freeman3 wrote:Your emotional points are not pertinent to the fraud potential in this program. You complained about fraud in disability. At least those people have had to work and generally have significant health problems that at least make working harder. Just about everyone who is elderly can be classified as being disabled. Their family member can pick up a cool $1400 a month for supposedly taking care of them. If you think this program is not being abused you are being very naive.

I gave a very specific example. Why? Because a broad-based, national law intending on being everything to everyone has many unintended consequences.

Nothing you have said addresses this situation specifically.

I would have to agree (partly) with Freeman on this issue. If there is evidence of fraud, the person should be tried and if found guilty punished to the fullest extent of the law, without the possibility of future government support. I feel the same about disability, SSI and food stamp programs. However, to prohibit a person from caring for family is too extreme. Punish the wrong-doers, but do not prohibit the caring of family without evidence of a crime.

As always, I am for the punishment of misuse of funds...

bbauska wrote:I would have to agree (partly) with Freeman on this issue. If there is evidence of fraud, the person should be tried and if found guilty punished to the fullest extent of the law, without the possibility of future government support. I feel the same about disability, SSI and food stamp programs. However, to prohibit a person from caring for family is too extreme. Punish the wrong-doers, but do not prohibit the caring of family without evidence of a crime.

As always, I am for the punishment of misuse of funds...

I agree.

However, he's citing a hypothetical. I was citing an actual person.

Doctor Fate wrote:I gave a very specific example. Why? Because a broad-based, national law intending on being everything to everyone has many unintended consequences.

Nothing you have said addresses this situation specifically.

if you look atthe original Oregonian article rather than the Peggy Noonan op-ed, you'd know that on the day you posted the reference, something happened. It was of course a 'fear' not an actuality that her money would be stopped.

And seeing the update I noticed a few things:

Officials with the state Department of Human Services said Friday that federal officials have agreed to work with the state to develop "the right processes" to allow guardians -- often times relatives -- to continue as paid caregivers. It's unclear yet what those processes will be, said Patrice Botsford, director of developmental disabilities services for the department.

So, Oregon will work with the feds to work something out. So as long as they work that through she won't lose her money.

So the 'specific case' is being dealt with among the 454 others that are in a similar situation.

The purpose of the federal provision is to protect against the possibility of financial fraud, since the guardian who develops a care plan has the ability to hire himself or herself as the paid caregiver.

However, Oregon has allowed guardians to be paid caregivers for more than 10 years under various federal waivers, reportedly without issue.

WAIVERS! OMG!

Hang on, though. that means that the ACA didn't bring this idea it, it was in earlier legislation and was waived for Oregon due to their own programme.

The new provision is part of the K Plan, a Medicaid state plan option under the Affordable Care Act. Oregon is the first state to implement the plan, which emphasizes home- and community-based services.

And here's a link to Oregon's K Plan.

So here's the thing:

1) The ACA probably copied the clause of other federal laws to guard against the problems of fraud and conflict of interest when a guardian is also a paid-for caregiver.

2) Oregon has previously obtained waivers to those provisions, and therefore should be able to again. I guess it does so by demonstrating rigour in how it administers its programmes.

3) Any waiver is not proof of the failure of the ACA itself, as it's the same as previous waivers for older legislation. It may demonstrate that federal legislation can cause complications when it comes into contact with how the states interpret them and wish to act. But it should not be used to extrapolate (as Noonan does) that the particular act is so awful.

A lot of the issue is, however, that US law is often set up saying that the government can only do limited things in limited situations. And in this case, it's paying someone to be a carer that the government wants to do. But of course we don't want a welfare provision that can be abused, say where instead of an independent provider of care, having an interested party be commissioned and paid to provide the care. It is key because in the same laws (and Oregon's K Plan) the guardian is also the main representative for the interests of the patient if they cannot be themselves.

They could avoid restrictions, and then open the door to fraud. Then people would raise hell about how the ACA leads to fraud. Not you though, DF, eh?

