tag:blogger.com,1999:blog-5291836878941730577.comments2009-10-04T11:55:54.955-07:00Barry The EngineerBarry The Engineerhttp://www.blogger.com/profile/08331449133641207575noreply@blogger.comBlogger18125tag:blogger.com,1999:blog-5291836878941730577.post-29738193833923683722009-10-04T11:55:54.955-07:002009-10-04T11:55:54.955-07:00I ran across an article written by Linda Halderman...I ran across an article written by Linda Halderman. She is a surgeon and her ideas about health care reform are very interesting.<br /><br />http://www.lindahalderman.com/2008%20Weber%20Halderman%20Common%20Sense%20Healthcare%20Reform.pdf<br /><br />I especially like her idea of physicians issuing 1099s for unpaid health care services. There are too many free loaders.Claudenoreply@blogger.comtag:blogger.com,1999:blog-5291836878941730577.post-41169615789474958892009-09-13T10:46:09.424-07:002009-09-13T10:46:09.424-07:00Claude,
Thank you for all the comments and referen...Claude,<br />Thank you for all the comments and references. I will review and incorporate. I do like to idea of making people more cost conscious. Right now most people are scared to even ask a doctor what something will cost.Barry The Engineerhttps://www.blogger.com/profile/08331449133641207575noreply@blogger.comtag:blogger.com,1999:blog-5291836878941730577.post-49252847689496016522009-09-12T16:47:03.181-07:002009-09-12T16:47:03.181-07:00Sally Pipes wrote an interesting book on health ca...Sally Pipes wrote an interesting book on health care. It's available in PDF at<br /><br />http://liberty.pacificresearch.org/publications/the-top-ten-myths-of-american-health-care-a-citizens-guideClaudenoreply@blogger.comtag:blogger.com,1999:blog-5291836878941730577.post-56981397059392019522009-09-12T10:48:20.608-07:002009-09-12T10:48:20.608-07:00Prescription drugs are another problem altogether....Prescription drugs are another problem altogether. Insurance companies have been raising co-pays and deductibles on drugs to try to lower their costs. I can attest that they are fighting a losing battle. I was able to keep drug costs within reasonable limits until the pharmaceutical companies were allowed to advertise prescription drugs on mass media (TV). After that the number of prescriptions for the latest wonder drugs skyrocketed. I was forced to raise co-pays and deductibles for brand name drugs. It barely made a dent in the rise in costs. Then I tried lowering the co-pays for generics. That didn't make any difference. Even at $5 many generics cost less than the co-pay. Today pharmacy chains and Walmart are offering generics for $4 per prescription.<br /><br />We need to restrict advertising directly to patients and encourage physicians not to prescribe only the latest wonder drugs. Currently, if a patient asks the physician prescribes.<br /><br />The other problem we have is other countries imposing price controls. Since the US is a free market, we pay the going price to support R&D and development costs. The US needs to address this problem with those countries and establish tariffs if those countries are unresponsive.<br /><br />[3 of 3]<br /><br />Your solution sounds very much like the Swiss health care system. In 2002 it seemed to be working well and providing almost universal coverage. Its cost in 2002 was very close to US health insurance premiums. However, I read recently that their system was having problems with cost increases. I have no other details and do not know the cause of their increases.<br /><br />I hope you can review my suggestions and incorporate what you like in your solution.<br /><br />Rational people without a political agenda must enter this discussion and help reform the system.Claudenoreply@blogger.comtag:blogger.com,1999:blog-5291836878941730577.post-47011039386078176802009-09-12T10:41:09.721-07:002009-09-12T10:41:09.721-07:00The creation of Health Savings Accounts (HSA) comb...The creation of Health Savings Accounts (HSA) combined with high deductible major medical insurance has been successful for many people and anecdotally most users seem happy with the system. This model probably cannot be applied to Medicare immediately. HSAs would not work for Medicaid or the chronic uninsured unless some welfare grant can be constructed perhaps in conjunction with the public health system described below. HSAs could probably be phased in for Medicare over a decade or more as people reach retirement with existing HSAs in place. Meanwhile Medicare and Medicaid reimbursement can be managed more closely to reduce costs without cutting provider payments. We have almost a decade (2017) to shift the system before Medicare costs exceed tax revenue. If we can lower costs meanwhile, that deadline can be extended until the system is reformed.