BuiltWithNOF
Future Vision

 

VISION OF THE FUTURE

 

HEALTH CARE SYSTEM

 

The American Health Care System is experiencing a dual Quality and Cost crisis. Our economy cannot sustain the cost inflation and rate of growth.  It must be understood, that from a business standpoint, we are now paying for Universal Care, just not getting the benefits of improved quality and cost savings (See:Cost & Quality).Fortunately, the progressive movement toward Universal Health Care is on the horizon.

The continuing debate regarding whether Health Care for all Americas is a “Right” or a “Priviledge” is an interesting  philosophical exercise, but not productive. This discussion keeps conservatives and progressives from cooperating to develop a meaningful solutions to this major economic problem. All Americans must understand that taxpayers and insureds would see a reduction in their cost for health care under a single purchaser (Universal Health Care) system.

 

Americans now pay for

 

Universal Health Car

 

 without getting the benefits.

 

Government Health Care Spending as Percent of Overall Health Spending

 

Medicare Medicaid & VA

Public Employee Health Care

Health Care Tax Subsidies

TOTAL

Percent

47.8%

6.4%

10.1%

64.3%

Dollars

$1.53 Trillion

$188 Billion

$294.9 Billion

$2.013 Trillion

American Journal of Public Health 106, no. 3 (March 1, 2016): pp. 449-452

Our government (taxpayer) funds 64.3% of the health care now delivered in America.Taxpayers also pay for their own health care. Some have insurance. Some pay out of pocket. The cost of care for those who cannot pay is shifted to those who pay taxes and purchase insurance.  Health care insurance “purchased” by employers is, in reality, part of the cost of labor that includes vacation, sick pay, disability, worker’s comp, retirement funding, etc.. This insurance cost is coming out of the worker’s pocket. The remainder is “take-home pay” or salary less Federal & State income taxes.

 

EXPANSION OF MEDICARE TO COVER ALL AMERICANS

 

Providing Medicare to all Americans would enroll everyone into a managed system that would reduce cost of caring for uninsured and underinsured folks that now receive their acute care (when they crash) at high cost emergency rooms. The cost of this care and any admissions that result is presently shifted to those who do pay This cost shifting would be eliminated by the Single Payer System. Individuals with major chronic illnesses would have their conditions managed to provide quality care at the lowest possible cost.

Under the future Universal / Single Payer System, all Americans would be covered from birth to death by Standard Medicare or Medicare Advantage (PPO or HMO plans). Medicaid would reduce it’s “Medi” focus providing only financial support for Medicare deductibles/copays and continuing the primary mission of supporting the social and economic needs (not wants, desires or entitlements) of the poor and disabled. 

HOW WOULD A SINGLE PAYER MEDICARE ADMINISTERED SYSTEM WORK?

 

FROM THE PATIENT/TAXPAYER PERSPECTIVE:

The system would work exactly as Medicare is now structured but expanded to all Americans. The Taxpayer (government) would continue to fund Medicare as it now does. Citizens and immigrants would “enroll” in a private Standard Medicare Plan or a Medicare Advantage (PPO/HMO) plan. As they do now, the private insurance companies would administer the benefits (manage care and process claims). Standard Medicare offers an “80/20” plan requiring the enrollee to pay 20% of the standard Fee Schedule. The enrollee pays the rest - unless the enrollee purchases a Medicare Supplement insurance policy from one of the private insurance compahies. For those wanting complete flexibility of choice of health care provider and facility, Standard Medicare and purchasing the supplement may be the way to go.

Many Americans do not have the financial strength to purchase any insurance, let alone a supplemental policy for Standard Medicare. The poor (as defined by the feds) and everyone now enrolled in Medicaid would be required to select a Medicare Advantage (HMO) plan. These plans provide almost complete coverage with low maximum out-of-pocket expense and minimum co-payments. The very poor would not have the means to meet these obligations. Medicare could allow “Network Providers” and facilities with Medicare Advantage contracts to balance bill (“subrogate”) the deductibles and co-pays to the present state managed Medicaid programs, thus keeping physicians, hospitals and clinics with Medicare/Medicaid contracts whole.

Getting the American Health Care System from our present inefficient Fee-for-Service, essentially for profit structure to the Universal Health Care / Single Payer model is presented in the “Road Map” page on this web site.

