A BI-PARTISAN COMPREHENSIVE
PRACTICAL “DOWN-TO-UP”- BASED
HEALTH CARE REFORM PROPOSAL
FOR ALL AMERICANS
By
Robert Smith, Ph.D.
PREFACE
CHAPTER 1
BACKGROUND
§ 1.1.0 NATIONAL DEBT & NATIONAL DEFICIT
Deficit (D) is the amount overspent yearly. This is added to last year’s national deficit to give us the new national deficit, plus interest.
YEAR ND ND / PP (PER PERSON) ND % OF GROSS DOMESTIC PRODUCT (GDP)
2000 $5.0 T (Trillion) $17,000 50%
2009 $11.8 T $39,000 80%
I argue that deep tax cuts for the wealthy work during periods of economic expansion, serving to reward the industrious. Enhancing consumer spending and confidence is key during an economic recession or depression. The cuts were too deep to sustain government commitments, the growth in national security programs, and the growth in entitlement spending.
Ý Tax cuts were too big for shrinking economy! Trickle down theory says that tax cuts stimulate an economy. It is suggested that tax cuts stimulate a growing economy but not a shrinking one. The tax cuts for the wealthiest Americans from 2001-2008 added $2 trillion to the national deficit of the total $6.8 trillion.
Ý Free Trade Agreements (FTA‘s) reduce the tax base, force businesses to locate overseas, and hemorrhages US jobs, trading these for cheaper products for US consumers.
Ý Increased unemployment and under-employment
Ý Americans, businesses, and Wall Street Needed or Received More Assistance
Ý Crime and prison populations Increased Due to Expansive Laws and “Desperation”
Ý Shifts in income source (e.g., from wages to Professional Corporations, dividends, Short Term Capital Gains (STCG), and Long Term Capital Gains (LTCG), and off shore tax havens) outpaced IRS’ ability for enforcement! This added an estimated $2.4 trillion to the national deficit of the total $6.8 trillion and proper enforcement and taxing of these revenues is just and necessary.
Ý There is not a single time in history in which the
§ 1.2.0 CIVIL WAR DEBT
“There wouldn't be such a thing as counterfeit gold if there were no real gold somewhere.” - Sufi Proverb
§ 1.2.1 The only time, thus far, that
§ 1.3.0 GAO PROJECTED SAVINGS
§ 1.3.1 PROBLEM:
§ 1.3.2 ANALYSIS:
§ 1.3.2.1 - It is, indeed, very difficult to project savings from specific prevention programs. There is a measure of inaccuracy in any estimate, whether it is of inflation, confirmed kills of enemy combatants, or number of avoided cases of cancer. Steps ought to be taken so that the best measure of prediction is utilized. Strengths and weaknesses ought to be discussed. The source for this measure and an explanation of the technique ought to be elaborated upon. As new information becomes available, prevalence, incidence, costs, etc., report revisions ought to be provided to Congress. Prevention programs must not be avoided just because they are difficult for actuaries and accountants to calculate the benefit.
For example, inflationary figures are almost always included in multi-year projections. Tying the hands of Congress is leading to the passage of programs that are not fully efficacious for the people of the
§ 1.3.3 ALTERNATIVES:
§ 1.3.3.1 - Maintain GAO reports so that proposed savings are not identified.
§ 1.3.3.2 - Require the GAO to immediately change reporting to include projected savings.
§ 1.3.4 RECOMMENDED PROPOSAL:
§ 1.3.5 OUTCOMES:
§ 1.4.0 BALANCE SPENDING & PRIORITIES
§ 1.4.4 Throughout this document, I refer to the current economic climate as a downturn, retraction, or recession.
Definitions of an economic depression vary. Pundits do not want to use the “D” word (economic depression),
§ 1.5.0
§ 1.5.1 The nations with higher per person (PP) incomes have higher tax rates. But, despite those higher tax rates, the people still earn more than in the US and they also enjoy free medicine, free higher education, and the QOLs are higher. Higher taxes seem to be related to greater economic prosperity in those nations. That’s not what is taught as being possible in introductory economics.
§ 1.5.2 The
§ 1.5.3 Many of our founding fathers (e.g., Benjamin Franklin) had the capitalistic spirit described by Adam Smith. Capitalism is written nowhere in any founding document. Yet, capitalism is at the core of Americans’ very being. It’s potential to bring prosperity to the industrious (look at the pauper to riches stories, e.g., Bill Gates) appeals to our beliefs of hope and democracy and that anybody has the potential to succeed. On the other hand, capitalism can also be a tool for abusing democratic principles (e.g., slavery, child labor 100 hours a week, lobbying, Madoff, Phil Graham’s de-regulation of the financial sector that cost $2 trillion (T) or so).
§ 1.5.4 In the 1800s, the
§ 1.5.5 The US government looked inward while it was a small nation. It now looks outward, globally. It is recognized as the world’s sole superpower today.
§ 1.5.6 Land was acquired by low-ball purchases or theft from Native Americans and then sold, bringing needed money to the government.
§ 1.5.7 The
§ 1.6.0 LAST ERA OF GREAT
§ 1.6.1 The US’ manifest destiny was fueled by tremendous quantities of land, slave and later abusive labor, plentiful natural resources, and American ingenuity.
