Thursday, December 24, 2009

Is A tax Revolt Forthcoming?

I wonder what would happen, if all taxpayers file their own tax returns reporting all income as usual but include a new or additional form. This form would be a Schedule C showing business income or loss. However, the net would be a loss sufficently large enough to bring taxable income to ZERO! One might call his new company “Geitner Insolvency Group” Business Code 523900, He might be tempted to  show income of Zero but deduct as taxes all taxes he paid or had withheld for the year. Then he might deduct as a Bad Debt all Social Security taxes he had paid in since he started working as an other deduction. (At the rate the socialist are going anyone under 55 mostlikely will never collect what was taken from them) I as a tax professional would never suggest this tactic to any of my clients , but I see how anyone who files their own tax return using the free e-file tax section of WWW.IRS.Gov might be tempted to do in that way. If one was so brazen as to try this they might also be smart enough to deposit those funds in a special account and have ready to access if feds storm in!>

The Change That Destroyed America

In four years from now, the Healthcare legislation that was passed by our legislators was  like a patient getting a flue shot for H1N1 and pleased that he didn't become ill. However in 2013 he discovers that the shot was laced with the Ebola virus that gave him a cruel and agonizing death. The patient however was the USA whose electorate bought into an idiotic message of change.

The Only Way to have a Just Public Option

If indeed this country can not deliver a good health system without involvement of insurance let’s broaden the options to include not only private insurance companies and the so called public option but a private option as well. This private option would be self insurance or funded Health Savings Accounts (HSA) that could buy high deductible Catastrophe Insurance with tax treatment compared to the so called Cadillac plans. This feature should soften the objection of the libertarians who opposed mandated purchase. Low income people who elect to have the private option could be granted health stamps to fund their HSA’s.


Then, continue the states authority to monitor all health insurance sold or issued in their respective jurisdictions. Continue the states obligation to see that all insurance companies issue policies that have a fair and adequate premium (this will include any public option) as well as have the financial strengths to pay all current and future claims arising out of current claims and newly discovered catastrophic conditions. This would also apply to any federal plans or their sponsored co-ops or other schemes. The states already through their respective insurance departments have the infrastructure necessary to regulate this system thus the time frame could be moved up to 2011 the same year when all new taxes and fees begin.


Individual risk that our deemed to be so adverse that no premium is adequate could be pooled and assigned to carriers. The assignment similar to auto assigned risk would be based upon each insurer’s prior three year average premium written in the particular state and further factored based upon the quintiles of profitability. These quintiles would be assigned a number of zero through four with zero the least profitable to four the most profitable. To determine profitability 100% minus the loss ratio (claims incurred divided by premiums earned) minus .12 for overhead(12% of premium maximum standard for all) would equal percent of earnings of 3%. Note, income taxes would not enter into the profitability equations as all health Insurance carriers should be exempt from income tax just as the public option schemes would be. The 12% allowance for administrative cost should be adequate to cover reasonable expenses and motivate efficiencies and innovation. The loss ratios which state insurance examiners will verify every three years will hold steady at 85%+/- if the growth in utilization and hypochondrias holds at current rate which is highly unlikely. In the event that this country’s health care cost as a percent of the Gross National Product does not decrease by two percent by the tenth year of this law then all health insurance programs (including Medicare) except HSA’s should be terminated and a direct repayment of Medicare tax to all wage earners who have paid into the Medicare trust fund.

Saturday, November 28, 2009

First State Diner

Everyone one, especially the media, is all in a dither about Michaele and Tareq Salahi successful crashing the White House first state dinner. Does not their outwitting the Secret Service pale in comparison to the couple who fooled the American Electorate with the help of the blind media?. Michaele and Barak Obama will stay for four years not just one evening dinner! Now that is what’s outrageous!

Wednesday, November 11, 2009

Yesterday, home of the free and the brave: Tomorrow, home of the wheeps and the slave!

http://en.wikipedia.org/wiki/Yucca_Mountain_nuclear_waste_repository



For anyone who has an ounce of faith in developing technology and reducing reliance on foreign oil to avoid the pending global climate change illusion, I suggest that you become familiar with the Yucca Mountain project. (see link above) Then ask yourself, do we really want to become a third world nation? What will it take to open the eyes of the masses  as to where the current administration is trying to take us?

Tuesday, November 10, 2009

Some Thoughts About Insurance Options!

If indeed this country can not deliver a good health system without involvement of insurance let’s broaden the options to include not only private insurance companies and the so called public option but a private option as well. This private option would be self insurance or funded Health Savings Accounts (HSA) that could buy high deductible Catastrophe Insurance with tax treatment compared to the so called Cadillac plans. This feature should soften the objection of the libertarians who opposed mandated purchase. Low income people who elect to have the private option could be granted health stamps to fund their HSA’s.


Then, continue the states authority to monitor all health insurance sold or issued in their respective jurisdictions. Continue the states obligation to see that all insurance companies issue policies that have a fair and adequate premium (this will include any public option) as well as have the financial strengths to pay all current and future claims arising out of current claims and newly discovered catastrophic conditions. This would also apply to any federal plans or their sponsored co-ops or other schemes.


Individual risk that our deemed to be so adverse that no premium is adequate could be pooled and assigned to carriers. The assignment similar to auto assigned risk would be based upon each insurer’s prior three year average premium written in the particular state and further factored based upon the quintiles of profitability. These quintiles would be assigned a number of zero through four with zero the least profitable to four the most profitable. To determine profitability 100% minus the loss ratio (claims incurred divided by premiums earned) minus .12 (12% of premium standard for all) would equal percent of earnings. Note, income taxes would not enter into the profitability equations as all health Insurance carriers should be exempt from income tax just as the public option schemes would be. The 12% allowance for administrative cost should be adequate to cover reasonable expenses and motivate efficiencies and innovation. The loss ratios which state insurance examiners will verify every three years will hold steady at 85%+/- if the growth in utilization and hypochondrias holds at current rate which is highly unlikely.


