DOUBLE MANDATE: As in car insurance, Everyone should be required to purchase insurance unless unemployed & Insurance Companies MUST accept ALL applicants.
PRE-EXISTING CONDITIONS AND CANCELATIONS: Insurance companies should be prohibited from canceling any policy regardless of AGE, RACE, SEX, RELIGION or PRE-EXISTING CONDITIONS. This insures complete Portability of Insurance for Individuals and increases the pool of insured which should mitigate cost along the larger pool.
HEALTH INSURANCE PLANS WITHIN AN INSURER: Regardless of pre-existing conditions, age, race, religion, or sex, EVERY PLAN AN INSURER OFFERS should be available to ALL applicants. Additionally, each Health Insurance Plan within an Insurer should be mandated to have the same price for ALL INDIVIDUALS, with a MAXIMUM additional surcharge of 20% EXCLUSIVELY for people with PRE-EXISTING CONDITIONS or over 65yrs of age. NO SURCHARGES for gender differences.
INSURANCE DISCOUNTS: Mandate minimum 20% Discounts for CHILDREN under age 21. Discounts should ONLY apply to CHILDREN UNDER 21 and to GROUP INSURANCE, with all rates and plans within the group fixed and set as above. No other discounts should be allowed. If this is not mandated, insurance companies will use DISCOUNTS as a method to OVERCHARGE as they are doing now, setting their rates un-SUSTAINABLY High, and then offering discounts to everybody EXCEPT people with pre-existing conditions, so that only those rates would be reasonable, thereby driving all others off their plans.
NOTE: "make health insurance plans completely portable for individuals with life changes, in order for the insurance companies to compete on a flat playing field for the whole U.S. population. Ideally we should move away from employment-based health care. If employers do not have to pay the soaring costs of healthcare for their employees, they can raise their employees' salaries in a commensurate manner, and the employees, in turn, can choose which LEVEL and TYPE of health care plan they want to purchase. " Dr. Paul Toffel, http://www.huffingtonpost.com/dr-paul-toffel/health-care-reform-an-ori_b_258388.html
MAXIMUM INCREASES LINKED TO INFLATION: Mandate Maximum Premium Increases to be linked to INFLATION. Wendell Potter: "Potter described how underwriters at his former company would drive small business with expensive insurance claims to dumpt their CIGNA policies. … "When that business comes up for renewal, the underwriters jack the rates up so much, the employer has no choice but to drop insurance,"
http://www.cnn.com/2009/POLITICS/08/12/health.industry.whistleblower/index.html
PROHIBIT: Insurance Caps, Preventive Care Caps, Discrimination, Gender based discrimination (until men can bare children themselves), and Employer Mandates. EMPLOYER MANDATES WOULD BE A DISASTER !! –Particularly in the midst of a recession, as it can have unintended consequences. Today there are many small-business owners doing without salaries in order to try to maintain the businesses in which they invested years of their labor and love, hoping they can outlive the recession.
PREVENTIVE CARE: Mandate Full coverage of yearly physicals and yearly tests for Mammograms and eye and foot tests for Diabetics.
CHILDREN: Parents should be allowed to include CHILDREN up to age 21 under their own plans without exceptions or explanations. This facilitates and helps guarantee that young adults are insured.
