E-Party HEALTHCARE ANSWERS FOR OBAMA's TRANSITION TEAM! Must be done by 12/31
Highlights of our concerns pulled from past discussions. (Seems, in review, that we were more focused prior to election – with planks and points and purpose…btw).
Concerns:
1. Insurance companies are making money at the expense of American’s health.
They made 5 times the profit of oil companies last year.
• - CEO’s are making in excess of $20 million a year while denying coverage to those who need it. Insurance companies are fully responsible for the mess that we are in and are doing nothing to help but only to compound the issues and lying to the policyholders because they know we “have to have insurance” – controlling EVEN the amount that doctor’s are allowed to charge self-pay patients by saying they can’t offer discounts less than the discount given to them in network savings.
• Insurance companies are increasing their pressure to control what services a patient receives – taking over the decision making process (away from the patient and physician) by frequently denying services and medicines.
• Pharmacuetical companies have inflated the costs of drugs to Americans while discounting them to other countries all under the guise of research. This has to stop. Fair payment is fair payment for all.
• Premiums and co-payments go up every year while at the same time payments (reimbursements) to physicians and facilities go DOWN every year. The “charge” amount by facilities and physicians are not real as insurance and Medicare determine beforehand what each service is worth so facilities and physicians have no control over the “COST” of healthcare. For example – an office visit cost $65, ins says it’s worth 36, patient pays $25 co-payment, insurance only pays $11. But tell the patient “costs are up?”
• Premiums should be more like auto insurance – with positive and negative effects based on personal responsibility. You smoke – it goes up, morbidly obese – it goes up, treated for suicide, drug abuse, alcohol abuse, etc – up. As with insurance – somethings should cause you to be denied regular insurance and pay higher rates. Drunk driving – you have to sign up for high risk insurance , so consequently –drug abuse, suicide ? should be treated the same way.
• Under NO CIRCUMSTANCES should any illegal citizens be allowed coverage. Illegals who show up for medical care – can receive up but INS must then be responsible for deporting them so they cannot continue to be a drain on the system without paying into it.
• Under NO CIRCUMSTANCES should retired or disabled military pay anything for healthcare.
• Tort Reform: Malpractice insurance goes up EVERY YEAR – thanks to suit happy lawyers and patients who think they can sue any and everybody for any stupid reason with no personal accountability. I.e. – suing a physician because you develop complication during a procedure which was a direct result of you being at risk because of your poor choices in life – smoking, drinking, obesity, not taking care of risk factors, and general non-compliance with your own healthcare.
Universal Healthcare – Majority are against any system that limits quality of care and access to quality physicians. There were some very good arguments for a ‘variation’ of Universal Healthcare that included accountability, tort reform, and called for REASONABLE premiums that even the poor could afford.
Another idea was the tax (cost of insurance) to be built into a national sales tax so that everyone pays into it.
So here is the best summary I can come up with for our E-Party Universal Healthcare:
1. Healthcare is offered and available to EVERYONE.
2. Management of Healthcare – is NON-PROFIT!
3. Payment to the physicians will be fee based on a schedule similar to the fee
schedule currently used by commercial insurance but higher than medicare as the
current medicare fee schedule won’t even pay for a physician’s overhead. We
DEMAND a great deal from the people we trust with our lives – they should be
reasonably compensated for the hours of training and hours on call, as well as
overhead expenses to provide care.
4. Physicians MUST be RECREDENTIAL – or REQUALIFY no less often than
every three years and ACCOUNTABILITY must be by peers and Medical Board
– NOT HOT SHOT LAWYERS AND LAWSUITS!
5. We do NOT WANT THIRD WORLD MEDICINE – with restricted access to
necessary care such as annual mammograms, diagnostic testing, etc.
6. Paying for it:
A REASONABLE portion funded through sales tax.
