December 1, 2007

Hillary’s ‘$50 Billion to Avoid Paying Claims’ Is a Claim Debunked

Journalism’s defenders often describe it as a profession or craft unto itself, and minimize the importance, or even sometimes the relevance, of subject matter expertise.

That lack of subject matter expertise, and the apparent unwillingness to seek out a source of that expertise when necessary, probably explain how a Hillary Clinton whopper has survived on the campaign trail for so long.

In a subscription-only op-ed in today’s Wall Street Journal (bolds are mine), Merrill Matthews of the Council for Affordable Health Insurance does the job that Old Media campaign chroniclers haven’t done:

Earlier this week, campaigning in New Hampshire, presidential candidate Hillary Clinton asserted that health insurance companies spend $50 billion to avoid paying claims. “This is all part of their business model,” she was quoted as saying. “This is how they make money, but it’s so bad for the rest of us. I say to them, use the $50 billion to actually take care of people.”

Statements like these raise real questions about Sen. Clinton’s grasp of the facts.

….. Currently, the private sector health insurance industry spends about $600 billion a year paying traditional health care claims for those under age 65. According to a major actuarial firm, the industry spends roughly $30 billion a year adjudicating those claims — not “denying” them, but evaluating and processing them. There doesn’t seem to be a solid number for the amount of claims actually denied, but several health actuaries estimate that amount to be around $3 billion.

Regardless of Mrs. Clinton’s insinuations, however, the money spent evaluating claims is not wasted, and would not be better spent “taking care of people.”

An Associated Press report by Holly Ramer indicates that this is not the first time Mrs. Clinton has filed this bogus claim with America’s voters (bold is mine):

Clinton repeated a statistic she cites often—contending that insurance companies spend $50 billion a year figuring out ways to avoid paying claims.

There’s no way to get from Mr. Matthews’ stats to anywhere in the neighborhood of Mrs. Clinton’s $50 billion figure. There’s also no way that someone with a background in financial analysis would have failed to scrutinize her claim for as long as Old Media’s journalism “professionals” have.

For an object lesson in the truth of the last excerpted paragraph from Mr. Mathews above, and in how misguided and numerically challenged Mrs. Clinton is, consider that the estimated fraud rate in Medicare alone in 2001 was 6.3% (scroll down to Section 1.2 at the link). As to Medicaid — yikes. In 2005, the New York Times reported that Medicaid fraud in the Empire State alone “May Reach into (the) Billions.”

How rampant fraud against Medicaid and Medicare has become, and why there’s little reason to believe that the somewhat dated statistics just cited have improved, is exemplified in this anecdote Mr. Matthews recites later in his column (bold is mine):

Last summer, the Centers for Medicare and Medicaid Services (CMS), the agency that administers the country’s two largest insurance programs, announced a pilot program to investigate fraud in the medical device industry. Law enforcement officials, for example, visited 1,600 businesses in Miami that were billing Medicare for services. One-third of them didn’t even exist, yet they billed Medicare for $237 million in the previous year. The government has now charged 120 people in 74 cases, and Medicare filings in the area are down by $1.4 billion from last year.

Questions:

  • So how many years were taxpayers funding over $1 billion annually in fraud — in just one metro area — before the arrests?
  • If this is a “pilot” program, how much fraud hasn’t been caught in the rest of the country?
  • Does anyone really think that a private insurance company competing against other companies would allow itself to be bilked to this extent?

Finally, will anyone in the press either call Mrs. Clinton on her “$50 billion to avoid paying claims” assertion (regardless of whether she continues to make it), or note its disappearance, if that indeed happens, as a result of Mr. Matthews’ column?

Cross-posted at NewsBusters.org.

Positivity: Just doing his job — Officer with LPD intervenes to stop teenage girl from jumping off overpass

Filed under: Positivity — Tom @ 6:54 am

From Lufkin, Texas:

Sunday, November 25, 2007

n the bright sunshine of the day, Lufkin can seem like a beautiful, friendly town with little or nothing to fear, but not many know what goes on after dark when most families are safe inside the warmth of their homes.

Lufkin police officers, however, have seen the darker side of Lufkin and do their best to fight it, but sometimes what they’re fighting is not a physical enemy but inner demons. One Lufkin officer recently found himself in that situation when he was engaged in a fight to save the life of a teenage girl.

Lufkin police officer Kevin Jackson responded to the call concerning a 15-year-old girl walking along the U.S. 59 North overpass that night with the intent of checking up on her and making sure she was OK. Jackson didn’t realize what seemed like an ordinary late-night call would quickly turn into a life-threatening situation.

While patrolling Winston Park, a call from a concerned citizen came in over the radio and Jackson headed out to talk to the girl. After parking and turning on his flashers he began to approach her, but realized the frightened girl planned on jumping off the overpass when she warned him not to come any closer.

Remaining at least six feet away from the girl, Jackson began to talk with her, trying to coax her away from the overpass and calm her down. Although all police officers receive brief training on what to do in situations of this kind, normally officers are only expected to use this training until a negotiator who is trained in how to handle possible suicide threats can be located and arrive on scene.

This particular night, however, Jackson was left alone with the girl for half an hour while the police department attempted to locate someone trained for this type of situation. By the time one was located and sent out, it was too late and Jackson was forced into action.

When the girl began climbing over the wall Jackson knew he couldn’t stand by and wait any longer.

“I was over there and had her in my arms before I even knew what was happening,” Jackson said. …..

Go here for the rest of the story.