To the Editor:

The Affordable Care Act moves toward improving health care, but may increase costs because the ACA continues complex billing procedures and loopholes.

Improved Medicare for All could provide health care for everyone, without adding one dollar more than current health care spending. Your children, neighbors who cannot afford cancer treatment — everyone — would simply show a Medicare card to get care.

Here is an example of a loophole that would close when we cover everyone in a single system.

The Office of Inspector General, which monitors Medicare, just documented overpayments to Pacificare, which insures patients who choose Medicare Advantage. The loophole is that Congress requires that Medicare Advantage payments be “adjusted, based on the health status of patients,” to be “fair” to insurers.

After review of 100 Pacifi- Care claims for adjustments, OIG determined that 45 were invalid. No PacifiCare documentation supported the claims. Overpayment: $244,388.

No big deal? Wrong.

If all PacifiCare Medicare Advantage claims show a 45- of-100 error rate, overpayments come to $423,709,068 OIG statisticians determined that PacifiCare’s overpayments could be as much as $559 million — or maybe “only” $288 million.

Whether PacifiCare intentionally scammed Medicare or not, the overpayment is outrageous and reprehensibly wasteful. How much do we overpay other big insurers?

The U.S. data are clear, and the experiences of other countries confirm them. We could eliminate wasteful complex billing and reprehensible loopholes and also cover everyone.

Improved Medicare for All would provide health care, not profits. You could, and should, ask congressional representatives to enact Improved Medicare for All.

William D. Clark, MD
Woolwich