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Patient-Centered Health Care

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What Is Wrong With Health Care in America?
(Diagnostic Report)

 

 

During the 2016 election cycle, health care became a hotly debated topic. Many opposed The Affordable Care Act (a.k.a. ACA or ObamaCare) and wanted it repealed and replaced, although most people were not sure with which to replace it. Many others argued that the ACA needed to be fixed, again not supplying any ideas about how to do that. I am old enough to remember what health care was like before the ACA. Back in the mid-1990’s, politicians were screaming about the “health care crisis.” The ACA was supposed to be a “fix” for this “health care crisis”, but it ended up making the problem worse.

 

Before we can “fix” the ACA or “repeal and replace” the ACA, we need to do a full scale examination of the problems with the ACA and the health care system that existed before the ACA became law. If we do not identify the health care problems of the last 40+ years, we will never be able to solve the problem and the best we can hope for is a Band-Aid on a gaping problem.

 

Upon examination, we can easily identify two major problems with the health care system we have had for the past 60+ years. Most of the minor problems typically fall under one of these two major problems. The two major problems in the American Health Care System are 1) the marriage between healthcare and employment, and 2) insurance for every medical issue, big and small. Although you may not think these are major issues, let me explain each one in depth to show you how these two major flaws and crippling healthcare in America.

 

 

Marriage Between HealthCare and Employment

1.  Employer-Based Insurance Suppresses Wages

According to The Henry J. Kaiser Family Foundation (KFF), 49% of Americans are covered by employer-provided healthcare.[1] According to the official Census, in 2015, 55.7% of the population is covered by employer-based health insurance for some or all of the year.[2] From these two, very reputable and official sources, we can see that about half, or just over half, of the population is covered by employer-based health insurance. This means that these people are getting their health insurance through their employers.

 

In my experience, most people do not really understand how insurance, and especially employer-based insurance, works. Luckily, since I spent nine years working for a major health insurance company, I have a wealth of experience in this arena and can explain it.

 

First, you need to understand the players involved and the various contracts involved. As an employee, you have a contract with your employer. The employee provides his or her time, energy, knowledge, skills, education, etc. to the employer for a designated amount of hours per day, week, or month. In return, the employer provides the employee (worker) with compensation (your paycheck) and certain benefits (paid sick time, paid vacation time, health insurance, dental insurance, vision insurance, etc.). The employer (company) also has a contract with the insurance company, which lays out what medical procedures and services will be covered, how much they will be covered for, how much money the employer will provide for the coverage of these services, how much the employer will pay the insurance company for processing (paying and/or denying) the claims (bills) submitted by the medical providers (doctors, hospitals, pharmacies, etc.) and much more. Then there are the contracts between the insurance company and the providers, which detail what is covered, how much is covered, etc. The providers want as much as they can get for the services they provide. The insurance company wants to pay the least. This is hammered out in negotiations.

 

When the cost of health insurance premiums go up, this cost is passed on to the consumer. If you have employer-based coverage, that cost is going on to your employer and you. When you have insurance through your employer, typically the employer pays a portion of your monthly premium and you pay a portion of your monthly premium through your payroll deductions. What comes out of your paycheck for each pay period usually is NOT the full cost of the premium. It’s just your portion. Typically, employers pay between 70% - 85% of your monthly premium and you pay only 15% - 30% of the premium.[3] So, if you are upset about your portion going up, remember that your employer’s portion went up a lot more!

 

 

In 2017, the typical family policy costs $18,687 per year in premiums, with the average employer contribution being $13,469 and the average employee contribution being $5,218.[3] This means that the monthly premium is $1557.25, with the employer paying $1,122.41 per month and the employee paying $434.83 per month.

 

If the health insurance premium goes up by only 10% this year, this means that the total cost will go up by $1,868.70. Ten percent is astronomically low, considering that premiums have risen 34% in 2018.[4] If your employer had intended to give you a $1,000 raise this year (which works out to 48 cent per hour for full time), your employer may instead apply this $1,000 raise to the higher cost of your insurance premiums instead of giving it directly to you. But, that $1,000 raise will not cover all of the increase in premium. So, the remaining $868.70, may be split between you and your employer. So, you will think your employer is not giving you a raise and on top of that, your portion of your premiums (taken out of your paycheck) will go up, resulting in less bring-home pay for you. However, your employer IS giving you a raise, it’s just that it’s going towards the increase in health insurance premiums.

 

Employers have not always provided health insurance. In 1942, as World War II was in full swing, the demand for workers climbed sharply because the men were leaving the workforce to go fight in the war, yet there was a larger demand for goods to support the war effort. As employers started raising wages to attract workers from the diminished workforce pool, “Congress passed the Stabilization Act of 1942, which allowed the President to freeze wages and salaries for all of the nation’s workers.”[5] On October 3, 1942, President Franklin Delano Roosevelt signed Executive Order 9250 Establishing the Office of Economic Stabilization.[6] In Title II (Wage and Salary Stabilization Policy), section 1 of this Executive Order, it states:

 

"No increases in wage rates, granted as a result of voluntary agreement, collective bargaining, conciliation, arbitration, or otherwise, and no decreases in wage rates, shall be authorized unless notice of such increases or decreases shall have been filed with the National War Labor Board, and unless the National War Labor Board has approved such increases or decreases."[6]

 

There was one loophole in the Stabilization Act, though. It allowed for “insurance and pension benefits” to grow “in a reasonable amount” during the freeze. Since employers could not offer higher wages and salaries to lure workers (and many women) into their companies, the employers offered health insurance as a very sweet benefit. The idea caught on quickly and soon, there was employer-based health insurance from sea to shining sea. Oddly, we are still seeing health insurance being provided in lieu of actual income (see the previous example of raises being used to pay for raising premiums). In the 1940’s employers used health insurance to sweeten the pot because they couldn’t raise wages and now wages are being suppressed because of the health insurance. Oops. I doubt they anticipated the “benefit” becoming a wage “curse”.

 

 

2. Health Coverage Costs Fluctuate Wildly When You Change Employers

As we grow in our education, experience, and skills, most of us prefer to advance our careers, whether it would be for higher pay, shortened commute, better location, more challenges, or some other benefit. Very few people would say that they want their first job to be the job they work until retirement. In our effort to advance our paychecks and careers, we often are faced with changing employers (or even leaving employment behind to start our own businesses). However, when we change employers, everything about our health care also changes. First, even if we end up with the same health insurance company, the plan will often be very different concerning copays, coinsurance amounts, deductibles, what’s covered, etc. We definitely will have a new insurance card and policy number. But, that is not all that changes.

