Friend of mine, a doctor and fellow musician, came up with the
following, an intriguing plan to revamp the US health care system from a
practicing physician's perspective.

Be sure to read the entire plan before making any judgments, it's tricky
in few spots.

Open Letter

Dear Mr. President,

Here are the basic principals upon which a sound, sustainable and
ethical health care system can and should be built:....

1. It shall be illegal for physicians to contract with anyone other than
their patient or patient's legal representative. There shall be no
contracts with the government, with any "managed care" entity or
insurance company, or with any other third party.....

2. It shall be illegal for physicians to receive payment directly from a
third party "payor." Payment must come from the patient directly and
shall be made at the time of service.....

3. It shall be illegal for third parties to request discounts from a
physician for their clients. The price for various services is to be
negotiated between patient and physician, as is the case with all other
professions. ....

4. Each American citizen shall have a Health Savings Account established
at birth. The HSA will be maintained with an investment firm or bank,
the accounts being insured by the Federal government to the amount of
$150,000, as are bank deposits. Increases in value on these accounts via
interest, dividends or increases in investment value are not taxed, and
these assets are protected from creditors, as with the usual IRA.
(Regulations will need to be developed regarding the type of investment,
allowing a certain low percentage to be invested in more volatile
investments.) Funds in the HSA can be spent only for Health Care, but
can be passed on to heirs over multiple generations, to be used for the
heir's health care needs. ....

5. Each American citizen shall be able to exclude from taxation the
amount of $5000 per year (adjusted for inflation) for deposit in his or
her Health Savings Account, with catch up contributions allowed if the
prior year's expenses exceeded this amount. There shall be no limit to
the total amount of capital the citizen can accumulate in his or her
HSA. ....

6. Businesses may no longer subtract from taxable income any payments to
"insurance companies" for health insurance plans. They can, however,
deposit money yearly into their employees' HSAs as a dedutible business
expense, the yearly maximum contribution per employee to be determined
after study by qualified economists. ....

7. Each American citizen shall have a catastrophic health insurance plan
in place that covers yearly health care expenses over $20,000 (adjusted
yearly for inflation). This plan will be sponsored and financed by the
Federal Government. See below for Comments about administration of this
plan.....

8. Citizens with income below the poverty level will be provided yearly
with a "tax rebate" from the Federal Government, deposited directly into
their HSA.....

9. The government will mandate that each state educate its citizen about
this "self-reliant" system. Every citizen must realize the need for
preventive health care and a healthy lifestyle. They must realize that
prudent use of these funds and maintaining a healthy lifestyle are the
surest route to security. They must be made aware that contribution
yearly to the HSA must come before purchase of consumer goods, a new
car, or a vacation, for example. There will be no free “safety net”
other than the catastrophic coverage.....

10. Citizens who become ill before they have accumulated sufficient
funds in their HSA to cover the "gap" (whose HSA balance falls below
zero in a given year) will be LOANED the needed funds by the Federal
government, to be repaid with interest in the future. This loan will
show up on their credit report and will influence their ability to
borrow for other purposes until it is repaid. ....

Comments.....

This plan relies on human nature to reduce costs. When payment is coming
directly from funds controlled by the patient, the patient will make
wiser choices. There will be less desire to obtain expensive tests that
are marginally indicated for minor complaints or to obtain expensive
tests when less expensive tests will do. Less expensive, but equally
effective, medications will be demanded by the patient..... and so forth.

With this system, the medical profession will be restored to an ethical
status, it being unethical to allow outside influences to intrude on the
physician-patient relationship (as contracts with third parties
invariably do). ....

The public will demand transparency in the pricing of services and will
cease to tolerate overpriced services. ....

The nation will then be pooling health risks that are in the
catastrophic range, rather than simply using the "insurance industry" as
a (leaky) conduit of money from employer to physician or hospital for
everyday care. ....

With prudent living and prudent saving, within five to six years each
citizen will have in their HSA sufficient funds to cover the $20,000
"gap" in any one catastrophic year, and within ten or so years should
have the funds to cover the gap for several years of catastrophic ill
health. With good health and good planning, these funds can be passed
from generation to generation, allowing those families with good health
to become fully covered with only rare intervention by the government. ....

The government can negotiate with the current managed care industry to
obtain management of the catastrophic funds with minimal administrative
expense, or can set up its own administrative agency (to replace the
current CMS, for example) to manage and administer the catastrophic
coverage program.....

Physicians will now be free to concentrate on what they do best, care
for patients and maintain their knowledge base, and will no longer have
to waste time dealing with managed care contracts and meaningless
requests from managed care companies. ....

I urge you not to let the powers that be within the current managed care
industry or within the established government agencies to bring pressure
against the adoption of such a rational and beneficial plan.....

Respectfully yours,

Lawrence E. Mallette, MD, PhD, FACP, FACN
April 2009

/Open Letter

Once again, chew on it for a while before rushing to judgment.

--
www.e-woodshop.net
Last update: 10/22/08
KarlC@ (the obvious)

Swingman wrote:
Friend of mine, a doctor and fellow musician, came up with the
following, an intriguing plan to revamp the US health care system
from a practicing physician's perspective.

Be sure to read the entire plan before making any judgments, it's
tricky in few spots.

Open Letter

Dear Mr. President,

Here are the basic principals upon which a sound, sustainable and
ethical health care system can and should be built:....

1. It shall be illegal for physicians to contract with anyone other
than their patient or patient's legal representative. There shall be
no contracts with the government, with any "managed care" entity or
insurance company, or with any other third party.....

2. It shall be illegal for physicians to receive payment directly
from a third party "payor." Payment must come from the patient
directly and shall be made at the time of service.....

3. It shall be illegal for third parties to request discounts from a
physician for their clients. The price for various services is to be
negotiated between patient and physician, as is the case with all
other professions. ....

4. Each American citizen shall have a Health Savings Account
established at birth. The HSA will be maintained with an investment
firm or bank, the accounts being insured by the Federal government to the
amount of
$150,000, as are bank deposits. Increases in value on these accounts
via interest, dividends or increases in investment value are not
taxed, and these assets are protected from creditors, as with the
usual IRA. (Regulations will need to be developed regarding the type
of investment, allowing a certain low percentage to be invested in
more volatile investments.) Funds in the HSA can be spent only for
Health Care, but can be passed on to heirs over multiple generations, to
be used for
the heir's health care needs. ....

