(Open letter to Rep. Rush Holt, D-12th District)
As a senior citizen, former school board member and board president, and as one who died (Dec. 26, 2007) from a “blown” mitral valve and who lives today thanks to the health care system, I would like to discuss the various proposals under consideration.
My background includes being employed as the loss control manager (handling workers’ compensation) for a rather large governmental entity. As a senior, I also am involved in community affairs, as a volunteer staff member of the local Office of Emergency Management, and am a trained member of the Community Emergency Response Team (CERT). My back-ground also includes service to our country in the armed forces, and my last posting was as a battalion communications sergeant in an artillery unit; I am now an FCC licensed ham radio operator and a volunteer with Radio Amateur Civilian Emergency Service.
My experiences have shown both the good and the bad of the current health care system. The good points are obvious: lives are saved by the system. The bad points are also obvious: insurance bureaucracy run amok, costs out of control, not all citizens with insurance coverage.
Here is one specific example of what I consider obscene. A hospital charged $4,708 for certain services. When the bill was submitted to a “repricer” for “repricing,” the bill came down to $817 and was accepted. The “repricer” charged a fee of $972. We paid more for what I consider to be a “clerical” function (to access their contracted rates) than to the actual health care provider. If appropriate fees were charged up front by the providers, the same fee to anyone with or without insurance, there would be no need for a “repricer” and their fees.
According to President Obama’s former personal physician, approximately 30 percent of his overhead is in billing staff to handle the different billing systems between his office and different insurance companies.
That is too much.
I can understand why those in Congress somehow feel that these town hall meetings are reminiscent of Dr. Frankenstein in his castle, surrounded by angry villagers with pitchforks and torches. Well, the horror movie may have been scary to moviegoers, but the potential nightmare of government running the country’s health care system is truly frightening to most Americans, especially senior citizens. All the polls show that. As an elected official, you must be well aware of that. I truly believe that those who oppose the current health care reforms called “Obamacare” have the responsibility and the duty not just to oppose, but to propose an alternative. No one is saying that reform is not needed.
First, we need to define the real problems of health care: access and cost.
My thoughts, for what they are worth:
1. Health care itself is not broken, it is the bureaucracy surrounding it that needs reform.
2. Control the costs of medical malpractice insurance by creating a workers’ compensation-type system of settlements, not the full-time job security and grab bag for attorneys as it is now. This would help control costs by eliminating unneeded tests done only to protect the doctors from a medical malpractice suit. Any plan that avoids this is simply a fraud and captive to the trial attorneys’ special interests.
3. Control the bureaucratic costs of health insurance by creating a single, nationwide system, run by a nonprofit corporation (not the government!), allowing the system to cross state lines, and end the myriad of state regulations. This is very close to the idea of a “single payer” so warmly embraced by “liberals.” However, government’s only role would be to facilitate, not obstruct or control, this system. Such a system will bring efficiency, productivity and economy of scale not currently seen in the bureaucracy surrounding health care. Semi-annual audits of course will be needed to ensure that the system is working honestly. There could be a series of regional service centers to provide this national framework. The steps in 2 and 3 as outlined above should provide cost containment and reduction.
4. Let’s say the ABC (not-for-profit) company is awarded the contract to provide the framework of the nationwide system; all medical practitioners and providers would need to be aligned with them (for portability and economy of scale). The rates will need to be determined based upon cost and region (some areas are more expensive than others). All their costs must be covered. We would bring competition into the system by setting up a reinsurance system of all current health insurance competitors — so all current private, for-profit insurance company players continue to be involved, especially on a local basis. Extreme use of electronic communication is critical to achieve bureaucratic clerical savings, as well as provide documentation on an
individual’s diagnosis and treatment on a worldwide basis (allows portability of both coverage and treatments). One standard billing system for all, not a myriad of different billing systems would end the need for private practitioners to engage a huge clerical staff to handle billing. Private, for-profit insurers would have the reduced bureaucratic costs, by going through the national framework and should be able to compete on the basis of sound underwriting standards and pricing.