§ 1.6.2 Ironically, the last great period of real
SELECT 1950s INFRASTRUCTURE INVESTMENTS
c$ WW II & Korean War c$
c$
c$ Veterans Health c$ Universities
c$ Marshall Plan c$ GI Bill
§ 1.6.3 These “socialistic” programs were initiated by the republican WWII hero / President Dwight D. Eisenhower.
§ 1.7.0 KNOW THY CREDITORS
Neither should it be cause for reckless abandon.
§ 1.8.0
“I firmly believe that if the whole materia medica could be sunk to the bottom of the sea, it would be all the better for mankind, and all the worse for the fishes.” - Oliver Wendell Holmes
§ 1.8.1 US Health Care = $2,500 billion / year
= $8,333 PP / year
= $33,333 For Family of 4 / year
= twice the spending PP as other 29 OECD nations
§ 1.8.2 US Health Care As % of US GDP: = 13.1% in 1999
= 13.2% in 2000
= 16.7% in 2009
= 20.0% in 2020
I estimate that with economic retraction, the figure of 2009 will be 18.0% and the 2020 figure will be 22.0%.
§ 1.8.3 Why the rapid growth in health care spending?
4.
§ 1.9.0 HEALTH CARE COSTS AS PP GDP
$2.5 T * 37% = $925 billion Saved
$2.5 T * 40.7% = $1,018 billion Saved
§ 1.10.0 THE WAR TO RE-CAPTURE ECONOMIC PROSPERITY!
§ 1.10.1 The CIA Book of Facts reports the following ranking of nations by their GDP PP. As these data correspond robustly with figures from the IMF and World Bank, so, accuracy is reliable.
Rank Country US $
1 Liechtenstein $145,734 (Off Shore Banking)
2 Qatar $141,733 (Oil)
3 Luxembourg $118,538 (Off Shore Banking)
4 Norway $103,586
5 Ireland $68,574
6 Denmark $67,387
7 Switzerland $64,974
8 Iceland $62,490
9 Kuwait $61,499 (Oil)
10 UAE $58,424 (Oil)
11 Sweden $56,703
12 Netherlands $54,640
13 Finland $53,616
14 Austria $52,696
15 Australia $50,887
16 Belgium $47,617
17 United States $47,103
18 Canada $47,090
§ 1.10.2 This ought to startle baby boomers who remember that
§ 1.10.4 Even these nations with PP GDP greater than that of the US spend less on health care PP GDP! Less, even though they are smaller, have less economy of scale, better health, and greater longevity!
§ 1.10.5 Reduce spending on health care through increasing efficiencies.
§ 1.10.6 A much better altnative is to increase economic prosperity. As the old industries are shipped overseas for less costly construction, the US must invest in human capital and new businesses that provide domestically, reducing the trade deficit, as well as providing internationally cutting edge technologies. Not only does economic prosperity improve the government’s financial condition, it lengthens the lifespan of Medicare and Social Security, and, happy employed workers use fewer health resources than unhappy, frightened, or unemployed workers.
§ 1.10.7 Health care, alternative energy, and environmental services will be in greater demand internationally. As the world looks to the
§ 1.11.0 THE
“Two birds disputed about a kernel,when a third swooped down and carried it off.” - African Proverb
§ 1.11.1.1 - Riskier Lifestyles and More Dangerous Work and lack of access to primary care
§ 1.11.1.2 - Factors other than simple abuse of the economic system
§ 1.11.2 The uninsured often are eligible for generous charitable programs by drug companies.
§ 1.11.2.1 - Some drug companies work with charities to pay for people’s health insurance so that the insurance
§ 1.11.4 Hospitals write off bad debts as a tax deduction if they prove due diligence in attempts to collect debt. So, they charge 3 times what they charge insurance companies. The end result is often that the hospital is better off than if it had performed a service for a patient with health insurance. Who pays for this? Taxpayers.
§ 1.11.5 Many of the uninsured are young adults with well below average health care costs.
§ 1.11.6 These estimates of the costs of providing health care coverage for the uninsured are higher than those of the White House. I estimate that the total, gross cost will be $153 billion a year.
§ 1.12.0 COSTS OF UNTREATED MEDICAL CONDITIONS (UMC)
UMC à higher crime, SA, & related fatalities UMC à higher permanent disability
UMC à higher absenteeism UMC à shorter life span
UMC à higher school drop outs, lower wages, lower tax revenues, and more employee disciplinary problems
§ 1.12.1 A spike in health care utilization by the previously uninsured when first covered ought to be expected. This is natural and brings them back to better health, to a point which we all enjoy. We should not be alarmed at slightly higher initial costs.
§ 1.12.2 One study revealed that 18,000 Americans die each year while awaiting decisions or appeals by their private insurance company’s authorizing agent who denied them coverage. Private insurance companies only provide coverage for 94.5 million people (plus government employees). Thus, 1% of the people with private insurance will die due to private health insurance company’s death panels.
§ 1.12.3 It is estimated that approximately 20% of
§ 1.13.0 CAPITALISM’S HISTORIC ABSENCE FROM
§ 1.14.1 WHAT DRIVES HEALTH CARE COSTS GREATER THAN INFLATION?
“We’ve met the enemy and he is us.” - “Pogo”
every dollar that health insurance companies generate. In the last 17 years, non-MLR costs (insurance ADMIN and profits) jumped from 5 percent to 20 percent; health care costs increased 400 percent; ADMIN and profits increased 300 percent; income increased 1200 percent; and, profits increased 1000 percent. GOLDEN FLEECE AWARD!!!
and premiums were increasing hundreds to thousands of percents!