They could use greater scrutiny and oversight, and then increase the costs of overheads. Then people would raise hell about how the ACA adds to bureaucracy and wastes money. Not you though, DF, eh?

Or then can exclude risky situations and, well, then you get people raising hell about how people fear (not actually will, but 'fear') that they'll lose out.

Now, I would expect that people think it is generally a good thing that US law works that way, as opposed to the alternative - that unless disallowed in law, the government do what it likes. That is pretty much the situation in UK law, although we have over time been adding laws to say what the government cannot do.

But I guess your founders (who we absolutely must not insult or criticise) had a reason to turn that around.

bbauska wrote:I would have to agree (partly) with Freeman on this issue. If there is evidence of fraud, the person should be tried and if found guilty punished to the fullest extent of the law, without the possibility of future government support. I feel the same about disability, SSI and food stamp programs. However, to prohibit a person from caring for family is too extreme. Punish the wrong-doers, but do not prohibit the caring of family without evidence of a crime.

She's not being prohibited from caring for her daughter. She 'feared' she may not be able to be paid $1,400 a month by the government to do so.

As always, I am for the punishment of misuse of funds...[/quote]And, I suppose, intending to set up law to avoid the fraud in the first place, right?

danivon wrote:Hang on, though. that means that the ACA didn't bring this idea it, it was in earlier legislation and was waived for Oregon due to their own programme.

Right, but:

1. This never had anything to do with fraud. Why Freeman dragged that in, I have no idea.

2. The concern was that Obamacare would eliminate this as an option.

2) Oregon has previously obtained waivers to those provisions, and therefore should be able to again. I guess it does so by demonstrating rigour in how it administers its programmes.

There are a lot of "shoulds" (i.e. common sense) that are prohibited by Obamacare, so . . .

3) Any waiver is not proof of the failure of the ACA itself, as it's the same as previous waivers for older legislation. It may demonstrate that federal legislation can cause complications when it comes into contact with how the states interpret them and wish to act. But it should not be used to extrapolate (as Noonan does) that the particular act is so awful.

Actually, the waivers are evidence of its poor construction. If it were well thought out, there would not be so many exemptions. I'd need a website just to list them all.

And, unions want more modifications. I don't know if you saw it, but Trumka (AFL-CIO) thinks there are many changes needed Of course, he wants the President to change them. We used to have a Constitutional Republic, but now we live under a relatively benign monarch. .

They could avoid restrictions, and then open the door to fraud. Then people would raise hell about how the ACA leads to fraud. Not you though, DF, eh?

Oh, please. The ACA, like every massive government program, will surely engender fraud. That's what government does best.

They could use greater scrutiny and oversight, and then increase the costs of overheads. Then people would raise hell about how the ACA adds to bureaucracy and wastes money. Not you though, DF, eh?

Actually, as you well know, that's built in. What do you suppose the tens of thousands of "navigators" are?

Or then can exclude risky situations and, well, then you get people raising hell about how people fear (not actually will, but 'fear') that they'll lose out.

In fact, we already KNOW people are losing their coverage. We know Healthcare Savings Accounts are taking a hit. We know businesses are holding back. There are a good many "losers" in this fiasco that we have to live under. So, put a sock in it.

danivon wrote:

bbauska wrote:I would have to agree (partly) with Freeman on this issue. If there is evidence of fraud, the person should be tried and if found guilty punished to the fullest extent of the law, without the possibility of future government support. I feel the same about disability, SSI and food stamp programs. However, to prohibit a person from caring for family is too extreme. Punish the wrong-doers, but do not prohibit the caring of family without evidence of a crime.

She's not being prohibited from caring for her daughter. She 'feared' she may not be able to be paid $1,400 a month by the government to do so.

As always, I am for the punishment of misuse of funds...

And, I suppose, intending to set up law to avoid the fraud in the first place, right?[/quote]


No need to set up a new law. Fraud is already against the law.

bbauska wrote:No need to set up a new law. Fraud is already against the law.

