tag:blogger.com,1999:blog-62147537035841147152023-11-15T08:44:27.857-05:00Health Care Reform SuggestionsThe health care system needs reforms so all Americans can have quality Health Care!Unknownnoreply@blogger.comBlogger3125tag:blogger.com,1999:blog-6214753703584114715.post-13644456440700767992008-12-19T11:11:00.006-05:002008-12-24T01:08:49.207-05:00Universal Health Care Financing<div align="justify"><a name="_Toc217441212"><span style="font-size:130%;color:#000099;"><strong>There is got to be a better way to finance health care</strong></span></a><span style="font-size:130%;color:#000099;"><strong>!</strong></span></div><div align="justify"><span style="font-size:130%;color:#000099;"><strong><br /></strong></span><a name="_Toc217441213"><span style="color:#000099;">The current way we pay for health care is unacceptable!</span></a><br />The way Americans pay for health care services is very wasteful. We pay premiums to health insurance companies who use it to pay company profits, administrative cost and buy health care services. There are a lot of health insurance companies, so the advantages of scale are lost and the states insist on being the regulators of the health insurance companies, which results in adding to the overall cost of health care. The health-care-provider must deal with each health insurance company, resulting in more administrative costs. In addition the health-care-provider must waste time on things like health insurance paper work and the insurance companies’ bureaucracy. </div><div align="justify"><br />The government (Medicare, Medicaid, Etc) is the insurance to seniors and the poor adding more complexity and deep pockets. They would like to control the cost of health care, but there is no hope in sight and they are running out of money. There is a limit to the amount of money available for health care. </div><div align="justify"><br />Employers buy health insurance for the employees or pay for the health care and have insurance companies administer the health care program. </div><div align="justify"><br />Some individuals try to pay their own bills and are financially penalized. </div><div align="justify"><br /><a name="_Toc217441214"><span style="color:#000099;">What is acceptable</span></a><span style="color:#000099;">?<br /></span>Some feel that government should pay all the medical bills. </div><div align="justify"><br />Others want the insurance companies to be in control of paying the medical bills. </div><div align="justify"><br />That is to say, we the people of the United States will hand over our money and control to either the government or health insurance companies because we do not want to pay our own medical bills. We pay for this privilege. </div><div align="justify"><br />There is got to be a better way! </div><div align="justify"><br /><a name="_Toc217441215"><span style="color:#000099;">Third-Party-Payers</span></a><span style="font-size:130%;color:#000099;"> </span></div><div align="justify"> The patient and health-care-provider are the two parties involved in health care. When health insurance companies or the government providing health insurance is paying the health-care-provider for health care services, a third party is now involved. </div><div align="justify"><br />I do not pay for my health care services. Do you pay for your health care services? I do pay co-pays and deductibles, but I do not receive a bill for health care services. The bill is sent to a third-party-payer, who pays the bill. Well, they don't pay the whole bill; they determine what they are willing to pay and make a partial payment which is accepted by the health-care-provider as payment in full. The question is, do you receive a bill for your health care services and then pay the bill or are you making use of a third-party-payer to pay for medical services? Even though you are using a third-party to pay your medical bills you may still feel that you are paying the medical bill. The third-party-payer is using “your money” to pay your bills, so you feel that you are paying for your medical care even though a third-party-payer is paying and is using money collected from you and others. </div><div align="justify"><br />When using a third-party-payer, you are not paying for health care services you received! </div><div align="justify"><br />If you were paying for something that was not medical care, you might pull out your wallet and pay cash. That is the most efficient way to pay. A debit card is yet another way or a charged card still another. If the bill came in the mail, writing a check is a good way. All methods have advantages and disadvantages and one is cost. This may not be a complete list, but these methods or some variation should cover how most bills are paid most of the time. But what is missing is contracting with a third party to pay your bills, which is not a normal method for bill paying. </div><div align="justify"><br />Let’s try to imagine how contracting with a Bill Paying Service might work. First, you turn over most if not all of your paycheck each month to the Bill Paying Service. As you make purchases you would ask for the bill to be sent to your Bill Paying Service which would then pay the bill. Does this sound good or you seeing problems? First, the Bill Paying Service will want to be paid for its work (10% maybe). Second, if it’s assumed that the merchant will agree to send your bills to your Paying Service, they will need to be compensated for their efforts (5% maybe). Third, there is a good chance you will over spend because you have no idea (record) of what you are spending. Forth, it is easy for the merchants to pad the bills. Fifth, The Bill Paying Service and the merchant, in order to simplify their book keeping, charge the average cost so people getting chicken salad pay the same as those getting a 16oz steak dinner. You probable could add to the list of examples that bring into question whether a Bill Paying Service makes any since for anybody. </div><div align="justify"><br />Let’s compare the Bill Paying Services to the third-party-payers. With either there are administrative costs to pay. It is hard to control spending and cost. The door is wide open to fraud and abuse. And this may not be a complete list of problems they share. There is no question; the third-party-payer will use “your money” to pay other people’s medical bills and if you have medical bills you hope they will use other people’s money to pay your medical bills. With the third-party-payer, the money you pay them is gone, it is no longer users. Hopefully at this point neither the Bill Paying Service or third-party-payers looks like a good way to pay your bills. </div><div align="justify"><br /><a name="_Toc217441216"><span style="color:#000099;">Are You Now Thinking about Paying Cash? Bad Idea!</span></a><br />At this point you might be considering paying cash for your medical care. In some cases this may be OK, but in many cases it is not a good idea. Medical bills can be very large and you probability do not have sufficient cash to pay the bill. Even if you can find the cash there is a problem. The third-party-payers get a big discount if they are paying; you do not get a discount for paying cash. Everyone is changed the same, but not everyone is required to pay the same<a title="" style="mso-footnote-id: ftn1" href="http://www.blogger.com/post-create.g?blogID=6214753703584114715#_ftn1" name="_ftnref1">[1]</a>. When you are paying cash, you are “asked/ required/ demanded” to pay the “fair and reasonable” full charge, no discounts for cash. One exception is to qualify for charity. Something is wrong when a person paying cash cannot get a discount. It appears that third-party-payers pay a lot less than what is “fair and reasonable”. </div><div align="justify"><br /><a name="_Toc217441217"><span style="color:#000099;">By Paying Cash You Are a Victim of Cost Shifting</span></a><br />It appears that by not conforming (using third-party-payers) people paying cash are penalized. Most people paying cash cannot afford to be punished. They did not have enough money to pay the third-party-payers in the first place so it is very difficult to pay what might be considered a very inflated price. We have price discrimination. </div><div align="justify"><br />The health-care-providers need to collect from all payers what they need/want to cover their costs and profits. When third-party-payers do not pay their far share, what they do not pay is shifted onto the less fortunate, those paying the “Billed Charges” from their own pocket. When an individual is paying the “Billed Charges”, they are the victim of what is called “cost shifting”. </div><div align="justify"><br />If the “Billed Charges” are so high that all costs and profits of health-care-provider are paid by the third-party-payers even with their discounts, then the medical-care-provider is profiteering at the expense of those paying the “Billed Charges”. </div><div align="justify"><br />Everybody is billed the same for the same health care services, but third-party-payers are not required and do not pay the “Billed Charges”. They pay much less than what is billed. What is considered as payment-in-full is a function on who is paying the bill. The Billed Charges has little meaning or none to third-party-payers; it only has meaning if the patient is paying the bill. Third-party-payers determine what they consider as their full payment for the medical care services the patient received. The results, “Billed Charges” are not the same as the reimbursement expected from all bill payers. The amount on the bill sent out to all payers of health care services is a fantasy, a fiction, a fraud. The real payment-in-full is determined by agreements between the health-care-providers and third-party-payers. The “Billed Charges” do not represent what is a fair and reasonable price for the health services delivered to the patient!</div><div align="justify"><br />What is a fair and reasonable price is an unknown. The court is used to force individuals to pay the inflated “Billed Charges”. By the court’s action, they have converted the “Billed Charges” (Charges inflated, unfair and unreasonable) into a “fair and reasonable price” because the court would not force a person into paying unfair and unreasonable prices. (One would hope)<br /><br /><a name="_Toc217441218"><span style="font-size:130%;color:#000066;">Same Health Care, Same Charge, Same Payment for All Payers!</span></a></div><div align="justify"><span style="font-size:130%;"></span></div><div align="justify"><span style="color:#990000;"><span style="font-size:130%;"></span></span></div><div align="left"><strong><span style="color:#cc0000;">Action needed: </span></strong></div><ul><li><div align="justify"><span style="color:#cc0000;"><em><strong><span style="color:#cc0000;">The “Billed Charges” must be the same as reimbursements expected from all payers and which is paid by all payers, even the government.</span> </strong></em></span></div></li></ul><div align="left"><span style="font-family:trebuchet ms;"><em><strong>This would go a long way to making health care more affordable and get us a little closer to reality in health care financing.</strong></em></span></div><div align="left"><strong><em><span style="font-family:Trebuchet MS;"></span></em></strong> </div><div align="left"><strong><em><span style="font-family:Trebuchet MS;"></span></em></strong></div><div align="left"><a name="_Toc217692081"><span style="font-size:130%;color:#000066;">Purchasing Health Care Services</span></a></div><div align="justify">The free market is absent when third-party-payers are the purchasers of health care services. The employers, governments and health insurance companies, in general, are the buyers of health care services not the patient who wants and needs health care.</div><ul><li><div align="justify"><em>As a consequence the battle between payers (both government and employers), deliverers, and insurers of care placed the real consumer, the patient, on the sidelines. In the traditional economic model there is a tension between the buyer and the seller, but the buyer is also the consumer. In medicine the tension between the purchaser and the seller still existed, but the purchaser---the employer--- was not the consumer. That role belonged to the patient who, seemingly, was left out of the equation. There was little reason to believe that the purchaser truly represented the patient's needs and desires. The priorities that the potential patient set might or might not be those of the employer. Furthermore, the seller was no longer the producer. The seller was the insurance company----insurance, after all, is what the employer was buying. The producer, however, was the physician, the allied health personnel, and the hospital and its infrastructure. The insurer did not represent those interests either. This departure from the traditional economic model that balances interests (not always in, the most equitable manner) between parties with, divergent interests, this con­fusion of roles, was among the forces making for what has been referred to as the "destabilization" of health care. (1)</em></div></li></ul><em></em><em><p align="justify"><br /></em>The interest of third-party-payer is to decrease its cost by negotiates discounts but not the price. Note that the greater the price for of health care services the greater the “savings” (smoke and mirrors) for third-party-payers which “proves” they are doing a “good job”. </p><p align="justify"><br />If third-party-payers are not negotiating for a fair and reasonable price, how can a free market exist? Without a free market in health care services, can the claim be made that the “Billed Charges” (Price) is fair and reasonable? In the absent of a free market how is the price for health care services determined?