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Health Care Plan

Christa - posted on 07/15/2009 ( 14 moms have responded )




This is an email I just received.

> Universal Health Care Program



> !!!!!.....






















> ????????



> ...ASAP !!!!....THIS

> IS WRONG !!!!!


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Laura - posted on 07/28/2009




Have any liberals really researched the English and/or Canadian health care system? And I don't mean just the elected liberals, the private citizens. Do any of them care to know what they are getting into. When people at the age of 59 can't even get a bipass surgery because it's too expensive and deemed unnecessary for someone of that age. The Congressmen and Senators may not be on this health care program they are shoving down our throats but they will have other family members that I hope they hear from. People from other countries, including Canada and England come to our country for help. Why are we ashamed of that? We are going to throw all of our knowledge and experience out the window. And if Barack does this how on earth is he going to find a cure for cancer as he promised in campaign speeches? While doctors go into the business for the good reason of wanting to help people they need to make money because they have huge school loans to pay off. There will be a shortage of doctors eventually (of course that will come long after Obama is gone and no one will remember what the cause is) because people can't take on that debt with no promise of being able to pay it off in a reasonable amount of time. We pay for our own health care. We are very fortunate to be healthy people and never meet our 1,000$ deductible so we uped it to 5k$ deductible to save money. The health insurance thing frustrates me to no end but what's being proposed isn't a fix. We will be stuck with whatever is proposed because private insurance will be too expensive for us to afford after gov. plan comes in to play. There needs to be much more thought and observation before something is passed. Btw I am new to this group and I am glad to have a place to share thoughts with people who understand and are truelly concered about the direction we are going.

Heather - posted on 07/27/2009




Nah, if they or their children need a kidney or something they would like to actually have the option to get on the top of a waiting list.

Kari - posted on 07/25/2009




Wow! This is amazingly well-thought out and very complete! I have actually debated the creation of groups to mimic what insurance companies deal with when providing insurance through employers for those who can't get/aren't offered insurance...I like taking that to the next level and making insurance not hinge on your employment at all.

It also allows for a lot of reform in the medical industry as a whole. And it wouldn't cause the insurance market or the medical field to collapse. It's a shame he can't get anywhere with reps. with this. I also like the mention of the high cost of father-in-law had to have a PET scan every 2 weeks before he passed away and they cost about $7000 each!

I applaud your father and hope someone will ultimately listen and help steer our country in this direction!

[deleted account]

Here is some info for you. My father has been a doctor for over 35 years and has come up with suggestions, submitted them to his state government reps and hasn't been able to have any candid conversations with anyone because of the huge political game being played with our futures. If you are interested in what a real person working first hand with our health care system and his real ideas on how to fix it, please read on.