The rest should be PREMIUM paid based upon a percentage of income (can be
obtained through yearly tax statements)
7. PENALTIES (increases) in premiums should be added when EXCESSIVE
personal abuse is documented. I.E. – suicide, drug or alcohol abuse, fraud or
misuse of the system (such as obtaining p*********** drugs only to sell them on
the street), MORBID CONTINUOUS obesity NOT directly related to a
diagnosed issue (such as thyroid or hormones issues).
8. No COSMETIC SURGERY will be paid unless it is reconstruction for injury or illness related amputation.
9. Disabled and Retired Military personnel should NOT be subject to the tax (they can present a card as business and non-profits do at the time of
purchase) and are exempt from Premiums.
10. We expect WHATEVER healthcare is offered that our CONGRESSMAN AND SENATORS AND PRESIDENT – have the SAME THING! No more special golden packages. THEY MUST LIVE WITH THE LAWS THEY MAKE!
11. LONG TERM NURSING HOME CARE – This was not discussed much
– so I’m throwing this out there for you to feed on: -
Qualification for nursing care should be broken into three categories based on the ability to recover.
Long Term care with rehab designed to get the patient back home.
Hospice care in the home (theirs or their childrens) for the terminally ill or
permanently disabled with DNR status. *Substantially less costly than nursing home care**.
Minimal ACCESS with STRICT guidelines – permanent facilities for indigent and homeless with no where else to go who are terminal or permanently disabled and UNABLE to do anything for themselves (such a severe stroke or brain damaged).
I believe FAMILY should be required to provide a home for hospice care if there is family! Hospice care can take much of the hands on daily burden away from the family members but the family can provide the roof and bed and food – at least!
OKAY - HAVE AT IT! Please make points specific to a particular # or issue. Remember we are looking for SPECIFIC PROBLEMS and SPECIFIC SOLUTIONS to present to our President!
Add, delete, amend....Go for it!
Concerns:
1. Insurance companies are making money at the expense of American’s health.
They made 5 times the profit of oil companies last year.
• - CEO’s are making in excess of $20 million a year while denying coverage to those who need it. Insurance companies are fully responsible for the mess that we are in and are doing nothing to help but only to compound the issues and lying to the policyholders because they know we “have to have insurance” – controlling EVEN the amount that doctor’s are allowed to charge self-pay patients by saying they can’t offer discounts less than the discount given to them in network savings.
• Insurance companies are increasing their pressure to control what services a patient receives – taking over the decision making process (away from the patient and physician) by frequently denying services and medicines.
• Pharmacuetical companies have inflated the costs of drugs to Americans while discounting them to other countries all under the guise of research. This has to stop. Fair payment is fair payment for all.
• Premiums and co-payments go up every year while at the same time payments (reimbursements) to physicians and facilities go DOWN every year. The “charge” amount by facilities and physicians are not real as insurance and Medicare determine beforehand what each service is worth so facilities and physicians have no control over the “COST” of healthcare. For example – an office visit cost $65, ins says it’s worth 36, patient pays $25 co-payment, insurance only pays $11. But tell the patient “costs are up?”
• Premiums should be more like auto insurance – with positive and negative effects based on personal responsibility. You smoke – it goes up, morbidly obese – it goes up, treated for suicide, drug abuse, alcohol abuse, etc – up. As with insurance – somethings should cause you to be denied regular insurance and pay higher rates. Drunk driving – you have to sign up for high risk insurance , so consequently –drug abuse, suicide ? should be treated the same way.
• Under NO CIRCUMSTANCES should any illegal citizens be allowed coverage. Illegals who show up for medical care – can receive up but INS must then be responsible for deporting them so they cannot continue to be a drain on the system without paying into it.
• Under NO CIRCUMSTANCES should retired or disabled military pay anything for healthcare.
• Tort Reform: Malpractice insurance goes up EVERY YEAR – thanks to suit happy lawyers and patients who think they can sue any and everybody for any stupid reason with no personal accountability. I.e. – suing a physician because you develop complication during a procedure which was a direct result of you being at risk because of your poor choices in life – smoking, drinking, obesity, not taking care of risk factors, and general non-compliance with your own healthcare.