</p><p align="justify"><br /><a name="_Toc217692082"><span style="font-size:130%;color:#000066;">Determining Price</span></a><br />Determining a fair and reasonable price for a product or services is very difficult. The free market system is normally used to make the determination. When a buyer and seller, in a free market, acting on their self interest agree on a price, the price is assumed to be fair and reasonable. To have a free market the buyers need to have sellers of products and services; and the sellers need to have buyers willing to buy the products and services when price and quality is “right”. The buyers need information such as price and quality so a comparison can be made. The sellers need to provide appropriate information. A monopoly will exist when there are too few buyers or sellers, potentially resulting in prices that are not fair and reasonable. Our nation depends on free markets working correctly. It is the responsibility of the government to assure that the free market system is working correctly so that fair and reasonable prices can be determined for the Citizens of America. When a free market cannot exist, the government must create a way to determine the correct price (fair and reasonable?). </p><p align="justify"><br /><a name="_Toc217692083"><span style="font-size:130%;color:#000066;">Determining Price When Third-Party-Party is Present</span></a><br />Determining a fair and reasonable price for a patient's health care services is even more difficult, especially when the situation is as follows: The patient is the consumer of prepaid health care and the seller is a third-party-payer (insurance) that does not produce the health care services but buys it form health care providers when needed. The provider delivers to the patient health care services which hopefully will result in health care for the patient. </p><p align="justify"><br />There is no reason to believe that a third-party-payer can correctly represent the patient's self interest, needs and desires. Likewise the third-party-payer cannot correctly represent the self interest of health care providers. The normal relationship between buyer (patient) and seller (health care provider) that is used to determine the fair and reasonable price does not exist. In his situation a fair and reasonable price cannot be determined. The free market system is not operating as desired. </p><p align="justify"><br /><a name="_Toc217692084"><span style="font-size:130%;color:#000066;">Determining Price When Third-Party-Party is Not Present</span></a><br />One would hope, that determining a fair and reasonable price for a patient's health care when the buyer is the patient and the seller is the health care provider would be working. It is not working. One reason is the price and quality information is not readily available so comparisons cannot be made. Another is the price agreed on by the seller (health-care-provider) and the buyer (third-party-payer) is a lot less than what is asked and required for a patient to pay to the health-care-provider. There are agreements between third-party-payers and health-care-providers that enforce the price discrimination. Different payers pay different amounts for the exact same health care services. This happens under the illusion that the third-party-payer deserves a discount by limiting their customers’ choices of health care providers. With competition for patients diminished, it is easier for the health-care-provider to control the price. The paying-patient either pays or is taken to court unless deemed to be a charity case. The fair and reasonable price has not been determined. </p><p align="justify"><br /><a name="_Toc217692085"><span style="font-size:130%;color:#000066;">No Fair and Reasonable Price for Health care</span></a><br />There is no free market in health care because fair and reasonable prices are not being determined. The self interest of the buyer (consumer, patient) of health care is not being represented in the price negotiation. The prices are being determined by third-party-payers and health-care-providers. This results in a health care system that is open to exploitation by the greedy. The system depends on the people in authority to set “fair and reasonable prices” leaving the patient out of the price negotiation. </p><p align="justify"><br /><a name="_Toc217692086"><span style="font-size:130%;color:#000066;">Profiting on the Less Fortunate</span></a><br />As a results of the unfair pricing, the biggest part of health-care-providers profits come from the uninsured and the under insured. The people who pay their health care bills are taken to the cleaners. The people who cannot pay the bills are taken to court with some exceptions to prove that charity is still “alive and well”. The message comes across load and clear, get “good” health insurance or pay. The system wants and needs monthly income to pay the large fixed costs of hospitals. The system does not like billing individuals, for some reason it’s better to bill third-party-payers. The government implies that everyone must have health insurance to get health care by calculating and publishing the number of uninsured. There are many statistics that could measure the performance of the health care system, why the number of uninsured? The less fortunate pay or else! </p><p align="justify"><br /><a name="_Toc217692087"></a><a name="_Toc215935194"><span style="font-size:130%;color:#000066;">Health care System Allows Unbridle Greed</span></a><br />There is nothing to stop people in authority to raise the price of health care in monopolistic fashion. There should be no question that unfair prices impact the less fortunate. The fully insured are impacted by paying inflated premiums. With higher premiums the insurance companies have greater profits. There is nothing stopping the greedy from profiteering. </p><p align="left"><strong><span style="color:#990000;">Action needed: </span></strong></p><ul><li><strong><em><span style="color:#990000;">A way to Determine what is a Fair and Reasonable Price for Health Care Services!</span></em></strong></li><span style="color:#cc0000;"></ul><p align="justify"></span><a name="_Toc217692088"><span style="font-size:130%;color:#000099;">No Free Market in Health Care</span></a><br />We know that health care services are bought and sold. The question, is there market for health care? Does any health -care-provider sell health care? Health care and health care services are not the same. </p><p align="justify"><br />Health care services are consumed to make a sick person healthier or keeping a person from getting sick. </p><p align="justify"><br />From Wikipedia: </p><ul><li><div align="left"><em>Health care is the prevention, treatment, and management of illness and the preservation of health through the services offered by the medical, nursing, and allied health professions.<br />Health care embraces all the goods and services designed to promote health</em> <em>…<br /></em></div></li></ul><p align="justify">Health care is not the goods and services used in an attempt to provide health care. When a person is sick, they will seek out health care. Health care services are used in an attempt to provide health care so the person’s health can improve. If there is no improvement in the person’s health, has the person received health care? Health care services have been consumed with no health care results. </p><p align="justify"><br />Normally health care is not viewed as a product or service that is bought or sold. Health care services are what is bought and sold. This distinction is very important! The patient wants to get health care, but what they receive is health care services. The third-party-payers in general are paying for health care services not health care! When we or our employer buys health insurance, we think we are purchasing future health care, but what Insurance companies pay for is health care services. </p><p align="justify"><br />Because in general health care is not being sold to the patient or third-party-payers, there is no market in health care. </p><p align="justify"><br />If you contracted for a house to be built, you would pay to the contractor the agreed upon price for the house. You normally would not get a bill from each subcontractor every time they completed a task or ordered material. You can pay out a lot of money and still have no house.<br />When you ask for medical care, a lot of fee-for-services may get paid and you are still no better than when you started. You where sold medical care services not medical care. </p><p align="justify"><br />You are purchasing health care, when the bill is based on the results in treating your medical condition. It will not be easy to have a market in health care and paying for health care services will not be eliminated. The health-care-provider must do a good job of treating the patient or they will suffer financially. There should better quality and prices if there is a market in health care.</p><p align="justify"><strong><span style="color:#990000;">Action needed:</span></strong></p><ul><li><em><span style="color:#990000;"><strong>We need health-care-providers to sell Health Care</strong>.</span></em></li></ul><p align="justify"><a name="_Toc217692090"><span style="font-size:130%;color:#000099;">Do We Want Discrimination in The Health Care System?</span></a><br />At the present time, we have a tax system that discriminates. The government gives a tax break to employers that provide health care benefits to employees. If you are paying for your own health care, you are paying more for health care than you should. The government allows employers to use the whole earned dollar to be spent on health care. On the others hand, those not being favored by this discrimination, must pay taxes on the earned dollar and then what is left can be uses use for health care. This discrimination should stop. One method of correction is not to tax the money spent on medical care. This would be a way to make medical care more affordable to a lot of people that need the help. This should happen in all reforms of the health care system.</p><p align="justify"><br /><a name="_Toc217786763"><span style="font-size:130%;color:#000099;">Who is the most important person in the medical care process?</span></a><br />One would hope it was the patient? The money that is paying health-care-providers and third-party-payers comes from people that at some point will, in all probability, be a patient. As a patient, you are a liability and other people’s money will be spent for your medical care, so the third-party-payers “must” control the health-care-providers so they do not spend other people’s money unreasonably on your health care services. The health-care-providers and their employers are being paid by the third-party-payers not by the patient. Does this not imply that health-care-providers are working for third-party-payers not the patient? The patient’s interests are secondary in spite of what should be a physician-patient relationship. The third-party-payers are very important to the health-care-providers, because the health-care-providers are assured of being paid when third-party-payers are paying for the health care services provided to the patient. The options and information the patient receives from the health-care-providers may be limited by the third-party-payers in their attempt to control how much they will pay for health care services. Thus the most important person does seem to be the patient. </p><p align="justify"><br />Is the patient ready, willing and able to make decisions about their health care? Is the patient ready to be in the center? Then the third-party-payers would be working with and for the patient, not exerting control over the health-care-providers in anyway. The health-care-providers would work with and for the patient not allowing third-parties to interfere in the patient’s medical care. Third-party-payers could help to find options for the patient so that the best option(s) could be selected from the best medical care available. </p><p align="justify"><br />Is the patient ready to make their health care decisions? When a person is sick, they can be quite willing to turn the decisions to some else (“mother”). They do not want to worry about how I am going pay for my medical care. At this point third-party-payers look very attractive, assuming they will pay for the correct medical care.</p><p align="justify"><br />Can the patient be allowed to have the authority to make their health care decisions?</p><p align="justify"><br /><a name="_Toc217786764"><span style="font-size:130%;color:#000099;">A Desirable Model for Health Insurance</span></a><br />The money that people pay to have health care sometime in the future should not be considered as income for the insurance company. The IRS should not tax this money as income. This money should be considered as a deposit in an account that will be use by the company to pay for someone’s health care. It would be like depositing money into a savings account in a bank where the bank pays interest on the deposited money. In this case there would be only one account to which everyone makes deposits. When there are medical needs, money is withdrawn to pay for medical needs. When the patient agrees to the amount of medical care delivered, the company takes from the account payment for the health care services delivered. This payment is taxable income that the company has earned by seeing that the patient receives the best health care possible. There is no income for the company until health care has been delivered to patients. The amount of income would be proportional to the health care delivered. If the patient made a full recovery, something like a maximum of 10% of the costs could be taken as income. If the patient was expected to make a full recovery and did not, then the income might be just 1% of the cost. If the patient died, maybe even no income. </p><p align="justify"><br />Keeping the customer healthy is another way of delivering health care which could generate income for the insurance company.</p><p align="justify"><br />The company makes an income (profits) by getting their customers healthy and keeping them healthy.</p><p align="justify"><br /><a name="_Toc217786765"><span style="font-size:130%;color:#000099;">A Search for Health Care for All the People of the United States</span></a><br />In most cases health care is something you will need in the future. So why not have every one save on a regular basis so when they get sick, they will have the money to pay for their medical care? Sounds good, but it only works some of the time. One problem is that not everyone earns sufficient income so they can save for their medical care when they have a need. Another is that people do not like saving, especially for something they do not believe they will need. Even when people save a substantial amount of money, their unexpectedly high medical cost can exceed their savings and their ability to pay the medical bills. So savings may be a necessary first step, but it is not sufficient to get the required health care in all cases for all people. Something more is needed.