MEDICAL TEACHING HOSPITALS/SCHOOLS: All NEW MEDICAL TEACHING HOSPITALS/SCHOOLS in any way funded by the government, even if indirectly, whether federal or otherwise, must be located in low-income under-served areas. All NEW government funds should only to be provided to MEDICAL TEACHING HOSPITALS/SCHOOLS which serve and are located in low-income areas. New TEACHING HOSPITALS/SCHOOLS should be located in a Low-income underserved area. IF all low-income areas are already being served, then they can be located in any low-income area. Dr. Pual Toffel: "Thus, the final no new-tax solution to the health care problem is to get all of the urban medical schools back to serving their local indigent populations, with a standing "open door" policy, and no dumping of those patients off to other private hospitals or clinics while still obtaining Federal Grants (such a dumping policy was recently disclosed to have taken place at the University of Chicago Medical School)." Read the original: http://www.huffingtonpost.com/dr-paul-toffel/health-care-reform-an-ori_b_258388.html
ILLEGAL IMMEGRANTS: Mr. Kyl: "many illegal immigrants, unable to get coverage elsewhere, go to hospital emergency rooms when they are ill, driving up costs for everyone else." As we are not a nation truly about to let any people bleed to death in the streets, illegal immigrants should be allowed to obtain health insurance for themselves, without requiring proof of legal status. EMPLOYERS OF ILLIGAL IMMIGRANTS: should be FINED the full amount of any medical expenses incurred by the illegal immigrant at regular Hospitals - a strong incentive for Employers of illegal immigrants to fund an insurance plan for illegal workers or hire a Doctor to visit every 4 months for preventive and other care, with a fund for medication. Or hire ONLY Legal workers. If you are not providing jobs, then there is NO incentive to cross the border ILLEGALY and no additional burden on the middle class taxpayer – goes triple for non-farm jobs. See also Teaching Hospitals
DRUG MANUFACTURER's MARKUP: Maximum of 20% markup over (1)the net manufacturing cost + (2)the Total cost of research spread across the period of Patent Protection. NOT to Include: Administrative overhead, CEO salaries, nor any expenses/research funded or reimbursed by government grants or other public or charitable funds. – The important reasons for NOT including administrative expenses and Executive salaries: These are often arbitrary and, particularly in the case of Executive salaries, used to bleed the profits of corporations, to the detriment of both long-term planning and the profits of the corporate stock holders. As a supplementary method, we should "relate the Price of a new and existing products to the price of the same or similar product in other (developed) countries, as Switzerland does". (http://content.healthaffairs.org/cgi/reprint/13/3/98.pdf )
This has the effect of preventing drug companies from SUBSIDIZING their sales in other markets on the backs of the American Consumer.
NO GOLDEN PARACHUTES FOR HEALTH INSURANCE COMPANIES: Due to the PRIMARY nature of this industry, GOLDEN PARACHUTES should be prohibited if greater than 2xMedian Income, including all non-monetary benefits. -No more $600 Million+ Golden Parachutes for leaving a company – Why provide an incentive for failure?
Dr. Paul Toffel : "return health care insurance companies to the pre-1984 federal regulations that limited their fees to administration only (about 15% of medical dollars), without excessive profits going to their boards of directors, CEO's or shareholders. The provision of medical care is not the type of profession that can be treated as a simple commodity. The corporatization of health care was a bad idea" http://www.huffingtonpost.com/dr-paul-toffel/health-care-reform-an-ori_b_258388.
COST-BENEFIT ASSESMENTS/BEST PRACTICES: Carry out cost-benefit assessments for Pharmaceuticals, Tests, Equipment, and Procedure. Many drugs and tests pushed by their manufacturers are no more effective than older cheaper ones (specific to an illness/set of symptoms) and are therefore over-prescribed in relation to cost and effectiveness. PUBLISH THE RESULTS. This has 3 purposes:
1. Reducing costs associated with some less effective but more expensive items.
2. The publicly published list would be a tool that the GENERAL PUBLIC can use to restrict doctors from prescribing medications and procedures patients may not need or want, preventing Doctors from prescribing in order to receive fees and perks from Pharmaceutical companies and preventing them from overcharging Medcare and Medicaid.
3. Providing a list of BEST Practices, Medications, and Tests - in order of effectiveness – and mandating that insurance companies AT LEAST cover one of the top 3 or 4 procedures, ensuring that insurance companies cannot simply opt out coverage of on invented excuses.