In the event that this country’s health care cost as a percent of the Gross National Product does not decrease by two percent by the tenth year of this law then all health insurance programs except HSA’s should be terminated and a direct repayment of Medicare tax to all wage earners who have paid into the Medicare trust fund.

Wednesday, November 4, 2009

Medicare(less)

The current healthcare bills offered in the house and senate appears DOA (dead on arrival) and should go away. However, the current bill foes not only are failing to offer a package that addresses the cause for out of control escalating healthcare cost, they are insulting the intelligence of the seniors of this country with adds that imply they we are entitled to the current Medicare system and thus should not be touched. WRONG! It is our age group that voted in the FDR “new dealers” and the LBJ ‘great society” Medicare program without regard for actuarial funding. Now we expect our offspring to pay the bill; how selfish indeed!
I am sickened while listening to many of my fellow old age coots who sit around comparing their aches and pains and anticipate their next visit to the doctors as the highlight of their dull existence. They should be instead educating their offspring and harping how our generation lost its greatness by surrendering our independence for entitlement. Our age group on average incur five times more resources than the youngest tier, Yes, we allowed our politicians to fool us into thinking our healthcare needs would be funded by inadequate payroll tax. But at some point we as a group need to bite the bullet and act like grownups!

Friday, October 16, 2009

Hubble Spacecraft & Healthcare

The other night I watch a program on PBS about the rejuvenation and fix of the Hubble Telescope. What an inspiration this success story portrayed of what we can accomplish in this country when the right minds are directed to the task. Contrast that to the feeble attempts our politicians are trying to accomplish on health care.




We should demand that are congress empower some commission to apply the fix that health care needs. We all know that the cost of health care is increasing and out of control. This cost escalation as a percentage of our Gross National Product can like the Hubble be fixed and decreased. Once it is controlled we can export this service through out the world. But it cannot be done by the lobbyist and politicians as they will only make it worse.



So let’s appoint a group of experts with diversified backgrounds in economics, healthcare, computer services, and any other related field who share a vision for improvement in the delivery system at less cost. I would think a group of 15 +/- individuals could adopt a plan of action that could be written up in legislative form in no more than 20,000 words or about 50 pages. There task should be expected to be concluded in six months and have an 80% consensus on the recommended plan of action. The membership of this committee should swear to be free from any lobbyist and supportive of our free historical democratic republic and not looking to run for any public office or expect any public appointment. In other words, be a competent true American. Our healthcare system can be fixed and be the “Hubble” of the world.

Saturday, September 26, 2009

ACORN Housing Corporation Statistics

AHC Stats 1986-2006


Clients counseled

250,226

Mortgages created

79,539

Mortgage Amount

$10,080,912,633

Clients educated

284,758

29 offices nationwide


The information above was copied off ACORN Housing Corporation website. Note the average mortgage $126,742
For the 21 year period from the 29 offices. That computes to nearly 11 loans per month assuming all 29 offices were operational over that period of time. But notice In that same period they also educated 284, 758 and counseled 250, 226.

I sure would like to know what percent of these loans were forfeited or renegotiated. Also, prudence would dictate that
the principal breadwinner of each home should have an income equal to or more than 1/3rd of the amount borrowed.
It would be interesting to see how close the actual number was.

http://www.acornhousing.org/index.php

Obama Health Insurance Reform?!

So the Obama administration does not want insurance companies who offer the only worthwhile Medicare program available (Advantage Plans) to express their disagreements concerning their omniscient health plan. Good, I too would just as soon see all health insurance (including governmental) abolished. The solution is simple: Health Savings Accounts (HSA’s). Then honor the contractual obligation the Government forced upon the citizens since 1966 & remit 80% of the so-called “subsidy” now paid the Advantage Plans to seniors who elect to be self-insured.

Let me and my doctor decide how to spend my HSA, and allow me to give funds out of my HSA to others for their medical needs and ultimately pass on this HSA to my heirs. I can join with other like HSA members to form an Alliance whose dual purpose will be to gather electronic historical medical information and encourage health providers to publish their fee structure and discounts.

This approach will let the government concentrate on only those concerns we expect of them as outlined in our constitution.

Wednesday, September 23, 2009

Tax Exempt Organization

Tax Exempt Foundations:

http://www.irs.gov/instructions/i1023/ar01.html


If you click on the above link and scroll down half way on the page, you will see the QUALIFICATIONS of a Section 501 ( C ) (3) Organization. It should be clear that for years now the IRS, probably with congressional restraint, has been turning their heads when it comes to Organizations such as Acorn, NEA et al whose mission is to destroy our freedom loving capitalistic society. Maybe we should call or write to our representatives and ask them to review all these organizations with assets greater than $100,000. An annual pamphlet listing these organizations should be published for dissemination to a vigilant public upon asking for same.

Wednesday, September 16, 2009

The Wrong Train Ride

Let’s assume you have been offered a great job in Chicago, but as you hate to fly you decide to take the train to move to your new location. Down to the depot you go, hop on the train which immediately takes off and you settle down in a window seat to view the scenery. Suddenly you realize that the train is headed west to California. Now is the time for decision and action. THE BIG QUESTION... When are you going to get off this train?

Well, fellow Americans, you got on the wrong train back in 1965 when Medicare was adopted, now the politician-porters are trying to convince you that you’ll enjoy for ever the fairyland in the horizon. Since you didn’t do your homework then you have just enough time to get a dose of reality by reading a paper by Steven Hayward and Erik Peterson “ The Medicare Monster” January 1993 Reason Magazine www.reason.com/news/show/29339.html . See how the good intentions then led congress to believe that Medicare deficit would only be $12 billion by 1990 adjusted for inflation but actually became $107 billion.

