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Posts Tagged ‘Health Services

Health Care and the Government

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Not approving Ryan Care was a narrow escape from an increasingly intrusive government that seems bent on controlling every aspect of American lives.

Most people would prefer to see a doctor when they have an illness or physical complaint. They would not willingly take a sick child to an insurance outlet or government building unless they had no choice. (Imagine taking a feverish baby to the DMV for treatment). Yet when you enter the doctor’s office and notice all the busy people that greet you from behind a desk – what do you think they are doing? They are filling out forms and documenting your access to insurance companies and government agencies who dictate the cost of your visit and the care you are entitled to receive.

Countries having high levels of subsidized health care, France and Italy are good examples; require that everyone pay into the government health fund. In America we all pay 1.45% of income, (hiked by an employer tax of an additional 1.45%), into our Medicare system but only people getting Social Security get the benefits. In 2015 the American Hospital Insurance Trust Fund garnered 275 Billion in taxes and spent 646 billion in services for only 15% of the population, (according to AARP).

So the illustration here is that we already have a universal insurance system that is paid into by every worker but the benefits are only distributed to retired people and the outlays for this insurance scheme exceed the inputs by about 371 billion dollars a year. The numbers get MUCH worse as they are analyzed to include every citizen.

Consider, for a moment, what insurance is supposed to provide. Health insurance is supposed to pay for the professional services, equipment, and drugs provided by licensed physicians and hospitals. In order to Control prices and services the government and insurance companies create rules, regulations, and make an effort at price fixing procedures. They require immense databases to achieve these goals and you can appreciate the health code designation of being bitten by a duck as just another line item under their scrutiny. If you think that is a bit complicated, there is another entry for walking into a lamp post. Too much? How about the designation of having walked into a lamp post for the second time?

Clearly we have too many ducks, lamp posts, and regulatory constrictions that are meant to control costs but inadvertently end up controlling lives and behavior.

Since the insurance is supposed to pay for professionals – take a look at what we could do with the 275 billion collected every year:

Give every licensed physician $100,000 …. .90 billion per year.

Give every registered nurse $30,000 ……… 90 billion per year.

Give every hospital $17 million………….…95 billion per year.

I just ran out of Medicare funds at 275 billion but our government spends over 646 billion on Medicare and adds another 546 billion with Medicaid, (2015 numbers). Where does this money come from? The general fund supplies the extra largess – – in case anyone is noticing our country currently has 20 Trillion in debt.

Well what if we doubled the tax rate for Medicare and now garnered an extra 275 billion for:

$75,000 for every licensed Nurse Practitioner…..…..8.3 billion per year.

$45,000 for every Physician Assistant………………3.2 billion per year.

Drug subsidies………………………………….….263 billion per year.

There – everyone in the USA would now be covered to some extent and to receive the subsidies all the accepting parties would have to do is not turn away any citizen from medical services. The government would no longer be in an insurance business where they have proven to be incredibly inept. The Government involvement would be relegated to a disbursement of collected funds to health professionals. The savings in paperwork, regulating, and oversight would actually save about 30% over current medical costs dictated by insurance. If the extra taxes are too big a burden consider paying the extra 275 billion from the general fund while still reducing the overhead by over half a trillion dollars per year.

Nothing is free, however, and the amounts mentioned will still not cover the total expenses. An average doctor’s earnings are about 160,000 per year and how will they make an income – not to mention the pay of specialists who spent years in getting certified?

Co-pays.

Let doctors, hospitals, drug venders, and specialists charge whatever they desire in the form of co-pays. Some doctors in Kansas are charging $50.00 per month for adults and $10.00 a month for children to cover all medical services and they negotiate a discount of over 80% for drugs used by members who pay the monthly service fee. (Only 100 patients would be needed to add 60,000 per year but facilities and staff are still an expense that requires income). Catastrophic insurance can be purchased to cover the large co-pays that may be demanded for major medical services like cancer treatments, transplants, significant surgeries, expensive drugs, or continuing services like dialysis.

In the future, one might see catastrophic health insurance ‘bundled’ with car and home insurance plans. Medicare, Medicaid, and Obamacare would be gone. Only the Medicare tax would remain. Paperwork would be an addition to the IRS tax form.

There is more the government could do of course – Allow health employees, doctors, assistants, etc. to pay minimal or no taxes for example. Tax free health saving accounts and catastrophic insurance sales across state lines could be allowed and perhaps, someday, be offered by employers that allow employees to carry the account privately or onward to new employers.

And what about the poor people who get sick but have no job, pay no taxes, and have no catastrophic health insurance? The poor will always be with us – that is why we paid the doctors up front. No citizen will be denied service by those who promise first to do no harm.

