Rick Scott Is Enraged At "Liberals" Trying To Steal Florida Senate Election? Gimme An Effin' Break!

Asswit and sleaze criminal FLA governor Rick Scott has some nerve calling Senate voting counts an "ethical violation".  

The scenes of Rick Scott - Florida gubernator - going off half cocked and belching he will not allow "liberals to steal votes"-   is choice.  This SOB has been in the habit of sophisticated voter suppression for years in the Sunshine state. Recall, for example, the ungodly lines caused by his deliberate inefficiency and fell plan to limit voting 6 years ago, i.e.

Scene at one of the polling places in Florida in 2012, compliments of Gov. Rick Scott who cut early voting days by half. And now this asswipe vermin has the nerve to bitch about liberals stealing votes?

As I noted in a post from Nov. 4 that year:

"Scott did not do diddly about extending early voting times, thereby causing unconscionable voting line waits of up to 6 HOURS as reported in The Miami Herald. Now, Scott has forced the hand of the Florida Democratic Party to file a lawsuit early today to force Scott and the state to extend early voting. This followed a stream of complaints from voters (mostly African-American, Hispanic) who reported voting line waits of up to SEVEN hours Saturday. It also followed an ardent request on Thursday  from both the Florida Democratic Party and the League of Women voters to extend early voting hours. But Scott, unreconstructed asshole of the month that he is (maybe asshole of the year) has done neither.
As a number of outside observers have put it: "The extraordinarily long lines and extreme delays created have unjustifiably burdened the right to vote"

Let's also be clear Scott is a degenerate scam artist, con man and  criminal. Which too many Florida voters seemed to ignore - or were ignorant about - when they put this turd into office. 

To jog memories, his healthcare outfit Columbia HCA was once found guilty of overcharging Medicare over $600m while Scott was CEO. Scott himself admitted "As I have said repeatedly Columbia HA made mistakes, and I take responsibility for what happened on my watch as CEO."  What were those 'mistakes'? The Miami Herald in an expose of Scott's Columbia HCA and the aftermath (June 27, 2010) noted, despite Scott denying that he knew frauds were taking place:

"However, federal investigators found that Scott took part in business practices at Columbia/HCA that were later found to be illegal -- specifically, that Scott and other executives offered financial incentives to doctors in exchange for patient referrals, in violation of federal law, according to lawsuits the Justice Department filed against the company in 2001."

The doctor payments were among 10 different kinds of fraud identified by the Justice Department in its 10-year probe of the company, records show. Three years after Scott left Columbia HCA, the company admitted wrongdoing, pleading guilty to 14 felonies -- most committed during Scott's tenure -- in addition to paying two sets of fines totaling $1.7 billion..."

This degenerate, (like Calif. Rep Duncan Hunter very soon) ought to have been a jailbird not a sitting governor of a major state.

No one ought to take Scott's barking (or Trump's, obviously) seriously given his background. Every vote, including absentee ballots and provisional ballots, needs to be counted - not dismissed or ignored. Not to do so, to capitulate to a maggot like Rick Scott and his gang of thugs, is to cause citizens to lose confidence in the electoral process. Thereby democracy, and our Republic, is imperiled. Because if citizens are disallowed the fair expression of their ballot, they will resort to other less peaceful means.

Let the vote counting continue in Dade and Broward counties, unlike in 2000 when a Reeptard mob besieged the counting venue, e.g.

Steven Rosenfeld

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2018 Elections

Republican Goons Are Trying to Pull Another Brooks Brothers Riot in Florida’s Recount—But So Far They Can’t Get Inside the Door

Scott then, can shut his mutt mouth, and keep out of the Democratic process, as well as his goon brigade.

See also:

Sonali Kolhatkar

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Election Integrity

Billionaires, Not Voters, Are Deciding Elections

AND:

Georgia Voter Purge Victim: “This Was a Strategy From Kemp”

What's Driving The Enormous Medicare Fraud?

Comparison of Medicare fraud losses to other expenses in the federal budget (From AARP Bulletin, April, p. 10-11)

In my book, 'The Elements Of The Corporatocracy',   I noted that when a genuine social insurance program exists in a predatory capitalist society it is in constant peril from parasites, scammers, con men, assorted grifters and corporate predators.  Thus, it is no surprise that both Social Security as well as Medicare, the two most viable current social insurance programs, are under sustained attack.

