Ideas to Save America
Richard Salbato 3-23-2010
Nothing should frighten Americans
more than the unfunded obligations of both the Federal Government and the
State Governments. And the most frightening of these is Medicare even before
the latest passage of Obamacare. No
matter what you think about your personal health care and health care
insurance, if we continue the government programs we have now, we will
no longer be a nation at all in just a few years.
We will be a sovereign bankrupt ex-nation.
The
These deficits require funding from other tax sources or
borrowing. The present value of these deficits or unfunded obligations is an
estimated $41 trillion. This is the
amount that would have to be set aside during 2008 such that the principal and
interest would pay for the unfunded commitments through 2082.
Approximately $7
trillion relates to Social Security, while $34 trillion relates to Medicare and
Medicaid.
In other words, health care programs are nearly five
times as serious a funding challenge as Social Security. Adding this to the
national debt during September 2008 of nearly $10 trillion and other federal
commitments brings the total obligations to nearly $53 trillion.
Pay close attention to the
dotted line. This is the revenue
expectations that the Federal Government will collect over the next 70 years. We are not yet talking about State debts
which pay a large part of the Medicare bills.
Now look just at the Red (the interest on the debt). The interest alone will be
greater than all Government revenue by 2060.
Medicare has six times the unfunded liability
of Social Security. The cost of the Medicare program is rising at such a rapid
rate that program cuts, tax increases or both will be necessary to keep the
public insurance program solvent. Right
now, Medicare receives 11 percent of federal non-entitlement tax dollars, and
by 2020, the program will receive one in five tax dollars. By 2030, Medicare
will claim one in three dollars and by 2050 that number rises to one in every two tax dollars.
Let us make it simple and so logical that it
cannot be disputed. Medicare as it is now will end the American nation forever. The dollar will collapse and everyone will
have to start over forming a new nation.
All the savings of everyone, rich and poor will be worthless. All
government services will stop – police, fire, utilities, army, etc. Only radical changes can save this
situation.
The simple and most radical change to this
will have to be to totally take away all health care and insurance from the
Federal and State governments, except for the indigent, handicapped and poor
elderly. How to do that is not so
simple.
Before you think this is too radical,
understand that the greatest nation in the history of the world,
did not have any government health care system until 1965, and even then it
only covered the elderly and/or retired.
It was not until 1988 that it really became
a socialist system. So this thing we think is so important to our life has only existed for
22 years. See history of Medicare below.
Radical Ideas
to Save
Insurance:
1. Remove all Medical Insurance away from Businesses
The biggest problem with private medical insurance is that the insured
does not pick the insurance in most cases. The company you work for negotiates with
an insurance company to insure his employees, present and future. What they
insure must be based on everyone, male and female, healthy and not so
healthy. So they have a one program that
fits all.
For example, I would be covered for pregnancy even though I do not
think I can get pregnant. The argument made for business insurance is a larger
group will get a cheaper cost, but that means that large companies have cheaper
insurance and small ones less. What gives a company an advantage over an individual
is that they get a tax deduction and the individual does not.
However, if everyone was insured one by one, all together it would be
greater than group insurance, which would not exist. In the end insurance would be cheaper when we
include the rest of these ideas. Most
important of all, it takes away a cost of doing business that is passed on to
the customer and makes us more competitive with other nations. When you get a pay check, let us say $20.00
per hour, you do not know that the company costs are $40.00 per hour. Let us suppose the company paid you $40.00
per hour and you took care of your own health care and retirement?
2. Mandate all Medical Insurance to be privately owned
In order to do the above, we need a law that does not allow business to
offer insurance except for company liability, which is already the law. The object here is to let the individual have
control of his own insurance, which can now be itemized and not include things
he does not need as shown in item 3. It should be tax deductable for you just
as it is now for the business.
3. Insurance Coverage to be itemized coverage and itemized costs.
When you have a private insurance form (not a business form that you
never have seen ) you will be able to pick the
coverage and the cost like you do with automobile insurance. You might want to cover only Catastrophic and
yearly check ups which I think should be a minimum, because yearly checkups
will prevent a great deal of Catastrophic problems.
If your family is prone to heart attacks you might want to include this
as an additional cost. If you smoke your insurance will be higher, but it will not be
higher simply because 35% of the other people smoke. If you have a
family it will be higher than if you are single, and will include each member
of your family.
You may want to have a check up to prove that you are very healthy
before signing the insurance and that could make it less expensive. As you get older you might want to increase
your coverage, but it will be up to you and the insurer and not the
company. Your insurance #number will go
onto the internet system so that when the doctor checks your #number he knows
what is covered and what is not.
Then you get the bill, not the insurance company. You agree that what
the bill says is what you got, sign it and send it to the insurance
company. You become the insurance
company’s investigator and the medical fraud is almost eliminated.