5. Each American citizen shall be able to exclude from taxation the
amount of $5000 per year (adjusted for inflation) for deposit in his
or her Health Savings Account, with catch up contributions allowed if
the prior year's expenses exceeded this amount. There shall be no
limit to the total amount of capital the citizen can accumulate in his or
her
HSA. ....

6. Businesses may no longer subtract from taxable income any payments
to "insurance companies" for health insurance plans. They can,
however, deposit money yearly into their employees' HSAs as a
dedutible business expense, the yearly maximum contribution per
employee to be determined after study by qualified economists. ....

7. Each American citizen shall have a catastrophic health insurance
plan in place that covers yearly health care expenses over $20,000
(adjusted yearly for inflation). This plan will be sponsored and
financed by the Federal Government. See below for Comments about
administration of this plan.....

8. Citizens with income below the poverty level will be provided
yearly with a "tax rebate" from the Federal Government, deposited
directly into their HSA.....

9. The government will mandate that each state educate its citizen
about this "self-reliant" system. Every citizen must realize the need
for preventive health care and a healthy lifestyle. They must realize
that prudent use of these funds and maintaining a healthy lifestyle
are the surest route to security. They must be made aware that
contribution yearly to the HSA must come before purchase of consumer
goods, a new
car, or a vacation, for example. There will be no free “safety net”
other than the catastrophic coverage.....

10. Citizens who become ill before they have accumulated sufficient
funds in their HSA to cover the "gap" (whose HSA balance falls below
zero in a given year) will be LOANED the needed funds by the Federal
government, to be repaid with interest in the future. This loan will
show up on their credit report and will influence their ability to
borrow for other purposes until it is repaid. ....

Comments.....

This plan relies on human nature to reduce costs. When payment is
coming directly from funds controlled by the patient, the patient
will make wiser choices. There will be less desire to obtain expensive
tests
that are marginally indicated for minor complaints or to obtain
expensive tests when less expensive tests will do. Less expensive, but
equally
effective, medications will be demanded by the patient..... and so
forth.
With this system, the medical profession will be restored to an
ethical status, it being unethical to allow outside influences to
intrude on the physician-patient relationship (as contracts with
third parties invariably do). ....

The public will demand transparency in the pricing of services and
will cease to tolerate overpriced services. ....

The nation will then be pooling health risks that are in the
catastrophic range, rather than simply using the "insurance industry"
as a (leaky) conduit of money from employer to physician or hospital for
everyday care. ....

With prudent living and prudent saving, within five to six years each
citizen will have in their HSA sufficient funds to cover the $20,000
"gap" in any one catastrophic year, and within ten or so years should
have the funds to cover the gap for several years of catastrophic ill
health. With good health and good planning, these funds can be passed
from generation to generation, allowing those families with good
health to become fully covered with only rare intervention by the
government. ....
The government can negotiate with the current managed care industry to
obtain management of the catastrophic funds with minimal
administrative expense, or can set up its own administrative agency
(to replace the current CMS, for example) to manage and administer
the catastrophic coverage program.....

Physicians will now be free to concentrate on what they do best, care
for patients and maintain their knowledge base, and will no longer
have to waste time dealing with managed care contracts and meaningless
requests from managed care companies. ....

I urge you not to let the powers that be within the current managed
care industry or within the established government agencies to bring
pressure against the adoption of such a rational and beneficial
plan.....
Respectfully yours,

Lawrence E. Mallette, MD, PhD, FACP, FACN
April 2009

/Open Letter

Once again, chew on it for a while before rushing to judgment.

This plan does not rely on "human nature" to reduce costs - it relies on
government setting rules on how health care contracts should be negotiated
and enforced. There is nothing that would prevent, today, a physician from
demanding payment up front from the patient and refusing all third-party
involvement.

"HeyBub" wrote in message
...


This plan does not rely on "human nature" to reduce costs - it relies on
government setting rules on how health care contracts should be negotiated
and enforced. There is nothing that would prevent, today, a physician from
demanding payment up front from the patient and refusing all third-party
involvement.



I know of at least on who does just that. You get to negotiate with your
health insurance company and wait for them to pay.

"HeyBub" wrote in message
...

This plan does not rely on "human nature" to reduce costs - it relies on
government setting rules on how health care contracts should be negotiated
and enforced. There is nothing that would prevent, today, a physician from
demanding payment up front from the patient and refusing all third-party
involvement.



Precisely, and that is the beauty. Once again competition between doctors
and their services would keep costs low. Already there are groups of
doctors, clinics, pharmacies, and hospitals that will not accept insurance.
You have to join their group for well under $100 per month for your whole
family but a typical office visit costs around $35.

Leon wrote:
"HeyBub" wrote in message
...
This plan does not rely on "human nature" to reduce costs - it relies on
government setting rules on how health care contracts should be negotiated
and enforced. There is nothing that would prevent, today, a physician from
demanding payment up front from the patient and refusing all third-party
involvement.



Precisely, and that is the beauty. Once again competition between doctors
and their services would keep costs low. Already there are groups of
doctors, clinics, pharmacies, and hospitals that will not accept insurance.
You have to join their group for well under $100 per month for your whole
family but a typical office visit costs around $35.

But what do you do for critical care wherein costs can easily run into
the $100's of K numbers--a friend had heart valve replacement at roughly
$300K recently.

The routine office visit is simple; the costs are in the high-dollar
items that are less frequent, high liability (tort) costs and the costs
for unreimbursed care that have to be picked up by those who do pay.

The "competition" between physicians for expert medical care is a
fallacy -- in general the consumer has insufficient expertise to judge
quality or to know how to select alternate care options for the highest
efficacy. When forced to make difficult decisions on perhaps
life-or-death issues, in the end its not likely that the overriding
concern will be the cost. Easy enough to hypothesize that's what the
so-called rational consumer SHOULD do, but just as the markets are as
much or more emotion-driven, health care choices are as well.

--

"dpb" wrote in message ...
Leon wrote:
"HeyBub" wrote in message
...
This plan does not rely on "human nature" to reduce costs - it relies on
government setting rules on how health care contracts should be
negotiated and enforced. There is nothing that would prevent, today, a
physician from demanding payment up front from the patient and refusing
all third-party involvement.



