India Virtually Eliminates Tetanus as a Killer
nytimes.com
nytimes.com
I'm uncomfortable with the meme of corruption in public welfare programs (and I may be overreacting to the author's implication, but I still think my point applies more generally). There is corruption in every program and institution, from private business to religion to government to little league baseball. If you have thousands or millions of people involved, some will behave badly; it's the nature of humanity. We can't wait to do things until the institution or the people it services are saints.
Not all corruption is equal, and absolutely we should find ways to minimize it (which usually involves looking in the mirror and making systemic changes, not complaining about the inevitable, well-established consquences of our current system). But considering the string of massive corruption scandals on Wall Street, for example, I'm surprised when people think government and welfare programs are particularly corrupt.
It is a well established fact by the CBO (Congressional Budget Office) that roughly 10% of the medicare budget is wasted on fraudulent claims (even though their rejection claim rate is roughly 1000 times that of most private insurance).
So there are some cases where the status quo is untenable, fraud is blatantly obvious, and people could die untreated do to a lack or resources.
Yes, fraud and corruption should always make the headlines and should always be a priority to eradicate.
[EDIT for typo of medicaid instead of medicare]
For comparison, I wonder if the CBO was given full investigatory power into private insurance, would they discover a higher or lower fraud percentage? It would not surprise me if they were higher, and that at some point they just accepted that fraudulent claims would be cheaper to ignore than to uncover, based on dollar amounts and so on. It similarly of course wouldn't surprise me if they were lower being able to deny more people at the outset, or were able to use more information to find high risk claims (that privacy concerns prevent the government from using for the exact same purpose).
If we are talking about fraud within the company/government, I would expect the same - less in the company than in the government. Not zero, but less overall.
That doesn't imply that they aren't demoralized, ineffective, or hamstrung, but still.
For instance, aid to Sub-Saharan Africa constitutes roughly 70% of the budget of SSA countries. Illicit outflows of that aid money is increasing at a rate of 20% per year. I'm struggling to find the data about how much aid actually reaches the intended location, but it's significantly lower than one would hope for.
Sure, I think that foreign aid to developing countries should happen. But clearly the way that we're doing it right now is encouraging a self-perpetuating corruption economy. Burying my head in the sand about corruption of foreign aid wouldn't help anyone, just like merpnderp is saying.
Which is exactly what you've described in Africa. If a general can divert 20% of the aid to his offshore account one year, why would he shoot for 40% the next?
that way the corrupt people see it in their interest to pull back rather than increase...
Obviously it needs to be paired with some instances being pursued to its logical conclusions and done so publicly.
Assuming the figures you quoted are correct, how much of the medicare budget is spent on fraud prevention? That includes:
* time spent by Congress and Medicare deciding what is and what is not covered, * deciding who is and who is not covered, * what the rules and processes are for preventing and discovering fraud, * what the process is for handling fraud * the actual time needed to enforce these rules and follow the processes * time spent by care givers and patients complying with the rules
I suspect that all of that adds up to more than 10%, and it would go much higher if Medicare tried to reduce the fraud rate below 10% through further enforcement.
(Three of the Four agencies you mentioned don't even investigate Medicare fraud, except incidentally.)
Given how big a deal the FBI made out of a medicare fraud case that garnered nation attention just a few weeks ago, I'd say very little is spent tracking down fraud.
Here's the biggest bust ever, and it amounts to catching around $100/million a year in fraud, a tiny fraction of the $60b total. http://www.hhs.gov/news/press/2015pres/06/20150618a.html
I don't think it really matters, since you are the one who narrowed the original suggestion that the total cost of Medicare fraud -- which you've stated is $60 billion with a handwave at CBO without specific citation -- might be less than the total cost of resources expended in "fraud prevention" (not just investigation), including (explicitly, per the post upthread) the resources expended in all of the following activities:
* Congress and Medicare deciding what is and what is not covered
* deciding who is and who is not covered,
* what the rules and processes are for preventing and discovering fraud
* what the process is for handling fraud
* the actual time needed to enforce these rules and follow the processes
* time spent by care givers and patients complying with the rules
You reducing this to just investigation costs is, well, missing the point being made.
I agree in general; I seem to have given another impression. Absolutely we should reduce corruption and there are cases where it causes serious problems.
But if by "untenable" you mean Medicare should be shut down rather than continue like this, I'd disagree. You describe a serious problem, but worse would be to let all those people suffer. But I agree that 10% is a huge waste (in an enormous budget) the opportunity cost - the people who go untreated - seems high; reducing that waste should be a high priority (I'm assuming they are correct; I have no personal knowledge).
EDIT: Make wording a little more precise
As for trusting the CBO, if you can't trust their accounting, there's literally no one else you could trust.
Its a story about a developing country.. it would be a brave editor who approves a piece without the story sticking to the dominant narrative about the country.
Not sure if there are any Journo's who can comment on my insinuation but that is how i see many media pieces. not sure if it is forced by editor or comes from a journo's own biases.
One in one thousand of over a billion is still a rather large number. Shouldn't the WHO use proportional statistics for populations over, say, 100 million?
[1] http://qz.com/317518/finally-indias-population-growth-is-slo...
In India, nearly half of the population
- more than 590m people -
relieve themselves in the open
In California it's a rare occurrence among the 38 million people that live there, caused by a tiny fraction of the population - almost exclusively a subset of the homeless.
In India, it's ~45% of 1.2 billion people.
And late-night alcohol drinkers! Maybe you've never done it, but lots of people, of both genders, have.
Nothing strange at all, congrats!
Thinking of starting some kind of kickstarter campaign to solve this in few villages and let the community/government to replicate this model to everywhere in India.