The proposed Health Reform bills in both Houses of Congress should be scrapped. Neither bill does anything real for health care reform in this country or addresses the immoral, unethical, and inhuman practice of denying coverage to the sick or delaying treatment of the covered thus prolonging or promoting pain, suffering, and premature death, all for increased profits. That is the private insurance system we have today. A prosperous society requires a healthy, productive population. Therefore, it is in our self-interest as a nation to ensure the health of our citizens. I believe the best, most cost effective way to accomplish this is through a semi-autonomous single payer system. My proposed plan is budget neutral, cannot be raided by Congress, provides universal coverage, provides choice in coverage, encourages innovation in treatments and wellness, and promotes bending the cost curve down.
Let's start with some of the basic facts.
1)The percentage of the population that is uninsured is estimated to be about 46.3 million in 2008 or 15% (Pu).
2)About 46 million for 2009 or 15% are on Medicare.
3)About 43.5 million in 2008 or 14% on Medicaid (http://www.kff.org/medicaid/7606.cfm).
4)About 176.3 million in 2008 or 56% that have employer based insurance, (Pi) (http://www.commonwealthfund.org/Content/Publications/Testimonies/2009/Sep/Changing-Course-Trends-in-Health-Insurance-Coverage-2000-2008.aspx).
That is 100% of 312.1 million people.
There is some dispute regarding the actual overhead of private insurance companies compared to Medicare. The value ranges from as high as 27 cents / premium dollar(Richmond Times Dispatch http://www2.timesdispatch.com/rtd/news/opinion/commentary/article/ED-MILL12_20090710-195604/279279/) to 16 cents/ premium dollar (Regulating Health Insurance http://regulatinghealthinsurance.blogspot.com/2007/10/what-goes-into-cost-of-health-insurance.html) more of every premium dollar than does Medicare (Oi). According to Center for Medicare and Medicaid Services (CMS) using a PricewaterhouseCooper 2006 report and a National Association of Health Underwriters (NAHU) 2008 report 14% of premiums are used for non-medical expenditures. (http://www.legis.state.pa.us/cfdocs/legis/TR/transcripts/2009_0041_0010_TSTMNY.pdf). However, I find this difficult to believe because of the resistance to the proposed 20% and 15% limits for overhead expenditures in the Senate bill. How many more people could be covered by reducing the overhead and profit of private insurance to Medicare?
Pn= % of the population that can be covered.
Pi= % of the population with employer based coverage.
Oi= the difference in overhead of Medicare and private insurance (27% to 16%).
Ni= the new premium cost as a % of the current private premium dollar (73% to 84%).
56%*27%/73% = 21% of the population at the high end or 65 million people
56%*14%*/86% = 9.1% of the population at the low end or 28.5 million people
Per these figures the worst we would achieve would be the addition of about 28.5 million people and at best 65 million people of the 46.3 million currently uninsured , just by switching premium payments and coverage to Medicare for all and not changing any of the current payments structures for services, pharmaceuticals, or equipment. These calculations do not address the savings that can be gleaned from increased productivity, by promoting early intervention, decreases in emergency room visits, reduction in bad debt, and reductions in the prolonged denial/appeal processes in the current system. Factor in that the majority of the uninsured are working and they and their employers could contribute toward their premiums using sliding scale subsidies and the worst-case scenario of 17.8 million remaining uninsured could be covered easily.
I suggest the following changes to Medicare:
1)Independent board appointed by the President and confirmed by Congress to administer Medicare. Board composed of medical professionals; doctors, nurses, researchers, ethicists, and economists with emphasis on the first four.
2)Multiple coverage plans with appropriate premium rates, with a minimum plan to cover routine check-ups, acute illness, wellness services, prescription and catastrophic needs.
3)Income based sliding scale on premium payments, both individual and employer.
4)Premiums paid directly to Medicare.
5)Reimbursement rates to health care providers should be set to the standard "Customary and reasonable" rates used by insurance companies today minus 10%. (base rate).
6)Performance based bonuses for health care providers with better outcomes up to 30% of base rate. (Incentive to develop better treatments and practices, fewer secondary infections, fewer re-admissions due to re-lapse or in complete recovery, etc.). This could result in a reimbursement of 117% of today's rate for the most efficacious treatments.
7)Reimbursements based on local considerations not just on one national rate.
8)Congressional oversight and detailed, internet published, periodic statistical, accounting, and treatment assessment reports.
9)Panel proposed changes to coverage to require an up or down vote by Congress after a 60-day public review period (posted to the internet).
This program would still encourage innovation, would remedy the problem of Medicare underpayment, and would protect the populace from an unaccountable bureaucracy. This is a real starting point for Healthcare reform. There are many details to be worked out like the sliding scales and compensation to private healthcare insurance stockholders. The net loss of jobs in the insurance sector will need to be addressed through retraining programs, though I anticipate this to be minimal except at the top management level. I propose handling abortion funding by requiring two plans. One does not cover abortion and has the subsidy rate applied to the whole premium. The other is identical with the exception of abortion coverage and only the premium of the sister plan is eligible for subsidy.
I believe we should try this approach and let the Republicans and blue dog Democrats filibuster through the mid-term elections. Let the people vote on this issue. It is the closest thing we have to a referendum system. This is the only poll that counts on current opinion of the American public. If more progressives win, the reform will pass. If more conservatives win, they can propose their own reform plan. Either way, we must move quickly to avoid the health insurance and the healthcare system becoming the one sure cause of the collapse of the entire economy.