 

When you change employers, your portion of your insurance premium will most likely change. And this is not always a negligible change (from $400 to $450 per month). Often, it can vary wildly, especially if you are leaving a large corporation to work for a smaller, growing company. You could see your $400 per month premium skyrocket to $1400 per month with the company that’s will to give you a $7,000 per year raise but can’t afford to subsidize the health insurance premiums. That’s an additional $1,000 out of your checks each month, or $12,000 per year! Even with the raise, you will see $5,000 per year less! Yikes!

 

Even in the best of scenarios, where there isn’t much of a change in your health insurance nor the cost to you, there is still a massive problem that may hinder you from taking that fabulous new job – a gap in coverage.

 

 

3. Gaps in Coverage When You Change Employers

Typically, when you leave a job, the coverage you had through that employer continues through the last day of the month you quit. So, if you quit on March 1st, you still have coverage through March 31st. But, if you quit on March 29th, you only have coverage for 2 more days (March 31st). However, most employers require a 90 day probationary period before your coverage kicks in. This means that you could have no coverage for 60 – 90 days, even if you didn’t have a break in employment (started new job the day after your last day at the old job). Now, if you have a spouse and/or children, how eager are you to have your family go without insurance for 60 – 90 days, just to change jobs?

 

For most families, any one of these problems could be a deal breaker when considering changing employers. This prevents many workers from advancing their careers. Americans are being held back from reaching their full potential when there are barriers to changing jobs, such as raising premiums, drastically fluctuating premiums, and gaps in coverage.

 

 

4. Job Change = HealthCare Change / Lack of Portability

With health care being attached to the company or employer, when the employee changes employers, that employee will have a different health plan with the new employer than he or she had with the old employer. You get new insurance cards, new policy numbers, new doctors, new pharmacies, new hospitals, new specialists, and new coverage levels (coinsurance amounts, copays, deductibles, maximum out of pocket amounts, etc). When a patient finds a doctor that he or she likes, that patient wants to continue with that doctor and not be forced to change doctors. We are typically resistant to change, so changing everything about out healthcare every time you change your employer makes it more difficult for people to make positive change in their employment.

 

 

The Insurance Model

1. Insurance for Every Medical Issue, Whether Big or Small

After spending nearly a decade in the medical insurance business, I saw the transition from Indemnity plans to HMO and PPO plans. Indemnity plans were the original type of healthcare plans where you pay a premium each month, then when you obtain medical services, you present your insurance card and pay a coinsurance (typically 10%, 15%, 20%, or 25%). The insurance company was responsible for the rest of the bill (less the amount beyond “usual and customary”, which the provider had to “write off” or forgive). Since the patient has to pay a percentage of the cost, people would only go to the doctor when absolutely necessary.

 

HMOs, or Health Maintenance Organizations, became popular because they targeted routine care, check-ups, immunizations, and other services that helped to prevent illness and injury. The key was “preventive medicine”. Of course, prevention is the best solution to any health issue. However, this was abused. Growing up in the 1980s and 1990s, it was common for people to go to the doctor for everything. Antibiotics were prescribed for almost everything. This led to the antibiotics taking the place of the body’s natural immune system. People were becoming less capable of fighting illnesses without the use of antibiotics. This resulted in bacteria and viruses mutating into “superbugs”. Stronger antibiotics were needed and eventually developed. In the 21st century, doctors began reducing the amount of antibiotics they prescribed, acknowledging that antibiotics had been overprescribed, suppressed the body’s natural immune system, and contributed to the mutation of “superbugs”.

 

 

2. Wasteful Abuse and Hidden Costs

While the overuse of antibiotics has had a negative impact on society, the cost of health care skyrocketed. With people running to their family physician for every sniffle and cough, the demand for more health care providers climbed. The demand was so high, that providers could increase what they charged and still be secure in the fact that people wouldn’t be swayed by the higher costs. After all, the patient was paying the nominal copay of $10, $15, $20, or the like, regardless of what the provider charged. There are no incentives for the patient to be frugal in his or her use of health care. Quite the contrary. If you pay $200 per month in premiums for a health care plan, you will want to get your money’s worth out of that plan. In you don’t go to the doctor at all that month, you just wasted that $200 in premiums. But, if you go 2 or 3 times that month, you have actually saved a lot of money and the cost of the premium was worth it. So, the consumer is actually encouraged to overuse health care, even when it is not necessary.

 

We have all heard doctors say that the best thing for treating a cold is water, rest, and time. Medication may or may not speed up recovery. Going to the doctor for a cold usually results in that very advice, no prescription, and no shot. But, your insurance company may have to fork over $200+ for you to be told to go home, rest, and drink lots of fluids. Was that worth $200? Can you see how the cost of health care has been driven by wasteful spending on unnecessary care? You may not see the impact of health care costs, because you are only charged that nominal copay, but you will eventually see it in higher premiums.

 

Most of the time, the patient is not informed of the actual cost that will be charged to the insurance company. Does the patient have a fiduciary duty to the insurance company to go to a reasonably priced provider? No. The patient is not even thinking about the cost, other than the cost of the copay.

 

The insurance company was the one being targeted. However, the insurance companies would just raise their premium rates, resulting in the consumers and their employers paying more for the insurance. At first, this did not seem excessive. But over time, it has grown into a crisis. This is a recipe for disaster.

 

Let’s take the health care insurance model and apply it to auto insurance. What would happen if auto insurance started covering “preventive” care? Let’s imagine that auto insurance covers tune-ups, oil changes, tire rotations, replacement batteries, replacement tires, and gasoline. You pay $150 per month for the insurance and every time you get gas, you swipe your auto insurance card and then pay $5. Would you only put $10 - $20 of gas in your tank at a time? Of course not! That would be stupid. You would run your vehicle as close to empty as possible, get $60 worth of gas and pay only your $5 copay, right? The most bang for your buck. You would take your vehicle in for tune-ups, oil changes, and tire rotation more frequently, even when it really didn’t need it. The gas stations wouldn’t compete for businesses by keeping prices down. They would continuously increase the cost per gallon. Soon, gas would be $10 per gallon or more. Eventually, the auto insurance company would have no choice but to raise rates. Eventually, we would all be paying $800 per month or more in auto insurance. It would be too expensive for most people and if it continued long enough, people would quit buying auto insurance, putting them at severe risk if something catastrophic happened, like a bad car accident.