4. Consider having "Cost-and-Clinical effectiveness" become part of the nation’s pharmaceutical "registration process". http://content.healthaffairs.org/cgi/reprint/13/3/98.pdf
ANOTHER OF REASON TO GET THE ASSESMENTS DONE: "The most worrisome issue", Hall says," is whether the millions of CT scans done on children are all really necessary. Children are roughly 10 times more sensitive to radiation than adults." http://www.forbes.com/2009/08/27/medical-imaging-radiation-study-business-healthcare-scans.html?partner=popstories
"restore core values of medicine that were strong in the past, such as a reverence for the healing power of nature and the importance of the therapist-patient relationship. … It is fiscally conservative in its willingness to look beyond the blinders of high-tech medicine to identify inexpensive therapies that may be useful and in its insistence that they be held to the same standard for clinical- and cost-effectiveness in well-designed outcomes trials." Dr.Andrew Weil http://www.huffingtonpost.com/andrew-weil-md/why-i-am-a-conservative-o_b_259869.html
ADDITIONAL DISINCENTIVES FOR OVER-PERSCRIBING AND UNNECESARY, REPETITIVE TESTS AND PROCEDURES: "Monitor the Prescribing behavior of Doctors to identify those prescribing HIGHER THAN AVERAGE Quantities of Drug and/or Higher than average High-priced prescription" as a ratio of number of prescriptions written.". Ex: 1000 out of 2000 perscriptions written. http://content.healthaffairs.org/cgi/reprint/13/3/98.pdf. I can see this collected as part of the information collected at the pharmacy level in reference to prescription drugs – sorted by an identification number for each Doctor.. PUBLISH THE RESULTS on the same website as ‘Best Practices’ is published so that the GENRAL PUBLIC is empowered to make decisions about the type of doctor they would like to visit. Of course, an even better metric, if it can be done reasonably, would be to ALSO Monitor and Publish the ratio of Prescriptions and of High priced prescriptions to the number of patient seen. The same would be highly effective for Surgical Procedures, Monitoring and PUBLISHING the ratio of surgical Procedure to Number of Patients seen. – "Knowledge is Power" and the Public should have it in order to make their own informed decisions, as they are the only ones guaranteed to have their own best interests at heart.
INCENTIVES TO REDUCE UNECESARY PROCEDURES AND FAKE BILLING: Insurance companies, for their own benefit, might consider running a nationwide cooperative program calling it something like "Citizens for Honesty in Health Care," something like "join us in fighting back against the damaging fraud that hurts us all’ and offer a $100 rebate at the end of the year for people who had NO procedures or prescriptions other than yearly checkups like mammography. Offer $50 for people who at the end of the year had less than 3 tests or procedures or whatever seems reasonable and did not have double tests for different doctors or hospitals that could have been limited to one. It is only an incentive to get people interested in Monitoring their own doctors and hospitals. Possibly offer a $300 refund if there were no test or prescriptions in 3 or 5 years other than the regular checkups. This would work best if it was something all insurance companies offer... or a large majority….. The PROBLEM is expressed succinctly by this blogger: "Stop doctors from prescribing MRIs, chest X-rays and stress tests when it’s evident that the patient is suffering from the common cold." – Paul Styers - http://blogs.kansascity.com/unfettered_letters/2009/09/how-to-control-health-care-costs.html -
REGULATED INTER-STATE INSURANCE EXCHANGE: Sounds Excellent. Would promote competition and lower cost of insurance. But Companies allowed to participate in the exchange MUST be regulated in order to prevent insurance companies from moving to States with minimal regulation in order to operate more cheaply by avoiding regulations meant to protect the citizenry, with the added disadvantage of REDUCING THE VARIETY OF INSURANCE PLANS.
