Saturday, September 19, 2009

HCFP PART 1

A BI-PARTISAN COMPREHENSIVE

PRACTICAL “DOWN-TO-UP”- BASED

HEALTH CARE REFORM PROPOSAL

FOR ALL AMERICANS

By

Robert Smith, Ph.D.



DEDICATION


I am grateful to many people who have looked over and commented on this proposal. I am grateful for the patience and understanding of my family, from whom I’ve disappeared into my study for far too many hours this past six months.

I dedicate this health care reform proposal to J. Judson Booker, III, M.D. A Family Practice physician, the last in a line of five generations of family practice physicians (his son chose to become an OB-GYN). Many options were available to him, but, he chose to serve the people in rural Appalachia. He was a delightful person, everyone’s best friend, and a very fine and knowledgeable physician. The world has been blessed by his too brief presence and his recent passing saddens all who knew the man.



PREFACE

I tend to identify myself as a fiscally conscientious, libertarian, democrat. That libertarian in me was appalled as I wrote some of the proposals herein. Some of these proposals can be more intrusive than I’d like for government to become. However, I find that these suggestions are cogent and necessary for comprehensive reform.


CHAPTER 1

BACKGROUND



§ 1.1.0 NATIONAL DEBT & NATIONAL DEFICIT

§ 1.1.1 National Debt (ND) is total amount of money owed. The deficit (D) is the amount overspent yearly. This is added to last year’s ND to give us the new ND, plus interest.


YEAR ND ND / PP (PER PERSON) ND AS % OF GROSS DOMESTIC PRODUCT (GDP)

2000 $5.0 T (Trillion) $17K 50%

2009 $11.8 T $39 K 80%

§ 1.1.2.1 - US ND grew between 2000 and 2009 by $6.8 T ND from $5.0 T to $11.8 T during President Bush #43’s term, a record-setting $850 Billion (B) a year!

§ 1.1.2.2 - As a fiscal conservative, I propose that the more than doubling of the ND while inflation increased only 16% looks to me like dramatic overspending. Why? Republicans have a reputation for being fiscal conservatives but in the last 20 years of republican administrations, D has mushroomed while in 3 years run by a democrat, there were surpluses (which were actually just what’s supposed to be Social Security (SSA) and Medicare additions to their own trust fund).

§ 1.1.2.3 - Why? A lot was going on from 2000 to 2009. First, in the 2000 election year, the dot.com bubble burst decreased the speed of economic growth as well as potential tax revenues. Then, 9 -11 resulted in a significant decrease in the confidence of the American consumer, fear, further reduction in the speed of economic growth, and reduction in potential tax revenues. With stock values slashed in half, increases higher than inflation occurred easily. We began a war in Afghanistan in which many nations pledged support for the first year or two but then pulled out. We immediately moved to placing the focus of our military engagement into Iraq. We responded with deep tax cuts designed to stimulate the economy. These cuts backfired – 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. The cuts were too deep to sustain government commitments, the growth in national security programs, and the growth in entitlement spending.

§ 1.1.2.4 - President Obama projects that the ND may approach $17 T by 2020. Given that $11.8 T was inherited, that adds up to $5.2 T in additional debt over the next 10 years, amounting to $520 B a year. The annual D growth under President Bush (#43) was 17% per year whereas the annual D growth under President Obama is projected at 4.4%. The added 4% population and inflation of 10% must also be factored in. Thus, where the last D PP was $2,833 per year, the D PP per year, factoring inflation, is $1,500. It is too much D for my comfort and it must be responsibly addressed, but, it is a dramatic improvement from the previous years. President Obama inherited economic challenges the severity of which had not been faced by any American president. At this time, he appears to be executing the Bush loans and stimulus, the stimulus introduced in his early weeks, and reducing costs of war in Iraqwhile re-focusing on Afghanistan. I propose that we give our president an opportunity to do what is needed.

§ 1.1.2.5 - The democrats have introduced a pay-as-you-go plan. It forces Washington to balance new spending with offsets. A well thought out pay-go plan is needed and ought to be endorsed by all D hawks. Government should not spend more than its revenues (except perhaps in times of crisis and when the situation is not exacerbated by deep tax cuts).

§ 1.1.3 Why the explosion in D from 2000 to 2009?

Ý Tax cuts were too big for shrinking economy! Trickle down theory says that tax cuts stimulate an economy. I suggest that tax cuts stimulate a growing economy but not a shrinking one. The tax cuts for the wealthiest Americans from 2001-2008 added $2 T to the ND of the total $6.8 T.

Ý Free Trade Agreements (FTA‘s) reduce tax base, businesses, and jobs in the US, 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!

Ý Shifts in income source (e.g., from wages to PCs, dividends, STCG, and LTCG, off shore tax havens) outpaced IRS’ ability for enforcement! This added an estimated $2.4 T to the ND of the total $6.8 T.

Ý I don’t recall a time in history in which the US fought two wars simultaneously. Wars are costly!

§ 1.1.4 Senator William Proxmire’s GOLDEN FLEECE AWARDS would have been awarded to thousands of wasteful projects – republican and democratic - since discontinued in 1978. (I re-introduce them here and, I recommend that they ought to resume, in his honor, and be a staple for efficiently operated government, as we seem to require some reminder of the need for watching out for wasteful spending.)

§ 1.1.5 In 2009, D is estimated to be $1.6 T. In 2008, it was $1.0 T. Why so big in 2009? Because of previous commitments in 2008 to control the economic downward spiral, the combination of paying people’s unemployment while also not being able to tax them, and, the stimulus legislated by congress and signed by the president.


§ 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 last time US D equaled GDP was in the Civil War (although it came very close following WWII and, I suspect, after the Revolutionary War, too). President Lincoln and Secretary of the Treasury Salomon Chase borrowed extensively and printed dollars that were not backed by gold. US soldiers were paid with this money that was, technically, worthless, but, the economy survived.

§ 1.2.2 The US imposed income taxes during the Civil War.

§ 1.2.3 I can’t help but point out the irony that it was the nation’s first republican president who enacted taxes and who engaged in risky deficit spending.



§ 1.3.0 GAO PROJECTED SAVINGS

“A stranger has big eyes but sees nothing.” - African Proverb

§ 1.3.1 The Government Accountability Office (GAO) guidelines state that certain investments cannot be checked off or calculated. They’re right.