 

This example may seem ridiculous. But, that is precisely what we have done with health care. When you provide a middle man between the consumer and the provider, the cost becomes irrelevant to the consumer and the provider. The consumer abuses the services. The provider over inflates the costs. The middle man will never be able to control the costs without sacrificing service to the consumer. When we take out the middle man, the consumer and the provider can negotiate a cost reasonable to both of them. That is how the free market system works. It lowers prices to what consumers and providers consider “fair” or the “fair market value”.

 

Now, we see health care costs out of control and very few can afford health insurance. In our effort to provide preventive health care and increase the consumers’ quality of life, we ended up making health care unaffordable and unattainable for most Americans. It’s not too late to reverse this course though. We can provide preventive care while controlling costs. It just takes creativity and ingenuity.

 

3. Retail Medical Care = Inflated Costs

The insurance company is acting as the “middle man” in this process. We pay the insurance company through monthly premiums and the insurance company pays the provider for the services rendered. Of course, the insurance company has to pay for their employees to process (pay or deny) the claims and the customer service agents to take phone calls from patients and providers to check on benefits, coverage, eligibility, and explanations of how a claim was paid or denied. The insurance company also has to pay the managers of those employees and for all the building and operation expenses, so the insurance company has to make more than it pays out. This comes from us, the patients.

 

To put this in perspective, the insurance company is like a retail store who buys t-shirts from a supplier, or maker. The maker may buy the materials for $2, make the shirt, and charge the retailer $3 for the t-shirt. The added cost is for the time the maker spends turning the fabric into a shirt. That retailer then sells the shirt to you, but for more than the $3 they paid for it because they have to pay their cashiers, stockers, managers, and building expenses to be open for you to come in and buy that t-shirt. You pay $5 for a shirt that would have cost you only $3 if you purchased directly from the maker, or $2 if you made it yourself.

 

The insurance company is the middle man, or retailer, in the health care industry. By having a middle man, the cost of health care is inflated. To combat this issue, we need a more direct method to limit the middle man and to help drive the cost of health care down to a reasonable level.

 

 

4. Limited Care

When you sign up for a health insurance plan (through your employer, self-insurance, Medicaid, or Medicare), you have a set of “preferred providers” or “contracted providers” to choose from. There may be 50 MDs in your town, but only a dozen or so are “contracted providers” with your particular health insurance company. Since you are already paying the premiums for the insurance, you are highly incentivized to choose from that limited list. There are no guarantees that those doctors “contracted” with your health insurance are the best doctors. There are also no guarantees that those doctors charge the most reasonable rates. This leads to you passing up doctors that may provide a substantially higher level of care for a cheaper price, and you end up with a mediocre doctor that charges outrageous prices. How is that better for the patient? Furthermore, why aren’t we rewarding the best doctors with our business?

 

The insurance model of care is limiting your choices and we, as Americans, love choices and hate having limits on our healthcare options. The insurance model hinders freedom in healthcare. It forces you to choose from a small pool of providers.

 

Furthermore, we are paying someone else (insurance company) to tell us what types of procedures we can and cannot have. Most of us would prefer to pay for more choices. It seems rather ridiculous to pay someone to dictate how you can spend your health care dollars. Would this work in any other aspect of our lives?

 

Would you pay me $600 per month for me to dictate what foods for which I will reimburse you? That is ludicrous! Yet, we do that every time we pay health insurance premiums and are told what products and services they will “cover” with that money YOU gave them.

 

 

5. Lack of Coverage for Others

For years there has been a debate over how long a child can be covered on his or her parents’ health insurance plan. It used to be up to age 18. Then, it moved to 21 as long as the adult child was still in school and/or dependent. Under ObamaCare, it moved to age 26. But this completely ignores other situations and relationships beyond the parent/child relationship.

 

A prime example is if your parents have bad insurance or no insurance, you cannot cover them on your insurance. In other words, you cannot use your health care dollars to help out your parents. What if your parents need medication that is not covered on his or her health plan? Why shouldn’t you be able to access your health plan (which you paid for with your money) to assist your parents? Under our current system, that isn’t even an option. You either have to pay with cash, or your parents have to go without.

 

What if you wanted to help out a friend with his or her prescription cost? You do not have the option of helping others out, even if you have far superior coverage than they do. We need to be able to have a plan that allows us to use our health care dollars for the loved ones we wish to help.

 

With our current system, each adult or couple is autonomous from all others. There’s no sense of community in our current health care model.

 

And why are we arbitrarily picking the age 26. For some families, the adult child who is 22, is already married and has a child of his or her own. For other families, the 29 year old adult child may be disabled enough to still be dependent on the parents. We need more flexibility that makes it possible for each family to determine what is best for their particular family, without arbitrary numbers that are meant to make everyone the same. We need healthcare that is as diverse as the American family.

 

 

6. Delay in Payment for Providers

When a patient goes to a doctor for care, the doctor performs services for the patient on that day, only getting the copay from the patient on that day. Then the doctor has to submit a claim for payment to the patient’s insurance company. The insurance company has a time frame to process (pay or deny) that claim. The doctor will not get paid for that service for at least 2 – 6 months. There are very few industries where this “delayed payment” occurs. If you ran a business, you would want payment up front before you render services. Think about McDonald’s. They will not even entertain the ridiculous notion of giving you food for a promise of payment months into the future. Yet, we expect our doctors to wait for payment. This is unfair to the providers who had to pay a lot of money for specialized education and training so that they could provide those services. We need a system that pays providers at the time of service, rather than payment being delayed for months at a time.

 

 

7. Providers Need More Staff

Since providers need to submit “claims” to insurance companies to get reimbursement for products and services rendered, the provider often has to employ a full time person just to handle all that additional paperwork. These people are called medical billing specialists, with medical coding training. The provider, or doctor, needs to pay that person, which means the doctor has to charge more for his or her services to cover that additional employee.

 

 

Medicaid

1. Discrimination

When a person is approved for Medicaid, due to having a low income, Medicaid provides the covered person with a “medical card”, similar to an insurance card received when you sign up for any other insurance. The problem is that it clearly states “Medicaid”, or the specific Medicaid program name, on the card itself. This is highly problematic because when the Medicaid recipient presents the “Medicaid” card to a provider, the provider immediately knows that the patient is a Medicaid recipient and therefore, poor. The provider often treats Medicaid patients different than patients with some other form of insurance. The providers sometimes treat the Medicaid patient as “less important” than other patients. This is a form of discrimination, and it is often difficult to prove.

