Poyhonen's Blog

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Posts Tagged ‘health care

Health Care Reform Helps Insurance Companies Profit

We could subsidize Health Care service providers:

The cost of giving every licensed physician $100,000 would only be $90 billion per year.  This sounds ridiculous and expensive.  Ninety billion dollars spent with no detailed government oversight. People would have to pay co-pays and buy medical insurance without Government assistance.  Poor folk would get the same care without a lot of paperwork.  Dissolving Medicare and Medicaid would allow a free market to sell services for about fifty bucks a month per person. Yes, current payroll deductions would continue in order to augment compensation for all medical personnel relegating catastrophic health insurance to be bundled with car and home insurance schemes.


No one seems to like the idea of giving tax dollars to doctors, nurses, and healthcare professionals.  No…, no, no, we can’t do that–our politicians, (and voters), would rather give insurance companies your tax dollars.  The enlightened goal is to provide everyone with a ‘plan’.  We are fated to accept the voters demand for subsidized health care insurance.

Payment of your medical bills gives dividends to stockholders and companies who are in business to make a profit.  They need to give higher dividends, don’t they?  After all, the yearly compensation for the Aetna CEO was a paltry twenty-seven million in 2016.  Stock options helped a lot.

Our health plans subsidize insurance companies in order for them to make money from your illness.  Sounds harsh, doesn’t it?  Your medical bill – if you can figure it out – includes profit for the stockholders, compensation for insurance sales persons, insurance executives pay, insurance buildings, advertising costs, and finally – your doctor’s salary.  The bookkeeping and bureaucratic overhead alone adds only about thirty percent to your bill.  The government argues that their portion of overhead is low.  That bears some truth because the bureaucratic efforts are made by the providers, (more on that later).  The government must ensure the fair and correct spending of your taxpayer dollars and their oversight requires massive record keeping and the development of forms.  Just remember–the government is here to help… to help…to help.

Some details collected from Justfacts.com:

Roughly, 60 minutes of paperwork are performed for every hour of emergency department care, 36 minutes of paperwork for every hour of surgery and acute inpatient care, 30 minutes of paperwork for every hour of skilled nursing care, and 48 minutes of paperwork for every hour of home health care. “Each time a physician orders a test or a procedure, the physician documents the order in the patient’s record. But the government requires additional documentation to prove the necessity for the test or procedure.”

  • “Many forms … must be completed daily by clinical staff to submit to the government to justify the care provided to skilled nursing facility patients.”
  • Medicare and Medicaid “rules and instructions” are more than 130,000 pages (three times larger than the IRS code and its associated regulations), and “medical records must be reviewed by at least four people to ensure compliance” with Medicare program requirements.
  • “A Medicare patient arriving at the emergency department is required to review and sign eight different forms—just for Medicare alone.”
  • “Each time a patient is discharged, even if only from the acute unit of the hospital to the on-site skilled nursing unit, multiple care providers must write a discharge plan for the patient. This documentation, as long as 30 pages, applies to all patients, regardless of the complexity of care received within the hospital or required post-hospital setting.”
  • In addition to regulation by state and local agencies and private accrediting organizations, hospitals are regulated by nearly 30 federal agencies.

Our government cannot think about giving tax dollars to health care professionals when paper pushers are more necessary to guarantee profits for insurance companies.  The massive government database contains items for every illness to include getting bitten by a duck or walking into a lamppost. They even have an item designation for walking into a lamppost for the second time.  Yes, the government will document your lamppost ‘problem’.

Who pays for all this?  You do.  Does the doctor really make out financially?  The admin persons at the hospital can make more than a surgeon.  Do you want that Admin professional in the operating room?  Don’t worry – admin is always there in spirit.  Someone must ensure the stockholders make a profit.  Is your deductible paid?  How much will the government kick in?  Does the patient ‘plan’ ensure this procedure is cost effective?  Everyone should be concerned with the last statement.  What happens if the procedure is not cost effective?   Does the cost/benefit/risk analysis allow a bone marrow transplant for a patient deemed terminal, (without one)?  Ask the insurance company or hospital admin – the only case I know of concerns a deceased mother of two who did not meet the criteria.