§ 1.3.2 Using a prevention program to teach kids to not smoke saves money, right? But, the estimated savings are not allowed to be included in the calculation.

§ 1.3.3 Since the GAO can’t accurately calculate those savings, that prevention effort is not allowed to be included in savings estimates. Yet, GAO uses inflation projections, estimates, guesses, SWAGs. It must use estimates of savings based upon the best available data and those sources ought to be explained and identified. We all know that inflationary projections can be less reliable than prevention projected savings, but they are utilized.

§ 1.3.4 If the GAO estimated projected costs AND savings, new phenomenal programs could be included that save money and save lives. Without the actuarial-blessing of the GAO, congress won’t consider these programs.

§ 1.3.5 Congressmen must have the fortitude to instruct the GAO to use projected prevention savings, inflation, and economic growth.



§ 1.4.0
BALANCE SPENDING & PRIORITIES


§ 1.4.1 W
hy the Congressional inaction? Why didn’t we hear of escalating D until 2009? Why didn’t Congress
oppose detrimental legislation earlier?


§ 1.4.1.1 – After 9/11/2001, Congress passed many measures requested by the administration without a moment’s thought. Then, pork crept into spending. With 2 wars, it was easy to cover up or ignore.

§ 1.4.2 Now, suddenly, Americans, who, like myself, treasure balanced budgets, cite arguments not offered in past 6 years for the need to rein in out of control spending. Part of the reason for that is because we’re just hearing about the excesses now. Part of the reason is that some people do not like the present administration. Some people are prejudiced.

§ 1.4.3 All proposals for health care reform ought to result in net reductions of D and ND. I think that the D hawks agree.

§ 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, but, have not been met at this early time.


§ 1.5.0 US TAXES

§ 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 I was taught was possible as a kid.

§ 1.5.2 The US has one of the lowest tax rates among the economically advanced (OECD) nations. Why?

§ 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)).

§ 1.5.4 In the 1800s, the US government was small so there wasn’t a great need for taxes.

§ 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 US values capital over labor, more than any other nation. Taxes on capital are less than on labor. If congress represents the people, and the people’s primary income is from their labor, shouldn’t the people be asking congress to tax labor at a rate less than capital? Perhaps, as Adam Smith says, labor and capital are equally needed in capitalism. As such, in keeping with the original principles of capitalism, I submit that federal taxation codes ought to result in taxation of capital to an equal rate as that of labor.



§ 1.6.0 LAST ERA OF GREAT US GROWTH

§ 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 US economic expansion was fueled by infrastructure investments of the 1950s. The GDP and government revenues grew.



SELECT 1950s INFRASTRUCTURE INVESTMENTS

c$ WW II & Korean War c$ Vietnam Overtures

c$ Eisenhower Highway c$ Public Schools

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.

§ 1.6.4 The modest “surtax” of 10% on the most wealthy (from 36.0% to 39.6%) imposed during the democratic President Clinton was more of an inconvenience when it is compared to the 92% maximum marginal tax rate imposed in the 1950s by republican president Eisenhower.



§ 1.7.0 KNOW THY CREDITORS

§ 1.7.1 Almost one-third of the US debt is owed internationally - foreign nations (especially Japan, China, GB, and oil producing nations) and their wealthiest citizens.

§ 1.7.2 About 7% ($772 B) is owed to communist China. At first blush, this appears to compromise US national security. It has the potential to be a greater threat to military supremacy than any barrage of missiles. The “sleeping giant” still sleeps, but gains strength.

§ 1.7.3 However, this loan / debt solidifies a mutual economic dependence in which US citizens purchase inexpensive Chinese products propeling the Chinese economy. Some might, with great trepidation, say, “what if they called in their loan?”

§ 1.7.4 A nation economically dependent upon another seldom poses a military threat to that other. Industrially, China needs theUS to survive and prosper economically. The US needs China to produce inexpensive goods, loan the US government money, and not call in old loans.

§ 1.7.5 Over $5 T of debt was incurred during the 30 years in which Congress automatically “borrowed” from the Social Security Administration (SSA) and Medicare “Trust Funds”. These trusts are the largest holder of US debt.

§ 1.7.6 If Congress did not borrow from SSA / Medicare Trusts this week, the government would be broke next week.

§ 1.7.7 US government D does several things:

§ 1.7.7.1 It places the costs of our greed for personal comfort squarely upon the backs of our children.

§ 1.7.7.2 Federal bonds compete for credit with banks, corporations, and citizens. The more money that goes to federal D, the less money is available for business investments and consumer purchases.

§ 1.7.7.3 This matter wasn’t of concern during the last administration, so, it shouldn’t suddenly strike fear, today. Neither should it be cause for wreckless abandon.

§ 1.7.7.4 Great D jeopardizes global economic security.



§ 1.8.0 US HEALTH SPENDING

“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 B / 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 16.7% figure in 2009 will be 18.0%. I estimate that the 2020 figure will be 22.0%.

§ 1.8.3 Why the rapid growth in health care spending?

1. The US economy seeks sectors that can expand. With the shrinking economy, the health care sector is a good investment. The more money that pours into this sector, the more pressure there is to earn even more. The retirement savings of baby boomers have fueled the bubbles from several sectors, eventually resulting in crashes. If we don’t contain the health care bubble, it, too, will crash.

2. Real dollars spent on health care are increasing due to this pressure.

3. The % of GDP spent on health care is increasing fast.

4. America’s average age increases, with baby boomers headed to retirement, leading to more use per person (PP).

5. Americans use more health services PP than we used to, even at younger ages.

6. Use of expensive procedures is on the increase.

7. General inflation is a minor factor. Medical inflation is much higher and adds to total increase.


§ 1.9.0 HEALTH CARE COSTS AS PP GDP

§ 1.9.1 95% of health care spending in OECD nations can be predicted by PP GDP (that’s the total value of all goods and services divided by the number of people in the country).

§ 1.9.2 The more money you have, you’re willing to spend more on your health. We value health and life.

§ 1.9.3 As illustrated, all 29 other OECD nations are very close to a trend line. As the GDP PP increases, health care spending PP increases.

§ 1.9.4 Notice the trend line on the bottom right of the graph above. It takes a swift turn upward. That illustrates that the US spends a lot more on health care than what would be statistically projected – 37% more!

§ 1.9.5 Why does the US spend twice PP GDP as other OECD countries? Maybe we have collective national guilt for eating twinkies. Maybe we value capitalism and must invest our retirement savings in attractive stocks.