Sigh...

I mean, when setting up a government programme, shouldn't the law that defines that programme make it more difficult for people to defraud it?

danivon wrote:

bbauska wrote:No need to set up a new law. Fraud is already against the law.

Sigh...

I mean, when setting up a government programme, shouldn't the law that defines that programme make it more difficult for people to defraud it?

I meant no frustration to you. People are able to find ways to defraud in whatever law is developed. I am all for the best law possible, but the problem is that people are willing to find ways to skirt the system. Not all people, but there are some.

Make the law as effective as possible, but punish those who defraud to the fullest extent of the law.

Doctor Fate wrote:
1. This never had anything to do with fraud. Why Freeman dragged that in, I have no idea.

Because it is mentioned in the Oregonian article that was Noonan's source?

The new federal provision aims to resolve a conflict of interest that arises when the guardian who helps develop an individual service plan hires herself or himself as the paid caregiver, which could lead to financial fraud.

Voter fraud is a problem, but not the potential for financial fraud from a conflict of interest when someone is being paid £16,800 a year of public money is just theoretical so we should just carry on paying it out?

There's a new study on the efficiency of health care systems around the world. 58 countries are studied.
http://www.bloomberg.com/visual-data/be ... -countries

The US ranks 56th in terms of efficiency. (Measuring the current system, not the incoming ACA)
ACA is designed to do some things, and admittedly it won't be perfectcion. But will it be better and provide a more efficient system than the current system? well, the best systems, as ranked by Bloomberg, have some clues .... None of the charactreristics of the leading systems will satisfy ideologues on the right.
But if the idea was to get results for the money invested .... a business like approach ... the ideological approach doesn't make sense.

So what can the U.S. learn from the many countries that get more bang for their health care buck? Unsurprisingly, there is no one formula for success when it comes to efficient medical care. The systems that rank highly on Bloomberg's list are as diverse as the nations to which they belong. The unifying factor seems to be tight government control over a universal system, which may take many shapes and forms -- a fact evident in the top-three most efficient health care systems in the world: Hong Kong, Singapore, and Japan.
Ranking third on Bloomberg's list, the Japanese system involves universal health care with mandatory participation funded by payroll taxes paid by both employer and employee, or income-based premiums by the self-employed. Long-term care insurance is also required for those older than 40. As Dr. John W. Traphagan notes in The Diplomat, Japan controls costs by setting flat rates for everything from medications to procedures, thus eliminating competition among insurance providers. While most of the country's hospitals are privately owned and operated, the government implements smart regulations to ensure that the system remains universal and egalitarian.
Meanwhile, Singapore's health care system is largely funded by individual contributions, and is often hailed by conservatives as a beacon of personal responsibility. But as conservative David Frum notes, the system is actually fueled by the invisible hand of the public sector: individuals are required to contribute a percentage of their monthly salary based on age to a personal fund to pay for treatments and hospital expenditures. In addition, the government provides a safety net to cover expenses for which these personal savings are inadequate. Private health care still plays a role in Singapore's system, but takes a backseat to public offerings, which boast the majority of doctors, nurses, and procedures performed.
Despite being considered by some as having the freest economy in the world, Hong Kong's universal health care system involves heavy government participation; its own health secretary calls public medicine the "cornerstone" of the system. Public hospitals account for 90 percent of in-patient procedures, while the numerous private options are mostly used by the wealthy.
All this government care isn't taking much of a bite out of the state's bustling economy: According to Bloomberg, Hong Kong spends just 3.8 percent of GDP on health care per capita, tied for the third-lowest among nations surveyed and good for the most efficient health care system in the world.

http://www.huffingtonpost.com/2013/08/2 ... 25477.html

danivon wrote:

Doctor Fate wrote:
1. This never had anything to do with fraud. Why Freeman dragged that in, I have no idea.

Because it is mentioned in the Oregonian article that was Noonan's source?

Which HE never referenced?