Now, the new senate plan is only projected to be $880 billion. Get off your duff and off this train: go to the exit door now for the next stop, and do us all a favor and throw out the window immediately any politicians you see on your way!

Wednesday, August 26, 2009

A Senior's Take On Medicare

As a seventy-one year old retiree I believe Medicare as we know it today should be phased out. The total that each individual has thus far contributed has been tracked by the social security administration. These funds with no allowed accrued interest should be considered vested at various rates based upon age. The government should issue zero coupon bonds which would mature at age 65 to all individuals who choose to have an MSA. Vested percentages would start at age 25 at 3% increasing proportionately to 75% by age 50. Those individuals over 50 at the time of inception of this plan would have the option to receive Medicare benefits at age 65 at today’s rate with no future cola allowances. Current recipients now receiving Medicare could be phase out as they reach room temperature.

The only feature under the current Medicare model that is worthwhile is the Advantage plans where by some insurance companies assume the contractual liability for workers Payroll taxes that have been incurred for Medicare since 1965. Current retirees on these plans should be allowed to redirect 80% of this premium (No Obama, it’s not a subsidy) to their own Health Savings Accounts. This feature alone could save $17 billion dollars a year.

Tuesday, August 18, 2009

Is Common Sense Dead

Yesterday, I finally got up the energy and determination to get my tri-annual check up with Dr O’Bama (he’s 1/8th Irish). The good doctor told me that I was grossly overweight, sluggish and immobile and a victim of that evil profit making fast food industry. His prognosis was either liposuction or a visit to his associate Dr Kervokian down the hall. I was not comfortable with his assessment and decided to get a second opinion. I decided to see Dr Du Quack whom my eccentric neighbor assured me he would look at more than my symptoms and get at the cause of my problem. Whoa, after a brief review of my background and daily routine he told me that if I followed a recommended diet and start an exercise program I could slowly regain my youthful physique. The cause of my health problems was my own overeating. Then he said that you did not just get in your condition overnight you’ll need to get back where you should be with a slow and methodical approach.

Signed’
Americus Commonie Sensical.

Thursday, August 13, 2009

A Simple Healthcare Bill

A Simple Health Care Bill

1) Quadruple Current Healthcare Contribution Limits for HSA's from $3000/$5950 to $12000/$24000 for self or family in addition to any employer contribution.
2) In addition to currently allowed coverage expenditures, allow for purchase of medical catastrophe insurance coverage. Minimum deductible equal to poverty limit.
3) Furthermore allow interest free loans or gifts from one HSA to any other HSA.
4) In recognition of current and future retirees prior funding of Medicare coverage, allow age 65 or orders individuals to receive 60% of the average monthly Advantage (Currently estimated at $700 per month) to be deposited in their respective HSA’s for electing out of government plan.
5) Provide HSA’s to families in the form of Health stamps for all lawful citizens whose annual income are less than 150% of poverty level.
6) Establish a Non-governmental organization (similar to Center for Health Transformation) with $10 Billion (decreasing to $1 Billion) for ten years for funding to set up standardization of medical records for mining purposes etc, but restricting access of individual records to patient and doctor only.

Friday, July 24, 2009

Obama Health Insurance Reform?!

Perhaps Obama just doesn’t get it! But maybe he thinks the rest of us don’t. There are many factors affecting the Cost of Healthcare. One of the chief cost is DEFENSIVE MEDICINE. In Omaha, this was greatly exemplified by a $900,000 (“feel good”) award against a doctor and local hospital.
Yes, reform is needed but the best place to start is with Malpractice Insurance and not government health insurance.

Monday, July 13, 2009

My Take on the US Health Care Crisis

My Take on the US Health Care Crisis
By James D Lynch

For over twenty-five years now, one of the major challenges of corporate executives has been the attempt to limit the growth in the cost of health insurance. As the total cost of health care has increased , in percentage of our gross national product, the concern has spread to all political and social leaders. most of whom vision an inept and quick fix. Unfortunately the politicians have zeroed in on the wrong attributes of the whole healthcare system, directing attention only to the obvious problem; inadequate insurance to cover our medical needs.

The percentage growth alone in not in itself indicative of a real problem. We are fortunate as a nation in that we have undoubtedly the best medical care along with the highest standard of living in the world. As new research and longer life expectancies come to fruition, we should be thankful that our standard of living can afford ever- growing technology in science and medicine. There are multiple factors which have an accumulative effect on the distribution of medical care. These factors or problems did not suddenly appear on our door-step. Therefore, they cannot, nor should they be, rectified by quick experimental programs or copycat approaches by elite societies.

Fixing the problems of escalating health care costs and the distribution of adequate health care will, in my view, take a commitment from the following parties: The Federal Government (Tax exemption for health savings account); All 50 States, by adopting uniform legislation that supports insurance and legal reforms; The American Medical Association and affiliated associations; All the Medical Schools and related medical education institutions; All the providers of health care services; And we the patients ourselves.

The following is a list of factors affecting run-away health care costs:

1) Technological Innovations Outpacing Supply And Demand.
When one envisions technological innovations that can be introduced to the fields of medicine, three questions needs to be addressed and answered.
A). What is the approximate number of cases and resulting degree of misery and discomfort that existing procedures now address or should address?
B). How easily can the required information or skill be disseminated to the practicing community so that efficient use is exercised and overuse or abuse is avoided?
C). What is the expected payback when one considers the total production and educational costs and obsolescence of existing remedies?

Currently innovation and demand seem out of balance. This is most likely due to the fact that the practicing community is reluctant to use unproven procedures for which they have not had enough training or educational experience. With today’s legal environment, caution is the order of the day. Being on the cutting edge of societal evolution is only preferable when ones actions are deemed to be heroic, as opposed to new age quackery.