NON-PROFIT COOPERATIVES: If Cooperatives are as cost effective as advertised, government should insure Medicare and Medicare recipients through EXISTING CO-OPS by choosing whatever plan is CHEAPEST and most effective overall. I can’t imagine that there is anything in the current system precluding this. Individuals have always been free to join Non-Profit Cooperatives at any time. Government should NOT and has no need to be in the business of starting, running, nor funding companies of any type. Dr. McEwan,Group Health Cooperative: "If we do more for our patients, we don't get compensated more. … I don't know that it's the total answer for health care nationwide." http://www.google.com/hostednews/ap/article/ALeqM5h_RKSMLgqMUoma85XeS3rDnGrhlQD9AH9MTO2
MEDICARE ADVANTAGE PLAN: Beneficiaries receive their Medicare benefits through private health insurance plans. Medicare pays a private health plan a set amount every month for each member. http://en.wikipedia.org/wiki/Medicare_(United_States)
TRADITIONAL MEIDCARE: "Medicare has a standard benefit package that covers medically necessary care that members can receive from nearly any hospital or doctor in the country." This traditional Medicare is Fee-for-Service.
FEE-FOR-SERVICE in HEALTH INSURANCE: "occurs when doctors and other health care providers receive a fee for each service such as an office visit, test, procedure, or other health care service. Typically allow patients to obtain care from doctors or hospitals of their choosing, but in return for this flexibility they may pay higher copayments or deductibles." http://en.wikipedia.org/wiki/Fee-for-service
PROBLEM:
"The Chief Actuary testified that the insolvency of the system could be pushed back by 18 months if Medicare Advantage plans that provide more health care services than traditional Medicare and pass savings onto beneficiaries were paid at the same rate as the traditional fee-for-service program. http://en.wikipedia.org/wiki/Medicare_(United_States)
SOLUTION:
Pay them at the same rate or CANCEL MedicareAdvantagePlan or have those beneficiaries who still want to participate in this plan pay the difference between the cost of Traditional Medicare and the MedicareAdvantagePlan. But insure these Fee-for-Service providers and limited by Cost Benefit Assesments, Best Practicies, and other tools to limit fraud and over-billing. NOTE: One big reason that those in Medicare Advantage are still on these plans is that the patients the private insurers are accepting are the healthiest of the lot.
FDA: 1. only staffed by Medical researchers and scientists unaffiliated with any pharmaceutical enterprise. 2. Change whatever laws/regulations necessary in order to eliminate the perception within the FDA of DRUG COMPANIES as clients.
3. Dedicate Specific Funding to the testing of Natural Products, such as flax seed for high blood pressure, in order to reduce the number of branded medications prescribed for patient treatment that can be treated and/or cured with MUCH cheaper natural products, which generally have the additional benefit of avoiding the seemingly endless list of side-effects many new drugs carry, and sometimes even eliminating the need for a scary cocktail of pharmaceuticals.
NIH and UNIVERSITIES: Fund research in the NATURAL CURES and INEXPENSIVE THERAPIES that Dr. Andrew Weil and many others propose. (me too).
MEDICAL JOURNALS: "formerly bastions of objectivity, are today often ghostwritten by shills for moneyed interests. … physicians, once free to make healing their only goal, must now obey the dictates of lawyers and stockholders (particularly HMOs charging Medicare/Medicaide) by ordering endless tests and dangerous, dubious surgeries for even minor conditions." Dr. Andrew Weil http://www.huffingtonpost.com/andrew-weil-md/why-i-am-a-conservative-o_b_259869.
Senator Edward Kennedy, on Charlie Rose: on MEDICARE EXPENDITURE: "75% is for people in the last 6/8 months of life and for 17% of the Elderly that are disabled. If through Science improve that 17% to 15%, increases the lifespan of Medicare for another 10yrs. Breakthroughs in Alzheimer’s would empty 2/3 of nursing home beds in Massachusetts. … What’s really necessary in order to do this is Information Technology, Preventive Case Management, Best Practices, encourage the breakthroughs in terms of Prescription Drugs and New Technologies, and we can deal with this."
- Brilliant Justice in Ceaseless Aid of those less fortunate -
Make these saving happen! Please. . and spend the savings AFTER they are realized. The government already takes big enough chunks from all our salaries to do what is needed for the uninsured– the rest is mismanagement.