Whatever health care system you like should exclude stockholder dividends.  Your bill should not include a dividend to stockholders gambling on making money from your illness.  Some CEO should not be making millions each year by managing insurance schemes that profit from people requiring medical attention.  People are actually demanding government-sponsored monopolies because politicians tell them there is nowhere else to go and no other method of eliciting professional service.

All hospitals, including Non-profits, currently absorb the costs of services provided to the poor.  (Insurance covers costs in order to make a profit and do not include non-paying patients).  For example: According to the research by the research of Craig Garthwaite, Tal Gross and Matthew J. Notowidigdo, the cost of each poor patient in Tennessee is over a thousand dollars.  The hospitals lose money unless Medicaid shares the burden.  Your taxes pay for that as well.

A single payer plan will allow the Government to ‘help’ everyone by raising taxes and dictating the costs of all benefits.  ‘Medicare for all’ is a mantra for single payer advocates.  Sounds good, doesn’t it?  Cuba and Canada enjoy the benefits of single payer.  You may experience Canadian relatives taking residence in the USA in order to get medical attention but such activities would never happen if Our government took over health care and dictated the compensation to all medical providers.  Our government has a proven and cost effective record of … ‘helping’.  You can relax and feel secure when your doctor enters the operating room and tells you, “I’m from the government.  I’m here to help.”  Hopefully, you can understand the language used.

Twenty percent of our doctors currently come from foreign countries and there is a predicted shortage of doctors in our future but never fear – government insurance schemes will provide succor and it will only cost a couple TRILLION dollars.  Of course, we may have to deal with the government directing our lifestyles in order to keep premiums low and profits, um, manageable. Drinking soft drinks and eating meat may become as unhealthy as owning guns.  Government mandated bicycles could replace electric cars and who would want to go to school for 14 years to become a low paid doctor employed by the government?  A small increase in taxes, perhaps an extra TRILLION, might cover the expense but don’t worry, we can always raise taxes.

Now may we discuss subsidizing the providers instead of subsidizing insurance companies run for profit and controlled by government bureaucrats?


How to Repeal and Replace Obamacare and Avoid All the Complaints

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Think about the complaints and concerns instigated by the dire thought of repealing Obamacare:

People would lose the free services provided by Obamacare.

The Government would lose tax income provided by Obamacare taxes.

Democrats will complain and spin any replacement concepts as insufficient – and probably racist.


My suggestion is to consider Replacing Obamacare before repealing the act, mandates, and taxes.

Replacing Obamacare with a concrete system would allow all supporters and detractors to review the efficacy of the replacement – before – dissolving Obamacare.  The concerns of replacement aspects will be answered, improvements can be made, and costs can be determined so that health services can be available before the ACA collapses due to an inherent poor design seemingly created for income redistribution rather than health care. The added bureaucracy is astonishing, (and adds about 30% to the cost of health care).


The largest issue in this method is cost.  The government would be paying for two health systems during the SHORT time allowed for a comprehensive review.  Still, the added cost can be justified as the price of getting the new system right.  One might note that paying for the medical costs of disadvantaged folk is likely to be a cost in both systems so that should not be considered an additional expense.

The second largest issue is also cost – in terms of lost revenue gained by ACA taxing of citizens already taxed by Medicare.


Politically oriented complaints and accusations, name calling, and reports comprised of misinformation and ‘spin’ will be provided by many politicians and media pundits more concerned with gaining self serving power than serving citizens.  Such is the divisive state provided by the last decade of politicians and this proclivity will not suddenly disappear, however, logical and sincere debate should be encouraged for a short period.  Creating another 2000 page series of laws crammed into an Act cannot be allowed.


Sounds simple – well, no – but I believe the concept is more reasonable that Repeal and Replace.

What do you think?