§ 1.9.6 Let’s consider the 3 following formulae:


$2.5 T * 37% = $925 B Saved

$2.5 T * 50% = $1.25 T Saved

$2.5 T * 40.7% = $1,018 B Saved

§ 1.9.6.1 - In the first calculation, it shows that the US spends $2.5 T a year on health care, but, based on the spending customs of other 29 other democratic, capitalistic, economically developed countries, we ought to be spending 37% less. That would save $925 B a year and reduce costs to a mere $1,575 B a year.

§ 1.9.6.2 - In the second calculation, we spend $2.5 T, but, we spend twice PP of other OECD nations. If cut in half, that would be $1.25 T spent and $1.25 T saved.

§ 1.9.6.3 - In the third calculation, we spend $2.5 T. Between greater US ingenuity and greater economy of scale, we could reduce costs from 37% to 40.7% and save $1,018 B a year.

§ 1.9.7 Let’s think about the most conservative figure: $925 B ($3,083 a person). This is the same as:

85 Nimitz Aircraft Carriers –

SSA Operations for 17 months –

DOD Operations for 18 months –

US Education for 13 months –

Pay Off Debt, With Interest, in 18 years –



§ 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, I’m pretty confident in their validity.

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 As a baby boomer, I’m startled by this finding. America used to be #1 when I was young.

§ 1.10.3 We’ve lost that leading edge and we’re not terribly concerned about that loss.

§ 1.10.4 Even these nations with PP GDP greater than ours 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 alternative 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 I’d presume to suggest that health care, alternative energy, and environmental services will be more needed.


§ 1.11.0 WE PAY MANY COSTS OF THE UNINSURED, ALREADY

“Two birds disputed about a kernel,when a third swooped down and carried it off.” - African Proverb


§ 1.11.1
The uninsured are 20% more likely to obtain ER services than the insured. Why?

§ 1.11.1.1 - Riskier Lifestyles and More Dangerous Work

§ 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 company continues to pay for medications.

§ 1.11.3 The uninsured often obtain free or reduced fee services from providers.


§ 1.11.4
Hospitals write off bad debts as a tax deduction if they prove vigorous attempts to collect the debt. So, they charge 3 x what they charge insurance companies. The end result is often that the hospital is better rearded 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 My 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 B 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 and employee disciplinary problems

§ 1.12.1 We can anticipate an increase in health care utilization by the previously uninsured when first covered. This is natural and brings them back to better health. 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. Given that private insurance companies only provide coverage for 112.5 M people, this adds up to 1% of people with private insurance dying due to private health insurance company’s death panels.

§ 1.12.3 I estimate that approximately 20% of America’s 50 M uninsured would be able to obtain treatment for conditions that currently precludes them from employment. 10 M averaging the wages of high school graduates equals $330 B additional GDP. They would contribute an additional $10 B to Medicare each year, $41 B a year to SSA, and another $33 B to other taxes. That alone totals $84 B a year. Further, I estimate that one-fourth of these people could be prevented from requiring disability services, saving $25 B a year for SSD and $25 B a year for Medicare.


§ 1.13.0 CAPITALISM’S HISTORIC ABSENCE FROM U.S. HEALTH CARE

“The candle is not there to illuminate itself.” - Nawab Jan-Fishan Khan

§ 1.13.1 Insurance companies and the CMS, combined, form an oligopoly. The top dozen insurance companies set consumer prices and CMS fixes provider fees that private insurers use to calculate their own fees.

§ 1.13.2 It’s “take it or leave it” policies are no longer the attitude of how can I compete?

§ 1.13.3 They seem to violate antitrust laws with impunity. Perhaps they’re too big to fail or maybe they lobby successfully?

§ 1.13.4 Capitalism was an economic ideal espoused by the Englishman, Adam Smith, in The Wealth of Nations, first published in 1776.

§ 1.13.4 The chronological coincidence of its publication in 1776 along with the signing of the Declaration of Independence led some wealthier signers to embrace the ideals advocated by Adam Smith.

§ 1.13.5 True capitalism has not been sustained anywhere, including that last bastion of capitalistic ideals, the USA. Why not?

§ 1.13.6 Systematic abuses (remember slavery, child labor, pension pilfering, promoting unsafe working conditions, RICO violations, misleading the SEC and stockholders of corporate facts such as Enron, Anderson, Madoff) occurred.

§ 1.13.7 As a result of violations, modifications have been made. Thus, we’re left with a hybrid, something different from “pure capitalism” that adds measures of protection to people and businesses.

§ 1.13.8 While capitalistic theory sees that the free market’s invisible hand will correct health care overspending, it will do so inefficiently after $Ts and hundreds of thousands of lives are lost.


§ 1.14.1 WHAT DRIVES HEALTH CARE COSTS GREATER THAN INFLATION?

“Smooth seas do not make skillful sailors.” - African Proverb

§ 1.14.1 Health insurance premiums have increased 5 times faster than wages! That is a greater increase than any sector has experienced before.

§ 1.14.2 Wages remain flat but costs of business continually increase and are passed on to consumers. This contributes to bankruptcy filings.

“We’ve met the enemy and he is us.” - “Pogo”

§ 1.14.3 Health service and insurance companies are mostly owned by our own retirement funds.

§ 1.14.4 Our portfolio manager seeks the best ROI.

§ 1.14.5 Publicly traded companies are pressured to increase profits quarterly or money managers invest elsewhere.

§ 1.14.6 Myoptic, short-sighted views of our investments lead to CEOs scrambling to better the numbers reported over last quarter. We’ve parked our money in the dot coms and then that bubble burst. Then financials. Then mortages and real estate. Now, health care companies. There will be another bubble burst unless we control health care expenses and greed immediately.

Hobo Symbol for “House Has Already Been Burgled!”

§ 1.14.7 Wall Street economists look at the Medical Loss Ratio (MLR). That’s the % paid for health services. In the last 17 years, non-MLR costs (insurance ADMIN and profits) jumped from 5% to 20%; health care costs increased 400%; ADMIN and profits increased 300%; income increased 1200%; and, profits increased 1000%. GOLDEN FLEECE AWARD!!!


§ 1.14.8
Typical salaries increased a pultry 40% while insurance company bonuses and profits and premiums were increasing hundreds to thousands of percents!

