Journalism's defenders often describe it as a profession or craft unto itself, and minimize the importance, or even sometimes the relevance, of subject matter expertise.
That lack of subject matter expertise, and the apparent unwillingness to seek out a source of that expertise when necessary, probably explain how a Hillary Clinton whopper has survived on the campaign trail for so long.
In a subscription-only op-ed in today's Wall Street Journal (bolds are mine), Merrill Matthews of the Council for Affordable Health Insurance does the job that Old Media's campaign chroniclers haven't done:
Story Continues Below Ad ↓Earlier this week, campaigning in New Hampshire, presidential candidate Hillary Clinton asserted that health insurance companies spend $50 billion to avoid paying claims. "This is all part of their business model," she was quoted as saying. "This is how they make money, but it's so bad for the rest of us. I say to them, use the $50 billion to actually take care of people."
Statements like these raise real questions about Sen. Clinton's grasp of the facts.
..... Currently, the private sector health insurance industry spends about $600 billion a year paying traditional health care claims for those under age 65. According to a major actuarial firm, the industry spends roughly $30 billion a year adjudicating those claims -- not "denying" them, but evaluating and processing them. There doesn't seem to be a solid number for the amount of claims actually denied, but several health actuaries estimate that amount to be around $3 billion.
Regardless of Mrs. Clinton's insinuations, however, the money spent evaluating claims is not wasted, and would not be better spent "taking care of people."
An Associated Press report by Holly Ramer indicates that this is not the first time Mrs. Clinton has filed this bogus claim with America's voters (bold is mine):
Clinton repeated a statistic she cites often—contending that insurance companies spend $50 billion a year figuring out ways to avoid paying claims.
There's no way to get from Mr. Matthews' stats to anywhere in the neighborhood of Mrs. Clinton's $50 billion figure. There's also no way that someone with a background in financial analysis would have failed to scrutinize her claim for as long as Old Media's journalism "professionals" have.
For an object lesson in the truth of the last excerpted paragraph from Mr. Mathews above, and in how misguided and numerically challenged Mrs. Clinton is, consider that the estimated fraud rate in Medicare alone in 2001 was 6.3% (scroll down to Section 1.2 at the link). As to Medicaid -- yikes. In 2005, the New York Times reported that Medicaid fraud in the Empire State alone "May Reach into (the) Billions."
How rampant fraud against Medicaid and Medicare has become, and why there's little reason to believe that the somewhat dated statistics just cited have improved, is exemplified in this anecdote Mr. Matthews recites later in his column (bold is mine):
Last summer, the Centers for Medicare and Medicaid Services (CMS), the agency that administers the country's two largest insurance programs, announced a pilot program to investigate fraud in the medical device industry. Law enforcement officials, for example, visited 1,600 businesses in Miami that were billing Medicare for services. One-third of them didn't even exist, yet they billed Medicare for $237 million in the previous year. The government has now charged 120 people in 74 cases, and Medicare filings in the area are down by $1.4 billion from last year.
Questions:
- So how many years were taxpayers funding over $1 billion annually in fraud -- in just one metro area -- before the arrests?
- If this is a "pilot" program, how much fraud hasn't been caught in the rest of the country?
- Does anyone really think that a private insurance company competing against other companies would allow itself to be bilked to this extent?
Finally, will anyone in the press either call Mrs. Clinton on her "$50 billion to avoid paying claims" assertion (regardless of whether she continues to make it), or note its disappearance, if that indeed happens, as a result of Mr. Matthews' column?
Cross-posted at BizzyBlog.com.
—Tom Blumer is president of a training and development company in Mason, Ohio, and is a contributing editor to NewsBusters
Editor at Large
Comments Policy
According to Her Royal
December 1, 2007 - 08:27 ET by motherbeltAccording to Her Royal Clintoness, I guess insurance companies are not supposed to verify claims; they should just shut up and pay out every claim they get.
Look how well it worked in Miami with Medicare!!
As for anyone who questions HRC's statement, they're just picking on her because she's a woman. They would never question a man who made that statement.
I'll see your Hillary & raise you a John Edwards whopper
December 1, 2007 - 08:27 ET by sarcasmoTake a look at yesterday's Downsizer Dispatch email.
JMR
D o w n s i z e r - D i s p a t c h
Quote of the Day:
"I'm going to be honest with you, I don't know a lot about Cuba's health care system. Is it a government-run system?"
- Sen. John Edwards, would-be president
Subject: Is reality negotiable?
We do a lot of reading here at Downsize DC. Behind every 800-word
Dispatch we send you there are usually many thousands of words of
research we've read before daring to open our mouths. Were that not so
you would see many more campaigns from us, and many more mistakes too.
