This is the fourth letter sent to Senators Menendez and Lautenberg. Menendez has responded by form letter each time. Lautenberg has never replied in any manner. One should remember that he stood for election after the incumbent Democrat ran into some typical New Jersey legal problem. Frankly one may wonder of Senator Lautenberg is still amongst the living, and yet he will be re-elected well into the 22nd Century! And we are concerned about Central America!
Dear Senator,
I am writing your office again, for the fourth time this year, regarding the proposed Health Care Plans. I appreciate that you have returned a form response since it at least recognizes the receipt of my prior correspondence by your office. We have been studying this issue in depth and since my last latter I have completed a book detailing the analysis of health care as both policy and politics. Having been involved in this area for forty years I believe that with my experience starting and running my own business globally that the perspective of reality and the day to day needs of individuals provide some merit to my results.
I have enclosed White Paper Report of an analysis of a proposal for a Health Care Plan which we have recently developed. Unlike the current Administration's plan which will cost trillions this proposal actually returns funds to the Treasury. Let me briefly describe what this document details:
FIRST, THE PLAN MUST HAVE A SIMPLE AND UNDERSTANDABLE SET OF CORE PRINCIPLES.
I do not differ greatly from the current plan with two major exceptions; I vehemently oppose the public option and I strongly believe that the comparative clinical effectiveness ("CCE") needs to be done but outside the Government, and by professionals, namely Physicians and Surgeons, not Government appoint officials. The core principles should be:
1. Universal : All citizens and legal residents are covered and the Core benefits package is required
2. Catastrophic Coverage: Pays for all Catastrophic Diseases and Accidents but for the Core Coverage Plan if Pays for CCE Treatments only of these disorders. The CCE treatments will be specified by a Board of Physicians and Physicians only and it shall be independent of any Federal Entity.
3. Routine Care: Pays a fraction of all routine care and there is a Deductible of $1,000 per person per year. This will take people out of the ER at more than $1,000 per visit.
4. National: Sell policies across all state lines and there must exist National Standards for all policies.
5. Personal : Policies purchased by individual/family and all company plans are to be eliminated by a five year phase out. Employers will be expected to contribute to the personal plans.
6. No Pre Existing Condition Constraint : No pre-existing condition constraints for the Core plan and a participant or their family can readily and without cost transfer between plans.
7. Competitive : There must be a public market for these plans as there is for auto, home, life insurance and the Plans must be transparent and competitive, and added benefits may be provided above base price, The Plans must be regulated by the Federal Government at a National Level.
SECOND THERE MUST BE ACTIONS TAKEN TO REDUCE HEALTH CARE COSTS NOW FROM FACTORS WHICH ARE READILY CONTROLLABLE IN THE SHORT RUN.WE HAVE IDENTIFIED $650 BILLION OR MORE OF COSTS WHICH WOULD REDUCE HEALTH CARE BY 30%.WE FURTHER BELIEVE THAT THIS COST CONTROL CAN BE A CONTINUING PROCESS.
This, as described in the enclosed, can be achieved via the following areas which in turn can cut 30% off the current expenditures on health care:
1. Obesity and Overweight and Type 2 Diabetes : Well over $250 Billion or 12% of the health care costs can be eliminated by eliminating obesity. Or it can be paid for by taxing it.
2. Smoking Related Diseases: There is still well over $120 Billion of 6% of the total due to smoking related diseases. Again taxing this is one alternative.
3. Defensive Medicine: This is an elusive but know practice. This can be reduced by tort reform.
4. Misdiagnosis : This is not only costly based on fixing a problem but harms the patient. This can be reduced by a well evolved EMR.
5. Nosocomial Infections: These hospital infections are a result of both poor sanitary practices and poor design of hospitals. I have argued for years that hospitals are not hotels, despite the need to comfort patients. We see too many hospitals with rugs and curtains, which are Petri dishes for infections.
6. Re-hospitalizations: This is the classic Medicare problem if too early a release based on the hospital maximizing the Medicare profit and then seeing a rehospitalization.
7. Retesting
8. Excess Procedures: This is outright fraud. It is difficult to determine this but every physician has heard tales of Medicaid mills and the like.
9. Controllable Diseases: We have managed to see a continuing incidence and mortality of cancers and this has begun to save not only lives but money.
