In short, it is a joint public / private approach that should provide a solution for most people needing coverage...
The main points are:
1. A 5% increase in premiums which are matched by the insurance carrier
2. This goes into a fund-an uninsured healthcare fund. (similar to the uninsured motorist fund that already exists for our car)
3. Utilizing the Medicare Cost Reporting System already in place the funds will be distributed.
4. Most hospitals have Urgent Care facilities which are adjunct to the hospitals Emergency Departments. This would serve as the Primary Care Physician Services.
5. Other services beyond the abilites of the Urgent Care facilities would be handled by the hospital that owns them.
6. The uncovered patient can be issued a card which would grant them access to the Urgent Care facility.
7. The uninsured patient would have to prove that he/she was here legally.
8. A small $5 copay for PCP and $20 for Hospital would reduce people who are abusing the system.
The impact is minimal to the hospitals as many already have these facilities and the start up for one is about $150,000.
The impact to the average consumer is minimal. The Urgent Care clinic is not so luxurious that there is not an incentive to accept traditional insurance and move off these rolls.
Bruce A LaPorte
Wednesday, July 29, 2009
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.
Financing
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 bruce.laporte@yahoo.com 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.
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.
Financing
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 bruce.laporte@yahoo.com 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.
Sick and Tired of "CHANGE" !!!
Just a quick though.....
Obama's campaigne motto was "Change We Can Believe In"...
I think it more accurate to say that it should have been:
"Changing What YOU Believe In"....
Obama's campaigne motto was "Change We Can Believe In"...
I think it more accurate to say that it should have been:
"Changing What YOU Believe In"....
Thursday, July 23, 2009
"Obamacare" on hold ...maybe
I love how the world has change and we can all get the word out...
One of the truly great things about technology is the ability to get the “word” out, whatever that word may be. I have been in the computer game for nearly two decades and have seen many changes. When I was in high school, the school district computer guys allowed a few of us “chosen ones” an chance to lay hands on what was at the time the state of the art in computer technology, the HP 2000 mini computer which was the main computer for the entire district. This thing had all the lights, bells and whistles one would expect a design of the late 60’s to early 70’s vintage machine to have. It had punch card readers and reel to reel tape drives and punch tape encoders and readers and made the devil’s own racket when all the gizmos were turned on. The terminals were a hodgepodge of dumb monochrome (no color, folks) workstations with integrated keyboards, to really antiquated (even then) teletype stations that made the lab sound like the set for the CBS Evening New room set, just no Walter Cronkite. The sound of teletype chatter could be heard for 100 yards in any direction from the class where they were located. I can’t remember how many “nudie cutie” posters made from wingdings and symbols and how many games of “TREK 73” we played in those years, but it was a bunch. I know Mr. Eklund, the computer and Physics teacher could tell you, but I hope he doesn’t as it would be embarrassingly high.
Now here I am nearly 30 years later, looking at a computer screen, powered by a machine as infinitely more advanced from the seemingly “advanced” mini-computer of that time as an Model T Ford is from a Formula 1 race car today. We use computers for a dizzying array of things as common and innocuous as keeping our financial house in order to indexing the family collection of recipes, to playing video games against people half a world away.
In the modern political context, the computer is the best tool to keep those in power honest. Cyberspace is the one place without borders, culture, or complete “Big Brother” control. It is ALL out there….. Cyberspace makes no distinctions between race, creed, color, national origin, religion, language, or political persuasion. Everyone is equal and the battle of ideas is can be fought on relatively equal and hopefully civil terms. It comes down to who can persuade through use of language and ideas, people to follow and act on a thought or idea. If America has done nothing else for mankind, the development of computing and networking technology for the mass market will be as important, if not the most important contribution to civilization.
I sit here at my desk, typing away, exchanging views with many all over the world, and all over the political spectrum. Most will agree with some of what I say, but many will think me a reactionary fascist who hates the human race and has no heart or conscience. The beauty is that we can exchange those thoughts and views and all who wish can react and participate in the dialog. It all comes down to that exchange of ideas. It is the epitome of the “town hall meeting” but in a virtual world of our creation. It is a great tool that must be protected and cherished.
The recent actions of those who hold power in Washington D.C. have put all of us who are involved in the process of sharing ideas and participating in the dynamic political and economic life of our nation, on notice that there is a new game afoot. That game is one of stealth politics and power plays in the early morning hours while our nation slumbers. They who exercise power know in their hearts that they are in the wrong by their actions, and by their methods. They have denied the mass of the American people a chance to act as we always have historically. They are arrogant, condescending and dangerous to our republic as the Nazis or the Communists were in days past. They are the sort of people who won’t let any opportunity pass them by, to enact their agenda even if prudence and fact dictate sober reflection and debate, even if that agenda has to be accomplished by cutting deals and twisting arms and casting votes on unfamiliar texts at pre-dawn sessions of Congress. Why did they do this? Why are the congressional leadership and the White House folks so willing and able to run rough shot over all of us to get their way?