In the case of the first, we learned from one website ('Lifelock'):

"There are a lot of ways to commit Social Security fraud. Not all of them are obvious. Fraud often occurs anytime someone receives Social Security payments they’re not entitled to. The Office of the Inspector General of the Social Security Administration (SSA) cites a few common examples:

• Hiding work activity while receiving disability benefits.
• Getting Social Security benefits for a child not under your care.
• Failing to let the SSA know that a beneficiary has died and continuing to receive and cash the checks sent to the deceased.

Consider this: About 6.5 million people who had active Social Security numbers in 2015 appeared to be at least 112 years old, a government audit found. The real number of living Americans more than 112 years old is closer to five."

In the case of Social Security the yearly losses from fraud are estimated to be in the billions of dollars. But this may still be an order of magnitude less than the fraud losses ($60 b) exacted on Medicare, as reported in the most recent AARP Bulletin ('Medicare Under Assault', April, p. 10)  Reading through the assorted strategies vermin use to defraud the program is enough to make a citizen vomit.  Probably the most odious, in my opinion (p. 20),  was the "recruiting" of homeless people to create fake patients.  These hapless pawns are then trotted into doctors' offices to be approved for services and the physicians themselves may or may not be in on the scheme  In return for signing off on falsified documents, the phony patient is paid a small amount (e.g. $20- 30) for showing expensive care never delivered.  As the segment notes: "Homeless shelters are fertile ground for recruiters involved in this type of fraud."

Well, I wouldn't go so far as to call them "recruiters" - they are bugs, vermin - who merit extermination, just like roaches.  Am I being too "hard", too "judgmental", too "inhumane"? Nope, I am calling it exactly as I see it: anyone who preys on a homeless person, giving him or her chump change to help undermine a health insurance system that serves tens of millions,  is a feral rat who deserves to be put down.   Let's further note, for emphasis, all these modes of fraud undermine the ability of real patients to find treatment - which may lower reimbursement rates for doctors and facilities - and even push some providers to stop accepting Medicare. 

The assorted other modes of  Medicare fraud include:

1) Medical identity theft:

Here, the scammer or thief manages to get hold of your Medicare card or the beneficiary number.  This can then be used to access medical services under your name - say to get treatment, devices or medicines. This interference can also impinge on your medical care (say if the wrong treatment is administered because providers believe you are the frauduter)

2) Upcharging:

This is also known as "up code billing" and it occurs whenever Medicare is billed for a more expensive device or procedure than the one you actually received.  This is why seniors need to be vigilant in checking Medicare statements, especially the CMS Summary sheets. Any discrepancy noted ought to be followed up by calling the doctor to rule out an innocent billing code error.

3) Phantom billing - double dipping:

These fraudulent tactics would also show up on one's Medicare statements.  "Phantom billing" is charging Medicare for services not delivered. Double dipping is filing duplicate claims for one service or procedure. If not caught and rectified they can hurt futur health coverage.

4) Fake freebies:

These are used by scammers to sucker the unwary into receiving devices or services,  e.g. wheel chairs, walkers, back braces you may not need. They're usually offered at "no cost to you"  but Medicare is billed for them. Often they are inferior products, e.g. walkers that collapse.

5) Prescription fraud:

In this fraud, Medicare crooks take your Medicare number and use it to fill prescriptions, e..g. for hydrocodone, then sell them on the black market.  Very often people discovere they have become a victim when their prescriptions are denied.

It follows from all that's been discussed that eternal vigilance has to be the motto of every Medicare recipient. It is in the self-interest of all of us to look over every statement carefully, and guard our Medicare cards and numbers as zealously as we would our car or house keys.

Spending Too Much On The Elderly? Absolutely Not!

Affirmation: Medicare and Social Security are the bedrock programs of American liberalism.

Question:

 "Then why do so many liberals consider it taboo to even suggest adjusting these systems to ensure their sustainability for future generations?"

