THE US REPORT

FBI director Robert Mueller announced a crackdown on healthcare fraud indictments against 53 people in a combined enforcement effort specifically targeting fraud schemes that threaten Medicare.Politicians and media pundits repeatedly claim 45 million “Americans” can’t get health insurance, prompting me to research the makeup of that constituency. I settled on data from the Employment Policies Institute in part because the organization had just released a study containing specifics about the types of individuals who don’t have insurance. I did compare figures to information at the National Coalition on Healthcare, a group claiming to be “rigorously nonpartisan.” Members include the AFL-CIO, the League of Women Voters, the NAACP, healthcare organizations and teachers’ unions.

A reader pointed out EPI is a lobby group. Who isn’t these days? In my opinion, the NCH has a lobbyist-like approach. Yet the figures from both organizations are comparable. However the EPI provided more descriptive specifics as detailed in my earlier column.

The experts who created the EPI study aren’t exactly rabid right-wingers. Dr. June E. O’Neill and Dr. Dave M. O’Neill both earned their Ph.D.s at Columbia. Dr. June O’Neill served as director of the Congressional Budget Office under President Bill Clinton. Dr. Dave O’Neill formally served as Senior Economist, Research Division, New York Federal Reserve Bank and as senior staff economist for the General Accounting Office during President Jimmy Carter’s administration.

Aside from abundant professional credentials, the O’Neills focused on the numbers. There was no political rhetoric in the data, although there were politically oriented recommendations in the narrative.

Their findings upset advocates who want to expand socialized medicine. I think the study is important because the findings are among key components in determining how to fix a problem President Barack Obama views as a crisis. If you don’t know who needs the product, how do you know what product to offer?

In a news release about the study, EPI said, “Current policy proposals dramatically overestimate the cost of providing affordable health insurance for those Americans who currently cannot afford coverage due to a lack of understanding of who the involuntarily uninsured population is, why they lack coverage, and the amount of health care resources that they currently access. With greater understanding and recognition of the diversity within the uninsured population, the goal of providing affordable health insurance to all Americans should be possible with solutions that cost far less than the CBO’s estimated figure of $1.6 trillion for implementing recent congressional proposals that would only address two-thirds of the problem. “

Does that sound like rightwing propaganda to you?

One finding touched a nerve in some of our readers: “the uninsured are more likely to be male, under the age of 35, much more likely to be unmarried and have no children. The uninsured are almost 4 times as likely to be high school dropouts, more than 3 times as likely to be Hispanic, and close to 4 times as likely to be foreign-born non-citizens.”

That, by the way, isn’t a political statement. It simply assesses the numbers from available data.

My own position on healthcare is well-documented. In 2005 I wrote a book detailing my frustration in dealing with a mystery illness our younger daughter experienced. The book had a happy ending, but I stressed patient advocacy and the need for change in our existing system.

Furthermore, it’s my opinion the federal government has been under siege by fraud for years. I’ve criticized members of both parties because of lack of oversight. The enormous fraud in healthcare and other areas, not only in the government sector but also in the private sector, weakens our nation and dishonors our taxpayers. In 2005 an FBI release said, “$100 billion—with a 'b.' That’s how much health care fraud costs our country every year, according to conservative estimates. Who picks up the tab? Our government (a major victim). Our nation’s businesses (especially insurance companies). And you and I, every time we get medical care.”

Four years later isn’t it reasonable to assume the figure has risen and also to assume additional fraud goes undetected, considering the FBI just announced a new crackdown on healthcare fraud?

Here's an example of an indictment from the Houston FBI field office: "[F]rom September, 2004 until August 2005, Assessment Professionals, owned by Armstrong, submitted claims to Medicaid for individual and group therapeutic sessions allegedly conducted and provided to Medicaid-eligible adolescents for drug and alcohol abuse...parties were held in low income neighborhoods, complete with food and entertainment, where Wilson and employees of Assessment Professionals would obtain the Medicaid numbers of attendees. Those numbers were then used to fraudulently bill Medicaid for drug and alchohol counseling." AP billed Medicaid $3,500,972.93; the company was paid $1,789,333.94. Company officials used the money in part to buy Rolex watches and cosmetic surgery among other things.

Puts a whole new spin on community organizing, yes?

I believe true reform begins with correcting the system to reduce the fraud. That approach is a result of a career spent working with a number of small businesses as well as running small businesses. The approach is also a result of a mindset foreign to most neoliberals—that government is not a panacea. I believe reform should occur within the free market and I believe that while we are patients we are also consumers in the healthcare market.

There is also hypocrisy in claims about this crisis. My utility bill will “skyrocket” if the president has his way on energy policy (he promised us that publicly). Costs for everything from food to Internet provider services have also increased substantially. We pay taxes on the local, state and federal level and Democrats have been searching for new ways to tax us in order to fund record spending by this administration on top of record spending by the previous administration. What, Mr. President, do we do about those increasing costs?

During last night’s press conference, media tossed the president a few softballs and he expertly batted them onto the field. The press conference sounded like a campaign speech; no specifics were provided. Despite the repeated claims about those 45 million, not a single reporter has ever asked the simple question, “Who are they?”

I believe that is key to any solution proposed, in addition to reforming the federal government to be accountable for the dollars wasted in such an offensive manner.

I have unwillingly funded bailouts for banks, unions and auto manufacturers under a GOP president and a Democratic president. It is obvious no one has the taxpayers’ best interests in mind and if we continue on a path of indiscriminate spending, the result will be a weakened republic, a blight on future generations and further deterioration of personal liberty.

Politicians, president and media aren't talking about who can't get health insurance
by Kay B. Day
The US Report, Jul. 23, 2009