New Idea for Health Care

A New Health Care Idea.

Well this should open the preverbal can of worms. We all want to see that all Americans can get affordable healthcare. Obama set out to do that. But the law that he signed is a disaster. While it’s a mess it does have some good points, very few. Despite the best efforts of Obamacare, not all Americans will have health insurance. In addition, over 45% of all companies will drop health care benefits and just pay the $2,000 fine. Many companies and Unions who wanted this law are opting out of the coverage and Obama is signing off on them. If it is so good why is everyone bailing on it? Not to mention all the additional taxes we must pay. And despite that, Medicare will still go broke soon.

So it is a tough undertaking to get all Americans health insurance. What we need is a policy that is affordable, covers everything, not just some illnesses or short change treatments, needs to allow pre existing conditions, needs to not lapse if someone loses their job, needs to cover prescriptions, needs to be there for the elderly, not need Government subsidies, and it needs to not burden Medicare .

Is it possible to achieve such a lofty goal? This system will take some time to put together and to implement, but it will address all of those concerns and many more.

The first thing that needs to be done is a group of representatives from all aspects of health care such as:

Doctors of Internal Medicine:

There are many subspecialties (or subdisciplines) of internal medicine:

• Cardiology
• Critical care medicine
• Endocrinology
• Gastroenterology
• Geriatrics
• Hematology
• Hepatology
• Infectious diseases
• Nephrology
• Oncology
• Pediatrics
• Pulmonology/Pneumology/Respirology
• Rheumatology
• Sleep medicine

Surgery

Surgery has many sub-specialties, including:

• general surgery
• cardiovascular surgery,
• colorectal surgery,
• neurosurgery,
• maxillofacial surgery,
• orthopedic surgery,
• otolaryngology,
• plastic surgery,
• oncologic surgery,
• transplant surgery,
• trauma surgery,
• urology,
• vascular surgery,
• pediatric surgery.

· In some centers, anesthesiology is part of the division of surgery ophthalmology and dermatology, but are not considered surgical sub-specialties per se.

Diagnostic specialties

• Clinical laboratories
• Pathology
• Radiology
• Nuclear Medicine
• Clinical Neurophysiology
• Polysomnography

Other major specialties

The followings are some major medical specialties that do not directly fit into any of the above mentioned groups.

• Anessthesiology
• Dermatology
• Emergency Medicine
• Family Medicine, Family Practice, General Practice or Primary Care
• Obstetrics and Gynecology
• Medical Genetics
• Neurology
• Ophthalmology
• Pediatrics
• Physical Medicine and rehabilitation
• Psychiatry
• Preventive Medicine
• Occupational Medice

Interdisciplinary fields

Some interdisciplinary sub-specialties of medicine include:

Addiction Medicine

Medical Ethics

Biomedical

Clinical Pharmacology

Conservation Medicine

Disaster Medicine

Forensic Medicine

Gender Based Medicine

Hospice and Palliative Medicine

Hospital Medicine

Laser Medicine

Medical Information

Pain Management

Sexual Medicine

Sports Medicine

Therapeutics

In addition we should assemble Hospital Administrators, Physician assistants, Nurse Practitioners, Certified Nurses Assistants.

All the representatives shall meet to create a Health Care Procedure Manual. Basically, they will establish protocols for all Illnesses, Diseases, Surgeries, Preventative Medicine, etc. It will outline all steps to be taken to address everything from Diagnoses, to Recovery on everything from the common cold to complex surgeries and all the steps needed to ensure complete and proper recovery.

After the manual is completed a consensus as to affixing a set cost for all procedures. This can be done by consulting the medical community as to what the average cost is per procedure. Those fees should be examined, negotiated to get the lowest price as possible. Once the monetary value is set, those numbers will lock in place for the first 3 years. The costs will be evaluated every 3 years after that by a panel of 60 people from the medical field, congress, and citizens. The panel will be called Medical Community Panel. They will hold hearings, listen to testimony and come to a conclusion. A rate increase can only be approved with a 2/3 majority vote. The people who serve on this board cannot be serving on the Insurance Policy Panel. It should be noted that procedures will change due to new discoveries of medicine, new technology, and new discovery of cure or better procedures to improved medical care. These changes will occur at any time and will go into effect as soon as they are approved by the Medical Panel.

Once the manual is completed with procedures and reparations, it will be presented to ALL medical insurance providers. They will bid on the cost of health insurance coverage to provide coverage as prescribed in the Medical manual. The lowest bid will be the cost of the policy for the American people. This also will be locked for 3 years. As with the costs the medical community, the insurers will be evaluated by a board of 60 people called The Insurance Policy Panel. They will hold hearings, listen to testimony and come to a conclusion. A rate increase can only be approved with a 3/4 majority vote. The people who serve on this board cannot be serving on the Medical Community Panel.