$ Overpricing $
$ Medical Errors $
$ Medication Errors $
$ Malpractice Costs $
$ Providers Inaccess to Cost $
$ Defensive Medicine Practice $
$ Heroic but Ineffectual Measures $
$ Administrative Wasteful Spending $
$ Legislation to Help Sometimes Has Blowback $
$ Money
$ We don’t practice Safety and Wellness Knowledge $
$ Providers’ Wise Investing Leads to Ethical Dilemmas $
§ 1.15.0 THE
“Put aside your pride, Set down your arrogance, And remember your grave.” - Ali ibn Abu Talib (radi Allahu anhu)
§ 1.15.1 Think about these numbers:
Medicare Retirees 36.0 M Medicare - Disabled 6.0 M
VA 3.0 M VA 1.0 M others
Military 9.0 M State and Local 15.0 M
Federal, State & Local Dependents 30 M IHS and Prisons 3.0 M
Public = 158.5 M (52%) Private = 94.5 M (31%) Uninsured = 47.0 M (17%)
§ 1.15.2 The
§ 1.16.0 US & PUBLIC PROGRAMS IN OTHER DEMOCRACIES
direct care (doctors, nurses, medicine, and machines) but spend 15% less time on ADMIN!
skill!
Service (NHS) care in GB, Hawking clarified that he, indeed, lives in GB, has received NHS care his whole life, and he is delighted with the quality of care he receives from NHS.
from buying medicines from other countries. Medicare is forbidden from negotiating best prices. Why? Because price negotiation is a feature of capitalism. Pharmaceutical companies are oligopolies and their profits are threatened by capitalism.
today. People with terminal illnesses die without needed care.
background – the elderly or ethnic groups.
no control over private insurance companies, but, we could write legislation so that bureaucrats would never be able to interfere.
the stepping in seems random and intrusive, imagine if a bureaucrat called a doctor and said, “90% of people given that treatment die, whereas only 5% of people given this alternative treatment die.” Sometimes those bureaucrats who have access to consolidated and current information and who are compassionate might be beneficial.
expensive to operate, I have no concern today about a bureaucrat saying no today to doctors. Medicaid is not the country’s success story and any attempts at health care reform must address Medicaid’s deficiencies.
the needs of the people. That possibility is equally found in private companies, except they don’t have elections or accountability to the people. While the public can vote by not spending their dollars at an overpriced store, employees usually can not get employers to switch insurance carriers that are setting fees within an oligopolistic structure.
politicans or executives won’t ever have the authority to interfere with decisions between our doctors and ourselves. We can design such a system in the government, but, we can not design such a system in the private sector.
§ 1.17.0 EXCESSIVE HEALTH SPENDING DRIVES ECONOMY INTO DEPRESSION
“The chains of habit are too weak to be felt until they are too strong to be broken.” – Islamic Proverb
locations where health care costs are nill.
§ 1.17.4 There are 2.3 million people employed from the insurance industry but only 800,000 doctors. Imagine if we reduced the insurance paper-pushing squad by 250,000 and replaced them with nurses or engineers who make great inventions and lead
§ 1.18.0 THE REAL ISSUE
all Americans in need, while being fiscally responsible.
§ 1.18.5 Those who profit from the status quo (insurance companies, health service providers, contrarian politicians) are spending dazzling sums of money in order to prevent health care reform.
§ 1.18.9 This is a battle of economic forces. The Chamber of Commerce, small business owners, large companies, the American Medical Association, American Nursing Association, the American Association for Retired Persons, and 77 percent of voters all join voices. Strange bed fellows lead to a major cacophony in contrast to the organized, harmonic efforts of health insurance GIANTS who profit from the status
§ 1.18.10 - On the other hand, there are health service providers, insurance companies, drug companies, and investors who are scared. They see that the rising bubble of health care will be popped if the health care reform plan is implemented. Frankly, this could cause the collapse of their financial stability. They also see some opportunities for making increased profits in the next one to three years until the health care bubble pops naturally.
§ 1.18.11 PREDICTION
§ 1.19.0 SEMPER FIDELIS
“Nothing is more noble, nothing more venerable than fidelity. Faithfulness and truth are the most sacred excellences and endowments of the human mind.” - Marcus Tullius Cicero
§ 1.20.0 QUALITY MEDICINE
§ 1.20.4 Americans die 5 years younger than the others from OECD nations with “socialized medicine”. Is this quality?
§ 1.20.5 Americans report less satisfaction with their health care than citizens from the other 29 OECD nations with “socialized medicine”. 8 in 10 Americans are not satisfied with their health insurance. Maybe that’s why HMO patients decreased from 29% to 23% in 2001 alone. Is this quality?
§ 1.21.0 COMPARING THE
§ 1.21.1 Of the wealthiest 28 OECD nations, the
§ 1.21.2 Have 27 SEPARATE countries blindly jumped on board a fleet of sinking ships, at SEPARATE times, that provide inferior health care to their people? Logic would suggest it is unlikely. Why not try it?
§ 1.21.3 Or, not having constraints imposed by private, oligopolistic companies, do those governments have the freedom to try new things, like capitalism or government-run programs? Why not try it?
§ 1.21.4 I’m all for trying new things when the old things haven’t been working. So, the fact that all 28 democratic capitalistic countries that tried public health care have not returned to private health care says something. Why not try it?