2. Malpractice & Defensive Medical Treatment

The trial attorneys have been partially successful in claiming that the frequency of suits is relatively small. They claim that total judgments are an insignificant fraction of our total health care costs. It would appear by their numbers that they are disregarding the cost of settlements out of court. It is these types of settlements which create large malpractice premiums along with the encouragement of excessive defensive medical tactics.

Perhaps what is needed in this area is some credible study that really looks into what has been happening in terms of trends and expectations of the medical profession. It is indeed a real problem and can be partially verified by statistical data published by insurance companies.
The size of individual judgments should be reflective of the present values of future lost earnings and future expected medical costs pertinent to the claim. Perhaps an actuarial process should be part of jury room deliberations. An alternative would be having the settlement funds held in escrow by a trust for periodic payments as those expected cost are realized.

One major element of many settlements is punitive damages. The historical rationale of this payoff evidently is the infliction of pain (loss of equity) so that perpetrators will not prosper due to their malfeasance. There is indeed a need for this retribution. Society as a whole, however, is the real victim of this type of behavior. Therefore, would it not suffice that these damages be awarded to a charitable organization that would serve society as a whole? The enrichment of the plaintiffs of these actions is comparable to winning a lottery, and their immediate reaction when injuries occur, too often is similar to same. Attorney fees for these judgments should be limited to no more that 10% of the punitive judgments. It would be better that slight negligence be forgiven in the absence malicious conduct and compensation for this type of malfeasance should never exceed the cost of the original services...


3. Shortage of General Practitioners and Pedestals.

We need to have a system that screens out incompetent practicing physicians. This, in my opinion, would best be done by peer review. Not every graduate from our medical schools should be expected to perform in an errorless manner. There is a need for many areas of medical expertise, including teachers, researchers et al. A given Doctor may be too careless or inefficient in patient diagnostics, but he (she) may be a superb researcher or teacher. A system of peer review might recognize and redirect some of a doctor’s talents to an area where he could more fully contribute to the overall system’s needs. Should the degree of earnings variance create a system of stigmatizing one area as being preferable over another? I think not, but rectification of any current disparities should come from within the medical profession as opposed to governmental or insurance guidelines. Perhaps a dues assessment mechanism could redistribute earnings so that one area actually subsidizes others by given grants and/or rewards. Internal peer review safeguards should also be established whereby other medical professionals such as nurses, pharmacists, physician assistants, et al, could report incidents or concerns without fear of retribution. Today MD’s have earned the right to possess a large ego and we patients should show them respect. However most would not want their egos to shield them from incompetence or lack of knowledge in a given area. We should not treat them as little gods or expect perfection from them. They are as human as the rest of us are, and thus capable of making judgmental errors. Slight negligence judgment errors should be overlooked and forgiven for when one seeks medical treatment, he is entitled only to ordinary care. It is a fact of life that some of us will endure pain and suffering, but this does not entitle us to remedies that enrich us. Perhaps the traditional practice of addressing them as “Doctor,” instead of “Mister” (evidently, the custom in the England) or their first names, has helped to create the mystical pedestals that we the public have built for them and they would be best removed.

The systems of distribution of medical expertise and the centralization of acquisition of medical services with the related individual’s medical records should be streamlined under the control of a general practitioner (GP). This would undoubtedly result in a much greater role and control of each individual’s total health needs by the GP. He would be a responsible for all specialists who are called in for a particular patient. His practice might wind up with less patient direct exposure and perhaps more administrative functions. However a team approach of providing total medical care for each patient could be obtained by perhaps two physician assistants with each GP. The specialist as we now know and employ services from would be unchanged. The GP, however, would act as the patient’s agent, and with the patient’s consent, be responsible for all charges and procedures used by the specialist. This could result in much better communication between patient and provider. One of the physician assistants (who would be professionally trained as a patient communicator) could be responsible in delivering written communications as a confirmation of what previously was conveyed orally to them. Thus, the patient would have a record to get further enlightenment and understanding from selected friends and/or family as he (she) so chooses.

The specialist fees would still be subject to the market forces. However their market values would be determined by the GP who would have a better appreciation of worth than a patient left to the mercy of the specialist. In the long run, one would expect that the earnings disparity would change to the benefit of the GP. This does not mean that the GPs should make more than the specialist.

4. Need for Broadening Education and Role of Physician Assistants and Nurse Practitioners,

Evidently, the American Medical Association (AMA) is the prime enforcer for the growth of doctors in this country. They certify or have considerable input on what schools can teach medicine and how many students they can accept. If only 10% of all medical school applicants are accepted into all the American Medical Schools while 90% (let’s say) of this group obtain the competency to finish, then perhaps these high standards are in place mainly to protect the “vested” physicians earning capacity as opposed to protecting the consumers from incompetent graduates. What effect on the average medical charges would occur if the ratios were 20% and 85%? Is there any evidence that the quality of medical services would deteriorate? It is obvious that the rural areas and other less attractive communities would benefit from the increased availability of practitioners.

One need only look at the CPA accounting profession to get some idea of what could happen. Forty years ago, it was projected that the public accounting professional after ten years would have a need for more new CPAs each year than the number of students then in all the accounting schools while only something like 40% could get a CPA certificate. Thus the schools increased their enrollments to meet the upcoming demands and the profession accepted female students in far greater numbers. Today the business community has ample CPAs and their growth in salaries has remained steady or perhaps declined slightly when compared to other non-medical professions. In other words, let’s increase our medical school enrollments to meet the growing demand here and in our exporting facilities.

