What Is Medical Fraud, Waste And Abuse?

Today’s Weekly Standard posted an article by Stanley Goldfarb, associate dean of clinical education at the University of Pennsylvania School of Medicine and a nephrologist.  Mr. Goldfarb points out that President Obama plans to pay for a large part of his healthcare proposal by getting rid of medical fraud, waste, and abuse.  The question then becomes, what is fraud, waste, and abuse.

There is general agreement that healthcare in America is expensive.  But the dissatisfaction with healthcare in America seems to be a general rather than a specific thing–the people who express dissatisfaction with our healthcare system generally are happy with their current health insurance.  So what is driving the movement to change it?

Mr. Goldfarb points out that our healthcare is expensive because it is easily accessible and because medical care is expensive in our country. 

The article points out:

“What has been called “waste and abuse”(two parts of the iconic but never repaired problem of “waste, fraud, and abuse”) is actually another term for the wide access to technology and advanced care that Americans have come to expect from their encounters with the health care system. Certainly “fraud” should be eliminated. Medicare does a very poor job of this as has been well documented. Its low administrative costs are partly the result of its meager efforts at detecting fraud. However, one person’s “waste and abuse” is another’s piece of mind because an MRI scan or a CT scan has definitively ruled out a tumor when it was an unlikely but possible diagnosis and could simply have been followed along for several months to observe the late outcome.”

There is a suggestion that we consider a person’s age when we examine our treatment options.  It is interesting that the cost of a cardiac bypass in Canada is nearly twice the cost of a bypass in America.  The average hospital stay in Canada is 20 percent longer than the average hospital stay in America.

The thing that is being overlooked in the healthcare debate is the role that free enterprise plays in scientific progress.  One of the reasons we have the medical breakthroughs in this country that we do is that scientific discovery in America is profitable.  Whether we like it or not, money is a motivator.  There is nothing wrong with people making profits in medical care or anywhere else.  That has been a part of our country since its founding.

One last thought, if the current healthcare proposals are so wonderful, why is Congress opting out of being part of any program that it enacts?