Response: Liberals emphatically do not regard it as "taboo" to "adjust" these systems so long as that does not mean outright cuts - which serve no one's purpose. In addition, adjustments have already been implemented including ACA future budgetary fixes to "means test" more middle class seniors in Medicare as well as moving greater medical burdens to individuals, including: higher medical co-pays, higher premiums, etc.

This response is needed given 'We The People Live'  host Josh Zepps' claim of  "progressive orthodoxy" (e.g. to fix Medicare especially)  in an original Salon.com video filmed at the Democratic National Convention. (You can google Josh Zepps video at DNC to pick it up)

Zepps claims that America’s resource allocation is "in need of a serious reexamination"  This is also a theme that's been recycled in a number of media outlets including The Wall Street Journal, The Financial Times and New York Times.  The core argument or thread running through all is: Young workers, families are getting the shaft as more and more resources, funds are funneled to the elderly in social programs.

What is Zepps further justification? He argues:

“Medicare costs more than $500 billion per annum, 30 percent of which is spent on the five percent of beneficiaries who die each year. One third of that is spent on the final month of life. The final month. I mean, you want to talk about priorities, let’s just take that one datum. More than $50 million each year spent on the final month of life.”

Let's examine this at some length. First, Medicare costs are exploding, but a large part of that is due to a program called "Medicare Advantage" (MA) which was created by BushCO and the Republicans with their Medicare Modernization Act of 2003. It basically confected a privatized form of Medicare ("Part C"), with the express purpose of bleeding regular (traditional) Medicare into insolvency by blowing up to $20-25 billion or more a year (based on gamed "risk scores")  and funneling much of it from the older program. Unless this (MA) program is killed (the sooner the better),  no other cuts will matter - because MA will metastasize to the point every $ is swallowed up.. For those who wish to read the details on why MA is hurling Medicare into insolvency check out the content in these links:

https://www.publicintegrity.org/2014/06/04/14840/why-medicare-advantage-costs-taxpayers-billions-more-it-should

And:  https://www.medicareresources.org/blog/2015/11/04/is-medicare-on-the-brink-of-insolvency/

Zepps is correct about the magnitude of Medicare spending in the final months of life. But I believe that is the fault of the medical establishment and its specialist practitioners. This is based on not leveling with severely infirm elderly people regarding limits of additional treatments and their real costs v. benefits.. Missing in most treatment discussions, for example, is any reference to quality of life . The focus is exclusively on quantity and that also often comes with huge medical costs. Missing "the talk" is it any wonder older patients tend to believe medical treatments can offer curative solutions rather than only palliative ones?

In my own case I already mentioned my prostate cancer which has now recurred. I also discussed some of the many treatment options, e.g .

http://brane-space.blogspot.com/2016/07/no-you-dont-have-to-accept-further.html

and:

http://brane-space.blogspot.com/2016/07/why-do-so-many-men-opt-for-castration.html

I have been immersed in research on treatment options and what I have found thus far isn't encouraging, including:

1) Cancer experts themselves can't agree on which primary treatment is best.

2) The same experts (oncologists) can't agree on which ("salvage") treatment for recurrent disease is best, or when to start it.

3) Most agree that if a guy has recurrent disease and a biopsy shows it has spread to the bones ("bone mets"), his days are basically numbered - though certain treatments (e.g. hormone) will allow some limited life extension.

The question then becomes: How much life extension? While I don't want to croak prematurely and deprive my many readers of my blog posts and insights, I also recognize that once I hit a certain phase in possible further treatment (called "castration resistance") it is basically time to pack it in. Game over. Finito. Some will yelp: "You can't give up or quit!" but the flip side of that is Zepps' point that we spend excessively to stay alive in the last months when all the pointers show we ought to be going to hospice care and telling the medical industrial complex 'Enough!'

The problem is that the medical complex doesn't want to quit since they see it as a renunciation of their practice to fight for life all costs.  Hence, they regard the palliative option as failure, even though added treatments may only marginally increase life - but usually at the expense of life quality. (E.g. hormone treatments for advanced prostate cancer can increase life by 1-3 years but usually with side effects including: memory loss, depression, diabetes, cardiovascular problems, enlarged and tender breasts, shrunken testicles, zero libido and hot flashes such as suffered by menopausal females.).