5. Small businesses with fewer than a defined number of employees would be combined into a group of like-kind businesses (similar exposures) — for example, all restaurant employees, all funeral homes employees, etc., and rates would be based upon the individual group risk. But the bureaucratic costs would be the same per-person cost going through a national framework. Those businesses with a size-able staff where it makes sense to self-insure health care could compare self-insurance costs with what this new system might cost using private insurers, but all would go through the national framework system whether insured privately or self-insured. All government employees, especially where currently self-insured (federal, state, local, independent authorities) would also go through this system. Remember that insurance has always been based upon the “law of large numbers” to have a more predictable cost projection. Property and casualty insurance, including automobile insurance, have their rates based on this fact. Other factors of course
influence the projections (age and type of construction, age and driving record, etc.). Health care is no different.
6. Medical providers would have a standard rate, either per procedure or through outcome-based pricing; if they accept as payment in full from insurance, they cannot charge more than that to one who is uninsured. While I think it is better for a spread of risk that all be insured, some may not wish to purchase insurance. Perhaps it is better for these to purchase a catastrophic insurance policy (high deductible/high co-pay), so that, for example, a young adult in an accident would have protection from bills that can far exceed $10,000. End the need for repric-ing, as I mentioned above and its ultimate additional costs by charging up front the proper amount. It is ludicrous to pay more to a repricing firm than the health care provider for what is, in effect, a clerical review function. It is also immoral. By eliminating this type of middleman, we certainly reduce the bureaucratic over-head, having nothing to do with actual delivery of health care services.
7. Prescriptions would also be handled, for the most part, through a mail-order pharmacy, again on a national basis. The lowest bidder to run the framework of the national program would be required, as above, to allow all other competitors get a piece of the action through reinsurance. All pharmaceutical companies would be required to deal with this entity, so econ-omy of scale (and efficiencies) would result in a lower cost. Local drugstores would be needed for the 10-30 day sup-ply; 90-day supplies must go through the mail-order pharmacy. Perhaps the local pharmacies could be a distribution adjunct of the mail-order national system.
8. It is necessary that everyone insured under this system pay something toward it, say a percentage of their disposable net earned income not to exceed 1.5 percent or a dollar figure (or capped at a set dollar amount). Employers would or should pay a substantial portion of the actual cost for their employees as the cost of doing business. Those truly indigent or disabled would be allowed some taxpayer-supported subsidies. But, by reducing the overall costs, these subsidies will also be reduced in the long run.
9. We need an improved system of primary care, such as setting up a national system of local family medical offices (or emergency medical offices) where all non-life-threatening issues would and could be handled, from the common cold and flu to broken arms and legs. We must end the abuse of utilizing hospital emergency rooms for what is really primary care. As part of residency requirements, doctors and nurses in training would be required to spend two years in a primary care center and the rest of their residency in a hospital setting. This would result in better training and improve health care. Some doctors have set up a general primary practice together, charging a small up-front monthly amount to families, who have 24/7 access to the general practice. Such a system, on a national basis, could be a good start. Perhaps some sort of not-for-profit local organization formed by medical practitioners (health care co-op?) would be a possible answer to providing primary and preventative health care.
10. All should undergo an annual exam, including blood work, to identify possible problems at their earliest stage. Standard exams should also be based upon age and gender as deemed medically appropriate by your doctor (not a bureaucrat).
11. Elementary, middle and high schools (and higher education) need to add serious courses in nutrition to help overcome obesity and its resultant problems.
12. Medicare and Medicaid should also go through this system, run by the non-profit framework. We could eliminate government overhead through this private, not-for-profit network. It must truly be a not-for-profit (which would also limit compensation for employees, including executives — no multimillion dollar pay and perks for execs). All federal officials, from the president down to the janitor (including members of Congress) would go through this system. If it’s good for us, it should be good for them.
13. Again, government must facilitate, not control this.
14. While it is morally right to provide emergency lifesaving treatment for illegal or “undocumented” aliens, someone will need to pay for this. The problems with illegal aliens certainly impact our health care system and must be addressed, but not here. Government has failed to ad-dress this problem under both Republican and Democrat rule; why would anyone trust the government with running our entire health care system when it is unable to even get control of our borders?
