Lawmakers warn the WISeR model would replicate the worst abuses of Medicare Advantage, shifting life-or-death decisions to algorithms and for-profit contractors.
They should just pay companies or hire retired physicians to review utilization for appropriateness. Not have companies making money by denying services. As with most government contracts, smells like some inside scheme to funnel money to someone with connections.
In the early 90's my employer signed us up for a "managed care" health plan. Under their care they saw me appt. after appt. and so on, never running the appropriate tests for my condition, which I informed them of at every visit, and of course no referral/permission to see the specialist I knew I needed. They said I was just unwell because of my condition(!) Finally I became too ill to work. I sought outside services at my personal expense and after tests were run, was ordered to drop everything and check into the hospital where they were affiliated . I was in renal insufficiency, facing a possible transplant, dialysis or an experimental chemo program (long story.) The out of plan specialist was very angry and said earlier proper testing and meds likely would've avoided the state they'd let me lapse into. I had to threaten to sue to get the so-called insurance company to pay for my 8-day hospitalization and two years of a chemo treatment that worked, thankfully (but I was "so far gone," the docs who basically saved me had not been optimistic.} Fast forward to the time to select a Medicare plan and there was "no way" I could risk getting into anything that even vaguely looked like managed care, requiring preauthorizations, etc. This is the reason many folks like me choose original Medicare plus a supplement, even if it's a struggle financially. And we're the ones most likely to be harmed if they start contracting out for outsiders (or AI programs? OMG) because most of us fall outside the "standards of care."
Our government (both sides of the aisle) has long since failed us healthcare-wise. They forget that they SHOULD be working for us, not the other way around. Living overseas a few years back, people ex-U.S. can't fathom their government not taking care of health insurance. We should have had single-payer years ago.
I'm staring down not having health insurance next year for the first time in my life. As a single-person LLC, it's just not anywhere near in the realm of affordable in NYS and while I do ok most years, I could really use that subsidy, which I've never qualified for. And this is with working in healthcare for nearly 30 years and as a board certified patient advocate who knows how to get things done.
There is no reason to regulate corporations as they insert themselves into our health care. All that does is encourage them to game the system like they do the Tax Code. Regulating how corporations screw up Medicare just turns the insurance company lobbyists to nibble away at our care.
All that needs to happen here is keep the corporations out of our government benefits!!! End of story. This is one of the issues where I don't trust Democrats in Congress not to sell us down the river. It must be a litmus test in the Democratic primary elections.
I will write my Colorado Senators, again, asking them to support this. Both of them frequently talk about supporting health care reform, yet their Congressional records are sorely lacking.
Last line of the article sums it up “continued privatization of Medicare” which only causes suffering and only lines the pockets of corrupt insurance/middle men/politicians.
According to the neoliberal economics by which everything government has operated for the last 50 years, everything but what is necessary for defense of private property is to be handled not by government but by the “free market”. For those who support it, all that really matters is maximizing shareholder profits. You don’t achieve that by paying for anything.
Eliminate the massive administrative costs of denials, use AI to locate patterns of fraud and address, and honor the prescriptions of the licensed practitioners who examined the patient and worked with them directly to work out what is best for them. When denials are incentivized people will worsen or die before they have their needs met if they ever do. AI as second guesser of the face to face evaluation and decision by qualified LIPs is sick and inhumane. Who will be held responsible when you don’t get your home ventilator or the best medication you’ve bee prescribed? Force separation of practitioners from hospital and insurance employment and provide what is prescribed. The “evidence base” will never serve what is best for all as outliers fall out of the statistics provided by the “current” science. Our medicine is advanced compared to the past but archaic compared to the future. Never allowing innovation and creative prescribing for said outliers will not save money ultimately and will kill many. Let doctors doctor, prosecute fraudsters and patients will get the true precision medicine modern healthcare should be delivering.
I worry about the possibility that vendors would be paid based on care denied. This leads to inverse incentives. Perhaps if the goal is genuine prevention of fraud, CMS should base pay on a selected margin of error with yearly or biannual auditing to see if these programs are actually effective in their intent or another way for companies to benefit off taxpayer dime.