<br />The incorporation of co-pays and deductibles has not been very successful in containing costs. There are “Medigap” insurance policies that reduce co-pays and deductibles, thus reducing incentives to conserve resources. Our affluent retirees can purchase a “Medigap” policy and receive all the medical services they desire with little additional expense.<br />Private insurance companies have moved to lower co-pays and deductibles if service is obtained within a network. This has led to higher premiums and lower physician reimbursement rates. All of this has led/forced providers to curtail services in order to generate more revenue.<br />Comprehensive medical insurance has not constrained the cost increases. Without significantly modifying our health care payment system we cannot change the spiraling increases in costs.<br />We already have a large existing public health system with offices and clinics distributed throughout the U.S. This network could be expanded and staffed 24 hours a day 7 days a week with nurse practitioners and physician assistants under physician supervision at a cost surely less than providing routine care in ERs for the uninsured. This would take the pressure off emergency rooms and provide access to health services for citizens who cannot otherwise afford it.<br />Most realistic non-partisan estimates of the number of chronically uninsured individuals are between 8 and 15 million people. This estimate is arrived at after removing illegal aliens, individuals with high incomes, people eligible for existing programs and people transitioning between jobs. That estimate represents only 3-5% of the U.S. population. There is no reason to destroy the health care system while providing health insurance to this small segment of our population.<br />Illegal aliens (approximately 12 million) are a large percentage of the oft quoted 47 million uninsured. Currently proposed legislation does not openly contemplate providing health care for this group. The only humane way to address this problem is to control the U.S. borders, eliminate employment of illegal aliens and develop a reasonable program for legal immigrants and temporary workers. The U.S. cannot provide welfare for the world!<br />The problem is not the uninsured; the problem is the runaway costs resulting from our broken payment system.<br /><br />[2 of 3]Claudenoreply@blogger.comtag:blogger.com,1999:blog-5291836878941730577.post-86754307871508328552009-09-12T10:38:44.010-07:002009-09-12T10:38:44.010-07:00I replied to one of your comments on a WSJ web sit...I replied to one of your comments on a WSJ web site. You touched on the topic of my comment. I recently wrote my congressman a letter outlining my ideas. The response was underwhelming. I spent 35 years developing and managing very large software systems. That experience has given me an insight into large complex systems.<br /><br />To put this letter in context, I am retired after 40 years of working for private companies doing government contracting in the information technology area. For the last 25 years I managed the health insurance benefits for a company employing approximately 1,000 employees. During that period of time I watched health care costs sky rocket. The rate of increase was much greater than the rate of inflation. The owners made a conscious decision to self insure the health insurance benefits. We bought catastrophic reinsurance at reasonable prices to protect the company against large claims. We were able to design our health care benefit plan to benefit the employees and encourage prudent use of the program. Close management allowed us to provide the employees with excellent health coverage at very competitive prices. The intent of this biographical sketch is to show that I have 25 years of experience administrating health care programs.<br />The current health care legislation that the Democrats are trying to enact would be a disaster. It would raise the cost and lower the quality of health care in the United States.<br />The cause of the rapid increase in costs for health care is a combination of cost shifting from the public Medicare and Medicaid programs and the prevailing third party payer system for health care services both in the public and private programs. The payment for medical services must be put back into the hands of the consumer. <br />When Medicare and Medicaid were created there were many more young workers to pay for health care for the aged. Now those workers have grown old and there are not as many young workers to support them. To contain costs, Medicare and Medicaid have reduced reimbursement rates. This has forced providers to raise prices for the private sector. Now the private insurance companies are negotiating lower prices and the uninsured are receiving astronomical bills as costs are being shifted to them.