So in this I do side with Zepps. The tricky question for him (and other would be "adjusters")  is: WHO assumes responsibility for telling an older patient his or her days are numbered and they need to just go gently into that good night? Medicare now has a special program where end of life issues are addressed, but as yet too few patients are getting these consultations, often because their nervous PCPs don't refer them.

I encountered this when I told my own PCP back in June - after the latest PSA test came back at 6.0 - that I planned to do nothing more. I wanted no urologist referrals, no more biopsies, no more anything.  Her reaction? She wouldn't hear of it. Short of strapping me down to the exam table and coercing me, she said I HAD to see the urologist and listen to what he said concerning the latest MRI results  So, while my inclination was to halt all further medical involvement, she wasn't going to play along.  In effect, she intended to add more medical intervention and expenses to my Medicare account. .(Mind you, her adamant stance could well be traced to our litigious culture, especially relative to  medical practitioners, whom we often hold to absurd standards of action and  judgment.)

Same thing with an oncology RN at UCSF who phoned me up after the MRI and stated I "sounded too young" not to accept brachytherapy salvage therapy, i.e. instead of possibly dying at 74 or 75.  When I asked about the side effects she kind of dodged the extreme "level III toxic comorbidities" which included loss of bowel and urinary control and extreme pain with every excretion - thanks to the radiation (36 Gy delivered in two fractional treatments a week apart - under general anesthesia)

How does Zepps propose we deal with  such situations? Clearly, his superficial call for simple "adjustments" shows he doesn't want to get "in the weeds".  But at the same time, you can't just uniformly cut $50b from Medicare and tell sick oldsters to "sink or swim".  And as I noted, Medicare already has the end of life palliative care option in the program (as part of the ACA), ostensibly to limit end of life expenses. But how does it get maximized without resorting to draconian cuts? The devil, as always, is in the details.

Zepps adds:

"The left needs to reckon with the uncomfortable truth that what this country is doing is sapping the vitality of the young and pumping it into the elderly,” he says. “It is a gigantic resources Hoover from young professionals into old retirees.”

But as I pointed out the ball is not in the "Left's" court, it is really in the province and court of the medical establishment.  It is also in the court of the craven politicians who are not prepared to tell Medicare Advantage folks that they need to come out of that too expensive program and go into regular Medicare. Their MA is costing taxpayers way too much each year.

First, if Medicare Advantage had been mothballed, as Obama originally vowed to do back in 2011-12,  we would already have seen more than $75 b saved over the past 4 years. Second, if that Part D Medicare drug plan had been altered to allow bargaining for lowest cost prescription meds like the VA, another $200b would have been saved. (Especially in the wake of the news that costs for catastrophic disease drug prescriptions (like for Hepatitis C) have gone up 85% since 2013.

Third, if the medical establishment more faithfully implemented end of life palliative care conversations with patients - via the Medicare program for that purpose - we'd save a lot of that $50b used in the last months of life. But this portends a massive change in perception by that same medical establishment, to wit, maybe they themselves need retraining especially in the nature of palliative care. This latter as opposed to pushing new and expensive treatments that only marginally improve life extension.

How then do we convince patients as well as the medical experts that end of life quality is as important as quantity?

When Zepps can answer these difficult questions, as opposed to merely interjecting "adjustments" (read cuts) for the sake of cuts, we would be more likely to take his arguments seriously.  It is evident to this observer that Zepps, like so many of his younger cohort, is too ready to blame oldsters for what are really faults of the health system we have. That includes the presence of insurance companies with their built in extortion and selective rules As I noted before, the only way out is a single payer system such as my wife and her activist group are fighting for here in Colorado with ColoradoCare and Amendment 69, see e.g.

http://brane-space.blogspot.com/2016/07/janice-gives-robust-defense-of-colorado.html

Sadly, Zepps objects to those who would "change the topic" by pointing to other items in the federal budget that could use cutting. But this is being myopic and foolish. Because unless we closely examine those other items, especially military spending for which the GDP allocation has doubled since 9/11, we will never get anywhere in terms of real world priorities.  See e.g.  http://brane-space.blogspot.com/2012/07/muricans-need-to-wake-up-about-military.html

Does the U.S. REALLY need 900 foreign military bases worldwide to fund to the tune of over $1 trillion a year? Especially as the Pentagon already "misplaced" $1.2 trillion in budget allocations prior to 9/11, according to former Defense Dept. analyst Chuck Spinney in a 2002 PBS NOW appearance . Does U.S. "defense" spending REALLY need to exceed that of the next 25 nations?  Clearly Zepps needs more education, though one must give him a prop or two for his audacious salon.com video. But to shed needed light (for his benefit) we can thank Nancy J. Altman and Eric Kingson, authors of 'Social Security Works' .

