It was 25 years ago the first time that I heard anyone mention the desire for health care reform. Even at that time, I heard discussion about a "public option". That seemed frightening to me at that time! I was still a trickle down, Reagonitic aspiring economist. The government messed up Medicaid, so, how could I trust it to handle MY healthcare?

FLASH - 25 years later. I've witnessed the economic devastation brought about by pure trickle down economics and I have shifted a bit. I still believe that the government must reward industrious ingenious individuals in times when our economy is growing. However, when our economy is contracting, the main job of government, and business, is the provide confidence to the consumer and attend to the needs of the individuals in need of financial support. Later, when times are plush, we can return to incentivizing new industry.

The health care reform plan that I proposed accomplishes several things.

First, it examines some expensive programs and makes recommendations for change. Faith and the placebo effect are discussed. The practice of defensive medicine, in which doctors prescribe and act as though their defense lawyer were right there fighting for them so that they are not successfully sued, costs about $350 billion a year. That's a lot more than the "mere" $25 billion paid in malpractice premiums. This excessive felt need must be approached from an economic, medical, and psychological approach. Medical Tort Law Reform drives this $350 billion unneeded expense and would save the typical family of four $4,666. Special programs to reduce medical errors will save $165 billion a year. The use of evidence-based practices will save $125 billion a year. Simplification of the US Tax Code is something that citizens and Congress have wanted for decades: compliance costs $400 billion per year. I suggest simplification that would reduce compliance costs $150 billion per year. Fraud, waste, and abuse identified by the Senate Finance Committee will save $10 billion per year. Private purchasing coops can save $5 billion per year. Modification of regional payments could save $15 billion per year. Medicare Advantage elimination could save $17 billion per year.

Second, I advocate a shift from disease treatment to wellness and prevention. We'd, of course, keep the former, we'd just take steps to prevent and reduce the need for the treatment of illness. State Department ought to require travelers to and from to study on the web international health issues. Americans ought to be trained in first aid, CPR, heart stimulators, lifesaving, as desired. Gun safety courses offered by NRA would seem logical for everyone who owns a gun. Driver safety courses ought to be expanded and DUI ought to be treated more harshly. Equipment purchases for safety (e.g., defibrillators, first aid kits, fire extinguishers, monitoring equipment ought to be tax deductible). Everyone can attend fitness centers and $5 per day would be credited to their "Lifetime Savings Account". This money would collect and could be used for center costs, health expenses, college expenses, or retirement expenses. I propose massive increases in the budgets of a number of federal programs - CDC, NIH, NSF, NOAA, PHS ...

Third, I discuss several things that will not work. These include: stipends to employers, outcomes payments, cost bundling, taxing of any health care benefits, health and child care thrift programs, giving private insurance companies another chance to rectify a situation they've had 60 years to manage, excise tax on medical devises, and the 21% Medicare payment cut.

Fourth, I discuss new programs for children and youth - school-based prevention programs, school-based health programs, prevention and safety education, obesity prevention, purchases of equipment for pediatric medicine, programs for athletics and physical education, labeling, organization of school-day for attention-deficit, nutrition, science programs, and coordination with other federal agencies.

Fifth, I discuss new programs for seniors, increased payments for nursing homes, eliminating the donut hole in medicare medicine policies, suicide prevention, research focusing on quality of life, expansion of traditional medicare, community seniors programs and family re-integration, encouraging seniors to work / volunteer, use of wills - living wills - and advanced directives, getting the disabled to seek treatment for conditions that make them disabled provided they have health insurance, use of hospice and end of life measures.

Special programs will be introduced for women and people in rural communities. I also suggest that the health care through the Indian Health Service requires much greater investment. Illegal aliens who are hard workers and driven ought to be embraced and given a chance to improve themselves while illegal aliens who are violent ought to be returned to native countries. The hard working aliens will finally begin to hold jobs for which employers must pay taxes, they will extend the life of Medicare and SSA significantly, and reducing the prison population will save $10 billion a year. Expanded programs for military are essential. Fairness to life partners to determine end of life decisions over remote family are needed.

Programs must be cogently, thoughtfully developed to address health care shortages in the next 15 years. I introduce several herein.

I propose that end-of-life care for one-third of people results in no progress and is simply costly. If only one-half of procedures for only one-third of those near end-of-life were diverted to hospice, an additional $125 billion could be saved per year.

I propose a program in which all employers contribute a sum into a pool that is equally divided among employees. It would factor salaries, bonuses, investments, profits. Individual employees would then have their need analyzed. If they personally earn minimum wage and they have a single income, then the government provides additional health care assistance. All of these monies are in the form of vouchers that the individual can then use to purchase health care mini-policies - hospitalization, outpatient, medicine, vision, dental, behavioral, catastrophic, long term care. They could select from policies offered inter-state by private for-profit companies, private not-for-profit organizations (e.g., AARP or NRA), or government. People can select more costly programs by self-contributions / LSA or less expensive, resulting in savings to LSAs. A number of statutory regulations will be imposed on health care insurers, like accepting pre-existing conditions, not allowing them to drop needy patients. Programs are designed to slow increased costs of medicine. Programs are introduced to pay for experimental procedures. Medical procedures would be designated as medically necessary, medically recommended, and elective. Medically necessary costs would be subject to full tax rebate. Medically recommended procedures would be subject to tax deduction. And, elective procedures would be subject to an excise tax. A program to address medical bankruptcy is needed and introduced.

Lobbying changes are critical.

Doctors must provide full transparency of conflicts of interest. Their malpractice must include a modest, even 5% copayment, so that doctors are motivated to change practices. Programs are recommended for increasing providers in under-served regions. First responder programs are elaborated upon. Medical records and giving providers cost information when prescribing is logical. Use of less expensive professionals and students is recommended for routine procedures. IT consultations must be covered by insurance. Outsourcing routine but costly procedures is recommended. Blending behavioral health care services with primary care is needed and will save as much as $300 billion. Doctor's salaries in the US have wild fluctuations. I recommend a regression to the mean in most cases.

Quality Assurance will shift from a clerical function to automatic, electronic analysis of best practices utilization. Allowing the US government and insurers to negotiate prices with pharmaceutical manufacturers seems logical, capitalistic, and would save $100 billion per year.

The costs of administration by insurance companies, Medicaid, and private providers approaches $833 billion per year. It is proposed that $250 billion in administrative costs could be eliminated through electronic medical records.

If each patient were to have a medical card, each time s/he went to the doctor, accurate and up-to-date information could be available to that physician. Medical errors would be reduced significantly. Payments would be automatic.

Various other programs, including patient education, would save an additional $100 billion.

It is recommended that several measures be undertaken immediately to assure the solvency of Social Security, Medicare, and the US government. I propose as possible measures: US nicotine tax of $90 billion, export tariff of $50 billion on nicotine, alcohol excise tax of $30 billion, unhealthy choice premiums of 10%, excess healthcare profits tax of $100 billion, taxing capital at the same rate as labor for the next 10 years would generate $225 billion a year, dangerous foods tax of $55 billion, a wealthy supplemental tax of $266 billion a year, taxation of off-shore savings and "laundering" would generate $435 billion a year, a medicare / social security tax increase of $380 billion a year, and environmental health taxes of $45 billion a year.