Actually I wrote this one day out of total frustration with all the b.s. going on over health care or whatever. It was never edited, so please excuse any errors etc or incomplete thoughts. To me, it seemed that back last July when I originally wrote this that the only winners were BIG special interests and the only losers were all the rest of us! Nothing has changed except that now this program is being pushed on an electorate that doesn't want it and yet will be "taxed" in many ways to pay for it.
Don't the idiots in our government realize this is no different from the taxation without representation issue that led DIRECTLY to the American Revolution? When all the financial life is sucked out of the middle and lower classes, the stage will be set for National catastrophy.
Just some “thoughts”, not even “ideas”, and certainly not “proposals:
To truly fix health care a couple of factors have to be eliminated from the equation before attempting to establish a credible and market driven payment system for our health care. First, as Chapter Six of this Liberty Plan calls for, all student loans should be forgiven. The reasons are stated before, but as it applies to health care it is a “thought” that this may be a way to eliminate a tremendous overhead expense from the backs of the practitioners and their support staff thereby reducing the expenses they have to pass through to their patients. If the government can gift billions to firms like AIG and Goldman Sachs, they can certainly do this to help stem rising health care costs and restore market driven forces to this industry which will soon account for over 20% of GDP if costs are not checked.
Second, tort reform is absolutely imperative. This system benefits trial lawyers only and is the principal source of the need for unnecessary tests and redundant and excessive treatments and procedures. A doctor can be sued if he misses a diagnosis by not running some obscure test, but he is somewhat protected if he spends our money protecting himself. The true story on the elderly being “throw away patients” speaks for itself and is indefensible by the legal profession.
“Thoughts!”
Adults, defined as everyone not eligible for Medicare, and not a dependent child, essentially our workforce and families:
?! How come health care reform has to be considered as one big complicated issue? Wouldn’t the principle of “K.I.S.S.”, keep it simple stupid; apply here perhaps more than in any other government involved program?
?! Don’t we have competitive entities here? How can the interest of insurers, vs patients, vs providers be homogenized by a socialist program that doesn’t work anywhere else in the world and won’t work, especially not in any society as complex as the United States? Are we talking “health care insurance” or “health care”; these may be mutually exclusive?
?! Why can’t insurance companies sell standard health care insurance policies nationwide?
Why do they have to be restricted to individual states? Doesn’t this drive up costs?
?! If we’re talking “health care insurance”, how is this any different from the underwriting and actuarial practices of auto insurance or homeowners insurance? Shouldn’t the same criteria for buying coverage apply to health care? Shouldn’t ‘health care insurance” policies be structured like auto and homeowners? Premiums are determined by one’s record as a driver or property owner. Shouldn’t one’s “health record” be evaluated the same as a driving record? In other words should pre existing conditions, such as obesity and diabetes, be calculated the same way for health care insurance premiums as a bad driving record? Nobody is forced to “speed” or drive recklessly on the highway, and no one is forced to eat unhealthy garbage and ignore a healthy diet. The extra premium costs, or “financial penalties” should correspond to the healthy history of the insured. By the way, I am overweight and have a pre-diabetic sugar problem.
?! The argument being put forth now is that private insurers are raping the system and running up huge profits mainly because of “denial of services” to the insured. Why can’t individuals, and families, obtain health care insurance with clearly defined benefits? My auto policy has limits, deductibles and clearly states what is and what isn’t covered. Why can’t health insurance be written the same way?
?! Why not allow people to buy the type of health care insurance they want, or in some cases afford? Shouldn’t policies be available that cover routine doctor’s office visit, or not? Auto policies sometimes have “catastrophic” coverage options, why not the same provisions in health care insurance policies; for example, maybe a policy with $50,000 catastrophic coverage, or “X” number of days of hospital care? Shouldn’t actuaries be able to calculate premiums for ALL levels of coverage just like they do for auto and home owners?
