Health Care Fraud: One Reason Gov't-Sponsored Universal Health Care is Essential (Dale Tavris M.D.)

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Dale Tavris, MD, MPH -- World News Trust

Health care is too important to the well being of the American people to entrust it to for-profit corporations.

A 2004 report by the Institute of Medicine noted the amazingly ironic fact that, although the United States leads the world in spending on health care, it is the only wealthy country in the world that does not offer universal health care to its citizens. The report noted 18,000 unnecessary American deaths every year resulting from lack of access to health care. There are currently 47 million Americans without any health insurance, and the health insurance carried by a large portion of the more than a quarter billion Americans who are insured is woefully inadequate.

To understand why our country’s mostly privately run health care system is so inadequate, let’s start by looking at the issue of health care fraud.



A brief look at health care fraud in “fee for service” systems in the United States

An excellent discussion of health care fraud in the United States is provided by Malcolm Sparrow’s 1996 book, “License to Steal -– Why Fraud Plagues America’s Health Care System.” Though somewhat outdated, the good majority of principles discussed in Sparrow’s book are as valid today as they were then. On the scope of the problem, Sparrow has this to say:

The proportion of the nation’s health care budget lost to fraud and abuse remains unknown. Conventional wisdom, crystallized in a 1992 Government Accounting Office (GAO) report, puts it at 10 percent. But the 10 percent figure has no basis in fact. The GAO report merely says, “Estimates vary widely on the losses resulting from fraud and abuse but the most common is 10 percent ... of our total health care spending …”

The 10 percent estimate has been politically useful: high enough to be credible in the face of continuing media revelations about fraud and to justify the “get tough on fraud” rhetoric, yet low enough not to disturb the medical profession too much. The truth is, of course, that nobody knows the true figure, because nobody systematically measures it.… The true level of fraud losses could be lower than 10%, or it could be significantly higher.

None of that has changed in the 11 years since Sparrow wrote it. There has still been no systematic measurement of the fraud problem, in spite of a multitude of evidence that it is massive.

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1. The first sentence in this article says it all. " Health care is to

important to the well being of the American people to entrust it to for-profit corporations". I printed this article by Dr. Travis.