As the authors observe (p. 40):

"It is false that most older Americans are on "easy street". A very small percentage are, many more are poor or near poor, while some maintain a modest, middle class life style, often struggling to make ends meet."

So much for Zepps' indiscriminate claim of a "resource Hoover" hoovering up everything not bolted down for the benefit of fat, complacent seniors.  (Many of whom still have kids living in their homes, basements because they can't get decent jobs).

Last but not least, Zepps doesn't cover Medicare fraud at all, which could easily be neutralized by implementation of a computer system to track care received over time by different providers.  

I have shown in this post (including links) that Zepps' arguments are immature and don't take full account of: a) how seniors have been exploited by the existing system, and b) how younger workers and families are being exploited by a Neoliberal system with misplaced priorities.  One whose design and financial reward basis finds it more profitable for companies to fund massive stock buybacks than create jobs with decent salaries.

But one thing we cannot do is permit superficial memes and facile arguments against senior health and other benefits to be spread, thereby propelling a push for an elderly  "hunger games" . 

Btw, if the Reepos in the Nov. election seize  all branches of the government, Zepps may get his wish of massive cuts, thanks to Paul Ryan's Medicare voucher plan..  That will save hundreds of billions for sure, but leave most elderly in the same position they were in before Medicare arrived in 1966. That is, begging and scraping for financial help from family, offspring just to stay alive to deal with normal health issues - never mind treating stage IV prostate or breast cancers.

Great! Now It's Medical Identity Theft!

Just frickin' terrific! It's bad enough we have to worry about hackers getting into TARGET and stealing credit card numbers, and terrorists designing new shoe bombs, now - in addition to standard identity theft - we have to worry about medical identity theft!  According to a recent piece in The WaPo by Christie Aschwanden, none of us with any kind of medical insurance can relax. Indeed, according to the article, "an estimated  1.84 million people were victims of medical identity theft in 2013, according to the Poneman Institute". This is absolutely ridiculous.

Sadly, victims usually don't know a damned thing until it's too late. That means their credit score takes a dive or worse, a collection agency comes after them full bore for unpaid medical bills. This, according to Jim Quiggle, Director of Communications for the Coalition Against Insurance Fraud.. While it's true most of the cost of medical ID theft is borne by the health care industry and government, the Poneman Institute estimates that 36 percent of victims in 2013 incurred out of pocket costs for services actually provided to impostors.  The average cost for the victims, including legal fees and ID protection services- amounted to $18, 660 and in a few cases exceeded $100,000.

Astoundingly, too many of us don't even know or understand how we're helping the medical ID thieves.  Some of the common methods used by medical ID crooks include:

1) The crook(s) persuade the victim to divulge his medical ID number, whatever it is - either for a policy like COBRA, Medicare or standard private insurance.  The strategies can be highly sophisticated, including inviting seniors to special "fairs"  - where their BP is taken, they're given complementary nutritional supplements - and then asked to see their medical insurance cards.

2) The crooks outright pay for the medical insurance number.

This one is hard to fathom, but according to Jennifer Trussell - who investigates medical identity theft for the Dept. of Health & Human Services' Office of the Inspector General- there are actually cases where criminal rings target senior centers or homeless shelters and offer people fifty bucks each for their Medicare number. According to Ms. Trussell: "That information is sold over and over again."

Though victims voluntarily share their numbers they've  no clue of the impact or how their Medicare account is being "maxed out" by thieves", including making false claims against the policy.

