> The program succeeded despite corruption. The Times of India recently reported that an audit had found clearly fraudulent payments — including some to a 60-year-old woman registered as having been pregnant five times in 10 months.
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.
In the US there have been recent papers discussing how roughly 10% of the medicare budget goes to people who live less than a year, with the implication that perhaps we shouldn't be spending so much on people with so little time.
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.
Fraud should be a concern, however at some points, the attempts to eliminate it outweigh (in terms of cost and effort) the effect of its existence. At that point it becomes a morality issue rather than a practical one.
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).
I would expect it to be the reverse: there is no incentive for government programs to root out fraud, if they fall short, they just raise taxes. For private companies - if they are being defrauded, it directly affects their bottom line, and the bottom line of their executives (who would be VERY interested to make sure bonuses increase).
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.
> 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.
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).
I don't mean untenable as in it should be shut down, but untenable in that people are about to start having treatment withheld do to lack of funds. Given that medicare is already considered simply a supplemental insurance program, there are already people suffering from a lack of available resources.
As for trusting the CBO, if you can't trust their accounting, there's literally no one else you could trust.
Exactly. Fraud is terrible in both cases, and should be a known factor so that we can evaluate how to procede.
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.
I think you've laid out why corruption and fraud should always be a high priority to fight even when they are a low cost. Fraud is corrosive, and when left unchecked will expand. If a dentist can get away with 50 fake treatments at a nursing home one year, why would he shoot for 100 fake treatments the next, thus doubling his portion of the fraud.
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?
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.
Medicare's budget is around ~$600 billion. It is highly unlikely that the CBO, FBI, DHS, and IRS spend $60 billion looking into potential medicare fraud given how many of those just named organizations could fit into a $60 billion budget (3 of the 4).
Strangely, you left out of that list of organization the main one that investigates Medicare fraud (and the one whose expenses in doing so are included in Medicare's budget), to wit, HHS, the agency that actually administers Medicare.
(Three of the Four agencies you mentioned don't even investigate Medicare fraud, except incidentally.)
Those organizations do investigate medicare fraud with the HHS. And do you really believe that more than $60 billion is being spent investigating? That would make the auditing organization roughly 6 times as big as the IRS.
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.
> And do you really believe that more than $60 billion is being spent investigating?
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'm uncomfortable with the meme of corruption in public welfare programs
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.
This is very cool.
I remember as a kid every time I had a cut or scrape my parents would rack their brains for the date of the last 'booster shot'. I was also told cautionary tales of tetanus seizures (?) that could break major bones because of the stress of the convulsion.
>India has reduced cases to less than one per 1,000 live births, which the W.H.O. considers “elimination as a public health problem."
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?
I'm not sure if you're implying that the population growth rate of India is very high, but if you are that's not true anymore. It's actually very close to replacement levels with parts of India where it's actually below replacement levels [1]
This really bothers me. Any ideas to cure this issue with local/government support. I would like to explore more about current solutions in terms of what worked and what not worked so far (with numbers, of course).
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.
This was also a problem among the colonial militia camped outside Boston in 1775. It was difficult to solve because people don't like being told where to shit by officers they elected a few weeks ago.
No people don't say the same thing about California.
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.
Yes. I live in downtown San Jose, and well-dressed folks (ie clearly not homeless) do it outside the apartment community I live in. I've taken pictures a couple of times, but never sent them to the cops for fear of ruining their lives. (I've heard of people getting charged with "lewd" behavior and being put on sex offenders lists)
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.