Is the greed and the underline pockets being filled to stop healthcare reform in this country?

The fact is both sides in Congress have their pockets filled, Democrats as well as Republicans. The deal is simply no-preexisting conditions, prevention, unlimited coverage to be included, in exchange for government subsidies, one expensive comprehensive plan design w HSA’s limits, and mandates. The American public will not notice the increase cost due to the subsidies, and the carriers will make the plans look different by color coding it, and make it look patriotic. So the American public can purchase healthcare by having a platinum, gold, silver, or bronze plan. The only difference is in the payout percentile. The carriers will start from 90% and go down to 60%. Oh let’s not forget the young invincible who will now have to buy insurance (the bronze plan modification), for which the carrier will call it catastrophic insurance. All this can now be administered by each state having to have their own exchange (layer of bureaucracy) and overseen by the insurance commissioner (former insurance executive). And finally the carriers will use the same claims administration distribution system for everyone, so they can CONTROL, by collect all the premiums, by charge 22% up to 30% administration, and by discounting the fees paid to physicians, medical facilities, hospital, and providers who do the work. The American consumer should now be thankful for only having to choose one plan, have more bureaucracy and administration, be force to buy insurance, and pay premiums three times. Government subsidies, insurance companies premiums and providers directly whom will not accept this plan. Is there another alternative? I believe there is, a community option.

What insurance has done to our physicians in our country?

When did we stop following the Hippocratic Oath and began looking at human as dollars signs in the world of practicing medicine? If the government focus continues on rewriting the insurance regulations and practices, it better start looking at the medical profession as well. Since the insurance industry has turn the medical professions to be more concerned on how they will be paid rather then treating a six year old girl.

Yes, a family whom has been seeing this medical group known as Pediatric Associates for over two years will treat the other children in the family, but refuse to treat a six year old with the flu symptoms, in a time of H1N1 epidemic, simply because the Medicaid changed the primary doctor at the time of recertification for the six year old, and not the rest of the family.

It is a shame a Pediatric Associate Management Services, a Primary Care Physician office would deny to see a six year old with flu symptoms. When the doctor was approached directly, he only responded “I am sorry due to the insurance, there is nothing he can really do”. Aware of this problem with Medicaid, the doctor’s office refuses to treat their own patients. So a patient health and treatment is determined by the insurance PPO network arbitrary selected at recertification.

So if the insured with Medicaid cannot get access to care due to the inefficiency of the current healthcare distribution system, and a physician would refuse to examine a child who has been a patient for over two years due to insurance payment, during H1N1 flu season, we must wonder what insurance has done to our physicians in our country.

How can a physician refuse coverage to a six year old with flu systems? Makes you wonder if physicians are now just puppets to this healthcare monopoly, called insurance.

Where insurance CONTROLS the behavior of physicians and the oath to serve your patient is ignored.

5 Stars to the President on some issues, back to the drawing board on others

In listening to the President the other evening, I can see a person who believes in the American dream. To do everything possible to build a bridge between party lines, and fundamentally reach out to all sides to change this healthcare dilemma which has lasted for over 63 years. He clearly stated “he is not the first president to attempt to change healthcare, but he is determined to be the last”.

As I watched Congress unfold, the divide between the parties was clear, as it has been for the past 8 years. With America’s war over seas, the economic challenges at home, and the millions of unemployed, uninsured, hardworking Americans struggling to stay above water, one would think that a feeling of solidarity might exist. Before I continue with my comments on President Obama’s speech, I would like to invite every American to wake up and see the politicians that they are electing as party-less individuals and thoroughly evaluate what they stand for. We cannot afford to elect politicians who are unwilling to participate in the movement for healthcare reform.

Now concerning Obama speech, his ideas in fixing what is wrong with our current healthcare system is based on the accumulations of all the concerns and cries of the American people. So it is clear he is responding to the needs of those cries. So to ask to balance the playing field and have the insurance industry take responsibility and include everyone, without dropping coverage, applying caps, he gets 5 stars. This is needed and the industry should be held to those high standards, isn’t this why we buy insurance?

The idea of having the healthcare reform not increase the budget deficit, and having a provision in the law to prevent this from ever happening, again he gets 5 stars, if he could do it.

So with all this positive energy there should not be any more objections, you would think? Well, this reform plan still needs adjusting. Here are my concerns over what was stated,

Everyone will have to buy insurance; this is a mandate which was compared to car insurance. The reason given is many American simply refuses to buy health insurance, specifically the young invincible. I understand the reasoning, but would it not be better to offer a community healthcare center option, where those individual can join the center and contribute directly and/or purchase catastrophic insurance. This idea offers those individual a choice of gaining access and/or purchasing insurance at an affordable cost. Otherwise, the consumer will always opt to purchase the most inexpensive insurance plan and will have gained no guaranteed to get healthcare access. Which bring me to the other points?

