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INSURANCE FRAUD - the Democrats Plan

Updated on March 14, 2010

There are a few commercials floating around demonstrating the downside to insurance fraud. So, we get the idea that we don’t want to turn in false insurance claims. My question is, “Do the Democrats who want to “reform” health insurance, also understand that they are not to file false insurance claims?” Based on their fearless, inexperienced leader, aka the President, they do not.

The Democrats keep talking about the need for everyone to have health insurance….as if most of America does not have it. It’s here where the submission of false insurance claims hits the felony level. Of the approximate total population of America, 84% or over a quarter of a billion people, HAVE health insurance. That leaves that number of uninsured the Democrats love to tell us about. “There are over 47 million people in America without health insurance!”

One form of insurance fraud is the exaggeration or embellishment of losses by increasing the amount of or the total span of the damages. In other words, they are fudging the numbers. CSPAN was kind enough to broadcast an in-depth presentation by 5th District of Iowa, Republican Steve King. He exposed insurance fraud being committed by the Democrats. In that presentation, he detailed the numbers the make up that 47 million people. Read carefully:

Six million people (2%) are illegal immigrants; does “illegal” mean anything?

Five point five million (2%) are legal immigrants not yet eligible for health care.

Nine million (3%) earn over $75,000 annually, can afford health insurance, but do not purchase it.

Nine point five million (3%) are eligible for existing government programs, but have not signed up for them

Five million (2%) are eligible for employer programs, but don’t sign up for them.

Twelve million (4%)…do not have health insurance or any access to it.

Twelve million versus forty-seven million equals a 290% swelling of mistruth and misleading.

We can’t afford the Democrat’s plan, because it changes nothing. The lawyers keep getting richer, the hospitals continue to agonize over the cost of providing for those who don’t have insurance, the doctors constantly review their positions as to whether they can keep solvent, and insurance costs continue to skyrocket. If those plans don’t address these subjects, then they are just this year’s multi-billion dollar bowl of lame put out by the Democrats.

Where is the “tort reform” we have been promised for decades? Doctors don’t want to ply their trade anymore because they can’t afford the malpractice insurance. Gynecologists went into family practice because they couldn’t withstand the possibilities of births taking a turn for the worse. You, know, someone always has to be blamed, hurricanes, volcanoes, mudslides, wildfires, and earthquakes, don’t just happen, someone has to blame….

I blame our government, the health insurance companies, but most of all, the lawyers. Blaming the lawyers is the one thing that connects the blame together. A huge percentage of our law makers are lawyers. Health insurers spend more money consulting their legal departments than they do their doctors. Then come the lawyers, the ones who make the money no matter what happens. I wonder what would become of the practice of law if judges started ruling that the representing lawyers malpractice cases start to face the same consequences as their clients.

Judge: “I am ruling in the favor of the defendant. The plaintiff will reimburse the defendant for all legal fees, half of which will be paid by the attorney of record. That attorney will serve 1000 hours of community service for bringing this case to the courts.”

Our problem is you have people who do a job and get paid whether they win or lose? Now that works in the World Series, the Super Bowl, and the Stanley Cup finals. There, it’s the best of the best completing for the title. The only difference is how much they get paid. But in this arena, there is no downside to bringing capricious lawsuits into the system. There is no consequence for the lawyer who seeks out people who might have been hurt by some drug or medical action in the past. What if the Judge said, “Sure, counselor, bring it to court, and if you win you will be awarded for the cost of your services, and the damages to your client. However, if the court rules against you, your client and you will pay for the defendant’s fees and the accumulative amount of their time wasted by your action at the rate of $500.00 per hour”. Hmmmm, do we want to do this?

How do we fix this? Change all the tort laws. Add consequences against the plaintiff in every lawsuit. Make people think a hundred times about whether it is worth it to file a complaint against hospital, a doctor, a paramedic, a nurse, or anyone who has committed their lives to helping others. Drop the subjective “pain and suffering” awards.

Have the insurance companies work together with the medical profession to come up with fair fares for all the work done. In Danville, Pa, the Geisinger Health System is developing new ways to price the services of doctors. The actually base the cost of services on the total issue. It’s like getting an oil change at a set price: This surgery costs $XXXX.XX, and that includes all doctors’ work, visits pre and post surgery, all prescriptions, and anything having to do with the successful completion of that surgery. No more doctors stopping by for 45 seconds, and billing your insurance company $450.00. I may not have the details exactly right, but the concept is in practice and everyone sees this as the future for reasonably prices medical costs. And when this happens everywhere, then insurance companies can charge less for the insurance simply because they will have to pay out less.

My daughter had surgery on her jaw three years ago. She was in the hospital for exactly 30 hours. The hospital bill was $42,000, the anesthesiologist’s bill was $6,000, and the surgeon’s bill was $12,000…that’s $60,000 for 30 hours. The first two were paid immediately, with the hospital bill paid entirely by the insurance because our deductible was met, and then we paid two grand for the anesthesiologist’s portion. Our doctor argued with our insurance company for the next 6-7 months as to whether she should have had the operation and whether or not is was cosmetic (it was an operation on her jaw, and evidently close enough to teeth to get insurance companies to question it). Of course this left us in limbo for that period of time, and then the doctor and insurance company settled on a lesser amount. The point? Outside of the outrageous costs by the hospital the total system is crazy and needs reform.

Reform, however, has to be based on truth. Reform has to target the needs of all Americans. I have insurance, but it costs me over 10% of my monthly gross. And that’s my portion. My employer pays 60% of the premium. I need this to be reduced, but not by the government taking over, rather by the ideas I have already suggested. I want to see those people who come into the hospital be covered automatically, where there is no hesitation on the part of the hospital administration. But I want that care to cost less for them and everyone. Every year the costs keep going up, but the real reforms that would slow, stop, or reverse the increases are not being even talked about. Reform must start with our representatives coming up with a plan to change how it’s done, not just throw more money and bureaucracy at it.


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