</p><p align="justify"><br />Not everyone gets sick at the same time, and some people almost never need medical care. So is there a way to share the savings since all the money is not needed at the same time. People could put their savings in a pool so that it could be shared with other people also putting their savings in the pool. If someone in the pool does not have sufficient funds to pay for their medical bills, the fund could give or loan them the needed money. A Medical Care Pool is needed, with an administration, to receive and distribute funds. </p><p align="justify"><br />Not everyone has money to put in the pool. But some people have sufficient wealth that they can pay for their own health care and have funds left over so they could share some of their wealth with people less fortunate than themselves. Everybody needs to make a contribution based on their wealth. For all the people to have health care there must be charity and or welfare. If the total shared wealth is large enough, then with a method of distribution based on health care needs, all the people in America can have health care. </p><p align="justify"><br />The government is already using taxes to pay medical bills for the qualified poor. These tax dollars could be deposited into the pool to pay for the poor. The special government medical assistance programs would not be needed. The government can quit forcing ER’s to treat the poor since all people will get medical care. The poor would get medical care just like everyone else. There would be one universal method to pay for health care for all the people. Is this not an objective of Universal health care?</p><p align="justify"><br />Most people are already paying for health care, theirs and others, one way or another. Thus they are not in a position to make a contribution to the Medical Care Pool. There are drastic changes that are needed if these people are to going to have their medical care dollars deposited in the Medical Care Pool. Today the government collects taxes with a large percentage being used to pay for health care. This money needs to go into the pool. This is money that people are already contributing to health care even if they are not aware of it. The amount of money that employers are paying for health insurance needs to go into the pool. The money that people are paying for health insurance should go into the pool as well as the money they are paying for their health care needs. There is a large part of people’s income that is already going to pay for someone’s health care. Many employers are using the employee’s earnings to pay taxes and health care insurance. There must be a major restructuring of the system so the health care dollars get to the Medical Care Pool which then gets to the people that need health care. By doing this, the employers can be relieved of providing health care for their employees which means they do not have to retain a portion of the employees earnings. Since everybody may not be making a contribution based on their wealth, some adjustments may be needed in the tax code. It would be nice if everyone made a contribution freely, but unfortunately the word contribution may be just another word for government taxes. But as already stated the money is already coming out of American’s pocket. What is being changed or eliminated are the hands it passes through before it gets to pay for some one’s health care. Hopefully with most it making to its final destination, the health care provider, with the hope of reducing administration costs, waste, fraud unwarranted profits and costs.</p><p align="justify"><br />Today we have a very chaotic way of funding health care and not everybody gets health care. There are different ways to collect the wealth and there are different ways to distributed it. You can only get the wealth from the people that have it. In some way, we must get the health care to the people in need. There is a limit to the amount of health care that can be delivered because there is a limited to the amount of wealth available for contribution into the Medical Care Pool. So everyone must be continually vigilant on health care cost so that there is money to pay for everyone’s health care. Even though the objective is to have health care for all, providing all the health care possible no matter what the cost is not practical. </p><p align="justify"><br />How do we distribute the funds so that everyone can have health care? The funds would be redistributed based on people’s health care needs. If everybody is going to have health care, is there any other way. People need medical funds to ‘stay well’, so money will be added to their account on a regular basis to satisfy this need. Most people when they have a catastrophic medical event become the less fortunate and need help with paying for medical care. When this happens, the person receives a ‘get well’ deposit. The amount normally needed to get well from their medical condition. When there are extenuating circumstances additional deposits may be needed and made. Some medical conditions are chronic and the people will need regular deposits into their account so their health can ‘remain okay’. In this way all patients at all the time can pay for their medical care.</p><p align="justify"><br />Now that the patient gets the health care funds to be used to pay the medical care providers instead of being paid by third-party-payers, a problem has been introduced since the patient may use the funds to pay for something other than the medical bills. To solve this problem the funds are deposited into a special account, “The Individual Medical Investment Account”, on which restrictions are placed. The funds may only be used to pay for the patient’s medical care which is delivered by a qualified health professional. In this way, there is some assurance the medical care provider will be paid for the medical care they delivered. The patient receives care and then gets a bill (which will be a major shock and adjustment) for the medical care delivered. The patient reviews the bill, and if they agree that it is for the medical care they received and the amount they agree to pay, then they authorize the bill to be paid from their special account. The provider would get the funds transferred to their account as quickly as if it was charged on a credit card. Everyone would use the same method (Universal) for paying for their medical care. This should eliminate a lot of administrative costs as well as get the insurance company out of the “doctor’s office”. </p><p align="justify"><br />The medical care providers will need to make changes in their billing practices. They need to bill for what has been accomplished for the patient, what medical condition has been resolved, what medical diagnoses was made, what medical help the patient received, etc. So the patient will be able to understand what medical care has been delivered. For example: The patient should not be billed for tests. They should be billed based on what the tests accomplished. When the patient is billed on results, they will be in a better position to select medical care providers that deliver the best medical care value.</p><p align="justify"><br /><a name="_Toc217786766"><span style="font-size:130%;color:#000099;">The Individual Medical Investment Account</span></a><br />A purpose of the Individual Medical Investment Account (IMIA) is to give control to the individual, the patient. There is a relationship that must be restored between a patient and the medical care provider. Because there is third party paying for the medical care, this third party lays clams to the right to affect decisions made by the medical provider and the patient for the purpose of reducing the third party’s financial obligation. When every individual uses their IMIA to pay for medical care, the medial care provider has no need to know the source of the patients’ funds. From the provider’s point of view, the patent is paying the provider; there is no third-party-payer. Now the health care provider is free to talk about all options available and their cost to patient. </p><p align="justify"><br />Another purpose of IMIA is to eliminate the need for the interaction between the health-care-provider and the third-party-payers. The provider can concentrate on health care for the patient with no need to be evolved with third-party-payers. The health care providers administrative cost should also be substantially reduced, sense all patients use one method to pay for their medical care, no third-party-payers.</p><p align="justify"><br />Individuals would have the account from birth to death, used to pay all of their medical bills. Money would be deposited in the account based on the individuals medical care needs. The account would be like a bank account that is used for savings, checking, credit card, debit card, investments, etc. The money in the account would be the individual’s to spend on their medical care expenses. They could also deposit funds to their account. The account would have a credit limit, so they could change to the limit without asking for financial assistance. If they had special needs, they could ask for financial assistance. </p><p align="justify"><br />The money would be held in a trust insured by the government. The trust would have the responsibility to care for this money as outlined below. It would pay the bills and invest the money. It would maintain a database and see that the money was only used on appropriate medical costs. It would oversee monies owed to the trust from borrowing against ones account. The trust would be a nonprofit organization. It would invest the money that is held trust so that it could pay dividends to the Individual Medical Investment Accounts and to pay for the expenses to run the trust.</p><p align="justify"><br />The trust needs money, financial reserves, to invest so that it can pay dividends to the Individual Medical Investment Accounts and pay its expenses. The trust should have money because of the money that is being deposited into the accounts. There is a risk that the monies used to pay the medical bills would be greater than the deposits. If this is so, the contribution must be adjusted so that the fund would have money to invest. When there are sufficient financial reserves, the contribution would be reduced. The trust should not make highly speculative investments or where investments would present a conflict of interest. It should prefer to make investments in the health care industry with the objective that everyone should have access to quality health care.</p><p align="justify"><br />An organization would need to be created to oversee the trust so that it is accomplishing its mission, which is quality health care for all. It needs to keep the trust on track, but not tied in knots.</p><p align="justify"><br />When an individual has sufficient funds to pay anticipated medical expenses, they can direct how their money is invested as one would do with an investment account. There are limits on how they can invest. For example, they cannot invest in great paintings and hang them in their home or their brother-in-law's plumbing business where they have a financial interest like being on the payroll. The trust must guard against people making investments that are conflicts of interest. The purpose of the individual investing is to allow those who put their own money in the account to make their own investments. A person can borrow money from their account when there are sufficient funds to pay anticipated medical expenses and the person has sufficient needs and is in a position to pay the money back. They will pay interest on money they borrow, which will be equal to the money that the trust is earning on their investments. If the trust is making 10% a year on their money, then the borrower will have to pay 10%. The loan rate will track, up and down, with the trust's earning rate. The trust must guard against people abusing the loan privilege. The purpose for loans is to allow those that have been aggressively putting money into the account to be able to get to it for important personal financial needs. Most people should not need the borrowing provisions of their account. </p><p align="justify"><br /> There is a gifting provision where a transfer of monies is made from your IMIA to another IMIA.</p><p align="justify"><br />Some people will not be able to pay their debt. The gifting provision is intended to help reduce this number. The trust will need methods so that they can forgive some of the debt. There's a fine line between forgiveness and entitlement. The trust will need to work hard to educate people that the medical payments are not entitlements, and they are to be repaid. There will be people who will pretend not to be able to make the payments and then others that truly cannot. It will be hard to tell which is which. But the trust must to do the very best it can.</p><p align="justify"><br />The owner of the account will need to have one or more beneficiaries and directions on how the money in their account is to be divided among the beneficiaries. When loans are made, there needs to be provisions on how the loans will be paid upon death of the owner.</p><p align="justify"><br />When third-party-payers make payments for medical bills, they will make the payment to the persons individual investment account. There will be absolutely no money going to or from third-party-payers and medical care providers. There is no need for the third-party-payers to have any dealings with the medical service providers. The trust can send the billing information to the third-party-payers, which should be sufficient for them to make payment to the individuals account. The third-party-payers should pay the same amount as it would have paid if this system did not exist. The provider should not expect any more money than it would have received if the system were not in place. </p><p align="center"><br />(___To Be Continued___)</p><div align="center"></div><div align="center"></div><div align="left"><br /><a title="" style="mso-footnote-id: ftn1" href="http://www.blogger.com/post-create.g?blogID=6214753703584114715#_ftnref1" name="_ftn1">[1]</a> See appendix B (to be added)</div>Unknownnoreply@blogger.com7tag:blogger.com,1999:blog-6214753703584114715.post-65201741187949475932008-07-06T09:59:00.007-04:002008-07-16T16:49:28.228-04:00Health Care Crisis Solution: More Competition, Less Government<div align="right"><span style="font-size:78%;">Last Updated</span></div><div align="right"><span style="font-size:78%;">16Jul2008</span></div><div align="center"><span style="font-size:130%;">Preface</span></div><span style="font-size:85%;"><br /><div align="justify">In Michael Moore’s movie “Sicko”, he a talks about a place where the only thing you needed to give was your name to get health care. This sounded like a utopia for health care. How much simpler could it get if it really worked? Could this country make health care that simple? My employer paid for my health care which made getting health care simple and I was not looking forward to switching to Medicare. Medicare was much more complicated, and my financial outlay was greater. It is true that some people look forward to having Medicare insurance. Having Medicare and insurance is better than having no insurance or very expensive insurance.