Precisely, and that is the beauty. Once again competition between
doctors and their services would keep costs low. Already there are
groups of doctors, clinics, pharmacies, and hospitals that will not
accept insurance. You have to join their group for well under $100 per
month for your whole family but a typical office visit costs around $35.

But what do you do for critical care wherein costs can easily run into the
$100's of K numbers--a friend had heart valve replacement at roughly $300K
recently.

The only reason that the procedure cost that much is because insurance
companies probably only pay 30% of that cost. Eleminate the insurance
companines and you get the better pricing because every one is paying their
fare share and the medical industry does not need nearly as many on staff
whose only job is to "try" to collect what is owed them by the insurance
companies.

The "groups" that I referred to so surgery also at a dramatic reduction in
cost.






The routine office visit is simple; the costs are in the high-dollar items
that are less frequent, high liability (tort) costs and the costs for
unreimbursed care that have to be picked up by those who do pay.

The "competition" between physicians for expert medical care is a
fallacy -- in general the consumer has insufficient expertise to judge
quality or to know how to select alternate care options for the highest
efficacy. When forced to make difficult decisions on perhaps
life-or-death issues, in the end its not likely that the overriding
concern will be the cost. Easy enough to hypothesize that's what the
so-called rational consumer SHOULD do, but just as the markets are as much
or more emotion-driven, health care choices are as well.

--

Leon wrote:
"dpb" wrote in message ...
Leon wrote:
"HeyBub" wrote in message
...
This plan does not rely on "human nature" to reduce costs - it relies on
government setting rules on how health care contracts should be
negotiated and enforced. There is nothing that would prevent, today, a
physician from demanding payment up front from the patient and refusing
all third-party involvement.


Precisely, and that is the beauty. Once again competition between
doctors and their services would keep costs low. Already there are
groups of doctors, clinics, pharmacies, and hospitals that will not
accept insurance. You have to join their group for well under $100 per
month for your whole family but a typical office visit costs around $35.
But what do you do for critical care wherein costs can easily run into the
$100's of K numbers--a friend had heart valve replacement at roughly $300K
recently.

The only reason that the procedure cost that much is because insurance
companies probably only pay 30% of that cost. Eleminate the insurance
companines and you get the better pricing because every one is paying their
fare share and the medical industry does not need nearly as many on staff
whose only job is to "try" to collect what is owed them by the insurance
companies.

The "groups" that I referred to so surgery also at a dramatic reduction in
cost.
....

Do they do the difficult surgeries or are they like the private heart
clinics and others I'm aware of that "cherry-pick" the routine cases w/
high probability of success and low probability of complications and
leave the rest to the others thus driving up average costs drastically.
Again, _there's_ where the rub is.

I'd wager it's the latter--every one of those groups I've ever seen have
very selective membership criteria.

I don't understand the 30% example--typically insurance carriers are
covering 80% or "standard and normal" for any particular procedure.

I'll agree there is some overhead in processing claims but I'm yet to be
convinced it is a preponderant fraction of costs--rate it compared to
liability cost and uninsured/uncompensated care costs and I'd wager it's
the tail of the dog. Just as I'm totally unconvinced electronic records
will have any discernible effect on actual costs--it may help in some
cases w/ precision, add errors in coding in others and every large
data-processing implemented I've ever seen simply transferred one group
of overhead costs to a different set to implement/maintain/operate the
system.

--


--


--

dpb wrote:

The "competition" between physicians for expert medical care is a
fallacy -- in general the consumer has insufficient expertise to judge
quality or to know how to select alternate care options for the
highest efficacy. When forced to make difficult decisions on perhaps
life-or-death issues, in the end its not likely that the overriding
concern will be the cost. Easy enough to hypothesize that's what the
so-called rational consumer SHOULD do, but just as the markets are as
much or more emotion-driven, health care choices are as well.

I can't answer all your concerns, but quality can be judged by those
competent to make the call; in this case, your family physician. If he
refers you to a specialist that's not quite appropriate, some of the blame
will trickle down to him and he'll (usually) adjust his referrals
accordingly.

My internist has referred me to three different specialists (opthamologist,
plastic surgeon, and orthopedic physician). Upon my return to him, the
internist inquired as to whether I was treated properly by the referral.

The health-care delivery system in the U.S. is not perfect by any measure.
It is, however, like democracy, better than any other system available.
While there are problems, the vast majority of Americans are satisfied with
their options.

What worries me is that the very real possibility of ****ing-up something
that works properly for 250 million citizens in the hope that a few
under-served people will be helped.

Another issue - and I don't recall whether you mentioned it - is physician
liability. My state, Texas, instituted a severe tort reform measure four
years ago. Among other things, it capped non-economic losses (pain &
suffering, punitive damages) at $250,000. We've stopped hemorrhaging
physicians and, in fact, had a tremendous increase in doctors moving here
from less-enlightened places.

"HeyBub" wrote in
m:

dpb wrote:

The "competition" between physicians for expert medical care is a
fallacy -- in general the consumer has insufficient expertise to
judge quality or to know how to select alternate care options for the
highest efficacy. When forced to make difficult decisions on perhaps
life-or-death issues, in the end its not likely that the overriding
concern will be the cost. Easy enough to hypothesize that's what the
so-called rational consumer SHOULD do, but just as the markets are as
much or more emotion-driven, health care choices are as well.

I can't answer all your concerns, but quality can be judged by those
competent to make the call; in this case, your family physician. If he
refers you to a specialist that's not quite appropriate, some of the
blame will trickle down to him and he'll (usually) adjust his
referrals accordingly.

That's indeed the ideal situation. I wish it were true for more people,
including me, and I work in hospitals, albeit as a bench-type researcher.

My internist has referred me to three different specialists
(opthamologist, plastic surgeon, and orthopedic physician). Upon my
return to him, the internist inquired as to whether I was treated
properly by the referral.

The health-care delivery system in the U.S. is not perfect by any
measure. It is, however, like democracy, better than any other system
available. While there are problems, the vast majority of Americans
are satisfied with their options.