5. Product Development Review and Price Reduction Strategy

Today great advances have been made in medical technology to the point that advances are introduced in a piecemeal fashion. Each new item has to be first sold to an extremely limited number of users. At the same time the word gets out slowly on what this new gadget will do for a patient. The developmental cost due to product liability and other factors is extremely high. Likewise there is educational cost that the developer must endure to market the product. These costs are included in the price that the developers think the market will bear. The developer must have the incentive to accept the risk of not recovering investment and operating costs. This is called profit. What could satisfy the developers concern may be alleviated somewhat if the medical community would accept endorsements from a new advisory board called the MEPB (Medical Equipment Payback Board)

The MEPB would serve like the banking industry’s Federal Reserve Board. Instead of interest rate management, this board would assist in the control and development of new major (ei unit cost greater than $100,000) medical machinery. They would have available to them a cooperative fund that would assure a satisfactory test market for all new, extremely costly products and procedures. They would see to it that sufficient concomitant educations of the medical professionals are being developed as the new expensive product is being refined and fabricated. This would assure that technology would closely lead the demand for these new products. An example following this idea might be as follows:
General Electric’s Health Products Division announces that preliminary research has been concluded for a new wonder machine called a magnetic resonance tool (MRT) similar to an MRI. This product will allow video and graphical tracking of minute surgical instruments so that the surgeon can minimize the destruction of good tissue as foreign or malignant cells are pulverized and extracted from the body. The net result would be quicker and safer surgery with rapid if not instant recovery. Because of the computerized machinery and software development costs along with the pure miniature instruments and fabrication costs, this system, when built one at a time, would sell for 25 million dollars.
Since it would be anticipated that only 500 procedures could be done on one unit in a year, if payback were expected in 2 ½ years, each procedure would cost the patient $30,000 (50% markup to cover other incidental cost $10,000 per procedure) Now let’s assume that the MEPB approved the development of this unit and furthermore there would be a need for 200 of these units to cover all the major cities and floating facilities described in item #8 below. GE could set up and produce 200 in the same time frame for double the cost of one unit. The units would sale for $250,000 each and the procedure would cost $200 per procedure plus the $10,000 incidental costs or a savings of $19,800 per procedure. This of course does not include any savings projections for alternative procedures.

The co-operative would get its fund to underwrite these orders by selling their tax exempt bonds to “Catastrophe Health” Insurance Companies (CHC) and other investors. The respective hospitals or surgery facilities would pay upon delivery and installation of the units.

6. Medisave Account Goals and Transition and Catastrophe Insurance

Universal coverage can best be obtained by using a twofold approach similar to food consumption. First, those who can afford to fund their own savings account either directly or in conjunction with their employee compensation package, would have the tax incentive to do so. Second those individuals and families unemployed who are at poverty levels defined by existing authority would receive health “stamps” (vouchers) that would fund their own Medical Savings Account (MSA).

Several plans we hear advocated and attempted today include a medical savings account, however, all appear to be too lean to motivate thrift in buying medical services. The goal for each savings account would be phased in limitation starting at 20% of each individual’s running average of five prior year’s adjusted gross income (RFYA) increasing each year by 20% until reaching 100% after five years. This technique would be sufficient to motivate everyone to be wise consumers.

In addition to any incurred medical expense (which would include reasonable expenses to maintain physical and mental lifestyle) paid from these accounts would be catastrophe health insurance premiums and a long term care premium insurance (LTC) (discussed in detail in item 22 below). The companies that administrate the savings account would also provide the catastrophic and LTC coverage for the multiple levels of each individual’s defined limitation. Note: Catastrophe medical insurance would be a gradually increasing deductible relative to each individual’s ability to pay. It could be based upon a percent (such as 50%) of any given year end MSA balance.

The third type of disbursement from an MSA would be gifts to other MSAs. Assume that my neighbor who has had a condition requiring reoccurring expensive medical treatments has another family member who required a very expensive surgery when their MSA was very low. I could either loan (at zero percent interest) or give them funds from my MSA to cover some of or all the required surgery

The fourth type of withdrawal would be for partial down payment on a married couple’s first home. This feature would be to induce young families and singles to save for a home as well as encourage them to allow for medical savings. The withdrawal would be limited to 50% of account balance and be totally exempt from tax. However, the withdrawal should not cause the MSA to reach a level less than 45% of RFYA. The savings account limitation might be 150% of current five year running average of AGI for those under 50 years of age, increasing by 10% for each year thereafter, with the five year running average indexed to inflation for ones final five years of full-time employment.

Finally, if ones account has reached the 150% or maximum RFYA level, he could draw those funds for personal use and qualify for 50% exclusion from income tax. In fact, in order to receive the tax free contribution to ones account, he would be expected to withdraw the excess by one of the foregoing described disbursements.

Medicare as we know it today would cease to exist. The total that each individual has thus far contributed has been tracked by the social security administration. These funds with no allowed accrued interest would be considered vested at various rates based upon age. The government would issue zero coupon bonds which would mature at age 65 to all individuals who would have an MSA. Vested percentages would start at age 25 at 3% increasing proportionately to 75% by age 50. Those individuals over 50 at the time of inception of this plan would have the option to receive Medicare benefits at age 65 at today’s rate with no cola allowances. Current recipients now receiving Medicare would phase out as they reach room temperature.

For administrating these MSA funds the Catastrophe Health Companies (CHC) would be compensated at the rate of 1/12 of .5 percent of each monthly balance plus $2.00 per disbursement and 5% of annual earnings of each MSA account. They also would be entitled to write the catastrophe and long term care insurance as well as provide retirement systems described in item 22 below. At the death of any individual with no dependents or spouse remaining, the insurance company would be entitled to keep any remaining funds after a standard final burial benefit. For those deceased who have a spouse and linear decedents, any remaining funds should be passed on to family who would be expected to add these funds to their respective MSA accounts. The passed through amounts should be excluded from other inheritance laws.

Underwriting of catastrophic coverage would be more realistic in reviewing individual risk exposures, as currently most health insurance is written on a group basis which ends up being closer to a wealth transfer system as opposed to true insurance. However, genetic information should never be part of the underwriting process. Some individuals because of their uniqueness would be judged to be a bad risk at any premium level. This miniscule amount of individuals would be assigned to a pool for placement to companies by a draw system similar to auto assigned risk..