<br /><br />Having socialized medicine does not appeal to me and Medicare is not a good example what medical insurance could be. I ask the question “Is there a way to reform our medical care system so that everyone can have adequate quality medical care and eliminate the bureaucratic nonsense that is in our current system?”<br /><br />To put it another way, “<strong>What is wrong with the current system and what can we do to fix it?”<br /><br /></strong>I am not an expert on health care reform, and never will be. I am only a user of the health care system just like the rest of Americans; however I have become a student of the subject by reading and analyzing in a search for answers to the above question. This paper represents my current incomplete answer to the above question.<br /><br />It would be greatly appreciated if you would like to help with my education on this subject or ways to improvethe quality of the document.</div><div align="center"> </div><div align="center"> </div><div align="center"><br /><span style="font-size:130%;">1. </span><span style="font-size:180%;">More Competition<br /></div></span><br /><div align="left"><span style="font-size:130%;"></span></div><div align="justify">There are two kinds of competition needed in health care. First, we must have free market competition in health care. “<em>The critical focus should be on putting consumers in charge of the money and letting them make cost-conscious decisions about spending health care dollars”.</em> (1) The patient in making cost-conscious decisions must also have performance data about medical care providers so as to make good decisions in selecting their health care options for treating their medical condition. Second, we must have sports like competition between the health providers. Transparent metrics are needed to enable the competition in health care to improve the quality and reduce the cost of health care. In baseball we keep score to know the winner and track the win loss record to determine the best team. Also in baseball individual statistics are kept so all kind of comparisons can be made from individual improvement to be the all time best. The team owners use this data when selecting new players or replacing current players. We have metrics in sports to determine who is best, where there is room for improvement and when improvement has been accomplished. The medical care system must have transparent metrics so that the medical care providers can compete, make good decisions so as to improve their performance.<br /><br />“Redefining Health Care” (2) talks about competing on “value for patient”. Health Care Value for Patient is health outcome per dollar of cost. When Health Care Value increases, costs go down or quality goes up or both. Metrics on health care value are needed if we wish to improve and fix the health care system. Health Care Value is measured at medical condition level over the full care cycle so that meaningful competition can take place resulting in a continually improving health care system.<br /><br /><span style="font-size:130%;">Corporate Competition<br /></span>The purpose of a company is to provide products and services to customers. The general thinking is profits are the purpose. Profits are a tangible way to measure how well a company is serving its customers when it is operating in a truly competitive environment. A profit is made when it successfully delivers products and services to customers. Profits are then used to pay the owners and grow the business. The focus tends to be on profits when it should be on the customers, the source of the profits. In health care, it does not seem right for a business to be making a profit on the sick, but as long as the business is delivering good health care value in a competitive environment this should not be a problem. Also there is no reason to believe that a nonprofit business will automatically deliver better results than a for profit business. It is the value of the health care results delivered that matters.<br /><br /><span style="font-size:130%;">Corporate Competition in Health Care</span><br />Business in health care needs to put health care value delivered as their primary measure ahead of profits. It would be nice if profits were proportional to health care value delivered. Deliver no health care value then get no profits. Deliver health care value then get profits to the degree that health care value was delivered.<br /><br />In a free market system it is possible to have a monopoly, which eliminates competition. It was necessary to enact antitrust legislation to combat monopolies so that competition could exist in the market place. There are other ways to eliminate competition and when this happens it is the role of government to create, change and enforce laws that guaranty competition in the market place.<br /><br />To compete in a market, it is normal to have a product or service. For there to be competition, comparisons need to be made so a person can select the best product or service that meets their needs. If a product or service does not exist, can there be competition? If all that exists is a promise to deliver a produced or service sometime in the future when special conditions have been meet, can a person make intelligent comparisons when purchasing the promise? Is this a situation in which the business should not declare a profit or income until the customer has received the product or service promised/purchased? Does government have a role to see that a competitive environment exits in such a market? In the health care industry what is needed is competition on the value of health care delivered. No health care, no income, no profit.<br /><br /><span style="font-size:130%;">Competition in Health Insurance<br /></span>If health insurance companies are to compete in the market place, the buyer needs to understand what they are purchasing. Without that knowledge, can intelligent decisions be made? Can there be competition? What are the health insurance companies selling?<br /><br />Is it a game of chance?<br />The customer says I will get sick this month. The company says ‘no you will not and we will take that bet’; just pay the monthly premium (your wager) and we will pay your medical bill. When you do not get sick, you lose the bet and the monthly premium. If you get sick, you win; they pay the medical bill. Well, maybe, there is no guarantee that the medical bill will be paid. The company will review your claim and may deny it, thus not paying off the bet. Somehow you did not get what you thought you had purchased (health care when you got sick).<br /><br />Is it assuming your health care risk?<br />Instead of you getting sick the company will get sick for you. Somehow that is not what they are selling. It’s the cost of the health care they will assume? That’s getting closer. The first dollars spent for medical care is your problem. No small change for the company. Then they will pay the rest? Not necessarily. There is a limit depending on the size of your premium (wager). And you claim is reviewed just like previous paragraph.<br /><br />Is it a savings?<br />Your deposit money in an account, which is held there so that when you need medical care, you can withdraw the money needed to pay the medical bills.<br /><br />Is it a pool?<br />You join a group of people that will help pay your medical bills if you help pay their medical bills. You pay a monthly premium that is placed in a pool so when someone in the group has medical needs the money in the pool can be used to pay the medial bills. It is a kind of group savings account.<br /><br />Is it investing?<br />Your money is being invested in the health care industry so that when you need health care the providers are available and you will be paid a dividend in the mean time. Then when you need health care you will have funds to pay for your health care and the health care providers will be available.<br /><br />Is it health care?<br />You are paying now for health care you may need in the future.<br /><br />Is it redistribution of wealth?<br />You are making donations (paying premiums), the amount is based on your wealth, so that people who cannot afford health care when needed can receive health care they/you need.<br /><br />Is it insurance for the provider?<br />The money is collected from you by insurance companies before you need medical care. The providers are now assured of receiving compensation when providing medical services. They bill your insurance company when providing medical services.<br /><br />Is it an advocate for your good health?<br />They will help you find the best providers as well as paying for you to get you well. They will work with you to stay well. They can be an advocate because of keeping track of which providers do the best job and know what is required to get you well and stay healthy.<br /><br />When selecting a health insurance company, you are trying to purchase expensive (unaffordable) medical care you may need in the future. You need to know if the company will help you get the best health care value. Will they help you find the best provides that deliverers quality medical care for your medical condition? How much do they pay in calms each year to how many people? How much money did they save by denying claims? What percentage of the premium is paid in benefits? When they increase rates, is it the same for all policyholders they insure or do different groups have different increases? Buying health insurance is not the same thing as buying health care. The health insurance company needs to compete on how well it can get you quality health care, something it has no part in creating, but it is what you want and need.<br /><br /><span style="font-size:130%;">Provider competition</span><br />The patient has no idea what their health care will cost and has no reason to ask or be told since a third party will be paying the bill. The health care provider may not know what will be paid for the patient’s health care. So to get provider competition, make the providers prices for medical care transparent and applied without discrimination (the same payment collected from everyone). Then give the health care bill to the patient for review, approval and payment instead of sending the bill for payment to a third party, who has utterly no idea what medical care was really delivered.<br /><br />Since many people do not have the funds to pay the bill at the time that they receive medical care, they could pay the bill from their medical account. Everyone should have a medical account used to pay all their medical bills, and all medical bills would be paid from an individual’s medical account. The medical care provider would receive payment only from the medical account of the patient (no cash, no third party). The government and insurance companies paying for the medical care would make the payments to the individual’s medical account. The amount they pay to the individual medical account would be the same as that they would have been paying to the provider for the medical care delivered. Charitable contributions could also be made to the person’s medical account. The patient or guardian of the patient would be financially responsible for the medical account. What is not paid by the insurance companies, governments, and charities; is paid by the person or persons responsible for the medical account. From a providers view point, it is the same procedure for everyone (uniform) with the benefit of not waiting months to get paid and no third party making demands.<br /><br />The patient has the right to make the choice of their health care provider(s) and the health care they want. When a person makes a choice in the marketplace, they consider many things; cost, quality, functionality and many subjective factors. It is very difficult for one person to make a good decision for another person. For a bureaucracy to make good decisions for people they don't even know is impossible. It is also highly unlikely if not impossible to make good decisions without good information. Also, when a third party is interfering in a very difficult and emotional process by limiting options based on cost and other factors which do not result in quality health care, it is very hard to have a positive outcome.<br /><br />The patient needs to be making decisions about their money as well as selecting the correct options to treat their medical condition. They need financial information (cost) and medical information so they can select the best options for them self. When a person is sick, it is a time when some very difficult decisions need to be made. This is not the time for a third party to be limiting choices solely to control costs and having no interest in finding choices that will have the best results for the patient.<br /><br />There are two problems that must be solved. First, the patient must have the ability to authorize the expenditure of funds. This could be accomplished if a sum of money sufficient to cover the anticipated cost to treat their medical condition was deposited into their medical account, an account that can only be used for medical expenses. The money would come from government, private medical insurance, a cost sharing pool or charity. The patient could elect to have a procedure that was more or less than the money deposited in their medical account. If they elected for a more expensive procedure, they would be responsible to make up the difference. If the procedure were less expensive, the surplus would be in their account to be used for medical care as needed. Second, medical outcome data (provider performance) must be available so the patient can select the provider that will deliver, for them, the best medical outcome. Providers must have transparent metrics that are indicative of the quality of the medical care being offered. The patient may need professional help when using the metrics to evaluate providers to be used in treating their medical condition.<br /><br /><span style="font-size:130%;">Reformers Competing For Better Health Care<br /></span>The government publishes a measure of the number of people who are uninsured, with the implication that you must have health insurance to get medical care. This number is quoted over and over again and used as an indication of the magnitude of the problem in our health care system. When everyone has health insurance, the problems with funding health care will go away; at least that is the inference. By innuendo the government is selling the idea of insurance delivered by profit making companies. Or maybe they are selling universal health insurance, delivered by a single payer system, the government.