 

 

2. Fraud, Waste, and Abuse

Just as with the employer-sponsored health care, people do not exercise frugality when someone else is picking up the tab. This leads to needless office visits, prescriptions, and tests. The patient isn’t thinking about the taxpayers that will have to pay for these unnecessary services. When we are spending someone else’s money, we tend to be more extravagant and less frugal. This leads to fraud, waste, and abuse.

 

In March 2018, the U.S. Department of Health & Human Services, Office of Inspector General provided its report “Medicaid Fraud Control Units Fiscal Year 2017 Annual Report”. In it, they report that there were $1.8 Billion recovered for Medicaid Fraud.[7] This is just the amount recovered. The actual amount is more likely much higher. Even if that amount was the total amount of fraud, that’s $1.8 Billion of your tax money being wasted on fraudulent claims. That’s not a nominal amount.

 

 

3. Limited Providers

There are many providers that refuse to take Medicaid recipients. This narrows the list of providers for the patient to choose from and this limits the patients’ choice of providers. Everyone, regardless of their employment status or economic status, should have access to all available providers. The limited amount of providers often results in Medicaid patients only having access to subpar providers. Many of the top doctors and facilities do not accept Medicaid patients, which leads to further discrimination.

 

 

4. Higher Costs for More Restricted Care

One of the worst things we can ever do is throw more money at healthcare while we continue to receive further and further limitations being imposed. Why pay more for less coverage? The American spirit is one of frugality. We all want the best for the least cost. Currently, we are receiving fewer and fewer options as our costs continue to rise. That is backwards. Certainly, we can provide much better options at reduced costs.

 

 

Medicare

1. Double Charging for Premiums

People work for decades, with a portion of their paychecks going to fund Medicare. You pay into Medicare for decades, but once you sign up for Social Security and start receiving Social Security, they take out your “portion” of your “premium” for the Medicare. How is it you have been paying these “premiums” for decades and still have to pay for it when you are retired and on a fixed income. This is a form of double paying. By the time a person reaches retirement and Social Security age, their Medicare premiums should be considered paid in full. This is akin to charging the elderly for something they already paid for.

 

 

2. Unsustainability

Our own government claims that Medicare is not sustainable as it is. “The estimated depletion date for the HI [hospital insurance (Medicare Part A)] trust fund is 2026, 3 years earlier than in last year’s report.”[8] We keep having problems with the sustainability of Medicare, especially with a growing need for Medicare. As medical advancements as made, our elderly are living longer lives, translating into more years spent on Medicare. We need to ensure Medicare is sustainable for all of our elderly from retirement to death, regardless of whether that is 2 years or more than 40 years.

 

 

Conclusions

We need to torpedo the health care industry (cabal) in American and rebuild it into a truly American system of health care. We can do this. As Americans, our ability to think, and dream, of ideas no one else has ever dared to think or dream up, is infinite. We can come up with a health care system that benefits employers, employees, patients, and providers. We can invent a health care system that provides preventive medicine while preventing abuse. We can balance the interests of everyone, while allowing everyone to contribute to the determination of health care costs. We can have a system that allows the free market system to bring costs to a market sustainable level (not too high, not too low). We can make everyone happy and healthy. We can take care of our poor, disabled, and elderly, while reducing costs for everyone and increasing quality. That is the American way – best in the world and at the most reasonable price! Let’s solve this problem together!

 

Sources:

 

[1] The Henry J. Kaiser Family Foundation (KFF), Health Insurance Coverage of the Total Population (2017), https://www.kff.org/other/state-indicator/total-population/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D, Accessed January 12, 2018.

[2] United States Census Bureau, Barnett, Jessica C. & Vornovitsky, Marina S., Health Insurance Coverage in the United States: 2015, Issued September 2016, https://www.census.gov/content/dam/Census/library/publications/2016/demo/p60-257.pdf, page 1 (page 7 if opened in PDF), third bullet point that starts “In 2015, private health insurance…”, Accessed January 12, 2018.

[3] The Henry J. Kaiser Family Foundation (KFF), https://www.kff.org/other/state-indicator/family-coverage/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D, Accessed January 12, 2018.

[4] Avalere, Pearson, Caroline F., Carpenter, Elizabeth, and Sloan, Chris, Silver Exchange Premiums Rise 34% on Average in 2018, October 25, 2017, http://avalere.com/expertise/managed-care/insights/silver-exchange-premiums-rise-34-on-average-in-2018, Accessed January 12, 2018.

[5] Chicago Tribune, Mihm, Stephen, Employer-Based Health Care Was a Wartime Accident, February 24, 2017, http://www.chicagotribune.com/news/opinion/commentary/ct-obamacare-health-care-employers-20170224-story.html, Accessed January 12, 2018

[6] The American Presidency Project, Franklin D. Roosevelt, Executive Order 9250 Establishing the Office of Economic Stabilization, October 3, 1942, https://www.presidency.ucsb.edu/documents/executive-order-9250-establishing-the-office-economic-stabilization, Accessed August, 11, 2018.

[7] U.S. Department of Health & Human Services, Office of Inspector General, Murrin, Suzanne, Deputy Inspector General, Medicaid Fraud Control Units Fiscal Year 2017 Annual Report, March 2018, OEI-09-18-00180, https://oig.hhs.gov/oei/reports/oei-09-18-00180.pdf, accessed October 7, 2018.

[8] Centers for Medicare & Medicaid Services, Mnuchin, Steven T. (Secretary of the Treasury), Acosta, R. Alexander (Secretary of Labor), Azar II, Alex M. (Secretary of Health and Human Services), Berryhill, Nancy A. (Acting Commissioner of Social Security), and Verma, MPH, Seema (Administrator, Centers for Medicare & Medicaid Services), transmitted on Jun 5, 2018, 2018 Annual Report of the Board of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds, https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/ReportsTrustFunds/Downloads/TR2018.pdf, page 7 (page 13 if downloaded in PDF).

Solution: 

Freedom Health Bill

I. UNLEASHING THE FUNDS

 

In order to reinvent our health care system, we have to ensure that there are funds available for the new plan. This requires us to separate healthcare from employment by stipulating that employers would no longer provide health insurance for their employees. However, there MUST be a key requirement that the employers would be required to funnel 80% of their “healthcare savings” back to their employees in the form of higher wages and salaries.