Health Care Reform

Problem: 47 Million Americans are without health insurance. This is due to many things but the main causes are: (1) unemployment; (2) employment that doesn’t offer health insurance benefits; and (3) pre-existing health issues that make some individuals “uninsurable”. This leads to people not accessing the health care system for preventive care; using the most expensive venue for health care (hospital emergency departments); and unpaid health claims to health care providers that result in increased cost to the paying clientele. This is leading to the current Democratic and Presidential initiative to “reform” health care. Unfortunately this means a nationalized health care system. I believe that a federal government owned and operated health care system will be enormously expensive, severely bureaucratic and cumbersome with many inefficiencies and ultimately not serve the American public well. It will take away the entrepreneurial aspect of health care delivery that has made the American system the envy of the world, and a leader in health care research and innovation. It is my belief that health care should be left to the private sector. However, there are several reforms that if applied to the private sector would make the “system” provide universal coverage at the lowest possible cost and with the greatest possible access and efficiency.
Proposed solutions: Make health insurance individual and portable. To do this we must disengage health insurance from employment.
A. Affordable health insurance premiums are only offered to “groups”...and these groups are in large part defined by employer status. The concept of insurance is to spread the risk...this is done over a large group. Right now the “group” is an employee group. Most employee groups are composed of individuals who are at the lowest health risk...ages mid 20s to mid 60s. This allows for a lower premium cost to cover the insurers financial risk. Additionally, current insurance regulations allow insurers to discriminate against individuals who have preexisting health issues, thus making insurance even more expensive for these individuals. Some individuals are defined as “uninsurable” because of preexisting health issues.
B. Insurance regulations allow insurance companies to charge more for individual policies. Why not allow individuals or insurance companies to form “groups” that are not employer defined? Make the “groups” that are insured independent of and not tied to an employer or for that matter employment status.
1. To spread the risk and thus make insurance work there needs to be a mix of healthy and unhealthy individuals, old and young, and male and female. Why not allow insurance companies to define the proper mix and then enroll individuals/families in insurance pools. They already have mountains of actuarial data that would allow them to do that. There would be no allowance to exclude individuals from coverage....the insurance companies could manipulate the enrollment in the various groups to optimize the spreading of the economic risk. Once a group was formed, it could be closed with a new group opened for additional individuals/families. There could be multiple insurance pools for each insurer managed to create the optimum economic performance while providing insurance benefits to the members of each pool. Some geographic/regional locations have a higher disease prevalence than others. Through manipulation of group size and demographics the insurance company could spread the risk in the most favorable way. This should allow for health coverage for the individuals, and profitability for the insurance company. No one/family would have to pay a higher premium for “individual” insurance. No one would be excluded from insurance coverage. Different insurance groups may conceivably have different premium structures based on disease prevalence and demographics for that particular group, but all persons would have available to them health insurance coverage. Insurance would need to be mandatory so that we don’t have individuals not covered by an insurance plan.
2. The federal government would have to set a definition of a basic package of health benefits that the insurers would have to offer. This should also allow for more generous benefits at an extra premium cost. This should also allow different rate structures based on differing deductibles thus allowing those individuals who can pay out of pocket a larger proportion of their health care expenses to have a lower premium rate. This also allows for competition between insurance companies over premium rates thus making the cost of health care insurance the lowest possible amount. It puts accountability for managing the health care costs on a local level making it more responsive and efficient. If individuals want a higher benefit version of medical care coverage they would have to cover the expense of it out of their own pockets, or pay a higher premium for more a more generous offering.
3. Reinsurance could group multiple health insurance companies together to further spread the economic risk. This is already done and provides protection for the individual insurance companies from the risk of adverse case selection. This is usually the means by which insurance companies are able to provide coverage for “catastrophic” or “major medical” cases without suffering severe economic losses. The ultimate reinsurer may be but would not necessarily need to be the federal government....something akin to the FDIC that insures individuals money in private banks. If an insurance company mismanages and goes bankrupt, the federal backstop could manage the insured individuals until another more solvent private insurer could take them up.
4. This could then take the cost of health care premiums away from the employer and put them on to the individual. To make this palatable health insurance premiums should be either tax deductible or better still be editable for a tax credit. Broader and more generous Medical Savings Account regulations would be helpful. Federal government subsidies could be provided for individual/families at various income levels so that everyone could afford health care coverage regardless of their income. Perhaps make the subsidies such that every individual/family then pays an equal percentage of their income for health insurance (up to some high income ceiling so that the “rich” are not paying more than the cost to insure themselves.) Each individual/family would “own” their own health insurance coverage. It would go with them if they changed employment thus avoiding the expense of changing insurance coverage with changed employment. It would even go with them if they left employment either by retirement, layoff or any other circumstance.
5. This proposal would not need major federal dollars to institute. It would require legislation and regulation to change current insurance regulations to allow for the needed latitude on the part of the insurance company. It may require laws to coerce the private insurance companies to the new system. Current “welfare” insurance....Medicaid...could come on a par with private insurance since welfare recipients would have subsidies to purchase the exact same insurance coverage from the same private insurance companies that any other individual could purchase. States would be relieved of the burden of providing and administering health care benefits. Welfare recipients would be able to seek medical care and find it on the same footing as any other individual with health care insurance. (As you know, currently many physicians and health care providers will not accept Medicaid insured patients due to the low level of reimbursement for services.) It would take away from labor unions the ability to coerce private business to provide opulent insurance benefits as a condition of having workers. It would allow businesses to compete on a level playing field with the world wide market and not be hamstrung by the cost of providing insurance benefits to American workers. It would allow businesses to compete for employees on some other basis than for the “benefits package” offered. Individuals would not have to fear losing their health insurance if they lost employment, or decided to change employment, or to start a new business. Individuals and families would not have to worry about the risk of personal bankruptcy due to health care expenses. And it would allow the private sector to continue to provide health care insurance and not shift the cost or management of it to the federal government.
6. This proposal would take far less start up time to be up and running than to start from scratch developing a new, comprehensive nationalized health care system. All of the elements needed are already in place. With some proper legislation and regulation it could be running within a very few short years.