This style of funding should also spur an interest in more people willing to become doctors which are currently predicted to be 90,000 short by 2025.

Concrete and predictable medical costs have proven to be elusive when payments are made by governments and insurance companies. If someone else is paying – the billing is of little consequence to the patient. In this subsidized system, transparent costs would allow patients to seek the best service at the lowest co-pay. No two hospitals charge alike and most patients only get solid costs after services have been rendered.

No one would like to take a car to a mechanic, who never provides an accurate estimate of charges unless they knew someone else was paying, (insurance company). Fortunately, mechanic mistakes can be expensive but are not usually life threatening. Medical services, conversely, are given very little latitude where judgments fail to achieve desired results. Complex problems are weighed in terms of outcome and risks to the patient vs. costs, profits and risks to the insurance providers. Health providers do make mistakes but such errors are often the product of being human where, in the end, we all return to the manufacturer.

Health Service Reform Letter to the Governor

with 3 comments

Dear Governor Walker,
When I reviewed the costs associated with health care I was amazed at the disparities of charges for like procedures and the expensive impact of health insurance, which added tremendous overhead to the costs of medical services.
I added up all the costs for salaries of all health care workers in our state of Wisconsin – My analysis resulted in total salaries of 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 margin of $26B after all salaries are paid. $26 Billion dollars for what? Energy, buildings, and equipment for one year?
Key finding: State Insurance is the wrong direction. There is a lot of data to support the purchase of services over the purchase of insurance.
Patients at Bayonne Hospital Center in New Jersey requiring treatment for the respiratory ailment known as COPD, or chronic obstructive pulmonary disease, face an official price tag of $99,690. Less than 30 miles away in the Bronx, N.Y., the Lincoln Medical and Mental Health Center charges only $7,044 for the same treatment. The federal database of national health care costs just made public exposes the wildly varying cost of services charged through health insurance mediums. The new database reveals a perplexing assortment of prices for similar medical care.
Even within the same metropolitan area, hospitals charge prices that differ by staggering degrees for the same procedures. Virtually everyone who seeks health care winds up paying inflated prices in one form or another as these stark disparities in price inefficiencies are apparent throughout the entire marketplace. Add to these exorbitant costs is the burden of charges shared by the person who has insurance and gets a bill that maximizes his deductible while much of the remaining bill is forgiven and not paid by any insurance company.
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 3 visits per year for every man, woman, child resident of Wisconsin would be less than $200 Million state funded dollars. Compare that number to the cost of insurance and it is easily seen that adding more overhead burdens to an out of control pricing model is like trying to make cars more efficient by putting an elephant in each passenger seat and claiming the cost of the ride is now being shared.
Health Care Summary for Wisconsin:
Dump the elephants!
Health Services are paid by customer co-pay and State co-pay per visit/procedure.
Minimal Records – patient X seen by Doctor Y on xxx date for yyy service. It is imperative to include patient co-pay for all medical services. While state subsidies will make care affordable, studies have shown that when a patient pays for service, unnecessary services are kept to a minimum while total health and longevity remain unaffected.
Doctors expect fair compensation and their salaries are what this concept is focused upon. Hiring of the doctor is reflected within the state co-pay. In all cased reviewed, where an employer hired the health providers, the costs were greatly reduced and the services were enhanced. This suggested process represents a hybrid approach where the state supports the total earnings of the health services professional.

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, patient co-pay is determined by the doctor.
State co-pay is a calculated rate,($35 – $60 for an office visit). Specialist co-pay subsidies need to be calculated and accepted by medical staff. No Wisconsin resident will be turned away. (State and physician Contract). It must be noted that NO existing insurance scheme includes everyone.

Patients can use any insurance (except Medicaid/Medicare) the servicers will accept.
But for insurance users, fees are paid upfront and the patient bills insurance company for reimbursement. The doctor’s office can provide the necessary forms.
Other than Hospitals and major equipment, servicers will pay for office facilities but materials and equipment can be purchased from the state whose capability in bargaining for large purchases will make equipment less expensive.

Additional improvements for State Medical Service Reform:

Discard B.S. degree requirement for credentials – Exam requirement is acceptable.
Consider giving all facilities non-profit status.
Execute Paul Ryan Tort reform.
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.

Servicing out of state patients does not garner State co-pay but it may be in our future to have agreeable states cooperate for service costs.

I am trying to keep it short so I’ll stop at this summary.
This reform process that subsidizes Services is cheaper, easier to manage, and encompasses everyone while keeping a competitive edge to allow for innovation in medical services.

Please contact me for further information, (questions, briefing, etc.).
Thank you for your time and attention,

Mark Poyhonen

Resolution for Health Care Reform

with 2 comments

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!
Thanks,
Mark Poyhonen
Crivitz, WI