Often, we are not fully satisfied until we've found arguments that
challenge our views, and sometimes we are surprised, learning that
things are not what we assumed them to be.
This commitment to challenging pre-conceived notions is largely missing
from the public debate, and desperately needed. Our state-run schools
teach too much dogma without stopping to consider conflicting evidence
and alternative theories that might better explain that evidence.
No, we're not talking about the evolution debate. We're talking about
history and law and economics. The deeper we look the more we find that
most of what passes for conventional wisdom in these areas is pure rot,
and the rot extends from our schools to the media and straight-up to
the latest roster of would-be presidents.
For instance . . .
We are constantly amazed by how often reporters get their facts wrong.
Consider the issue of health care; journalists pump-out massive factual
errors on what seems to be a daily basis. They misreport the number of
uninsured Americans by a HUGE margin, and used rigged health-care
rankings that distort the health care debate beyond any connection to
reality.
But reporters are pikers compared to our politicians.
The above quote from John Edwards is just one example. How could anyone
aspiring to be president be so ignorant? Is that name calling? We don't
think so. Mr. Edwards is seeking great powers, covering a vast array of
policy issues. Anyone who doesn't know that nearly everything in Cuba
is state run, especially health care, isn't qualified to pontificate on
either health care or foreign policy.
But Senator Edwards is hardly alone among politicians in the ignorance
and error departments. Senator McCain put on a fine display of both in
the most recent Republican presidential debate. His accusations, that
Ron Paul is an isolationist and that isolationism caused World War II,
are simply wrong, both by definitional and historical criteria.
Someone who favors both a non-interventionist foreign policy and a
restrictive trade policy might reasonably be called an isolationist,
but that has nothing to do with Congressman Paul, who favors free
trade. Non-interventionism wedded to free trade might be better called
"foreign policy originalism," because it was the policy the Founders
favored. So . . .
Senator McCain was either taking a cheap shot, in which case he was
dishonest, or else he doesn't know what isolationism really is. But if
he has problems with the meanings of words his deficiencies in history
are even worse.
McCain's claim that isolationism caused World War II is simply wrong.
The Nazi and Japanese lust for conquest caused World War II, and anyone
who thinks either country would have been deterred by the threat of
American intervention is simply ignorant. Indeed, it was the threat of
American intervention that led to the attack on Pearl Harbor.
As for the European side of the war, perhaps McCain believes that
Hitler could have been defeated earlier had America involved itself
sooner, but even this widely held belief is highly dubious for the
following reasons . . .
One could easily see Hitler responding to the threat of an early
American intervention by delaying his invasion of the Soviet Union and
focusing on Britain first. A few more divisions sent to Rommel in North
Africa might have done the trick. Capturing the Suez Canal and cutting
off Britain from India might have been enough to win Hitler a peace
settlement with Britain, then . . .
With Britain out of the war there would have been no port of entry for
America into Europe, and Hitler could have turned his full might on the
Soviets, fighting on only one front. Admiral Raeder proposed just such
a strategy to Hitler, and Hitler almost followed it, going so far as to
invade Crete as a first step.
It's actually possible that the threat of an early intervention by America might've led to victory for Hitler.
Real students of history know these things, and McCain should know them
too if he wants to establish current policy on historical examples. But
it seems as if McCain, like most politicians, really doesn't understand
much about history, even though he likes to invoke it.
McCain's comments about Vietnam seal the verdict. To contend that
America only lost in Vietnam because of public opinion is to
misunderstand the nature of guerrilla warfare and to automatically
disqualify oneself for the job of president.
McCain is right that the U.S. never lost a major battle in Vietnam, but
guerrillas don't need battlefield victories in order to win wars. They
only need staying power. The Vietminh had already demonstrated 20 years
of staying power, with no end in sight. The Vietminh were never going
to lose, and we were never going to win.
Facts matter. Reality isn't negotiable. Given all the rot uttered by
the media and our politicians it's incumbent upon someone to restore a
factual understanding of reality to the public debate. We are trying to
make our contribution toward that end -- and getting the facts right
takes a real investment of effort, which, thankfully, our supporters
make possible.
Today is the last day of November. We intend to make new contributions
to the cause of reality in December, but we could use a few more
financial contributions to close out the month on a positive note. We
ONLY need $1,096 more to finish paying our bills. That's not much - 22
donations of $50 would cover it. If you can help, the donation window is open here.
We'll be back next week to make new contributions of our own.
Thank you for being a DC Downsizer.
Jim Babka, President
&
Perry Willis, Communications Director
DownsizeDC.org, Inc.
D o w n s i z e r - D i s p a t c h
is the official email list of DownsizeDC.org, Inc. &
Downsize DC Foundation
Rally online with fans of Dr. Ron Paul.
