-faq/health/how-will-members-of-congress-and-designated-staff-obtain-health-coverage/ https://www.opm.gov/frequently-asked-questions/insure-faq/he...

canucker2016 2y ago

from Dec 2016, https://www.thestar.com/politics/provincial/ontario-s-top-billing-doctors-overcharged-ohip-health-ministry-audit-suggests/article_34b99dd2-4044-57d5-b670-96b55eaeb6a3.html https://www.thestar.com/politics/provincial/ontario-s-top-bi... ==== The province’s 12 top-billing doctors — who received payments of between $2 million and $7 million in one year — are overcharging the Ontario Health Insurance Plan, documents obtained by the Star suggest. [stuff deleted] Among additional “concerns” alleged in the report: - Three specialists “inappropriately delegated” duties — for which they billed OHIP and which were supposed to perform themselves — to unqualified individuals to undertake. - Six claimed to have worked between 356 and 364 days of the year. - Eight recorded notably high volumes of claims and/or patients. One radiologist, who worked 332 days, billed for 100,000 patients, indicating that more than 300 scans were interpreted per day, the report stated. - Eleven billed OHIP incorrectly. - An obstetrician/gynecologist billed for seeing male patients. ====