Healthcare Debate A Clueless Congress continues ignore the only solution

9 Steps to Comprehensive Quality Health Care in America

1) Shut down the private health insurance corporations.

2) Enroll every American (including Veterans, Medicaid, Children) and the 50 million uninsured citizens into the Medicare Health Insurance Corporation. Since the current functioning Medicare Insurance Company is already accepted by almost all physicians, Hospitals and clinics in the Country, hardly any infrastructure investments on the health care delivery end will be necessary. Have all private businesses pay a Medicare premium for their employees instead of private health insurance premiums. Let employees as well as businesses contribute a fixed premium amount based on their age up until 65 for their Medicare services and drugs. Freeze current premiums for all Americans over 65 and adjust in the future according to the cost of living index. These premiums paid by businesses to Medicare for their employees should be less than that paid to current private insurance companies because of the lower overhead costs of the Medicare Corporation and improved risk pool distribution which for the first time contains healthier younger patients. For Americans under 65, Medicare insurance premiums should be adjusted for age. All premiums should be lower than current private insurance due to non profit nature of the Medicare insurance company and associated lower overhead costs.

3) Hire the now 1.25 million unemployed former private health insurance corporate bureaucrats to actually deliver and not inhibit health care by working in hospitals, doctors’ offices, clinics and nursing homes around our Country. Demographically, the percentage of elderly Americans is rapidly increasing. With every American now insured through Universal Medicare Insurance, real health care workers will be in desperate need. For the first time in the brief but bloody history of managed care, these former private insurance corporation employees will actually touch and improve care for patients by working in physical therapy, nursing, home health care and other ancillary patient care capacities. No longer will we have 1.25 million patients who are bankrupted each year due to medical illnesses which is equal to the number of bureaucrats previously employed by these companies.

4) Obtain by eminent domain (for the public good) the best of the intellectual property protected computer codes which the closed private insurance businesses previously used to monitor patient care and doctors utilization and performance. Private health insurance companies have used these computer programs exclusively for the purpose of strong-arming their contracted health care providers into doing less for their patients and increasing the premium costs for sicker patients in order to achieve higher corporate profits by 10-20%. Medicare on the other hand can use these same computer programs for the common good; to monitor, collect data and eventually improve the efficacy of diagnoses and the treatment of diseases and medical outcomes every time a doctor submits a bill. For example, wouldn't it be nice to know as a medical consumer (patient) which oncology groups in Boston, New York or Houston have the highest cure rates for stage III breast cancer or Stage II prostate cancer? All those numbers currently exist in cancer registries nation wide and just need to be collected and honestly disseminated. Currently, instead of medical data which delineates morbidity and mortality and outcome performance, the medical consumer when choosing an oncologist must rely on word of mouth, physician referrals or advertisements in the local papers or billboards which show photographs of smiling doctors in white coats who claim to be the ‘best’ doctors in town. Solid medical outcome and prevention data would foster a beneficial marketplace capitalistic competition among private physicians and hospitals based on quality which currently doesn’t exist due to the complete lack of outcome revelations by the private insurance and drug companies. In addition to garnering invaluable instantaneous epidemiologic data on diagnoses and treatment of diseases based on severity and other variables, a strong Medicare based utilization review computer code would also allow Medicare to easily monitor doctors and hospitals who abuse a fee-for-service billing system. Any physician, institution or service found to fraudulently abuse the Medicare fee for service billing system after proper review and appeal should be dealt with severely through stiff penalties and loss of their Universal Medicare provider contract.

