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!