 

 

What most people do not understand about health insurance that you receive through your employer is that the employer often pays 60% - 85% of the cost of the monthly premiums (77.7% for single plans[1], 72% for family plans[2]). Some employers pay higher percentages, some pay lower percentages. These numbers are the national averages. Nationally, it costs an average of $530.67 per month for a single plan and $1,557.25 per month for the family plans. If you have health insurance premiums coming out of your paycheck and your deductions over the course of a month do not equal these amounts, that’s because your employer is paying the rest of that monthly premium for you.

 

 

So, if you have $500 coming out of your paychecks each month, via payroll deductions, your employer is probably paying $1000 per month towards that monthly premium, totaling $1500 per month in premiums for your family plan. Obviously, if employers no longer provide the health insurance, the company will be saving a TON of money. But, we would require that they funnel the majority of those savings back to their employees via raises in wages and salaries.

 

 

It may sound complicated, but it isn’t. Businesses file taxes and they itemize all of their expenses. The company only needs two numbers to calculate how much this raise would be.

 

 

      A = Total Annual Cost of Healthcare Premiums Paid on Behalf of All Employees Combined                                         

      B = Multiply “A” by 0.8 (which is 80%) to get the amount of money going back to employees                                 

      C = Total Number of Hours Worked per Year by All Employees (regardless if they had the employer insurance or not,       regardless of whether they were even eligible) (This also includes FT, PT, Temp, Seasonal, Hourly, Salary, etc.)

 

 

Formula: B/C = Amount of Raise per Hour for each Employee in the company

 

 

This means that EVERYONE in the company gets a raise. If your manager gets a $2 per hour raise, so do you. If the employee is a salary employee, the “per hour” raise is simply multiplied by 2080 (40 hrs/week * 52 weeks/year). In this scenario, the salary employee would get a $4,160 per year raise, or about $80 extra per week.

 

 

Based on my calculations, it appears that the average employee would get about $2 - $4 per hour raise. Even with a mere $2.50 per hour raise, this translates into an extra $400 per month or an extra $5,200 per year!

 

 

However, that is not where the benefits end. Not only would you get a raise, but you would no longer have health insurance premiums being deducted from your paychecks. So, if you currently have $500 being deducted from your paychecks during a month, that money is also back in your paycheck. Adding your $400 per month raise and the $500 you are saving on premiums, you have an extra $900 in your pocket each and every month. Of course, you don’t have health coverage either. But, hang in there. We will get to that in a moment.

 

 

Another requirement under the Freedom Health Plan is that these new wages and salaries are required to be the new baseline for the company’s wages and salaries. This protects the employee in the event that he or she is making $15 per hour, then goes up to $17 per hour after the changes, but gets fired so the company can hire someone else at your lower, former wage of $15. The new wages and salaries will be required to remain the same, or higher, for all future employees.

 

 

End Result: Average American worker will have an extra $900 per MONTH in his or her pocket!

 

 

 

II. MAJOR MEDICAL & HEALTH SAVINGS ACCOUNT = 2 PART HEALTH CARE

Since people will no longer have health insurance through their employers, they need coverage from somewhere else. We can completely re-invent "HealthCare.gov" as an “information only” website that has all the valuable information every American would need. It would consist of at least three different sections (possibly more) – Major Medical, Health Savings Accounts, and Health Care Blue Book. Let’s go through each one of these.

 

 

 

A. Major Medical Plans

The first section of "HealthCare.gov" would be for Major Medical plans. You would be able to go into this section of the website and compare Major Medical plans side by side, based on searchable criteria, like deductible, premium amount, coinsurance, maximum out-of-pocket, lifetime limits, and so forth.

 

 

 

When you find the plan you like best and which suits your needs best, click on the link for that plan. Instead of you applying through the government (middle man), you are re-routed to that insurance company’s website and the page specific to that particular plan. Then you purchase that Major Medical plan directly from the insurance company.

 

 

First, all of the Major Medical plans would need to be “Nationwide Plans”, which means that you can use that insurance anywhere in the United States. You will not be limited geographically to only one location. We are a much more mobile society in the 21st century, so we need Major Medical that fits with our mobility.

 

 

Second, these Major Medical plans would cover any dependent up to age 26. This provides coverage for adult children who are in college and still building a foundation in their lives and it will act as a transition from “mom & dad’s plan” to getting onto the adult child’s own Major Medical plan.

 

 

Third, these Major Medical plans cover all of those big health care expenses – accidents, heart attacks, emergency room visits, expensive tests, and so much more. These Major Medical plans would NOT normally cover office visits, routine labs and x-rays, most prescriptions, and other minor health care products and services. They would only cover the BIG expenses.

 

 

Fourth, whichever plan you choose, you can stay with that plan for as long as you would like, even your entire life, if that’s what you want to do. It would be like your cell phone carrier or auto insurance company, where you can change anytime you want, but you don’t have to change. For many people, they would choose once and stay with that plan for their entire life, never again feeling the need to re-evaluate their options. Under our current system, most people have to re-evaluate their health insurance every year. This plan is truly a one-and-done choice, unless you decide to shop around for a better deal at some later date.

 

 

According to Trusted Choice, Major Medical plans range from $30 - $300 per month, with the average premium being $176 per month.[3] Even if you get the $300 per month type of Major Medical Plan and use part of your extra $900 to pay for it, you will still have an extra $600 each month in your pocket.

 

 

1. Transparency

The health insurance companies have to report their rates to the government annually to be on "HealthCare.gov" portal. This provides full transparency, including who the contracted providers are for that particular plan.

 

 

2. Basic or With Riders

Although this is only Major Medical coverage, without preventative or routine care benefits, the insurance companies would be permitted to offer “riders” for the Major Medical plans. These “riders” would cover additional services, but with additional costs. The riders would be completely optional for the consumer, but often pricey. Examples of riders would be: 1) 3 office visits per year for an additional $20 per month, 2) 5 mental health visits per year for an additional $30 per month, and so on. This would ease the transition from the insurance model to this new health care model for people who are nervous about this new health care system and want the security of preventive insurance.

 

 

3. Pre-existing

People with pre-existing conditions cannot be turned down. People with pre-existing conditions would pay a little more, but that would be capped at 50% higher than the regular premium. So, if the regular price for a particular plan is $200 per month, the person with a pre-existing condition would pay $200 - $300 per month for that plan. This allows the burden of high risk people to be shared among all people (with pre-existing and without pre-existing), but with the high risk patient taking on a larger burden than the patients without pre-existing. This is a compassionate, but fair burden sharing.