Affordable Health Buffet

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Affordable health care is a confusing description that disguises a menu of government mandated insurance schemes.
Would you expect your car to be efficiently repaired by a restaurant because some mechanics may eat there? Sure, you get to pick the menu, but you pay for everything on it whether you eat or not. Mechanics are offered a buffet of gruel made from the cheapest produce and their care creates profit for the restaurant, who is the primary beneficiary of this flawed concept.
While it may be too optimistic to expect better service when you drop off your car at a government sponsored restaurant, we can all be assured the advertising will continue – Over 8 Million Served.

Medical Insurance

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Who pays for it? Everyone. It is a federal deduction that has no maximum limit although it is higher for those making over 200k per annum. Medicare and Medicaid are both insurance schemes that can be easily confused since both are considered entitlements. Medicaid is concerned with people having very low incomes while Medicare is offered for those over 65 years of age and can be identified by the tax automatically removed in each of your paychecks.
France and Italy rank first and second for medical care in the world. The World Health Organization Ranks the USA as 38th, although we are number one in per capita expenditures. Expenditures for France rank 4th and Italy ranks 11th in cost per person.
The key factor for universal health coverage is that everyone must contribute in order to have a viable national health care system. In America, everyone who works and pays taxes, contributes into our health care system as well as the social security retirement system. It should be observed that almost everyone seems to enjoy the socialist aspects of our country’s current health and retirement entitlements.
Historic Medicare costs or payouts, if you want to look at it that way, are much lower than private health insurance costs by over 25%. The federal VA also has a much better record at buying pharmaceuticals at lower prices. Overall, the Medicare system offers health services for less money than private insurers. There are quite a few reasons for higher health care costs in the private market but this demonstrates a rare occurrence where Government Management actually performs better, (cost wise), than the private purveyors. Since government run programs tend to be excessive in cost – there should be some room for improvement in both areas.
Admittedly, Obamacare was not the right answer to lower costs but the goal was desirable, albeit ineptly designed, administered, and executed under false pretenses. Perhaps, the strict adherence to a form of insurance concept may be part of the problem. Why sell insurance when we could simply pay for services and allow co-pays to be determined by the medical practitioners? By doing so, we could employ both socialistic and capitalistic models. Insurance can step back and offer co-pay insurance instead of examining and quantifying the cost and efficacy of each medical procedure by maintaining a database – (like entry W22.02XA – walking into a lamppost).
National health services can be achieved at a much lower cost than what we currently pay for individual medical insurance. I would recommend States or groups of States review experimental concepts that can be researched, analyzed, and implemented, using plain language regulations that anyone can understand. Paying for services instead of insurance, while including reforms in tort litigation, medical education credentials, and large volume purchasing of pharmaceuticals and equipment will significantly lower the costs of medical service.

Written by poyhonen

December 9, 2014 at 11:18 pm

Obama Care – The Good, The Bad, and The Ugly

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Obama Care – The Good, The Bad, and The Ugly
The Good:

The Affordable Health Care Act, ACA, ensures citizens have coverage without regard to preexisting conditions, offers ‘free’ medical procedures like mammograms, disallows insurance companies to drop patients who become high risk, and does away with annual and lifetime limits of coverage. All insurance companies are kept at bay, (by federal regulators), with regard to rate hikes, and are served by exchanges where consumers are provided assistance in choosing the best options available within their state. All insurance plans offered after 2014 will offer the same benefits, rights, and protections, (unless the insured is obese or a smoker). Citizens earning less than 400% of the established poverty level will receive government support for the payment of premiums. Children can stay on their parents plan until they reach 26 years of age.
The CBO predicted costs of the ACA have been lowered by 137 billion over the period 2014-2023 and this number is being used to demonstrate the savings of ACA, which is funded by taxes, spending cuts, reformations to the health care industry and an excise tax on the insured who choose the higher end plans which cover 80, (Gold), to 90%, (Platinum), of the out of pocket expenses.
“Bronze” plans, which cover 60%, of out of pocket health care costs, for individuals are expected to cost between $4,500 and $5,800 a year in 2016. But if you make less than 4 times the Federal Poverty Line – FPL – (about $45,000 for an individual in 2012), you’ll pay less by virtue of receiving tax credits. Someone making up to 133% of the FPL will get credits so that his net payment will be only 2% of income, while those making 300% to 400% of FPL will pay 9.5% of FPL. State subsidies and federal tax credits will help low income individuals to keep a typical families medical insurance cost to less than 8% of income. Total insurance costs for are expected to decrease by 7-9% due to ACL.
Gold and Platinum health plans can cost up to a maximum 12% of the insured persons income with an additional 40% excise tax. This feature, along with a 3.8% capital gains tax and a 3.8% additional income tax help redistribute income to offset the costs of medical coverage for lower income people.