 

FROM THE PROVIDER AND FACILITY PERSPECTIVE:

Very large integrated health care delivery systems (e.g., Kaiser Permanente) offer Managed Health Care Plans (“insurance” / Claims Processing), health care providers (doctors, nurses, physical therapists, etc.) and bricks & mortar (hospitals, outpatient facilities, clinics, etc.). These large integrated Health Care Systems would continue to function as they do now with Medicare enrollees, with the exception that all individuals in their service areas would be eligible to enroll in their Standard Medicare & Medicare Advantage Plans.

Physicians would continue to practice as they do now with the exception that all their patients would be covered by one of the private insurance companies now offering Standard Medicare, Medicare Supplement and Medicare Advantage plans.

Similarly, bricks and mortar facilities (Hospitals, OP Surgical Centers, Urgent Care Facilities, OP Lab & Imaging Facilities, etc.) would continue to function as they do now but all patients would with the exception that all patients would be covered by Medicare.

 

WHAT ARE THE INTENDED CONSEQUENCES OF EXPANDING MEDICARE?

Health Care for all Americans and tax paying legal immigrants would be paid to network/contracted providers and facilities within the terms and limitations of Standard Medicare or Medicare Advantage.

Medicare would negotiate a nation wide Pharmacy Benefit Package (Formulary) with drug companies resulting in significant cost savings.

All Americans and tax paying legal immigrants would be in the “Self Funded Risk Pool” of 324 million souls.

Consideration for preexisting conditions and “Premiums” based on age, sex or health risk become meaningless.

Insurance Companies would be out of the expensive (high profit) Risk Management business and focused on claims processing (a “commodity”)  and managing care to improve quality and reduce both administrative and medical costs. 

Quality Improvement efforts would minimize unnecessary medical care and services (estimated at 40% of the total health care dollar) reducing yearly health care costs by up to $1.28 trillion and reducing the Health Care percent of GDP from 17.8% to 11%.

Since taxpayers now fund the 64.3% of the  total health care dollar now funded by the government plus the cost of their own health care, the cost savings of the Quality Improvement efforts in a Single Payer System would reduce the taxpayer’s bottom line obligation.

WHAT ARE THE UNINTENDED CONSEQUENCES OF EXPANDING MEDICARE ?

These “Consequences” might be more properly categorized as “Known Side Effects” - some good, some bad depending on who’s Ox is being gored.  They are the result of quality improvement efforts to reduce to a minimum administrative costs and unnecessary health care (about 40% of the total present cost).  There is no free lunch. Health care costs would be financed by exchanging high health care insurance premiums for a lower health care system tax.

So what are some of the predictable  “Known Side Effects?”

A tax increase would support the Single Payer System but Insurance Premiums would be eliminated.

Health insurance tied to employment (the “Golden Handcuffs”) would end.

Individuals choosing Standard Medicare but not purchasing an additional Medicare Supplement would be exposed to significant medical cost risk, in some cases, contributing to personal bankruptcy  (and inbility to pay their co-pays and deductibles.

The cost of these unpaid services would be shifted to Medicare and/or Medicaid.

Effects of Quality Improvement efforts and the practice of “Evidence Based Medicine” will eliminate most unnecessary medical services and promote preventive care resulting in:

  • Reduced cash flow for bricks and mortar Facilities (hospitals, OP Lab & Imaging, etc.).
  • Reduced revenue for providers that preform procedures (invasive, short term care).
  • Reduced patient load (revenue) for surgeons.
  • Increased workload and revenue for physicians managing care.
  • Increased workload and revenue for case management, home care and Hospice care givers,
  • Increased workload and revenue for perventive health services.
  • Increased workload and revenue for public health services.

“An ounce of prevention is worth a pound of cure.”

 

THE CAUSE AND THE CURE FOR AMERICA’S HEALTH CARE CRISIS

The document below is the PDF file for a Power Point Presentation that documents the Americah Cost and Quality Crises and offers the only reasonable solution. The document does not address the raging debate about whether Health Care is a “Right” or a “Privilege” for all Americans. In my view, Universal Health Care is the only practical, business solution.

Re-engineering and implementation of Universal Health Care will, and should take years to allow our economy time to adjust to the massive changes. The “Road Map” for effecting Health Care Reform is presented on the next page of this web site.

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