The article argues that recent executive overreach and politicization have severely undermined established norms of U.S. civil-military relations. To restore professional standards, the incoming Congress must actively exercise its oversight powers, moving beyond mere criticism to demanding transparency in defense policy and personnel decisions. Key reforms include enforcing meritocratic promotion processes, requiring documented justification for senior officer removals, and preventing the partisan use of the military. These actions are crucial for bolstering public trust and ensuring the military remains a nonpartisan instrument of civilian control.
Inpatient Hospital Upcoding in California Among Fully Insured Commercial and Medicare Advantage Stays Between 2018 and 2023
English Summary
The RAND analysis concludes that upcoding—the practice of assigning higher-severity diagnoses—significantly contributed to inflated hospital payments for fully insured commercial stays in California between 2018 and 2023. Key evidence shows that upcoding was responsible for up to $535 million in additional payments in FY2023, with the growth concentrated primarily in non-vertically integrated hospitals. While the impact on Medicare Advantage (MA) plans was less definitive, upcoding was linked to higher out-of-pocket spending, particularly among lower-income patients. Policymakers must implement enhanced oversight and targeted interventions to curb unnecessary billing practices, control costs, and protect vulnerable populations from financial burdens.
中文摘要
蘭德（RAND）的分析結論指出，向上編碼——即將病症歸類為更高嚴重性——的行為，在2018年至2023年間，顯著推高了加州全額保險商業住院的支付費用。關鍵證據顯示，向上編碼在2023財年造成了高達5.35億美元的額外支付，且增長主要集中在非垂直整合的醫院。雖然對醫療保險優勢計畫（Medicare Advantage, MA）的影響尚不確定，但向上編碼與更高的自付支出有關，特別是對於低收入患者。政策制定者必須實施加強的監督和有針對性的干預措施，以遏制不必要的計費行為、控制成本，並保護弱勢群體免受經濟負擔。
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