So you want single payer? Medicare has 375,000 case appeals backlog

posted at 5:21 pm on March 19, 2014 by Bruce McQuain

And that sort of a backlog has Democrats worried. POLITICO brings us up to date:

Rep. Jim McDermott (D-Wash.) is sounding the alarm this morning about a massive backlog within the Office of Medicare Hearings and Appeals. The 357,000-appeal clog delays providers from having their cases heard for longer than two years, McDermott noted in a letter to HHS Secretary Kathleen Sebelius. ” “The agencies must review their administrative procedures and act now to protect seniors who are struggling to get Medicare payment appeals addressed,” he wrote. He argued that problems with recovery auditors have been identified as the leading cause of the backlog.

McDermott’s letter in full can be found here. This sort of a problem is also visible in another government run health care system. VA currently has almost 400,000 disability claims pending. It claims to be on track to erase that in 2015, but observers are skeptical of that claim.  While it claims to have shed 200,000 previously backloged claims, new claim backlog numbers continue to rise.

The fact is, both of these programs are bureaucratic nightmares. Reading McDermott’s letter (he is the ranking member on the Ways and Means Subcommittee on Health), it is clear that the system in place is both inadequate and ineffective. It is also clear that it is subject to micro-managing by Congress, especially Democrats who are more and more worried about the impact of health care problems on their re-election prospects this November.

The bigger picture, however, is this is what “single payer” would look like, most likely at its best.  2 year waits for an appeal process.  As McDermott notes, that’s a long time for a system designed to care for the elderly.  Some may not survive the process and many are on fixed incomes.  That and the fact that providers shouldn’t have to wait that long for resolution either.  If it were a private insurance entity taking this time, they’d likely not be in business long as customers would endeavor to find a provider which was much more efficient in processing appeals.  That’s just a few of the benefits provided by incentive, competition and a profit motive.  Government bureaucracies, of course, aren’t motivated by any of those factors.  And this is the result.

Make no mistake, there are a large contingent of Democrats who would love to move us to a single payer system.  Fair warning – this is a mild example of what the party which can’t even build a functioning website in 2014 would inflict on the citizens of this country.

~McQ


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it is subject to micro-managing by Congress, especially Democrats

Some may not survive the process

These are FEATURES not bugs of course!

geojed on March 19, 2014 at 5:26 PM

Medicare has always had the highest claims rejection rate, highest reported fraud rate, and poorest claims adjudication process of any insurer in the US.

Zomcon JEM on March 19, 2014 at 5:27 PM

The bigger picture, however, is this is what “single payer” would look like, most likely at its best. 2 year waits for an appeal process. As McDermott notes, that’s a long time for a system designed to care for the elderly. Some may not survive the process and many are on fixed incomes. That and the fact that providers shouldn’t have to wait that long for resolution either.

This is exactly why I lost my job in the healthcare industry two months ago. Medicare reimbursement is crappy, and our system has a meeting once a week called MBE – Medicare Break Even, where the powers to be make financial decisions based on Medicare reimbursement.

And with obaka non-care hitting the industry, it’s only going to get worse. Presently, they aren’t cutting direct care professionals but eventually they will.

ladyingray on March 19, 2014 at 5:31 PM

…can’t wait till everyone is involved!

KOOLAID2 on March 19, 2014 at 5:31 PM

In the old days, if you had a beef with your insurer or Dr you could turn to courts or government.

In the future. No recourse.

Just don’t get sick.

Thanks Democrats.

forest on March 19, 2014 at 5:31 PM

DO what the VA did…delete the records. No records, no backlog!

tdarrington on March 19, 2014 at 5:34 PM

If they approve every appeal there won’t be a backlog, I can’t believe Dims haven’t thought of that.

Sven on March 19, 2014 at 5:35 PM

What happens when there is no competition??

CW on March 19, 2014 at 5:38 PM

Under single payer, there would be a panel of political appointees. This panel would decide, on a blanket bases, who does, or does not receive treatment. They would establish guidelines such as Smokers do not get coronary bypasses. Over 80 do not get knee replacements. Over 75 does not receive cancer treatment. Under 18 months does not get intensive care or or cardiac surgery.

Death panel? No…..

tdarrington on March 19, 2014 at 5:39 PM

One of the things I dislike about the HA commenting system is the inability to edit posts.

*basis not bases

tdarrington on March 19, 2014 at 5:40 PM

Make no mistake, there are a large contingent of Democrats who would love to move us to a single payer system. Fair warning – this is a mild example of what the party which can’t even build a functioning website in 2014 would inflict on the citizens of this country.

Yes, but this time it’ll be different, you’ll see! /national socialist left

DinaRehn on March 19, 2014 at 5:40 PM

REPUBLICANS DIE QUICKLY!!! I AM ALAN GRAYSON, HEAR ME ROAR!!!

22044 on March 19, 2014 at 5:41 PM

One of the things I dislike about the HA commenting system is the inability to edit posts.

*basis not bases

tdarrington on March 19, 2014 at 5:40 PM

Heh.. that’s one of the only advantages to Disqus.

But it’s not worth it when you counter-balance it with all of it’s other issues.

DinaRehn on March 19, 2014 at 5:43 PM

REPUBLICANS DIE QUICKLY!!! I AM ALAN GRAYSON, HEAR MY WIFE CRY IN PAIN AS I THROW HER TO THE FLOOR!!!