§ 1.21.5 Wouldn’t, eventually, the people in at least one of those nations protest, like the uninsured and underinsured are doing today in America, if their health care systems were unacceptable? Their health has to be more meaningful to them than “soccer”. Why not try it?
§ 1.21.6 CONSIDER:
§ 1.21.7 47 million are uninsured (1 in 6), projected to be 66 million by 2019. Another 100 million are underinsured. Most of these are working to middle class people who cannot afford insurance or who are ineligible due to pre-existing conditions.
§ 1.21.8 A Colorado study found 50% were either uninsured or underinsured in that state. That’s consistent with the above paragraph.
§ 1.22.0 COMPASSIONATE CONSERVATISM
§ 1.22.1 All religions (Protestant, Catholic, Jewish, Islamic, Buddhist, Hindu, Native, other) and liberal, moral imperative thinkers like John Locke call us to care for others. Why are fear mongers listened to who shout over the peaceful quiet voices of Jesus or Ghandi?
“Give, and it shall be given to you. For whatever measure you deal out to others,
it will be dealt to you in return.” - Islamic Proverb
“Health care is an essential safeguard of human life and dignity, and there is an obligation for society to ensure that every person be able to realize this right.” - Cardinal Joseph Bernardin
“Do not be wise in words - be wise in deeds.” - Jewish Proverb
“Therefore all things whatsoever ye would that men should do to you, do ye even so to them: for this is the law and the prophets.” - Bible,
“The desire of power in excess caused the angels to fall; the desire of knowledge in excess caused man to fall; but in charity there is no excess, neither can angel or man come in danger by it.” - Francis Bacon
The old man called out, “Good morning, what are you doing?” The young man paused, looked up and replied,
“Throwing starfish into the ocean. The sun is up and the tide is going out. And if I don’t throw them then they’ll die.” “But, young man, don’t you realize that there are miles and miles of beach and starfish all along it. You can’t possibly make a difference!” The young man listened politely, then bent down, picked up another starfish and threw it into the sea, past the breaking waves and said, “It made a difference for that one.” - Author Unknown
“This is my commandment, that ye love one another, even as I have loved you. Greater love hath no man than this, that a man lay down his life for his friends.” - John 15:13
§ 1.23.0 DISPARITIES IN USE
5% of people consume 44% of healthcare dollars
44% of people consume 20% of healthcare dollars
50% of people consume 3% of healthcare dollars
due to obesity. There are people who become obese due to illness (or side-effect of their medication), a roadside IED destroyed leg function, or a chronic thyroid condition. Ought a modest risk premium be assessed on the obese? Should it be assessed on all people who are obese or just those who make unhealthy choices?
healthier and live longer whereas Native-Americans seem less healthy and die younger. Let’s study, learn, intervene, and adopt best practices.
manufacturing, marketing, distribution, and sales. Would an increase in federal taxes on tobacco be reasonable in order that revenues received more closely equals health care expenses paid to treat those conditions? An additional $5 a pack would generate $90 billion a year, paying for President Obama’s plan’s projected costs yet it would still only pay 45 percent of health care costs associated with smoking / nicotine.
condition. Part of the reason for this is – as people age, they develop additional ailments. As one organ system fails other systems also begin to fail. Patients who report multiple ailments are rewarded for this by seeing more caring doctors and nurses. Patients who report multiple ailments are often independently treated by multiple specialists without benefit of a “comprehensive medical care manager” to coordinate services and medicines.
can and must find new, less costly, more efficacious methods of prevention and intervention.
§ 1.23.9.2 - Second, the inter-relatedness of organic systems is seen every day. With an “N” of 300 million people, the
CDC and NIH ought to be able to collate data, identify patterns, and predict probabilities of, say, additional ailments surfacing within x days. In cases in which risk is greatly elevated, interventions might be warranted early on, having the potential to save money.
behavioral health services with primary care, and assuring the providers are caring and professional but not reinforcing of personality disorders.
have access to another specialist’s lab results, so, they’re ordered again. They don’t often know what medications another specialist prescribed, so drugs interact resulting in months of anguish, tests, and finally, sometimes, communication. A single EMR access card would enable specialists to read a listing of all providers, medicines and true dosages, lab results, etc. While a Primary Care Provider (PDP) would provide coordinated care, specialists could be more cost effective, less redundant, and more efficacious.
($11,089 v $3,352).
§ 1.24.0 MORE SPENDING DOESN’T ALWAYS MEAN INCREASED QUALITY
§ 1.24.1 WHO ranked the
· highest cost per person
· first in responsiveness
· 37th in performance
· 72nd in overall health
· 73rd in infant mortality
§ 1.25.0 A DOLLAR SAVED ISN’T ALWAYS REALLY SAVED
§ 1.26.0 PARADOXICAL SPENDING
“They who give have all things; they who withhold have nothing.” – Hindu Proverb
§ 1.26.1 I propose several paradoxical spending measures:
Ý Spending on Children and Youth Nicotine Prevention à Less Smoking
Ý Spending on Children and Youth Obesity Prevention à Less Obesity
Ý Spending on Children and Youth Safety, First Aid, CPR à Saved Lives
Ý Spending on Children and Youth Health Care à Healthier Children
Ý Spending on Health and Science Education à Less Deficiency of Providers
Ý Spending on Athletics and
Ý Spending on Recruiting Providers to Underserved à Lower Mortality Rates
Ý Spending on Clinical Research à Less Disease, Better Management & Lower Costs
§ 1.27.0 DEFLATE A BALLOON AND THE AIR ALWAYS GOES SOMEWHERE
What happened following the mortgage and real estate bubble? The brokers struggle. The banks received
trillions in loans and grants from the federal government. Many of the consumers are having their properties foreclosed upon and they are filing bankruptcy. And, local governments and school districts that rely on property taxes for income are in fiscal crises.
