Community For Affordable HealthCare
Vol IX, No 1, April, 2010
Utilizing the $1.8 Trillion Information Technology Industry
To Transform the $2.4 Trillion HealthCare Industry into Affordable HealthCare
Through innovation by moving from a vertical to a horizontal industry
In This Issue:
1. Featured Article: Health Care: A Two-Decade Blunder
2. In the News: Why government can't manage cost-effective health care
3. International HealthCare: Life-saving cancer drugs still not available in the NHS
4. Government HealthCare: HIPAA Revisited
5. Lean HealthCare: Personal Responsible Healthcare
6. Misdirection in HealthCare: Reducing rather than increasing spending and taxes
7. Overheard on Capital Hill: Fuzzy Government Accounting
8. Innovations in HealthCare: Open markets will work efficiently when enabling conditions exist
9. The Health Plan for the USA: Health Plan USA
10. Restoring Accountability in Medical Practice by Moving from a Vertical to a Horizontal Industry
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HealthPlanUSA is upgrading its website. We have members in more than 30 states and 20 foreign countries from six continents as near as we can estimate from the URL endings of the email address list. We have a large contingency of members from Canada, the UK and India, and we will have greater focus on these areas. Although Canada has a law against private HealthPlans, many Canadians obtain their health care from south of our border. We will be able to service more than half of their population from the states bordering Canada since we are web based. South Africa and South America, especially Chile, are increasing their interest in our newsletters and our patient centric HealthPlan. Great things begin with a small, focused plan. We think this will save personalized health care, not only for the people of the United States, but also for the UK, India and other countries that desire individual liberty. We are grateful for all of your interest.
At this time, it has become imperative that we have more accurate demographics of our membership. This is necessary to more accurately focus on the areas and countries interested in our patient-oriented HealthPlan. For promotional and informational purposes, we need accurate statistics measured by double-clicks. To begin this process, we have instituted a registration program and will charge a minimal fee for you to have full access to the archive portions of our websites. This same fee will also allow you to enter all the HealthPlan sites, whether HealthPlanUSA, HealthPlanUK, HealthPlanIndia or HealthPlanWorld, and others as interest grows. These sites are under construction.
Our patient-centric HealthPlans have the unique concept of not penalizing people with illnesses, but rather surcharge those who participate in unhealthy living, such as smoking, overeating, overdrinking or drug abuse, that then cause high-cost disease and jeopardize most health plans. Maintenance costs of your body are no more insurable than maintenance costs of your automobile or home. Thus, we have an annual deductible that is equivalent to the average cost of the yearly basic healthcare maintenance for your age. Current projections range from $200 per year for someone in their twenties to perhaps $400 per year for someone in their forties.
We also have the unique concept of no restrictive panels of physicians, hospitals, pharmacies, laboratories, x-ray or other diagnostic or treatment facilities. These will be policed by the patients themselves. Patients in the open Medical MarketPlace will automatically go to the most cost-effective physicians, hospitals, pharmacies, laboratories, x-ray or other diagnostic or treatment facilities because all charges will be transparent and they can therefore choose where to go. This is facilitated through a graded co-payment system for every item, which makes every patient police their own expenses. This eliminates most of the oversight costs of having doctor and nurse reviewers of utilization costs for every office and on every hospital ward.
There is no more important cost control than by the patients themselves. We have demonstrated this with our clinical practice cost analysis studies. Satyam Patel and I flew to Phoenix and spent an entire day with an actuary to review this plan. He was actually dumbfounded at what he though was the ingenuity of the plan. His initial actuarial projection was that HPUSA would realize a 30-40 percent savings in healthcare costs. Since then, our continued cost analysis with real patients have shown up to a 60 percent cost savings on Emergency Room visits and up to an 80 percent cost savings for annual physical exams. In both of these instances, the patients are in a dialog with the physician on what is really necessary. This results in unusual savings because the patient is in charge with his medical counselor at his side advising what is appropriate for the best cost-benefit ratio.
The PowerPoint outline of www.HealthPlanUSA is now available through our bookstore for you to download and study or peruse.
We have also completed our startup cost projections. These are outlined in the Executive Summary of the HPUSA Business Plan available for your review and study. Since these are proprietary documents, we will require a Non Disclosure Agreement before being able to download these products for your personal use. Like any Proprietary Business Plan, it cannot be shared. But your associates will be able to acquire one through the same mechanism that you use and this will allow you to share proprietary business information with them. These cannot be returned for refunds. As you will note from the cost projections, we will need true freedom-loving, successful entrepreneurs to bring about the restoration of private personal health care.
Welcome to an exciting journey that will change health care in the first part of the 21st century much the same way as the computer revolution of the latter 20th century.
Please Note: We are sending this also to our MedicalTuesday subscriber lists. If you subscribe to both newsletters, we apologize for any duplication. We hope you feel the message is important enough to warrant this one-time intrusion. To keep up, why not subscribe to HPUSA.
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1. Feature Article: Health Care: A Two-Decade Blunder by
In 1991 the political world was rocked by the unlikeliest of victories. Harris Wofford, a former aide for John F. Kennedy, upset two-term Republican Governor Richard Thornburgh in a special election to fill the seat of the late Pennsylvania Senator John Heinz. Wofford was guided to his victory by a little-known campaign manager named James Carville, who told him to make a bold and unequivocal case for "universal health care." Wofford's underdog victory left the GOP shell-shocked.
Fast-forward 19 years: it is the Democrats who are now faced with divining the results of another underdog's victory. In January, a little-known state senator named Scott Brown defeated Massachusetts Attorney General Martha Coakley in a special election for the United States Senate. Universal health care was once again on center stage. This time around, though, the Republican seized on widespread antipathy to what has come to be seen as an incoherent Democratic scheme for an unworkable federal takeover of health care.
The unlikely victory not only defied the odds of a Republican winning in Democrat-owned Massachusetts; Brown's ascent also put him in the storied seat of the liberal lion Ted Kennedy. Before Brown, no Massachusetts Republican had won a Senate election since Edward Brooke in 1972; no Republican presidential candidate had secured Massachusetts's electoral votes since Ronald Reagan in 1984; even more striking, the Bay State had not sent any Republicans to the House of Representatives since 1996. However, beyond the mere realization of an improbable data point, this special election called into question much of the received political wisdom of the past 20 years. Brown's victory directly contradicted the liberal claims that Democrats own the health-care issue and that comprehensive reform is popular. As a candidate, Brown ran on a platform promising to serve as the health-care roadblock he instantly embodied on being elected.