The Bad:
Average cost for insurance will go up for men by 97% and by 55% for women. Health and Human Services did report an overall decrease of 16%, which is a bogus number not based on any actual costs. Misinformation constitutes one of the worst attributes of the ACA implementation. The misinformation comes from both political parties and almost all the news agencies.
Rising costs cannot be avoided. If you had no insurance before ACA and wish to avoid costs by choosing to not having insurance you will be penalized for not having insurance. Everyone will pay something unless your financial situation is very low.
If your current income is low, keeping it low will garner more benefits than working towards higher wages and better paying jobs. This creates a counterproductive environment that is supported by ACA and other progressive handouts.
The ACA system is extremely complicated. Petitions for waivers allow small businesses to acquire low cost insurance during the transition period of ACA implementation. The waivers are reviewed and granted to make sure businesses don’t become devoid of insurance. It is assumed that, as ACA implementation continues, tax incentives will allow the waiver beneficiaries to join the mainstream. This is just an example of the complicated effects of Government intrusion into small business while trying not to destroy small businesses in the process.
ACA continues the move towards a centralization of medical health care and services. This is an inherently bad concept because innovation has disappeared when the services are centralized as they are in Europe. Corruption, waste, and rationing accompany centralized health care. The largest negative impact that impeding innovation is that the loss of innovation will not be recognized or missed.
Regulators always, Always grow their organizations. Management and overhead costs will rise as the organizations swell and grow more regulations. The concept is insidious and is guaranteed. Since ACA is now considered a tax, higher taxes are a future feature that will compete with health care rationing in an attempt to keep costs down.

The Ugly:
A great deal of the rhetoric concerning the fallacies and efficacy of Obama care are false. Some statements are misleading while others are outright fabrications and the B.S. flows from both political parties and all of the news agencies. The divisive result upon our culture is ugly. Who would want to raise their children to become politicians? The personal diatribes against individuals is vitriolic and usually does not support any semblance of problem solving. This article won’t address fixing the demeanor of our politicians and news agencies but will remain focused on the Affordable Care Act, A.K.A. Obama care.
To be succinct; ACA is ugly because it is a stupid solution to the costs and distribution of health care. It only serves to give control of personal lives and behavior to a centralized authority that may or may not be benevolent.
ACA attempts to control health insurance. Most people would prefer to have health services instead of insurance. Read that last sentence again, slowly. If your leg is broken do you want to see an insurance agent or a doctor? Isn’t it obvious that ACA is aimed at the wrong target, (unless you are seeking to control the lives and behavior of your fellow citizens). If the state is concerned with the cost of health services then why would they add a huge complex bureaucracy to ride on top of the means for paying for such services? i.e. Insurance. The insurance paperwork, regulations, and bookkeeping already add 20 – 30% to the costs of health care today. ACA would force everyone to pay for more paperwork and bookkeeping plus additional regulations. More regulators produce more regulations which must be reviewed and enforced by an ever expanding bureaucracy. If you think that is implausible, look up W61.61XD. W61.61XD is a billable ICD-10-CM code that can be used to specify the ‘approved’ medical diagnosis of being bitten by a duck.
Yes, I believe ACA is ugly, ignoble, and serves as a means that could be used to force our society down undesirable paths while disenfranchising innovation. Ugly and dangerous.
Even this unknown analyst can, and has, proposed a system that allows insurance to be bypassed. Subsidizing health services rather than insurance will allow innovation while actually reducing the costs of services that may be provided to everyone, at their choice. The concepts have been discussed in past articles and limit the scope of such activities to State participation and execution. This blog is one small voice – surely there are others, having significant audiences, that can bring such concepts forward. A debate centered upon Health Services reform Vs. Affordable Health Insurance would be efficacious and enlightening for our society.