PUBLIC FORUM/TOWN-HALL MEETINGS: I watched many of the Congressional public forums on Health Care. I was very relieved to see the forums held by Senator Lisa Murkowski (R-Alaska) and Congressman Ron Kind (D-Wisconson). Both were informed, pragmatic, exemplary representatives proposing reasoned solutions, concerns, and ideas, unlike many who have devolved into ranting and propagating inflammatory and inaccurate information. The difficult situation the country and its citizens face should inspire all sides toward constructive dialogue, aimed at proposing feasible solutions and discussing real and logical problems, both of which abound. – One of the interesting issues expressed by Senator Murkowski was that in Anchorage Alaska, something like 70% of GENERAL PRACTICIONERS were REFUSING TO ACCEPT MEDICARE PATIENTS due to excessively low Reimbursement rates from Medicare, causing a shortage in available doctors.
SAVINGS FOR MINOR WEEKEND EMERGENCIES: Suggest that insurance companies, for their own savings, list where to go on WEEKENDS for procedures like setting a broken bone, burned hand, child's fever, ear-aches ..etc.. in order to avoid the excessive expense of going to hospital emergency rooms for these minor emergencies, for which people will absolutely go to an emergency room if are not strongly informed of a feasibly option. One possibility is for insurance companies to establish some system of clinics throughout the city that they fund co-operatively with each other just for these emergencies. Or select a list of certain doctors that will take ANYone in the insurance pool for these types of events during the weekend, and make it clear where they are in the 1st sheet of the INsurance Provider booklet.
TORT REFORM: $2 Million cap in damages linked to INFLATION with additional lifetime medical coverage should be enough for ANY error. "
SOCIAL SECURITY: STOP TOUCHING IT! The Congress SHOULD NOT have the authority to use these funds for loans to other programs or any other reason.
Many Thanks to President Barrack Obama and his administrative team: "Hospitals agreed to the gradual reduction of $50 billion in government payments they receive for treating the uninsured." http://www.bloomberg.com/apps/news?pid=20601170&sid=a52ZhqS.hGVw
- Hospitals receive Pulbic Funds and Grants-
REASONS FOR NOT HAVING A GOVENMENT PLAN or OPTION:
1.
The insurance companies are sure to figure out a method by which to dump all the people with pre-existing conditions unto the government option. If there is NO government option, the people will scream bloody murder and stop any schemes. With a public option, the Insurance Industry will eventually push through some seemingly minor change in the law that will have the same result.
EXAMPLE: " In 2003, when the (Medicare) Part D drug program was being planned … Republicans insisted that the program be administered by private insurers and that the government be PRECLUDED from negotiating prices. Before that shift, Medicaid administrators had the legal authority to negotiate prices with drug makers ... the government suddenly started paying higher prices for their drugs — 30 percent higher on average, … As a result, Mr. Henry Waxman (D) contends, the drug industry got a $3.7 billion windfall in the first two years of the Medicare drug pgram." and we all know drugs are unreasonably expensive! [1]
Lincoln Diaz-Balart (R) 08-31-09 on PBS-WLRN responds that MEDICARE Part D drug Premiums are 40% lower than originally projected because COMPETITION was included in the plan. "The Chief Actuary also testified that the 10-year cost of Medicare drug benefit is 37% lower than originally projected in 2003, and 17% percent lower than last year's projections."[2] – BOTH Competition and Drug Price Negotiations are needed and justified to spare Public funds – Public Funds are not meant to be windfalls for anyone!
2.