§ 1.14.9 These escalating fees and profits numbers can not be sustained. Again, we must correct this situation now, because our fragile economy may not be able to withstand another bubble burst, especially in a sector that now controls 17% of GDP.

§ 1.14.10 - Many things can contribute to the rise in costs of health care. A few things include:

$ 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 Managers Drive CEOs to Out Produce $

$ We don’t practice Safety and Wellness Knowledge $

$ Providers’ Wise Investing Leads to Ethical Dilemmas $


§ 1.15.0 THE US ALREADY HAS PUBLIC HEALTH INSURANCE

“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:

Medicaid 53.0 MILLION Federal & Postal Employees 2.5 M

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 US already has public health care. Now, only 31% of Americans have private health insurance offered through a private employer.

§ 1.15.3 The increase in uninsured is not totally a fault of the uninsured themselves. Over one-third of them have applied for private health insurance and have been denied.

§ 1.15.4 77% of Americans support a public health care option or a single payer program.

§ 1.15.5 63% of American physicians support a public health care option and 10% support a single payer program.

§ 1.15.6 90% of adult Americans who are uninsured say they will vote for supporters of a public health care option. Of course, with 15 months between now and the 2010 election, we’ll if they are inclined to vote for this single issue.


§ 1.16.0 US & PUBLIC PROGRAMS IN OTHER DEMOCRACIES

§ 1.16.1 People in other OECD nations and in the US with public insurance are more satisfied with their insurance than are Americans with private insurance.

§ 1.16.2 Allow me to report a few facts:

§ 1.16.2.1 Canada and Great Britain (GB) are selected as examples of inefficiencies, excessive wait times, and denials. Their wait times are, in fact, less than in the US. Even US patients in public systems have shorter wait times than those in the private sector and, therein, HMOs have the longest wait times.

§ 1.16.2.2 Where Canada and GB spend half the US PP on health services, they spend about the same on direct
care (doctors, nurses, medicine, and machines) but spend 15% less time on ADMIN!

§ 1.16.2.3 The quality of paperwork won’t save my life. It is compassion, dedication, knowledge, and skill!

§ 1.16.2.4 Recently, in response to statements that Steven Hawking would have died had he received National Health
Service (NHS) care in GB, Hawking clarified that he lives in GB, he has received NHS care his whole life, and he is delighted with the quality of care he receives from NHS.

§ 1.16.2.5 People in public systems incur no user fees.

§ 1.16.2.6 Medicines cost twice more in the US as Canada, 3 feet to our north. FDA prevents Americans from buying medicines from other countries. Medicare is forbidden from negotiating best prices. Why? Because price negotiation is a feature of capitalism and oligopolies’ operations and profits are threatened by capitalism.

§ 1.16.2.7 Bureaucrat #1: private insurance company employee is rewarded for denying patients health care today. People with terminal illnesses die without needed care.

§ 1.16.2.8 Bureaucrat #2: government employee who might say no tomorrow to all people of an undesirable background – the elderly or ethnic groups.

§ 1.16.2.9 I don’t like the thought of any bureaucrat stepping in between me and my doctor. I have no control over private insurance companies, but, I could write legislation so that bureaucrats would never be able to step in.

§ 1.16.2.10 For as scary as is the thought of “stepping in” is, there is the occasional time when a bureaucrat might deny unnecessary care. While at this time 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 information and who are compassionate can be beneficial.

§ 1.16.2.11 So long as Medicaid is taken from the states and absorbed, perhaps, into the more efficiently operatedMedicare system, I have no concern today about a bureaucrat saying no today to doctors. Medicaid is a failure, certainly, I cannot conclude that globally, but, certainly, in states that do not or can not adequately support it.

§ 1.16.2.12 We always have the possibility of encountering another Nero, a future administration not sympathetic to the needs of the people that does not care for the people. That possibility is the same as 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.

§ 1.16.2.13 Let’s design a system, together, so that brainless bureaucrats following the dictates of heartless politicans or executives won’t 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.

§ 1.16.2.14 The system must never be abused and it must pass review of the USSC.



§ 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

§ 1.17.1 A small US business with 40 employees and 60 dependents has health care costs of $833,000 a year, or $21,000 per employee (if we use the overall total). When an employee costs $21,000 before even paying her salary employers struggle to make a profit and are reluctant to hire people. They look at over-seas options where health care costs are nill.

§ 1.17.2 Free Trade Agreements (FTA) have worked wonders for developing prosperity and allegiance to democratic ideals in many other nations. FTAs provide Americans with inexpensive goods and services. FTAs have not given one American worker more competitive wages (except those in the transportation industry to haul loads to us for our consumption via ports or borders).

§ 1.17.3 With globalization, Americans will continue to experience declines in prosperity. America must revamp in order to maintain its competitive edge. What is the next thing to study and invest in? Again, I suggest that health care, global warming, and environmental sciences will be sectors of great importance internationally.

§ 1.17.4 There are nearly as many insurance bureaucrats as there are doctors providing care for us! 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 America to prosperity and safety.

§ 1.17.5 A conservative congressman stated that 1.6 million jobs will be lost if President Obama’s health care plan is implemented. First, no living American has yet seen the details of President Obama’s elusive plan, so, I don’t know how such estimates could be calculated. Second, if the US looses administrative paper-pusher jobs and those people receive re-education in a productive field, I’d support the temporary loss of 1.6 M people if it would help us climb from the depths of the economic depression. And, third, keeping the status quo with increasing premiums and decreasing coverage will cost 2 M businesses and 20 M jobs over the next 10 years unless health care costs are contained. As 1.6 M is less than 20 M, I vote for change to help save and grow the US economy.




§ 1.18.0 THE REAL ISSUE

§ 1.18.1 I wish health care reform debate were about ideals. Philosophy isn’t blocking reform. It’s money.

§ 1.18.2 The political right would say we shouldn’t de-stabilize health care and insurance companies, grow government, sink our nation further into debt, or reduce the profits of corporations that give politicians millions of dollars.

§ 1.18.3 The political left would have us believe that health care reform is about reaching out to our brethren and helping all in need, while being fiscally responsible.

§ 1.18.4 What blocks health care reform is the money of the health care sector, by the health care sector, and for the health care sector. This includes pharmaceuticals, insurance, health services, even health investment funds.

The crux of the matter is this:

“Avoid the crowd. Do your own thinking independently. Be the chess player, not the chess piece.”

