Health Care Solutions: I’ll
describe what I believe is the only step to take in the repair of our
health care system. The solution below is simple and it has already
been tested. In fact, it continues to be tested on a
daily
basis.
Small
employer groups are defined as groups with less than 50 employees.
The National average of family health insurance coverage for "Large
Group"
is approximately $8,000.00 per year. The average cost
of family
health insurance coverage for Small
Group is
significantly higher, (more than double in many cases).
Most uninsured working Americas are employed by this Small
Group of
employers. Therefore, we need to focus on these
groups.
I believe we
can fix our Health Care System,
but first I need to line up some of the pieces of this “Jigsaw Puzzle”.
We need to consider a few concerns and to review some of our
institutions.
Concerns:
- Insurance Companies are financial institutions
and like any financial institution, their income is in part based upon
the volume of dollars that they manage. To reduce this volume is not in
their interest. To reduce the volume of dollars that flow
throught their system would result in a decrease in profits, a decrease
in dividends, a decrease in executive
compensation and a decrease in employees. To
remedy our Health Care Crisis is not in the interest of any Health
Insurance Company.
-
When
the cost of any problem is removed from our responsibility we no longer
practice the same thriftiness. If my car is involved in a fender
bender, do I mind receiving extra money from an insurance company?
- Insurance is supposed to spread the
financial risk, however, an office visit is not a risk. it a common
event and by
making it eligable for insurance reinbursement we have
tripled the cost.
- Lawsuits
& Insurance: Insurance is a financial incentive to create a law
suit. People like the concept of found or easy money and “passing on”
or
“spreading” the cost. We just spread the cost until the average person
can’t afford it. Therefore, some form of tort reform is necessary.
Institutions:
We
have agencies and or commissions, which police industry. Stockbrokers
answer to the Securities Exchange Commission, (SEC). Insurance agents
answer to the Insurance Commissioner. Industry answers to OSHA.
Worker
Compensation Laws are a set of laws,
which prohibit an employee from suing his employer. This is a
type of tort reform!
Worker compensation takes care of the employee in the event that he or
she is involved in a work related accident. Worker compensation provide
the following coverage:
1. Replacement for loss of income while
recovering from a work related injury.
2. A settlement to compensate in the event
there is a permanent physical injury.
3. Medical
coverage.
Worker
compensation is a successful program.
This
set of laws can and should be retrofitted to apply to patients and
medical providers similar to that of the employee and employers, thus eliminating the need for
medical Malpractice Insurance. This set of laws is an already
tested system, which has proven itself to be successful.
Introducing
tort reform would create years of debate. We don’t have years!
Workers
compensation insurance is not free. This is a form of insurance.
Workmen’s compensation insurance can be and has been abused. However,
this is an efficient alternative to malpractice insurance and the
answer to our need for tort reform.
OSHA,
(Occupational Safety & Health Act), protects the employee in
the
work place. For more information about OSHA visit the following web
Page: http://www.semcosh.org/osha-view.htm.
In
the event a provider is guilty of malpractice an “OSHA” type commission
needs to be empowered to remove the medical provider from practicing
within the United States.
OSHA
is a successful program.
About Medical Coverage:
Medical coverage can get extremely
confusing. There are many variations of coverage which include:
- hospital
expense insurance,
- surgical
expense insurance,
- regular
medical insurance,
- major
medical expense insurance, and
- comprehensive
medical insurance. (combine all of the above insurances)
These
are the five standard types of health insurance that cover the cost of
treatment associated with an illness or an accident. (see kinds of
health policies http://www.ag.ndsu.edu/pubs/yf/fammgmt/he515w.htm )
A
National Standard does exist, that standard is Medicare Part A
& B.
We
need to accept and use this as a national standard, not only for
retired persons but for all. If we were to take the time to examine the
differences in policies between all the states, we will never make any
forward progress. Medicare may or may not be perfect, however our
priorities need to be focused on first adopting a standard of coverage
and finding a way to make the program affordable!
Medicare
Part A (http://www.webmd.com/medicare/medicare-part-a-hospital-care-and-services)
generally covers inpatient services -- medical care when you're checked
into a hospital or are recovering in a nursing facility. It
also
covers some short-term home health care, along with hospice
care.
Most people are enrolled automatically in Part A when they reach age 65
and get it for free.
How Much Does Medicare Part A Cost?
The
vast majority of people over 65 get Medicare Part A for free. But if
you or your spouse worked and paid Medicare taxes for less than 10
years total, you will have to pay a monthly fee of $233 or $423 per
month in 2008. How much you will have to pay depends on how long you or
your spouse worked and paid into Medicare.
Medicare Part B is Medical Insurance Rather
Than Hospital Insurance. It Helps To Pay For:
( http://www.fretzins.com/rn/870f001a.htm )
- physician
services
- outpatient
hospital services
- emergency
room visits when you are treated and released
- outpatient
surgery
- diagnostic
tests
- clinical
lab services
- outpatient
physical therapy
- speech
therapy
- medical
equipment and supplies
- rural
health clinic services
- renal
dialysis
- other
health services and supplies
Cost
of health insurance works differently in each state.
