Health Care BS

Free market reform advocates object to single-payer health care for a variety of reasons, including our belief that such a system would involve government micromanagement of hospitals and doctors. As if to prove our point, Medicare is about to send out an army of auditors whose primary mission is to put the clinical and billing decisions of providers under the microscope:

‘What we have here is bureaucrats and government contractors coming in and trying to second guess what doctors and nurses have done in a hospital setting,’ said Don May, vice president for policy at the American Hospital Association.

The ostensible purpose of the nationwide audit is to recover overpayments made by Medicare, which sounds innocuous enough. But the CMS bureaucrats have devised a system whose incentives are virtually guaranteed to produce corruption among the auditors. Hows that? Because these private auditing outfits don’t get paid unless they find “errors.”

The program’s critics say that contractors have too much incentive to question as many claims as possible. That’s because they get to keep about 20 percent of the overpayments … The auditors will keep a tidy percentage for their services.

Robert Centor is among those who find this incentive structure disturbing:

I hope that … bothers you as much as it does me. Clearly the auditors have a financial incentive to err for their own profit.

Why would a physician be worried about this? Well, in a pilot project conducted in three states, a primary (and highly controversial) source of “recoveries” involved the alleged lack of medical necessity for a variety of services:

What gets health care providers most upset is when auditors determined a procedure or hospital admission was not medically necessary.

The auditors will be looking at medical charts for patients long ago discharged from the hospital and deciding retroactively that the doctor should not have ordered a given medical procedure or hospital admission. In other words, CMS has authorized commission-paid hirelings to overrule the decisions of your doctor. 

Once the flying monkeys have descended upon your community hospital and “discovered” all of the “errors,” Medicare automatically deducts the money from current payments. And if the hospital or doctor believes the finding to be unfair, they can appeal to …. Medicare. Anyone want to guess how many decisions get overturned?

This is exactly how a single-payer health care system would work—arbitrary bureaucratic decisions from on high. If this doesn’t scare you, you’re not paying attention. There is no such thing as benign government management.