5) Freeze Medicare physician, hospital and ancillary services reimbursements at current levels after adjusting inter-specialty reimbursement imbalances based on procedural medicine. Adjust reimbursements for future care services yearly by Cost of Living increases, or in the event of a deflationary economy a decreases in doctor and hospital payments. Ask any physician and they'll tell you they would accept current reimbursement rates with COLA over the current mysterious illogical fee adjustment system of Medicare, or the monopolistic political racketeering reimbursement formula used by most colluding private insurance corporations. Two tiered medical systems separating the “haves and have not’s” of society have and will always exist. Therefore, we must allow physicians to practice medicine without enrolling in or accepting the Universal Medicare reimbursement. With private medical insurance no longer available, and no performance based evidence for improved morbidity and mortality among their private for-pay patients, these extraordinarily expensive private ‘VIP’ practices will be limited.

6) Close down the Part D government subsidizes for drug and insurance companies, and allow Medicare, much like the current Veterans Administration System and every other private health insurance company and government health care system around the world, to bid on medications from pharmaceutical corporations for its Medicare drug formulary. Every physician recognizes that we don’t need a choice of a dozen redundant drugs in each pharmaceutical category. For example, we need only 2-3 statins for cholesterol, a handful of antibiotics for infections, 2 beta blockers for hypertension, and a few pain killers. Once the Government bids on pharmaceuticals for the Medicare Corporation formulary, micro economics will force prices to massively decrease to levels identical to that which all the other people of the world outside of America are paying for the same medicines. Since it has not effectively decreased morbidity or mortality in this Country, and only wastes money, we should also prohibit pharmaceutical companies and their workers from contributing to political campaigns or buying commercials on the public airways. We need to also prohibit the current practice whereby your local pharmacy and pharmacist sells your confidential private medical diagnoses and your doctors private prescribing drug information to pharmaceutical companies so the pharmaceutical companies in-turn can directly pressure-market physicians. Prohibit pharmaceutical companies from contributing to organized medicine societies, colleges or associations because the doctors can’t rely on soft bribes or free lunches to prescribe what’s best for their patients. Prevent pharmaceutical representatives from visiting doctors’ offices or hospital pharmacies directly. Allow delivery of Medicare formulary approved sample medications for patients to physicians’ offices via post office mail only. Allow pharmaceutical companies to market products to physicians only via peer reviewed publications delivered by email or snail mail.

7) Private health insurance companies have never supported medical research. With some of the savings incurred from closing the private insurance corporations and paying less for drugs, have the American government fully fund the National Institutes of Health (NIH) and the National Cancer Institute (NCI) and Small Business Innovative Research (SBIR) programs. Emphasis should be placed on basic bench research carried out at not-for-profit American Institutions which employ or utilize a majority of American Citizens in their laboratories and clinics. Too often American Universities rely on free overseas labor to conduct bench research. Clinical trials should emphasize new drugs and devices which have promise to significantly decrease morbidity and mortality for any disease, including orphan diseases. Since a large percentage of private funding for drug and device studies will originate in the expanding financial liquidity and innovations and patients of the emerging developing world, we should allow the FDA to utilize research data obtained by reproduced laboratory and clinical studies performed overseas as well as in this Country.

Corruption of honest academics should be curtailed. Force all investigators to release reproduced publicly funded scientific data for all scientists to review on the internet via the Freedom of Information act (The Senator Shelby® Amendment). Prohibit rights of first refusal on scientific data for private companies performing research in non-for profit institutions which receive public funding. Any rights to profits obtained from intellectual property and patents invented with combined funding from government and private sources should be split fairly among the contributing government institutions and any other private corporations funding the research, as well as with the individual inventor. Prevent organized medicine societies, associations or colleges from contributing to political campaigns since campaign donations have no relevance for physician performance or patient morbidity or mortality.

8) Offer physicians the same legal protection from malpractice lawsuits which had been established to allow risk free negligent health care rationing by commercial health insurance corporations during the last 3 decades. This med mal protection will allow family practitioners and internists to fulfill their role as primary care physicians efficiently and productively tackling dynamic illnesses without prematurely referring their sicker patients to expensive specialists without medical benefit. Limiting med mal lawsuits against physicians and hospitals will also allow doctors and hospitals to use the national EMR and outcome data for the common good via peer review, thereby improving underperforming hospitals, doctors and therapists instead of simply suing their scrubs off.