§ 1.18.5 Those who profit from the status quo (insurance companies, health service providers, contrarian politicians) are spending dazzling sums of money preventing health care reform.

§ 1.18.6 American businesses can no longer afford to compete. Auto makers pay $1,500 more on health insurance per car than Japanese competitors. Detroit suffers, merica suffers. So goes GM, so goes the American economy. That resonates the truth!

§ 1.18.7 As a small business person, I could not provide insurance for employees because the premiums would have been higher than my salary, profit, and investments, combined. I couldn’t access a policy, as 9 employees were too costly or too small for insurers to cover as a group. So, I bought dental insurance and gave everyone an insurance stipend of $200 a month – which was taxed for both me and employees.

§ 1.18.8 In the last 20 years, the majority of jobs created have been by small businesses, most affected and hurt by increasing premiums.

§ 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% 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 quo.

§ 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

If the status quo remains, in the next 10 years the US will hemorrhage businesses and jobs overseas, and the federal government will become insolvent. Health care reform of some sort must be enacted if the US is to be viable in the 21st century. It must be done now in a manner that is fiscally responsible. We benefitted from not paying taxes for the last 8 years while we allowed the ND to increase from $5.0 T to $11.8 T. Now, we must tighten our belts and pay down this tremendous debt. As health care consumes so much of our economy and 37% of health care spending is wasteful, health care spending reductions is an excellent place to start to contain costs and pay down the debt.

Congressional voting will come down to one thing – whose interests are being looked after. Remember to donate and vote against those who voted against your interests.



§ 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

§ 1.19.1 Semper Fidelis is Latin for “always faithful”. Semper Fi is the motto of the US Marine Corps. We don’t leave soldiers behind. We fight to protect one another. We will die, if need be, protecting one another. With those kinds of values, I see why the Marine Corps is a premier organization. Are you and I willing to go to any lengths, even death, in order to help others?



§ 1.20.0 DR. HARROLD

§ 1.20.1 As my neighbors aged, our mutual doctor, Warren Harrold, drove his 10 year old VW 20 miles to their home once a month. Sometimes, he reclined and ate dinner with them. Just before delivering me, he sat in the chair in my mom’s room, asleep, for 2 hours, until I was ready to face the world. Dr. Harrold was faithful to his patients, a dedicated professional, and a role model. His dedication is a model for all to follow.



§ 1.21.0 COMPARING THE US WITH OTHER OECD NATIONS

§ 1.21.1 Of the wealthiest 28 OECD nations, the US is alone in not providing public health care. Why not try it?

§ 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 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: America spends twice as much per person on health care. It has a lower QOL. We die 5 years earlier. Why do we keep repeating the mistakes of the past? Why not try it? GOLDEN FLEECE AWARD!!!

§ 1.21.7 47 M are uninsured (1 in 6), projected to be 66 M by 2019. Another 100 M 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.



§ 1.22.0 COMPASSION

§ 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 do we listen to fear mongerers shouting 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, Matthew, Ch. VII, v. 12

“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

“And now abideth faith, hope, charity, these three; but the greatest of these is charity.” - I Corinthians, 13:13

§ 1.22.2 Americans see the need to protect our brethren and support a public option. As of the end of August 2009, it was supported by 77% of Americans. That means that if the House and Senate vote to represent the people and not special interests, health care reform ought to pass the house and senate by a 3/4 majority.

§ 1.22.3 Fear mongering has led many to irrational fears. These scared minds can not be comforted by logic.

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

§ 1.23.1 1% of people consume 33% of healthcare dollars

5% of people consume 44% of healthcare dollars

46% of people consume 20% of healthcare dollars

50% of people consume 3% of healthcare dollars

§ 1.23.2 Some patients with MI (mental illness) consume 14 times more healthcare dollars. That’s why treating MI significantly reduces physical health care costs.

§ 1.23.3 Women (who live 6 years longer than men during illness prone years and who deliver children) consume 3 times more than men in total Medicare and SSA resources. Women consume twice the total health care dollars than men. Even with maternity costs of $40 B, this is $660 B more than men. Ought a modest, token risk co-payment be imposed without establishing a precedent encouraging further discrimination? If men used health care resources as much as women, I wonder, might they might live longer?

§ 1.23.4 The obese use 50% more services than individuals who are not over-weight. Let me introduce the chicken and egg question here. There are clearly people who are obese who become ill due to their obesity. There are clearly people who become obese due to illness (or as a 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? All, or just those with bad choices? Ought the premium be based on extent of risks or percent above their healthful range? Obesity produces more health care expenditures than age, smoking, drinking alcohol. Obesity claims more lives and costs more than the wars in Iraq and Afghanistan. We must declare war on this “enemy combatant”.

§ 1.23.5 The average African-American male does not live to collect SSA or Medicare, whereas the average Asian-American female collects SSA for 20 years. Would it be fair to reduce health premiums for African-American males? Would it be fair to increase premiums for Asian American women? At least, wouldn’t it be wise to find out what’s behind the difference, so we can emulate Asian women as well as research and offer cures for those things that take the lives of African American males early?

§ 1.23.6 RACE AND THE UNINSURED 33% of Hispanics 21% of African-Americans 11% of Caucasians

§ 1.23.7 - Asian-Americans and Native Americans use health care resources less than others. Asian Americans seem healthier and live longer whereas Native-Americans seem less healthy and die younger. Let’s study, learn, intervene, and adopt best practices.

§ 1.23.8 - Health care costs for cigarette smoking equals $11 per pack of cigarettes, plus the “natural” costs of growing, manufacturing, marketing, distribution, and sales. Would an increase in federal taxes on tobacco be reasonable in order that revenues received equals health care expenses paid to treat those conditions? $5 a pack would generate $90 billion a year, paying for President Obama’s plan’s projected costs.



§ 1.24.0 MORE SPENDING DOESN’T ALWAYS MEAN INCREASED QUALITY

§ 1.24.1 WHO ranked the US:

· highest cost per person

· first in responsiveness

· 37th in performance

· 72nd in overall health

· 73rd in infant mortality

§ 1.24.2 It seems that we, Americans, live less healthy lifestyles. We are willing to spend lots of our children’s money on our own healthcare. That money is spent whether by private insurance companies or public care. We have providers who twirl quickly (and with amazing grace), but seldom save us from our own demise.



