Today’s post is a history lesson for all those paying attention. In 2010 the Democrats passed the Affordable Care Act, better known as ObamaCare, without a single Republican vote. It was implemented in 2014 and people quickly came to realize it was not what it was cracked up to be. Rather than a panacea for rising healthcare costs, it drove them even higher.

President Obama made several promises then including the famous “If you like your healthcare plan you can keep your healthcare plan” which turned out to be lies. He promised ObamaCare would reduce healthcare premiums by $2500 per person per year but in fact they only increased. Less than five years later in 2018 insurance premiums doubled for individuals and rose 140% for families, even while deductibles increased substantially.

Democrats said the solution was to convert ObamaCare into single-payer healthcare; a government guarantee for all medical care they insisted would be “free.” The British have such a system called The National Health Service, which was established by the constitution, and says: “You have the right to receive NHS services free of charge.” But they ignore the fact that the U.K. funds the program by taxing citizens some $160 billion a year, even with its severe limits on access to specialists, drugs and technology.

Dr. Scott Atlas wrote of the problems of such a system in 2018 in The Wall Street Journal. Here is what he said then: “In the past half-century, nationalized programs have consistently failed to provide timely, high-quality medical care compared with the U.S. system. That failure has countless consequences for citizens: pain, suffering and death, permanent disability, and foregone wages.”

“Single-payer programs usually impose long waiting lists and delays unheard of in the U.S. Last year, a record 4.2 million patients were on England’s NHS waiting lists; 362,600 patients waited longer than four months for hospital treatment as of that March, and 95,252 waited longer than six months. By this July, 4,300 people had been on the wait list more than a year—all after receiving their diagnosis and referral—according to NHS England’s “Referral to Treatment” waiting-times data.”

The same was true in Canada. In 2018, the median wait time between seeing a general practitioner and following up with a specialist was 10.2 weeks, while the wait between seeing a doctor and beginning treatment was about five months. According to the Fraser Institute study, the average Canadian waited three months to see an ophthalmologist, four months for an orthopedist, and five months for a neurosurgeon.

This issue came up in the mid-term elections of 2018 and was promoted by socialist Vermont Senator Bernie Sanders in a slick campaign called “Medicare for All.” Then Senator Kamala Harris jumped on the bandwagon, endorsing Sanders’ socialized medicine plan. It is doubtful you’ll hear her say the same thing now, but her record is clear.

The Wall Street Journal editorial board wants you to remember this important history since Democrats are trying to re-write history. Here’s what the editors say: “Harris campaign aides are whispering that she no longer supports single-payer healthcare, but travel back to Ms. Harris’s Senate tenure. She co-sponsored a bill from Vermont Sen. Bernie Sanders that would set up a single-payer system in the U.S. in four years. That would toss 150 million Americans who receive health insurance at work into a new government plan, inevitably financed by ferocious tax increases across every income level.

At a Democratic debate in 2019, a moderator put this question to the primary contenders: ‘Many people watching at home have health insurance through their employer. Who here would abolish their private health insurance in favor of a government-run plan?’ Ms. Harris raised her hand.”

The WSJ editors say the Harris plan from 2019 could cost $44 trillion over a decade, according to a forthcoming analysis from health economist Stephen Parente and Theo Merkel at the American Action Forum. That includes some $1.8 trillion to cover some 11 million illegal immigrants. America can’t afford this and doesn’t want this even if it could.

In Part I of this series, we learned that home nursing visits are being used by private insurers to bilk the taxpayers for billions in additional Medicare funding. In Part II we will see who is abusing the system the most and how they do it.

The Wall Street Journal reported on an investigation into the home nursing industry and found home nurses were adding billions to the cost of Medicare. To find out how insurers use home visits to add diagnoses, the Journal interviewed nurses, patients, home-visit managers and industry executives and reviewed hundreds of pages of internal documents from home-visit companies. They described a system that used nurses, software and audits to generate diagnoses.

“They do the job with a purpose, and it pays off for the Medicare Advantage plans,” said Francois de Brantes, a former executive at Signify Health, a company that does home visits for insurers. “Identifying the diagnoses, that’s the job.” Insurers, including UnitedHealth and CVS Health, owner of both Signify and Aetna, said the house calls help patients by, among other things, catching diseases early and making sure people are taking their medicine properly. The insurers said they relay home-visit findings to primary-care doctors.

Nurses who made visits said they felt they were helping some patients with advice about medications, performing needed tests and sometimes reporting health emergencies. For UnitedHealth, the parent company of the largest Medicare insurer, each home visit was worth about $2,735 in extra Medicare payments during the three years covered by the data, the Journal analysis found. That’s nearly three times the average for all other Medicare Advantage insurers.