10. Drug Control: The use of generic drugs and the prevention of pharmaceutical advertising along with a costs informed drug ordering system on an EMR has shown that it can reduce the pharmaceutical costs by at least a factor of 2.
11. Malpractice Costs: This is a simple matter of tort reform which I believe is essential.
THIRD, THE CORE PLAN MUST BE SUCH AS TO ENSURE THAT ALL ARE PEOPLE, CITIZENS AND LEGAL RESIDENTS, ARE COVERED WITH A CORE BENEFIT PACKAGE AS DESCRIBED AND THAT THE COSTS TO THE FEDERAL GOVERNMENT DO NOT EXCEED THE CURRENT EXPENDITURES.
Then we propose payment for the Core Plan is provided as follows:
1. Basic Payments: The Core Plan requires three types of basic payments; an annual out of pocket, a deductible, and an employer/self employed payment. We assume that the self employed will have to make the employer payment and that there is no tax benefit difference between what the employer or the self employed contributes.
2. Individual and Employer Caps: We assume that there is a cap on maximum payments from either the individual and the employer. The individual's total out of pocket payments, or a HH if that is the case for a family, must not exceed in our current example 10% of their gross income and an employer no more than 15% of the gross salary paid. These of course are changeable with resulting consequences in a more costly or less costly plan. For many below a certain gross income level this then creates a shortfall on the revenue required to cover the expenses. The shortfall would be from both HH and employer funds which would have to be made up.
3. Government Subsidies: The shortfall then must be made up from Government funding. We are suggesting that the current Medicaid funds be applied to this shortfall as we have shown above. This Core Plan would eliminate any need for Medicaid. Yet even if we then apply Medicaid funds we may still have a shortfall. We then suggest that we place a "bottom cap" on health care expenses. That is we have a maximum any HH can pay and we have a minimum that any HH must pay. For example we could establish an 8% of gross income as a minimum.
Using this Plan the Treasury actually collects $30 Billion in returns.
I am certain that I am not the only one who is considering such alternatives. I and many of my colleagues here in New Jersey as well as back In Massachusetts believe that there are better ways than HR 3200 which frankly is a disaster! Everyone wants a change, we know that change is required, and change is achievable. But not with the extreme Government heavy handedness of HR 3200.
Very truly yours,
Dear Senator,
I am writing your office again, for the fourth time this year, regarding the proposed Health Care Plans. I appreciate that you have returned a form response since it at least recognizes the receipt of my prior correspondence by your office. We have been studying this issue in depth and since my last latter I have completed a book detailing the analysis of health care as both policy and politics. Having been involved in this area for forty years I believe that with my experience starting and running my own business globally that the perspective of reality and the day to day needs of individuals provide some merit to my results.
I have enclosed White Paper Report of an analysis of a proposal for a Health Care Plan which we have recently developed. Unlike the current Administration's plan which will cost trillions this proposal actually returns funds to the Treasury. Let me briefly describe what this document details:
FIRST, THE PLAN MUST HAVE A SIMPLE AND UNDERSTANDABLE SET OF CORE PRINCIPLES.
I do not differ greatly from the current plan with two major exceptions; I vehemently oppose the public option and I strongly believe that the comparative clinical effectiveness ("CCE") needs to be done but outside the Government, and by professionals, namely Physicians and Surgeons, not Government appoint officials. The core principles should be:
1. Universal : All citizens and legal residents are covered and the Core benefits package is required
2. Catastrophic Coverage: Pays for all Catastrophic Diseases and Accidents but for the Core Coverage Plan if Pays for CCE Treatments only of these disorders. The CCE treatments will be specified by a Board of Physicians and Physicians only and it shall be independent of any Federal Entity.
3. Routine Care: Pays a fraction of all routine care and there is a Deductible of $1,000 per person per year. This will take people out of the ER at more than $1,000 per visit.
4. National: Sell policies across all state lines and there must exist National Standards for all policies.
5. Personal : Policies purchased by individual/family and all company plans are to be eliminated by a five year phase out. Employers will be expected to contribute to the personal plans.
6. No Pre Existing Condition Constraint : No pre-existing condition constraints for the Core plan and a participant or their family can readily and without cost transfer between plans.