Federal Spending for 2008 was $2.9 Trillion [3]. Defense Spending accounted for 21% of Federal Expenditure for 2008 or $613 Billion, but those numbers RISE to approximately $800 Billion when you account for extra-budgetary supplements and Emergency Discretionary Spending [4] . Medicare and Medicaid account for 23% of government expenditure. "Federal Medicaid outlays were estimated to be $204 billion in 2008. [17]"[5] Medicare spending reached $440 billion for 2007. " Medicare will spend more than it brings in from taxes this year (2008). The Medicare hospital insurance trust fund will become insolvent by 2019. [6] So, in conclusion, Government doesn't function on the cheap, and if we have a pragmatic proactive administration now, it is NO GUARANTEE that in the future we won't have another untax-n-Spend-Republican, out-sourcing Health care to his most expensive buddy (like Bush unbelievable out-sourced war), or a tax-n-spend-Democrat adding public programs irrespective of the expense to middle-class pockets... BOTH sides sometimes seem to imagine that the Treasury self-funds. Practically every penny government spends is coming out of some middle-class person's pocket, the same middle class whose buying power is deteriorating yearly. The same middle-class who is concerned about unemployment and the sky-rocketing cost of their children's college education, is dishing out thousands upon thousands yearly in Health Care, Home & Hurricane insurance, Property Taxes, Electricity, Gasoline, and the rest. The same middle-class whose funds have bailed out and guaranteed the excesses incurred by the Brilliant WALL STREET gambling spree
3.
A Plan exclusively funded with taxes from the top 2% will not work either. Tomorrow that plan will still be there, but the Taxes on the top 2% will be cut back, and the middle class will be paying the bills again..... Using the program outlined above for the FREE and mostly ALREADY FUNDED Medical Teaching Schools/Hospitals makes a lot more sense.
The Middle Class
Stepping stone to the American Dream
MIDDLE CLASS TAX CONTRIBUTIONS: Medicare, Medicaide, tax subsidies to GAS companies, bail-outs, tax subsidies to corporate farms, FDIC guarantees of MortgageSecurities, $2Trillion FED backstops, etc………
STOP ALREADY !! please !
Why am I so concerned with MONEY? – The tax monies in the Treasury of the United States of America is the labor of a People. The sweat and sacrifice of a people’s labor, loaned to the nation, were NEVER intended to be misspent on unethical schemes of small men nor on the poor plans of thoughtless bureaucrats. MONEY in the form of pay-as-you-go budgets, has another important purpose. It sets limits to waste. By having to work within a set budget, instead of an unlimited debt-budget, Congress would be forced to weigh the costs of programs and legislation versus their real benefits and effects, thus improving the possibility of more streamlined and effective legislation and outcomes.
- Please be the Legislators you once dreamed of being -
– A nation in crisis cannot afford less -
I like a quote Obama used about "the ship of state not turning on a dime" but as a friend I love put very succinctly in reference to another issue "the titanic does not turn on a dime." We are in troubled waters, please, start turning in the right direction asap.
Speak the Truth!
The nation cannot today afford lies, bribery, scare-tactics,
and misrepresentations of the facts.
There’s plenty of True Problems and Legislation to talk about
FEDERAL SPENDING 2006
http://en.wikipedia.org/wiki/Government_spending
Fiscal Year 2006 [3] -‘most recent year on which all the figures are in’
Total Federal & State: $4,704.1 Billion, 36.1 % of GDP
Pensions $747.1 Billion, 5.7 % of GDP
Health Care $783.8 Billion, 6.0 % of GDP
Education $786.8 Billion, 6.0 % of GDP
Defense $622.2 Billion, 4.8 % of GDP
Welfare $411.4 Billion, 3.2 % of GDP
Interest $312.3 Billion, 2.4 % of GDP
Government spending expressed as a percent of Gross Domestic Product (GDP)is based on a total of $13,015.5 billion ($13 Trillion GDP) for calendar year 2006 reported by the Bureau of Economic Analysis[4].
1 http://www.nytimes.com/2009/08/26/health/policy/26dual.html .
2 http://en.wikipedia.org/wiki/Medicare_(United_States)
3 http://www.gpoaccess.gov/usbudget/fy08/pdf/hist.pdf
4 http://en.wikipedia.org/wiki/Military_budget_of_the_United_States
5 http://en.wikipedia.org/wiki/Medicaid#Budget
