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August 22, 2008

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The government is the primary payor in two major systems --- veterans' medical benefits and Medicare/Medicaid. The leading edge babyboomers are approaching Medicare. This means a HUGE portion of our society will be experiencing what is currently the status quo of government payments. The status quo is broken. If the government eventually becomes the primary payor for those younger than Medicare, then I think the government should have the right to 1) exlude smokers. How? Develop a simple skin patch test that indicates that nicotine is in the system. I think the tobacco industry is too influential for the government to do the ideal --- that is ban cigarettes. 2)Ban foods that cause obesity grocery shelves. 3) Since Medicaid winds up paying a huge long term care tab, limit gambling in casinos to a loss of, say, $150/month ---- unless the gambler can show evidence of Long Term Care insurance (sort of like not being able to license a car without showing proof of insurance). 4) Prohibit drug companies from advertising on TV. The costs of prime time spots has to be recouped somewhere, and I'm sure it affects the cost of drugs. Limit the advertisements to print ads only so that industry cannot accuse the government of banning freedom of the press. 5) Permit those on Medicare to continue to contribute to Health Savings Accounts if they go into a high deductible Medigap plan.

Your mention of the "end of life" healthcare expenses got me to thinking about all of the cases of abuse in this area that I have personally observed during recent years. The abuse is rampant from the perspective of the dying people's families and the healthcare providers.
I can't tell you how many times I've seen families DILIGENTLY transferring assets away from what is expected to be the estate of a family member...so that they can turn all of the costs of that care over to the government...without reducing what the family divides up for themselves. I would guess that this increases the cost of the government's share of this end of life care by BILLIONS (maybe 10s of billions) of dollars every year.
On the other side of the coin, the healthcare providers abuse the system just as blatantly as the families of the end of life folks. Again, I can't count the number of times that I've seen hospitals keep terminally ill patients alive until their government payments run out. My own mother's case was a classic example of how this works. (She didn't have any assets, so the family didn't get to participate in the first phase of the fraud that I referred to above.) As a result of a gross and incredibly stupid error on the part of the hospital, she had a stroke that essentially rendered her brain dead. The hospital kept her alive, at ICU rates, literally until her benefits expired. Then, conveniently for them, she was pronounced dead at approximately 11:50pm on October 31st... the day that her benefits ran out.
BOTH of these forms of fraudulently milking the government need to be stopped even under the current system. Nobody seems to have the cajones to take these issues on (although it IS against the law to transfer the assets out of a patient's estate, nobody enforces the law that is there). I absolutely shudder to think how exponentially frauds like this will increase if the government gets into the middle of everyone's healthcare!! NBC

Again, thanks for the blog and for making me think.

A few items: Medicare is full of fraud. Why would we give the government our health insurance when they can't handle what they have? On the other hand, has anyone found out if there is fraud in the health insurance industry. I assume greed...but fraud? Can we regulate the greed (although I do hate regulation) and keep health insurance in the private sector? It works for a lot of us.

Does universal health care mean we (the taxpayers) have to cover the idiots who went windsurfing in a hurricane and crashed? I would resent having to pay for someone who smokes, is an alcoholic,
is addicted to drugs, or who is just plain foolhardy.

Again...no problem covering the health care for those who cannot afford it. Big problem covering health care for those who can.

Illegals are another story. What happened to the guest worker policy? Many small business (mine included) use workers without questioning their right to be here because US citizens will not do the work or do shoddy, lazy work. Mexican immigrants are among the hardest working people I know. I'd hate to see them deported or not to go the doctor for fear of deportation.

Keep writing and we'll keep thinking.

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