?! We all shop for business, auto and homeowners insurance, so why can’t we shop for our own health care insurance? We would “own” the policy and where we worked, or whether or not our employer kicked in, or whether or not a “group” or even an HMO was involved would be irrelevant. We could shop for our own doctor and other health care needs within the provisions of whatever policy we purchased. If the current “outrageous” premiums for health care insurance are the result of an inexhaustible supply of government money, wouldn’t the so-called “government-backed health-insurance plan” exacerbate this problem by removing all competition from the insurance markets, instead of providing “competition”?
?! Drug coverage? If the insurance company has your “medical profile” the type and amount of drugs to be covered should be easy to reach agreement on, don’t you think? Again, stated provisions in the policy should spell out how additional necessary drugs are to be covered, or not. This is not rocket science; this is just business, supply and demand at work to establish limits without government involvement of any type.
?! If lower income workers or the poor who don’t qualify for Medicaid or other social assistance need help with premiums, then shouldn’t the Federal or state governments provide direct assistance to help with premiums? After all, what else is the “social umbrella” for?
?! If American household costs for health care averages somewhere around $15,000 per year, shouldn’t personal health care insurance coverage, with no government interference, cost a lot less per household? Just the elimination of paperwork should help drive down costs.
?! Competition between companies writing this insurance should keep premiums on the up and up. State insurance regulators will monitor policy terms and provisions, I’m sure. The laws of supply and demand and free markets will regulate coverage and premiums; capitalism at its best, making sure approximately 20% of our GDP remains in the hands of private enterprise, and not bureaucrats.
?! Why can’t we treat those who are uninsured as the various state governments treat uninsured drivers with the penalties set forth as a matter of state law, not Federal mandate, unless they are below the poverty level and don’t qualify for any Federal or state health insurance subsidy? No excuses are acceptable for uninsured drivers, do we have to accept excuses for not carrying affordable health care insurance? However, shouldn’t allowances be made for those who choose to be “self insured”? If a person self pays for medical treatment and/or hospitalization, what tax payer interest is threatened or abused?
Medicaid and the uninsured poor:
?! The ability to purchase health care insurance with different levels of benefits is not available in the open market to those who don’t have the financial ability to buy it. This is where the “social safety net” comes into play; and this is where the most fraud, abuse and corruption exists today – namely Medicare and Medicaid. I know that Medicaid is “needs based” and Medicare is available to all who reach the age of 65 regardless of financial resources. If the “social safety net” is the means by which the poor and disadvantaged receive health care, why do they need health care insurance? The “single source payer” here is the government, both Federal and state. This group of people doesn’t need to be “insured”, they just need health care!
?! Before adding another H-U-G-E government run health care program, shouldn’t Medicaid, and Medicare, be audited and the fraud, corruption, waste and unnecessary administrative expenses be purged? How long can this take if we assign law enforcement agencies to the task and provide them with the resources and support needed to do the job?
?! Food stamp recipients are given what works like a “credit card” for the amount of their benefits and that seems to work well both at the point of sale and for monitoring a recipient account. Why can’t ALL Medicaid recipients be given a similar card for use when they obtain benefits? Not so much to monitor the recipient, but to monitor the providers. President Obama is pushing electronic health records, so why can’t Medicaid benefits be one of the first programs digitalized? Using the same criteria for projected audits that the IRS uses, why can’t Medicaid benefits be audited the same way?
?! Nobody is constitutionally entitled to unrestricted health care. But nobody is also entitled to deny health care to those who can’t afford it in this highly complex and advanced society we call the United States of America. Health care for the poor and underprivileged is the responsibility our society has in return for the unrestricted chances for wealth and advancement given under our constitutionally guaranteed way of life for all. If Medicaid is in reality “health care insurance” for the poor, shouldn’t the poor also be governed by the same degree of personal responsibility for their health maintenance as drivers are for their driving records used to compute auto insurance rates?