<br /><br />We need meaningful metrics to tell us the magnitude of the medical care system problems. With metrics in place, health care reformers will be able to tell if their changes are working, and how well they’re working. In addition they can compete on which reforms are doing the best job of delivering quality health care. The professionals in the medical care system need to be continually adding metrics as they learn how the metrics can help in delivering quality health at a lower cost. The government needs to establish measures that are definitive in telling how well the medical system is meeting the needs of the American people. All metrics need to be readily available to all the people making health care decisions.<br /><br /><span style="font-size:130%;">When Competition Is Not Possible</span><br />There are times when cooperation is the watchword, not competition. Normal competition is not possible in but one health care system which can only compete by working to improve its own performance. When all the parts of the health care system need to work in harmony in order to provide quality health care, competition is not possible but cooperation is mandatory!<br /><br />Everyone has a medical history. Every time you see a medical care provider the medical history can change and also the provider needs to update your medical history. When seeing a provider for the first time, one is quizzed on their history and their family’s history. The history is very import. One’s good health could be in the balance, or may be one’s life. In this example there is a lack of cooperation and no amount of competition will make the situation any better. With our technology, great minds and importance, a patient’s medical records should be accessible by any medical care provider 24/7 anywhere in the world that the internet can be accessed.<br /><br />For this situation, something more than cooperation is needed, leadership. The medial care industry has no leadership.</div><ul><li><em>“The absence of national medical leadership that would offer programs and policies to deal with the growth and complexity of medical care in the last third of the twentieth century added to the frustration of many physicians. The umbrella organization for all physicians was the Amer­ican Medical Association, which came to be perceived by the outside world as offering knee-jerk opposition to almost any proposed inno­vation in the delivery and financing of medical care. Its doctrinaire opposition to virtually all governmentally sponsored programs put it at odds with elected representatives of both parties. Since it seldom proposed meaningful alternative solutions --- as did the leadership of a number of specialty societies---it appeared to behave as if it either did not recognize the problems that beset medicine or preferred the status quo. Significantly, the AMA provided little evidence that it understood or was sensitive to the expressed needs of the general public. This ap­peared especially to be the case during the period in which Congress passed the bumper crop of health legislation in 1965. Inevitably, the organization's behavior during the debate on the two major initia­tives, Medicare and Medicaid, led it to lose credibility among, or to be viewed as irrelevant by, policy makers in both the public and private sectors.” (3)</em><em> </li></ul></em><p align="justify">The importance of leadership in the medical industry cannot be over stated!<br /><br />Competition and cooperation are very important components in solving the health care crisis but without a true and dedicated leader it is going to be very difficult to accomplish. The leader can be an organization.<br /><br />PS The epiphany, of no health care leader, came after starting this document.<br />The title might have been “Health Care Crisis Solution: More Competition, Less Government and a Health Care System Leader” </p><p align="center"><span style="font-size:180%;">2. Less Government</span></p><p align="justify">To solve the health care crisis we need less government. The government’s laws, rules mandates and bureaucracies create major problems in delivering quality health care in a cost-effective manner! Special interest groups get government to pass laws to solve their problems their way. Laws tend to force people to behave as lawmakers and special interest groups believe to be in somebody's best interest. The laws may help some people, like special interest groups, but hurt other people and have unintended consequences. </p><ul><li><div align="justify"><em>"We have seen that the myriad problems with American health care and health insurance are the result of decades of government interference in the markets for these goods and services. The systematic violation of the rights of health care providers and insurers to freely produce and trade goods and services has created a dysfunctional system that has harmed countless providers, insurers, employers, and patients.</em><br /></div></li><li><div align="justify"><em>We have also seen that more government control of medicine and health insurance is not the solution. Evidence and logic show that government interference in the market leads only to rising costs, rationing, and needless suffering and death.</em><em><br /></div></li><li><div align="justify">The current system is unsustainable. Unless policy changes are made, American health care and health insurance will not remain in their currently dysfunctional conditions; they will necessarily get worse (recall that health care costs are rising far more rapidly than the rate of inflation). One way or another, the current situation will change. We do not have a choice in that matter, but we do have a choice as to the direction of that change.” (4) </div></li></ul><p align="justify"></em>We need a new health care system, but to do this the government needs to remove the things it has done to create the health care mess. Let us now consider some of the ways the government is hurting health care. This is a short list of an extremely long list of unknown length.<br /><br /><span style="font-size:130%;">Health Care Insurance: The Addiction</span><br />There is a belief that the free market system is not working for health care. Health care costs and quality are not being controlled as would be expected in a free market system. Could it be that a free market system does not exist for health care? Is health care insurance playing a role?<br /><br />Health insurance is a ‘great thing’? Hospitals and physicians have the assurance of being paid for their services. Employers attract employees with medical care benefits. Employees get medical care they need without worrying about how they are going to pay for it. Employers get to treat medical insurance as a business expense. The health insurance company collects and disperses funds. Health insurance is so great that it is sold to individuals not covered by employer benefits even at a tax disadvantage. These great benefits of health insurance were extended to all over 65 by the government providing health insurance (Medicare). Health care insurance is so great that health care has been turned into a profit making business. Business entrepreneurs are assured of income just by sending bills for services to the health care insurers, like Medicare. The country has become addicted to the concept that one must have health insurance to be able to have health care.<br /><br />The employers, governments and health insurance companies, in general, are the buyers of health care services not the patient. The consumer of health care does not purchase health care or health care services! Without the consumers of health care participating in the purchasing of their own health care, then one must conclude that a free market in health care does not exist.<br /><br />Some individuals do buy health care directly, so one would think here could be some free market activity in health care. Health care providers charge the same to all. Medicare and insurance companies set the price that they will pay to providers, which is not what was charged in most cases. The provider's must make their price as high as possible so they can get a reasonable reimbursement from Medicare and other insurance companies. This then shifts the cost onto the uninsured, and those that are not getting as big a discount as Medicare or other insurance companies. For all practical purposes, the charge is nonnegotiable and must be paid and is enforced by legal action. So even for the uninsured, a free market does not exist for medical care.</p><ul><li><div align="justify"><em>“As a consequence the battle between payers (both government and employers), deliverers, and insurers of care placed the real consumer, the patient, on the sidelines. In the traditional economic model there is a tension between the buyer and the seller, but the buyer is also the consumer. In medicine the tension between the purchaser and the seller still existed, but the purchaser---the employer--- was not the consumer. That role belonged to the patient who, seemingly, was left out of the equation. There was little reason to believe that the purchaser truly represented the patient's needs and desires. The priorities that the potential patient set might or might not be those of the employer. Furthermore, the seller was no longer the producer. The seller was the insurance company----insurance, after all, is what the employer was buying. The producer, however, was the physician, the allied health personnel, and the hospital and its infrastructure. The insurer did not represent those interests either. This departure from the traditional economic model that balances interests (not always in, the most equitable manner) between parties with, divergent interests, this con­fusion of roles, was among the forces making for what has been referred to as the "destabilization" of health care” (3)</em></div></li></ul><p align="justify"><em></em><br />It should be clear that the way that health care insurance has been used makes a free market in health care totally impotent. The free market system is what we depend upon to keep prices down and quality up. Then when there is an “infinite” amount of money available for medical care, because insurance will pay, the price for medical care will increase as well as the profits to medical care providers. A for-profit business raises its prices until it starts losing market share or gross profits. To keep prices down the purchaser must be in the position of saying; you price is too high I will buy health care from another health care provider. Since the payer is not the consumer and the health care service has already been delivered, the payer is not in a position of doing this. Medicare tries to keep prices under control by fixing the prices it will pay. This is an impossible task for any bureaucracy to accomplish. Since health insurance has eliminated the free market in health care and thus eliminating competition that is normally used to determine a fair and reasonable price, there is no way to tell how much should be paid to the health care provider. One might think cost information could be helpful, but since there is no competition and no reason to keep costs under control, that doesn't help either. Since, what is charged has no relationship to cost and what is paid has no relationship to what was charged or the costs of providing the medical care. One must conclude that the health care compensation system is totally out of control.<br /><br />In today's market, insurance pays for services not medical care. It is called fee-for-services. It is resources expended in an attempt to deliver medical care. The more that the provider does the more they bill the insurance and the more they will be paid. What the provider accomplished for the individual is not important when the insurance company pays the bill. The patient/insurance should only be paying for medical care results received.<br /><br />There can be no free market in medical care when medical care is not what is being bought by the patient and sold by the medical care provider. The government has played a major role in the destruction of our free market system in health care by promoting our addiction to health insurance.<br /><br /><span style="font-size:130%;">Medical Malpractice<br /></span>Medical malpractice insurance adds to the cost of medical care by virtue of the premiums paid by medical care providers. There seems to be some debate whether this is a significant cost are not, but the threat of litigation may be much more costly than the cost of malpractice insurance premiums.<br /><br />The threat of litigation may be doing more harm than good. It is suppressing the disclosure of valuable information, which could be used to increase health care quality and decrease costs through meaningful competition. The patient needs performance information about the perspective providers of medical care when making life-changing decisions.<br /><br />The below quotation is an indication that the information is being withheld because of the fear of litigation. </p><ul><li><div align="justify">“<em>These continuing medical education and recertification efforts, de­signed to assure that practitioners maintained their skills, were well intentioned. Nevertheless, they could not be more than proxies for clinical performance. Although "audits" of office practice became a component of some recertification programs, there was no agreed-­upon acceptable way to judge how well a physician performed in a day-to-day clinical setting. Regrettably, informal peer review also did not serve well. The threat of litigation led physicians, hospital adminis­trators, and medical societies to keep information about performance quiet. Dr. Fein recalls asking some hundreds of members of a state medical society whether they knew any physicians whom they felt their own family members should avoid. The overwhelming majority responded in the affirmative. Nevertheless, when asked why they were unwilling to "do something about it" in order to protect the pub­lic at large and in order to avoid government intervention and handle the problem "within the family," the president of the society inter­vened with a reminder that if they attempted to deal with "incompe­tence in some formal manner," they would have to face the threat of suit. In turn, that would require an increase in dues. It became clear that these physicians would readily advise their family members on as­pects of physician competence, but were disinclined to take action that would protect all patients. Though refusing to act through their soci­ety, they nevertheless continued to decry government attempts to po­lice the system----particularly through licensure----in an effort to im­prove quality. (3) </em></div></li></ul><p align="justify">Information is required so that good decisions can be made when patients are evaluating medical care providers. This kind of evaluation can result in a competitive environment, which then can lower costs and improve health care quality. With improved health care quality there will be fewer deaths from medical provider’s errors. The lack of the needed information can thus be very costly, much more costly than malpractice insurance. The threat of litigation may not be the only reason for suppressing the required performance and cost information, but it should not be one of the reasons. Any other reasons should also be eliminated.