In fact, the Brown election can be seen as the closing of the door on a two-decade era in which Democrats, Republicans, and most of the political class came to believe that the Democrats possessed an inherent electoral advantage on the health-care issue. The history of the past 20 years reveals two Democratic presidencies, first Bill Clinton's and now Barack Obama's, upended by health care, whereas a single administration—that of a Republican, George W. Bush—benefited from it. In 2004, Bush was able to secure a narrow re-election victory in part because of his success in securing a form of targeted health-care reform through the creation of a Medicare prescription-drug benefit.
The combination of Democratic wishful thinking and an American electorate suspicious of the intentions of those pushing relentlessly for an ever greater government involvement in health care has proved a ballot-box disaster for Democrats. How did this happen? And why? . . .
While health care was certainly an important part of the Wofford win, it is not clear exactly how central its role was. Interest in the race developed too late for pollsters to organize exit polls, which would have better determined what motivated Pennsylvania's voters. Nonetheless, the election instantly became part of political lore. For liberals across America, it was a giant-killer moment in which health care was the murder weapon. As Ted Kennedy put it, "Harris Wofford's dramatic victory makes clear that the American people want comprehensive health care reform, and they want it now."
Democrats entered into the 1992 election cycle with renewed optimism, eager to wield health care as an issue once again. Carville ascended to a senior position in Bill Clinton's campaign against the incumbent president. Like Thornburgh, the first President Bush had once appeared unbeatable but had become undeniably vulnerable. Clinton, promising an improved economy and a vaguely defined system for "universal coverage," defeated Bush, with the anti-trade, anti-deficit Ross Perot playing a major spoiling factor in a third-party candidacy that received nearly 20 percent of the vote. Clinton's "New American Health Care Plan," remarkably similar to the promises Barack Obama would make 16 years later, sought:
To cover everybody. Control costs, improve quality, expand preventive and long-term care. Maintain consumers' choice of doctors. Take on the insurance companies and the medical bureaucracy, and demand reform.
Even so, polls showed that voters ranked health care behind both the economy and the deficit in importance. Nonetheless, Bill Clinton entered office believing that he had a mandate to overhaul the nation's health-care system. The legislative conduct he backed in 1993 and 1994 should look eerily familiar to observers of the current debate: the overwhelming moral certainty, the secret deliberations, the hardball tactics, the question of whether to use the Senate reconciliation process to get around rules giving that body's minority the power to block the legislation's forward movement, the initial questions among Republicans of whether to get aboard a moving train or stand against the proposals, and complaints from the Left about the slowness of the process. At one point in 1994, the first lady, Hillary Clinton, who was serving as head of the Task Force on National Health Care Reform, gave a forceful speech to liberal activists in which she criticized them for seeking "parochial victories," warning that "you'll end up with no bill being passed—or a bill so weak the president will veto it."
And as is true about the Obama plan, the more the public learned about the Clinton health-care reform and its cost (for the nation and for themselves), the less they liked it. According to Harvard polling expert Robert Blendon, support for the Clinton plan fell from 70 percent to 43 percent over the course of a year. As public support dropped, Republican flirtations with reform, especially among liberal Republican senators like John Chafee and Bob Packwood, diminished, and opposition hardened. Furthermore, Senate Republican leader Bob Dole, with an eye on the 1996 presidential nomination and recognizing that his perceived openness to a bipartisan compromise weakened his own shot at the nomination, became a staunch critic. . .
In 1994, up for re-election, Senator Harris Wofford served as a bellwether once again, but of a different kind. Having once foreshadowed Clinton's win, Wofford now served as a leading indicator of Clinton's political weakness. Katharine Seelye wrote in the New York Times that Wofford was so weighed down by Clinton and his health-care plan that his staffers "prepared a four-page, single-spaced list of ‘significant Wofford/Clinton policy differences'?" Wofford failed in his 1994 re-election bid, as Democrats lost a total of eight Senate seats and 54 House members. . .
Attempts by politicians on either side to upset this balance are likely to generate accusations of "privatization" from the Left or charges of "creeping socialism" from the Right. Bush's more targeted approach kept him from affecting the balance, but it also limited the scope of his ability to improve the system.
It appeared to Barack Obama and his dramatic majorities in the House and Senate that the balance was ready to be upset in 2009. Ted Kennedy had been championing a nationally managed universal system since the late 1960s, and the Senate Health, Education, Labor and Pensions (HELP) committee, long chaired by Senator Kennedy, had designed the Senate's legislation in the spring. The bill was then sent to the Congressional Budget Office (CBO) for an independent assessment of its cost. The CBO quickly determined that the Kennedy bill would cost $1.3 trillion over 10 years and would cover only 16 million people. At a time when President Obama was bemoaning the problem of 46 million uninsured people in America, the news that $1.3 trillion would cover only one-third of them seemed like a lousy deal. The American people, who had been understandably tempted by the siren call of Obama's cry for a health-care overhaul that would somehow cover a huge number of the uninsured while simultaneously reducing costs, began to have second thoughts. This skepticism was exacerbated by the continuing financial meltdown, which reminded Americans that perhaps we could not afford to have it all.
The CBO produced many more health-care scores of different proposals throughout 2009. Price tags were similarly gasp-inducing, and none of its findings mitigated the initial and accurate impression that the taxpayer would be spending in the range of a trillion dollars for the various plans, which would require the majority of Americans to be contributors to, rather than recipients of, government largesse. . . .
As this was happening, Scott Brown traversed the state and pounded his opponent, Massachusetts Attorney General Martha Coakley, on her support for the Democratic health-care proposals. Brown insisted that he would be the "41st vote" against the Senate's attempts to reconcile its bill with that of the House, going so far as to say that he was "the only person who can stop the debate on this monstrosity of a health-care bill and make them go back to the drawing board." His opposition resonated with voters far more than Coakley's promise to be a reliable vote in favor of the bill.