15. What we cannot do is have a plan that in any way restricts or rations health care based upon age or illness as is done in other countries. Medical experts, not bureaucrats (government or insurance), must make the health care decisions in consultation with the patient. No “gate-keepers” being paid extra for cutting serv-ices, as was done in the past with HMOs.
16. No taxpayer funds should be utilized to pay for abortions, period. Women who want this coverage must pay extra for this coverage. Those who support abortions could contribute, if they wish, to a fund to help pay for abortions without any subsidy by taxpayers. To do otherwise would entangle government with religious and moral beliefs. No medical provider, physician, nurse or hospital should be forced into performing abortions if that is against their moral or religious belief. These
provisions must be specifically written into any bill. Currently, the major-ity in Congress claims that the taxpayers will not pay for abortions. However, when the minority in Congress proposed an amendment putting that into writing, the majority refused. Why? Sorry, but most people just don’t trust politicians. The honest concern here is that courts would interpret the lack of prohibition of this, in any health care bill, as an area that could be “liberalized” or “broadened” if a court challenge were brought.
17. When an overall, comprehensive plan that all (liberals, moderates, conservatives) can accept, is agreed upon, there should be a minimum two-year trial program in three regions — Northeast, South and West to see where tweaking and fine-tuning of the program might be needed. This is too important an issue to be rushed; we must be both cautious and creative in our approach. Also, there will probably be unintended consequences, none of which we are aware of at this time. Once the value of the program has been proved (and all the kinks worked out), then and only then would it be ready for a national rollout.
18. “End of life consultations,” currently proposed in HR3200, I have no problem with. However, euthanasia or assisted suicide must never be paid for under this system or with taxpayer funds, and this prohibition must be specifically written into any proposed bill, for the same reasons I outlined in my point No. 16.
19. Back to electronics relating to efficiency. I would recommend utilizing that which is available currently, namely, USB flash drives, which could easily contain individualized medical records, including current prescriptions, diagnoses, conditions, test results and other important in-formation such as medical insurance, doctors, contact list, even a living will and medical directives (a signed copy would need to be provided as well, unless a signed, scanned PDF file is available and accepted as a legal document). A 2GB flash drive would probably be sufficient in most cases. I happen to wear one around my neck, so I know it is easy and could be accessed by any EMT — but if this were commonplace, any EMT and E.R. would immediately know to plug in the flash drive. A swipe card would probably not be able to handle all this data.
20. We need to address the issue of providing health care services to more people. More patients will impact the delivery of services and will cause a de facto rationing unless the supply of medical providers is increased sufficiently to meet the demand. The supply of doctors, specialists, nurse practitioners and nurses, along with ancillary medical services, needs to be increased. Here is where government assistance in the educational field might have a positive return for the
up-front investment of medical education. Until supply is increased, increased demand will strain the present system. In return for educational assistance, medical students (doctors/nurses) would be required to intern in the FMO or EMO community framework for a specific pe-riod of time. This would be similar to volunteers being educated in the military service schools and enlisting for a specific time period.
21. How to pay for government services — and health care expansion — beside cost containment outlined above would be to eliminate the IRS and go to both a flat income tax over a certain sustenance level (perhaps $25,000/individual, $40,000/family) and a consumption tax (value-added tax). This streamlines the collection of taxes, saving a great deal of money as well. While it is not good during a recession to stifle consumer spending, ultimately we do need to have a better savings rate for our own future. Both Democrats and Republicans felt it was
appropriate to force banks to lend money to people who had no real way of ever paying the mortgage. The failure of the housing market, and the resultant economic damage, caused by irresponsible social programs shows how dangerous well-meaning programs fostered by government can actually be! This is too important an issue to rush to judgment. Let’s just slow down and get this right.
Thank you for taking the time to read this letter and I would request your comments as to the specifics contained in this correspondence.
Please understand I am neither an “evil-monger” as the esteemed Senate Majority Leader Harry Reid has said, nor am I “un-American” as House Speaker Nancy Pelosi has said. I am merely an American citizen, a senior, who has worn the uniform of my country, and who still serves as a volunteer. I suggest both sides need to ratchet down the rhetoric, roll up their sleeves and get to work on behalf of those who pay their salaries.
By the way, I do vote.
Thomas F. Stokes is a resident of Middletown.