Toward Universal Healthcare

Toward Universal Healthcare: How a hybrid of Medicare, VA, and Medicaid health insurance models with a single payer source would be the best of all worlds.

As an active past president and chair of the Legislative Committee of the Michigan Home Health Association for years, I have gone to Washington and Lansing as a spokesperson, contacting every Michigan Federal Senate and Representative office annually over a period of many years. We were very successful in advocating for and achieving many of our home health related goals primarily because we always limited the scope of our efforts to 3 or 4 items, came with several members who had supporting examples to share, and viable recommendations for resolution of the concerns.

As a healthcare provider for over 30 years, I do not support voucher payments for healthcare. I have seen the various quality of services erode based on return on investment and paying taxpayers either with tax breaks or monthly stipends. I believe voucher programs will cause further erosion of access to healthcare as lower income people choose to use the money for food, rent, etc. leaving them with no insurance for needed services. In such situations, taxpayers will be faced with higher taxes due to coverage for unpaid services to providers. The Medicare model and some aspects of the VA model (RX coverage) might be better choices to allow states and the federal government to control costs while monitoring quality, efficiency and effectiveness of services.

I believe that a hybrid of Medicare, VA, and Medicaid models with a single payer source might be the best of all worlds. Allowing private insurances to participate as they do now through the Federal Fiscal Intermediaries but with the oversight of checks and balances the Federal and State programs provides. In my opinion, a single payer source reduces paperwork and eliminates price setting by insurance companies and basing payment of the reasonable costs of the services themselves. Also a Federal/State program as a not-for profit program, would not have a Board of Directors to satisfy with a specific return on investment. The biggest single immediate way to reduce all healthcare costs, regardless of payer source is to enforce the laws and regulations already in place to control fraud and abuse.

Both Medicare and VA healthcare services have do have problems that need to be addressed, but both have regulations already in place to address those problems through crackdown on violations and increased civil and criminal ramifications for violators. Reduction of redundancy in required documentation for payment is another area which could save billions.

A brief review of the history of how current MC, MA, and VA fraud is handled highlights the availability of significant cost savings if current punitive regulations were enforced. The current practice of crackdowns on Medicare fraud is to settle without criminal action and requiring a very small percentage of the dollar return on the Medicare losses. By making such fraud and abuse a crime, the “so-called” providers are prevented from starting a new company and repeating their criminal activities.

There are procedures in place to do this, but the FBI and OIG have indicated that they don't have the resources to investigate the volume of these types of crimes so they concentrate on those over a certain dollar limit (say $50K). By simply auditing the claims of all providers for suspicious coding patterns, number of claims per ordering physicians, and total number of submitted claims per agency size and geographic location, a reasonable pool of potential fraudulent actors can be identified and become subjects of 100% review and withholding of their claim payments until their review confirms the fraud or validates proper claims. These programs already have appeal rights for the providers being investigated. Those who have clearly crossed the lines should be prosecuted, held to repayment of the fraudulently obtained funds plus a substantial financial penalty for the fraud and hopefully imprisoned. Naturally, they would be permanently excluded from participating in the MC, MA, or VA program involved.

These are just two of the easily implemented options to control costs and increase funds available for direct patient services. Every health care provider type could identify similar areas for immediate cost containment, allowing us to focus on cost-effective quality of care across the healthcare spectrum.