Just as the Wofford win revealed a decline in popularity for George H. W. Bush in 1991, the Brown win revealed a decline in Obama's, with consequences yet to be determined.
To be sure, our health-care system is flawed: the U.S. spends far too much and gets too little, and far too many people lack coverage or are concerned about the expense or the long-term inability to secure coverage. Despite the fact that America's doctors, nurses, and medical innovators are the finest in the world, our delivery and allocation systems are defective, leading to an inefficient and expensive distribution of care. Our current spending patterns are unsustainable, and both Medicare and Medicaid are headed toward insolvency. Recognition of the problem and agreement with President Obama's approach are vastly different things, but the existence of a crisis is beyond dispute.
Without a clear and cohesive way forward, the American people seem willing to live with the current, inefficient arrangement, in which most people are in the private market, while the poor, disabled, and elderly get Medicaid and Medicare. One lesson of the Brown election is that attempts to push too far in any one direction will likely generate a voter counterattack. Anyone who wants to change the system will have to get bipartisan cover in order to make real changes. . . .
Unfortunately, while the Brown election has upset Obama's plans in the short term, it has not caused the Democratic leadership in Congress and the White House to question whether they are right on either the merits or the politics of the health-care issue. The merits can be debated endlessly, but this review of the past two decades indicates the foolhardiness of Democratic certainty regarding health care's political advantages. Not only do Republicans have the ability to play in the health-care arena, but the recent debates have also further diminished the American people's faith in the Democrats, both on the issue itself and on the larger question of profligate government spending.
As we get deeper into 2010, Barack Obama seems reluctant to unburden himself of what must be an exasperating dilemma for a politician so given to lengthy address: his explications have only served to make Americans more mistrustful of a dysfunctional health-care takeover. Indeed, two decades of debate have delivered a strangely elusive verdict: the promise of a comprehensive health-care overhaul is not a winning tactic for Democrats. Nor, for that matter, could it ever be one for Republicans. All we do know is that discrete measures, ones that hone in on this or that flaw in the health-care system, have the inestimable value of being widely palatable—and, not incidentally, achievable.
Tevi Troy is a visiting senior fellow at the Hudson Institute and was deputy
secretary of the U.S. Department of Health and Human Services from 2007 to
Julius Krein assisted with the research for this article.
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2. In the News: Why government can't manage cost-effective health care
By Jim Sanders, Sacramento Bee, email@example.com Tuesday, Mar. 16, 2010 | Page 1A
Of eight staff members targeted, Sara I. Ramirez received by far the largest raise, jumping her pay from $125,256 to $190,008 for serving as Pérez's top assistant, according to documents obtained under state open-records law.
Ramirez will be paid $80,204 more per year than her boss or Senate President Pro Tem Darrell Steinberg, whose pay was cut from $133,639 to $109,584 last year by the state's independent salary-setting commission.
By comparison, lawmakers who are not in leadership positions make $95,291, plus about $142 in per diem while the Legislature is in session. . .
The new pay increases come as the state is reeling from recession, however, with thrice-monthly furloughs imposed on most state workers and the state facing a projected budget deficit of up to $20 billion through June 2011.
Lew Uhler, president of the National Tax Limitation Committee, called the raises a case of "tin ear" in which lawmakers are ignoring the pain of voters who are straining to keep jobs and homes. . . .
Political analyst Tony Quinn agreed, noting that the Legislature's public approval rating had fallen to 16 percent in a recent Field Poll. . .
They obviously cannot manage any government costs or expenditures.
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3. International HealthCare: Life-saving cancer drugs are still not available in the NHS
By Rosa Prince, Political Correspondent, Published: 03 Apr 2010, Telegraph.co.uk
In November 2008, amid public outcry at the failure of the National Institute of Clinical Excellence (NICE) to approve drugs on cost grounds, Alan Johnson, the then-health secretary, promised more medicines would be made available.
He set a new ceiling of £80,000 – compared to the previous limit of £48,000 – for treatments which could extend good quality of life for more than a few months.
"Patients and the public can be confident that from today there will be greater clarity, greater fairness and, most importantly, greater access to a wider range of drugs," Mr Johnson said.
Since then however, research by the Conservatives shows that not a single new drug has been fully approved by NICE.
The Tories also claimed that there had been a substantial decline in the number of medicines for all conditions approved for use by NHS patients in recent years.
In 2000, no new drugs were refused compared to 29 per cent in 2009.
Many cancer medicines which are widely available in Europe, such as the bowel cancer drug, Bevacizumab, and the kidney cancer drug, Sorafenib, are not available in the United Kingdom. . .
Government medicine does not give timely access to sophisticated cancer therapy.
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4. Government HealthCare: HIPAA Revisited
I learned about the lack of health privacy when I hung out my shingle as a psychiatrist. Patients asked if I could keep their records private if they paid for care themselves. They had lost jobs or reputations because what they said in the doctor's office didn't always stay in the doctor's office. That was 35 years ago, in the age of paper. In today's digital world the problem has only grown worse.
A patient's sensitive information should not be shared without his consent. But this is not the case now, as the country moves toward a system of electronic medical records.
In 2002, under President George W. Bush, the right of a patient to control his most sensitive personal data—from prescriptions to DNA—was eliminated by federal regulators implementing the Health Information Portability and Accountability Act. Those privacy notices you sign in doctors' offices do not actually give you any control over your personal data; they merely describe how the data will be used and disclosed.
In a January 2009 speech, President Barack Obama said that his administration wants every American to have an electronic health record by 2014, and last year's stimulus bill allocated over $36 billion to build electronic record systems. Meanwhile, the Senate health-care bill just approved by the House of Representatives on Sunday requires certain kinds of research and reporting to be done using electronic health records. Electronic records, Mr. Obama said in his 2009 speech, "will cut waste, eliminate red tape and reduce the need to repeat expensive medical tests [and] save lives by reducing the deadly but preventable medical errors that pervade our health-care system."