Universal Healthcare – Majority are against any system that limits quality of care and access to quality physicians. There were some very good arguments for a ‘variation’ of Universal Healthcare that included accountability, tort reform, and called for REASONABLE premiums that even the poor could afford.
Another idea was the tax (cost of insurance) to be built into a national sales tax so that everyone pays into it.
So here is the best summary I can come up with for our E-Party Universal Healthcare:
1. Healthcare is offered and available to EVERYONE.
2. Management of Healthcare – is NON-PROFIT!
3. Payment to the physicians will be fee based on a schedule similar to the fee
schedule currently used by commercial insurance but higher than medicare as the
current medicare fee schedule won’t even pay for a physician’s overhead. We
DEMAND a great deal from the people we trust with our lives – they should be
reasonably compensated for the hours of training and hours on call, as well as
overhead expenses to provide care.
4. Physicians MUST be RECREDENTIAL – or REQUALIFY no less often than
every three years and ACCOUNTABILITY must be by peers and Medical Board
– NOT HOT SHOT LAWYERS AND LAWSUITS!
5. We do NOT WANT THIRD WORLD MEDICINE – with restricted access to
necessary care such as annual mammograms, diagnostic testing, etc.
6. Paying for it:
A REASONABLE portion funded through sales tax.
The rest should be PREMIUM paid based upon a percentage of income (can be
obtained through yearly tax statements)
7. PENALTIES (increases) in premiums should be added when EXCESSIVE
personal abuse is documented. I.E. – suicide, drug or alcohol abuse, fraud or
misuse of the system (such as obtaining p*********** drugs only to sell them on
the street), MORBID CONTINUOUS obesity NOT directly related to a
diagnosed issue (such as thyroid or hormones issues).
8. No COSMETIC SURGERY will be paid unless it is reconstruction for injury or illness related amputation.
9. Disabled and Retired Military personnel should NOT be subject to the tax (they can present a card as business and non-profits do at the time of
purchase) and are exempt from Premiums.
10. We expect WHATEVER healthcare is offered that our CONGRESSMAN AND SENATORS AND PRESIDENT – have the SAME THING! No more special golden packages. THEY MUST LIVE WITH THE LAWS THEY MAKE!
11. LONG TERM NURSING HOME CARE – This was not discussed much
– so I’m throwing this out there for you to feed on: -
Qualification for nursing care should be broken into three categories based on the ability to recover.
Long Term care with rehab designed to get the patient back home.
Hospice care in the home (theirs or their childrens) for the terminally ill or
permanently disabled with DNR status. *Substantially less costly than nursing home care**.
Minimal ACCESS with STRICT guidelines – permanent facilities for indigent and homeless with no where else to go who are terminal or permanently disabled and UNABLE to do anything for themselves (such a severe stroke or brain damaged).
I believe FAMILY should be required to provide a home for hospice care if there is family! Hospice care can take much of the hands on daily burden away from the family members but the family can provide the roof and bed and food – at least!
OKAY - HAVE AT IT! Please make points specific to a particular # or issue. Remember we are looking for SPECIFIC PROBLEMS and SPECIFIC SOLUTIONS to present to our President!
Add, delete, amend....Go for it!
Views: 0
Replies to This Discussion
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Permalink Reply by Kelly Crosby on -
OOPS - forgot to add 2010!
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Permalink Reply by Fred Mars on -
While I do agree with most of your statements, I feel that the medical industry is as much to blame as the insurance companies. First, writing a p*********** is passing on responsibility for wellness to the drug company. I know it was the AMA "prescribes" that doctors do, but it's time that cures came from doctors and not drugs.
The Atomic Energy Commission has shown that exposure to radiation is a cause of cancer, yet radiation is prescribed as a treatment. How many people have been cured by this method? Chemo-therapy is another "cure" that has killed more people than it has cured, yet it remains standard practice to administer these toxic chemicals after surgery, when a patient is most vulnerable to infections and the toxic effects of these potent drugs.