I'm not sure the majority is, and maybe some who are shouldn't be. That
goes vice versa as well. Some patients are just not taking the care they
should. Things as simple as the correct answer to have you recently
taken aspirin or other similar medications are not answered correctly (I
can prove this in my work).

What worries me is that the very real possibility of ****ing-up
something that works properly for 250 million citizens in the hope
that a few under-served people will be helped.

Yes, that is pssible. The reverse is much more likely.

Another issue - and I don't recall whether you mentioned it - is
physician liability. My state, Texas, instituted a severe tort reform
measure four years ago. Among other things, it capped non-economic
losses (pain & suffering, punitive damages) at $250,000. We've stopped
hemorrhaging physicians and, in fact, had a tremendous increase in
doctors moving here from less-enlightened places.

Congratulations. That example should be followed everywhere. In
addition, physicians who make bad decisions should get more than a
friendly pat - some should be really punished, and it should NOT be
covered by insurance.


--
Best regards
Han
email address is invalid

Leon wrote:
"HeyBub" wrote in message
...

This plan does not rely on "human nature" to reduce costs - it relies on
government setting rules on how health care contracts should be negotiated
and enforced. There is nothing that would prevent, today, a physician from
demanding payment up front from the patient and refusing all third-party
involvement.




Precisely, and that is the beauty. Once again competition between doctors
and their services would keep costs low.

Do you really think the medical profession would keep the cost low or
would they continue to keep jacking their price up to match the ones
that are charging the most?

Already there are groups of doctors, clinics, pharmacies, and hospitals
that will not accept insurance.

That's because they feel the "usual and customary" charges, agreed to by
those practicing and accepting the payment amounts the insurance
companies have negotiated, are too little and they don't like being
questioned when they overcharge.

You have to join their group for well under $100 per month for your whole
family but a typical office visit costs around $35.

How do they handle payment for the expensive things like surgeries,
cancer treatment, child births, hospital stays, etc.?

--
Jack Novak
Buffalo, NY - USA

"Nova" wrote in message
...
Leon wrote:
"HeyBub" wrote in message
...

This plan does not rely on "human nature" to reduce costs - it relies on
government setting rules on how health care contracts should be
negotiated and enforced. There is nothing that would prevent, today, a
physician from demanding payment up front from the patient and refusing
all third-party involvement.




Precisely, and that is the beauty. Once again competition between
doctors and their services would keep costs low.

Do you really think the medical profession would keep the cost low or
would they continue to keep jacking their price up to match the ones that
are charging the most?

Competition drives down prices. With insurance paying for your care there
is no competition.






Already there are groups of doctors, clinics, pharmacies, and hospitals
that will not accept insurance.

That's because they feel the "usual and customary" charges, agreed to by
those practicing and accepting the payment amounts the insurance companies
have negotiated, are too little and they don't like being questioned when
they overcharge.

I suspect it is because they make more money and have lower costs extcept
for the extensive advertising.



You have to join their group for well under $100 per month for your whole
family but a typical office visit costs around $35.

How do they handle payment for the expensive things like surgeries, cancer
treatment, child births, hospital stays, etc.?

A patient that is a member of one of the Houston area groups had a daughter
than needed arthroscopic knee surgery. He shopped the price and got quotes
in the $15,000 range. IIRC his group did the surgery for less than $3,000.

There will probably still be insurance for catastrophic needs if you feel
that living an extra year or two is woth having insurance for.

"Leon" wrote:

Competition drives down prices. With insurance paying for your care
there is no competition.

Reading the above brings a question to mind about another industry.

How much competition is there among auto body shops for insured
accident repair?

Lew

Leon wrote:
"Nova" wrote in message
...

Leon wrote:

Precisely, and that is the beauty. Once again competition between
doctors and their services would keep costs low.

Do you really think the medical profession would keep the cost low or
would they continue to keep jacking their price up to match the ones that
are charging the most?


Competition drives down prices. With insurance paying for your care there
is no competition.


The competition comes into play with the insurance providers. When I
choose my medical insurance plan one of the major considerations is
which doctors participated in each of the plans that are available.
The lower priced plans had fewer participating doctors and specialists.

snip


You have to join their group for well under $100 per month for your whole
family but a typical office visit costs around $35.

How do they handle payment for the expensive things like surgeries, cancer
treatment, child births, hospital stays, etc.?


A patient that is a member of one of the Houston area groups had a daughter
than needed arthroscopic knee surgery. He shopped the price and got quotes
in the $15,000 range. IIRC his group did the surgery for less than $3,000.

I don't know that I'd always want my medical treatment to go to the
lowest bidder.


There will probably still be insurance for catastrophic needs if you feel
that living an extra year or two is woth having insurance for.

It doesn't take a catastrophe to end up with astronomical medical bills.
I don't foresee any major reduction is the cost of medical care
regardless of who foots the bill.

As proposed in Swingman's original post:

"Each American citizen shall be able to exclude from taxation the amount
of $5000 per year (adjusted for inflation) for deposit in his or her
Health Savings Account, with catch up contributions allowed if the prior
year's expenses exceeded this amount. There shall be no limit to the
total amount of capital the citizen can accumulate in his or her HSA. .... "

How does this work for a hypothetical married couple with three young
children and one wage earner making minimum wage? Obviously they won't
be able to put $25,000 per year into their HSA.

Then there's:

"8. Citizens with income below the poverty level will be provided yearly
with a "tax rebate" from the Federal Government, deposited directly into
their HSA..... "

A "tax rebate" would indicate the citizen is paying federal tax. A
family of five earning $13,624 per year ($6.55 per hour x 40 hours x 52
weeks) does not pay federal income tax.

And there's:

"10. Citizens who become ill before they have accumulated sufficient
funds in their HSA to cover the "gap" (whose HSA balance falls below
zero in a given year) will be LOANED the needed funds by the Federal
government, to be repaid with interest in the future. This loan will
show up on their credit report and will influence their ability to
borrow for other purposes until it is repaid. .... "

Let's bury the hypothetical family in debt and take away all incentive
to work. Tim and I can cover all their expenses with out tax dollars.

--
Jack Novak
Buffalo, NY - USA

On Fri, 29 May 2009 18:03:59 -0500, Swingman wrote:

They must be made aware that contribution yearly to the HSA must come
before purchase of consumer goods, a new car, or a vacation, for
example. There will be no free €œsafety net€� other than the catastrophic
coverage.....