Problem: Much of the most costly health care expenses could be reduced with timely access to basic medical services. Many individuals seek health care late in the course of their disease process and at the most expensive venues. Many individuals in our society participate in life style practices that significantly increase their health care risks, especially if they are late coming to the health care system for diagnosis and treatment. If a new national health care system is to produce savings in health care costs, these issues need to be addressed.
Proposed solutions:
A. Promote preventive and urgent care. Preventive health services should be part of the basic health care package offered by insurers. This should be based on best medical evidence and not on unproven practices. We don’t need boutique care, just basic preventive health services. As mentioned above, a basic package should be mandated by the federal government to make equal access to these services for all individuals.
1. Cancer screening, diabetes screening, cardiovascular health screening should be standardized based upon best available medical evidence. It should be the same across all insurance companies. These services do not require physicians and could be efficiently and economically delivered by mid level health care practitioners such as physician’s assistants and nurse practitioners. Some of these services could be provided by health care technicians.
2. Individuals will need to be given incentives to avail themselves of these procedures. They also need to be penalized for not doing so. Premium rates, or possibly rebates on deductibles may be a way of doing this. I would suggest leaving the method to the individual insurance company. With time the best solution will be found from business experience.
3. Persons who participate in activities or lifestyles that produce increased health risks should have to pay a higher premium for health insurance. Smoking, alcohol consumption, obesity, etc. need to be discouraged. However, as noted above no one should be excluded from health care coverage because they participate in these unhealthy lifestyles. It might be that people who stop these behaviors should be eligible for some type of rebate on their insurance cost. How this is to be done should be left to the individual insurance companies. Again, with experience they will find the way that works.
B. Urgent care should be expanded. Insurance companies should be encouraged to build, staff and manage urgent care centers to take pressure off of hospital emergency rooms. This is already becoming common. These centers could be staffed by Nurse practitioners and Physician Assistants as they are now to reduce cost. They might profitably be located next to hospital emergency rooms to allow for rapid transfer of patients who choose an urgent care setting when they truly have an emergency. Emergency center personnel should be allowed to triage appropriate cases away from the EC and to the urgent care centers. (As you know, current rules mandate that hospital EC departments treat all persons who present to their departments and cannot legally turn them away.) Current regulations would have to be changed to allow hospital EC departments to do this.
C. Insurance companies should be encouraged to vertically integrate health care services. This based upon a preset, federally defined set of basic health insurance benefits. Let them manage them within one company, or form joint ventures across several insurance companies for efficiency and economy. This should allow for the most cost efficient provision of these services. Thus an insurance company would own or offer services from preventive services, to medical professional services, to ancillary services such as lab, imaging services, pharmacy, physical therapy, to durable medical products, to hospital inpatient services, and to post hospital services such as skilled nursing facilities and home health care services. With good management these services could then be provided at the lowest possible cost and still provide a profit for the insurance company.

Problem: The current reimbursement model for paying physicians is outmoded and counterproductive. It has led to the increased cost of health care delivery by medical professionals. It has altered the career path choices of physicians in a way that is adverse to the best health care interests of the public.
Proposed solutions:
A. The “relative value” system of determining the value of physician services is outmoded. It has led to a distortion of physician payment in which a primary care physician is paid as little as one fifth as much as a specialty physician....both of whom may work the same amount of hours. It has led to the current situation where radiologists are the highest paid medical specialist while primary care doctors are the lowest paid.
1. This has led to a crisis in primary care. Each year less and less physicians enter primary care specialties. Each year more primary care physicians leave their practice for some other opportunity. Easily 50% of currently practicing primary care physicians would quickly leave there practices if a more lucrative arrangement were available to them. The low reimbursement as compared to overhead that is experienced by primary care providers makes the provision of primary care extremely stressful and demanding. And this is happening at a time when the 60 million baby boomer generation is entering the time of it’s need for medical services.
2. This results in patients having trouble finding primary care. Preventive services are missed, a tendency to seek care at hospital emergency rooms is increased.
3. This large inequality of medical professional reimbursement is leading to a surplus of specialty physicians all of whom charge at a rate for services higher than primary care. Additionally, the more specialists there are the more specialty care is given again all at a higher cost to patients and whoever insures their health costs.
B. If we put a cap on specialist physician earnings we will reduce their motivation to work up to their full capacity and we will have a lot of part time specialists and increase the waiting time for patients to get into their care. This would not be in the public’s best interest. In countries with government run national health care systems the wait for specialty services is intolerable and sometimes dangerously long. We do not want that to be the face of the new health care system in America. But, we do not need the overabundance of specialists and the deficiency in the number of primary care physicians that we are now experiencing in the USA.
1. A federal decision should be made about medical manpower needs. How many primary care physicians, how many specialty physicians are needed to optimally service the health care needs of our population—there is already data out there that gives at least a preliminary answer to this.
2. The available training spots for the various medical specialties should be determined on a national level. They should be capped at levels that are predicted to provide the optimal number of specialists and primary care physicians.
3. Incentives need to be put in place for primary care training slots. This will have to be in the form of higher pay, for nothing else will motivate more physicians to choose these specialties.
4. Specialty training slots should be restricted to a number that is judged as needed to meet the national need. Physicians will have to compete to have entry to these training programs much more than is presently the case.
5. Specialty physicians should be paid at a rate higher than primary care to compensate them for the additional training time needed to qualify in their specialty. But, it should not be as now when the rate can be five or more times the reimbursement as for primary care. The old Relative Value Scale system for determining the level of physician reimbursement needs to be abandoned and a system that is based on the relative costs to qualify in one of the specialties compared to primary care should be put in place.
C. Mid level medical practitioners can meet a first contact need for medical care. National standards for training, certification and determination of scope of practice are needed to define their proper place and function.
1. They could profitably be used to provide preventive services at a lower cost that physicians.
2. They could, as they are now, be used to augment the ability of primary care physicians to provide primary care services.
3. Their role in augmenting specialty physician services should also be expanded, but their billing rate should not be commensurate with that of the specialty physician in providing these services. Their reimbursement should be more in line with primary care since they are not providing the specialty care but are serving as an extension of the specialty physician in providing care.
D. Ancillary services are extremely expensive and are highly profitable for the providers. The current reimbursement levels for such things as imaging, lab services, and outpatient surgical services allow for huge profits. A CAT scanner or MRI scanner can easily pay for itself with only a few scans per day, leaving a large profit margin when that threshold is passed. Similar profits are made in other aspects of medical care. If we are going to improve the cost performance of medical care, these charges and costs need to be closely examined and a payment system crafted to provide reasonable profitability without abuse.