§ 1.27.2 We can carefully deflate it now or we can let it unexpectedly go “pop”. The meteoric rise in profits of market
capitalization cannot indefinitely be sustained. We keep pumping air in the
§ 1.27.3 My Recommendations for Controlling the Health Care Bubble:
3. Increase investments in new programs such as prevention and research to soften the fall and increase potential for national economic prosperity, reduced health care costs, and exports.
4. Re-train labor from number crunching (e.g., insurance denying agents, attorneys, accountants, health care billing) to production (e.g., engineers, health providers, nurses, researchers, educators) where possible.
5. Export the finest and cutting edge
§ 1.28.0 THE
government calculate the average contribution and then allow every organization to contribute and receive tax deductions for amounts up to 175% of the national average.
Retirement Plans (529) would be collapsed into a flexible Lifetime Savings Account for each beneficiary. All amounts transferred to beneficiary’s accounts into LSA would not be taxed. I propose that every beneficiary be permitted to save $5,000 per year into a LSA, in addition to other targeted programs such as employer contributions or gym participation, although that figure might be adjusted.
For Profit Corporations: * $1,800 PP (Fixed - adjusted for inflation each year)
* 5.00% (Variable – sum of salaries, bonuses, AND gross profits)
* 2.50% (Variable – sum of investments)
* $5,000 (Employee Contributions to LSAs per Dependent (in addition to the difference between contributions and costs of policies)). These can be
used for health care, college costs, or retirement, contributions, and earnings are tax deductible up to, say, $1 million.
For Profit Start-Up Businesses: * $900 PP (Fixed - adjusted for inflation each year)
* 2.50% (Variable – sum of salaries, bonuses, AND gross profits)
* 0.75% (Variable – investments as so much money is often invested in
start-up businesses)
* Bonuses would not be permitted to be paid by start-up businesses in the
first 3 years if they elect to utilize this reduced formula.
* $5,000 (Employee Contributions to LSAs per Dependent (in addition to the difference between contributions and costs of policies)). These can be
used for health care, college costs, or retirement, contributions, and earnings are tax deductible up to, say, $1 million.
Not-For-Profit Organizations: * $2,000 PP (Fixed - adjusted for inflation each year)
* 6.00% (Variable – sum of salaries, bonuses, and investments)
* Not subject to levee on investments or profits
* $5,000 (Employee Contributions to LSAs per Dependent (in addition to the difference between contributions and costs of policies)). These can be
used for health care, college costs, or retirement, contributions, and earnings are tax deductible up to, say, $1 million.
Government Entities: * $2,000 PP (Fixed - adjusted for inflation each year)
* 6.00% (Variable – sum of salaries and bonuses)
* Not subject to levee on investments or profits
* $5,000 (Employee Contributions to LSAs per Dependent (in addition to the difference between contributions and costs of policies)). These can be
used for health care, college costs, or retirement, contributions, and earnings are tax deductible up to, say, $1 million.
§ 1.28.1.4.5 Special Considerations to Contributions
sum, as well as variable sums that reflect the changing circumstances of each employer. These sums
§ 1.28.1.4.5.2 - I suggest contributions on bonuses in the formula to reduce abuse potential.
The spouses could purchase a joint plan. Excesses would be placed in a LSA. Finally, working couples would receive total benefits for both individuals and justify the second partner working.
§ 1.28.1.4.5.15– So, after employer contributions to an individual’s health insurance plan, a calculation is made to factor in such things as regional health care costs, number of dependents, pre-existing conditions. From this calculation, a government subsidy is determined for each individual, for which a voucher would be issued. Based, then, upon the individual employer voucher, the government voucher, and the type of policy desired, the individual would then contribute money, say, from their LSA or they would put the surplus from the employer and government vouchers into a LSA.
§ 1.28.2.1 - PROBLEM: The current
§ 1.28.2.2 - ANALYSIS: Competition is needed. Regulation (at least up to the 19th century) is needed to protect the public. A refocus upon wellness and prevention is needed in order to reduce the disease-intervention system
§ 1.28.2.4 - RECOMMENDED PROPOSAL:
“Your own soul is nourished when you are kind; it is destroyed when you are cruel.” - Islamic Proverb
§ 1.28.2.4.1 – I propose that health insurance plans be provided by the government, for-profit insurance companies, and not-for-profit groups.
* Perhaps a not-for-profit plan would be provided by conservative Christians. They might be most comfortable with the ethics and values that are provided by a religious group’s health care plan rather than one that pays for abortion or infertility or bribes-by-prostitute. The difference between their costs and revenues might be designated for third world outreach and missions.
* Perhaps a not-for-profit plan would be provided within the GLBT community in which “identity crisis” and “coming out” counseling and generous coverage of HIV, substance abuse counseling (3 times the general rate likely due to identity and coming out issues), and gay adoption would be covered more generously.
