Matthew Holt
Two weeks ago, I wrote an article about April Fool, claiming that Elon Musk and Doge will nationalize U.S. health care to save some money. That work is joking, but it is quite serious.
If you look at what Musk is complaining about, there are two main areas of “waste, fraud and abuse” in government spending.
One is a person directly hired by a government agency. Most of the people I meet in government are working hard and there is much less money than the private sector gets. But you can certainly find stories about useless government bureaucrats who do not do any work and join their expense accounts. These stories may be as real as Reagan's pink Cadillac driving welfare queen, because there is a small number of bad actors in reality with a certain basis, but politics has gone beyond the truth. (By the way Very Long! )
Musk claims to be looking for another major area of fraud that is being signed. Of course, there are many types of government jobs. If, like me, you are already big enough to remember the Iraq War, then you might think of ring bandits like Halliburton, offering any service to the army. (Remember when Cheneys was a bad guy?). The other is the Blue Cross & Blue Shield program, which was the contractor that initially handled Medicare & Medicaid claims. Interestingly, they couldn't actually achieve this, so they outsourced it to others like EDS's Ross Perot and ACS, which later were spare. But, there are more for every agency.
Musk & Doge has been running around in the most obstacles, bringing both actual employees to beat, including 20,000 of the 80,000 employees working at HHS, allegedly cutting $150 billion in contracts. Of course, after careful inspection, many “contracts” have been ended or been compensated. Doge has always been a pathetic performing art, and it would be fun if it didn't ruin so many people doing well, or killing so many poor children in poor countries.
Brookings (Elaine Kamarck and Paul Light)’s smart guys derive an estimate of the ratio between direct employees and contractors in detailed articles on the subject.
As you can see, the number of civil servants (actual employees) has been staying for nearly 15 years. The number of contractors has bounced, but that number is 2.5 times.
The GAO contract industry has estimated that the cost of 40,000 to 50,000 jobs will be slightly below $800 billion per year in 2023, with 60% of which goes to national defense.
However, there are third type of government “contractors”. These are private companies that provide services to private individuals who pay for third parties. Sometimes, a third party is a government, such as CMS pays for Medicare claims. Sometimes it is a private entity, such as an employer pays another employer, such as a hospital, but both governments subsidize the fees. Sometimes both governments and private individuals pay the same transaction, such as Medicare pays certain fees, while private Medigap plans pay the rest.
Musk and the Governor basically overlooked this.
You can see where I'm going.
These are not “contracts” and are not present in GAO's analysis. If they do, it will be more than $2 trillion in health care in total. But they do represent government spending.
And, every day in healthcare, there is news about what private companies offer for that expenditure “overcompensation.”
I won't even talk about United Healthgroup and Medicare Advantage here. After all, even the Trump Justice Department seems to think they are guilty of escalating and fraudulent risk adjustments.
But there are many other examples
Last month, Centene, the country’s largest Medicaid program, grabbed a cookie jar. Medicaid is a state-based program, so if someone moves from one state to another, the state and federal governments should stop paying Medicaid in one state, but instead paying for the program in another state. Centene certainly knows this, but WSJ found it was telling local plans not to inform the state that its members had moved away.
A Centene director urged some of the company's case managers in February to enroll Medicaid recipients after moving. “Don't close the case when you learn that members have moved out of the state,” the supervisor said in a Microsoft Teams message. “If members qualify and are not out of the state, they can still [sic] Take advantage of some benefits. A spokesman for Centene said the company must maintain coverage for members until the state decides whether to cancel beneficiaries.
Centene raised about $150mm of $150mm for patients who didn't even live under its coverage and lied to taxpayers. WSJ clearly shows that they are not alone. Manchester United, AETNACV, Molina and Hepance are all doing the same. If you can get it, pure profits are good!
In the semi-news, some more corrupt states are joining. It is presumed that the money should be back to taxpayers in Florida, but the Florida regime told Centene to donate the $10 million to a dark money public “charity” that was a pet project by its founder Ms. Casey Desantis. He obviously married the governor of Florida and wanted to be the next one!