The new federal provision aims to resolve a conflict of interest that arises when the guardian who helps develop an individual service plan hires herself or himself as the paid caregiver, which could lead to financial fraud.

Voter fraud is a problem, but not the potential for financial fraud from a conflict of interest when someone is being paid £16,800 a year of public money is just theoretical so we should just carry on paying it out?

Make an actual allegation against the woman cited by Noonan. Otherwise, you've got "potential" fraud, which you all scoff at as a voter issue, even though the solution is 100% painless.

Ricky:

The US ranks 56th in terms of efficiency. (Measuring the current system, not the incoming ACA)

Do you think we will move to 55?

Meanwhile, is Obamacare good for the economy . . .

Well, we won't know for sure until sometime after the exchanges get going. They're scheduled to begin October 1. My guess is . . . fiasco.

But, here's something we know: the Feds are in charge of things in Nebraska and . . . prices are skyrocketing:

Nebraska Insurance Commissioner Bruce Ramge pointed out that a comparison of rates between Coventry and Blue Cross Blue Shield, the only companies of the four that offered rates in past years, showed that health insurance costs are going up for most Nebraskans.

Tom Gilsdorf, director of product development at Blue Cross Blue Shield of Nebraska countered: “An apples-to-apples comparison of 2013 health insurance costs to 2014 costs is virtually impossible,” he said. “Health insurance that will be sold to individuals, families and small businesses for 2014 is new and must cover a range of Essential Health Benefits that were not covered in the past.”

Lower-cost options are available to Nebraskans that are not shown in a one page 2013-to-2014 comparison sample posted by the department.

In the example, the cost of a Blue Cross Blue Shield “silver” plan covering 70 percent of health costs was $245 a month for a 30-year-old single man living in Lincoln, up 82 percent from a year ago, and for Coventry, $271.65, up 143 percent.

Family coverage in Hastings on a silver plan for a 50-year-old single mother with three children was almost $1,000, up 21 percent for Blue Cross Blue Shield and down 5 percent for Coventry, at $975.

This is what’s known as “cost control” by the Obama administration. In this case, they can’t blame Nebraska for tweaking the exchange to the disadvantage of consumers, because Nebraska is one of the states that refused to comply with ObamaCare and construct their own exchange. The prices in this case come from the federal exchange that HHS is creating in Nebraska in order to deal with the gap.

You can't blame Republicans. HHS is setting up the exchange--and it's going, um, not so well.

From the same post, a self-professed "left-leaning social activist" has had an epiphany contra the lines of rickyp's usual argument:

“It sounded like a good idea to offer insurance to all the people in the country.”

Christensen was originally concerned with patients who go to the emergency room for minor ailments instead of seeking a primary care physician and felt that Obamacare would allow people to stay healthier and remove perverse incentives that clog up hospitals across the U.S.

The only problem? He didn’t realize how much it would cost him, and he’s horrified by how much it’s going to cost his employees.

“Some of those regulations about what the costs of my employees are going to be are horrendous, and I can’t understand the math,” he said. “Listening to the insurance providors and people providing webinars on how to figure out what our costs are going to be in this program, it’s gigantically troublesome to me.”

And, people who have insurance are going to lose it:

Not only does the math make his accountant shudder, Christensen is fairly certain that his employees are going to totally lose all coverage, he said. That’s because the economical CoverTN program that he’s currently using doesn’t qualify under Obamacare’s rules, and will disappear at the end of the year. CoverTN costs employees and Christensen about $60 each per month, but Obamacare would double that, placing it out of reach for those at the low end of the pay scale.

ray

Do you think we will move to 55?

More likely than moving to 57 ....

The real point that this study shows is that the US system is remarkably inefficient. By working towards a system that provides greater efficiencies there have to be contributions to the economy as whole.
Its unfortunate that the US couldn't have moved, like every other nation to similar govenrment systems, years ago. It hs made the transition more difficult ... and has entrenched inefficiencies over the last 30 years.