Although physicians may charge $85.00 per office visit, plus any examinations or procedures, I resent having to pay such an amount for 10 or 15 minutes of the doctors time, most of which is spent with an aide or nurse. I did work for a healthcare provider some years ago, and the doctors received "capitation" which rewarded them for performing certain procedures merely to drive up the costs of healthcare. Yes, they do limit the amounts they are willing to pay for the services up front, but they "kick back" to the medical practice, when it suits their agendas.
Maybe when we get the costs of energy down to free or close to it, then all businesses and services will then adjust their pricing accordingly. At the very least they will no longer have energy costs as an excuse for their extortionist tactics. -
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Permalink Reply by Kelly Crosby on
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But they aren't PAID THAT! - READ the explanation of benefits the next time you get a statement like that. They probably got PAID .50 cents.
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Permalink Reply by Kelly Crosby on
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Hmm....never seen capitation in the four practices I worked in - not sure how that works. But I'm not arguing - I've just never been exposed to it.
Kick backs are prohibited by the Stark I&II&III laws. It is also illegal for doctors to 'unite' in any way to fight insurance or set fees - Kennedy/Kassenbaum. Stark laws also prohibit the 'discounting' of bills to patients and cover the issue of professional courtesy. Basically they can't treat each other for the cost of insurance. If one doctor wants to treat another doctor with no cost to that doctor - they can't file the charge with his insurance either.
I'm not saying there is not corruption in the medical profession - there is corruption in every profession because their are PEOPLE in every profession and that means there are Good and there are Bad ones. If you doctor is not giving you the time you think you deserve - or working with you to decide WHICH treatments are best for you and that you are open to - well FIND another DOCTOR.
I have been dealing with chronic lower back pain for 19 years - I've been to multiple orthopedist and haven't found one yet that will even try to DIAGNOSE my problem - they just want me to do expensive, painful injections for inflammation but refuse to find out what is CAUSING the inflammation. I refuse the treatment because I'm not letting them stick a huge needle into my lower spine unless they KNOW why they are doing it and know it won't cause even further damage. I participate in my healthcare. Chiropractor did more than they have. I don't go back to them...and I don't recommend them to others.
That said - if you hate being processed through your doctor's office now - wait until socialized medicine hits - you'll be luck to SEE a doctor when you need him. It'll be a PA or a long, long, wait with poor service. Because we will be down to the quality care of an ER 'rent-a-doctor'.
When was the last time you saw a successful SINGLE physician practice? They're a dying breed because profit is down so much that they are forced to share overhead expenses to make money.
NEWSFLASH - it's okay to PAY our GOOD doctors - they save lives, the help us more often than they hurt us, and when we are injured - we need their expertise. I expect to make a profit working - don't you? -
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Permalink Reply by Regina Magee on -
Doctors only receive a capitation if the patient belongs to an HMO.
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Permalink Reply by Fred Mars on
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Yes, that is where I worked, for a subsidiary of New York Life and it was a HMO.
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Permalink Reply by Kelly Crosby on
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Would love item specific input - What do you agree/disagree with - what other, possibly better, ideas do ya'll have out there?
Definitely need real input on long term, late life care, please. -
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Permalink Reply by Bill Tucker on -
Kelly,
Good work and well stated, thank you for all of your efforts. There are a couple of points I would like to address:
1) ACCOUNTABILITY must be by peers and Medical Board – NOT HOT SHOT LAWYERS AND LAWSUITS!
I tend to disagree, here in Florida Medical Boards and for that matter the AMA do not discipline doctors but tend to make excuses for them. Accountability through the civil courts is foolish. Though there are times that a Health care profession should be held accountable through the civil courts because of woeful negligence the first step should be censure by a state board, the state board should have not just Doctors, but nurses, and civilians so that Doctors can not sweep things under the rug so to speak.
