“It is very expensive to provide bad medical care to poor people …”
- Paul Farmer
Part I
Why is it expensive to provide “bad” medical care to poor people …?
In many instances, bad medical care demonstrates lack of availability, which coincides with available services that may exist, but lack quality. In order to provide high quality care, the utmost integrity among both professional medical providers and healthcare insurers must be consistently present. In Florida, historically, highest percentages of questionable or otherwise illegal activities occurs amongst participating Medicaid [and Medicare] healthcare providers. This includes both [the former] - medical professionals, [and the latter] - medical insurance companies.
Florida Medicaid is a conundrum, filled with defective policies and practices; millions nonetheless do have access to medical services that meet needs, “by degrees.” The focus of this report is Medicaid, which serves individuals most in need of support, and terribly vulnerable; they are children, the poor, and individuals also often living in poverty, people with disabilities. Conversely, seniors, while medical needs are great, “more generally” report satisfaction with Medicare in Florida.
Regarding Medicaid providers, [as likewise exists within other systems] there is a preponderance of performing unnecessary procedures; paradoxically, Florida Medicaid regularly rejects approval for needed procedures. Participating providers, (doctors, other professionals and support services), reportedly engaged in unscrupulous practices, may seek justification by shifting blame, to the aforementioned posture on the part of Medicaid. It is a sound argument, even if manipulative in purpose.
Meanwhile, adding to corruption in Florida is fraudulent billing activities, whereby services billed never took place. Further, more instances of medical negligence exists among these same providers, unquestionably increasing escalating costs. Not as it pertains to proverbial “frivolous” lawsuits, rather, incidents of documented malpractice having percentages in excess of the norm.
Arguably, the primary factor removing quality is indeed the failure to deliver services. Multiple factors combine, however, the major reason is this . . . “Private health insurance corporations” routinely make decisions on patient care, (despite proven medical need), based upon administrative and other costs they incur, not reimbursed by the state, as opposed to costs deferred or eliminated. Therefore, quality care is unfortunately absent when pursuant to these examples.
“This is not to say that Medicaid participating professional providers are all criminals and/or lacking skills and abilities meeting the medical needs of their patients. “For that is simply not true.” Personal interviews and documents attest to that, and journalistic integrity demands a full accounting. The point is that instances of abuse and poor care is highest among Medicaid providers. Healthcare insurance corporations “contracted” with Florida state government also deserve fair assessment.
Investigation proves they are not “absolute” negative entities. Certain media voices claim they are 100% negligent and go so far as to make accusations of immorality. Corporate bottom line decisions do render personal lives exposed to horrid conditions in particular cases. These instances make for big headlines. However, the truth in Florida continues to be a maladaptive systemic culture. That somehow succeeds in serving the needs of Medicaid consumers more than fifty percent of the time. This fact is nowhere near the statistical claims previously cited, for they are incorrect. At the same time, sadly, due to the human factor, success rates remain decidedly deficient. These inadequacies cannot be over-stated, and that is a fair analysis.
Insofar as quantity is concerned, this pertains to the fact that availability and complete or nearly complete coverage is lacking to the degree to which mortality rates are higher for consumers of Florida Medicaid. Nevertheless, at the same time, without it, and participating providers, (including doctors, clinics, hospitals and ancillary necessities), Floridian’s living in poverty would have no access to said participants via healthcare insurance at all. Uninsured otherwise receive “all” medical care through public hospital emergency rooms, at costs reported to add outrageous sums. Some estimates as high as $ hundreds of millions of dollars more than Medicaid would, annually in Florida.
Overall, Medicaid as a whole – representative of what a publicly funded healthcare system for the poor and disabled, consists of in Florida, is altogether indispensable, effective to varying degrees, but unquestionably in great need for improvement.
The system is constructed as follows … “Private” healthcare insurers, medical professionals and supporting services “contract” with the state government as participating Florida Medicaid providers. Most participants adhere to the state government’s design of policies and practices. Nevertheless, perhaps expected, abuses contaminate it with iniquities. Prosecution for criminal practices has not discouraged “cheating the system.” The most glaring example is the unprecedented $1.7 billion dollars in fines incurred by the healthcare insurance corp. formerly owned and operated by FL. (R) Gov. Rick Scott. The company he created found guilty of fraudulent billing practices along with bribery to medical providers. Although this successful indictment and prosecution resulted from both Medicaid and Medicare abuse, the same illegalities continuously apply singularly to Florida Medicaid.