Someone has a lot of faith in people acting responsibly. It'll never
happen. And what happens to the health needs of children of
irresponsible parents?

Make the HSAs mandatory, deducted from earnings, and the plan has a
pretty good chance of working.

--
Intelligence is an experiment that failed - G. B. Shaw

Larry Blanchard wrote:
On Fri, 29 May 2009 18:03:59 -0500, Swingman wrote:

They must be made aware that contribution yearly to the HSA must come
before purchase of consumer goods, a new car, or a vacation, for
example. There will be no free €œsafety net€� other than the
catastrophic coverage.....

Someone has a lot of faith in people acting responsibly. It'll never
happen. And what happens to the health needs of children of
irresponsible parents?

Make the HSAs mandatory, deducted from earnings, and the plan has a
pretty good chance of working.

Just what we need, more government micromanagement.

On Fri, 29 May 2009 18:39:56 -0500, Larry Blanchard
wrote:

Make the HSAs mandatory, deducted from earnings, and the plan has a
pretty good chance of working.

Analogous to Social Security/Medicare deductions? (No judgment implied
or intended)

Many employers now offer optional "before tax" deductions to medical
deposit accounts that are limited to payments for health care. The
only one I'm familiar with had a "Use it this year, or it's gone
forever" clause and too many "if, ands, and buts" about it to be very
attractive to me. It was primarily intended to cover deductibles and
other expenses beyond the group health insurance coverage.

Sounds like a revamping of plans such as those could come pretty close
to the "open letter" suggestion.


Tom Veatch
Wichita, KS
USA

"Larry Blanchard" wrote in message
...
On Fri, 29 May 2009 18:03:59 -0500, Swingman wrote:

They must be made aware that contribution yearly to the HSA must come
before purchase of consumer goods, a new car, or a vacation, for
example. There will be no free "safety net" other than the catastrophic
coverage.....

Someone has a lot of faith in people acting responsibly. It'll never
happen. And what happens to the health needs of children of
irresponsible parents?


The "Right" thinks that the "Left" can learn this responsibility.

"Leon" wrote in message
...

"Larry Blanchard" wrote in message
...
On Fri, 29 May 2009 18:03:59 -0500, Swingman wrote:

They must be made aware that contribution yearly to the HSA must come
before purchase of consumer goods, a new car, or a vacation, for
example. There will be no free "safety net" other than the catastrophic
coverage.....

Someone has a lot of faith in people acting responsibly. It'll never
happen. And what happens to the health needs of children of
irresponsible parents?


The "Right" thinks that the "Left" can learn this responsibility.

The "right" more often than not, is wrong.

"Ed Edelenbos" wrote in message
...


The "Right" thinks that the "Left" can learn this responsibility.

The "right" more often than not, is wrong.


Yeah, you are probably right, the left should be handled by the government
and the right should take care if it self with out having to help the
government take care of the left.

"Swingman" wrote:

snip Lawrence E. Mallette, MD, PhD, FACP, FACN plan

"This plan relies on human nature to reduce costs"

There in lies the fallacy of the plan.

Lew

"Lew Hodgett" wrote in message
...
"Swingman" wrote:

snip Lawrence E. Mallette, MD, PhD, FACP, FACN plan

"This plan relies on human nature to reduce costs"

There in lies the fallacy of the plan.

Lew



I recall a company that wanted to reduce their expenses for sales and
service people with expense accounts. They had company credit cards and
cell phones.

They took away the company cards and phones and instead, had them use there
personal cards and phone, but also paid their entire phone bill, not just
the company portion, and gave them some extra on other expenses. Once the
people handled the money themselves, saw the bills, saw the waste, they
reduced the overall expenses considerably.

I may work.

Swingman wrote in
:

Friend of mine, a doctor and fellow musician, came up with the
following, an intriguing plan to revamp the US health care system from
a practicing physician's perspective.

Be sure to read the entire plan before making any judgments, it's
tricky in few spots.

Open Letter

Dear Mr. President,

Here are the basic principals upon which a sound, sustainable and
ethical health care system can and should be built:....

1. It shall be illegal for physicians to contract with anyone other
than their patient or patient's legal representative. There shall be
no contracts with the government, with any "managed care" entity or
insurance company, or with any other third party.....

2. It shall be illegal for physicians to receive payment directly from
a third party "payor." Payment must come from the patient directly and
shall be made at the time of service.....

3. It shall be illegal for third parties to request discounts from a
physician for their clients. The price for various services is to be
negotiated between patient and physician, as is the case with all
other professions. ....

4. Each American citizen shall have a Health Savings Account
established at birth. The HSA will be maintained with an investment
firm or bank, the accounts being insured by the Federal government to
the amount of $150,000, as are bank deposits. Increases in value on
these accounts via interest, dividends or increases in investment
value are not taxed, and these assets are protected from creditors, as
with the usual IRA. (Regulations will need to be developed regarding
the type of investment, allowing a certain low percentage to be
invested in more volatile investments.) Funds in the HSA can be spent
only for Health Care, but can be passed on to heirs over multiple
generations, to be used for the heir's health care needs. ....

5. Each American citizen shall be able to exclude from taxation the
amount of $5000 per year (adjusted for inflation) for deposit in his
or her Health Savings Account, with catch up contributions allowed if
the prior year's expenses exceeded this amount. There shall be no
limit to the total amount of capital the citizen can accumulate in his
or her HSA. ....

6. Businesses may no longer subtract from taxable income any payments
to "insurance companies" for health insurance plans. They can,
however, deposit money yearly into their employees' HSAs as a
dedutible business expense, the yearly maximum contribution per
employee to be determined after study by qualified economists. ....

7. Each American citizen shall have a catastrophic health insurance
plan in place that covers yearly health care expenses over $20,000
(adjusted yearly for inflation). This plan will be sponsored and
financed by the Federal Government. See below for Comments about
administration of this plan.....

8. Citizens with income below the poverty level will be provided
yearly with a "tax rebate" from the Federal Government, deposited
directly into their HSA.....