Having insurance does not guarantee you will have access to see a medical provider. Many providers are opting out of dealing with any insurance carriers all together. Mainly because of the low reimbursement payments offered by insurance, as well as the over burden administration associated with the carriers, and the full time staff needed to handle the collections and billing. Top that off with shortage in primary care physicians, and no incentive given to become a PCP. What good is insurance with no access to doctors?

Now looking at the plan design to include prevention and wellness as the standard in every policy, although it is vital, has this not been added to the policies back in the 80s & 90s?. The results have been low and the carrier simply increased the premium accordingly to cover the cost of the preventive exam and wellness. So by having the carriers include this in the design, we are enhancing the problem of administration and increasing cost. Why do we need a middleman? A community option/ direct care facility can solve this situation, without administration. It can also eliminate many standard treatments that are associated with standard care. So by having community options centers work with carriers in providing most of the primary care functions, we can eliminate most of the administration cost associated with the small claims, which in some instances represents 80% of expenses in healthcare administration.

These centers operate independent of insurance carriers, and can be private, non-profit, and co-operative in the community. It services the need of its citizens and is based on the population of the community. The fact is we do not have to wait four years; these facilities can exist immediately servicing the uninsured by following the 47MR model.

Not only are these centers an options to affordable care, but it also upgrades the quality of care given to the citizen in their community where doctors can be doctors free of protocol treatment. Quality of care is also a serious problem not address in the speech. The “stabilize and release” tactics practice in private hospitals, the waiting weeks for an appointment base on who is your insurance carrier, the “protocol medicine” doctors are force to practice, all are the result of the insurance carrier “controlling the payment” to providers, or the concern of proper coverage and payment.

Again, the system of distribution on how we handle the claims, how we pay the providers, and how the consumer understand the EOB, while administrating the employers enrollments and eligibility is all encumber some and administratively overburden. So if we are to lower cost we must find alternatives which streamlines, optimizes these function. Not just accept the status quo and continue the same pattern.

And finally, the infamous public option of which seems to be the controversy in getting healthcare reformed passed. Well now that we understand the ideology of creating an government insurance carrier to compete with the private carriers, to break the monopoly of the industry by listing them in the exchange, with no subsidy and only for those small business and individual who are looking for affordable care is great, if the community option is whom they insure, which will offer a different and unique plan apart from the status quo of the insurance companies. This way there is no conflict with free enterprise.

So I accept the President invitation to come forward with new and innovative ideas and let’s get this healthcare reform passed this year. The biggest concern is how do you get to the President to discuss these issues.

H1N1 swine flu approaching, RX Card free to everyone

It is important to understand that by this time next month thousands of people would be infected by H1N1 swine flu. With so many uninsured, the risk becomes even greater in spreading the swine flu here in the USA. The cost for those who are sick and require antibiotics medication may be prohibitive without insurance.
Therefore it would be an injustice if something is not offered. So now all small business, non-profit organization, health providers, unemployed, etc can get a free Rx Cards, which reduces the cost of any prescription medication from 15% up to 60% by just downloading the Rx Card from the website. www.47millionreasons.org.

Organizations could Link to the website and offer it to all their members, part time employees, unions, small business, etc as a preventive measure if vaccines are not available for everyone. Waiting one month makes a big difference in whether you get the flu or the vaccine.

Is Access vs. Insurance the real issue in healthcare reform.

The American public is confused as to the issue of access vs. insurance. Are we reforming how we access healthcare or just in how we buy insurance? It seems the way we buy insurance is continuing without change. Whether we buy it from an exchange, privately, or the public option we are buying insurance and paying a premium for the coverage. So to argue this point is to no avail. The fact is we will be paying insurance premium to the insurance companies for healthcare coverage period. We are relying on the current insurance distribution system.

Now let’s look at access. Even though we buy insurance does not guaranteed a medical provider will accept the insurance. Many medical providers today are accepting no insurance, whether private or public, only direct cash payments.

So even though we have reform which will mandates insurance there will be no guaranteed you will have access to care. So just having a policy is not enough.

Now the design of policy coverage is also a big question. If reform includes no pre-existing conditions, no limits or caps, no high deductibles, and all plans must include prevention and wellness, the insurance industry will surely increase the premiums.

So by not changing the current insurance distribution system, the insurance companies will continue to control and receive all the money in premiums. So by offering a comprehensive plan which pay for everything, they can freely increase the cost of plan, and with mandate everyone must buy a plan.

Providers in the other hand, does not have to accept the insurance. The fact is, with a 30% administrative cost in the premium, and the excess office administration expense to the provider, it better to offer direct care, direct payment and accept no insurance.

I think the president plan should allow providers to continue to offer care directly, allowing for providers to offer primary care services and accept no insurance.

Americans are looking for access to healthcare, and affordable premium. Providers are looking for direct care and direct payment. It’s time to re-examine the current insurance distribution system.

Why can healthcare reform have this combination of access, direct care, and catastrophic insurance for the back end at an affordable cost? A 47MR model exist can shows how this can work. www.47millionreasons.org