* Perhaps a not-for-profit plan would be provided for the millions of Americans of a far eastern tradition who might prefer to see a health care plan in which ayurvedic medicine is covered.
* Perhaps a consortium of public universities, say the Virginia Public Higher Education Authority, might offer insurance for its 1 million graduates and employees. They might choose to have the $800 million a year “profit” be entered into a scholarship program for children of graduates of
Traditional Hospitalization Outpatient Care
Medications Dental
Vision Catastrophic
Long Term Care Behavioral Health
§ 1.28.2.4.3 – The above insurance plan would expand the potential market of private plans from 94.5 million to 300
million (more than 300 percent overnight). Plus, every American would purchase 8 categories of insurance, thus, private insurance companies would have the potential for increasing the scope of their products and their profits. Unequivocally, private insurance would benefit from expanding the market to include the 47 million newly insured Americans. Private plans could serve and profit from the 158.5 million “publicly” insured Americans, including those former Medicare and Medicaid beneficiaries, those with extended coverage, and public servants and dependents.
§ 1.28.2.4.5 - Lifetime Savings Accounts (LSAs) would be used by everyone. Credits from
utilization by the government of, say, $5 a day would be credited to each person’s LSA whether private, not-for-profit, or public insurance. This figure might automatically be tied to inflation.
People who elect programs that cost more than their employer allowance and federal contributions would pay
the difference from their LSA or out of pocket. People selecting programs less costly than insurance could place the balance in a LSA. LSA’s balance could pay for medical costs incurred by anyone, not subject to gift tax for medically necessary procedures. LSAs and their gains would be untaxed. At death, the balance could be transferred, not subject to inheritance, state and federal income tax, to beneficiaries, up to a maximum, say $1 million, if entered into LSAs.
genetic, familial, and environmental risks; history; and coverage desires. A selection of policies would be offered. If a different policy is desired, different parameters would be entered.
full transparency and oversight, somewhat like that of the Securities and Exchange Commission, only effective.
§ 1.28.2.4.9 - A panel of patients, provider groups, and representatives from corporations, not-for-profit organizations,
and government assemble to review compliments; complaints; use patterns; suggestions for quality improvement, increased efficiency, reduced costs, and CII reports. Results are prominently published. Congress reviews recommendations and recommendations are enacted unless otherwise legislated specifically by congress.
§ 1.28.2.4.10 - Procedures would be identified by providers using CMS definitions authorized by a citizen’s panel. As a
modest determent for over-utilization, co-payments would be based on the patient’s freedom of decision for services. For example, a person with cancer, it might be argued, has less freedom to decide about treatments and costs than a person with a dermatological condition. Tax rebates and deductions might be offered for the items with little choice and a modest excise tax might be imposed on elective services. Bureaucrats ought to never be permitted to determine these definitions.
“Medically Necessary” = Tax Rebate of x%
“Elective” = Excise Tax of x%
§ 1.28.3.1 - PROBLEM: While some public health insurance programs are models of efficiency, others appear to be less
effectively managed. If public systems will be placed in competition with not-for-profit and for-profit systems, they will need to compete for providers, patients, quality, and price. The private sector has not reached down and offered a plan for the working uninsured for the past 60 + years. The government must reach out and assist individuals whose income is too low to afford health insurance premiums or co-payments. There are 47 million people who are uninsured and 100 million people who are underinsured. Half of the
§ 1.28.3.2 – ANALYSIS: Public health insurance programs have mixed results with regard to quality and cost, whether they be military, veteran’s programs, the Indian Health Service, Medicaid, Medicare, or programs for government employees and dependents. A singular government plan ought to be developed. A government voucher system must be developed to assist individuals in the purchase of their insurance that is based upon need and regional costs.
§ 1.28.3.3 – ALTERNATIVES:
§ 1.28.3.4 - RECOMMENDATIONS:
§ 1.28.3. – With regard to paperwork and ADMIN, most providers now prefer to work with Medicare, then private insurances, and, lastly, Medicaid. AMIN costs are significant for Medicaid, moderate for private insurance, and minimal for Medicare. Given the following distribution of ADMIN costs, Medicaid ought to be absorbed within a federal program. This action will save $19 billion each year.
Medicare Operations = 3% Medicaid Operations = 8%
Private Insurance Operations = 21% Senate Fin. Comm. to Give = 35%
GOLDEN FLEECE AWARD!!!
§ 1.28.3.4.2 – Medicaid funding is insufficient. Medicaid payments to providers are 60 percent of costs. Medicare payments to providers are 85 percent of costs. Insufficiently paid public programs meant that providers shifted the cost to private insurance, but, now that private insurance dictates provider payments, that’s not possible. Providers must absorb costs of insufficiently funded public programs. That is usually feasible when providers have 15% of patients on public insurance, but, when 85 percent of patients are on public insurance, as in many underserved regions, the provider is forced to no longer accept public health patients. When providers must relocate from a region because they can’t afford to provide services, public health and private health patients both incur hardship and it defeats the ultimate objective of programs such as the National Health Service Corps. Thus, payments for the typical Medicare service ought to be increased by at least ten percent. Medicaid payments ought to be uniform (sometimes payments differ by 50 percent for adjacent states) and increased by at least 25 percent so that payments are not allowed to be less than 85 percent of private insurance companies fees for services nor less than 10 percent of costs for the procedure in that region. Medicaid specifies that no provider shall ever offer services different to its patients than to private paying patients. Low Medicaid payments result in rationing of health services to the few providers who care for Medicaid patients and these patients must often travel two hours to see a specialist who accepts public health insurance.