Resolution for Health Care Reform

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I briefed Congressman Ribble about Medical Coverage Reform for the state of Wisconsin. He is thinking about my suggestions. The Tea Party Patriots asked for a one page summary so I gave them the following input.

One page is barely sufficient to accurately summarize this concept but I’ll try to give you an idea of what is suggested.
Please let me preface this summary with some information that instigated further analysis – I added up all the costs for salaries of all health care workers in our state of Wisconsin – My analysis resulted in about $8 billion.
$8B for all care workers, pharmacists, doctors, nurses, therapists, technicians, bed pan changers. Wisconsin budget and census data agreed with this order of magnitude, however, adding Social Services raised the figure to about 14 Billion. Another key piece of data is the Milwaukee Sentinel report stating that Wisconsinites had spent about 40.9 Billion Dollars on health care. (2009).
There is a glaring 32B difference in salaries of providers vs. service. Even adding social services leaves a spent cost of $26B. $26 Billion dollars for what? Energy, buildings, and equipment for one year?

Key factor: State Insurance is the wrong direction. There is a lot of data to support the purchase of services over the purchase of insurance.

We need to buy health services and abandon the costly health insurance schemes. We can purchase  services using a co-pay methodology that allows doctors to charge whatever they want for a patient co-pay, subsidized by the state, which would have maximums at a small level and outright full payment, (by the state), for expensive procedures, (heart transplants). Concrete example: with a $35 patient and state co-pay doctors having only 800 patients can make $168,000.00 per year after servicing each patient an average of three times a year. That is seeing only 10 patients per day. The total co-pay for every man, woman, child resident of Wisconsin would be less than $200 Million state funded dollars. Ok I’ll stop the preamble here.

Health Care Summary for Wisconsin

Health Services are paid by customer co-pay and State per visit – Minimal Records
Existing health dollars are folded into the new State Health Fund
Medicare, Medicaid, Badger Care, any Federal funding, etc.
Doctors and Patients keep Health records – Doctors bill State for co-pay subsidy.
State buys Equipment, Hospitals, (as needed), Pharmaceuticals, Energy, and vehicles.
All services require co-pay, low income co-pay is determined by the doctor.
State co-pay is a flat rate,($35), but Certain areas may require higher co-pay by State – Option
No Wisconsin resident will be turned away. (State and physician Contract).
Patients can use any insurance (except Medicaid/Medicare) the servicers will accept.
Fees are paid upfront and patient bills insurance company for reimbursement.
Other than Hospitals and major equipment, servicers pay for office facilities.
No limit on number of patients per doctor
Discard B.S. degree requirement for credentials – Exam requirement is acceptable.
Consider giving all facilities non-profit status.
Execute Paul Ryan Tort reform.
Servicing out of state patients does not garner State co-pay.
Discard existing regulations and regulatory agencies, Wisconsin Health Board will make new regulations as needed Wisconsin physicians will be certified by the Wisconsin Health Board.
Lower requirements for licensed health care professionals.
I am trying to keep it short so I’ll stop at this summary. Make changes, ask questions, and share with your representatives!
Mark Poyhonen
Crivitz, WI

Was America betrayed by our Supreme Court?

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Obama care is in and the conservatives are surprised.  How could it happen?   The commerce clause was rejected by the majority of the SCOTUS but  the law passed under the explanation that congress held the power of taxation.  The level of corruption demonstrated by our politicians  might make one think some liberal found a skeleton in Justice Robert’s closet – but there is no evidence supporting a conspiracy.  He explained his vote.  What about the votes of his fellow justices?

What were they really thinking?  The constitution supports the right of congress to tax citizens  to oblivion?  Let’s rewrite the proposal  and substitute ‘Tax’ in place of ‘Commerce Penalty’ and now the law is fine?