There are three basic rating systems:
1. Age: A
59-year-old-single may be required to pay a monthly premium of $400.00
whereas a 29-year-old single may pay only $150.00. As an employer, I am
not encouraged to pay 70% of the older employees premium.
2. Composite
age rating system:
If I have three employee ages 24, 36, 48, the average age of
my
group is 36. If I hire another 48-year-old, this
would
really drive my premiums up.
3. Average cost system: In
New York, the cost for a single person age 59 is the same as the single
person age 29.
State
Insurance Commissioners defines what will be covered medical illness.
Hence, coverage provided by Blue Cross is no different than Aetna’s
medical coverage.
If Aetna
covers it, then Blue Cross covers it, as does every other medical
provider in that state, so long as we are comparing commercial
coverage to commercial coverage within a given
state. However, every state has differences from every other state.
So,
here is what I would do.
I would
adopt the New York State's rating system. Any other method creates an
age discrimination situation for an employer.
I would elimate the large groups system,
providing Small
Groups with the
same cost strucure.
All insureds would be part of the same rating system. This could
be on a state level. The object is to provide Small Employers with a
competitive rate structure.
I would adopt Medicare part A & B as
a national standard for medical coverage.
I
would replicate our worker comp system eliminating the need for
malpractice insurance for all out-patient procedures, “ Med
Comp” (i.e., tort reform).
I would create an OSHA Type program to
police the medical providers, “MOSHA”.
I would return to the cost sharing method of
medical insurance, deductibles, coinsurances, stop-loss etc.
I
would apply a modification factor to an individual’s premium based upon
their level of fitness. This modification would penalize persons for
smoking or obesity.
I would institute a significant national
fitness campaign.
I would make
Physical Education a daily requirement for all school students grades 1
thru 12.
I
would exclude basic (Out-Patient Services) services such as flu, colds,
and physical exams, from being an expense eligible for insurance
reimbursement, thus forcing the medical community to provide a service
that individuals can afford “out of pocket”. To
pay for my need to see a doctor for a cold through insurance or taxes,
does not shield me from the cost, but only the knowledge of the cost!
I would utilize HSA's, (Health Savigs Accounts).
A percentage of an individual premium is directed into this saving
account. A bank card is issued for this account and the employee uses
this card and the funds in the HSA account to pay for unreinbursed
medical services. This would be a pre-tax account. If the funds in this
account accumulate beyond a specific level then the individual would
have the option to draw off this excess.
In Summary
By
eliminating malpractice insurance, I would hope to lower the cost of
routine medical service to the point where insurance on this part of
medical coverage would become unwarranted.
Somehow,
we need to cover everyone for debilitating diseases, such as cancer,
MS, etc, regardless of whether this person pays for coverage or not.
It is absolutely necessary that individuals
have an awareness of the cost of medical services.
We do not need to have our government run our health care
program. We do not need to have our
States run our health care program.
Each State currently has it own Insurance Commissioner. What we do need
is a National Insurance Commissioner to impose smart regulations and
restrictions on insurance providers. Every State in this
country
is experienceing the same Health Care Crisis, therefore it would be
smart if we had a national commission providing a national solution for
everyone at the same time.
Questions:
Could a
person afford medical care for routine service without insurance if
doctors had no malpractice premiums? If
not, what will it take? If
we subsidized a medical practice by subsidizing the cost of medical
equipment (such as X-ray machines), can we get the cost of
routine
service down to where it needs to be?
Will
"Health Information Systems" reduce the cost of health care?
Has
anyone informed you of the cost per person? Has anyone even
mentioned tort reform or obesity. Has your doctor ever repeated a
medical test on you with out good reason? Just how many medical
providers are commiting fraud?
"Health
Information Systems" can
make the medical community more efficient. It can make fraud more
difficult if there is someone trying to detect fraud. However, if
someone were trying to detect fraud they probably
wouldn't need
a Health
Information Systems to find it . So who benefits? Well, the Health
Insurance Companies are off the hook again and the Creator of
the "Health
Information Systems" will be
making a lot of money!
Other
thoughts to entertain in an effort to further reduce the cost of
routine medical service might include subsidizing the cost of medical
schools.
About the Speaker:
Michael
Vallerie is an
employer and owner and owner of a
small business: Vallerie Trailer Service, located in the Baltimore
area. Mr. Vallerie is the founder
to the Baltimore Business Owners organization. He is an Alumni of
Western
Connecticut State University.
Mike Vallerie is originally from
Connecticut where he spent twelve years in the insurance industry
working with business owners, (contractors and manufacturers), on their
Insurance Portfolio’s.
"To work with a employer’s budget is overwhelming. The financial
contributions; insurance premiums, property taxes and wages are so
taken for granted, that it is belittling to those employers. And yet
these employers contribute so much."
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