2) Management of Healthcare – is NON-PROFIT!
While I agree with the principle here a not for profit corporation can still pay compensate executives with outrageous sums. Case in point would be The United Way CEO scandal of the 1980's. Granted it was nothing compared to the compensation of today's Managed Healthcare CEO's but still grossly overpaid. Bottom line is American Healthcare insurance and coverage should not be a profit generating vehicle for corporate executives and share holders.
3) A REASONABLE portion funded through sales tax.
While I agree in principle, I am not sure I like this one as it takes corporations out of the loop, many of us get sick or injured as a direct result of corporate short sightedness, but as it is a valid way to also force previous non contributors to pay then enough said.
You can feel the smoke and passion you have for the subject from the introduction. Once again well said and good work.
Thank You! 2010 -
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Permalink Reply by Bill Tucker on
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Kelly,
Long term care is not something that I think about too much as I have already decided if I ever need how I am going to go out. A shotgun and a gang banger neighborhood, that however is my choice. No matter how you look at it long term care is going to be costly, very costly. The very old and infirmed did not plan on being there but as a result of our longer life expectancy it is going to occur more and more frequently. While agree that the family should bear some responsiblity and many will I do not think it would be wise to force the issue. I would agree that the first step would be to rehabilitate (if possible) for a return to their or preferably a family members home.
Quality of care in a long term environment be it at home or otherwise is of great concern. I hear horror stories, but people are in need and going to need the care so that care needs to be available and the providers need to be compensated fairly but with vigilant oversight. If we can reasonably eliminate the waste and abuse of the for profit insurance system this should be achieveable, or maybe I am being overly optimistic.
Hospice, hospice providers are truly God's chosen. What relief to individuals and families they provide. People when ever possible should be at home when they pass. In my case I would rather go out quickly and hope I have not earned a lingering drawn out passing.
I think the answer to most of the problems with the health care system and how to fix the system are with non health care providers deciding how much something is worth. While health care providers doctors, nurses, technicians, researchers, what ever are entitled to a profit, companies, "bean counters", stock holders, and what ever are not in my humble opinion. A company like Johnson & Johnson that developes and manufactures equipment should make profit, but an insurance company like "you enter the name of your favorite" should not.
Pharmaceutical companies, what wonders they produce and how evil in their greed they are. Mr. Mars touched on the subject in a previous post, many so called wonder drugs are not all that wonderful. They treat symptoms and cause other problems. Doctors in an ever increasing dependancy on pharmaceuticals do not cure illness but prescribe drugs. There are those that treat the person with what the AMA would deem alternative medical practices but are simply where our doctors were before the pharmaceutical madness started. Our FDA is partially responsible for this trend, as they are not researching and controlling these drugs and practices enough. Our Surgeon General is also responsible as is the AMA. What is the AMA anyway but in effect a union for doctors. I know they are more than that but that is the way it actually breaks down. You can not do this or that because the AMA does or does not endorse the practice.
It feels like I am starting to ramble here so let me sum this up, more and more the water we drink needs to be purified, the air we breath is ever more polluted, the food we eat is full of preservatives, pesticides, fertilizers, antibiotics, growth hormones, and what ever else, we are more and more forced to work for places and people doing things we really don't want to do to keep food on the table and a roof over our heads, radio beams and electronic signals premeating the air we walk through. What I am trying to say here is that there are so many things to consider and so many reasons that we have not considered that it can be overwhelming, you have made a great start and we should go with that start you have made.
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Permalink Reply by Fred Mars on
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The AMA story is quite an interesting one. In spite of the legends, the AMA was created based on greed and profit, never as a true union of physicians, or a real oversight group protecting the patient. Here is a brief summary of the founder of the AMA:
"Dr. Morris Fishbein (1889-1976) originally studied to be a clown. Realizing he could make more money as a doctor, he entered medical school (where he failed anatomy), then barely graduated. He never treated a patient in his life.
