The fact is the Medicare is so massive, so complicated, and so bureaucratic while prevented from doing real management of the health care it pays for, that fraud and waste cannot be controlled. Only a major change and increased administrative efforts (and cost) has a chance of managing unnecessary spending.
Think about that when you consider Medicare for All.
Medicare covered over 58 million people in 2017 and has wide-ranging impact on the health-care sector and the overall U.S. economy. However, the billions of dollars in Medicare outlays as well as program complexity make it susceptible to improper payments, including fraud. Although there are no reliable estimates of fraud in Medicare, in fiscal year 2017 improper payments for Medicare were estimated at about $52 billion. Further, about $1.4 billion was returned to Medicare Trust Funds in fiscal year 2017 as a result of recoveries, fines, and asset forfeitures. Source: 2018: GAO Report
Your Medicare is in danger. Each year, roughly 10 cents of every dollar budgeted for the giant health insurance program is stolen or misdirected before it helps any enrollee. Looked at another way, about $1,000 is lost per Medicare member through theft or waste each year. That is according to the federal government’s reckoning. But it could be far worse. Malcolm Sparrow, a Harvard University professor and leading expert on health care fraud, says the true amount lost to fraud, abuse or improper payments could be 20 percent, or even as high as 30 percent.
“The fact of the matter is, we don’t know how much is lost,” Sparrow says. “We ought to know. We shouldn’t have to guess. But the truth would be hard to swallow.”