[deleted account]

Here is a novel idea. Let's use the Congress and POTUS as guinea pigs and if the plan is a brilliant as they say, then sure...sign me up! lol

[deleted account]

I'm writing my senators and reps and telling them that if this plan is so good for me then it's good for them and the President, every member of Congress, and every federal employee. They need to put their money where their mouth is and sign up!!!!

Tanya - posted on 07/17/2009




It will kill people not just possibilities. I don't understand why people want something for nothing. There is plenty to be done regarding reform to what we have - and I fail to see that it is such a crisis that it needs to be done NOW! Nothing rushed ever works out. Especially government policy. As it is, the House and Senate barely had time to read the stimulus - and look how well THAT worked out! So now they hope to rush it through as "urgent" before August recess so that we Americans can get blindsided again???

Do people know that the House bill creates a time limit that requires us to either obtain private health care - or else be automatically required to be under federal healthcare? It does. Pretty transparent - right?

What incentive will there be for people to become doctors? Sure people start out in a medical career wanting to do good for others in need, but who dreams of becoming a doctor spending years going to school, then a residency only to make a piddling salary that is set by the government? The government payout to a doctor doing a hip replacement is only about $1200. Remember - a price tag will be put on everything - including you and your loved ones. Let's hope you or someone you love doesn't need surgery or expensive drugs if you are deemed "too old" to be worth the financial expenditure under government run healthcare...You will be out of luck!

We need to stop assuming our government will assume to know what is right for us and vote accordingly - and not take a back-seat to the important issues that will shape our future. Not to mention our children's future.

Gina - posted on 07/16/2009




The bottom line is, this healthcare plan is going to kill the possibility for creating any new jobs since they are going to tax the wealthy.... AKA business owners. Why would they do this at a time like this... hmmm it makes you wonder.

Tanya - posted on 07/15/2009




I know, it is so hypocritical, so despicable - its good enough for everyone else but not for him? I have never seen a president so hell-bent on making as many policy upoheavals in as little time as possible. He wants to leave a legacy all right...A legacy of destruction. Socialized/nationalized/universal/government-run healthcare would be the absolute worst thing anyone could do. I already pay a LOT for healthcare for me and my family - but I use it, and I am the one making decisions - not some government appointed board of health officials.

The General Services Administration announced that the Obama administration is spending $18 MILLION to redesign the website to show Americans where their hard-earned tax dollars are being spent. What?!? If they can waste $18 million in taxpayer dollars on a WEBSITE, just imagine what government-run health care will charge us for an x-ray.

Shannon Cassidy- - posted on 07/15/2009




This is F****ing Bulls*** !!!!!!!!!!!!!!!! If they are not going on it then why should we.

[deleted account]

And Christa - Please Please Please post this to the debating mom's group! I don't participate any more, but I do read it from time to time. Those women are so 'smart' they are blind!

[deleted account]

How about that? Our (elected) leaders are too good for their own plan?? Are we infants that we must take what is 'given' to us (after they take our money to pay for it) and they are not bound by the standard they set? I'm so FREAKING tired of the *&%$@ DOUBLE STANDARDS!!!

If our own leaders don't want it, why should we have to take it??!! It is total BS!

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