 

 

Pre-existing would no longer be a lifetime sentence under the Freedom Health Plan. If the patient has not needed treatment for at least 5 years, the patient’s former diagnosis is merely a part of the patient’s medical record and history, but no longer considered a pre-existing condition for coverage. The patient would no longer pay the higher premiums and would have his or her monthly premium reduced to the regular (base) level.

 

 

The patient would have to continue with regular check-ups and exams to document that the pre-existing condition no longer exists. Two prime examples are below:

 

 

Childhood asthma: The patient battled with asthma as a child, but as he or she grew up, he or she “outgrew” the asthma. Maybe the patient changed his or her lifestyle to reduce the effects of asthma, reducing the incidents and/or severity of the attacks. If the patient continues regular check-ups, but has not needed any treatment for at least 5 years, the condition is considered “resolved” and is no longer a pre-existing condition.

 

 

Cancer: The patient is diagnosed with cancer and gets treatment. The cancer, thankfully, goes into remission. The patient keeps going to his or her oncologist for check-ups and tests, but the cancer remains in remission for over 5 years. The patient requests that the oncologist share the records regarding the check-ups and test results with the insurance company so the patient can get the lower (base) rates again.

 

 

4. Lapse in Coverage

People who have gone 60 days or longer without a major medical plan would pay up to 50% higher for their plans for 12 months. This is to encourage people to get and maintain a major medical plan. After the 12 months of higher rates, the rate would drop back down to the regular (base) monthly premium.

 

 

5. Incentive for HSA and Preventive Maintenance

Consumers who also show that they have a HSA and have at least one (1) physical per year are eligible for a 10% discount on their premiums for 12 months, renewable each year.

 

 

This encourages consumers to maintain a Major Medical Plan, a HSA, and engage in prevention by having regular checkups.

 

 

The discount rate is “flexible”, meaning that we could make the discount a little higher, but anything lower than 10% would be too nominal (small) to be an incentive for preventive care and investment into an HSA.

 

 

6. Tax Deductible

The premium payments are tax deductible when you file taxes each year.

 

 

7. One Caveat

Some people may think that they would only need the inexpensive Major Medical plan and not get an HSA, relying on going to the emergency room whenever they need care. To discourage this costly practice, there would be one caveat built into this plan. Hospitals would be allowed to deny non-emergency services IF the patient can reasonably get care from a doctor’s office and it is during normal business hours.

 

 

There would be exceptions to this rule, such as when the condition is not critical, but it is after normal office hours (defined at Monday – Friday, 8am – 4pm) AND the condition runs the risk of becoming critical by the time normal business hours resume.

 

 

An example would be someone who has been suffering with symptoms of the stomach flu and has not been able to eat or drink water for hours, not seeking treatment because he or she thought it would pass. Now, the patient is showing symptoms of dehydration (dizziness, lightheadedness). If it is 10am on a Tuesday (and not a holiday), the emergency room would be able to deny care and advise the patient to go to a doctor’s office. However, if it is 10pm on a Friday night, the emergency room would be required to treat the patient because this situation has a great likelihood of becoming critical before a doctor’s office will office in 2 ½ days.

 

 

B. Health Savings Accounts

The second section of "HealthCare.gov" would be for the Health Savings Accounts (HSAs). These are basically a bank (savings) account that you manage. In this section of the "HealthCare.gov" website, you compare HSAs side-by-side, based on the criteria that are important to you (interest rates, services covered under that HSA account, minimum amount to sign up, minimum balance needed to maintain account, penalties, fees, etc.).

 

 

Again, when you find the HSA you want and click on it, you get re-routed to that financial institution’s website and the page specific to that HSA. You set up your HSA with that financial institution, not through the government. They will send you a card that looks like a credit card, but it will have “HSA” on it.

 

 

You can contribute as little or as much as you want and as frequently or seldom as you want. You can even use part of your income tax return to fund it for the year or part of the year.

 

 

You get to choose how you want to fund your HSA. Families that need more office visits, labs, x-rays, prescriptions, and other minor health care products and services would need to put more money into their HSA to ensure that there is enough to cover those expenses. If you have a fairly healthy family that doesn’t go to the doctor much, doesn’t require many prescriptions, you may not want to put as much into your HSA. It’s highly personalized.

 

 

The great thing about the HSAs is that you get to use it for a much broader assortment of health care products and services. Just some of the products and services that you can use your HSA for include (but are not limited to):

The bottom line is that it is your money and you have the exclusive right to determine what medical products and services you want to spend it on. Your care no longer will be dictated by some insurance company.

 

 

To use your HSA, you swipe your HSA card and the “medical” products and/or services are deducted from your HSA and paid to the provider. If you are at the grocery store and buy Tylenol and groceries, you swipe the HSA card first and it deducts the cost of the Tylenol, leaving the grocery balance, which you pay for like you do now.

 

 

You get to manage your HSA just like you manage your other expenses in life – food, utilities, and housing, to name a few. Of course you need a nifty tool to help you make those health care decisions such as who is the best provider for YOU. We will get to that in a moment. But first, the details of the HSA account:

 

 

1. Interest

The HSA would be an interest-baring account. This money can grow for you.

 

 

2. Rolled Over

The HSA can be rolled over from year to year, allowing the consumer to accumulate a large sum over time. This would allow young adults to contribute monthly for decades, and if used sparingly, it would result in plenty of money to cover out-of-pocket health related expenses in the later years of his or her life, when much more medical care will be needed.

 

 

3. Merged / Divided

The HSA can be merged (such as when two people marry) and divided (such as in the event of a divorce, where the HSA would be divided based on the divorce agreement or judgment by a divorce judge).

 

 

4. Willable

The HSA can be willed to beneficiaries. This way, the money is never “lost”, but can continue to be used by whomever the consumer chooses, even after death. The amount being willed can all be transferred to the beneficiary’s HSA account, or it can be split between the beneficiary’s HSA and a cash payment. However, at least 50% of the willed amount must be transferred to the beneficiary’s HSA, with 50% or less being available in cash payment.

 

 

An example would be if John Doe dies with $80,000 in his HSA, leaving it to his 2 children. Each child gets $40,000, of which at least $20,000 must go into the child’s HSA account. However, the child would be able to take any amount up to $20,000 in cash payment, with the rest going into the child’s HSA. Child #1 may want $10,000 in cash and put $30,000 in his HSA, while his sister (child #2) may want $20,000 in cash and put $20,000 in her HSA.