<br /><br />If the responsible people are doing the right things, they should be shielded from malpractice litigation.<br /><br />The right things:</p></span><ol><li><span><span><span style="font-size:85%;">Medical care providers document their performance and make it public. Such as: “Did things go as well as expected? Was the desired results achieved? If not why not? , Etc” </span></span></span></li><li><span><span><span style="font-size:85%;">Medical care providers compare their performance with their own past performance and other providers’ performance and do what is needed to improve their performance. </span></span></span></li><li><span><span><span style="font-size:85%;">When medical care providers determined that an error has been made, they report it. If harm has been done to the patient they take full responsibility and do what is needed to make the patient as whole as possible.</span></span></span></li><li><span><span><span style="font-size:85%;">They do an analysis to determine the facts and the reasons for errors so that the errors will not be repeated when providing care to future patients. The results of the analysis are made available to other providers so they also can avoid making the same mistakes.</span></span></span></li><li><div align="justify"><span><span><span style="font-size:85%;">They maintain performance metrics to see if their performance is improving over time, and how they their performance compares to other medical care providers’ performance. They can see who has room for improvement. Then they use the information to improve their own performance.</span></span></span></div></li></ol><p align="justify"><span style="font-size:85%;"><span><span></span></span><br /></span><span style="font-size:85%;">Litigation should not be necessary if all the responsible people are doing all that is humanly possible to deliver quality medical care. The information, which had been placed in the public domain by the provider or their representative, must not be used against them in litigation proceedings.<br /><br />If responsible people are <strong>not</strong> doing the right things so they can deliver quality medical care, then they should not be shielded from malpractice litigation. One might infer, in this situation, that medical malpractice litigation is very appropriate.<br /><br />If there is a need to determine, ‘who is financial responsibility for medical errors?’ that should be easy. It is the persons or organizations that would be profiting from the medical care provided. Basically, who is sending the bill and collecting the money for the services.<br /><br />The current way government handles medical malpractice is not working as intended and needs to be changed so that the quality of health care can be increased and the cost decreased.<br /><br /><span style="font-size:130%;">Government Forcing Emergency Rooms to Be Used As Primary Care Facilities<br /></span>Emergency Rooms (ERs) are designed and staffed so that emergency medical care can be provided rapidly. Overcrowded ERs defeat the primary purpose of ERs. The government should be concerned on how to keep ERs from being overcrowded. Instead it has passed laws (such as Medicaid, Medicare, and EMTALA) that add to the overcrowding of ERs. ERs are a very costly way to provide medical care. There is a high financial cost but there is also a cost in human life. People are waiting hours that they can ill afford to get emergency medical care. The Emergency Medical Treatment and Labor Act of 1985 (EMTALA) was put in place because the hospitals were asking for payment information before treating the patient. Now the patient can wait hours before being examined to determine their medical condition even when they have the means to pay. The government is causing people to die unnecessarily! In addition, hospitals are closing their emergency rooms because they are not receiving appropriate payments for services they are forced to provide.<br /><br /><span style="font-size:130%;">The Government Says the Paperwork Is More Important Than Health Care</span><br />In the "Health Insurance Portability and Accountability Act (HIPAA)." there is a provision to protect the individual's medical privacy. It makes health care providers criminals if they do not take care of paperwork before providing the patient health care. Health care providers must get a patient to acknowledge in writing their right to medical privacy. The government has managed to increase the cost of health care with no increase in health care benefits. People's privacy needs to be respected by the people handling personal medical information. Education may be needed for some people to accomplish this objective.<br /><br />A person's medical information is not strictly a private matter. A person with a contagious disease does not have the right to keep it a secret and infect other people. At Virginia Tech 32 people were killed. The individual’s right to privacy may have contributed to the death of 32 people.<br /><br />A person's medical history has information (implicitly or explicitly) about their medical providers that could be used in determining the provider's performance. This kind of information is needed by others so as to evaluate the providers when considering their own health care options. The information is needed so there can be competition among providers thus increasing quality and decreasing cost.<br /><br />The law, in protecting a person's medical privacy, makes it more difficult for the patient’s loved ones to work with the medical care providers so as to get proper health care for the patient. The loved ones need to be able to give information and get information so that the patient can be given the proper care.<br /><br />The law acts as a handy shield. When providers do not wish to give out information that might be incriminating, they say, “We cannot give you that information because it would violate the patient's privacy rights”. It makes investigative reporting difficult and hard for lawyers to get the facts in a malpractice lawsuit.<br /><br />An individual's medical information contains data that may be valuable to the public. The individual needs to be protected while allowing appropriate public access. The subject is too complex to fit into one-size fits all law. Professional judgment is needed when balancing these potential conflicting interests not a harsh costly law. </span></p><p align="center"><span style="font-size:180%;">3. Search for Solution<br /></span></p><p align="justify"><span style="font-size:85%;"><span style="font-size:130%;">The America Health Care Dollar Belongs to Americans</span><br />For all practical purpose the money spent on Health Care comes from the wealth created by the American People. There is only one source for this money even though to hear some people talk you could get the impression that there are other sources for the America Health Care Dollar. This may be because most of the money gets into the control of governments and health insurance companies where it becomes their money, which they must control and disperse so that it is properly spent on health care that is really needed, at least in their judgment. They do not want their dollars to be wasted. Because of this tortured journey, not all the American Health Care Dollar gets to pay for health care and not all Americas get the health care for which Americas have paid. It is lost to administration expense, profits, fraud, and who knows what else. It is possible that as much 50% of the American People’s Health Care Dollar does not pay for health care. It is clear the system needs to be reformed so that all the money destined for health care actually gets to pay for quality health care.<br /><br /><span style="font-size:130%;">A Search for Health Care for All the People of the United States</span><br />In most cases health care is something you will need in the future. So why not have every one save on a regular basis so when they get sick, they will have the money to pay for their medical care? Sounds good, but it only works some of the time. One problem is that not everyone earns sufficient income so they can save for their medical care when they have a need. Another is that people do not like saving, especially for something they do not believe they will need. Even when people save a substantial amount of money, their unexpectedly high medical cost can exceed their savings and their ability to pay the medical bills. So savings may be a necessary first step, but it is not sufficient to get the required health care in all cases for all people. Something more is needed.<br /><br />Not everyone gets sick at the same time, and some people almost never need medical care. So is there a way to share the savings since all the money is not needed at the same time. People could put their savings in a pool so that it could be shared with other people putting their savings in the pool. If someone in the pool does not have sufficient funds to pay for their medical bills, the fund could give or loan them the needed money. A Medical Care Pool is needed, with an administration, to receive and distribute funds.<br /><br />Not everyone has money to put in the pool. But some people have sufficient wealth that they can pay for their own health care and have funds left over so they could share some of their wealth with people less fortunate than themselves. Everybody needs to make a contribution based on their wealth. For all the people to have health care there must be charity and or welfare. If the total shared wealth is large enough, then with a method of distribution based on need, all the people in America can have health care.<br /><br />The government is already using taxes to pay medical bills for the qualified poor. These tax dollars could be deposited into the pool to pay for the poor. The special government medical assistance programs would not be needed. The government can quit forcing ER’s to treat the poor since all people can get medical care anywhere. The poor would get medical care just like everyone else. There would be one method to pay for health care for all the people.<br /><br />Most people are already paying for health care, theirs and others, one way or another. Thus they are not in a position to make a contribution to the Medical Care Pool. There are drastic changes that are needed if these people are to going to have their medical care dollars deposited in the Medical Care Pool. Today the government collects taxes with a large percentage being used to pay for health care. This money needs to go into the pool. This is money that people are already contributing to health care even if they are not aware of it. The amount of money that employers are paying for health insurance needs to go into the pool. The money that people are paying for health insurance should go into the pool as well as the money they are paying for their health care needs. There is a large part of people’s income that is already going to pay for someone’s health care. Many employers are using the employee’s earnings to pay taxes and health care insurance. There must be a major restructuring of the system so the health care dollars get to the Medical Care Pool which then gets to the people that need health care. By doing this, the employers can be relieved of providing health care for their employees which means they do not have to retain a portion of the employees earnings. Since everybody may not be making a contribution based on their wealth, some adjustments may be needed in the tax code. It would be nice if everyone made a contribution freely, but unfortunately the word contribution may be just another word for federal taxes. But as already stated the money is already coming out of American’s pocket. What is being changed or eliminated are the hands it passes through before it gets to pay for some one’s health care. Hopefully with most it making to its final destination, the health care provider, with the hope of reducing administration costs and unwarranted profits.<br /><br />Today we have a very chaotic way of funding health care and not everybody gets health care. There are different ways to collect the wealth and there are different ways to distributed it. You can only get the wealth from the people that have it. In some way, we must get the health care to the people in need. There is a limit to the amount of health care that can be delivered because there is a limited to the amount of wealth available for contribution into the Medical Care Pool. So everyone must be continually vigilant on health care cost so that there is money to pay for everyone’s health care. Even though the objective is to have health care for all, providing all the health care possible no matter what the cost is not practical.<br /><br />How do we distribute the funds so that everyone can have health care? The funds would be redistributed based on people’s health care needs. If everybody is going to have health care, is there any other way. People need medical funds to ‘stay well’, so money will be added to their account on a regular basis to satisfy this need. Most people when they have a catastrophic medical event become the less fortunate and need help with paying for medical care. When this happens, the person receives a ‘get well’ deposit. The amount normally needed to get well from their medical condition. When there are extenuating circumstances additional deposits may be needed and made. Some medical conditions are chronic and the people will need regular deposits into their account so their health can ‘remain okay’. In this way all patients all the time can pay for their medical care.