Why is he so important? Because he became head of the AMA, a position that he used to enrich himself and crush legitimate therapies out of existence. He appeared to be motivated solely by money and power. "
You may also check the Barry Lynes book The Cancer Cure That Worked: 50 Years of Suppression and decide for yourself if we are being treated fairly and told the truth about diseases and illnesses. -
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Permalink Reply by Kelly Crosby on
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Not well versed with the AMA except as a resource for continuing education for doctors, advocacy in issues with insurance, and training for staff.
Not a great beginning, I admit - but what is the AMA now?
I believe that Cancer will not be cured as long as Pharmacuticals can make the money they do TREATING it.
This *$@&* about cost of meds being high because of research costs being built into it is really getting old. The answer to that is to make sure research is funded through grants as it is in other industries AND make COSTING it out to the consumer illegal.
Bill - I see very well your point on the sales tax - so how about we set up a small percentage tax on Businesses - possibly based on their payroll tax dollars. After all it is still cheaper than the current system of over-priced group insurance.
As for non-profit. If this is government mandated insurance (Universal Healthcare of sorts) than I would hope (probably in vain) for mandatory reporting of costs, monies and how they were sepnt, and annual reports that are available to the public as is required of non-profit organizations now. What we don't want is greed involved in the process of protection the health of individuals, and that greed abusing the system. Although if I knew how to stop it - I'd be on Capitol Hill right now...lol. -
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Permalink Reply by Bill Tucker on
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Kelly,
As would I. Universal health care does not mean socialized health care. Why any one with the intelligence to use a computer would deny honest hard working tax paying Americans access to health care is beyond me. Of course their has already been statements siding with the insurance companies, that I could not believe but it is true I read and reread it. People that can afford quality health insurance are in the minority in the United States not the majority. Illegal immigrants while they are a drain on the public dollar are not the problem greedy insurance companies are. The largest insurance provider in my county is Health First, it also now owns all of the hospitals less one. If it is able to secure a monopoly then we are in for trouble. Not to long ago my local newspaper ran an article that talked about how when most companies are curtailing and eliminating benefits for retirees that one local company was expanding them, care to guess who that company was? Health First, was expanding benefits for it's retirees at our expense, that same year premiums went up, copays went up, coverage went down. Gee funny how that worked out isn't it?
Your sales tax thing would work but should not be the only source of revenue for a universal health care program. Some people are going to require more health care than others and should pay accordingly, for instance I am single with no children, I rarely go to the doctor, though now that I am 50 I will go ever year. Some one like me should not have to pay for the family of five that goes to the doctor 10 times a year, or the reformed drug addict who has shot their own health in the foot and now has to see a doctor regularly, or for that matter women need to and should see a doctor more than men. That is where I was actually going to with the sales tax, but then a family of five probably buys more than a single man, and a woman defintely does. LOL So after thinking about your sales tax idea why not run with it. There are other agencies that deal with health in the work place so it might actually lower the cost of doing business. Illegals and tourists and people outside the system would actually be paying into our health care system which to me would be a good thing.
When you are in school your taught that insurance companies work from a "pool" of income, that what ever monies are not used to cover claims it is reinvested and those investments are supposed to pay share holder dividends. That is not the way insurance, any kind of insurance works in America today.
By definition a publically held corporation's balance sheet, income and operating expenses are supposed to be accessable to the public. Though I have found that normally what is accessable is very cryptic and far from truthful. A not for profit corporate charter could fix executive compensation and provide for transparency as far as costs, income, and corporate expenses. My point with regard to not for profits are that just because they are not for profit does not mean that there is not alot of room for abuse. That can be dealt with from the start with a properly designed charter.
I find it very interesting that people want the new President to pay for his own health care and want to know what he is going to do about our southern border, when the out going President has done nothing except once again try to provide ammensty for illegals, he also met several times with the Mexican President prior to his election. Wasn't the last President to offer a blanket ammensty to illegal immigrants George Bush Sr.?
2010 -
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