4. Eliminate all State special requirements for coverage
Some states require chiropractic care as part of insurance even though
not all people believe in it. Other
states require Psychiatric care even though I do not believe it a science. As a result it is almost impossible to buy
insurance like you do gas or food. I am
not required to buy
5. Minimum coverage to be Catastrophic coverage and yearly check ups.
No one can be required to have medical insurance by law, but what
government can do is say that you cannot use the hospital emergency room
without being charged if you do not have at least Catastrophic coverage
((emergency coverage) and that should include yearly check-ups that would cut
down emergencies.
6. $50.00 per year tax to cover the uninsurable (pre-existing conditions)
(That is one dollar a
week for everyone who works, everyone.) This would pay for privately owned systems
that would take care of the disabled and chronically ill or handicapped.
Costs of Health
Care:
1. Restrict Liability claims and Increase Criminal Law on mal-practice.
The most important thing to cut down on liability mal-practice
insurance for doctors and hospitals is to mandate that the looser of any
lawsuit pay all court fees- court costs, all lawyer fees of both sides, and all
awards. This will eliminate all lawyers
who agree to take cases for a percentage of the awards, even when they know
there is no real case. They know that
insurance companies will settle out of court most of the time because even if
they win the cost of fighting in court will be in the millions. This more than anything else will cut the
costs of mal-practice Insurance for doctors.
The next thing is to limit the amount of pain and suffering to
reasonable amounts. Standard practices
should be the rule and not the “if you had done this or that this would not
have happened.” Example, if a doctor
does what is normal practice and something happens that was not expected, he
cannot be sued. It may result in new
standards but the doctor can not be blamed.
2. Line item bills to be signed by patient before payment by insurance
Now to get back to the patient signing the bill! I have been on Medicare for 10 years and once
used it to get two non-malignant moles cut off my face. In
I have no way of knowing but if I went to a dermatologist and had these
cut off it would have been done in an hour and cost about $175.00. My Medicare bill could have been $10,000 and
I have no way of knowing, nor does the Government.
Every day Fox News and CNN cite billing frauds in Medicare and other
government programs like the stimulus bill.
I will just site one, where the bill charged $100.00 for an aspirin and
billed for 40 IV bags when only one was used.
These were $300.00 per bag. In just one bill the fraud was $12,000.
No one bothered to check this out.
Just in health care this is ten billion dollars a year fraud. If the
patient read and signed the bill, it would not happen.
3. Special Trained non-professional techs.
Why do we need a very expensive, well educated nurse to take my blood pressure?
Why do we need a very expensive, well educated nurse to record my heart
beat? Why do we need a very expensive,
well educated nurse to take a urine sample?
Why do we need a very expensive, well educated nurse to fill out a
medical history form?
Let us visualize a person who wants to work giving x-rays. He goes to a class given in a hospital for
one week and gets a one week degree that allows him to give x-rays. That is all the education a nurse gets in
that procedure but she will make seven times as much money
for doing it.
4. Computerized medical history
This has already been talked about and is part of this stupid Obamacare
but in this I agree. I do all my banking on the internet, I get no paper. I buy and sell without money. If I have a medical history, why should it
not also be on line in the same way my money is and it is protected. This will save the medical system millions of
dollars per year.
5. Community checkup shops linked to out of town doctors.
Imagine a small shop in a small mall in a small town where there is no
doctor. In this small shop is some medical equipment and a few Special Trained Techs as
in item 3. On the wall is a large
computer screen. You go in and tell the
Tech that you have some problem that bothers you. He or she calls up the doctor who might be
thousands of miles away and he talks with you.
He tells the Tech to take a few tests and to call him back. He then advises you to go to the pharmacy and
pick up a prescription that he will call in and it will be ready for you. The
Tech adds the tests and office call to your medical record and you return in
two weeks as directed by the doctor on the computer screen.
6. House Calls through Computer systems
If you or someone close to your home has the same Computer System you
can have the same doctor visits without leaving your home or neighborhood. In fact, there is no reason why you cannot
take your own blood pressure and heart beat with computer added monitors that
the doctor can read as it is being taken.
This same system can be used to save a life in a 911 call that can be
forwarded to a doctor, who can guide you to life as you wait for arrival of the
ambulance. In the end you might not even
need it and it can be called off.
Someday soon every computer will have this system and that is very
soon. It is just time we learn all the
many different ways we can use this to save money and lives.
7. Free market payment of doctors and staff
Right now for both insurance and Medicare doctors are paid a set amount
for each procedure they do and often that does not even pay the costs to the
doctor. Let the free market take care of
this. Let the doctor charge what he
wants, but not by what he does but in a simple formula. So much per visit live or so much per visit
by computer hook up as per Items 5 and 6, and so much per every 15 minutes of
time. In this way if a procedure is
needed or not the doctor gets paid the same.
8. Computer aided surgery
There is nothing new about this.
It has been going on for 10 years.
Often a highly qualified surgeon helps in a surgery by computer screen
and monitors even though he is miles away.
But this is expanding all the time with robots, internet monitors and
multiple doctors watching for any problems.
This also will reduce costs over time.
9. Streamline Immigration of doctors and nurses
We are going to have a 40% shortage of doctors in the next two
years. And yet we train foreign doctors right here in American Colleges and give them
degrees but do not give them green cards to stay here or citizenships. We need to recruit and streamline citizenship
for those who are educated in good foreign nations.