<br /><br />Now that the patient gets health care funds instead of the medical care provider, a problem has been introduced since the patient may use the funds to pay for something other than the medical bills. To solve this problem the funds are deposited into a special account, “The Individual Medical Investment Account”, on which restrictions are placed. The funds may only be used to pay for the patient’s valid medical care delivered by a qualified health professional. In this way, there is some assurance the medical care provider will be paid for the medical care they delivered. The patient receives care and then gets a bill (which will be a major shock and adjustment) for the medical care delivered. The patient reviews the bill, and if they agree that it is for the medical care they received and the amount they agree to pay, then they authorize the bill to be paid from their special account. The provider would get the funds transferred to their account as quickly as if it was charged on a credit card. Everyone would use the same method for paying for their medical care. This should eliminate a lot of administrative costs as well as get the insurance company out of the “doctor’s office”.<br /><br />The medical care providers will need to change what is being billed. They need to bill for what has been accomplished for the patient, what medical condition has been resolved, what medical diagnoses was made, what medical help the patient received, etc. So the patient will be able to understand what medical care has been delivered. For example: The patient should not be billed for tests. They should be billed based on what the tests accomplished. When the patient is billed on results, they will be in a better position to select medical care providers that deliver the best medical care value.<br /><br /><span style="font-size:130%;">The Individual Medical Investment Account</span><br />A purpose of the Individual Medical Investment Account (IMIA) is to give control to the individual, the patient. There is a relationship that must be restored between a patient and the medical care provider. Because there is third party paying for the medical care, this third party lays clams to the right to affect decisions made by the medical provider and the patient for the purpose of reducing the third party’s financial obligation. Because every individual uses their IMIA to pay for medical care, the medial care provider has no need to know the source of the patients’ funds. From the provider’s point of view, the patent is paying the provider directly from the patient’s funds. Now the health care provider is free to talk about all options available and their cost to patient.<br /><br />Another purpose of IMIA is to eliminate the need for the interaction between the health care provider and the tired party payers. The provider could now concentrate on health care with no need to be evolved with medical insurance bureaucracies. The health care providers administrative cost should also be substantially reduced, sense all patients use one method to pay for their medical care, no third party payers.<br /><br />Individuals would have the account from birth to death, used to pay all of their medical bills. Money would be deposited in the account based on the individuals medical care needs. The account would be like a bank account that is used for savings, checking, credit card, debit card, investments, etc. The money in the account would be the individual’s to spend on their medical care expenses. They could also deposit funds to their account. The account would have a credit limit, so they could change to the limit without asking for financial assistance. If they had special needs, they could ask for financial assistance.<br /><br />The money would be held in a trust, like a national bank. The trust would have the responsibility to care for this money as outlined below. It would pay the bills and invest the money. It would maintain a database and see that the money was only used on medical costs. It would oversee monies owed to the trust from credit cards or borrowing against ones account. The trust would be a nonprofit organization. It would invest the money that it held in trust so that it could pay dividends to the Individual Medical Investment Accounts and to pay for the expenses to run the trust<br /><br />The trust needs money, financial reserves, to invest so that it can pay dividends to the Individual Medical Investment Accounts and pay its expenses. The trust should have money because of the money that is being deposited into the accounts. There is a risk that the monies used to pay the medical bills would be greater than the deposits. If this is so, the contribution must be adjusted so that the fund would have money to invest. When there are sufficient financial reserves, the contribution would be reduced. The trust should not make highly speculative investments or where investments would present a conflict of interest. It should prefer to make investments in the health care industry with the objective that everyone should have access to quality health care.<br /><br />An organization would need to be created to oversee the trust so that it is accomplishing its mission, which is quality health care for all. It needs to keep the trust on track, but not tied in knots.<br /><br />Gifting is the transfer of monies from your IMIA to another IMIA<br /><br />When an individual has sufficient funds to pay anticipated medical expenses, they can direct how their money is invested as one would do with an investment account. There are limits on how they can invest. For example, they cannot invest in great paintings and hang them in their home or their brother-in-law's plumbing business where they have a financial interest like being on the payroll. The trust must guard against people making investments that are conflicts of interest. The purpose of the individual investing is to allow those who put their own money in the account to make their own investments. A person can borrow money from their account when there are sufficient funds to pay anticipated medical expenses and the person has sufficient needs and is in a position to pay the money back. They will pay interest on money they borrow, which will be equal to the money that the trust is earning on their investments. If the trust is making 10% a year on their money, then the borrower will have to pay 10%. The loan rate will track, up and down, with the trust's earning rate. The trust must guard against people abusing the loan privilege. The purpose for loans is to allow those that have been aggressively putting money into the account to be able to get to it for important personal financial needs. Most people should not need the borrowing provisions of their account.<br /><br />Some people will not be able to pay their debt. The gifting provision is intended to help reduce this number. The trust will need methods so that they can forgive some of the debt. There's a fine line between forgiveness and entitlement. The trust will need to work hard to educate people that the medical payments are not entitlements, and they are to be repaid. There will be people who will pretend not to be able to make the payments and then others that truly cannot. It will be hard to tell which is which. But the trust must to do the very best it can.<br /><br />The owner of the account will need to have one or more beneficiaries and directions on how the money in your account is to be divided among the beneficiaries. When loans are made, there needs to be provisions on how the loans will be paid upon death of the owner.<br /><br />When the insurance companies make payments for medical bills, they will make the payment to the persons individual investment account. There will be absolutely no money going to or from insurance companies and medical care providers. There is no need for the insurance companies to have any dealings with the medical service providers. The trust can send the billing information to the insurance company, which should be sufficient to make payment to the individuals account. The insurance company should pay the same amount as it would have paid if this system did not exist. The provider should not expect any more money than he would have received if the system were not in place.<br /></span></p><br /><br /><p align="justify"><span style="font-size:85%;">Assumptions:</span></p><ul><li><div align="justify"><span style="font-size:85%;">a) There are people who have more than enough money to pay their own medical bills, and can help pay the medical bills of others.<br />b) There are people who can pay their own medical bills but would be very little help to anybody else.<br />c) There are people who cannot pay their medical bills, and never will be able to pay them.<br />d) There are people who cannot pay the medical bills now, but will be able to pay for them in the future.<br />e) There are people who cannot pay all of the medical bills, but can pay part of them.<br />f) By taking all the money that is available to pay the medical bills. All the medical bills can be paid. If this is not so, the universal insurance system will not work, a government run health care system will not work. The results would be that some people would not get health care.<br />g) Since not everyone will be able to pay for their own health care. Someone else will have to pay. Every system must get monies from those who have and use it for those who need. It does not matter whether an insurance company is redistributing the funds or the government is collecting the money in taxes and likewise redistributing the funds.</span></div></li></ul><p align="justify"><span style="font-size:85%;">Everyone should have the medical care they need. Is insurance the answer or maybe there is another way?<br /><br /><span style="font-size:130%;">Is Medical Insurance Necessary and Sufficient?<br /></span>We know that the medical insurance companies deny claims so they can increase their profits at the expense of human life. Thus, medical insurance is not sufficient! We also know that if we have a sufficient amount of money we can pay our medical bills. One must reach the conclusion that medical insurance is neither necessary nor sufficient.<br />OK, that is a little hard. For most people it is necessary and sufficient. But having medical insurance does not necessarily gets you the medical care needed or avoid bankruptcy caused by large medical bills. There are others that cannot or do not even buy insurance, so medical insurance increase their cost of medical care because of cost shifting. Let’s take a close look at Medical Insurance.<br /><br /><span style="font-size:130%;">Medical Insurance versus Home Owners Insurance</span><br />Home owner insurance does a good job of transferring risk from the home owner to the insurance company. For most people buying a house means taking out a “30 year” loan. If the house is destroyed, they are not normally in a position to pay for two houses. They could take the risk that nothing will happen. The chance is very low for the house being destroyed or severally damaged, but if it happens it would be financially devastating. Since the risk is low and the maximum liability can be determined, a company can sell home owner insurance at a reasonable premium. The insurance should be affordable if the house was affordable. The only people that need home owners insurance are the people that own a house.<br /><br />Everybody can be in the need for major medical care at any time in their life. The probability of a person needing medical care is high. The question is not if but when and how much. Everybody needs some amount of preventive care. For some health needs, there is no limit on the amount of money that could be needed for a person’s medical care.<br /><br />Asking insurance to assume the financial risks associated with health care expenses is not reasonable. Since the probability for everyone needing health care is high, the premium must be large (the average cost for all Americans plus ten percent). There are a large number of people that cannot afford the large premium, so health insurance is not possible for them. Since the cost of medical care for an individual has no upper limit, an artificial limit must be set no matter which third party is paying. The only question is how high a limit will be set. The higher the limit the larger the premium must be and the financial risk to individuals has not been eliminated. If the goal is health care for all Americans, then health insurance does not meet that goal. It does not take care of the less fortunate. It is not sufficient. If medical insurance is to exist, how should it work?<br /><br /><span style="font-size:130%;">A Desirable Model for Health Insurance</span><br />First it should not be called insurance. Maybe it should be called “Universal Health Care Financing “or “Health Financing”.<br /><br />The money that people pay to have health care sometime in the future should not be considered as income for the company. The IRS should not tax this money as income. This money should be considered as a deposit in an account that will be use by the company to pay for someone’s health care. It would be like depositing money into a savings account in a bank where the bank pays interest on the deposited money. In this case there would be only one account to which everyone makes deposits. When there are medical needs, money is withdrawn to pay for medical needs. When the patient agrees to the amount of medical care delivered, the company takes from the account payment for the health care services delivered. This payment is taxable income that the company has earned by seeing that the patient receives the best health care possible. There is no income for the company until health care has been delivered to patients. The amount of income would be proportional to the health care delivered. If the patient made a full recovery, something like a maximum of 10% of the costs could be taken as income. If the patient was expected to make a full recovery and did not, then the income might be just 1% of the cost. If the patient died, maybe even no income. Keeping the customer healthy is a way of delivering health care which could generate income for a company.<br /><br />The company makes an income by getting their customers healthy and keeping them healthy.</span></p><p align="justify"><span style="font-size:85%;"><span style="font-size:130%;">Is It Possible?<br /></span>Health insurance is needed because medical care is so costly.<br />Medical care is so costly because of health insurance<br /><br /><span style="font-size:100%;">Referees:<br /></span><br />1. Atlas, M.D., Scott W. Power to the Patient: Selected Health Care Issues and Policy Solutions. www.hooverpress.org/productdetails.cfm?PC=1095. [Online] February 25, 2005 . [Cited: Jun 29, 2008.] http://www.hooverpress.org/productdetails.cfm?PC=1095. ISBN: 978-0-8179-4592-3 .</span><br /></p><p align="justify"><span style="font-size:85%;">2. Porter, Michael E. and Teisberg, Elizabeth Olmsted. Redefining Health Care Creating ; Value-Based Competition on Results. Boston, MA : Harvard Busines School Press, 2006.</span><br /></p><p align="justify"><span style="font-size:85%;">3. Richmond, M.D., Lulius B. and Fein, Ph.D., Rashi. The Health Care Mess ; How We Got into it and What it Will to Get Out. Cambridge : Harvard University Press, 2005.