7. Facilities Design

It appears that since the Hill-Burten Act was implemented in the early 60’s, (which provided cheap funds to hospitals to expand their facilities) the resulting complexes have ended up being monuments to stupidity, (or at the very least, extravagance) as opposed to functional and simple structures whose primary purpose should have been the efficient delivery of medical care. Doctors, and their non-attentive boards, with the aide of architects who do not understand the need for efficient use of manpower, have been building facilities with no input from the nursing supervisors and other operating personnel whose jobs are to provide efficient care. So too, groups of Doctors have formed affiliations built around grand office /lab facilities that mainly soothe inflated egos and enhance their “images” so that higher fees can be demanded. A system of fee allowances should factor in (or out) excess and non-efficient cost.

8. Exporting Health Care and Satellite Communication

It generally is accepted that the United States is the world leader in providing health care. When the world’s elite seek the best health care, they come to the US; not to Sweden, Canada, or any other countries where government controls the health care industry. Our medical schools and health care institutions are purported to be the best. In other words, we have no problem producing an ample supply of medical expertise, for only the very top of the student pool is accepted into these schools. Many similarly talented students are not accepted due to limited enrollments and they find their way into law schools and other over-crowded and “non productive” courses of study. The American Medical Association would do better by encouraging doubling the number of medical students (perhaps cutting the number of law students in half). By increasing the total pool of medical professionals, the US would be in a position to export medical care.

With increased supply of medical expertise, this country could export it by way of hospital ships similar to Dr. Tom Dooley’s City of Hope. We would perhaps have to develop a small limited federal bureaucracy that would serve as the marketing catalyst for this type of program or possibly private profit concerns working in partnership with medical schools would suffice. Perhaps a federal agency could negotiate methods of payments by the third world (or even the second word?) countries either in terms of currency transfers and/or bartered raw materials, or whatever products or services that the recipient country could provide. Our number one export and economic assistance could be health care followed by food as opposed to defensive arms and cash which generally end up in the wrong pockets. Hopefully, this new agency could fund these operations from issuance of tax –exempt obligations owned by the health insurance companies and university endowments.

It would be expected that the goals and objectives of these hospital ships would follow the programs established by Creighton University’s ILAC (Institute for Latin American Concerns) where there is a two-way exchange of ideas. The students as well as their instructors are given an opportunity to learn from the third world people and their customs.

All of the fleet would be equipped with satellite two-way communication facilities that could put them into contact with the top medical experts as needed. In addition, each ship could have any number of Winnebago-type motor homes to travel on shore as needed.

It should be obvious what this endeavor, if undertaken, could do for the ship-building industry and the medical products and supplies industries that would service these floating hospital facilities. The net results of this exporting health care activity would help spread the cost of innovation to a much larger market and it would also help reduce the balance of payments for the United States.

9 Pharmaceutical Patent Protection and Statistical Tracking.

The Federal Drug Administration should be eliminated, and in its place, a something similar to Federal Reserve Board, funded by a special sales tax on pharmaceuticals. Let’s call it the Drug Monitoring Association. (DMA) . This entity would be responsible for maintaining all data on drugs and have a uniform website-type catalog displaying all accurate scientific information about each drug. A patient who has been issued a prescription for any drug could go to this website and enter the drug’s unique number. The data would show the historical experience and be in a continuous mode of updating where the number of patients were treated, the percentage who had adverse effects, the average length of treatment et al. Historical experience that would predict effectiveness and side effects, if any, as well as the year of initial market distribution would allow a patient to know how long his medication has been in use or if it is relatively new or experimental. GP’s, through their physician’s assistants, would report to the DMA the side effects experienced by each patient as history develops. The statistical experience (without disclosing patient identity) would be daily transmitted, when reported by patients, to one huge data base. The statistical tabulations would be held for continuous monitoring of results by age, sex, ethnicity, etc. Cautions and warnings would then be disbursed back through the DMA to the family physician who would be expected to use his professional judgment to continue or discontinue the medication. These statistics would not be available to our irresponsible press to prevent hysterical or hypochondria concerns.

Revised patient laws and international patent agreements should be renegotiated to give the holder sufficient time to recover their just rewards. Presently the time frame begins with the announcement of discovery. The beginning patent date should have a pending status which delays commencement of the protected years to coincide with marketing. Safeguards would have to be instituted to prevent premature patent applications that may discourage competitors’ research.

10. Uniform Health Care Code.

Uniform state laws have been very successful in regard to Commerce and criminal abuse. There should be no impediments in place that prevent the National Association of Insurance Commissioners from promoting uniform legislation which would include the spirit and guidelines of this treatise.

11. Quality of Life Review Mechanism.

A living will should be encouraged for all adult members of society. Once it is created, each year at ones birthday, it should be reviewed and refined with any notations of amendments needed. Then an electronic copy should be forwarded to ones GP and/or any others of trust and confidence.

The effort to extend life should be proportionate to an individual’s capacity to add meaning to other peoples lives. This “meaning” should not be restricted to revenue generation or retention but should account for a person’s awareness of his own being as relates to others. If he continue to share joy, ideas, warmth and appreciation with those near to them, regardless of family ties, his life quality mandates reasonable care. A hip replacement procedure might be appropriate for a 95 year old Armand Hammer or George Burns [Note: this essay originally started in 1994] but not for 56 year old Alzheimer patient that cannot feed himself, walk or identify himself. As long as at least 95% of the population recognizes our immortality we should not prevent the natural process of death to occur. Frozen brains and other far out practices should never be part of health maintenance programs.