But electronic medical records won't accomplish any of these goals if patients fear sharing information with doctors because they know it isn't private. When patients realize they can't control who sees their electronic health records, they will be far less likely to tell their doctors about drinking problems, feelings of depression, sexual problems, or exposure to sexually transmitted diseases. In 2005, a California Healthcare Foundation poll found that one in eight Americans avoided seeing a regular doctor, asked a doctor to alter a diagnosis, paid privately for a test, or avoided tests altogether due to privacy concerns.
Today our lab test results are disclosed to insurance companies before we even know the results. Prescriptions are data-mined by pharmacies, pharmaceutical technology vendors, hospitals and are sold to insurers, drug companies, employers and others willing to pay for the information to use in making decisions about you, your job or your treatments, or for research. Self-insured employers can access employees' entire health records, including medications. And in the past five years, according to the nonprofit Privacy Rights Clearinghouse, more than 45 million electronic health records were either lost, stolen by insiders (hospital or government-agency employees, health IT vendors, etc.), or hacked from outside.
Electronic record systems that don't put patients in control of data or have inadequate security create huge opportunities for the theft, misuse and sale of personal health information. The public is aware of these problems. A 2009 poll conducted for National Public Radio, the Kaiser Family Foundation and the Harvard School of Public Health asked if people were confident their medical records would remain confidential if they were stored electronically and could be shared online. Fifty nine percent responded they were not confident.
The privacy of an electronic health record cannot be restored once the contents are sold or otherwise disclosed. Every person and family is only one expensive diagnosis, one prescription, or one lab test away from generations of discrimination. . .
Some argue that consent and privacy controls are impractical or prohibitively costly. But consent is ubiquitous in health care. Ask any physician if she would operate on a patient without informed consent.
There is no need to choose between the benefits of technology and our rights to health privacy. Technologies already exist that enable each person to choose what information he is willing to share and what must remain private. Consent must be built into electronic systems up front so we can each choose the levels of privacy and sharing we prefer. . .
Privacy has been essential to the ethical practice of medicine since the time of Hippocrates in fifth century B.C. The success of health-care reform and electronic record systems requires the same foundation of informed consent patients have always had with paper records systems. But if we squander billions on a health-care system no one trusts, millions will seek treatment outside the system or not at all. The resulting data, filled with errors and omissions, will be worth less than the paper it isn't written on.
Dr. Peel, a psychiatrist
in private practice, is the founder of Patient Privacy Rights
(www.patientprivacyrights.org) and leads the bipartisan Coalition for Patient Privacy.
Printed in The Wall Street Journal,March 24, 2010, page A17
Government is not the solution to our problems, government is the problem.
- Ronald Reagan
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5. Lean HealthCare: Personal responsible health care
Lean health care has had increasing emphases in recent years. There have been both government and private initiatives expounding this concept. However, the two groups are trying to implement lean health care by going in opposite directions. The government fiats to reduce cost have not reduced cost but in each instance have increased cost. Medicare predictions of costs at inception in 1965 for 1990 have increased about 800 percent faster than expected. The same can be said for the cost of Medicaid over the same 25 years. These projections, however, pale to the prediction of the more than $1 trillion additional cost that the Obama plans will produce. With the additional 25 million Americans that will be placed in Medicaid and the many current Medicaid recipients feeling they don't have access, will we become like Canadian Medicare, where their Supreme Court ruled that Canadian Medicare does not give access to care but only access to a waiting list? Others are concerned about whether the same 800 percent increase in Medicare spending above predictions during its first 25 years will be replicated with Obama care. Are we really going to experience a catastrophic $8 trillion entitlement instead of a $1 trillion entitlement?
Physicians see examples of both on a frequent basis. That is why they see the other side of the coin from what nurses, teachers and other unionized workers experience. These are the professionals that we have to win over for the overall success of Lean HealthCare and the teaching of the economics of health care in our schools.
Many of our readers have written that they don't believe that a significant co-payment reduces healthcare costs by 30-40 percent. However, we have shown examples frequently in our Medical Gluttony column in MedicalTuesday on alternate Tuesdays for the past eight years.
Lean HealthCare can be demonstrated by the patient with a 20 percent co-payment, like Medicare was initially designed to do and pure Medicare without co-insurance still does. It will reduce emergency room costs up to two-thirds in our experience. We see ER cardiac evaluations frequently in the $9,000 range before discharge home. Patients with a 20 percent co-payment, for instance, usually stop the medical testing at about $3,000 when the ER doctor can assure them that they haven't had a heart attack. This is a two-thirds reduction in cost simply with a 20 percent co-payment, like the original Medicare but without any Medicare oversight or controls. Medicare with MediGap-insurance to make the co-payments does not have any patients interested in controls and thus has no limits and must depend on the Medicare police to reduce hospital costs through denial of care.
Similarly, patients admitted to the hospital with a 10 percent hospital co-payment policy ($200 per day on a $2,000 daily hospital cost) will reduce their days in the hospital by an average of two days on a six-day admission. This is a savings of $4000 dollars per $12,000 admission resulting from an $800 total co-payment, ($200 x 4 days) or 33 percent savings of hospital costs without any loss of quality. Not only is there a hospital cost savings of 33 percent ($12,000 for six days vs $8,000 for four days) but the patient also saves 33 percent ($1200 co-payment for six days vs $800 co-payment for four days) because he wants to get out as soon as medically possible- ASAMP.
Similar savings will also occur in lean outpatient medicine. A patient going to an internist for his annual exam for $150 will want to have his laboratory work done (basic chemistries, lipids, blood counts ($375), chest x-rays ($150), ECG ($125) for $650 and demand this every year on an ineffective $20 co-payment. However, if the patient is responsible for 30 percent of his outpatient annual examination costs of $800 (150 + 375 + 150 + 125) or $240, he will begin having a two-way discussion with his physician immediately, rather than after the insurance company has adjudicated the reimbursement, which is too late and time consuming. He will understand that since his lipids were normal last year, he really doesn't need to recheck them for five years. Since his chest x-ray and ECG were normal last year does he really need them this year? In fact, the patient will ask if any testing is really necessary this year at all except for the doctor's physical examination (the laying on of hands) and will forgo all the expensive testing of $650 and will only be liable for the 30 percent of the physician's time or $45. (30% of $150) He has saved $650 of healthcare costs and even reduced his 30 percent co-payment from $240 to $45, nearly $200. The patient has saved 80 percent of the cost of his annual examination by being responsible for 30 percent of outpatient medicine.