FIFY

vityas on March 19, 2014 at 5:45 PM

CW on March 19, 2014 at 5:38 PM

SinglePlayer?

Bmore on March 19, 2014 at 5:46 PM

whatever, and the politically connected go to the head of the line.

rob verdi on March 19, 2014 at 5:46 PM

FIFY

vityas on March 19, 2014 at 5:45 PM

Heh, thought of that.

22044 on March 19, 2014 at 5:47 PM

What happens when there is no competition??

CW on March 19, 2014 at 5:38 PM

That means everything will be wonderful without people have to compete with each other.

That’s means they can work in harmony and peace and tranquility. /sarc.

And besides, it’ll be much better than the ACA that the GOP foisted on everyone..

DinaRehn on March 19, 2014 at 5:48 PM

Hey, how about we include in that count (a) people who didn’t appeal because they knew it was futile (past appeal experience? M.D. discouragement?) and (b) people who dropped their appeal because they decided to focus on getting well instead of fighting the government; and (c) people who died because they could not afford nor obtain the medical care they needed to stay alive to actually appeal the decision?

Statistics.

Lance Corvette on March 19, 2014 at 5:52 PM

While it claims to have shed 200,000 previously backloged claims, new claim backlog numbers continue to rise.

Shed? That’s a pretty polite term. How about deleted?

http://dailycaller.com/2014/02/28/new-evidence-that-the-department-of-veterans-affairs-deleted-neccessary-medical-requests-from-veterans/

Oxymoron on March 19, 2014 at 5:55 PM

God, she’s one ugly broad.

lostmotherland on February 26, 2014 at 4:09 PM

Always a class act.

slickwillie2001 on March 19, 2014 at 6:03 PM

Rep. Jim McDermott (D-Wash.) is sounding the alarm this morning about a massive backlog within the Office of Medicare Hearings and Appeals.

This is the idiot that complained the FBI’s list of most wanted terrorists didn’t reflect greater diversity. You know, less Muslimy. Too bad this corrupt terrorist-loving bastard doesn’t care about working Americans being beat silly having to pay for thge worthless parasites on Medicaid, food stamps, and all the rest of the package for being a drain on society.

Happy Nomad on March 19, 2014 at 6:06 PM

Under single payer, there would be a panel of political appointees. This panel would decide, on a blanket bases, who does, or does not receive treatment. They would establish guidelines such as Smokers do not get coronary bypasses. Over 80 do not get knee replacements. Over 75 does not receive cancer treatment. Under 18 months does not get intensive care or or cardiac surgery.

Death panel? No…..

tdarrington on March 19, 2014 at 5:39 PM

Members of the TEA Party don’t get kidneys; anyone with a Carry Card doesn’t get chemotherapy, etc. Yeah, things like that.

Oh heckfire, let’s just rehire Lois Lerner and put her in charge of the Death Panel.

slickwillie2001 on March 19, 2014 at 6:09 PM

Heh, thought of that.

22044 on March 19, 2014 at 5:47 PM

We have to hang it around his neck and mention it every single time his name appears. Thanks for the tips, Saul!

vityas on March 19, 2014 at 6:22 PM

Bernie Sanders wants it. Lyndon LaRouche wants it. George Soros wants it. I can’t for the life of me fathom why, but there you go.

gryphon202 on March 19, 2014 at 6:29 PM

I think the democrats should put their money where their mouth is and the DNC should be the single payer.

Flange on March 19, 2014 at 6:31 PM

Look, I know there are some good, honest federal employees out there but the simple fact is, most just don’t care.

BKeyser on March 19, 2014 at 6:46 PM

Service-to-pay lag time has been approximately 2 years for a while now.

Just wait until ICD-10 become mandatory as of Oct’14. MACs are predicting 300% increase in claim returns.

lineholder on March 19, 2014 at 6:57 PM

Rep. Jim McDermott (D-Wash.) is sounding the alarm this morning

Gee, that sounds eerily similar to Killary ‘sounding the alarm’ {“we need to watch them”.} about Russia. Months late and ZERO foresight/c-i-c credentials/answers — yet, millions will vote for the “I’m DUE” B/S.

And with obaka non-care hitting the industry, it’s only going to get worse. Presently, they aren’t cutting direct care professionals but eventually they will.

ladyingray on March 19, 2014 at 5:31 PM

Unfortunately, this is what our future looks like. It’s precisely why we won’t enroll in any damn thing. I’m astonished of those who do, frankly.

Thus…

Mr. Obama — if you like your health care overhaul, you can damn well keep your hellkare overhaul. I surely won’t buy into it.

I’ll pay cash, see the doctors I choose, and oh yeah, take your administration to court if you’ve a problem with that.

jersey taxpayer on March 19, 2014 at 7:05 PM

To Dems, a ‘single payer system’ is registered ‘pubs paying for everyone else. Dems love the ‘disability’ roles because most of them are mentally disabled or drug addicts.

vnvet on March 19, 2014 at 7:32 PM

The only solution is to fire all the useless unionized HHS workers and outsource customer service, probably to India. It will be cheaper, and better service.

Adjoran on March 20, 2014 at 12:33 AM