Thursday, July 30, 2009

Here is a great reason why medical costs are so high.

If it's a medical emergency, Erie County 911 will respond, but there is one address many of its dispatchers know by heart.

They find Scott Graham usually waiting at that Buffalo address for his ambulance several times a week.

"Sometimes two times a day," Graham told 2 On Your Side. He suffers from Sickle Cell Anemia, a blood disorder. If left untreated, it can block blood flow to limbs and organs.

"It feels like somebody shooting me with battery acid, and I'm stepping on razor blades, and I'm having a heart attack at once," he said talking about the pain the disorder causes.

Graham doesn't have a job, insurance or car. So, when he feels bad, he doesn't call a cab. He calls 911 to have an ambulance drive him to the hospital.

A 2 On Your Side investigation found that from January 2006 to May of this year, Rural Metro Ambulance picked him up 603 times.

Medicaid picked up the tab for each ride, costing taxpayers at least $118,158.

Graham estimates he's requested even more rides. "I'd say about a thousand times."

Rural Metro and Erie County chose not to respond on camera about Graham's case. The county follows the same rules most emergency systems follow across the country. If you call, they must haul you to the hospital, no matter what your call is about.

Graham says he requests an ambulance because he can't see his doctor as much as he needs. He also says he gets help quicker by arriving in an ambulance rather than by cab.

2 On Your Side contacted Medicaid to have them look into the number of times Graham used an ambulance. Medicaid appeared more interested in how we got the information, rather than how much it cost taxpayers to pick him up.

Medicaid fraud and abuse costs $60 billion each year nationwide.

2 On Your Side contacted our lawmakers to discuss how to lower that number.

"As we look at health care reform," Senator Kirsten Gillibrand (D-NY) said, "we should also look at oversight and accountability for those programs to make sure that people aren't abusing the system."

Gillibrand says cracking down on abuse should be part of the major health care reform going through Congress to force more oversight.

Take Mr. Graham's case. His trips cost Medicaid $118,000, but the government reimbursements are low. In fact, most ambulance companies lose money, up to 30% or more, when they transport Medicaid patients, because the government simply does not pay the full cost. Therefore, Mr. Graham's actual cost to the ambulance company and to the health care system in general, is much more, as high as $360,000.

Erie County Executive Chris Collins, a Republican, says government is not the answer to limiting that type of alleged abuse and waste.

"Fundamentally, inherently I think the private sector is better able to do anything and everything compared to government," Collins said.

Instead, Collins said the solution is insurance that is private and not public.

"Would the type of reform that you're suggesting here be able to crack down more on this type of fraud?" asked 2 On Your Side's Michael Wooten.

"I'm actually talking about the basic design of the program in New York," Collins said. "where fraud is something we have to look at everyday. But the actual larger cost is the actual design of the program and the fact that we took the entire menu and said we'll provide it all."

Gillibrand disagrees.

"Bottom line then, expanded government-run health care can be efficient you believe?" 2 On Your Side's Michael Wooten asked Gillibrand. "Absolutely," she responded. "Talk to your mother. Talk to your father. Talk to someone who has Medicare. They're pretty happy."

Currently, New York has a dubious distinction of having the highest Medicaid costs in the entire country, about $2,300 per person. Collins said if we had a system similar the one in California, which does not provide as much care, we would save enough money to completely eliminate the county property tax.