Wait a minute.  Hold on while we think about our Supreme Court.  Isn’t our Supreme Court the third member of a triad meant to keep the other powers of our government at bay?   How could any of them have accepted a mandate to take over one sixth of the American Economy?  Yet few seem surprised that four of the justices voted ideologically instead of constitutionally.

Well, here is the point:  Our Supreme Court has been an extension of party ideology for years.  Each party has attempted to ‘salt’ the bench with like thinking supporters of one or the other party of government.

The Court now represents the culmination of fears  presented by our forefathers – most notably, George Washington, who feared the effect of a two party system, and Thomas Jefferson, who felt the life terms and power of the judicial branch could become a dangerous practice.  Jefferson was prescient when writing:

At the establishment of our constitutions, the judiciary bodies were supposed to be the most helpless and harmless members of the government. Experience, however, soon showed in what way they were to become the most dangerous; that the insufficiency of the means provided for their removal gave them a freehold and irresponsibility in office; that their decisions, seeming to concern individual suitors only, pass silent and unheeded by the public at large; that these decisions, nevertheless, become law by precedent, sapping, by little and little, the foundations of the constitution, and working its change by construction, before any one has perceived that that invisible and helpless worm has been busily employed in consuming its substance. In truth, man is not made to be trusted for life, if secured against all liability to account.

As time has passed, our Supreme Court justices have been selected along party lines but what went unnoticed was that the party lines were becoming very similar.  The result is bigger government and less freedom.  Both parties grow government and inundate us with the regulations of special interests.

Politicians have learned that they get more votes by giving stuff away.   Citizens will support politicians who give them free medical care, housing, food, and transportation.  It has happened and is happening.  Money is garnered by satisfying the whims of special interests.  Add a divisive agenda – blame all your woes on somebody else and it becomes easier to see how our courts and population are being manipulated.  Racial profiling, religious criticism, class warfare – it is all there and on television every day.  The goal is to bring at least half the population under government subsidy and control.  When that is achieved – the fundamental transformation of America will be completed by individuals who will always be reelected by the majority of voters who are fed and controlled by the politicians.   And that answers why the supreme court did what it did to America this past week.

The greed of Corporate America also echoes the grab for power by the opposing  Progressive America.  They are fighting each other for your dollar and your freedom – what’s left of it.

Funding the power or feeding the greed are both unacceptable courses of action.  We need to hold the public corporations at bay in a manner that does not impede the free enterprise that made those companies profitable and powerful in the first place.

We can bridle the private sector but we must not, at the same time, harness ourselves with a socialist model of government under the guise of providing safety nets for the disadvantaged.

Sure, you may be on food stamps because our economy is down.  You may fear you can’t afford medical care because your job doesn’t support complete medical coverage.  Why not vote for the subsidy?

Why not?  In truth, nothing is ever free.  The future payments for those alleged subsidies will cripple your children and if you are young enough today – those payments will cripple you.  Not just monetarily.  Their education and culture will also be impaired.  Those in power will see to the ‘enlightenment’ of your children.  Better make room in the basement; your kids will be living at home for a long while.

Currently, our United States has the best medical care in the world.  http://www.pacificresearch.org/docLib/20081020_Top_Ten_Myths.pdf

Of course our system can be improved,  but when people around the world are sick; they come here.  Have you ever been denied medical care?   I had Canadian relatives that lived in the US after they retired because of the availability of medical care.

We do have a long term solution.  It is an old solution but it still works.  Jefferson knew that the people were the final arbitrators of society.  He counted on the voters being willing and able to correct the imperfections of our republic.  He predicted that the authority of the various branches of government would become skewed at times and he put his faith in the power of the voters to correct the situation.

Vote for less divisive candidates. Vote for less government.   Don’t vote for anyone exposed in a lie of any magnitude – (deletes a lot of current office holders).  And if  we were to select a Supreme Court Justice, may it be suggested that we give preference to someone who studied history and demonstrated an understanding and philosophy that is in agreement with our constitution as it was written by our forefathers.  Please, don’t select another lawyer.

Written by poyhonen

June 30, 2012 at 2:41 pm