3) In some cases, employees of medical offices, or health care providers perpetrate the insurance fraud. In one case cited by Trussell, and Iowa chiropractor lifted the names and dates of birth from more than 200 patients to collect fraudulent Medicare payments. In another incident, a Baltimore pharmacy owner and employees were indicted for submitting bogus claims for prescription refills.

4) Perhaps rivaling (2) for stupidity, victims actually allow a family member or even acquaintance to use their medical insurance card to obtain coverage - according to the Poneman Institute.  These "Robin Hood" crimes (more like "Good Samaritan" crimes, to me) make up 30 percent of medical identity crimes.

While giving your insurance number to someone in need might seem like the "human" and decent thing to do, it's also a crime. You could definitely suffer serious consequences if the visits rack up bills that go unpaid or result in incorrect additions to your medical records.

Further, if an impostor's blood type or medical condition gets added to your record you could end up receiving inappropriate or even life-threatening treatment.

Alas, electronic medical records -which have been a boon to efficiency - have also made medical records easier to steal.  Thus, any clerk with malicious intent can load patient information onto a thumb drive and sell it to cronies or crime rings.

There are some basic ways to protect yourself:

- Never give your medical information, credentials to anyone but those with a legitimate reason for seeing this information, i.e. the billing person at your doctor's office.

-  Treat with suspicion anyone who asks for your medical insurance information without a good reason, and never EVER give the info to telemarketers.

- Check your medical records in timely fashion to make sure nothing suspicious appears. Medicare patients need to check their CMS Medicare Summary forms when they arrive. Make sure the treatments listed correspond to the dates and providers, as well as locations. If you see any discrepancy then complete the attached form questioning the filings, services.

- Think twice before sharing detailed medical info on social media. This is almost as bad as posting your address and  when you will be away on vacation.  An impostor could use this information to obtain services that might not raise red flags with your insurer. One example is if you tweet about your diabetes diagnosis. Next thing you know you're getting diabetes test strips you didn't order and which are billed to your insurance company.

- If you find your medical information has indeed been stolen or compromised the first step is a call to the police. The next is to the FTC or Federal Trade Commission at the identity theft hotline: 877- ID THEFT (877- 438 - 4338) or report the problem online at:  www.ftc.gov/idtheft

For any Medicare or Medicaid -related crimes report them at:  www.oig.hhs.gov/fraud/hotline

or call: 800- 447- 8477.

Be alert, be aware and don't let medical ID theft happen in the first place.

How Big Is Health Care Waste?

How large is the health care drain on this country? We already know at the rate its costs appears to be increasing, roughly 16% a year, it'll consume nearly all of our GDP within a very short time - maybe 20 years. The problem inheres in the source of the over-spending or as some call it "health care waste". Logically, the aim is on so-called 'entitlements' (a word I disdain) such as Medicaid and Medicare, but that doesn't necessarily mean that no waste exists in the private health care system! In fact, the private system is ranked 37th in the world by the World Health Orgnization, in terms of care delivered for the dollar.

Dr. Donald Berwick, appointed by President Obama by special recess appointment nearly 16 months ago, to be in charge of Medicare and Medicaid, has insisted (in a recent news interview before his term expires at the end of the month) that "20 to 30 percent of health spending is waste". He defines waste as something which yields no benefit to patients and that much needless spending is the result of "onerous, archaic regulations enforced by his agency".

He then elaborates a bit more, naming the following culprits as prime contributors to the waste:

- overtreatment of patients

- the failure to coordinate care

- the administrative complexity of the health care system

- burdensom rules

- fraud

Berwick didn't elaborate on the "rules" aspect, but one presumes this covers assorted provisions, such as in Medicare, to have elder patients re-admitted for assorted treatments, such as for pneumonia recurrence. I don't know what the answer is here, but it can't be simply to halt any further re-treatments, or re-admissions. There are instances where a patient may be improving on leaving the hospital and then has a relapse. Do we just let the patient die, or do we re-admit for more intensive treatment? Does the answer depend on his age? Say like if he's 85 or more (like my dad was when he died of complications from pneumonia) do we just say (as Hedge Fund Billionaire Peter G. Peterson): "Well, you've already had enough of a life, so if you can't afford to pay any more for your care, sorry, then we gotta pull the plugs!"