9) The quality of current medical records software lags two decades behind business software. Therefore, we need to fund and challenge America’s best software corporations to finally develop standardized electronic medical records software for use in doctors’ offices and hospitals in order to increase the efficiency and productivity of physician charting, billing and prescribing. We should use the integrated medical records system to instantaneously and confidentially gather important epidemiologic data on physicians’ performance, patient diseases, and treatments. Solid medical outcome and prevention data would foster a beneficial marketplace capitalistic competition among private physicians and private hospitals based on quality which currently doesn’t exist due to the complete lack of real time outcome revelations by the private insurance or drug companies. With new potent viruses and unsophisticated biomedical and nuclear warfare on the horizon, this system will be absolutely necessary for rapid National Security responses. Protect patient confidentiality at all costs to prevent the commercialization and abuse of patient data like that which the pharmacies trade today.

Lastly, some argue that Universal Government run health care in America will result in delays in diagnosis and treatment similar to those reported for some in Britain and Canada. One can not simply compare the massive extremely functional Medicare insurance based infrastructure which effectively and seamlessly delivers private health care to tens of millions of the most elderly, sickest, disabled and costly patients each year in the USA to the government run and owned socialized health care systems of Canada and Britain, France, Switzerland, Netherlands, Scandinavia, and Israel, where doctors and hospitals are employed and owned directly by the government. We already spend twice as much as Canada per capita on health care, and have more doctors and specialists per capita, four times the MRI machines and lower hospital occupancy rates than Canada (even in our hospitals located on the Canadian border), so we’re off to a good start. We can use Canada’s most recent analysis and correction of longer waiting times for certain elective procedures to avoid the same initial problems in America. Canadians have largely corrected the patient waiting time for elective procedures. However, Americans can only boast that we rush to the grave several years younger than the average Canadian citizen. America, for the last 40 years, thanks to the government run health insurance corporation-Medicare, has built an incredibly dense and fluid public insurance system for OUR oldest, sickest and most disabled citizens involving almost all private doctors’ offices, private hospitals, private clinics and private ancillary services. Medicare moved a large percentage of the elderly off the poverty roles when instituted, and single payer based on Medicare could do the same for our nations businesses. The Medicare insurance system dwarfs in breadth and actual private practitioners and efficacy the lesser insurance systems established in all other countries including Canada. The billing and reimbursement bureaucracy for private health care providers contracted with Medicare Insurance is already relatively streamlined and efficiently centralized in America thanks to 40 years of private physician, private hospitals and government cooperation. Those who argue that putting all citizens on Medicare insurance will be disruptive should remember that 4 decades ago we enrolled every elderly and disabled citizen in America in Medicare insurance in a period of just 9 months without the assistance of computers. I doubt that the 50 million uninsured and 100 million under insured citizens in America will think private care coverage under a single payer national health insurance would be disruptive. While American doctors are routinely terminated from private insurance company contracts in order to enhance insurance Co. profitability, Medicare insurance almost never terminates contracts of these same ethical and competent private physicians.

We all know that the medically bankrupt private health insurance corporations and medical malpractice lawsuit threats have caused many disheartened private physicians to quit practicing or downsize their practices in America. A continuation and technological upgrading of our most fair Universal Medicare based health insurance Corporation based on the concepts outlined above would undoubtedly motivate those disenfranchised physicians to return to the profession and bright younger physicians to invigorate the field. If patients, physicians and the Medicare Corporation continue to work together, without the deleterious interference of private for-profit health insurance corporations, malpractice threats and overt pharmaceutical marketing the future for American health care will be healthy indeed. A continuation of the status-quo mixture of an enormous overhead, government subsidized private health maintenance insurance and pharmaceutical industry operating parallel to and within Medicare Insurance is wasteful, and will continue to provide no potential future health improvements for America.

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