</span><br /></p><p align="justify"><span style="font-size:85%;">4. Zinser, Lin and Hsich, Paul. Moral Health Care vs. “Universal Health Care”. TOS Vol. 2, No. 4. [Online] The Objective Standard, Winter 2007-2008. [Cited: June 29, 2008.] </span><a href="http://www.theobjectivestandard.com/issues/2007-winter/moral-vs-universal-health-care.asp"><span style="font-size:85%;">http://www.theobjectivestandard.com/issues/2007-winter/moral-vs-universal-health-care.asp</span></a><span style="font-size:85%;">.</span><br /></p><p align="justify"><span style="font-size:85%;">5. Rich, Robert F. Health Policy, Health Insurance, and the Social Contract. SSRN. [Online] Comparative Labor Law and Policy Journal, Vol. 21, pp. 397-421, Winter 2000. [Cited: June 29, 2008.] </span><a href="http://ssrn.com/abstract=296221"><span style="font-size:85%;">http://ssrn.com/abstract=296221</span></a><span style="font-size:85%;">.</span><br /></p><p align="justify"><span style="font-size:85%;">6. Most Doctors Aren’t Using Electronic Health Records . [Online] The New York Times , June 19, 2008. [Cited: July 4, 2008.] </span><a href="http://www.nytimes.com/2008/06/19/technology/19patient.html?_r=2&adxnnl=1&oref=slogin&adxnnlx=1213884120-m/O7IKytEKHcNINTw0uMqg&oref=slogin"><span style="font-size:85%;">http://www.nytimes.com/2008/06/19/technology/19patient.html?_r=2&adxnnl=1&oref=slogin&adxnnlx=1213884120-m/O7IKytEKHcNINTw0uMqg&oref=slogin</span></a><span style="font-size:85%;">.</span><br /></p><p align="justify"><span style="font-size:85%;">7. Is Web-based-SaaS Software Right for Your Practice Software Advice. software advise. [Online] [Cited: July 4, 2008.] http://www.softwareadvice.com/medical/is-software-as-a-service-right-for-your-practice/.</span></p>Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-6214753703584114715.post-46490401022214340482007-11-07T18:11:00.000-05:002007-11-27T21:41:32.095-05:00The Individual Medical Investment Account<ol><li><span style="font-size:130%;">The account.<br /></span>Each individual would have an account from birth to death, used to pay all of his or her medical bills. The account would look (work) like a savings account, a checking account, a credit card account, a debit card account, and an investment account. The money in the account would be the individual’s to spend on their medical expenses and only on their medical expenses. When a person starts earning an income above some minimum gross income, they would make a minimum tax-free contribution to their Individual Medical Investment Account (IMI Account) as a percentage of their income. There would be no limit to how much they could contribute to their account above that minimum. There would be no ceiling on their income used to calculate the minimum contribution. It would be a constant percentage of their income to as large as their income might get. A person would pay their medical expenses from this account. If they had insufficient funds in their account to pay the medical bills, they would charge the bill to their account just like one would do with a credit card. They would be responsible for paying what they had charged, just like paying on a credit card. There would be some interest charged on the amount owed. Not high interest like a credit card, but the same rate as interest paid on the money saved in the account. (Will talk about account debt in more detail later.) </li><br /><li><span style="font-size:130%;">Taxes. </span><br />The money that is contributed to the Individual Medical Investment Account would be free of all taxes, federal and state income taxes, sales taxes, etc. The money that is used to pay medical expenses would be free of all taxes likewise. The only medical deduction of a federal income tax would be the contributions to Individual Medical Investment Account. This would make tax preparation a little simpler. People not using their Individual Medical Investment Account to pay the medical bills would not get a medical deduction. </li><br /><li><span style="font-size:130%;">Medical Insurance.<br /></span>A person could have medical insurance, but they would not be able to pay for it from their account. </li><br /><li><span style="font-size:130%;">The trust. </span><br />The money would be held in a trust, like a national bank. The money would be held in a big pot and the trust would have the responsibility to care for this money as outlined below. It would pay the bills and invest the money. It would maintain a database and see that the money was only used on medical costs. It would oversee monies owed to the trust from credit cards or borrowing against ones account. The trust would be a nonprofit organization. It would invest the money that it held in trust so that it could pay dividends to the Individual Medical Investment Accounts and to pay for the expenses to run the trust. </li><br /><li><span style="font-size:130%;">Medical bills. </span><br />The trust would pay medical bills, and only qualified medical bills. It would have the responsibility to determine if the bill was from a qualified provider of qualified medical products and services. It would determine if the provider is qualified to provide the medical products and service that were billed. It would not set a price for products and services, but it would check to see that the bill for products and services was reasonable based on information in the database supplied by the provider and other providers and based on what Medicare and insurance companies are currently paying for these products and services. The qualifying process should be mechanized so that there is very little human effort involved. </li><br /><li><span style="font-size:130%;">Investing the money. </span><br />The trust needs money, financial reserves, to invest so that it can pay dividends to the Individual Medical Investment Accounts and pay its expenses. The trust should have money because of the money that is being deposited into the accounts. There is a risk that the monies used to pay the medical bills would be greater than the deposits. If this is so, the minimum payment must be adjusted so that the fund would have money to invest. When there are sufficient financial reserves, the minimum payment should be reduced. The trust should not make highly speculative investments or where investments would present a conflict of interest. It should prefer to make investments in the healthcare industry with the intent that everyone should have access to quality health care. </li><br /><li><span style="font-size:130%;">Oversight commission. </span><br /><span style="font-size:85%;"><span style="font-size:100%;">An organization would need to be created to oversee the trust so that it is accomplishing its mission, which is affordable and quality health care for all. It needs to keep the trust on track, but not tied in knots</span>. </span></li><br /><li><span style="font-size:130%;">Minimum payment. </span><br />Besides the individual making a minimum payment to the Individual Medical Investment Accounts, all entities that pay income taxs would also make the same percentage minimum payment to an Individual Medical Investment Account even though they do not have medical expenses, per se. </li><br /><li><span style="font-size:130%;">Gifting. </span><br /><span style="font-size:85%;"><span style="font-size:100%;">Gifting is the transfer of monies from your IMI Account to another IMI Account. This would be the standard way for a parent to pay for the medical expenses of their dependents. It is also a way for people and companies to give financially to people that have large medical bills that would have a hard time paying them otherwise. The companies have medical investment accounts that they can use for people in great need, such as employees, stockholders, customers, and anybody in great need. This is one of the reasons for companies to have medical investment accounts. Gifting is encouraged by all who can afford to do so to help those in need of the help. Gifting has a potential problem that the trust must guard against. That is gifting to people who do not need the gift so as to avoid income taxes. Accounts with funds sufficient to pay all foreseeable medical bills and receiving gifting transfers, should be suspect and the trust should have the authority to stop such transfers</span>. </span></li><br /><li><span style="font-size:130%;">Investing. </span><br />When an individual has sufficient funds to pay anticipated medical expenses, they can direct how their money is invested as one would do with an investment account. There are limits on how they can invest. For example, they cannot invest in great paintings and hang them in their home, or their brother-in-law's plumbing business where they have a financial interest like being on the payroll. The trust must guard against people using investing to avoid paying income taxes and other conflicts of interest. The purpose of investing is to allow those who put more than the minimum in the account and feel they can do better than the trust can with their money. </li><br /><li><span style="font-size:130%;">Loans. </span><br />A person can borrow money from their account when there are sufficient funds to pay anticipated medical expenses and the person has sufficient needs and is in a position to pay the money back. They will pay interest on money they borrow, which will be equal to the money that the trust is earning on their investments. If trust is making 10% a year on their money, then the borrower will have to pay 10%. The loan rate will track, up and down, with the trust's earning rate. Again, the trust must guard against people using the lone privileges to avoid paying income taxes and other conflicts. The purpose for loans is to allow those that have been aggressively putting money into the account to be able to get to it for important personal financial needs. </li><br /><li><span style="font-size:130%;">Debt. </span><br /><span style="font-size:85%;"><span style="font-size:100%;">It is understood that many people will need to use the borrowing provisions of their account. It is also understood that some of these people will not be able to pay their debt. The gifting provision is intended to help reduce this number. The trust will need methods so that they can forgive some of the debt. There's a fine line between forgiveness and entitlement. The trust will need to work hard to educate people that the medical payments are not entitlements, and they are to be repaid. There will be people who will pretend not to be able to make the payments and then others that truly cannot. It will be hard to tell which is which. But the trust must to do the very best it can.</span> </span></li><br /><li><span style="font-size:130%;">Income tax credit for major medical expenses. </span><br />When a person has major medical expenses, they would get income tax credits equal to their medical expenses. When they are well enough to earn an income, they could use the credit to pay down their medical debt. A part of the income tax they pay to the government would go to their individual medical account to pay on the debt. This would be like 10% of the tax they owed until the tax credit was all used. They could also sell their income tax credit. A person would deposit two dollars for every dollar of tax credit they would receive into the individual’s medical account. This tax credit would be used to help pay on income tax they owed up to say 10% of the tax owed for the year until the tax credit was consumed. Some people will never be able to pay all of their medical debt so they will need help from relatives and friends and the government to pay the medical debt. </li><br /><li><span style="font-size:130%;">Inheritance. </span><br />The owners of the account will need to have one or more beneficiaries and directions on how the money in your account is to be divided among the beneficiaries. When loans are made, there need to be provisions on how the loans will be paid upon death of the owner. </li><br /><li><span style="font-size:130%;">Insurance companies. </span><br />When the insurance companies makes payments for medical bills. They will make the payment to the persons individual investment account. There will be absolutely no money going to or from insurance companies and medical providers. There is no need for the insurance companies to have any dealings with the medical service providers. The trust can send the billing information to the insurance company, which should be sufficient to make payment to the individuals account. The insurance company should pay the same amount as it would have paid if this system did not exist. The provider should not expect any more money than he would have received if the system were not in place. It is hoped that insurance companies are only involved until the transition is made to the new system. </li><br /><li><span style="font-size:130%;">Transition. </span><br />We have been paying money to insurance companies, taxes to the government, earning healthcare benefits from our employers. They should be holding money that is ours. They should put this money into our accounts. They will fight this tooth and nail and claim that they owe us nothing, or at least close to nothing. A lot of work and cooperation will be needed to plan for and make the transition from our current dysfunctional system for paying medical costs to a more efficient universal system. </li><br /><li><span style="font-size:130%;">Assumptions. </span><br />a) There are people who have more than enough money to pay their own medical bills, and can help pay the medical bills of others.<br />b) There are people who can pay their own medical bills but would be very little help to anybody else.<br />c) There are people who cannot pay their medical bills, and never will be able to pay them.<br />d) There are people who cannot pay the medical bills now, but will be able to pay for them in the future.<br />e) There are people who cannot pay all of the medical bills, but can pay part of them.<br />f) By taking all the money that is available to pay the medical bills. All the medical bills can be paid. If this is not so, the universal insurance system will not work, a government run health care system will not work. The results would be that some people would not get healthcare.<br />g) Since not everyone will be able to pay for their own health care. Someone else will have to pay. Every system must get monies from those who have and use it for those who need. It does not matter whether and insurance company is redistributing the funds or the government is collecting the money in taxes and likewise redistributing the funds.</li></ol>Unknownnoreply@blogger.com0