To me, this is barbaric, and also unnecessary! For one thing, all Dr. Berwick's hand wringing and frustration aside, we already know the sources of most health care waste.

Let's take cancer treatments, and specifically radiotherapy - say using radiation therapy to treat prostate or breast cancer. Right now, as things stand, each separate radiotherapy treatment merits a separate charge on a hospital bill. To me, THIS is wasteful! Repeated thousands of times it adds nearly two billion to the yearly health care tab. What we ought to have, if radiotherapy is prescribed, is one fixed rate for the program of treatment. The same applies to the administration of chemotherapy. So, if a patient requires some 15 treatments of chemo, he or she pays only once for the program prescribed, not for each time! That is over-charging!

Nor is this unusual, as it's a practice already followed in Germany and Japan. In the case of the Japanese they publish a yearly schedule of all the fixed rates to be charged for all manner of procedures. No physician or specialist is allowed to charge beyond what the schedule allows. This is the same in Barbados, where universal health care is provided and patients are only expected to make a co-pay.

What are other sources of waste?

One of the biggest is indeed administrative expenses, or what I call "paper pushing". But these are much larger in the private sphere (nearly 1 of every 3 dollars consumed by administration) than in Medicare, which accounts for only about 2% of admin fees. Thus, Medicare is not wasteful other than in the fraud - which accounts for nearly $30 billion a year, and for which much more attention must be paid.

A manner of waste also occurs in terms of Medicare's drug expenses. I have always argued that, rather than paring down Medicare providers' fees (which would merely have the effect of more seniors denied care or acceptance by physicians) it makes more fiscal sense to allow the program to bargain for the lowest cost drugs like the VA does. Where's the harm? The only conceivable reason this choice isn't on the table is to offer up the program as a profit bonanza for Big PhrMa!In effect, the government - to appease its corporate benefactors and lobbyists in PhrMa- is prepared to "milk" the Medicare cow into insolvency to do it! But by allowing a bargaining such as for the VA, nearly $200b could be saved over ten years.

Another form of deliberate waste, and designed as such, are all the "Medicare Advantage" plans. These were conceived as part of the Bush 2003 Medicare Act to bleed standard Medicare into insolvency by creating a private competitor within the Medicare system. Thus, thanks to the pushing of Lobbyists (then repuke handmaidens for the corporatists) like Billy Tauzin, a "Jekyll and Hyde" law was prepared - with standard Medicare for the less well off, and Medicare Advantage for the better off.

The problem, as the Government Accounting Office (GAO) has noted, is that the privatized version is bleeding off nearly $12 billion more each year and hence speeding the whole program - standard Medicare especially, into insolvency! This was to have been dealt with by Obama, in terms of cutting it completely out, but last I heard it was off the table: to many protests from the private lobbyists who are causing the most waste overall.

Sadly, the worst mistake Berwick committed in his interview on Thursday was in comparing the public's comprehension of Obama's Affordable Health Care Act to the NASA Apollo program. Berwick insisted that just as Americans supported manned missions to the Moon without knowing the details of rocket science, they ought to support the new law because of its ultimate destination. (I.e. health care for nearly all),

But that is plain old illogical bollocks and false analogy! Of course, the details of rocket science (especially to get to the Moon) would only be understood by the very few - mostly specialists in the field, with degrees in astrodynamics and aeronautical engineering from Caltech, MIT or wherever.

But we aren't talking about a narrow, highly specialized technological field of endeavor, we are talking of a law that impacts public policy and specifically public health! This ought to be understood at least by EVERY manjack of normal IQ (90-110 for most standard IQ tests). Indeed, the only reason it would be so "complex" at all, would be to obfuscate or HIDE the details. But the American people, as adults, deserve to see the details, not permutations or contortions of them.

Hence, it is the job of whoever writes the law to do in plain English, if there's nothing to hide. In the case of rocket Moon shots, the average American can't be expected to grasp the details of thrust, the essential hundred or so rocket equations that make a large delivery vehicle possible, or the nuances of celestial mechanics which assure a craft reaches its destination.

We don't need excuses, then, what we need and want is a plainly -written law that will also finally make the repukes shut up and cease their efforts to overthrow it!