Look, I know you all shocked the Florida Republicans and their friendly LAPDOG companies are involved in this corruption, but something different may have happened in the Blue Collar Democratic stronghold in Pittsburgh, Pennsylvania.
There, we found another type of government “contractor”, the University of Pittsburgh Medical Center. UPMC has been building an empire for decades. I've written about their MLB style executive salaries, while others have exposed the company's Jets. But while UPMC has all the impact of a large-scale for-profit company, Bex reports that 70% of its revenue comes from government programs. But what advantages will nonprofits that other citizens of Pittsburgh have to offer? Yes, no property tax is required. On land owned by $2.1 billion.
So when the mayor of Pittsburgh asked for the city's share, UPMC wasn't entirely on the highway.
To protect its condition, the hospital giant is competing in Pittsburgh Mayor's racethe Democratic primary election will be held on May 20. Incumbent Ed Gainey, elected in 2021, has been a voice critic for the medical center More and more tax-free property portfoliosaccusing the Center of abuse of its nonprofit status by imposing tax exemptions on unqualified properties. Progressive mayor is facing tough challenges from county controller Corey O'Connor, who is running Best choice Pittsburgh Development and Real Estate Community Donorsespecially the hospital board members. These include board members of the University of Pittsburgh Medical Center and its related Children's Hospital Foundation. According to the year so far, the members and their families contributed at least $25,000 to O'Connor's mayoral campaign. Campaign Finance Record.
This doesn't make me a valuable neutral charity act, and frankly, many other major healthcare systems act not. Quoting yourself (yes, I know it's still stolen),
Over the past 30 years, the United States' dignified community and narrow hospitals have merged into large health systems, mainly to be able to stick to insurance companies and employers. Blake Madden eliminated 91 Health System Chart This week, revenue exceeded $1 billion, revenue exceeded $10 billion, and revenue exceeded $5 billion. You don't need me to remind you, many systems have internal guis Monopoly price miningtighten Their clinicianprosecution Poor people,manage A large amount of hedging fundsand Pay dozens of executives Just like they were playing for the soon-to-be former Auckland A. There are some La Dodgers' style money.
Especially the money hanging out in their hedge funds. I estimate very roughly that the “reservations” of large hospital systems and nonprofit Bruce programs may have $500 billion, but it may be $1 trillion.
Then what is my answer?
Nationalize a large number of them.
If hospitals and doctors are part of government agencies like VA or the U.S. Marine Corps, all this theft and corruption will disappear, or be managed by the OIG and others.
They don't need to have these hedging funds. Or pay a payment to a private insurance company. This money can be used for good rather than profit.
Salary can be adjusted to reflect the salary paid to high-paying public sector employees. If the U.S. president gets $400KA in a year, why does the CEO of a regional medical center need $14 million? To do this, VA's clinical service line manager can make up for a price of up to 400ka years, which doesn't sound crazy. Obviously, a lot of adjustments have to be made, which may include making medical schools free, but overall, doctors are still a highly paid career, just like the rest of the world. We can return their vast amounts of power and autonomy that have been stolen by health programs and managers.
Now, I know that this will make most Americans a disgust. They would rightly say that SpaceX (although Musk is nominal CEO) was able to put rockets in orbit much cheaper than NASA. In many economic areas, this may be true, but it is not the case in healthcare. We spend more on roads than countries with government delivery systems.
Finally, nationalized health systems will allow us to remove some of the biggest inequality and idiots in the current government-based insurance system. Exhibit A is Medicaid. A federal government program for people over 65 years old, and a completely different state government program (Medicaid) that uses 1/2 of its money to people over 65 years old, with disabilities return In the federal plan, this is stupid, and it's always been.
The nationalized system will remove the second-class status of citizens without health insurance or good private insurance and enable our clinical professionals to practice medicine in their young and idealistic ways in the way they want.
Apparently, it was almost impossible to obtain American health care through nationalization, a British word that had little meaning in the 1940s.
But telling me that this is not the right thing to do. Even if you only care about reducing waste, fraud and corruption.
Matthew Holt is the founder, publisher and writer of THCB