According to a major
December 1, 2007 - 08:44 ET by MidAmericaAccording to a major actuarial firm, the industry spends roughly $30 billion a year adjudicating those claims -- not "denying" them, but evaluating and processing them.
My wife and I took care of my Dad for several years until his passing this last summer. The only real protection we had from bogus/fraudulent billing by doctors, hospitals, rehab providers, drug companies and the nursing home was his private insurance company. We had many many phone calls to them. They would tell us the straight facts as to what was owed and paid. They would check for billing of services that were inconsistant or made no sense and was just padding of the bill. After a hospital stay we would get bills with just an amount on it. No explanation. Then when we called for an itemized bill they couldn't understand why we needed this information. And then if we took too long to pay a bill that we couldn't figure out what it was for we would get the phone call theatening to send it to 'collections'. Had we not been proactive all these health providers would have just gone after my Dads savings like muggers in an alley. It's first come first serve. Like I said, the only one in this ordeal (and it was an ordeal) to play it straight with us was his private insurance company.
EvilCon555 MidAmerica - I
December 1, 2007 - 09:05 ET by EvilCon555EvilCon555
MidAmerica - I am so sorry for your loss and struggles. But I admire and encourage what you did. Understanding both commercial and Federal clinical and billing practices, it is without a doubt safer and more efficacious to deal with a private payer than Medicare. Commerical payers need to do the right thing - it's a little thing called competition - and the one doing the best job gets the business. Medicare has not one competitor. Not one. And in addition the powers that be in the federal system have put more than one honest provider out of business using their "selective" review and fraud capture practices. It is rarely done intentionally though. But it happens, and it stinks. It is a fact of life for an overwrought bureaucracy that mistakes and oversights are made - often at the expense of an honest provider or an innocent patient.
I encourage everyone to follow their itemized bills, get to the bottom of all health care charges before payment is made, and not be afraid to ask questions and negotiate payments. Regardless of the insurance carrier.
One of the sad episodes
December 1, 2007 - 11:11 ET by MidAmericaOne of the sad episodes with my father was when he was in his early eighties and reasonably good health except for his diabetes he broke an ankle coming down off a step ladder. He went to the hospital, of course, and while there he contracted a nasty anti-biotic resistant staph infection (those bugs that hospitals cannot clean themselves of) and it nearly killed him. He never truly got over it, he coughed and had a greatly reduced quality of life after that. While in the hospital the extra cost of isolation, drugs and extended stay greatly increased the bill for a visit that originally was just a broken ankle. All of which my father was financially liable for.
I agree...I've spent most
December 1, 2007 - 09:09 ET by motherbeltI agree...I've spent most of the year dealing with bills from my husband's protracted 7-month illness. We never had any problems with the insurance. Often, when I got a "rejected" EOB from them and I called, it was some kind of communication error and we got it cleared up and they paid the claim.
I don't remember them ever rejecting a legitimate claim. It was usually the doctors and hospital that screwed up with how they submitted the bills.
Does HRC expect us to believe that under her plan, no claim will ever be denied?
Yeah, riiiiiiiight.....
EvilCon555 I work in the
December 1, 2007 - 08:55 ET by EvilCon555EvilCon555
I work in the clinical/finance area. HRC is wrong, wrong, and wrong. (Thank goodness for Merrill Mathews). Yet most of my peers are going to vote for her. Why? I don't know. And many of them can't tell me with any certainty why, either. It is scary.
On another note I am a former Rochester NH native. What happened there with the "hostages" screams of HRC campaign involvement. Is anyone looking at this as a political stunt? Given HRC has been running ads about saving a boy by "making a hospital absorb the cost of a bone marrow transplant" (and let me add that the hospital surely did NOT absorb anything, but passed the costs along to us paying customers as they do to preserve the bottom line - cause without income NO ONE GETS CARED FOR---NO ONE), did someone from her campaign get this poor mentally ill soul to storm a small office and make HRC the saviour once again? It wrecks of an ill-conceived plan from start to finish. Here's a guy who probably shows up at HRC's campaign office on a daily basis - he apparently is a fixture around town; is known to be compulsive about things (he's got a stalking complaint against him for instance) and may be fixating on his situation as something only the great HRC can solve. He is then baited into a "cause" by someone at that office for free network exposure for HRC. Mix in a local TV station that worships the Clintons but lacks any professionalism. Think about the fact that the man had told his relatives to "watch for him on TV the next day". (Only a campaign can guarantee anyone National TV time in lil'ol' NH.) And remember that this same dude called CNN recently looking to complain about mental health care issues. The whole thing stinks of a bad set-up. And one of those silly little HRC "workers" may have devised the whole thing - maybe not thinking it would go that far perhaps. Add in the above article calling HRC out on her health care numbers and I smell a big, heavy-calved pantsuit wearing rat. Anyone else into this conspiracy? Or am I just paranoid, like the Dem's think I am?