§ 1.25.0 A DOLLAR SAVED ISN’T ALWAYS REALLY SAVED

§ 1.25.1 I make proposals in which Americans live longer and healthier lifestyles. Living longer means receipt of SSA payments for more years and simply postponing inevitable health care costs. Certainly, helping people in their 40s to live into their 80s would increase their contributions to society and payments of taxes.

§ 1.25.2 From the macro-economic perspective, we outlive some utility to society and family. Frankly, America hasn’t always had the best track record, here, and has slid down the slippery slope at times. Even now, CMS discriminates against the elderly, paying 50% instead of 80% of mental health services, knowing that people facing the added 30% will be less likely to obtain service and will be most at risk of suicide.



§ 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 Drug and Alcohol Prevention à Less D&A Abuse

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 Fitness Centers à Less Obesity & Health Care Costs

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

§ 1.27.1 The health care bubble is next to burst. What happened to employees, companies, and investors following the dot.com bubble burst? Unemployment. The companies folded. The investors lost hundreds of Bs of dollars in paper assets.

What happened following the mortage and real estate bubble? The brokers are struggling. The banks received Ts of 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 US health care balloon, as we did each of the previous bubbles - dot com bubble, real estate bubble, and financial services bubble. .

§ 1.27.3 My Recommendations for Controlling the Health Care Bubble:

1. Where overspending is $925 B a year, a reduction of $500 B a yr is quite attainable.

2. Programs / concessions must be granted to health care private industries to assure cushion.

3. Increase investments in new programs such as prevention and research to soften the fall.

4. Re-train labor from number crunching (e.g., insurance denying agents, attorneys, accountants, health care billing) to a production (e.g., engineers, health providers, nurses, researchers, educators).

5. Export US health care knowledge, practices, and technologies.


§ 1.28.0 THE PHOENIX: COMBINING PRIVATE, NOT-FOR-PROFIT, & PUBLIC HEALTH INSURANCE


§ 1.28.1 This health care reform plan reduces costs more than $500 billion each year; enhances health service quality; expands markets and profitability of private insurance, health service, and pharmaceutical giants; provides coverage to all Americans; enhances our QOL; lays the framework for lengthening of longevity; and, leads the nation back to economic prosperity.


Employers Partially Fund Health Plans:

“We make a living by what we get, we make a life by what we give.” - Sir Winston Churchill

§ 1.28.2.1 - Profitable, government, not-for-profit, and charitable employers would pool health benefits.

§ 1.28.2.2 - While I imagine that these monies would be pooled within each employer, some leaders might envision that these funds might be contributed by employer but divided by community, state or nation-wide. These funds ought to be divided equally. Each employee would be provided a voucher with which to buy insurance and invest remaining funds within an HSA. The following are sound figures today, but will need modification to reflect changing economic circumstances.

For Profit Corporations: * $1,800 (Fixed - adjusted for inflation each year)

* 5.00% (Variable – sum of salaries, bonuses, AND gross profits)

* 2.50% (Variable – sum of investments)

For Profit Start-Up Businesses: * $900 (Fixed - adjusted for inflation each year)

* 2.50% (Variable – sum of salaries, bonuses, AND gross profits

* 1.25% (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.

Not-For-Profit Organizations: * $1,800 (Fixed - adjusted for inflation each year)

* 5.00% (Variable – sum of salaries, bonuses, and investments)

Government Entities: * $2,100 (Fixed - adjusted for inflation each year)

* 6.00% (Variable – sum of salaries and bonuses)

* Not subject to levee on investments or profits



§ 1.28.3 Special Considerations to Contributions

§ 1.28.3.1 - I include a fixed and variable formula as a compromise, so that every employer pays, in
part, a fixed sum, as well as variable sums that reflect the changing circumstances of each employer. These sums

§ 1.28.3.2 - I suggest contributions on bonuses in the formula to reduce abuse potential.

§ 1.28.3.3 - Executive bonuses are increasing astronomically faster than inflation. While I believe generous bonuses ought to be lavished upon outstanding executives, in general, bonuses are now excessive and less often based upon ethical or legal company success. They allow executives to receive compensation in ways so that they do not have to pay as much in taxes. (One might assert that bonuses are based on performance and work and, as such, ought to be taxed at the same rate as earned income, even when “gifted” by the corporation.)

§ 1.28.3.4 - I include a percentage of investments in the formula to reduce abuse potential.

§ 1.28.3.5 - Start-up companies that do not turn a profit in the first 3 years ought to pool, perhaps, a portion of the assessment of usual companies, say, $900 plus 2.5% of salaries (no bonuses ought to be permitted if the company is not making a profit in the first 3 years – if bonuses are paid, then eligibility for start-up reductions will be forfeited). As re-investment is critical to start-up businesses, perhaps only 1.25% of investments ought to be pooled.

§ 1.28.3.6 – Not-for-profit organizations might be permitted to pool the same figures as start-up companies, providing that they satisfy criteria. Of course, gross profits would not be included in the formula.

§ 1.28.3.7 – Government and school districts might be permitted to pool the same figures as start-up companies, providing that they satisfy criteria. Of course, gross profits would not be included in the formula.

§ 1.28.3.6 - I’d imagine that this idea could be called the Ebenezer Scrooge approach to family health plans. I do not see why employers ought to contribute additionally for spouses or children. They might choose to do so and, I would argue, employers in competitive fields would do so. Single employees would receive the same “benefit” but would be able to place the additional monies into an HSA. Optional coverage would not set a precedent. Additional contributions would be rebated or fully tax deductible.

§ 1.28.3.7 - Employees and government would pay added costs of family health insurance premiums not gratuitously covered by employers. Why do I suggest this? It is more a responsibility of the individual and government to provide care for family members than it is for employers. Why should my employer pay higher insurance premiums if I choose to have 21 children?

§ 1.28.3.8 - The sums provided by one partner’s employer and the other partner’s employer would be combined. The spouses could purchase a joint plan. Excesses would be placed in a HSA. Finally, working couples would receive total benefits for both individuals and justify the second partner working.


§ 1.28.4 Private & Public Insurance Co-Exist in a Single Melting Pot, as do Americans:

“Your own soul is nourished when you are kind; it is destroyed when you are cruel.” - Islamic Proverb

§ 1.28.4.1 - Private plans might focus on enhancing quality. Public plans might focus on costs. Ultimately, both achieve both goals.

§ 1.28.4.2 – 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.