12. History of Health Insurance: Not a Right

Life itself is a right, but the notion that acquisition of health remedies, like food can never be a right. Rights can be recognized by the state but not granted by them. To do so, the state would have to have at its disposal an endless supply of the sustenance, without contribution from other individuals, that give meaning to the right. The state (or government) only exists due to the consent of its collective citizenry, and as such, can have nothing without individual contribution or confiscation. Thus medical resources, services, or care plans can only be exchanged between consenting individuals (corporations and other state sanctioned entities acting on behalf of affiliated individuals) by contract. The funds in satisfaction for the exchanged “contract” have previously came about by a third party (an insurance company) due to another contract .Contracts can only be enacted by two knowing parties willing to freely and lawfully exchange for an agreed upon consideration.

Attorneys, particularly those in politics who try to deceive an ignorant public about the source of our god given rights as recognized by our constitution, should be disbarred and stripped of their licenses to practice law or hold public office. Since the third party concept of paying has lost all meaning and mutual understanding, this type of contract should be disallowed for the public good. In its place MSAs and catastrophic insurance would be allowed.

Prior to World War II, most families provided for their health care needs on a pay as you go basis, yet the health care system generally took care of everyone’s needs. The omission of the tradition health insurance contracts would place us back to beginning of World War II, when a freeze was placed on salaries and wages to support our war effort.
That freeze did not work, for management and labor merely conceived of a new compensation technique--paying for labor’s health care with group insurance premiums. Note however, that calling this type of program insurance, was, in fact, a misnomer. “Insurance” implies that there is an underwriting of the individual risk, where these arrangements placed a flat premium on all employees with the younger workers paying the same rate as older workers. Thus it was a wealth transfer system.

Management, then and now, knew how to compute their after-tax profits, including labor cost. Labor cost consists of all wages and direct and indirect benefits. This is what the automakers consider when pricing their vehicles, as well as the fast food purveyors. The cost must end up in the price of the product or service.

13. Self Underwriting.

When an insurance underwriter performs his professional task, he examines and identifies those risks inherent in a particular activity, object, or person. He further evaluates and anticipates the likelihood of an event occurring with a notion of potential severity and frequency. He knows that any risk is a good risk if the premium is fair and adequate.

We too should do our own personal underwriting, not with a premium in mind, but rather with a notion and understanding of the loss of quality of life and existence. We are in charge of our own destiny. Our lifestyle must be geared to the choices that we are free to make. If I know my own personal family history, I can feel fairly confident that the genetics passed on to me can have predictable results. My life should such that I can accept the risk of various alternatives. If one knows his father could handle a high cholesterol of fatty foods with the payment of a large waistline which limits his perceived quality of life, and he also is prepared to pay that price, he should then not be restricted in his life choices. However, his acceptance of that risk should be paid by him through disbursements from his MSA and higher catastrophe premiums, not by his fellow taxpayers in a governmental program. Some genetic conditions will occur where little can be done about them. One must remember that the god-given equality we seek has only to do with the rewards we hope to realize after death. There is no level playing field when it comes to life, nor should there be. If one does not subscribe to this notion, he should take it up solely with his creator. (Whomever-What it is)

14. Legal Environment Cost Factors.

One outside factor affecting not only runaway medical costs, but also affecting all segments of our standard of living, has been the deterioration of our legal system. Perhaps this should be a whole separate and distinct reversionary task, but three elements are too significant to dodge and need to be at least mentioned. They are Judicial Activism, Class Actions, and The Jury System,


15. Psychological Factors and Alternative Medical Treatment.

What to do about hypochondriacs (HC) and subscribers to non-western medical standards is an area that cannot be ignored. This should merely be pointed out for what it is either by the GP in the case HCs or the CHC that would monitor that data and pay all providers based upon reasonable charges.

16. Return to Regulated Orphanages and Adoption Facilitation.

It should be obvious, that one of the so called “Great Society” innovations of welfare for young people who are not educated enough to support themselves save their illegitimate children, has proved to be disastrous. Not only are the children subject to healthcare neglect and poor education, but they are also deprived of learning social values which can eventually make them contributors to our society rather than misfits. The orphanages and foster care programs of the pre-sixties with all their reported problems were far more effective and productive in contributing citizenry than the so called victors of our war on poverty. Poverty obviously won that war!

17. Peer Review of Facilities and Providers
The Uniform Health Care Law described in 10 above should provide for peer review and uniformity in reporting accounting and statistical data so that valid comparative results can be monitored. A voluntary reporting and rating system similar to AM Best analysis for the insurance industry could be introduced.

18 Individual Responsibility and Occupational Risks, Life Style Risks

Each of us have been endowed with what makes us different than other animals, free will. Other than genetic flaws, we all have the capability of averting illness and disease. Our choice of lifestyle, occupation and education greatly affects the outcome of our health and life expectancy. Sometimes our greed, lust, and materialistic inclinations will lead us to rationalizations that expect others to fund our setbacks. A mature individual realizes that education is a life long process and if he has the correct attitude, he has ultimate control and is in charge of his own fate.

Wage levels have generally evolved in recognition of the risk inherit in each set of expected tasks. Therefore, it might be best that we do away with workmen’s compensation insurance. Retain the aspects of monitoring uniform rates and loss experience by employer, occupation, length of worker’s experience, then rate instead the job at a uniform rate. Example: Assume a carpenter with ZZ Company has a premium rate of 7% and the company has a 1.2 modification experience ratio. The hourly pay would be normally $20 per hour. The actual rate would be $21.68 per hour ( 7% x 1.2 + $20). The $1.68, plus his negotiated health care contribution (limited to 20%), would be paid to his MSA account. This practice would end many of the questionable claims in workmen’s compensation because often a worker prefers his injury to be work related so that he can draw short term disability pay. For real accidents that occur in a workplace, I am sure that most employers will generally join fellow workers who voluntarily contribute to a warranted workers MSA when need is obvious.

19. Convict and Other Human Guinea Pig Research.

One of the consequences of criminal activity might be the expectation that criminals consent to medical research as guinea pigs. Voluntary acceptance of physical harm would go along way in demonstrating that that a criminal is indeed remorseful. The more serious the crime, the greater health and life risk should be expected. Social workers and rehabilitators would be expected to pressure convicts into consenting to the tests.