9. The government will mandate that each state educate its citizen
about this "self-reliant" system. Every citizen must realize the need
for preventive health care and a healthy lifestyle. They must realize
that prudent use of these funds and maintaining a healthy lifestyle
are the surest route to security. They must be made aware that
contribution yearly to the HSA must come before purchase of consumer
goods, a new car, or a vacation, for example. There will be no free
“safety net” other than the catastrophic coverage.....

10. Citizens who become ill before they have accumulated sufficient
funds in their HSA to cover the "gap" (whose HSA balance falls below
zero in a given year) will be LOANED the needed funds by the Federal
government, to be repaid with interest in the future. This loan will
show up on their credit report and will influence their ability to
borrow for other purposes until it is repaid. ....

Comments.....

This plan relies on human nature to reduce costs. When payment is
coming directly from funds controlled by the patient, the patient will
make wiser choices. There will be less desire to obtain expensive
tests that are marginally indicated for minor complaints or to obtain
expensive tests when less expensive tests will do. Less expensive, but
equally effective, medications will be demanded by the patient.....
and so forth.

With this system, the medical profession will be restored to an
ethical status, it being unethical to allow outside influences to
intrude on the physician-patient relationship (as contracts with third
parties invariably do). ....

The public will demand transparency in the pricing of services and
will cease to tolerate overpriced services. ....

The nation will then be pooling health risks that are in the
catastrophic range, rather than simply using the "insurance industry"
as a (leaky) conduit of money from employer to physician or hospital
for everyday care. ....

With prudent living and prudent saving, within five to six years each
citizen will have in their HSA sufficient funds to cover the $20,000
"gap" in any one catastrophic year, and within ten or so years should
have the funds to cover the gap for several years of catastrophic ill
health. With good health and good planning, these funds can be passed
from generation to generation, allowing those families with good
health to become fully covered with only rare intervention by the
government. ....

The government can negotiate with the current managed care industry to
obtain management of the catastrophic funds with minimal
administrative expense, or can set up its own administrative agency
(to replace the current CMS, for example) to manage and administer the
catastrophic coverage program.....

Physicians will now be free to concentrate on what they do best, care
for patients and maintain their knowledge base, and will no longer
have to waste time dealing with managed care contracts and meaningless
requests from managed care companies. ....

I urge you not to let the powers that be within the current managed
care industry or within the established government agencies to bring
pressure against the adoption of such a rational and beneficial
plan.....

Respectfully yours,

Lawrence E. Mallette, MD, PhD, FACP, FACN
April 2009

/Open Letter

Once again, chew on it for a while before rushing to judgment.

Once upon a time I needed surgery to remove an excessive portion of my
uvula (the thingy hanging down in the back from the roof of your mouth -
it caused excessive snoring). The ENT said I needed Vioxx for pain
relief (that's how long ago). I asked why not Celebrex, and he said
Vioxx is better. End of discussion. Is that how you will be negotiating
prices?


--
Best regards
Han
email address is invalid

Han wrote:

Once again, chew on it for a while before rushing to judgment.

Once upon a time I needed surgery to remove an excessive portion of my
uvula (the thingy hanging down in the back from the roof of your
mouth - it caused excessive snoring). The ENT said I needed Vioxx
for pain relief (that's how long ago). I asked why not Celebrex, and
he said Vioxx is better. End of discussion. Is that how you will be
negotiating prices?

God! I first read you sentence as having a need to remove an excess vulva!

Anyway, if a doctor offered me Vioxx (or Celebrex) and declined my request
for Vicodin, (or if he insisted on Vicodin when I requested Morphine) I'd
ask for a referral to a more patient-friendly physician.

"HeyBub" wrote in
m:

Han wrote:

Once again, chew on it for a while before rushing to judgment.

Once upon a time I needed surgery to remove an excessive portion of
my uvula (the thingy hanging down in the back from the roof of your
mouth - it caused excessive snoring). The ENT said I needed Vioxx
for pain relief (that's how long ago). I asked why not Celebrex, and
he said Vioxx is better. End of discussion. Is that how you will be
negotiating prices?

God! I first read you sentence as having a need to remove an excess
vulva!

Anyway, if a doctor offered me Vioxx (or Celebrex) and declined my
request for Vicodin, (or if he insisted on Vicodin when I requested
Morphine) I'd ask for a referral to a more patient-friendly physician.

For reasons unknown to me he is not at the hospital anymore. That's all
I can say. The procedure worked as advertised - something like 5 days of
pain, but tolerable under the medications provided. I ate a lot of soft
food (Singapore Mai Fung(spelling??)) which provided beneficial capsacain
(hot pepper). Snoring was almost eliminated, but after 5 or more years
is returning somewhat. In my professional opinion there should not have
been much difference between the 2 COX-2 inhibitors, but I am not a
physician.


--
Best regards
Han
email address is invalid

I agree that changes are needed in our current system, but it scares the
heck out of me to think that the government would be more involved. These
are the same democrats and republicans that have sent our economy into a
tail spin.

I have witnessed our own insurance company dictating the course of treatment
for my wife's breast cancer over the last three years. We have had to fight
to get the proper drugs and treatment over the cost saving path the
insurance company would prefer. We have also been subject to huge
co-payments on drugs. Three years ago we had a co-payment of $65 per pill
for Anzemet!

I like the basis of the letter, but by the time our government gets through
haggling over it we may be ****ed again.

cm


"Swingman" wrote in message
...
Friend of mine, a doctor and fellow musician, came up with the following,
an intriguing plan to revamp the US health care system from a practicing
physician's perspective.

Be sure to read the entire plan before making any judgments, it's tricky
in few spots.

Open Letter

Dear Mr. President,

Here are the basic principals upon which a sound, sustainable and ethical
health care system can and should be built:....

1. It shall be illegal for physicians to contract with anyone other than
their patient or patient's legal representative. There shall be no
contracts with the government, with any "managed care" entity or insurance
company, or with any other third party.....

2. It shall be illegal for physicians to receive payment directly from a
third party "payor." Payment must come from the patient directly and shall
be made at the time of service.....

3. It shall be illegal for third parties to request discounts from a
physician for their clients. The price for various services is to be
negotiated between patient and physician, as is the case with all other
professions. ....