555
December 1, 2007 - 09:24 ET by HermanoI thought the same thing. What better place than an isolated location to pull a stunt like this. Maybe there will be a pardon in it for him. In addtion, my sister is PT and has been bemoaning the healthcare system ever since HRC got her paws on it in the 90s. The free market system works - and works well. Let it do its thing, and the healthcare providers will, as they have always, take care of those who cannot afford it.
I thought the same thing,
December 1, 2007 - 10:05 ET by HypocriteHaterI thought the same thing, with a tinge of guilt for the unfortunate victims who had to endure this scary incident, especially the children who were there. However, with all the shenanigans her campaign has pulled, how can anyone NOT be suspicious of this incident, especially the timing of it and how she's losing to Obama in Iowa.
I was also struck by a comment she made in her press conference last night. She said this kind of incident hasn't happened since it happened to Reagan before he became president. As if Hillary was trying to suggest she's destined now to become president because the last person this happened to was someone who eventually became president. Regardless of her involvement, she's going to milk her victimhood about this incident for all it's worth.
The HRC long winded comment on the NH bomber
December 1, 2007 - 10:21 ET by JayTeeDId anyone hear/see the Fox news Hillary comments on the New Hampshire bomber thing ? Was that a long winded rambling comment......When it started, I went to the bathroom to do a #2, and she talked the whole time I was in there....and was still talking when I got out.
I dont' think it was a conspiracy....bet she was certainly leveraging the "Face" time press issue. Her speach was longer than any Nobel prize winner, Academy Award speech.....someone get a clock on that speech.....but most networks will cut it short....but Fox went with the whole thingie.....She was thanking the Cousins of the Cops who negotiated with the bomber.
What good is a Free Press, if it is a False Press ? David Foote GoE
Clinton is a legislator.....where are her Senate Bills ?
December 1, 2007 - 09:07 ET by JayTeeIf hillary knows all these facts, why has she in 7 years done anything on the floor of the Senate towards addressing these issues ?
Are we hostages to making her a president before she pulls any Bills our of her Senate office ? Presidents do not Legislate.......but Senators supposedly do......
I think she's an incompetent NY Senator, now....she deserves no more consideration on a National level.
What good is a Free Press, if it is a False Press ? David Foote GoE
I think she's an
December 1, 2007 - 09:17 ET by motherbeltI think she's an incompetent NY Senator, JayTee
She's a nonexistent NY Senator, JayTee.. she got reelected and immediately jumped into running for President. When was the last time she was actually IN the Senate? Neither she nor Barack Obama have any interest in doing the job they were hired to do, to paraphrase HRC's husband's favorite phrase.
I don't care if voting is going on or not...the Senate is in session and they should be there. They weren't elected to just show up on voting days....
It's all about the ladder---get elected to one position and immediately start running for the next one.
The real issue
December 1, 2007 - 09:21 ET by c5thenHillary and the Liberal democrats want the Federal government to take over the health care industry because it fits their socialist ideology better. A true health insurance industry wouldn't require "approval" of proceedures or the now infamous pre-approval nor would you have to get a referal to see anyone other than your GP. What most people have now is an HMO service which is basically a pre-paid health care system.
Imagine a car dealership that set up a "Car insurance" program where you paid them a monthly fee, and then every 4 years or so, you could come in and pick out a new car. It would be in the dealerships interest to have tp pre-approve the model and options to make sure that you were not getting a car worth more than you had paid (and would "err" on the side of a cheaper car to help their bottom line). Of course, in that situation, the liberals would be trying to federalize the program because the "poor" wouldn't have "coverage" and "millions would be denied the car they wanted".
The day that "politician" became a career choice is the day we started losing the Republic. Let's get it back! Fred08.com
My insurance company
December 1, 2007 - 10:50 ET by ConservativeRexMy insurance company works hand in glove with me. If there are any discrepancies they explain them to where even I can understand them.
There is at least one thing nagging me about the Hildabeast claim. Why would it cost the insurance company's anything to deny a claim, must less $50B? On a common sense level just not paying it is a stroke of a pen , which shouldn't cost an additional penny.
This amongst many other things she comes up with just proves her bonifides of being a Marxist. People had better wake up. These people have the Marxist playbook down pat. Do not pay any attention to what they say, only watch what they try to do.
It may be too late though. I hope not, but too many people in this country have always wanted something for nothing and this Marxist, Clinton crime family is primed to give it to 'em, off the backs of us, the kulaks.