20. Criminal Retribution for Health Care Costs.
Another unnecessary addition to our total health care expenditures comes as result of criminal activity. Retribution is indeed warranted and if not satisfied wholly by the convict’s guinea pig cooperation then he should be given a unique social security number which would tell employers and tax preparers to charge an additional 10% tax earmarked for recompense.
The criminal activity of unlawful entry into this country without the means to acquire expected medical attention is another extremely burdensome weight that must be borne by state and local governments as well as the general payers for medical services. This segment of our uninsured probably accounts for at least 10% of the nation’s total health care bill. Our national government must resolve these issues with the Latin American counties and put liens on their natural resources like oil, and charge those nations for the debts of their impoverished poor, exported here contrary to our laws. If Mexico, which owns the oil, were to contribute oil at 50% of going market rate to our national oil reserve, then that oil could be sold to refineries and the proceeds used to pay off uncollected medical costs incurred by the so called “undocumented”! NAFTA must be amended to enforce this concept. If any of our poor flee to Canada and incur free care, I am sure the politicians would find a way to make things right.

21. Prevention of Access to Individual Data.

As the explosion of technology advances continues, we must anticipate all relevant issues. Areas of potential infringements of privacy rights must be guarded and in place before information is ever tabulated. Only information required for monitoring trends should be available to government agencies. Only those organizations and individuals responsible for each individual’s well being, that a reasonably informed person would consent to, should have access to one’s individual medical records. In other words, controls should be developed to assure that only John Doe’s doctor, pharmacist and data insurance file should have information stating that he has a prescription for Prozac, for instance. Data from the insurance file without identifying a person, but containing a summary of his vitals, would be sent to a Pharmacy Data Consolidation Bureau. Health care cards should only be issued by the CHC’s and available only to medical providers with consent of the individual involved
The maker of the Prozac would be required to monitor trends of Prozac usage. If segments of the population are identified as having adverse effects, an alert should be immediately directed back to the doctor who would have the responsibility of exercising his professional judgment appropriate to the particular patient. Likewise, a standardized gauge would be developed that would rate each drug so that a patient could see and compare his risk associated with any medication. A reasonable, informed patient, upon knowing the most current information on a given substance, must assume the ultimate responsibility for taking a given substance.

22. Redirecting Insurance Excess Equity

It should be obvious that as we shift the risk for health care and workmen’s compensation away from the insurance companies in those fields, to merely custodial and statistical data bases, the remaining surpluses will be out of proportion to risks retained. Therein lies the greatest of opportunities for this country to veer off its socialistic path. These companies would now be in position to accept all the risk associated with social security benefits. The experience of Chili’s privatization of this type of program should be studied and a plan adopted to give each individual the options of how these mandated long term needs should be funded. The disastrous mistake of the Roosevelt years was not in requiring all citizens to save for their retirement; but rather, how the funding would occur. Most likely, if they had the computer technology then that we have today, those conservative and moderate democrats would never have allowed such an expansion of government and socialistic approach to be implemented. It was a mistake then and it is a mistake today, for actuarial science was completely ignored (and evidentially funding as well), resulting in a tremendous economic and social drain. The Uniform Insurance Regulations adopted by the states should mandate a policy that includes for catastrophic features mentioned above, as well as a uniform decreasing term life policy that assumes all individuals have a spouse and two dependent children who would require support for the next 19 years in the event of an untimely death. Furthermore, discretionary savings plans which would provide for a joint and survivor annuity at retirement age. Long term disability benefits and long term care for the incapacitated would be provided as well.
Once an individuals faculties have deteriorated to the point that long term care is warranted, the closest of kin should have the option to provide custodial care in their home and be compensated at the rate of 80% of the present going rate for institutional care. This cost would be provided for by the long term care policy. The Policy will provide for a deductible equal to 8% of the MSA at the end of the previous year.
In conclusion, each mature and competent adult has an obligation to provide adequately for his retirement as well as securing protection from costly medical and disability setbacks for himself and his dependents. For the common good, government should mandate that we act responsibly in these matters. Minimum levels should be advocated. With today’s electronic capabilities, however. these obligations can be fulfilled by private entities. A W-2 type statement is sufficient to verify that all have complied with the minimum standard. In the event that one fails to do so, he could be given a unique social security number that requires a 20% surcharge be added to his tax. Then, at year’s end, these funds can be remitted by the US treasury to the assigned CHC.
The alternative type plans advocated by the progressive secularists that are now in control in Washington, will invade our society like a deadly cancer and catch us off guard before we realize what has happened. Euthanasia will be the cornerstone to solvency as the baby boomers reach retirement age. This is a shocking statement indeed, but do you think that a community of secularists who deny more than 50 million unborn babies to exist will not justify in their irrational minds that the elderly and infirmed are too big a drain on the Medicare, Medicaid and Social Security system now in place. With the advances in pharmaceutical science you can bet that the FDA will soon find an untraceable potent additive that will be phased into the annual flu shots. These could have staggered time triggers or be masked as a new pandemic flu. No Thanks to government controlled health care!

Thursday, January 29, 2009

HOW TO STIMULATE THE ECONOMY

The fastest and simplest way to stimulate the economy is to cut permanently all existing corporate income tax rates by 80% and reduce payroll tax rates by 50%. for 2009 and phase back in the payroll tax cut by 10% per year until 2014.

This cost to Federal budget of one trillion can be offset by all the waste and pork barrel programs that seep into the budget by our power hungry legislators who can not say “no” to the lobbyist. On the other hand a President who is true to his word might actually veto these spending bills.

If the first four lines were enacted into law the reduction in federal tax collections would be about 250 billion. However, think what this would do to the price earnings ratio thus over all stock market and the 40ik's that dems lament over: Not to mention the rise in employment!