Ideas to Save America: 3. Medicare

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 U.S. government is committed under current law to mandatory payments for programs such as Medicare, Medicaid and Social Security. The GAO projects that payouts for these programs will significantly exceed tax revenues over the next 75 years. The Medicare Part A (hospital insurance) payouts already exceed program tax revenues and Social Security payroll taxes fully cover payouts only until 2017.

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.

 File:GAO Slide.pngPay 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 America from Medicare


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 California food.  Enforce the interstate commerce clause of the constitution.

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 Portugal I had them checked at my own cost and brought them to the doctor to show the lab tests.  By the time I had these cut off I went to three different doctor’s offices, had three different check ups, waited 7 hours in offices and finally had a 25 year old cut them off.  I never once saw a doctor.  I never was given a bill.  Medicare never asked me if all they were charged actually happened.  I don’t know what the three doctors that I never saw billed, and Medicare never checked up on it.  

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 America until this medical bill is paid. 

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 Johnson signed H.R. 6675 (Public Law 89-97) to establish Medicare for the elderly and Medicaid for the indigent in Independence, Missouri, in the presence of Harry S. Truman who advocated for such legislation in a message to Congress in 1945.

• 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

• 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 administer both the Medicare and Medicaid programs.

1980: The Omnibus Reconciliation Act of 1980 expanded home health services

• 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.

• 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 Florida) was established to assess the feasibility of a long-term care benefit under Medicare.

Richard Salbato 

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