7. Competitive : There must be a public market for these plans as there is for auto, home, life insurance and the Plans must be transparent and competitive, and added benefits may be provided above base price, The Plans must be regulated by the Federal Government at a National Level.
SECOND THERE MUST BE ACTIONS TAKEN TO REDUCE HEALTH CARE COSTS NOW FROM FACTORS WHICH ARE READILY CONTROLLABLE IN THE SHORT RUN.WE HAVE IDENTIFIED $650 BILLION OR MORE OF COSTS WHICH WOULD REDUCE HEALTH CARE BY 30%.WE FURTHER BELIEVE THAT THIS COST CONTROL CAN BE A CONTINUING PROCESS.
This, as described in the enclosed, can be achieved via the following areas which in turn can cut 30% off the current expenditures on health care:
1. Obesity and Overweight and Type 2 Diabetes : Well over $250 Billion or 12% of the health care costs can be eliminated by eliminating obesity. Or it can be paid for by taxing it.
2. Smoking Related Diseases: There is still well over $120 Billion of 6% of the total due to smoking related diseases. Again taxing this is one alternative.
3. Defensive Medicine: This is an elusive but know practice. This can be reduced by tort reform.
4. Misdiagnosis : This is not only costly based on fixing a problem but harms the patient. This can be reduced by a well evolved EMR.
5. Nosocomial Infections: These hospital infections are a result of both poor sanitary practices and poor design of hospitals. I have argued for years that hospitals are not hotels, despite the need to comfort patients. We see too many hospitals with rugs and curtains, which are Petri dishes for infections.
6. Re-hospitalizations: This is the classic Medicare problem if too early a release based on the hospital maximizing the Medicare profit and then seeing a rehospitalization.
7. Retesting
8. Excess Procedures: This is outright fraud. It is difficult to determine this but every physician has heard tales of Medicaid mills and the like.
9. Controllable Diseases: We have managed to see a continuing incidence and mortality of cancers and this has begun to save not only lives but money.
10. Drug Control: The use of generic drugs and the prevention of pharmaceutical advertising along with a costs informed drug ordering system on an EMR has shown that it can reduce the pharmaceutical costs by at least a factor of 2.
11. Malpractice Costs: This is a simple matter of tort reform which I believe is essential.
THIRD, THE CORE PLAN MUST BE SUCH AS TO ENSURE THAT ALL ARE PEOPLE, CITIZENS AND LEGAL RESIDENTS, ARE COVERED WITH A CORE BENEFIT PACKAGE AS DESCRIBED AND THAT THE COSTS TO THE FEDERAL GOVERNMENT DO NOT EXCEED THE CURRENT EXPENDITURES.
Then we propose payment for the Core Plan is provided as follows:
1. Basic Payments: The Core Plan requires three types of basic payments; an annual out of pocket, a deductible, and an employer/self employed payment. We assume that the self employed will have to make the employer payment and that there is no tax benefit difference between what the employer or the self employed contributes.
2. Individual and Employer Caps: We assume that there is a cap on maximum payments from either the individual and the employer. The individual's total out of pocket payments, or a HH if that is the case for a family, must not exceed in our current example 10% of their gross income and an employer no more than 15% of the gross salary paid. These of course are changeable with resulting consequences in a more costly or less costly plan. For many below a certain gross income level this then creates a shortfall on the revenue required to cover the expenses. The shortfall would be from both HH and employer funds which would have to be made up.
3. Government Subsidies: The shortfall then must be made up from Government funding. We are suggesting that the current Medicaid funds be applied to this shortfall as we have shown above. This Core Plan would eliminate any need for Medicaid. Yet even if we then apply Medicaid funds we may still have a shortfall. We then suggest that we place a "bottom cap" on health care expenses. That is we have a maximum any HH can pay and we have a minimum that any HH must pay. For example we could establish an 8% of gross income as a minimum.
Using this Plan the Treasury actually collects $30 Billion in returns.
I am certain that I am not the only one who is considering such alternatives. I and many of my colleagues here in New Jersey as well as back In Massachusetts believe that there are better ways than HR 3200 which frankly is a disaster! Everyone wants a change, we know that change is required, and change is achievable. But not with the extreme Government heavy handedness of HR 3200.
Very truly yours,
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