Part I (start immediately and complete by end of 2010):
1. For some insured people: Define a lower flat rate for those in a state's "high risk" pool insurance plan and subsidize the pools by the difference between actual costs of premiums and the new flat cost. That takes care of many of the people who have preexisting conditions AND were responsible enough to get insurance anyway.
2. For the uninsured, put them into the new flat rate risk pool if the reason is unaffordable preexisting conditions. If the reason for being uninsured is just cost, give them credit relief if their previous tax year income show they were above MEDICAID requirements and below some additional figure, like 200% above poverty maximum income level. Also, if someone else gets coverage without insurance and doesn't pay in some timeframe or set up a payment schedule, investigate that person's criminal record and immigration status. If an illegal immigrant, send the bus for him and let him off outside America. If a criminal, send him to jail. If clear after those checks, have the IRS discuss with him paying arrangements and do an audit of past 3 tax years looking for under-the-table income and other illegal activities that are harming We the People..
3. Identify and document medical frauds and abuse. Create detailed plan to address the top 20% of the frauds and abuses in ALL systems that contribute to 80% of the lost revenues. Determine how to catch the abusers and prosecute. Within the fraud and abuse area, I would also limit overuse of preventive services beyond what is normal.
4. Define an upper limit on premium increases, say 6% or so many percent above inflation for the next 5 years. Maybe this will incentivize the private companies to clean up the waste. Subsidize them up to the increase they wanted (beyond the 6%) with payments equal to the costs of improvement programs, which could include them helping hospitals, physicians, drug companies, etc. reduce their costs. They should be given awards for cost reductions they define and implemet outside their industry.
5. Consulting groups who derive a cost reduction implementation plan within a Health Industry entity that is submitted to the Governments Health czar for review and for which details cost saving benefits should be awarded, say 20%, of the consulting contract, with another 20% going to the Health entity after the plan is implemented and improvement shown (one year after implementation plan is complete). Regular monthly progress reports must be sent to the Health czar.Note: a valid consulting contract could be to draft a GOOD overall Health Care reform bill!
6. Don't touch Medicare, Medicaid, CHIP at this time. We don't need to make too many changes that we can't measure or explain results.
7. Look out for the unfortunate who because of a catastophic illness/accidnet exceed their annual or lifetime maximum. Let them apply for relief and do subsidize them for most of the additional costs. This would imply checking their legal status and financial status. Maybe just an interest free loan would be required.
8. Set up quality measurements for the above changes, along with expectations. Review quarterly to determine progress and changes necessary. Have a 1-year and 2-year review of effectiveness and efficiency. Now determine changes and any new programs.
Part II (later, but to be completed by January 2012):
1. Stop the frivilous lawsuits. Start with trials like Obama suggested today. Implement tort reforms by end of 2011.
2. Programs identified in Part I, number 8 that are not convoluted mass changes. Only the top 20% with most benefit shoulod be address at any one time.
Cost? Much, Much, Much, Much less than $900 Billion !!!
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