* 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 M graduates and employees. They might choose to have the $800 M a year “profit” be entered into a scholarship program for students of graduates of Virginia colleges.

§ 1.28.4.3 - Every American selects plans in each of the following 8 categories, for oneself and any dependents:

Traditional Hospitalization Outpatient Care

Medications Dental

Vision Catastrophic

Long Term Care Behavioral Health

§ 1.28.4.4 – The above insurance plan would expand the potential market of private plans from 94.5 M to 300 M (more than 300% overnight) plus, as every American would purchase into each of the 8 insurance plans, 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 M newly insured Americans. Private plans could serve and profit from the 105.5 M “publicly” insured Americans, including those former Medicare and Medicaid beneficiaries, those with extended coverage, and public servants and dependents.

§ 1.28.4.5 - Private plans would provide at least one plan within each category that competes with the minimum public option. Public plans would provide at least one plan within each category that competes with the more comprehensive private policies.

§ 1.28.4.6 - Health Savings Accounts (HSAs) would be used by everyone. Credits from Health Fitness Center (HFC) utilization by the government of, say, $5 a day would be credited to each person’s HSA, by mandate, whether private or public insurance. This figure might automatically be tied to inflation. Where carrots and sticks combined are usually most effective, insurance carriers, private, not-for-profit, and government, would be permitted to charge a risk premium for unhealthy lifestyles but would also reward a modest, say, $30 a month into HSAs for non-smokers and $30 a month into HSAs of those between 90% and 110% of their ideal weight.

As discussed elsewhere, all HSAs would be combined with retirement savings plans and college savings plans to allow maximum flexibility in accessing these funds for critical or imminent needs.

People selecting programs less costly than insurance could place the balance in a HSA. HSA’s balance
could pay for medical costs incurred by anyone, not subject to gift tax for medically necessary procedures. HSAs 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, if entered into HSAs, retirement, or 529 higher education plans.

People who elect programs that cost more than their employer allowance and federal contributions would pay the difference from their HSA or out of pocket. People who elect programs that cost less than their employer allowance and federal contributions would keep the balance in their personal HSA, college savings plan, retirement account.

§ 1.28.4.7 - Public and private insurances can be mix-matched, allowing different coverage per person and category. Say I’ve never had a cavity but I’m at great risk of needing NH care. I’d select a basic public dental plan but a premium private NH plan. My son with allergies might need a mid-level
private outpatient (OP) and drug plan but basic behavioral health plan.

§ 1.28.4.8 - Matched by computer, most insurance marketing costs would be eliminated. Individuals might key in 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.

§ 1.28.4.9 - The computer would serve as the efficient free market. This type of computer-matching would require full transparency and oversight, somewhat like that of the Securities and Exchange Commission, only effective.

§ 1.28.4.10 - 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.

§ 1.28.4.11 - Procedures would be identified by providers using CMS definitions authorized by a citizen’s panel. As a modest determent for over-utlization, co-payments would be based on the patient’s ability to review services. For example, if I have cancer, I’ll take whatever medicine my doctor orders, regardless of cost, so, I shouldn’t be punished. However, if I have pimples, I would have the luxury of selecting less costly options, first. Tax rebates and deductions might be offered for the first two and a modest excise tax might be imposed on elective services. Bureaucrats ought never determine these definitions.

o “Medically Necessary”

o “Medically Recommended”

o “Elective”


§ 1.28.5 Public Health Care Plans:

“Those who lose dreaming are lost.” - Aboriginal Proverb

Medicare operations = 3% Medicaid operations = 8%

Private insurance operations = 20% Senate Finance Committee Wants to Give Private Insurance = 35% GOLDEN FLEECE AWARD!!!

§ 1.28.5.1 - As a provider, I preferred to work with Medicare, then private insurances, and, lastly, Medicaid. ADMIN costs were significant for Medicaid, moderate for private insurance plans, and little for Medicare. Private companies paid me the most, very closely followed by Medicare, and then Virginia Medicaid paid about 60% of Medicare, almost the cost of its ADMIN requirements. Providers are generally less satisfied with Medicaid than Medicare.

§ 1.28.5.2 - States can’t or don’t support Medicaid properly. They loose providers and offer an inferior product. In English, we call this, “rationing” of health care services for the poor. The US government must adequately fund services for Medicaid and Medicare if it also wants to expand coverage to the uninsured. What will happen otherwise? Well, if I were to suddenly see 17% more patients for whom the government pays 85% of cost (or, in the case of Virginia Medicaid, 50%) I would not be able to afford to serve the public. Medicare requires that providers serve patients on Medicaid. That would bankrupt providers. Again, the public health care plans must reimburse providers at a comparable rate to private providers and fully cover costs, if not profits.

§ 1.28.5.3 - Public plans must pay competitively with private plans. The lower reimbursement rates produce a two-tiered system of care in which beneficiaries of the lower paid insurances are provided inferior products and services.

§ 1.28.5.4 - Comprehensive QA must be available to provide immediate consultations. The current system offers automated responses to questions. This impersonal system is not effective.

§ 1.28.5.5 - GOLDEN FLEECE AWARD: All public programs ought to be operated by the “Medicare” program. This would provide an economy of scale, reduce administrative costs from Medicaid’s 8% to Medicare’s 3%. As the states and federal government spend $375 B, this would reduce costs $19 B a year.

§ 1.28.5.6 - Insurance companies will contract directly with employees and risk will be pooled across all Americans, who select their own health insurance.

§ 1.28.5.7 - SSA / Medicare Programs’ survival depends on decreasing the retiree: worker ratio by having lots more children (who grow up to earn higher wages). It would seem that government might provide greater incentives for children (especially by couples most likely to produce children who earn higher incomes).


§ 1.28.6 Private Insurance Requirements:

§ 1.28.6.1 – Eliminate pre-existing conditions clauses. An assessment of a modest 10% premium might be permitted for one year, but, since private policies are in greater competition amongst themselves, not-for-profit policies, and government, the premium would not be too likely to be enforced.

§ 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 care expenses if the chronically ill, care giver, or executor pay premiums, even retroactively.

§ 1.28.6.3 - Insurance companies, not-for-profits, and public programs would not be allowed to increase premiums, co-payments, co-insurances, deductibles, and annual out-of-pocket maximums beyond a rate that is tied to the general rate of inflation (say 10% above inflation, so that if the inflation rate were 5.0%, health care costs could not increase more than 5.5%) on a PP basis.