<br />This has led to a system that cannot be sustained. The current system has become a program of prepaid health services. Since the consumer is not paying for each service received there is no incentive to conserve health care spending dollars. The health care payers have developed a complicated system of co-pays and deductibles trying to control costs. The solution is not a public system that would be more of the same. The system must be reformed.<br />Health care reform should be based on 4 key points.<br />1. Third party reimbursement must be eliminated to the extent possible. That means the elimination of tax exempt employer paid health insurance as it exists today. The consumer must become responsible for his health care. One possibility is returning to “major medical” insurance coverage with routine care being paid personally.<br />2. State health insurance mandates must be controlled. Consumers should be allowed to purchase health insurance across state lines. The insurance policies must be designed to meet individual needs and facilitate the goal of reducing or eliminating third party payments. At the same time insurance regulations have to address issues such and pre-existing conditions and unreasonable denial of reimbursement.<br />3. The citizens who really need assistance with access to medical care must be given access to health services in a dignified manner; no 12 hour waits in an emergency room.<br />4. Tort reform must be enacted.<br />[1 of 3]Claudenoreply@blogger.comtag:blogger.com,1999:blog-5291836878941730577.post-59314535628706582912009-09-02T22:32:05.317-07:002009-09-02T22:32:05.317-07:00Thanks for your comments. In answer to your questi...Thanks for your comments. In answer to your question I personally have never written legislation. However as an engineer I’ve authored plenty of documents ranging from proposals to, specifications to design documents to standards. My take is that the text that appears on this page can be the introduction and if written correctly the details can be specified in less than 50 and at most 100 pages. I know congress and their other lawyers can probably figure out a way to turn anything in a War and Peace novel. I believe when they do this they are doing the country a great disservice. Things need to be written so average people can read and understand them. Doing otherwise opens the door for misunderstanding, poor review and buried hidden agendas.Barry The Engineerhttps://www.blogger.com/profile/08331449133641207575noreply@blogger.comtag:blogger.com,1999:blog-5291836878941730577.post-22426207631187202692009-09-02T20:49:06.660-07:002009-09-02T20:49:06.660-07:00How many pages would your plan turn into if we let...How many pages would your plan turn into if we let congress adopt it? This is the best idea I have seen - good job. I will also pass it on!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5291836878941730577.post-27952579872817788592009-08-28T10:51:41.612-07:002009-08-28T10:51:41.612-07:00Thank you for your well thought out SOLUTION based...Thank you for your well thought out SOLUTION based plan. I think you are right on and I will share your ideas with others who want to work on this issue rather than point fingers and blame.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5291836878941730577.post-30510283854768213642009-08-27T19:18:46.822-07:002009-08-27T19:18:46.822-07:00Thanks for your inputs Deb. Agree get government i...Thanks for your inputs Deb. Agree get government involved to degree you have to but do eveything to minimize their role.Barry The Engineerhttps://www.blogger.com/profile/08331449133641207575noreply@blogger.comtag:blogger.com,1999:blog-5291836878941730577.post-32064978086642419232009-08-27T16:51:53.944-07:002009-08-27T16:51:53.944-07:00I like your ideas; they seem well thought out and ...I like your ideas; they seem well thought out and reasonalbe. I wholeheartedly agree that government has a role in setting policies/guidelines, but they would not be the best administrators of the program. We need to see some real competition in the market. <br />Deb the Human Resources ManagerAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-5291836878941730577.post-23161954336189844672009-08-26T17:56:16.719-07:002009-08-26T17:56:16.719-07:00Nathan,