This is the reason I am NOT on Medicare Advantage
They should just pay companies or hire retired physicians to review utilization for appropriateness. Not have companies making money by denying services. As with most government contracts, smells like some inside scheme to funnel money to someone with connections.
In the early 90's my employer signed us up for a "managed care" health plan. Under their care they saw me appt. after appt. and so on, never running the appropriate tests for my condition, which I informed them of at every visit, and of course no referral/permission to see the specialist I knew I needed. They said I was just unwell because of my condition(!) Finally I became too ill to work. I sought outside services at my personal expense and after tests were run, was ordered to drop everything and check into the hospital where they were affiliated . I was in renal insufficiency, facing a possible transplant, dialysis or an experimental chemo program (long story.) The out of plan specialist was very angry and said earlier proper testing and meds likely would've avoided the state they'd let me lapse into. I had to threaten to sue to get the so-called insurance company to pay for my 8-day hospitalization and two years of a chemo treatment that worked, thankfully (but I was "so far gone," the docs who basically saved me had not been optimistic.} Fast forward to the time to select a Medicare plan and there was "no way" I could risk getting into anything that even vaguely looked like managed care, requiring preauthorizations, etc. This is the reason many folks like me choose original Medicare plus a supplement, even if it's a struggle financially. And we're the ones most likely to be harmed if they start contracting out for outsiders (or AI programs? OMG) because most of us fall outside the "standards of care."
Our government (both sides of the aisle) has long since failed us healthcare-wise. They forget that they SHOULD be working for us, not the other way around. Living overseas a few years back, people ex-U.S. can't fathom their government not taking care of health insurance. We should have had single-payer years ago.
I'm staring down not having health insurance next year for the first time in my life. As a single-person LLC, it's just not anywhere near in the realm of affordable in NYS and while I do ok most years, I could really use that subsidy, which I've never qualified for. And this is with working in healthcare for nearly 30 years and as a board certified patient advocate who knows how to get things done.
There is no reason to regulate corporations as they insert themselves into our health care. All that does is encourage them to game the system like they do the Tax Code. Regulating how corporations screw up Medicare just turns the insurance company lobbyists to nibble away at our care.
All that needs to happen here is keep the corporations out of our government benefits!!! End of story. This is one of the issues where I don't trust Democrats in Congress not to sell us down the river. It must be a litmus test in the Democratic primary elections.
I will write my Colorado Senators, again, asking them to support this. Both of them frequently talk about supporting health care reform, yet their Congressional records are sorely lacking.
Last line of the article sums it up “continued privatization of Medicare” which only causes suffering and only lines the pockets of corrupt insurance/middle men/politicians.
According to the neoliberal economics by which everything government has operated for the last 50 years, everything but what is necessary for defense of private property is to be handled not by government but by the “free market”. For those who support it, all that really matters is maximizing shareholder profits. You don’t achieve that by paying for anything.
Eliminate the massive administrative costs of denials, use AI to locate patterns of fraud and address, and honor the prescriptions of the licensed practitioners who examined the patient and worked with them directly to work out what is best for them. When denials are incentivized people will worsen or die before they have their needs met if they ever do. AI as second guesser of the face to face evaluation and decision by qualified LIPs is sick and inhumane. Who will be held responsible when you don’t get your home ventilator or the best medication you’ve bee prescribed? Force separation of practitioners from hospital and insurance employment and provide what is prescribed. The “evidence base” will never serve what is best for all as outliers fall out of the statistics provided by the “current” science. Our medicine is advanced compared to the past but archaic compared to the future. Never allowing innovation and creative prescribing for said outliers will not save money ultimately and will kill many. Let doctors doctor, prosecute fraudsters and patients will get the true precision medicine modern healthcare should be delivering.
AI cannot replace a persons heart in making decisions
I worry about the possibility that vendors would be paid based on care denied. This leads to inverse incentives. Perhaps if the goal is genuine prevention of fraud, CMS should base pay on a selected margin of error with yearly or biannual auditing to see if these programs are actually effective in their intent or another way for companies to benefit off taxpayer dime.
From wiser to operation southern spear seems criminal
#CRIMINAL
Everyone deserves smarter comfort, compassion and curative care.
Pass the Medicare for ALL Acts and we won’t have to fight at ALL.
These Acts were re-introduced to both houses April 29 this year.