In these illustrations, the patient saved 66 percent in the ER example, 33 percent in the hospital example and 80 percent in the office example. This gives you the concept of how HealthPlanUSA, if brought to fruition, will save between 33 to 80 percent of healthcare costs by putting the patient in charge in consultation with his physician. That is why the actuaries' initial estimate of a 30 to 40 percent healthcare savings has been projected upwards to 40 to 50 percent average savings in costs. Government alternatives have never saved costs - they only increase the costs. The future of Lean HealthCare must rest with the free-market based concept.
This plan would save the entire $1.2 trillion cost of the Obama Government Health Care Plan, save taxes and not enslave our children and grandchildren with obscene deficits. Government health care will always produce gluttonous increases in cost with further secondary restrictions required by the cost overruns that it caused, reducing the quality of health care we have come to expect in America.
We are projecting that HealthPlanUSA will institute such Lean HealthCare that will solve our healthcare problems without any oversight before the full Obama plan can be implemented over the next three or four years.
We are looking for supporters and investors who would like to participate in such a plan, information technology experts who would like to help develop the platform for such a plan, executives who would like to administrate and oversee such a plan, a health insurance company that wants to be a HPUSA BCBS, and a finance company that would like to issue the HPUSA Insurance/Health CreditCard. The challenge is huge - not only for health care, but also for the freedom for which our fathers and grandfathers gave their lives to provide us with the American opportunity. Let's not lose it.
For those with a serious interest, please proceed to our bookstore, purchase and download the PowerPoint Presentation. Review and study it. You may then proceed with purchasing and downloading the Executive Summary of this plan. If you are interested in being part of an historic, disruptive and innovative health plan that is patient centric, email or send us your CV, Credentials, Experience or Resume and a short letter on how you would see yourself participating in such a plan.
This opportunity, given our position in history at this time, is truly mind boggling, huge, demanding and beyond the reach of the ordinary. But so did people think of Larry Page and Sergey Erin prior to Sept 7, 1998 when they launched GOOGLE from a friend's garage. They went public in August 2004. Or of William Hewlett and David Packard, launching HP from Packard's garage in 1939 during the depression with $538, incorporated in 1947 and went public in 1957. They are now one of the world's largest information technology companies, larger than IBM or Microsoft, and they operate in nearly every country of the world.
Health care will be bigger than both. Are you up to joining the winning team?
The Future of HealthCare Has to Be Lean, Efficient and Personal.
However, the FUTURE is NOW!
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6. Misdirection in HealthCare: Reducing rather than increasing spending and taxes
Reader's Digest had a poll some time ago. What was truly amazing was that the rich and the poor agreed that no one should have to pay more than one-fourth of their earnings in taxes. The following proposal does not quite get us down to that level, but it would be a good start for our country. It would be especially good for implementing personal and private health care.
The financial crisis in this country is causing local and state governments to scale back. Only the federal government is spending more money because they have the ability to print money, which unfortunately then loses value every time they roll the printing presses. The root cause of the crises is the graduated income tax authorized by the 16th Amendment, which has no limits on taxes. So Congress has the SPEND MORE and then TAX MORE philosophy!
What this country needs before we can have any control of our finances, whether it's our healthcare or welfare costs, is a tax limitation amendment. The previous 16th Income Tax Amendment was passed in the days when people understood one could not spend more than one makes. This unlimited income tax on individuals and a duplicate tax on corporations, also owned by individuals, place no limits on Congress. Not only do they feel free to spend our money, but also the money of our children and grandchildren, because of the ease in raising the income and other innovative taxes. All of these come out of one pocket - the taxpaying citizens.
A sailor’s letter to the editor summed it up rather succinctly. I object and take exception to every saying that Obama and the Congress are spending money like a drunken sailor. As a former drunken sailor, I quit when I ran out of money.
It should be apparent that in these times of reduced income, the government should have reduced its outlays. The social security tax should have been indexed since inception in the 1930s when America's average life expectancy was 62, rising to the current life expectancy of 75. Our country cannot afford to have individuals live on Social Security benefits an extra 10 to 15 years when most of us are capable of working and earning our own keep. Most physicians now work past age 75 and some into their 80s and 90s. If you check the obituary columns, one finds a high percentage of people who lived into their ninth and tenth decade of life and worked into their eighth decade, some into their ninth. An initial attempt to index Social Security increased the Social Security retirement age to 67. It should have included a proposal to index the benefits gradually to the present average life expectance of 75.
Medicare is in a negative cash flow and is scheduled to go broke in the next decade. The Medicare age should also be immediately indexed to age 67 and gradually further indexed to match the Social Security indexing schedule. Only someone with a paretic brain could even think of lowering the Social Security and Medicare ages to 55. That would be total fiscal irresponsibility, meaning economic collapse for the United States, with possible loss of the world's highest credit rating.
By Constitutional Amendment, the 16th Amendment should be revised to limit all taxes. The three levels of government, federal, state and local or county, should each be limited in the number and the size of the taxes they can implement. The federal government should be limited to the following two taxes: a maximum income tax of 15 percent on the citizens and an excise tax limited to 10 percent on interstate commerce and imports. The state government should be limited to a 5 percent income tax on its residents and a 5 percent sales tax on items purchased in the state. The local government should be limited to a one percent tax on property held within the state and a one percent sales tax on items purchased in the county. No other taxes would be allowed. The property assessment should not increase more than two percent maximum for inflation per year to prevent citizens from losing their homes as they get older due to increasing property values and diminishing incomes. There should not be a corporate income tax since corporations are owned by the citizens and double taxation should not be allowed. There should never be a tax or surtax on any tax.
The citizens of our country could then manage their own health care with stability and protection from the government, which has confiscated their income in increasing fashion from year to year.
They could manage their own retirement also. But that is a subject for another day.
Well-Meaning Regulations Restrict and Worsen Quality of Care.
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7. Overheard on Capital Hill: Fuzzy Government Accounting
The U.S. Federal Government is rather adept at using "fuzzy math". Whether it be claiming jobs were created (when they were not), or grossly, grossly underestimate the cost of healthcare plans, government math seems to exist on a plane of existence where the normal rules of mathematics just don't apply.