§ 1.28.6.4 - If the insurance provided by private employers, then government steps in, reaches up and augments that employer’s health insurance benefit with a “Medicaid-like” supplement. If it is not enough, say, the employee wants premium category policies or the fee for covering a family of 21 children would be higher than the employer and government benefit, then the employee pays the difference.

§ 1.28.6.5 - This plan would provide all insurance companies the opportunity to provide health coverage across state lines, compete in a completely fair and transparent manner, and increase their potential markets.

“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 for us all. 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 - I expect my retirement fund manager to make decisions that’ll give my account big wins. So, he invests in profitable companies. There’s tremendous pressure for insurance, drug, and health care companies to increasingly outperform. CEOs that produce are compensated generously.

§ 1.29.1.2 - My doctor invested $800,000 for tuition and start up costs, plus 11 years of education with little income, where, in other nations, education would be free. Shouldn’t he earn a fair ROI?

§ 1.29.1.3 - My mother loves her Medicare. She doesn’t have to private insurance bureaucrats who used to deny care. They pay for everything. She’s afraid that public programs will cover “lazy” people, young adults too selfish to get insurance and share her burdens [AKA, transfer their dollars to her as she’d done for the elderly 30 years ago]. She’s concerned that including the uninsured in the pool or providing a public option may lower the quality of her 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 2 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.



§ 1.30.0 QUALITY MEDICINE

§ 1.30.1 The average wait to see a doctor, have an elective surgical procedure, even have an emergency surgical procedure is greater in the US than other OECD nations with “socialized medicine”. Is this quality?

§ 1.30.2 The average American waited 38 days for treatment of cancerous conditions! That’s more than in other OECD countries. Is this quality?

§ 1.30.3 The average American sees their physician 25% less often than others from OECD nations, yet s/he pays twice as much. Is this quality?

§ 1.30.4 Americans die 5 years younger. Is this quality?

§ 1.30.5 Americans report less satisfaction with their health care than citizens from the other 29 OECD nations. 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?



§ 1.31.0 HOPE: THE NEW INDUSTRIAL REVOLUTION: HEALTH CARE

“Don't look down on anyone unless you are helping them up.”

§ 1.31.1 The current health care crisis gives us an opportunity to dig our way out of this mounting debt; provides a new sense of purpose; increases employment; introduces a new period of economic prosperity; and, assures better health, longer lifespan, higher quality of services, and much improved Quality of Life (QOL) for all Americans.

§ 1.31.2 The US has shifted since 1600 from hunter-gathers, agrarian, industrial, electronic, to, presently, health services economies.

§ 1.31.3 US health care must be exported and we must encourage investments in foreign health care. Joint international enterprises must be encouraged between private and public investments.

§ 1.31.4 The % of GDP spent on health care isn’t of concern as long as exports in research, education, prevention, insurance, treatment, and technologies increase.

§ 1.31.5 WHAT IS IMPORTANT IS THIS – We can effectively reduce US health care spending by $500 B a year and improve quality of health care and cover ALL Americans! The shift could send our economy into further recession unless, again, it is handled carefully.

§ 1.31.7 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.

§ 1.31.8 Health care generates the highest paying jobs in the US economy. We must be careful not to save money by replacing $250,000 physicians with $18,000 clerks.



§ 1.32.0 MEDICAID ISN’T WORKING

“History is a signpost for the future...”

§ 1.32.1 Medicaid and Medicare are grossly underfunded public programs. They pay providers much less than the cost of actually providing services. Providers used to be able to pass on public costs to private payers and insurance companies, but, now that the oligopolistic insurance companies set prices and fees and violate antitrust laws with immunity, providers can’t do this anymore.

§ 1.32.2 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.

§ 1.32.3 Providers with a choice don’t accept Medicaid and Medicare. Providers in underserved regions have little choice, as the majority of their patients are on public insurance.

§ 1.32.4 If we’re to give public insurance a go, we must increase payments to the level of, at least, costs.

§ 1.32.5 I don’t want fraud and abuse of my tax money, whether it’s the tens of billions of “misplaced” dollars in Iraq and Afghanistan or on public health insurance.

§ 1.32.6 State Medicaid programs conduct frequent and over - reaching audits examining minor clerical details and demanding immediate repayment in full for every “projected” infraction for things as little as mis-spellings.



§ 1.33.0 PRIVATE INSURANCE ISN’T WORKING

“The lower self is greedy, teach it to be content.” - Islamic Proverb

§ 1.33.1 The intersection of greed and health is littered with many corpses. It deserves and requires greater regulation. If the US extended the average lifespan to equal that of the average OECD nation, we would have 270,000 fewer deaths each year! That’s 10 times the lives saved through gun regulation!

§ 1.33.2 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?

§ 1.33.3 Private companies justify bigger profits through flaming costs. So, they pad the payroll, make it look like they cut costs from gatekeeping of inexpensive procedures such as MI while “blindly” covering the most expensive procedures ($40,000 bypass surgeries or $50,000 breathing medicines), while they do not discourage lifestyles that result in costly services later on. They’re not paid to provide prevention, just pay for expensive health procedures.

§ 1.33.4 GOLDEN FLEECE AWARD: The CEO of United Healthcare received a bonus of stock valued at $1.6 B on top of his $8 M annual salary. Now, in my mind, $8 M 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.



§ 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

§ 1.34.1 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.

§ 1.34.2 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



§ 1.35.0 CRISES NOW & ON HORIZON

§ 1.35.1 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 of the giant insurance providers.

§ 1.35.2 A stalled economy is associated with greater demand for health care services (my unemployed wife might begin to get stress-related migraine headaches and could get depressed).

§ 1.35.3 The increasing age of Americans means that more of us will be vulnerable to diseases associated with age. For example, a 33% increase in Alzheimer’s Disease is anticipated in coming years.

§ 1.35.4 As Americans grow obese, we are more likely to develop diabetes and heart disease, propeling future costs.

§ 1.35.5 Americans’ lifestyles are a more dangerous threat than terrorism. We must exercise, eat more healthy and fewer calories, enhance mental health, reduce toxin exposure, and follow research.

§ 1.35.6 I briefly introduce discussion on global warming. If 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).

§ 1.35.7 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.

§ 1.35.8 We must act, now, responsibly.

The individual serves the industrial system not by supplying it with savings and the resulting capital; he serves it by consuming its products.” - John Kenneth Galbraith.



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