Points to be addressed, expanded:
“recent cost explosion in other categories under the Medicaid umbrella”
“Keeping track of it could be a Real job for AI”
“they enrolled unsuspecting, healthy people”
“rely on the physician’s honesty”
“Medicare/Medicaid dual eligibles are a large percentage”
“fraud contributes to the problem, but not the primary cause”
“big bucks in NICU and end of life care”
“90% of it goes to fund the government infrastructure”
“Hospital costs can be reduced by splitting most hospitals”
“primary cost: pharma, hospitals, doctors, medical devices, insurance not addressed.”
“hospices are required by federal law to have a physical office.”
You have monopolies especially in pharma, very tight restrictions crossing national borders for anything, caps on how many doctors get licensed (did you even know they do this?), alternatives are choked out (example midwives), insurances get semi-monopolies because there are rules in place on who can do business in what state (literally government limiting the competition for them)...
Just one example to prove my point: https://www.openhealthpolicy.com/p/medical-residency-slots-congress
Instead on focusing on supply (Reagan's approach macro economically to fire up the economy was supply oriented, and it worked!!!), they focused almost entirely on demand, like government bureaucracies tends to do, like socialists (the political left) tend to do.
Guess who created this system? Government bureaucracy and a bunch of more left leaning politicians who pandered to the insurance companies, doctors, hospitals and pharma so they don't face resistance.
Instead of leaning on pharma, insurance, doctors and hospitals, they basically just restricted the care “you” the consumer gets. Of course that is NOT going to fix the problem with rising costs, and that too was predictable even as the MSM cheered on Obama care (anything Obama did was awesome according to the US MSM. He could have farted, and the MSM would have reported about the sweet summer smell of flowers).
The solution is not to lean on the cost drivers by imposing cost caps/mandates (more communist thinking). The solution is to create a truly competitive market.
Here’s the advantage for why mandates and cost caps win over true long term structural reforms.
The mandate is simple to understand, easy to implement, and it’s effect immediate.
For a politician, you can show results from one year to the next. Heck, from one month to the next.
True structural changes will take time, years. But those changes are real, not just some temporary populist Mamdani style move which long term digs us into an even deeper hole which his rent control measures will surely cause. Mamdani in NYC is the perfect example of why mandates and idiotic cost controls win out over true structural changes that improve things long term.
“recent cost explosion in other categories under the Medicaid umbrella”
Other categories? IT company swamp now paid to avoid pinning the blame on them and pinning it on somebody else.
“Keeping track of it could be a Real job for AI”
AI is only as good as the data it is fed; not unique to AI. The Deloitte eligibility problem is the quality of the data.
“they enrolled unsuspecting, healthy people”
Deloitte does the enrolling/eligibility in most states, in all the big states.
“rely on the physician’s honesty”
And can we rely on the honesty of Deloitte?
“Medicare/Medicaid dual eligibles are a large percentage”
“big bucks in NICU and end of life care”
Medicaid is barbells, heavy in elderly, in women of pregnancy age, in NICU newborns, in those with bad lifestyle choices.
It is expensive to keep the elderly alive ... one more month. Most newborn expense is due to the bad lifestyle of parents. If excess sugar is added to the lifestyle choices then lifestyle is the overwhelming cost of Medicaid.
Bad lifestyle choices of tobacco, alcohol, drugs, STDs are the biggest preventable big expense. Set a policy: No person age 18 with bad lifestyle choice can apply for Medicaid. Increment it each year to 1 year older in age.. 19, then 20, etc. If a person wants to make bad lifestyle choices, he is free to do so. But don’t expect the taxpayer to pay for those bad lifestyle choices.
“fraud contributes to the problem, but not the primary cause”
“90% of it goes to fund the government infrastructure”
Employee bureaucrats are obvious. Not so obvious is the swamp of IT and consulting companies that devise ways to spend more money. Accenture taught me: If centralized, de-centralize. If de-centralized, centralize. Whatever the current way is, recommend and do the opposite. That will generate the most money for consultants. This pre-Trump policy continues under Trump/RFK/OZ.
“Hospital costs can be reduced by splitting most hospitals”
Metro Hospitals are paid a higher rate than Rural hospitals for the same procedure. To pay for big new metro Medicaid Centers patients must be brought in from the rural areas to fill the beds and keep the staff busy. The Metro Hospitals buy up the rural hospitals and use them to feed rural patients to the big Metro Hospital where Medicaid will pay more per patient. As number of patients in rural hospitals declines, the rural hospital loses its specialty departments, which further speeds the transit of patients to the big Metro hospital.
“primary cost: pharma, hospitals, doctors, medical devices, insurance not addressed.” Don’t forget government as a primary cost. It is state & federal regulation of doctors, hospitals, everything medical that raises the cost. And don’t forget the IT and other consulting companies in the swamp: Deloitte, Gainwell, Acentra, Optum, Accenture, GDIT, etal. Deloitte is outright FRAUD. The WASTE FRAUD ABUSE at Gainwell is mostly in processing the dirty data it receives from Deloitte.
“hospices are required by federal law to have a physical office.”
Medicaid & most states require ALL medical providers to have a Physical location where services are delivered. Most states require this be a licensed location that is physically inspected for cleanliness, etc. In GA and other states, Medicaid now bypasses that and pays for instate providers not in that licensed location, contrary to state law. Government bureaucrats are slow to come up with modern systems to handle this.