10. Make medical fraudulent billing a criminal offence
When a patient or insurance company finds a billing that is obvious
fraud, it should be turned over to the justice department for criminal trials
and jail.
11. Make all emergency room use a life time billing of not less than
10% of income
If someone has to use a hospital emergency room and is not insured at
least for emergency care, the tax payer should not have to pay for that.
(Indigent excluded). They should then be
billed at not less than 10% of income until paid off. This will get the young to at least have
Emergency Health Insurance.
12. Make use of emergency room
use by non-citizens a criminal offence
We will never turn away a non-citizen but we can remove them from the
country after they are well enough to be moved.
Once they have a record of immigration crime they will not be allowed
back in
13. Make frivolous use of emergency rooms a State fine equal to cost.
Some people go to the emergency room with heart burn and some just
because they want a bed to lay down on. The cost of using the emergency room for
frivolous use should be the same as calling a fire truck when there is no
fire. The fine should at least equal the
cost to the hospital.
14. Enforce National history of medical mal-practice
We have another problem that happens all too often. I doctor’s license is removed in one state
for Mel-practice and he applied in another without giving that history and is
never checked out. This needs a national
data base.
Medicare needs to go back to its 1965 intention and now.
History of
Medicare (Progressive Socialism)
1965: President
• Medicare Part A deductible: $40/year
• Medicare Part B premium: $3/month
1966: Medicare
coverage began. More than 19 million individuals ages 65 and older were
enrolled in Medicare.
1972President Nixon
signed the Social Security Amendments of 1972 (PL 92-603), the first major
adjustment to Medicare after its enactment. Medicare eligibility was extended
to individuals under age 65 with long-term disabilities. Medicare benefits were
expanded to include some chiropractic services, speech therapy, and physical
therapy
1973: Medicare
coverage began for individuals receiving Social Security Disability Insurance
1975:
• Medicare Part A deductible: $92/year
• Medicare Part B premium: $6.70/month
• Total Medicare population: 24.9 million beneficiaries
1977: Creation of the Health Care Financing
Administration (HCFA) to
1980: The
Omnibus Reconciliation Act of 1980 expanded home health services
1980:
• Medicare Part A deductible: $180/year
• Medicare Part B premium: $8.70/month
• Total Medicare population: 28.4 million beneficiaries
1981: The
Omnibus Budget Reconciliation Act of 1981 (OBRA 1981) included provisions to
slow the growth in Medicare spending, including a change that resulted in an
increase in the inpatient hospital deductible
1982: The
Tax Equity and Fiscal Responsibility Act (TEFRA) increased the Part B premium
to cover 25% of program costs as part of policies designed to slow the growth
of Medicare spending. Hospice services for the terminally ill were added to
Medicare's covered benefits.
1983: The
Social Security amendments of 1983 established an inpatient hospital
prospective payment system (PPS) for the Medicare program. The PPS is based on
diagnosis-related groups, or DRGs, a pre-determined
payment for treating a specific condition.
1984: The
Deficit Reduction Act of 1984 (DEFRA) froze
physician fees, established the Participating Physicians' Program, and
established fee schedules for laboratory services, all of which were intended
to slow the growth of Medicare's spending and constrain the federal deficit.
1985: The Consolidated Omnibus
Budget Reconciliation Act of 1985 (COBRA) made Medicare coverage mandatory for
newly hired state and local government employees.
1985: The Emergency
Extension Act of 1985 froze PPS payment rates for inpatient hospital care and
continued physician payment freezes to slow the growth of Medicare spending.
1985:
• Medicare Part A deductible: $400/year
• Medicare Part B premium: $15.50/month
• Total Medicare population: 31.1 million beneficiaries
1986: The
Omnibus Budget Reconciliation Act of 1986 (OBRA 1986) revised several of the
payment procedures for various Medicare services in order to help slow the
growth in Medicare spending.
1987: The
Omnibus Budget Reconciliation Act of 1987 (OBRA 1987) imposed quality standards
for Medicare- and Medicaid-certified nursing homes.
1987: The Medicare and
Medicaid Patient and Program Protection Act of 1987 was
enacted to improve antifraud efforts and strengthen beneficiary protection
programs.
1987: The
Balanced Budget and Emergency Deficit Control Reaffirmation Act of 1987 froze
Medicare payment rates in an attempt to slow Medicare spending.
1988: The Medicare Catastrophic
Coverage Act of 1988, the largest expansion of the program since the enactment
of Medicare, included an outpatient prescription drug benefit and a cap on
beneficiaries' out-of-pocket expenses, and expanded hospital and skilled
nursing facility benefits. Medicaid began coverage of Medicare premiums and
cost-sharing for Medicare beneficiaries with incomes below 100% of the federal
poverty level, known as Qualified Medicare Beneficiaries (QMB). The U.S.
Bipartisan Commission on Comprehensive Health Care (which became known as
"Pepper" Commission after the late Congressman Claude Pepper of
Richard Salbato
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