4. Each American citizen shall have a Health Savings Account established
at birth. The HSA will be maintained with an investment firm or bank, the
accounts being insured by the Federal government to the amount of
$150,000, as are bank deposits. Increases in value on these accounts via
interest, dividends or increases in investment value are not taxed, and
these assets are protected from creditors, as with the usual IRA.
(Regulations will need to be developed regarding the type of investment,
allowing a certain low percentage to be invested in more volatile
investments.) Funds in the HSA can be spent only for Health Care, but can
be passed on to heirs over multiple generations, to be used for the heir's
health care needs. ....

5. Each American citizen shall be able to exclude from taxation the amount
of $5000 per year (adjusted for inflation) for deposit in his or her
Health Savings Account, with catch up contributions allowed if the prior
year's expenses exceeded this amount. There shall be no limit to the total
amount of capital the citizen can accumulate in his or her HSA. ....

6. Businesses may no longer subtract from taxable income any payments to
"insurance companies" for health insurance plans. They can, however,
deposit money yearly into their employees' HSAs as a dedutible business
expense, the yearly maximum contribution per employee to be determined
after study by qualified economists. ....

7. Each American citizen shall have a catastrophic health insurance plan
in place that covers yearly health care expenses over $20,000 (adjusted
yearly for inflation). This plan will be sponsored and financed by the
Federal Government. See below for Comments about administration of this
plan.....

8. Citizens with income below the poverty level will be provided yearly
with a "tax rebate" from the Federal Government, deposited directly into
their HSA.....

9. The government will mandate that each state educate its citizen about
this "self-reliant" system. Every citizen must realize the need for
preventive health care and a healthy lifestyle. They must realize that
prudent use of these funds and maintaining a healthy lifestyle are the
surest route to security. They must be made aware that contribution yearly
to the HSA must come before purchase of consumer goods, a new car, or a
vacation, for example. There will be no free “safety net” other than the
catastrophic coverage.....

10. Citizens who become ill before they have accumulated sufficient funds
in their HSA to cover the "gap" (whose HSA balance falls below zero in a
given year) will be LOANED the needed funds by the Federal government, to
be repaid with interest in the future. This loan will show up on their
credit report and will influence their ability to borrow for other
purposes until it is repaid. ....

Comments.....

This plan relies on human nature to reduce costs. When payment is coming
directly from funds controlled by the patient, the patient will make wiser
choices. There will be less desire to obtain expensive tests that are
marginally indicated for minor complaints or to obtain expensive tests
when less expensive tests will do. Less expensive, but equally effective,
medications will be demanded by the patient..... and so forth.

With this system, the medical profession will be restored to an ethical
status, it being unethical to allow outside influences to intrude on the
physician-patient relationship (as contracts with third parties invariably
do). ....

The public will demand transparency in the pricing of services and will
cease to tolerate overpriced services. ....

The nation will then be pooling health risks that are in the catastrophic
range, rather than simply using the "insurance industry" as a (leaky)
conduit of money from employer to physician or hospital for everyday care.
....

With prudent living and prudent saving, within five to six years each
citizen will have in their HSA sufficient funds to cover the $20,000 "gap"
in any one catastrophic year, and within ten or so years should have the
funds to cover the gap for several years of catastrophic ill health. With
good health and good planning, these funds can be passed from generation
to generation, allowing those families with good health to become fully
covered with only rare intervention by the government. ....

The government can negotiate with the current managed care industry to
obtain management of the catastrophic funds with minimal administrative
expense, or can set up its own administrative agency (to replace the
current CMS, for example) to manage and administer the catastrophic
coverage program.....

Physicians will now be free to concentrate on what they do best, care for
patients and maintain their knowledge base, and will no longer have to
waste time dealing with managed care contracts and meaningless requests
from managed care companies. ....

I urge you not to let the powers that be within the current managed care
industry or within the established government agencies to bring pressure
against the adoption of such a rational and beneficial plan.....

Respectfully yours,

Lawrence E. Mallette, MD, PhD, FACP, FACN
April 2009

/Open Letter

Once again, chew on it for a while before rushing to judgment.

--
www.e-woodshop.net
Last update: 10/22/08
KarlC@ (the obvious)

On Sat, 30 May 2009 08:02:12 -0700, cm wrote:

I agree that changes are needed in our current system, but it scares the
heck out of me to think that the government would be more involved.
These are the same democrats and republicans that have sent our economy
into a tail spin.

But yet the SSA administers Social Security with an almost negligible
amount of overhead. A government program can work efficently, but the
devil is in the details.

For example, Medicare offers way too many opportunities for fraud just
because of the way it is structured and administered. And the fraud is
coming from the private sector part (i.e. patients, doctors, hospitals,
and insurance companies) not the government part.

--
Intelligence is an experiment that failed - G. B. Shaw

Larry Blanchard wrote:
On Sat, 30 May 2009 08:02:12 -0700, cm wrote:

I agree that changes are needed in our current system, but it scares the
heck out of me to think that the government would be more involved.
These are the same democrats and republicans that have sent our economy
into a tail spin.

But yet the SSA administers Social Security with an almost negligible
amount of overhead. A government program can work efficently, but the
devil is in the details.
....

Yeah, so efficiently they have thousands on the roles that have been
deceased, some for decades (GAO investigation I heard reported not long
ago)...

--

On Sat, 30 May 2009 11:01:05 -0500, dpb wrote:

But yet the SSA administers Social Security with an almost negligible
amount of overhead. A government program can work efficently, but the
devil is in the details.
...

Yeah, so efficiently they have thousands on the roles that have been
deceased, some for decades (GAO investigation I heard reported not long
ago)...

I don't doubt there's some fraud going on, but unless you can cite the
source I doubt it's in the thousands. And I mentioned low overhead which
you didn't seem to question.

I wonder if the costs of lowering the fraud rate would exceed the amount
that was saved?

--
Intelligence is an experiment that failed - G. B. Shaw

"Larry Blanchard" wrote in message
news
On Sat, 30 May 2009 11:01:05 -0500, dpb wrote:

But yet the SSA administers Social Security with an almost negligible
amount of overhead. A government program can work efficently, but the
devil is in the details.
...

Yeah, so efficiently they have thousands on the roles that have been
deceased, some for decades (GAO investigation I heard reported not long
ago)...

