The following are some principles which should apply to any health care proposal which comes out of Washington. They are the result of a detailed analysis of the current situation and the evolution anticipated in health care over the next twenty years.
Universal Coverage: The Plan should demand Universal Coverage. This balances the risk pool seen by any and all insurers. This does raise the issue that any non-citizen or resident alien must have their own coverage and such coverage must be demonstrated at the time of entry into the US. This is a common practice in most countries. It can be a part of the Visa process or it can be by Agreement for cross compensation and insuring for non-Visa aliens. This does raise the issue of illegal aliens and their coverage.
Individual Coverage: The coverage should be for the individual, including a family, and not via group plans.
Non-Tax Advantage: All payments must be done with after tax dollars and any and all plans should be structured as such.
Catastrophic Coverage: Each Plan must have a minimal level of coverage for catastrophic events such as accidents, acute illnesses and long term chronic illness. Thus normal procedures such as office visits, physicals, consultations may be covered but at a higher plan level and at an additional cost. The minimal plan level then would cover a statistically know base of accidental injuries, acute ailments, including cancers, and long term chronic illnesses such as Parkinson's, CML, Alzheimer's, MD, MS, and the like.
Choice: The subscriber should have choice in providers including physicians and hospitals as well as other providers.
Patient Data Access to Personal Records: The Patient should have access to their records, and if possible the records should be patient centric and should follow the patient from provider to provider. This would be secured by privacy rights.
Provider Quality Metrics and Access by Patients: Provider metrics should be developed and monitored and accessible to Patients. This would include a list of generally agreed to quality metrics so that patients will have informed accesses to providers.
Patient Payments: All Plans should have some form of Patient payment so that for common procedures the Patient shares in the payment.
No Pre Existing Conditions, Universal Acceptance: The insurers must accept all potential subscribers independent of any pre-existing condition. Variations in rate may be "life style" dependent for certain types of services which are the result of that lifestyle.
Common Rates and Rate Schedules: Rates should be the same for all subscribers. The Rate Schedules or the variance in rates by the extent of plan coverage should be the same for all insurers.
Rate Sensitivity to Patient Lifestyle: Patients can have an additional charge to their rates in the event that they have a life style controllable condition which they could change but refuse to do so. Thus, for example, there may be an increasing premium for BMI in excess of 25.0 such that any subscriber whose BMI is 1.0 above 25.0 is charged an additional 10% increase and it increases continually as BMI increases. A second point would be a similar taxing on patients who smoke cigarettes. Other lifestyle metrics can be developed.
Payment Mechanism: Physicians and other Providers must have a simplified payment method using a smart card method or the like where payment if made subject to ex post facto review. Namely all bills must be paid within seventy two hours of submission. However fines for inappropriate billing could be applied to incent inappropriate billing.
Government Participation: The Government would be limited to Medicare and Medicaid as is currently the case. All insurers would be private insurers.
Tort Reform: There would be established a Review Board to assess prior to any litigation the reasonableness of any claim and the Board would have the power to arbitrate any claims made. This would reduce the costs of the Tort burdens.
Inappropriate Use of Facilities: In the event that a medical facility or provider is inappropriately used, such as the use of an Emergency Room for a non-accidental or non-acute problem, an excess fee may be applied and payable by the Patient. An excess insurance coverage may be purchased to cover such events but these events are not covered in the basic plan.
Payment for the Indigent: For those Patients whose income levels are below a certain defined line, the Government may pay for their basic catastrophic coverage as well as a basic "Well Plan" coverage which would pay for basic visits to approved facilities.
Institute a Public Health System: Local Clinics can be established for access by those with Basic Well Plan coverage for common medical services such as physicals, common non-life threatening illnesses and for chronic care such as for Type 2 Diabetes management.
Establish Tuition Reimbursement for Public Health Service: Any physician or other individual health care provider who works in the Public Health Care System would have their Medical School or similar tuition reimbursed at a year for year level.