One Ft. Lauderdale dentist, Dr. Bernard, located in a decidedly low-income part of the city, allegedly investigated for Medicaid fraud no less than seven times. This insinuation unproven, and yet, it is indicative of widespread “questionable” activities. It is interesting to note that scores of Florida Medicaid providers often work in private offices with capacity for fifty or more patients at the same time. Few if any physicians or other professional medical providers “who do not accept Medicaid patients” practice medicine in environments containing such unusual numbers. It is impossible to ignore this aspect of plausibility of corruption, even where no investigation or subsequent indictment takes place.
An oft-cited example of abuse are the prices charged by public hospitals and clinics generally, and insidious when patients are Medicaid recipients. Daily room rates for inpatient services are exorbitant to the point that they are not justifiable; but they continue. Items inexpensive as a toothbrush recorded many thousands of times at prices as high as $90 dollars. Naturally, this should never occur. Meanwhile, it is one thing to over-bill a privately held corporation having no connection to public institutions, or individuals paying out of pocket - another thing entirely when Florida taxpayers absorb such costs.
“A privatized system benefits corporate interests,” and as stated, in Florida, taxpayers foot the bill.
It follows, that “impoverished individuals and uninsured using public hospitals emergency rooms for non-emergency treatment,” must be re-addressed. “This may be the worst result in the systemic deficiencies regarding both Florida Medicaid, and low income residents without insurance.” The connection between current Medicaid recipients and the latter aforementioned Floridians is this:
Prior to the Affordable Care Act, ACA, Medicaid Expansion Formula, enacted in 2014, millions of Florida residents who cannot afford the cost of private healthcare insurance, (where not supplied by an employer, or military service), had a household income slightly above the maximum allowable in order to be eligible for Medicaid. Again, the aforementioned context of use of emergency rooms for non-emergency needs applies. It not only adds abuse to the system, increasingly higher costs for the same care incurred, increasing exponentially.
In short, the ACA plan allows individuals, children and families in this situation to be eligible for Medicaid. However, Florida and more than twenty plus other states having a Republican Governor and state legislative majority decided to “opt out,” [rejected] the new plan. Forfeiting federal dollars that pay for the expansion in entirety through fiscal 2015 and continue in part for another two years. More than ten thousand higher median permanent new jobs in addition were lost; employment opportunities deprived in Florida and states doing the same.
Florida Governor Scott and a wide Republican Party majority in the legislature in Tallahassee created their own version of a new Medicaid formula. Instituted beginning on July 01, 2014. Conversely, compared to the ACA, it does not expand the availability of Medicaid to the uninsured; instead, it decreases services previously covered for current recipients. Who foots the bill for abuses, ineffective oversight and deficiencies of the system? In the case of Medicaid, the taxpayer does. In Florida, where there is no state income tax, and sales tax receipts are grossly insufficient in the percentages allocated to payment for healthcare, the solution is application of no solution at all. The result, all of the problems and deficiencies cited . . . “worsened.”
In the end, as so often happens in Florida, where ineffective policy likewise exist in public schools, public transportation, public libraries and public recreational facilities, enviable living conditions in the state of Florida unnecessarily decline. The Republican Party led government in Florida is dedicated to reducing taxes. Unfortunately, despite claims to the contrary, while cutting social services as well. When confronted, their spokesperson(s) affirm the State Constitution, which mandates a “balanced budget.”
In order to balance the budget, they cut “privatized” public healthcare access and coverage(s) in Florida. Now, Gov. Scott applauds himself for creating a budget surplus, but fails to recognize the harm protracted in the process. The result is higher overall healthcare costs, as millions of Floridians who cannot afford to buy their own insurance, continue to be ineligible for Medicaid. Inefficient delivery of services is not addressed, impoverished individuals, children and entire families negatively impacted, along with more than one million disabled American’s, military servicemen and women recipients of VA medical care notwithstanding.
As a resident of Florida, (and permanently disabled American citizen), I am continually reminded of these words, spoken by U.S. Sen. Bernie Sanders, “We must not balance the budget on the backs of the most vulnerable people in our country.”
- [Author’s note: Part II in this series will be a singular “personal” account. Many states in addition to Florida have these same problems; Part III will expand accordingly. Focus shifting to the nation as a whole].
Disabled activist Jay H. Berman is the author of “Jays Jewels.” Due to severity of illness, he is an infrequent contributor to Thepoliticus.com, buzzfeed.com and here at the dailykos.com/Community. His short stories appear in Chicken Soup for the Soul. Questions, comments, and concerns are always welcome. Send your correspondence to jaysjewels2015@gmail.com or use links when provided by a particular website. You can follow Jay on twitter @BermanJ1
References:
http://www.floridahealth.gov
http://www.floridahealth.gov/...
www.MyFloridaEQRO.com
South Florida Community Care Network www.sfccn.org
PBS http://www.wpbt2.org
Miami Herald
Orlando Sentinel
Tampa Tribune
Florida Times-Union