 

 

Minor Beneficiary: If a beneficiary is still a minor, 100% of the amount the beneficiary has been willed needs to be transferred into the minor’s HSA account to ensure that the minor has funds for medical purposes.

 

 

5. Adjustments

The consumer can adjust his or her contributions at any time, giving themselves the ultimate in flexibility.

 

 

6. Pauses in Contributions

The consumer can even stop making contributions without affecting the HSA account. The money is still there and available, can be used for products and services, and will never be lost or restricted, unless there is a lack of funds.

 

 

7. Tax Deductible

The contributions to the HSA are tax-deductible.

 

 

III. MEDICAID:  FROM SERVICE PROVIDER TO FUNDS PROVIDER

Medicaid would go from providing health care services to providing the money for health care products and services. Medicaid recipients would receive a monthly “award” amount based on income and family size, but the family would manage those funds just like everyone else. The Medicaid recipient would have a Major Medical plan that he or she chooses, and have a HSA that he or she chooses.

 

 

Medicaid would pay the premium amount for the recipient’s Major Medical plan and put the remaining balance into the recipient’s HSA. As an example, if the Medicaid recipient is “awarded” $580 per month, and the recipient has a Major Medical plan with a $300 per month premium, Medicaid would pay that $300 premium directly to the insurance company and deposit the remaining $280 into the recipient’s HSA account.

 

 

Consumer Control: The Medicaid recipient would manage his or her own HSA just like everyone else. There would not be a special Major Medical plan, or HSA, for Medicaid recipients. Medicaid recipients would have the same options to choose from as everyone else. The only difference is that the government is making the payments and/or deposits.

 

 

Seamless & Non-Discrimination: This makes it possible to keep the same Major Medical plan and HSA account throughout your entire life. You can change jobs, go on Medicaid, go off of Medicaid, continue to change jobs, and have the same Major Medical plan and HSA account. This provides seamless coverage throughout life. Because there are no special plans or ID cards for the Medicaid recipients, providers would not be able to tell if you funded your HSA yourself or if Medicaid funded your HSA. This eliminates discrimination based on economic status.

 

 

Breaking Point: There is one caveat that would also need to be in place, which is a “breaking point” for Medicaid’s contribution to a recipient’s HSA. If the recipient has at least $5,000 in his or her HSA, that month’s contribution is forfeited. For example, if the recipient usually gets $200 per month deposited into his HSA each month, but has $5,010 in his HSA on June 6th (his disbursement date), Medicaid will not make the June deposit into the HSA (but they would still pay the premium on the Major Medical Plan). But, if he goes to the doctor or gets a prescription during the month of June and by July 6th, his HSA is at $4,900, Medicaid will make his $200 July deposit into his HSA, but he would not get the “back pay” from June because that was forfeited.

 

 

The point of that is to ensure people have plenty in their HSA, but without the government (taxpayers) helping people who do not need the help. For most people, having at least $5,000 in your HSA is enough to handle most medical needs.

 

 

We can provide a minimum of $500 per Medicaid household, with the average Medicaid household receiving $750 per month (between Major Medical premiums and HSA deposits). This puts Medicaid recipients right on par with other working individuals who are self-funding their Major Medical and HSAs. But, the real beauty of this is that we can provide this at half the cost of Medicaid.

 

 

In 2017 (most recent data), we spent $581.9 BILLION on Medicaid.[4] In September 2018, there were 73,420,626 people enrolled in Medicaid.[5] This is a cost of $7,925.56 per Medicaid recipient ($660.46 per month per person). With the average American household of 2 – 3 people, that would be an average monthly Medicaid household cost of $1,320 – $1,981 (avg. $1651). This is about twice the monthly household amount under this proposed plan.

 

 

In essence, we would be providing much better health care to our Medicaid recipients, but at half the cost, saving taxpayers approximately $290.95 BILLION per year! Doesn’t better care for half the price sound good for everyone?

 

There would be some additions to the requirements for Medicaid though.

 

 

A. Drug Testing

As long as the recipient is on Medicaid, the recipient would be subjected to spontaneous drug testing. If the recipient tests positive, he or she would be directed to treatment programs (paid for by Medicaid) in order to continue receiving benefits. The goal is to help out those who are going through rough times, not to finance an addiction. Yet, we will provide the assistance needed to help the person recover from addiction. This is not meant to be a punishment, but to act as an aid to achieving better health.

 

 

B. Job Seeking & Volunteerism

All adults (non-disabled, non-pregnant, and capable of working), must prove attempts to find employment, and commit to volunteer a minimum of 10 hours per week. The volunteer jobs can be coordinated through the recipient’s case worker.

 

This keeps the Medicaid recipient engaged in society and helps them to maintain a work ethic. It also combats depression that can set in after prolonged unemployment.

 

 

C. Time Limits

We would also have the option to set time limits for receiving Medicaid to discourage people from becoming reliant on Medicaid. The goal is for able-bodied adults to work and contribute to society as a whole. Medicaid is a tool for helping people through life’s rough patches.

 

 

 

IV. SPECIAL CIRCUMSTANCE PATIENTS

Although this plan would provide great coverage for the normal family, there are some people that have much higher monthly health care costs and the typical HSA amounts would not be enough to cover their health care costs. I refer to these patients as “special circumstance patients”. People who have high monthly health care expenses would apply for “Special Circumstance Medicaid” to assist them with their higher costs, even if they would not qualify for regular Medicaid.

 

 

If your monthly medical costs are high, you apply for this specialized “Medicaid.” Even if you do not qualify for regular Medicaid, you may qualify for this Special Circumstance Medicaid because it is based on your needed medical costs minus (-) your reasonable contribution to your HSA. If your costs are $1000 per month, but you can only afford to put $300 into your HSA each month, you would get a “special circumstance” Medicaid award of $700 - $800 deposited into your HSA each month that you qualify. You would still provide your typical $300 deposit into your HSA.

 

 

This is a supplemental plan, specially tailored to those with higher health care needs. This either supplements your personally funded HSA or it may supplement your regular Medicaid. Either way, you WILL be taken care of one way or another.

 

 

But, how will we be able to pay for these extra payments? Since we are saving over $290.95 Billion per year on regular Medicaid, we can use some (maybe $30 Billion - $50 Billion) of that to fund this specialized, supplemental Medicaid. Yet, we will still save a LOT on Medicaid.