Remember Medicare 1990 Estimates?
As the Administration is attempting to downplay the cost of a government takeover of healthcare, it is worth reminding ourselves of just how good the government actually is at estimating future costs.
The Denver post today provides a good
Remember that Congress estimated Medicare's cost at $12 billion for 1990 (adjusted for inflation) when the program kicked off in 1965. Medicare cost $107 billion in 1990 and is quickly approaching $500 billion."
Does anyone seriously think the same won't happen this time with ObamaCare?
Peter Robinson (WSJ) interview with Gary
Becker, Nobel Laureate March
I begin with the obvious question. "The health-care legislation? It's a bad bill," Mr. Becker replies. "Health care in the United States is pretty good, but it does have a number of weaknesses. This bill doesn't address them. It adds taxation and regulation. It's going to increase health costs—not contain them."
Drafting a good bill would have been easy, he continues. Health savings accounts could have been expanded. Consumers could have been permitted to purchase insurance across state lines, which would have increased competition among insurers. The tax deductibility of health-care spending could have been extended from employers to individuals, giving the same tax treatment to all consumers. And incentives could have been put in place to prompt consumers to pay a larger portion of their health-care costs out of their own pockets.
"Here in the United States," Mr. Becker says, "we spend about 17% of our GDP on health care, but out-of-pocket expenses make up only about 12% of total health-care spending. In Switzerland, where they spend only 11% of GDP on health care, their out-of-pocket expenses equal about 31% of total spending. The difference between 12% and 31% is huge. Once people begin spending substantial sums from their own pockets, they become willing to shop around. Ordinary market incentives begin to operate. A good bill would have encouraged that."
Macrolytics' Chief Investment Officer Donald Luskin, in a note to clients, March 26,
For all the anti-growth implications in Sunday night's passage of Obamacare, it seems strange at first blush that markets pretty much haven't reacted at all. But why should they have? . . . And from the perspective of new recovery highs in stocks, we would say markets have reacted by expressing their satisfaction that it took a whole year. However distasteful the smoky-room processes that were ultimately required to achieve enactment, far worse would have been the legislative blitzkrieg that seemed inevitable a year ago. . . . Obamacare's enactment took so long, became in the end so unpopular, and required such unseemly procedural ploys, that the road has now been definitively paved for even slower policy processes in the future, thanks to the increasingly likelihood that Republicans will take control of one or both houses of Congress in November.
H.R. 4872, the
"Reconciliation Act of 2010" which the Senate passed this afternoon.
This legislation takes the flawed healthcare bill which President Obama signed into law on Tuesday and makes it worse. It adds on a net $53 billion in further tax increases, including:
These new tax hikes come at a time of 10 percent unemployment, and trillions of dollars in looming tax increases already on the horizon. It's the last thing taxpayers need after a very tough weekend of bad news.
Institution Senior Fellow Victor Davis Hanson writing . . . at www.Pajamasmedia.com:
President Obama has crossed the Rubicon with the health care vote. The bill was not really about medicine; after all, a moderately priced, relatively small federal program could offer the poorer not now insured, presently not on Medicare or state programs like Medicaid or Medical, a basic medical plan. . . .
No, instead, the bill was about assuming a massive portion of the private sector, hiring tens of thousands of loyal, compliant new employees, staffing new departments with new technocrats, and feeling wonderful that we "are leveling the playing field" and have achieved another Civil Rights landmark law. . . .
[W]e are in revolutionary times in which the government will grow to assume everything from energy use to student loans, while abroad we are a revolutionary sort of power, eager to mend fences with Syria and Iran, more eager still to distance ourselves from old Western allies like Israel and Britain.
There won't be any more soaring rhetoric from Obama about purple-state America, "reaching across the aisle," or healing our wounds. That was so 2008. Instead, we are in the most partisan age since Vietnam, ushered into it by the self-acclaimed "non-partisan."
Backroom Deals In the Democrats Healthcare Takeover
Cornhusker Kickback: Perhaps the most well known in the Senate bill, the provision, included at
the behest of Sen. Ben Nelson (D-NE), ensures that Nebraska would be the only state to have the
full amount of its increased Medicaid costs paid for by the federal government.
The Louisiana Purchase: The Senate bill provides extra Medicaid funding for any state in which
every county has been declared a disaster area. Because of Hurricane Katrina, Louisiana is the only
state that would qualify for the money. The $300 million provision for Louisiana was slipped in late
in the process to persuade Sen. Mary Landrieu (D-LA) to support the health care takeover.
Gator Aid: At the request of Sen. Bill Nelson (D-Fl), the Senate bill includes a formula for
protecting certain Medicare Advantage enrollees from billions in cuts. The formula would only apply
to five states, most notably to Florida in which 800,000 of the state's one million Medicare
Advantage users would be exempt from cuts.
New England Handouts: In addition to the $100 million included in federal Medicaid payments
for Nebraska, the bill provides two New England states with even more money Medicaid funding.
According to CBO, the Senate bill now contains about $600 million in extra Medicaid cash to
Vermont, and about $500 million in additional money for Medicaid to Massachusetts, making these
three states the only to receive such funding. Despite claims that these cushy extras for a few states
would be scaled back, reports indicate that the White House is still making deals so these states can
keep the handouts.
The Dodd Clinic: Section 10502(a) of the bill provides $100 million for construction at an
unnamed "health care facility" affiliated with an academic health center at a public research university
in a state with only one public academic medical and dental school. Senator Chris Dodd (D-CT)
later sent a press release saying that he was securing the money for the University of Connecticut,
and then Dodd bragged that, "These provisions will bring millions of dollars to the state so that
Connecticut's residents can receive quality, affordable health care."
Montana Medicare Earmark: A provision slipped into the Senate bill by Finance Committee
Chair Max Baucus (D-MT), Section 1881A(b)(2), specifically expands Medicare coverage for
individuals who reside "in or around the geographic area subject to an emergency declaration made
as of June 17, 2009." The area the bill refers to is an asbestos contaminated area near Libby,
Montana, for which Sen. Max Baucus has been trying to secure funding for years.