They do it because they KNOW that if WE knew the truth, the WHOLE truth and had all the facts before us, that we might run the whole bunch of them out of D.C. on a rail. To be sure, they deserve it with the shenanigans we have seen in the last few months.
The health care reform bill is now on Capitol Hill in committee, stalled as the Democratic leadership tries to figure out a way to move foreword. “Blue Dog” Democrats have balked at the costs and the speed of implementation. Many face stiff opposition from the home folks who actually know more than their representatives about what is going on. The talk show circuits are filled with those who are keeping tabs on the bill and its changes minute by minute and then putting out that information on the web and over the airwaves. It is making life miserable for President Obama and Speaker of the House Pelosi as more people tune in on the web and on their radios to get the straight dope on the soon to be nationalized health care delivery system, but only if the Democrats get their way.
One thing seems certain. If more conservative and reasoned heads prevail, Obama still has another card to play with when the fiscal 2010 Federal Budget comes to the hill. He and the Democrat leadership only have to put the health care plan they want into the 2010 budget and then let it end up in the reconciliation process. According to the Committee on Rules:
In the Senate, total debate on a reconciliation bill is limited to 20 hours, although the actual time for consideration of the omnibus package often exceeds this time limit set in the Budget Act. Motions and amendments may be offered and considered without debate at the end of this time period. There are also restrictions on the content of a reconciliation package and on the amendments which may be offered to it. For example, any amendment to the bill that is not germane, would add extraneous material, would cause deficit levels to increase, or that contains recommendations with respect to the Social Security program, is not in order. The Budget Act also maintains that reconciliation provisions must be related to reconciling the budget. For example, section 313 of the Budget Act, more commonly known as the "Byrd Rule", provides a point of order in the Senate against extraneous matter in reconciliation bills. Determining what is extraneous is often a procedural and political quagmire navigated in part by the Senate Parliamentarian. The Byrd Rule and other points of order in the Budget Act may only be waived in the Senate by a three-fifths vote. Furthermore, the Budget Act prevents reconciliation legislation from being filibustered on the Senate floor.
Why is this important to us and why is it important to the Democrats?
First the numbers must be understood.
1. The proportion of Democrats to Republican is such that it would take little effort to pass with a simple majority of 219 votes needed.
2. In the Senate, the ratio is 60-40 with a Democrat majority.
Simply put, the Senate could NOT stop bad legislation that is tacked on to a Reconciliation Budget bill. In short, if Obama and the rest of their sycophants in Congress put the Health care bill in the 2010 budget, it might get passed because there are too few votes (from Republicans and what “Blue Dog” Democrats can be brought on to oppose it ) to outright defeat it by a majority vote, and only simple majorities are needed to pass the bill. According to the Byrd Rule, no filer busters are allowed to stop the budget, hence stop the health care bill from passing.
This is another form “Stealth Attack” that has been considered by the President. He articulated this in a conference call to bloggers loyal to the party position the evening of July 20th. According to a report by the Huffington Post, “Obama floated the possibility that if it appears that health care reform lacks the 60 votes needed for passage, he might be open to reconciliation, which would allow for an up-or-down vote on budgetary and tax aspects of the bill.”. In the Senate, that would be a simple majority vote of 51.
Correcting the problem of health insurance availability and pricing could be corrected in ways that don’t require massive federal intervention. Many uninsured people are uninsured by choice. They have made a conscience decision not to buy coverage because they don’t see a doctor often enough to warrant the expense. In their mind, it’s a waste of money for something they may or may not need, especially if they are young and generally healthy. They would rather have a better lifestyle; a nicer car, better apartment or house, take a trip, go out more…. Why spend cash on something I don’t use all the time? We all know people like this who take risks like this. It’s their right to take that chance, but it isn’t our collective responsibility to pay for their choices. The folks who make these choices should not be pitied, or coddled. If a guy making $50,000 a year without coverage gets sick, I don’t want to have to pay for his medical bills. If he has to fork out $200-$300 a month for insurance, that is what he needs to do. He should not become a burden to the rest of society. It’s true that he may not get to party as much as he used to and he might not be able to get as nice a car on payments as he might have before, or live in as big a house or apartment as he might want, but that’s the breaks.
For those who are in the country illegally, and uninsured, you should get nothing…..Nada, zilch, nothing…..
You are, after all essentially, criminals who do not deserve to partake of the benefits of our society under false pretences. The only thing you will get would be that care necessary (we are a generous and humane people, after all…) to make you ambulatory enough to be deported (repatriated) back from whence you came. Let your native land care for you, not the American taxpayer or the American insurance subscriber who pays higher premiums to cover the losses hospitals suffer for treating the likes of you.