?! The problem here is that the Federal government does not have the “moral high ground” needed to set any type of standards for any personal responsibility, for anybody, in any class, especially the poor, when the Federal government not only condones corruption, greed and fraud on Wall Street but is now looking the other way while Wall Street goes right back to the very practices that destroyed trillions of dollars of average American’s assets. Only a new National political party as proposed in Common Sense – Part Two will stop this corruption and protect Medicaid recipients from the exploitation by the “political false prophets”, a/k/a the Democrat and Republican leadership, not the party members.
?! Medicaid is not a “necessary evil”, it is the necessary program for the delivery of critical health care to large segment of American society; maybe too big a segment of our society if we are truly the land of opportunity we say we are. Medicaid is also not the open wallet for the medical profession, its suppliers, its lawyers and it is not a source of “free money” to be handed out to the “party faithful” as a reward for their patronage.
?! Every dollar stolen from Medicaid, or every dollar of unwarranted Medicaid benefits given out by corrupt politicians to their “friends” is one less dollar that can be used to not only provide health care to the needy, but also could be used to feed hungry children. Children who receive an adequate diet are much less likely to be sick. President Obama and Congress to the needy and the hungry: “Screw you, our pals on Wall Street need the money”!
?! In reality, the best way to “fix” Medicaid is for the Federal government to actively pursue, identify and prosecute fraud, corruption and greed by providers, insurers and practitioners to the fullest extent of the law; only then can Medicaid costs be controlled.
Medicare, unnecessary tests, drugs, procedures; no “needs base” eligibility, no practitioner oversight – “show me the money”:
Let’s first look at one of the most prevalent health care issues for the elderly – diabetes. In throwing out the following “thoughts” on controlling Medicaid costs I fully understand that no politician or official is seriously going to require the elderly to practice “personal responsibility” for their health. It’s not going to happen and it would be immoral to require such behavior changes in a segment of our population that for the most part is already defenseless and the object of fraud, abuse and systemic corruption. Enough said about that because outside of limiting Medicaid on a “needs basis”, the only way to control these costs is to eliminate the criminal activity in the program. But, let’s just talk about “personal responsibility” like it is a serious objective – pretend this is a normal two-faced politician making this “argument”.
?! How many Medicare recipients also receive Medicaid? Should the “elderly” be entitled to the best programs in the world, or should they be thankful that their fellow and younger citizens support these programs by their taxes? I suspect it’s a little of both. But, at what age does a person’s “personal responsibilities” to society end? Does “just being old” qualify?
?! How many times a year does a Type 2 pre-diabetic need complete blood work done? One, twice or even four times? If an over 65 year old is obese or even moderately overweight, does he or she have any personal responsibility to lose weight in order to bring glucose levels down and prevent future expensive tax payer supported treatments for Type 2 diabetes?
?! If a primary care physician prescribes a diet as the necessary treatment for Type 2 diabetes and a patient refuses to follow instructions, is that patient entitled to receive the latest and most expensive drugs as treatment for their socially irresponsible behavior?
?! As a 68 year old pre-diabetic I know from personal experience that drugs taken to combat Type 2 diabetes lose their effectiveness as time goes by and that larger doses, or new (usually more expensive) drugs are needed, assuming no change in weight or even restrictive diet occurs. But I also know that in losing 10% of my body weight, 25 lbs off of 250 pounds, reduced my drug needs to almost zero! This weight loss also knocked out the drugs I was taking for cholesterol and high blood pressure. I now take two low dose generic drugs at minimum levels as insurance against flare-ups, which never happen!
?! Here’s a real “off the wall” thought on how to handle Type 2 diabetes Medicaid expenses! Instead of using billions and billions of tax payer dollars to bail out AIG, and also Goldman Sachs through the back door, why not “incentivise” the elderly to lower their risk of diabetes by paying them to lose weight and to keep it off! Instead of prescribing expense “new” drugs that only treat or control symptoms at best, why not have a primary care physician “prescribe” actual healthy food items and have these food items be covered and bought just like the food stamp program does. For example, a patient could receive a “script” for a month’s supply of healthy food; like frozen “cauliflower”, and “haddock”, and so on. The patient could go to the local supermarket instead of the pharmacy! It has to be cheaper and longer term effective at cost control than the normal never-ending drug regimen. If the patient, say over a set period of time, loses weight, for argument sake let’s say 10 pounds, then that person receives an additional “food script”, for let’s say $10 per pound – weight check and validation at primary care physician’s office. For every six months the weight stays off, $10 more in food script. Just one “small” thought for a very small area of the larger health care issue.