California Democrats: Dennis Cardoza and Jim Costa changed their votes from no to yes. Coincidently, just yesterday, The Dept of Interior announced water would again flow to their districts after restricting water to the region and causing high unemployment. Retiring Tenn. Bart Gordon (D-Tenn) congressman changed his vote from a no to a yes after being offered the job of NASA administrator.
What is Congress Really Doing?
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8. Innovations in HealthCare: Open markets will work efficiently when enabling conditions exist
The decentralization that follows centralization is only beginning in health care. - Christensen
The World Health Care Congress has just concluded its annual meeting. This year's meeting was highlighted by Dr Clayton Christensen and Dr. John Kenagy. Both spoke on how disruption and innovation work together. This newsletter has pointed out the need for an open market in Health Care for the entire eight years we've existed. We now understand why some of those that communicate with us don't think that open markets will work in health care. They don't understand open markets.
Dr. Christensen pointed out that open markets won't work because enabling conditions don't exist at this time in health care. Open markets require the "visible hand" of systemic, integrative management, so that
• Value created can be measured and known
• Price reflects value
• Those who create value can capture it.
Open markets will then work efficiently when these enabling conditions exist. However, we are currently in a period of centralization in health care. This is not a period to lose hope. The decentralization that follows centralization is only beginning in health care. Electronic medical records cannot be pushed into use. "They will simply sit unused on a disk drive, rather than in a paper file. Doctors will pull EMRs into use when applications are developed that help doctors get jobs done that they are trying to do."
The healthcare revolution may be similar to the computer revolution of the 1980s. When the mainframe computer companies were having difficulty, President Reagan did not bail out the mainframe workers as the United Auto Workers were bailed out at a cost of $150,000 for each vote anticipated in the next election. Burroughs and others are no longer in existence. This gave the impetus to the Personal Computer Revolution and, in a decade or two, the price went from $5 million for each mainframe to $500 for a Pentium V. If the current auto industry had been treated in a similar fashion, some would have gone under while others, such as Ford who took no taxpayers funds, are expanding. Americans have an aversion to buying cars from government (GM-Government Motors). We will be seeing a large switch to Ford products. Meanwhile, electric cars are on the horizon and becoming more common. Batteries now exist that will accommodate 100 miles of travel before recharging. That would allow traveling from Sacramento to San Francisco or to Lake Tahoe. China is working on developing car batteries that will soon accommodate 200 miles of travel. That will allow for roundtrips for the same distance. Within a decade or two, just like the personal computer, every family would have one electric car and only one internal combustion engine car, cutting our need for Arab oil in half and essentially eliminating any pollution problems. This would have happened with a president who understands disruptive revolutions rather than one just trying to maintain the status quo.
The hospitals received favorable treatment from the recent Health and Taxation bill. This is just prolonging the period of time before the decentralization of the healthcare industry can occur.
As Clayton Christensen, PhD, stated at the World Health Care Congress,
The Traditional General Hospital Is Not a Viable Business Model.
John Kenagy, MD, MPA, ScD, FACS, stated it somewhat differently:
The Traditional General Hospital Is Not an Adaptive Business Model.
At this period of time in medical history, more than three-fourths of operations no longer require a hospital and can be done safely in a free-standing surgery center. Surgery is only one-tenth of the practice of medicine. More than 90 percent of the practice of internal medicine and all of its subspecialties occurs in the private physician's offices and diagnostic centers. Only about 10 percent of the practice of medicine, such as heart attacks, strokes, and the critically ill require a hospital. The hospitals will have to adapt and redefine themselves much as IBM did. They did not go the way of Burroughs and others but joined the computer revolution, manufacturing PCs as they reformatted their large mainframes that are now so essential in the vast worldwide network of users, where millions need simultaneous access to the same or similar data.
We have returned from the World Health Care Congress, the premier event in its field, with more than 100 power point lectures. We will review those that we heard presented and sample some of the other simultaneous ten tracks for more interesting presentations. They will be reported on during the coming months. These are interesting times in medicine and will be increasingly disruptive and innovative. There won't be much that government or the mainframe hospitals can do about it. We hope the hospitals will adapt much as IBM and the mainframes did in the 1980s, when the world was transformed to the PC market. Those who object will not be able to stop the march to the 800,000 physician offices with their more efficient diagnostic and treatment facilities.
We will be reviewing Clayton Christensen's book: THE INNOVATOR'S PRESCRIPTION - A Disruptive Solution for Health Care and also John Kenagy's book: DESIGN TO ADAPT - Leading Healthcare in Challenging Times.
Retail clinics will disrupt primary care physicians' practices, pushing them up-market to disrupt specialists - Clayton Christensen
Never doubt that a small group of thoughtful committed citizens can change the world; indeed, it's the only thing that ever has. -Margaret Mead
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HEALTH PLAN USA, LLC: The PPT Presentation
The medical insurance scene is changing rapidly in the United States. Change always creates new opportunities. As healthcare changes resulting from the current reform become clarified, HPUSA is the only true market-based plan that will transform the industry from its current vertical structure to a horizontal structure outside of Medicare, Medicaid, VA and any other government-sponsored plans.
It will duplicate the efficiency of the Personal Computer Industry of the 1980s, when the mainframes were going through major transitions. The mainframe of yesteryear that cost millions of dollars were replaced by the PCs that now cost only a few hundred dollars, have more power, more capability, more speed and more storage. Some mainframes met their demise while others were able to look to new opportunities. The computerized banking, debit/credit card and ATM networks, for instance, would not be possible without the modern mainframe computers that do multiple and variable transactions that occur anyplace worldwide, with simultaneous access for millions requiring only a user-id and a secure four-digit pass code.
Health care is ready to go through the same progression from the vertical to the horizontal model. Hospitals doing routine outpatient work are frequently ten to hundred times as expensive as the small practice setting. It has been estimated that more than half of the current work done in the high-cost hospital center (the mainframe) could be done more efficiently and cost effectively in the small setting of the 800,000 private physician offices. Hospitals will be going through the same reorganization that IBM and the other mainframes did and come out stronger with a totally different medical business operating plan. This evolution will take place in the near future. Entrepreneurship and digital information technology is an unstoppable combination. Just as IBM could not stop this transition, neither can hospitals nor the government prevent this inevitable efficiency in health care.
