Monday, July 27, 2009

A NEW Approach to Health Care Coverage for the Uninsured...

After speaking to many, the consensus seems to be that the United States has the finest Health Care available in the world...

Few debate this unless you are seeking some "alternative" treatments or wishing to become a "medical tourist" seeking cheaper alternatives to what we have here, or seeking treatments that are not approved here. Either way, you have the freedom to make that choice and you are the ones who must live with those choices. Many thousands come to America for treatment because we have the most advanced system of medical care in the world. If you want the cutting edge stuff, the U.S. is you first choice. Most rank and file hospitals here are far and away better equipped, cleaner, and have better trained staffs than most any other hospital systems in the world.

Ask many Canadians who were denied timely or effective treatments back home if we don't provide first rate service...

A friend of mine, Bruce Laporte, who has been in the medical billing and medical practice management for nearly 20 years, has told me that the problems we have in covering so many people today is quite easily corrected with a very simple, and already familiar method used to cover those who have no automobile insurance. We need, in effect, an “uninsured patient pool” plan like the uninsured motorist pool presently used in all the states of the union, run in a similar fashion, and funded with both public monies and insurance company monies. This grouping plan will in effect act as a massive PPO insurance group plan to cover all those needing coverage, and would be run, under oversight of existing state insurance boards, and would require very little federal oversight or intervention. It would be the perfect counter to “Obama Care”….

The outline he sent me is below……….

Health Care Reform Proposal

The recommended solution for the current manufactured health care crisis is a hybrid of the HMO system, the military medicine system and the automobile insurance system that we already know in this country. This would effectively cover the uninsured and if properly implemented could be a replacement for the Medicaid system.

1. Mandate an uninsured care card; to be distributed by Health Care Carriers, who will be responsible for the assigning of PCP for the uninsured claimant.

2. Similar to the Military “Sick Call” use Urgent Care facilities, many already exist and are owned by local hospitals.

3. Require a co-pay of $5 for the individual, this will reduce those who are abusing the system since they would have to pay into the system through this responsibility, they would exercise more caution in the use of the system.

4. The Urgent Care would serve as PCP and therefore Gatekeeper for the patient to receive non-emergency care. The emergency care would be treated at the hospital in the emergency room and subsequent care in accordance with normal protocols.

5. The uninsured patient who chooses to elect this ‘coverage’ would have to produce the insurance card and the insurance carrier would be required to issue to only those persons with a valid legal status to be in the United States.

6. The Urgent Care facility would be paid a ‘capitated payment’ for each patient assigned by the insurance carrier for each facility. The capitated payment would be all the urgent care facility, plus the $5 co-pay would obtain for services and therefore would be required to manage the care cost effectively.


1. Discontinue Medicaid program in favor of this program; redirect those resources to this program to be administered by the private carrier.

2. Currently we have an ‘uninsured motorist pool’ where everyone pays for those persons who do not have auto insurance coverage. Adopt a similar method for health insurance, everyone who has health insurance pay an additional 5% for their coverage.

3. A pool from those 5% premiums would go to a pool and be distributed by the private carrier assigned.

4. 50% of the pool would go to the Urgent Care facilities for the purpose of covering the capitated payments for each patient.

5. 50% of the pool would go to hospitals for the management of the patient’s health beyond the urgent care’s abilities.

6. The dispensation of the capitated would be a formula of the total number of patients enrolled in this non-insurance, divided by the total allotted for the pool.

7. The dispensation of the hospital’s additional funding would be based upon the Medicare Cost Report which is already a requirement.

8. Limit liability for the Urgent Care and Hospitals for non-insured patients to reduce the malpractice insurance costs.

Benefits to the Hospitals

1. Urgent Care triage would reduce the number of Emergency Room patient’s who use the ER as their Primary Care Physician and reduce wait times for everyone.

2. Hospitals would be able to provide care, in accordance with guidelines for this non-policy just as they would any other real insurance policy.

3. Hospitals would have limited liability to reduce costs.

Benefits to the uninsured and Medicaid patients

1. The Urgent Care facilities would provide the same level of care that is given to our Men and Women in the Armed Forces. If this is not sufficient service then we need to address the level of service that the Men and Women in the Armed Forces receive.

2. The Urgent Care Facilities would be adequate but the ‘doctor on call’ would be serving as the PCP and therefore if the patient wants a relationship with their own PCP, they could get private insurance and then pay into the system instead of just taking out of the system.

3. Medicaid patients would not be incentivized to stay in Medicaid, currently Medicaid patients are seen by the same primary care doctors in the same offices as those who pay for services and therefore there is no incentive to be independent.

Benefits to the Private Physician

1. Medicaid patients and their very low reimbursement would be at the Urgent Care facilities and NOT in private practices which could be used by persons who have real insurance.

2. Reduction of bad debt by patient’s having the option of obtaining traditional insurance, paying out of pocket or going to a Urgent Care facility. This would reduce costs and help prevent all the private practices from going out of business.

If you are interested in Bruce's plan or have any questions on it, please contact him via his FACEBOOK.COM page or at for additiona detail.

I think this plan has merrit as it is a hybrid of existing protocols and would keep government intervention and expense to very low levels. That alone, makes it a winner in my book. It also can be administered state by state which is in keeping with our system of state rights and responsibilities demarcated from the federal level control.

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