§ 1.28.3.4.5 - Comprehensive QA must be available to provide immediate consultations. The current system offers automated responses to questions. This impersonal system is not effective for STAT circumstances. If
“We make a living by what we get, we make a life by what we give.” - Sir Winston Churchill
§ 1.28.4.12 Long Term Structural Study
§ 1.28.6 Private Insurance Requirements:
§ 1.28.6.1 – Eliminate pre-existing conditions clauses. An assessment of a modest 10 percent premium might be
§ 1.28.6.2 - Insurance companies may not drop individuals who contract chronic or terminal illnesses. Premium payments might continue during a chronic illness, but, insurance companies must pay for all covered health
§ 1.28.6.6 - Individuals would be limited to total payments caps. For those with an income equal to 150 percent of the FPL, no more than x percent of their gross income can go to premiums, co-payments, co-insurances, and deductibles. For those with a FPL of 300 percent, no more than x + 2 percent of gross income ought to go to health care. For those with a FPL of 450 percent or more, no more than x + 4 percent of gross income ought to go to health care. Thereafter, all “medically necessary” expenses will be covered by the government and “medically recommended and elective” procedures will be reviewed.
“No sound ought to be heard in the church but the healing voice of Christian charity.” - Edmund Burke
§ 1.29.0 UNDERSTANDING
§ 1.29.1 These are difficult times. Even when meeting those with whom we fundamentally disagree, they give us an opportunity to better learn from their concerns and fears and gives us an opportunity to practice understanding.
§ 1.29.1.1 – We all expect our retirement fund manager to make decisions that will give retirement accounts big wins. So, he invests in profitable companies. There’s tremendous pressure for insurance, drug, and health care companies to increasingly outperform. CEOs that outperform themselves each fiscal quarter are compensated generously. Those that don’t are fired and forgotten.
§ 1.29.1.2 –On average, doctors invest $800,000 for tuition and start up costs, 11 years of education with little to no income, where, in other nations, education is free. Shouldn’t doctors earn a fair Return On their Investment, too?
§ 1.29.1.3 – Mary Ann loves her Medicare. She doesn’t have those pesky private insurance bureaucrats who used to deny care. Medicare (and her supplemental policy) pay for everything and she rarely even gets a (confusing) statement or bill in the mail. She’s afraid that public programs will cover “lazy” people to drunk to contribute to society, young adults too selfish to get insurance and share her burdens [AKA, transfer their dollars to her as she’d done for the elderly for 40 years until her own retirement]. She’s concerned that including the uninsured in the pool or providing a public option may lower the quality of her own health insurance.
§ 1.29.1.4 - I appreciate the fear people have about the slippery slope that public health care could lead to socialism and threaten the profits of giant health care conglomerates.
§ 1.29.1. 5 - I feel the fear of the single mom with two children who was recently diagnosed with cancer and dropped by her private insurance. By the time she fights all of the review, authorization, and appeal boards, she might well already have died not having been able to receive the treatment she’d paid for all this time, leaving her children alone for the state.
§ 1.29.1. 6 -I heard a number – 14,000 people every day are now losing their health care. In the time that I’ve been writing this proposal (200 days), 2.8 million people have lost their insurance. I don’t make it a habit of quoting Stalin, but, didn’t he say something to the effect of, “one person’s death is a tragedy. One million people’s deaths is a statistic.” When, as Americans, do we shut down, the real-life tragedies merge into a combined statistic that is more easy for us to ignore. Psychologists call it cognitive dissonance. We ignore those things that challenge our own belief systems or our own behaviors. So, in order to justify our ignoring the needs of millions of souls around us, we ignore the tragic stories. The numbers, for us, as Stalin said, become mere statistics.
§ 1.30.0 HOPE: THE NEW INDUSTRIAL REVOLUTION: HEALTH CARE
§ 1.30.1 The current health care crisis gives us an opportunity to dig our way out of this mounting debt; provides a new sense of purpose as caring Americans; increases employment; introduces a new period of economic prosperity; and, assures better health, ways toward a longer lifespan, higher quality of services, and much improved Quality of Life (QOL) for all Americans.
§ 1.30.2 The US has shifted since 1600 from hunter-gathers, agrarian, industrial, electronic, to, presently, health services economies. Embrace currently that we are in a health care economy. In my opinion, %GPD PP of health care should not matter, as long as: (1) services are high quality and efficient, (2) the
§ 1.30.3
§ 1.30.4 WHAT IS IMPORTANT IS THIS – We can effectively reduce US health care spending by $500 billion a year and improve quality of health care and cover ALL Americans! The shift in spending on 4% of our economy might have some adverse short term effects on our economy, but, in the long term, saves money.
§ 1.30.6 We can shift some of our resources, using joint international public and private partnerships, to help other nations’ health care while employing more Americans and generating increasing profits.
§ 1.30.7 Health care generates the highest paying jobs in the
§1.31.1 Medicaid and Medicare are grossly underfunded public programs. They pay providers much less than the cost of actually providing services, about 85 percent and 60 percent of costs, respectively. Providers used to be able to pass on public costs to private payers and insurance companies, but, now that oligopolistic insurance companies set prices and fees, providers can’t do this anymore, thus, providers must “eat the losses”.