For those who can’t afford it at all, there should be National/State PPO Pools that individuals can subscribe to that can be shopped and compared. Federal regulations should also allow all citizens regardless of where they reside, to shop for the best deal to meet their needs. If an insurance company in Oregon has a policy that a guy in New Jersey wants because it is less expensive than what he can get neared to home, he should be able to buy it. That would force the insurers to be more flexible and to be more competitive in their pricing. Many states regulate coverage’s to the point that the cost become prohibitive, while other states are less restrictive or heavily regulated, making coverage there less expensive. Also, it would be helpful if an ale carte menu of services covered by insurance providers was available so customers could tailor their coverage to reduce costs. The customer could pick coverage’s for those things that are beyond his ability to pay for such as catastrophic illnesses or injury coverage. That would leave the basic services like wellness checks and visits for non-life threatening issues to the patient to pay out of pocket if the insured chooses.
Another program that could be put into place would be the Health Services Marketplace where a patient or potential patient would be able to negotiate a price for known and common procedures, such as birthing, certain cosmetic procedures, bariatric surgeries, dental, vision correction, and fertility issues. They would post a “cash and carry” price that would be charged for these services, and the cost would be fixed at the price when the service is rendered. If there were no complications, there would be no additional cost. If there were complications, then the cost would be passed on the insured person to pay out of pocket or to work out a deal for reimbursement with his regular insurance company. There would be much less administrative cost this way, thus less cost to all parties concerned.
Recently, I heard of a woman who was due to deliver her new child. The birth was due in a couple of weeks, and her husband had limited maternity coverage with his insurance plan at his work. The cost as quoted by the local hospital, where most of his fellow employee’s went was between $20,000 to $25,000 for the delivery and hospital stay, if he put it on his PPO plan from his job. The plan he had would only cover 75% of the costs, leaving him to pay anywhere from $5000 to $6250 out of pocket.
This did not include cost if there were complications. Nor did it discount costs if all went well and mother and baby were without adverse affects and released early.
Rather than going this route, the soon to be father did some smart shopping and determined that cost could be reduced by using his head rather than his check book. He and his wife explored alternatives like shopping all the local and regional hospitals to find out who had the best deal. As it turned out, a hospital in a city where a close relative lived was willing to take cash payments and charge only $4000.00, all inclusive, if there were no complications. The cost could further be reduced if a midwife at a birthing center rather than a doctor in a hospital was used. Eventually, the cost to this family was further reduced to around $3000.00, including travel expenses and a stay with relatives. The insurance company was then approached post delivery and they agreed to pay the cost in full as it was less than the $15,000 that was projected for the insurance Companies’ share of costs.
This was accomplished with without government intervention, without government mandate, without nationalized health care.
Most important was that it was done by free people who saw an issue, and dealt with it as all free people do, with resolute, responsible and timely action. It was a creative solution for a common and sometimes expensive problem. Why can’t politicians be this creative, this efficient, and this reasonable when they propose solutions? Why can’t people like Obama, Pelosi, and Reed leave well enough alone and let us fend for ourselves?
Tuesday, July 21, 2009
Why all the rush to pass this before August? Beware the "Stealth Health Care Bill" Coming this Fall...maybe!
We know why all the rush....
Obama and his denizens are running out of time and now that the American people see how he and the Democrats work (remember Cap and Trade?), passing bills without debate, review or even publishing them for the people to see and give feedback to their reps in congress. Then voting at 3:00 in the morning to avoid the fallout from the home folks... Yes in deed....Obama is beginning to get the message that he can't get things done as fast as he wants but that won't stop him trying. Don't forget that he could "Stealth Attack" the whole thing through via the "Budget Reconciliation” process which is usually used in October when the new fiscal year budget is put through the Senate.
An interesting wrinkle in the whole process is that filler buster is NOT allowed in the Senate on reconciliation bills so a simple majority is all that would be needed, not a super majority like what is needed to stop a filler buster. Think about it…. He could get all he wants via simple majorities in both houses of Congress…. That’s scary stuff!!!!
Obama and his denizens are running out of time and now that the American people see how he and the Democrats work (remember Cap and Trade?), passing bills without debate, review or even publishing them for the people to see and give feedback to their reps in congress. Then voting at 3:00 in the morning to avoid the fallout from the home folks... Yes in deed....Obama is beginning to get the message that he can't get things done as fast as he wants but that won't stop him trying. Don't forget that he could "Stealth Attack" the whole thing through via the "Budget Reconciliation” process which is usually used in October when the new fiscal year budget is put through the Senate.
An interesting wrinkle in the whole process is that filler buster is NOT allowed in the Senate on reconciliation bills so a simple majority is all that would be needed, not a super majority like what is needed to stop a filler buster. Think about it…. He could get all he wants via simple majorities in both houses of Congress…. That’s scary stuff!!!!
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