Neither can it be stopped in the socialized medicine countries. They had an interlude of 50 to 100 years of tragic government medicine which is failing all over the world. Each country is attempting some market base transition. However, after 50 to 100 years, there are few alive that remember such a concept. Hence, the feeble attempt at this effort. The triple play of the internet, entrepreneurship, and individual capitalism is an unstoppable force around the world, and that Individual Capitalism is the force that will shape the 21st Century.
This initial PPT presentation gives the basis for the next stage of healthcare reform. It will give you background information on which the horizontal business plan of the future will be based. This will decrease insurance premiums to about half what they are today, and place the patient, in consultation with his physician, completely in charge. There will be no muda (cost of billing, or rebilling, prior-authorizations, pharmacy formularies, restricted physician panels, etc.) to interfere with efficient and effective delivery of care.
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10. Restoring Accountability in Medical Practice by Non Participation in Government Programs and Understanding the Devastating Force of Government
Medicine and Liberty - Network of Liberty Oriented Doctors, www.MedLib.ch/, Alphonse Crespo, MD, Executive
Director and Founder
Medicine & Liberty (MedLib) is an independent physician network founded in 2007, dedicated to the study and advocacy of liberty, ethics & market in medical services.
- We support professional autonomy for doctors and liberty of choice for patients
- We uphold the Hippocratic covenant that forbids action harmful to the patient
- We defend responsible medical practice and access to therapeutic innovation free from
- We work towards a deeper understanding of the role and importance of liberty & market in
MedLib is part of a wide movement of ideas that defends
- the self-ownership principle & the property rights of individuals on the products of their
physical and intellectual work
- free markets, free enterprise and strict limits to the role of the State
· Entrepreneur-Country. Julie Meyer, CEO of Ariadne Capital, (Sorry about the nepotism, but her message is important to us in health care.) has launched Entrepreneur Country. Read their manifesto for valuable information: 3. The bigger the State grows, the weaker the people become - big government creates dependency . . . 5. No real, sustainable wealth creation through entrepreneurship ever owed its success to government . . . 11. The triple play of the internet, entrepreneurship, and individual capitalism is an unstoppable force around the world, and that Individual Capitalism is the force that will shape the 21st Century . . . Read the entire manifesto . . .
· Americans for Tax Reform, www.atr.org/, Grover Norquist, President, keeps us apprised of the Cost of Government Day® Report Read the entire report and the rest of this section . . .
This year, Cost of Government Day (COGD) - the day of the calendar year on which the average American worker has earned enough gross income to pay off his or her share of the spending and regulatory burdens imposed by government on the federal, state, and local levels - falls on August 12, which is almost a full month later than in 2008.
In last year's report, we cautioned that the looming entitlement crisis and efforts to drastically increase regulations were threatening to move Cost of Government Day later into the year.
However, no one could have foreseen the magnitude of the federal spending spree that was to begin in the second half of 2008, and has not abated since.
This massive government spending spree - a Keynesian (and utterly flawed) response to the financial market crisis and subsequent economic downturn - is the main culprit for this year's late Cost of Government Day.
As a result, taxpayers have to work 224 days out of the year just to meet the cost imposed by all levels of government.
As in previous years, this year's report seeks to shed light on the burden government imposes on taxpayers. A new feature of the report is a series of case studies taking a closer look at some of the more recent spending initiatives and other proposals that are currently threatening taxpayers.
For a broader perspective, we have included several narratives authored by lawmakers and think tank representatives analyzing the cost of government at the state level.
The recent federal spending spree paints a bleak picture for taxpayers. It started with the passage of the financial market bailout and continued with the "stimulus," the $410 billion earmark-stuffed "omnibus," the $3.55 trillion budget, and more bailouts leading to current threats of a national energy tax and a government takeover of health care.
· National Taxpayer's Union, www.ntu.org/main/, Duane Parde, President, keeps us apprised of all the taxation challenges our elected officials are trying to foist on us throughout the United States. To find the organization in your state that's trying to keep sanity in our taxation system, click on your state at www.ntu.org/main/groups.php. August 13 you can work for yourself. It takes nearly 8 months of hard work for every American to pay for the cost of government. Read more . . .
· Evolving Excellence - Lean Enterprise Leadership. Kevin Meyer, CEO of Superfactory, (Sorry about the nepotism.) has a newsletter that impacts health care in many aspects. Join his evolving excellence blog . . . Excellence is every physician's middle name and thus a natural affiliation for all of us. This month, read his The Customer is the Boss at FAVI "I came in the day after I became CEO, and gathered the people. I told them tomorrow when you come to work, you do not work for me or for a boss. You work for your customer. I don't pay you. They do. . . . You do what is needed for the customer." And with that single stroke, he eliminated the central control: personnel, product development, purchasing…all gone. Looks like something we should import into our hospitals. I believe every RN, given the opportunity and the responsibility, could manage her ward of patients or customers in a similar lean and efficient fashion.
· FIRM: Freedom and Individual Rights in Medicine, www.westandfirm.org, Lin Zinser, JD, Founder, researches and studies the work of scholars and policy experts in the areas of health care, law, philosophy, and economics to inform and to foster public debate on the causes and potential solutions of rising costs of health care and health insurance.
· Ayn Rand, a Philosophy for Living on Earth, www.aynrand.org/site/PageServer, is a veritable storehouse of common sense economics to help us live on earth. To review the current series of Op-Ed articles, some of which you and I may disagree on, go to www.aynrand.org/site/PageServer?pagename=media_opeds
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Satyam A Patel, MBA, CFO, & Co-Founder
6945 Fair Oaks Blvd, Ste A-2, Carmichael, CA 95608
Words of Wisdom
One nation, under bureaucracy, with penalties and mandates for all. -The New IRS
"The more elaborate our means of communication, the less we communicate." - Joseph Priestley: An 18th-century theologian and educator.
Always remember that Chancellor Otto von Bismarck, the father of socialized medicine in Germany, recognized in 1861 that a government gained loyalty by making its citizens dependent on the state by social insurance. Thus socialized medicine, or any single-payer initiative, was born for the benefit of the state and of a contemptuous disregard for people's welfare.