Heart disease, cancer and organ failures:
Unlike Type 2 diabetes, which may be able to be reversed, heart disease, cancer and organ failures may just be an irreversible part of getting old. Under the social safety net and the Federal government’s constitutional responsibility to its elderly citizens for their “health and safety” the best that can be realistically said about cost control here is to eliminate fraud, greed and corruption in the delivery of services to these patients. Maybe some day scientific research will develop “cures”, but that is a long way off even if the investment tax waivers for new products and services as called for in Common Sense – Part Two are adopted. A new National political party might bring about these tax code changes, but the R & D needed will still take a lot of time.
Treatment for these ailments under Medicare, and Medicaid, are out of control and subject to fraud and abuse by hospitals and practitioners as set forth in the case of “Joe” presented above. These providers of health care are systematically scamming Medicare and I surmise that this corruption extends well into the drug and laboratory services segments. The only way to stop this is perhaps the digitalization of health records and corresponding auditing methodology while recognizing patient confidentiality. No easy task.
Like it or not - It’s time for a “needs-based criteria” for Medicare:
?! Here’s a thought! To qualify for Medicaid a recipient must meet certain criteria based on their countable resources, if they have too much, they don’t qualify. How about changing Medicare to work along similar criteria, namely if a person has too much income or is fortunate enough to have enough wealth, then they may not receive Medicare.
?! In this time of a National health care crisp, isn’t this kind of a medical benefits triage in reverse? If you don’t financially need government assistance, you don’t receive it so that others less fortunate may. Even low income Social Security recipients have Medicare premiums taken out of their monthly checks. Is this money theoretically going to support Medicare for the wealthy? That’s wrong, fundamentally and morally wrong.
Thoughtful Questions and not necessarily Conclusions:?
Tongue in cheek idea!: The surest, quickest and easiest way to solve the Medicare cost problem is to kill off everyone over 65! (OOPS, that includes me – so we’ll forget about that idea).
Actually, there may be some simple steps that require a little political backbone which we will probably never get unless we get a new National political party in power; they are:
Why not a needs test for all, make too much money or are rich, no benefits? The reverse of Medicaid but just as appropriate. If you don’t need it, don’t take it!
Don’t we really need more family practitioners to meet the primary health care needs of the expanding elderly population, and to provide basic health care to those who can’t afford it?
Shouldn’t digitalizing and auditing of patient records be a first step?
Can’t the Federal government crush fraud, abuse and corruption investigations with criminal prosecutions for providers, practitioners and others where appropriate but leave recipients alone, for now?
Isn’t tort reform absolutely critical to protect providers from frivolous and absurd malpractice claims? Since the elderly are basically “throw away patients” in the legal world, throw away all malpractice lawsuits
there are arbitration methods that can bring justice to injured parties.
Considering how much debt doctor’s occur in their education, shouldn’t the government forgive all student loans? After all, paying doctors under Medicare and Medicaid is really just using tax payer money to pay back the tax payer any way! The Liberty Plan, Chapter Six presents this argument for what it’s worth.
Shouldn’t we as a nation encourage and reward healthy life styles for the elderly including financial incentives?
Anything else?
Conclusion:
This is too big a problem to solve with one massive new piece of bogus legislation and it is too big a problem for an instant solution. But it can be solved if some common sense is applied to the crisis. And, isn’t the logical first step to do the “housekeeping” by cleaning up fraud, abuse, waste and corruption? How about then taking the necessary administrative and “back office: reforms like digitalizing records and prescribing other treatments than drugs? Wouldn’t the best way to restore supply and demand for health care services be by making health care insurance work like casualty insurance – owned by individuals, not groups etc? Other ideas wanted!
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