Medical Malpractice

Can there be a truly bi-partisan health insurance program? Yes, I believe there can be if we look at where we are and where we need to be.

Current facts: There are 5 government plans that have been instituted in the last 4 decades paid for by our tax dollars.

Medicare, currently funded to seniors over 65 accounts for 16% of the federal budget, about $427 billion a year. Because of the baby boom generation, the projection in 2017 will account for $884 B a year. (Resource, Baby Boomers Coming to Age, content.healthaffairs.com.)

53 Million Americans are currently on Medicaid, which costs the government $338 Billion dollars a year. This program is currently funded by tax dollars and only 50-70% of the program is funded by the Federal Government. The reminder is funded by taxes from the state coffers.

The State Children's Health Insurance Program (SCHIP) currently insures over 6 Million children.

TRICARE is for those who currently serve or are retired from the military. Today this system is sorely inadequate.

Federal Employers Health Benefits Program (FEHBP) currently covers government workers and retirees and I understand a great system if you are a government employee!

Although these public, government programs were enacted to help those who needed medical coverage, there are several unintended consequences. Unfortunately, the first 4 above have lowered the quality of their product and service. This ranges from inadequate payment causing doctors and hospitals to charge private insurers higher premiums and costs to make up the shortfall in the government Medicare program. According to the Wall Street Journal, June 18, 2007, ½ of doctors have stopped taking Medicaid patients because reimbursements are low and payment delayed. Real costs are passed off to the private sector. Everyone who pays income taxes, both state and federal, pays for these shortages in Medicare, Medicaid and SCHIP. Plus there are many unseen tax costs added on consumer products (cigarettes, snack foods) we all purchase.

The real uninsured number is estimated at 45.7 Million, 15.3 % of the population, according to the 2007 Census bureau report: (Google 2007 Census report for the PDF). 18 M of these 45 M make more than $50,000 a year and out of these, 38M make more than $75,000. It is estimated that most of these are 19-29 year old "invincibles" who have the money but would rather spend it on other things besides health insurance. 10 M or more are not US Citizens. 14M are currently eligible for Medicare, Medicaid or SCHIP but have not enrolled because of personal responsibility, ignorance or laziness. That leaves about 8M who are the chronically uninsured working poor and are left behind and these are the people who need government help through private insurers. (Blue Cross/Blue Shield May 9, 2003 study results).

After 4 decades of larger government medical mandated insurance programs, the government is incapable of providing a level of care that is comparable through the private sector.

How to make this legislation a bi-partisan win-win proposal!

Clearly our current system is bankrupting the country and needs reform. Here are some proposals that our legislators should enact and would guarantee bi-partisan support and get the uninsured insured.

Reform the system by establishing fraud units. According to a CBS study from October 5, 2006, fraud is estimated to consume at least 10% of Medical outlays.

Reform the tax code to give individuals a tax incentive to carry their own health insurance. Continue to give the tax incentives to businesses that provide health insurance to their workers so they can attract new workers.

Give individuals income tax deductions for expenses that are not covered by their plan. Currently, most people can't deduct their out of pocket expenses unless they reach a threshold.

Expand HSA accounts so individuals can buy catastrophic coverage and put their deductibles and out of pocket expenses in a tax-free account. This requires education so people can understand the advantages and responsibilities of providing for their families.

Tort Reform is needed. It is estimated that 1 out of 8 doctors are sued annually. This is like an insurance pool lottery system and "jackpots" cost malpractice insurance companies millions of dollars each year, thus increasing the costs Doctors must charge patients to pay the premiums on these policies.

Establish incentives for 24 hour Retail Health Clinics so people that currently go to emergency rooms for care can use neighborhood clinics. These clinics operate well in most states to reduce costs of insurance. Educating the public and illegal's in emergency rooms would drive down doctor and hospital costs.

Get rid of over 1901 government mandates that have been enacted that have cost insurers and consumers millions of dollars and start over again. For example, funding clinical trials because they find cures for diseases is essential, but delete mandated programs for hair prosthesis, professional counseling, massage therapy, smoking cessation and in-vitro fertilization to name a few. Start over and allow people to purchase additional coverage on their own if they want these coverages.

Give those chronically ill, uninsured folks a voucher for a High Risk Pool. California currently has a program for those people who are uninsurable and have been denied insurance because of health issues. Today this program is inadequately funded but if the insurance companies were required to participate based on their premium volume and the federal and state government gave tax dollars to help fund the program, it was solve the shortfall for the 10 M folks who can't afford insurance.

Increase benefits paid to hospital and medical providers who service Medicare patients instead of reducing them. Medicare payments to providers (hospitals and doctors) are paid at a discounted rate of $70.00 for every $100.00 billed. This shortage has to come from somewhere and it is currently subsidized by private insurance companies and individuals.

Reform Medicaid payment structure so that it coincides with the truly poor-i.e. only fund those people who are at the poverty level (37M instead of 53 M Americans) and increase benefit payments so doctors and hospitals will give care needed to the truly poor.

Summary: There can be bi-partisan support and both sides can win the health care debate. I ask you to go down in history as a Congress that reformed the health care system, not burdened it further with more problems than can be solved in one universal program! This will definitely be a win/win for all sides of this great country.