All health care insurance providers will charge no more than the set price. Any insurer found violating this rule will be fined $ 25,000 per offense. The insured will have the option of choosing any health insurance provider. All health care providers will cover all procedures specified in the Health Care Procedure Manual. Any deviation, refusal of a medical procedure clearly shows in Health Care Procedure Manual, or refusal to pay for said procedure will receive a fine of $30,000 per offense. Should the action result in the death of a patient, The Insurance Policy Panel will meet to determine if the insurer is responsible for the wrongful death. If so the insurer will compensate the family three (3) times the cost of the procedures needed to care for the patient according to the Health Care Procedure Manual. In addition they will compensate the family five (5) times the amount of lost wages, retirement benefits and Social Security benefits up to the national average of longevity. This wrongful death payment is compensation for wrongful death without going through the judicial system. Payment to the surviving family will be made within 90 days of the board

Determining in favor of the family. The board shall meet within 90 days of the passing of the insured. The Board must come to a determination within 30 days of convening. Should the board find no wrongful death, the family has the right to take the insurer to the judicial system to seek damages. The insurer will abide by any court decision. Should the insurer be found responsible by the court, the payment will be made within 90 days. I either by court or by panel review the insurer is found to be responsible and not make the payment within the 90 day time period, the insurer will pay a fine of $25,000 per day they are late In addition, the amount due the surviving family, the insurer will add 25% interest to the fund until paid.

The 60 person panel will consist of 25 from the medical community, 25 citizens, and 10 members of Congress broken down as 5 from the Senate 5 from the House of Representatives. The 10 will also breakdown as 5 Republicans 5 Democrats No one from the Ethics Committee can serve on either panel.

In order for someone to serve on either The Medical Community Panel or The Insurance Policy Panel they need to submit their name for consideration. The House Ethics Committee will do the vetting on each candidate. They will vote to appoint a candidate to the board. The names will be sent to the President for final approval. Should the President reject a candidate the ethics Committee can override the President with a 75% majority vote. Once a candidate is on the panel they will serve a term of 6 years. A candidate can reapply for a second term but they must go through the entire process once more. No one can serve more than two (2) terms. Should a panel member resign, a replacement will be chosen from the list of applicants and they will be subject to the approval process. The replacement will serve out the remainder of the term but this time will not count towards the full two (2) terms that can be served. At no time can the Ethics Committee or the President appoint a replacement. An empty seat will remain empty till an applicant completes the entire process.

How will this system work and how is it paid for?

Basically Every American once they hit the age of 18 will get this policy. Upon birth, the infant will attach to the fathers policy. If the insured is going to college at the age of 18 they will remain on the responsible parent policy. (A responsible parent will be defined as the father first, the mother second. A child from birth will attach to the fathers policy. In the event of a single parent, they will be the responsible party. In event of a death the child will attach to the remaining spouses policy. In the event both parent pass, they will go on Medicaid till 18 years of age). This policy will stay with the insured until the passing of the insured. they will remain on the parents policy until the completion of college or the persons 26th birthday. At that time, they will be issued a policy in their name.

At the start of the program, companies that provide employees with health benefits will cease. The funds paid by the employer to the insurance provider will be paid to the employee in their weekly paychecks. It will no longer be the responsibility to insure employees, but those funds will always be paid to the current and future employees. In addition, the minimum wage must increase to an amount that allows for the employee to afford the piece of the insurance policy. For example if a policy is $400 per month it would cost $ 2.50 per hour. So minimum wage needs to increase by $2.50 per hour. The cost of the insurance policy plus 10% will be taken from the employee each pay period much like Social Security is. Those funds will be sent to the government to be placed in an account that the employee can check on at anytime. This will be a non interest, non investable, and funds can never be removed by the insured or by the US government. The only role the US government will have in this is to receive the funds Use them to make the payments to the Insurance provider, and maintain accurate records. The additional 10% will be held in the account. It will accrue until needed. Those funds can be used to keep paying for the policy on the insured should they lose their job (taking the place of cobra therefore saving the insured money). Coverage will not lapse. Payments will be made from those funds until the insurer returns to employment. When they do, in addition to the 10% another 5 % will be reduced to pay back the account the funds used to keep the employee insured. The reason for the extra 10% is simple. When the insurer retires there will be enough in the fund to continue to make payments and keep the policy in force. That way the elderly are insured and do not have to go on Medicare (no more Part B, no more forcing the elderly to take Medicare, saving Medicare money). The saving to Medicare will be huge and should relieve Medicare the stress of providing health care for so many. It will not go broke on this system as the demand for Medicare will drop enormously. . Those funds in Medicare can cover those under 18 without parents, those in foster care, and those in orphanages, even the homeless when they wander into emergency rooms can be cared for by Medicare.

There will be a cost to the Government for maintaining the accounts, collecting the funds, distributing to the insurance companies. But this will not cost the Government any additional funds out of the budget. The funds saved from the Medicare program will more than be more than enough to fund the new Medical Oversight Department.

Since the policies will be the same no matter which company offers them, and the price will be dictated as to cost, An insured can choose any insurance company they want. Insurance companies will offer this policy in every state. They cannot choose to not participate in a specific state. Should it be discovered that a company is avoiding issuing policies in a particular state, they will lose the right to issue any new policies for a period of 3 years and pay a one million dollar fine.

Now this only represents a broad stroke of an idea. I am sure there can be improvements made to it. And I am sure if this was expanded on in congress. It would not take 12000 pages to become law.

Copyright 2011

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