§ 1.31.2 All providers who have worked with Medicaid know that it is not efficacious. Medicare is substantially better and more satisfying to patients and providers. It’s also the least expensive to manage, at 3 percent versus Medicaid’s 8 percent and private insurances’ current 21 percent.
§ 1.31.4 If we’re to give public insurance a go, we must increase payments to the level of, at least, costs.
§ 1.31.6 Not only have Medicaid and Medicare experienced medical inflation much higher than regular inflation, but, the number of people eligible for these public programs is also increasing at a rate faster than the population growth rate. Attempts to control spending have been designed by bureaucrats and lobbyists and they are ineffective. New systems of controlling spending must be researched by a Citizen’s Panel, recommendations made and implemented. This citizen’s panel ought to include some citizens, a forensic accountant, economist, and several representative providers
§ 1.32.0 PRIVATE INSURANCE ISN’T WORKING
“The lower self is greedy, teach it to be content.” - Islamic Proverb
§ 1.32.1 The intersection of greed and health care is littered with many corpses. I love capitalism, but, it deserves and requires greater regulation when the stakes are great. If the
§ 1.32.2 Providers are denied their requests for care much more often by private than public programs. Private health insurance companies’ ADMIN costs are 7 TIMES that of other OECD nations’ administrative costs. Why such a substantial difference?
§ 1.32.3 Private companies justify bigger profits through expanding costs. So, they pad the payroll to make it look like they cut costs from gate-keeping of inexpensive procedures, justifying bigger expenses and bigger profits. At the same time, they “blindly” cover the most expensive procedures ($40,000 bypass surgeries or $50,000 breathing medicines), because a $50,000 cost will equal a $6,000 profit. Of course, private health insurance companies do not discourage lifestyles that result in costly services later on. Why would they? They’re not paid to provide prevention, they just pay for expensive health procedures. Thus, private insurance grows ever larger as Americans die younger and younger.
§ 1.32.4 GOLDEN FLEECE AWARD: The CEO of United Healthcare received a bonus of stock valued at $1.6 billion on top of his $8 million annual salary. Now, in my mind, $8 million is very reasonable compensation for someone with those kinds of responsibilities. But, when a CEO receives bonuses greater than the entire REPORTED profit of that corporation, my mind starts wondering if their accountants are as clever as the accountants from Enron? UH is one of the biggest spenders on lobbying against changing the status quo. What does UH have to gain from maintaining the status quo? Billions of dollars in profits until the bubble breaks.
§ 1.34.0 POLITICAL EXPEDIENCY
“I have always thought the actions of men the best interpreters of their thoughts.” - John Locke
“Plans are only good intentions unless they immediately degenerate into hard work.” - Peter Drucker
“Pride is concerned with who is right. Humility is concerned with what is right.” - Islamic Proverb
God made the illusion look real
and the real an illusion.
He concealed the sea
and made the foam visible,
the wind invisible,
and the dust manifest.
you see the dust whirling,
but how can the dust rise by itself?
you see the foam, but not the ocean.
invoke Him with deeds, not words;
for deeds are real
and will save you in the infinite-life.
- Rumi
§ 1.33.1 Lobbying groups spend money. Money influences and, in the unfortunate cases, buys politicians. More money rests on this health care reform than any decision ever made by Congress. I discuss lobbying and campaign contributions later.
§ 1.33.2 What if I were to donate $1,000 to every candidate who opposes a congressperson who votes against comprehensive health care reform? I urge every voting, non-lobbying American to do the same, to the extent that you can. Everyone must tell their congressmen of their well formed, researched thoughts on health care reform.
“Well done is better than well said.” - Benjamin Franklin
§ 1.34.0 CRISES NOW & ON THE HORIZON
§ 1.34.1 Insurance companies’ financial reserves have declined (look at real estate and the stock market). The loss of these cushions threatens the short-term survival of some giant insurance providers.
§ 1.34.2 A stalled economy is associated with greater demand for health care services (an unemployed wife might begin to get stress-related migraine headaches and could get depressed).
§ 1.34.3 The increasing age of Americans means that more of us will be vulnerable to diseases associated with age. For example, a 33 percent increase in Alzheimer’s Disease (AD) is anticipated in coming years.
§ 1.34.4 As Americans grow obese, we are more likely to develop diabetes and heart disease, even cancer, propelling future costs.
§ 1.34.5 Americans’ lifestyles are a more dangerous threat than terrorism. More Americans die in one year from unhealthy lifestyles than all people in the world during the 20th century during non-war times. As such, Americans must exercise, eat more healthily and consume fewer calories, take the time to enhance mental health, reduce toxin exposure, and follow research.
§ 1.34.6 I briefly introduce discussion on global warming. If it is a valid concept, then we ought to examine the effects of previous climate changes to the planet and our survival. We must act proactively in identifying diseases (e.g., used to be equatorial but will increase prevalence in more polar climates – what greater susceptibility might we have to these diseases or to diseases due to changes in the ozone layer, e.g., skin cancers).
§ 1.34.7 We’re all concerned with terrorism. Violence is used more frequently and with more destruction. We must
prepare for the eventual use of these tactics on civilian populations. We must invest in research, prevention, rehearsal, equipment, first responder training, and FEMA services. School children practiced hopping under their desks in case a nuclear bomb exploded nearby. Helping the public to practice and prepare for such disasters seems logical – along with realistic threat assessments
§ 1.34.8 We must act, now, responsibly.
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