Thank you for your comments. Let me try a...Nathan,<br />Thank you for your comments. Let me try an answer your questions<br />1. Cost per person – could not say but the whole plan is crafted to drive cost down so it should be significantly less than today’s average policy if all measures were enacted.<br />2. Cost for government – Again no formal analysis but the plan is designed to lower cost on many fronts. It is possible that covering the additional people under this plan could actually be less then government spends today on various programs (Medicare, Medicaid, VA, etc) . In any case picking up those people should directly help reduce the per paying person cost since those are indirect cost that burden coverage holders today.<br />3. It would be nice if companies passed on part of their savings to employees so they could go out and purchase their own insurance. However, the dynamics of the job marketplace will dictate that like it dictates salary and benefit packages currently.Barry The Engineerhttps://www.blogger.com/profile/08331449133641207575noreply@blogger.comtag:blogger.com,1999:blog-5291836878941730577.post-39872847174051720352009-08-26T09:56:15.382-07:002009-08-26T09:56:15.382-07:00what would this cost per person that is paying? w...what would this cost per person that is paying? what would it cost the government? would there be any requirements for salary increases after this system is in place?Anonymoushttps://www.blogger.com/profile/13024986035235968074noreply@blogger.comtag:blogger.com,1999:blog-5291836878941730577.post-4537349936968560852009-08-26T07:00:20.101-07:002009-08-26T07:00:20.101-07:00All good points - I will try and summarize your co...All good points - I will try and summarize your comments as yet another underlying causes/drivers factorBarry The Engineerhttps://www.blogger.com/profile/08331449133641207575noreply@blogger.comtag:blogger.com,1999:blog-5291836878941730577.post-53317270298037029832009-08-26T06:44:10.469-07:002009-08-26T06:44:10.469-07:00I saw that a comment to your proposal related to t...I saw that a comment to your proposal related to the average senior not complaigning about Medicare. Most seniors do not know they are being short changed with Medicare. First, they don't know that Medicare reimburses at 91 cents on the dollar. They don't realize that the low reimbursement rate is actually a rationing of service quality under the program. They don't realize that the board has already proposed additional cuts in the reimbursement rate aside from the current reform legislation. They don't realize that Medicare has losses of $65 billion per year as of 08. They don't hear the stories from doctors regarding what Medicare won't cover as Medicare fights coverage all the time. Doctors just throw up there hands because they are fighting with the government and face a no win situation. Seniors do not realize that the difference in the reimbusement rate vs. the cost is being paid by private insurance and the insured. This is passed along from the providers to the privately insured and goes unnoticed. Further reductions in reimbursement rates for Medicare (actually cuts in service) will further increase the cost of private insurance. Doctors will tell you privately that further reductions in reimbursement will force them to spend 10 minutes with a Medicare patient instead of 15 or even what they feel is really needed. This is rationing taking place and it will get worse.<br /><br />Please update your scenario to include the real picture of Medicare. Medicaid is even worse. Only 41% of physicians will even accept it. Their reimbursement rate is even lower.<br /><br />Keep up the good work of letting folks know what is and isn't reality.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5291836878941730577.post-28373601722931685482009-08-25T10:27:13.109-07:002009-08-25T10:27:13.109-07:00I think your ideas are excellent and a great start...I think your ideas are excellent and a great start to a plan that would work. I'm going to inform others of your ideas.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5291836878941730577.post-22080684738074291532008-10-12T07:46:00.000-07:002008-10-12T07:46:00.000-07:00In this proposal Veterans and the elderly get a cr...In this proposal Veterans and the elderly get a credit towards the average cost of all providers in their geographic area. If they select an insurance provider that charges less than the average plan in their area they get the plan for free and get a tax credit for half the savings (the other half of the savings stays in the government funds for its use). Low-income are on a similar plan that is scaled out based on AGI. People who fail to register each year for a benefit lose the opportunity to select a provider for that year. When they show up to a health care provider they are randomly assigned an insurance provider in their area. They also lose the opportunity for any tax credit. Note that no out-of-pocket insurance cost is charged to Veterans, elderly or the very poor unless they select a plan that is more expensive than the average insurance provider in their area. In this case the need to pay the difference between the average plan and the select plan. <BR/><BR/>Barry The EngineerBarry The Engineerhttps://www.blogger.com/profile/08331449133641207575noreply@blogger.comtag:blogger.com,1999:blog-5291836878941730577.post-2310476568539355922008-10-11T22:56:00.000-07:002008-10-11T22:56:00.000-07:00-What about the V.A. type of health care?-What about the V.A. type of health care?Anonymousnoreply@blogger.com