Eliminate the VA: The VA should be eliminated the existing system should be used to provide for universal service. Payment of Veteran's health care costs should be made by the Government at a reasonable level.
Universal Coverage: The Plan should demand Universal Coverage. This balances the risk pool seen by any and all insurers. This does raise the issue that any non-citizen or resident alien must have their own coverage and such coverage must be demonstrated at the time of entry into the US. This is a common practice in most countries. It can be a part of the Visa process or it can be by Agreement for cross compensation and insuring for non-Visa aliens. This does raise the issue of illegal aliens and their coverage.
Individual Coverage: The coverage should be for the individual, including a family, and not via group plans.
Non-Tax Advantage: All payments must be done with after tax dollars and any and all plans should be structured as such.
Catastrophic Coverage: Each Plan must have a minimal level of coverage for catastrophic events such as accidents, acute illnesses and long term chronic illness. Thus normal procedures such as office visits, physicals, consultations may be covered but at a higher plan level and at an additional cost. The minimal plan level then would cover a statistically know base of accidental injuries, acute ailments, including cancers, and long term chronic illnesses such as Parkinson's, CML, Alzheimer's, MD, MS, and the like.
Choice: The subscriber should have choice in providers including physicians and hospitals as well as other providers.
Patient Data Access to Personal Records: The Patient should have access to their records, and if possible the records should be patient centric and should follow the patient from provider to provider. This would be secured by privacy rights.
Provider Quality Metrics and Access by Patients: Provider metrics should be developed and monitored and accessible to Patients. This would include a list of generally agreed to quality metrics so that patients will have informed accesses to providers.
Patient Payments: All Plans should have some form of Patient payment so that for common procedures the Patient shares in the payment.
No Pre Existing Conditions, Universal Acceptance: The insurers must accept all potential subscribers independent of any pre-existing condition. Variations in rate may be "life style" dependent for certain types of services which are the result of that lifestyle.
Common Rates and Rate Schedules: Rates should be the same for all subscribers. The Rate Schedules or the variance in rates by the extent of plan coverage should be the same for all insurers.
Rate Sensitivity to Patient Lifestyle: Patients can have an additional charge to their rates in the event that they have a life style controllable condition which they could change but refuse to do so. Thus, for example, there may be an increasing premium for BMI in excess of 25.0 such that any subscriber whose BMI is 1.0 above 25.0 is charged an additional 10% increase and it increases continually as BMI increases. A second point would be a similar taxing on patients who smoke cigarettes. Other lifestyle metrics can be developed.
Payment Mechanism: Physicians and other Providers must have a simplified payment method using a smart card method or the like where payment if made subject to ex post facto review. Namely all bills must be paid within seventy two hours of submission. However fines for inappropriate billing could be applied to incent inappropriate billing.
Government Participation: The Government would be limited to Medicare and Medicaid as is currently the case. All insurers would be private insurers.
Tort Reform: There would be established a Review Board to assess prior to any litigation the reasonableness of any claim and the Board would have the power to arbitrate any claims made. This would reduce the costs of the Tort burdens.
Inappropriate Use of Facilities: In the event that a medical facility or provider is inappropriately used, such as the use of an Emergency Room for a non-accidental or non-acute problem, an excess fee may be applied and payable by the Patient. An excess insurance coverage may be purchased to cover such events but these events are not covered in the basic plan.
Payment for the Indigent: For those Patients whose income levels are below a certain defined line, the Government may pay for their basic catastrophic coverage as well as a basic "Well Plan" coverage which would pay for basic visits to approved facilities.
Institute a Public Health System: Local Clinics can be established for access by those with Basic Well Plan coverage for common medical services such as physicals, common non-life threatening illnesses and for chronic care such as for Type 2 Diabetes management.
Establish Tuition Reimbursement for Public Health Service: Any physician or other individual health care provider who works in the Public Health Care System would have their Medical School or similar tuition reimbursed at a year for year level.
Eliminate the VA: The VA should be eliminated the existing system should be used to provide for universal service. Payment of Veteran's health care costs should be made by the Government at a reasonable level.
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