UnitedHealth’s chief physician, Dr. Wyatt Decker, attributed the disparity to what he said was UnitedHealth’s sicker patient population and its nurse practitioners being so effective at their jobs. (No surprise there!) Sixty percent of UnitedHealth home visits generated at least one new revenue-producing diagnosis of a condition no doctor was treating, the analysis showed. Home visits by Humana, the No. 2 Medicare insurer, did so 39% of the time.

Step one is getting Medicare Advantage recipients to agree to a visit, especially patients whom insurers deem most likely to have undiagnosed conditions that would garner extra payments. Two former managers who oversaw home visits for Humana, and a third who worked for both Humana and Signify, said insurers used an internal scoring system to identify prospects. Under the Medicare Advantage system, diagnoses have to be documented every year to trigger the extra payments, so people who had an earlier home visit that produced extra payments were particularly valued, the managers said. Insurers also considered other factors, including how likely patients were to agree to a visit, some home-visit executives said.

The Medicare Payment Advisory Commission, a nonpartisan agency that advises Congress, has recommended that diagnoses from home visits shouldn’t count toward extra payments to Medicare insurers. The inspector general that oversees the Medicare agency has said it should reconsider the use of such diagnoses. A spokeswoman for the Centers for Medicare and Medicaid Services, said the agency recently ramped up audits to verify diagnoses. The agency also is eliminating some diagnoses from those that qualify for extra payments, including peripheral artery disease.

This is the kind of investigative journalism we need more of and my hat’s off to the Journal for this in-depth look at the home nursing industry. We cannot afford this kind of wasteful spending if our Medicare system is to survive.

It’s bad enough that the Biden/Harris Administration is expanding the rolls of Medicaid and therefore increasing the taxpayer’s burden. But now add to that scandal what’s happening to Medicare when that friendly nurse comes to visit your home.

In a new article published in The Wall Street Journal, the authors reveal how private insurance companies are bilking the government for billions. Anna Wilde Mathews, Christopher Weaver, Tom McGinty, and Mark Maremont now reveal the results of an intensive investigation into the home nursing business. Here’s how they describe what is happening:

“Millions of times each year, insurers send nurses into the homes of Medicare recipients to look them over, run tests and ask dozens of questions. The nurses aren’t there to treat anyone. They are gathering new diagnoses that entitle private Medicare Advantage insurers to collect extra money from the federal government. A Wall Street Journal investigation of insurer home visits found the companies pushed nurses to run screening tests and add unusual diagnoses, turning the roughly hourlong stops in patients’ homes into an extra $1,818 per visit, on average, from 2019 to 2021. Those payments added up to about $15 billion during that period, according to a Journal analysis of Medicare data.”

Nurse practitioner Shelley Manke, who used to work for the HouseCalls unit of United Health Group was part of that small army making home visits. She made a half-dozen or so visits a day, she said in a recent interview. Part of her routine, she said, was to warm up the big toes of her patients and use a portable testing device to measure how well blood was flowing to their extremities. The insurers were checking for cases of peripheral artery disease, a narrowing of blood vessels. Each new case entitled them to collect an extra $2,500 or so a year at that time.

But Manke didn’t trust the device. She had tried it on herself and had gotten an array of results. When she and other nurses raised concerns with managers, she said, they were told the company believed that data supported the tests and that they needed to keep using the device.

Last month WSJ reported that insurers received nearly $50 billion in payments from 2019 to 2021 due to diagnoses they added themselves for conditions that no doctor or hospital treated. Many of the insurer-driven diagnoses were outright wrong or highly questionable, the Journal found. The diagnoses added after home visits accounted for about 30% of that total. More than 700,000 peripheral artery disease cases diagnosed only during home visits added $1.8 billion in payments during that period.

How could this be happening?

That’s a good question and one that should be asked by those in the federal government in charge of Medicare – the Center for Medicare and Medicaid Services (CMS). This abuse of the system is happening particularly in the Medicare Advantage system. In the Medicare Advantage system—conceived as a lower-cost alternative to traditional Medicare—private insurers get paid a lump sum to provide health benefits to about half of the 67 million seniors and disabled people in the federal program. The payments go up when people have certain diseases, giving insurers an incentive to diagnose those conditions. But the system should not be paying for diagnoses not made by the treating physician. Allowing home nurses to add diagnoses is simply letting the fox into the chicken coop.

(Note: For more on this subject, stay tuned for my next post – Part II of this series.)