I don't doubt there's some fraud going on, but unless you can cite the
source I doubt it's in the thousands. And I mentioned low overhead which
you didn't seem to question.

I doubt it too. I'd think it is probably in the tens of thousands. Really,
I do. Then the ones fraudulently collecting disability is probably triple
that number. Read the last line in this .

http://therecordlive.com/article/Bey...c heats/52994
U.S. Congressman Kevin Brady (R-The Woodlands) met today in Houston with
officials from the Social Security Administration ahead of a congressional
hearing next week to examine fraud in the federal disability program. Brady,
who requested the hearing of the House Ways & Means Subcommittee on Social
Security, says scammers may be draining up to $11 billion from the Social
Security Disability Insurance Trust Fund that helps more than seven million
disabled Americans.

"We have a responsibility to taxpayers and the truly disabled to make sure
these precious dollars are not lost to fraud and those trying to game the
system," said Brady, a member of the Social Security panel.

Brady met Monday with Patrick O'Carroll Jr., inspector general of the Social
Security Administration, and leaders of the Houston Co-operative Disability
Investigative (CDI) unit which includes team members from the Social
Security Administration, the Inspector General's office, the state
disability agency and Harris County law enforcement.

Since the Houston unit was formed in 2000, the team has successfully
terminated 1,003 cases, saving taxpayers nearly $90 million. The unit
investigates disability fraud in applicants faking impairments as well as
those concealing work payments or medical improvements while receiving
disability payments.

O'Carroll told the congressman that 14 tax dollars are saved for every
dollar Congress allots to investigate disability fraud allegations. The
Social Security Administration is required to conduct continuing disability
reviews on each case.

In one particularly egregious case from last year, a dead man was actually
put in a wheelchair and brought to a check-cashing store in New York so one
of his friends could cash his check (Source: Reuters 1/9/08).

"cm" wrote in
news
I have witnessed our own insurance company dictating the course of
treatment for my wife's breast cancer over the last three years. We
have had to fight to get the proper drugs and treatment over the cost
saving path the insurance company would prefer. We have also been
subject to huge co-payments on drugs. Three years ago we had a
co-payment of $65 per pill for Anzemet!

I have to comiserate with you for the reasons for the drug Anzemet. I just
priced it for my insurance plan through US Healthcare (Medco administered).
Anzemet would cost me $100 for a 90 day supply. I am not familiar with the
drug (lucky me), so I don't know more.

I guess I am lucky to have a good coverage plan ...

--
Best regards
Han
email address is invalid

On Fri, 29 May 2009 18:03:59 -0500, Swingman wrote:

Friend of mine, a doctor and fellow musician, came up with the
following, an intriguing plan to revamp the US health care system from a
practicing physician's perspective.

Be sure to read the entire plan before making any judgments, it's tricky
in few spots.

Open Letter


snip


Why don't we just buy ourselves a doctor?

Let's say you belong to a builder's association with one hundred
members.

Each of the members has been spending $1000.00 per month on family
medical insurance.

That creates a theoretical maximum pool of $1,200,000.00 per year.

Let's say an internist earns an average of $200,000.00 per year.

His salary would cost each member $2,000.00 per year.

Since he only has a patient group of four hundred people, he can do
his own damned paperwork and he doesn't need an office because with
only four hundred patients everything would be a house call.

Alright, if you're gonna bitch about medical equipment and other
expenses, let's throw in $50,000.00 a year for that.

So now we have a medical subcontractor at a total cost of $250,000.00
per year divided by one hundred members for a cost of $2500.00 per
year. That's $208.33 per month for primary medical care for a family
of four.

That leaves $791.67 per month to pay for catastrophic coverage.

At a cost of $3500.00 per year for that coverage that would be another
$291.67 per month.

Total cost of primary and catastrophic coverage is about $500.00 per
month.


I haven't looked into the cost of buying an actual hospital yet but,
what the hell, we're talking about a builder's group. I'm thinking
$200.00 per square foot including the Chiwanese medical gear we'll get
from Grizzly.


I don't know why my son thinks that math isn't fun.







Regards,

Tom Watson
http://home.comcast.net/~tjwatson1/

Tom Watson wrote:
On Fri, 29 May 2009 18:03:59 -0500, Swingman wrote:

Friend of mine, a doctor and fellow musician, came up with the
following, an intriguing plan to revamp the US health care system from a
practicing physician's perspective.

Be sure to read the entire plan before making any judgments, it's tricky
in few spots.

Open Letter


snip


Why don't we just buy ourselves a doctor?

Let's say you belong to a builder's association with one hundred
members.

Each of the members has been spending $1000.00 per month on family
medical insurance.

That creates a theoretical maximum pool of $1,200,000.00 per year.

Let's say an internist earns an average of $200,000.00 per year.

His salary would cost each member $2,000.00 per year.

Since he only has a patient group of four hundred people, he can do
his own damned paperwork and he doesn't need an office because with
only four hundred patients everything would be a house call.

Alright, if you're gonna bitch about medical equipment and other
expenses, let's throw in $50,000.00 a year for that.

So now we have a medical subcontractor at a total cost of $250,000.00
per year divided by one hundred members for a cost of $2500.00 per
year. That's $208.33 per month for primary medical care for a family
of four.

That leaves $791.67 per month to pay for catastrophic coverage.

At a cost of $3500.00 per year for that coverage that would be another
$291.67 per month.

Total cost of primary and catastrophic coverage is about $500.00 per
month.


I haven't looked into the cost of buying an actual hospital yet but,
what the hell, we're talking about a builder's group. I'm thinking
$200.00 per square foot including the Chiwanese medical gear we'll get
from Grizzly.


I don't know why my son thinks that math isn't fun.



That's the best proposal in this thread. I also think that
the group participants ought to be able to pick the nurses
for their, um, non-medical attributes since these almost
certainly enhance healing ...

--
----------------------------------------------------------------------------
Tim Daneliuk
PGP Key: http://www.tundraware.com/PGP/

"Tim Daneliuk" wrote in message
...

That's the best proposal in this thread. I also think that
the group participants ought to be able to pick the nurses
for their, um, non-medical attributes since these almost
certainly enhance healing ...
----------------------------------------------------------------------------

How "Dr. Strangelove" of you.

--
Dave in Houston