The PPJ Gazette

Marti Oakley

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It is alarming to hear not only younger members of the country, but also some middle aged members, medical professionals and others, referring to Medicare as some kind of free, gravy train medical insurance that seniors don’t have to pay for. Are people really that ignorant of how this system works?

After paying into Social Security and Medicare for decades, those who receive medicare must also now pay a premium every month for this insurance. These premiums can range from a few hundred dollars a month, to several hundred. Married couples pay individual premiums which can amount to $700.00 per month or more, combined on average. These premiums are deducted from their Social Security checks; neither the government, nor taxpayers, pay this premium.

Then there is that handy-dandy “donut hole” where Medicare pays nothing. This was a huge gift to the insurance companies who whined about not getting a piece of the Medicare pie. From approximately the $2500.00 to $5000.00 costs of care, Medicare pays for nothing. Ta DA! We got your GAP insurance plan which will cost you another $200.00 per month at least. This will cover the costs incurred in the hole. Of course the insurance companies have no plans to make good on these GAP policies, so getting them to pay any percentage of anything is a monumental task.

Then there is the co-pay at your doctors office. Then the co-pay on medications. Then there are the costs of medications your insurance and Medicare don’t/won’t pay for. That comes right out of your pocket!

Now, to add insult to injury, an estimated 20 million illegal aliens will be given “free” healthcare and I have yet to hear the word “entitlement” attached to those benefits.

And of course, thanks to that wonderful Medicare Reform Act passed under Bush 2’s regime, (you’ll remember this was going to save Medicare prescription costs 150 billion annually and actually ended up costing &500.00 billion?) Medicare cannot negotiate for better drug prices. And you cannot go to Canada to buy your prescriptions at reasonable prices like so many had taken to doing.

Initially, the net cost of the program was projected at $400 billion for the ten-year period between 2004 and 2013. Administration official Thomas Scully instructed analyst Richard Foster not to tell Congress of Foster’s finding that the cost would actually be over $500 billion. One month after passage, the administration estimated that the net cost of the program over the period between 2006 (the first year the program started paying benefits) and 2015 would be $534 billion.[11] As of February 2009, the projected net cost of the program over the 2006 to 2015 period was $549.2 billion)

The number of persons enrolled in Medicare is expected to increase from 47 million in 2010 to 80 million by 2030.While the same demographic trends that affect Social Security also affect Medicare, rapidly rising medical prices appear to be a more important cause of projected spending increases.

The Medicare Shell Game

The general public seems to believe that the costs to medicare is money in the pockets of seniors. They also seem to believe (thanks to all the skewed reporting on MSM) that somehow, Medicare recipients are the perpetrators of the 60 billion per year estimated to cost Medicare in fraudulent charges.

The federal government admits that a staggering $60 billion is stolen from tax payers through Medicare scams every year. Some experts believe the number is more than twice that.

Let me be perfectly clear here: There is not ONE Medicare recipient that has the ability to charge, bill or collect money from Medicare. The fraud that is taking place is perpetrated by operators in the medical industry, hospital industry, rehabilitation services, nursing home scams, by doctors, psychiatrists, therapists and others who make their living supposedly providing health services of some kind.

Health care fraud costs the country tens of billions of dollars a year. It’s a rising threat, with national health care expenditures estimated to exceed $3 trillion in 2014 and spending continuing to outpace inflation. Recent cases also show that medical professionals continue, and may be more willing, to risk patient harm in furtherance of their schemes.

My goodness, just ask Rick Scott, governor of Florida who oversaw the largest Medicare fraud case in US history, and whose company was charged with 14 felonies related to that fraud right after he resigned! And was subsequently fined somewhere in the area of 2 billion.
About $400 million of the fines came from cheating on direct patient billing — called upcoding — in which Columbia/HCA filed claims stating that patients were sicker than they really were.

In addition to the scamming done by doctors, hospitals, nursing homes, and others in the medical industry, are the blue collar criminals who set up phony pharmacies, clinics and medical supply companies and who bill Medicare and get paid. These activities can generate millions in revenue; all of it billed to Medicare.

My point here is that seniors who are on Medicare, paid their dues and they are still paying. Until the federal government does its job and stops just fining those who are caught committing fraud, and instead jails them like they would any other criminal, this will never be fixed!

They have a solution!

Just this morning on MSM it was reported a that a new test that can supposedly predict whether you will die in the next month is now being used! It appears to be a series of health questions and tests that supposedly indicate whether or not you are at death’s door. The test of course is tied to your health risk assessment score; the same score used to determine the cost and access to health-care, for you.

A test to determine if elderly patients will die within 30 days of being admitted to hospital has been developed by doctors to give them the chance to go home or say goodbye to loved ones. Health experts say the checklist will prevent futile and expensive medical treatments which merely prolong suffering.
The screening test looks at 29 indicators of health, including age, frailty, illness, mental impairment, previous emergency admissions and heart rate and produces a percentage chance of death within one month and 12 weeks.

MSM reported that this will determine whether the patient receives ongoing medical care, or, they get sent to Hospice so that the fine folks there can hasten end of life.  Hospice will receive 11.5 billion in funding through Obamacare to change their mission from one of good samaritan for those terminally ill, to that of grim reaper, discouraging further medical treatment and hastening the end of life.

One way or the other, the elderly in this country will be cleansed from society. In the meantime, every dime that can be squeezed and wrenched out of our existence for any reason whatsoever will continue. And MSM along with government hacks will continue to portray the elderly as receiving “entitlements”, “free rides at the expense of the country”.

Never once will they admit the problem isn’t with the elderly, it is with those who exploit the elderly.

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2009 ANNUAL REPORT OF THE BOARDS OF TRUSTEES OF THE FEDERAL HOSPITAL INSURANCE AND FEDERAL SUPPLEMENTARY MEDICAL INSURANCE TRUST FUNDS, Table III.C19.—Operations of the Part D Account in the SMI Trust Fund (Cash Basis) during Calendar Years 2004-2018, Page 120 (Page 126 in pdf) http://www.cms.hhs.gov/ReportsTrustFunds/downloads/tr2009.pdf

http://www.economist.com/node/17800237

http://www.fbi.gov/about-us/investigate/white_collar/health-care-fraud

http://abcnews.go.com/Nightline/medicare-fraud-costs-taxpayers-60-billion-year/story?id=10126555

http://www.newsmax.com/Politics/rick-scott-medicaid-hca/2010/06/27/id/363201/

http://www.msn.com/en-gb/news/uknews/death-test-could-predict-chance-of-dying-within-30-days/ar-AA8umPZ