The federal health care provision in the Obama era is constantly under attack. At this moment we are beginning to discover where it works and where it is doomed to fail. It is going to fail in states that already have decided not to expand Medicaid. Critics warn that families living in states that turn their backs on poverty will not find help in “Obama-care,” either. Many have been pointing to the Republicans who refuse to let the federal government help anyone.

I am a Democrat. Yet I see one obstacle to full-out social welfare – which would put us in the ranks of other sophisticated industrial nations. The obstacle is not cost, because I truly believe lower-cost health benefits can be provided by a well-orchestrated network of providers. I have seen it work on the local level where hospitals agreed not to duplicate expensive services. However, on a larger scale, just as the Republicans fear, the mechanism for orchestration is clogged by bureaucrats who, though well-meaning, are not in the health care trenches. 

In 1982, the academic vice-president of a medical college told a small committee, including me, that in 20 years each of us would have our entire medical history filed in a microchip implanted in our hands or arms. This has not happened. Nor is there a chip or electronic file anywhere that provides an individual’s information in one handy place at the tap of a key. Until this is accomplished, the American healthcare system, however cleverly devised, patchwork or otherwise, will not be affordable. Here’s why:

In addition to the many thousands of people in each state who are eligible for health benefits, are dozens, or perhaps hundreds, of cheaters. These are the people who “double dip” by devious methods, such as confusing identities. They might appear at Urgent Care repeatedly, using two or more different names and different birth dates, for instance. In clinics, where the staff revolves regularly, they are not recognized, and where the staff is harried, a careful crosscheck of social security may not be made. Some of these cheaters get duplicate prescriptions which can be filled at different pharmacies. It is even possible to be covered by a private policy and still get federally-provided healthcare, simply by lying: mixing up numbers, or slightly altering the spelling of a name.

Some providers encourage cheating. On CNBC (August 29, 2013), Andrea Day reported on the federal arrest of a Brooklyn pharmacist who was claiming to fill prescriptions for patients but was, instead, giving them cash. Instead of taking HIV drugs, for example, someone could get $1400 from this pharmacist. A patient might claim his medication was stolen and get the prescriptions refilled — and sell it again.

But let’s say there are no patients who are outright liars in the health care system; dishonest providers still can take advantage of a crazy patchwork system. There are many patients with impaired cognitive abilities, others who are simply confused. An opportunistic business owner may provide two forms for a trusting patient to make a claim for a walker, for instance, one that covers half the cost, and another form allegedly to get the item completely covered. The clever provider will then use the signed second form to make a different kind of claim. There’s more — In the last few days it has been reported there are scam artists posing as federal employees calling on people to “help” them get their insurance cards but stealing their Medicare numbers.

Health care fraud costs taxpayers up to $630 million a day, up to $80 billion a year.

Unfortunately, Obamacare is not going to stop cheating, and there yet other dangers ahead in any improved scenario that relies on vast information systems. As Steff Duchesne pointed out in Health Care Finance News (June 29, 2012), many providers have not upgraded their computer systems to take on the new electronic files, and many others rely on cloud computing and data storage, so must be very concerned about security. Then there is the ongoing problem of face-to-face misunderstanding. Patients whose language ability falls short of understanding medical jargon may not be able to answer questions accurately. I have even seen health care professionals push a sheet of health history questions under the nose of a patient with dementia. Mistakes are made.

One of the most thought-provoking articles I’ve read appeared last year on the Washington Post “Wonkblog” page (September 7, 2012). Sarah Kiff explains why we are overspending on health care to the tune of $750 billion. She provides what she calls a “monster graphic” to make things more clear: The $75 billion on fraud actually pales next to the $130 billion on inefficiency and $190 billion on excessive administration, and $210 billion on unnecessary services. Kiff’s graphics show how other industries handle themselves by comparison, e.g., online banking allows a customer to view his or her entire banking history; online shopping sites allow consumers to compare prices before making decisions; factory assembly lines are continually monitored for efficiency and quality control. Why can’t the health care industry get it right?

A chip in the arm of a human being may seem barbaric to some of us. Then why can’t fingerprints or irises can be registered to an online checkpoint? Law enforcement agencies do it. Call it a safety net – catching those who need care with the right information and out of harm’s way, and keeping those who do not make a match out of the budget.

For the health care spending monster chart and Kiff’s analysis, here’s the link:


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