 

 

 

V. MEDICARE

Medicare has four parts for it. Part A is the hospitalization/major medical part, for when you go into the hospital or need expensive treatments. Part B is for most other medical care (office visits, labs, x-rays, etc.). Part C is just a combo plan that includes Part A and Part B. Part D is the prescription plan, for all of your prescriptions. Since Part C is a bundle of Parts A & B, we don’t have to specifically address it. We will stick to Parts A, B, and D.

 

 

Medicare costs for Part B for 2017 was $309 Billion.[6] Medicare costs for Part D for 2017 was $100 Billion.[6] In 2017, Medicare Parts B and D combined cost taxpayers $409 Billion.

 

 

Medicare serves a vital need in the community by providing health care for our elderly. We can save money without touching Medicare. Medicare stays exactly the same as it is now, but with one simple caveat. You cannot sign up for Medicare Part B or Medicare Part D if you have at least $5,000 in an HSA account. However, you can sign up for Medicare Part A, regardless of how much you have in an HSA.

 

 

However, once your HSA account dips below $5,000, you sign up for Medicare Parts B & D. Notice that you “sign up”, not “apply”. You do not need it “apply”, as long as you are Medicare eligible under the age qualifications, you are already eligible. It’s just a matter of the amount in your HSA account.

 

 

This is not a limit on Medicare recipients. No benefit is being taken away. For example, if you have $10,000 in your HSA, you use that to pay for your office visits, labs, x-rays, and prescriptions. But, before that HSA is fully depleted, you are already on Medicare Parts B & D. You are simply using your HSA first, saving taxpayers billions of dollars each year.

 

 

How will this affect Medicare in the future? In the beginning, not much will be affected. But, as time marches on and the years pass, fewer and fewer people will need Medicare Parts B & D, for longer periods of time in their twilight years.

 

 

Example 1: John and Sue are 60 years old. They will be Medicare eligible in 5 years. That’s not a lot of time to build an HSA account. They may have $3,000 in their HSA by age 65. At age 65, they sign up for Medicare Parts A, B, & D because they do not have more than $5,000 in their HSA. They are basically unaffected by the one and only change to Medicare by this bill, just as the current recipients are unaffected.

 

 

Example 2: Jim and Mary are 45. They have 20 years before they become Medicare eligible. They are able to put $400 per month in their HSA, totaling $4,800 per year. They use an average of $1,500 per year for their medical expenses. They are saving $3,300 per year in their HSA. Since they have 20 years until they are Medicare eligible, they will have saved $66,000 (principal only, interest would make this significantly higher) in their HSA by the time they are Medicare eligible. If Jim and Mary are in good health, eat right, and exercise, that $66K could last 5 – 10 years before it gets down to only $5,000 left. Jim and Mary just saved taxpayers over $60,000 over the past 5 – 10 years. That may not seem like a lot, but when you multiply it by millions of people, it begins to add up to significant savings for the taxpayer.

 

 

Example 3: Mike and Kate are 25 year old newlyweds. They are just starting out in life after college. They contribute about $300 to their HSA each month in anticipation of well-baby and well child visits in the future. They are contributing $3,600 per year and use an average of $1,500 per year over the next 40 years (less during childless years and during empty nest years, more during childrearing years). That’s a savings of $2,100 per year for 40 years, or $84,000 (principal only, interest would make this significantly higher) in their HSA at the age of retirement. Mike and Kate will save the taxpayers from more than half of their post-retirement medical expenses!

 

 

Now, this could be even higher if Mike and Kate increase their HSA contributions, have lower costs over the years, inherit any HSA money from their parents, and of course, there is the interest that will accrue over this time period, which has not been factored in.

 

 

All future amounts are calculated in today’s dollars, because even as costs may go up due to inflation, incomes typically also go up, making it possible to contribute even more per month. All amounts would be expected to increase in similar fashion.

 

 

Reducing Medicare Premiums:

Medicare recipients pay monthly premiums for their Medicare Parts B, C, and D out of their monthly Social Security checks. These recipients have already paid into Medicare for decades, and now that they are seniors they have to pay again in order to have Medicare. This is an assault on our elderly.

 

 

The 2019 premiums for Medicare Part B range from $135.50 – $460.50 per month.[7] The average estimated monthly premium for Medicare Part D for 2019 is $33.19.[8] This is a combined monthly premium of $168.69 - $493.69 per month. The average Social Security monthly benefit for a retired worker is $1414.37.[9]

 

 

This reduces our seniors’ meager $1,414.37 income to around $1,245.68 per month. This is an annual $14,948.16, which is approximately 11.6% below the federal poverty level for a household of 2 people.[10]

 

 

This Freedom Health Plan will make Medicare more solvent as time goes on, ensuring that we take care of our seniors even better in the future than what we are currently. Many of our seniors are living in poverty already. Charging them for Medicare (which they have already spent decades paying for) is kicking them when they are down. Our seniors deserve to be treated better, with more honor and dignity.

 

 

 

VI. MANAGING YOUR HEALTH CARE

As we leap into the 21st Century with advanced technology, we can now bring that advanced technology into the field of healthcare, to give the 21st Century Family the resources to make healthcare easier, and more affordable.

 

 

The first tool, Health Care Blue Book, provides you with the information needed to find the absolute best provider for YOU, but at the most reasonable cost. The second tool, Telemedicine, incorporates a wide variety to technologies to make access to health care providers easier and make that access more mobile, for the busy family on the go.

 

 

Both of these modern tools allow for the cost of health care to decrease, while improving access to providers. Providers are better able to manage their time, so they can treat more people in less time. Everyone wins.

 

 

 

A. Health Care Blue Book

The third section of "HealthCare.gov" would be “Health Care Blue Book”. This is where you can compare providers of health care services. You go to this section of “HealthCare.gov” and put in the criteria that matter to you and your family, such as zip code, distance you are willing to travel outside your zip code for health care, and a type of service. This pulls up a list of all the providers in that geographical area and lists them by the prices that they charge for that particular service.

 

 

Above the list of providers, there is a bar that shows the lowest amount and highest amount charged for that service in that geographical area. It also lists a “fair market value” for that service. The providers in the provider list would be color coded. It would look a little like this:

The providers in the green section charge “at or below Fair Price”. The providers in the yellow charge “slightly above Fair Price”. And the providers in the red charge “Highest Price”. As you can see from the example above, the range is $39 - $101+, with the Fair Price at $58.

 

Price is not the only way to choose a provider. There are many other criteria that each of us has for choosing a provider. The consumer can click on any of the providers listed below the Price Bar and a “pop-up window” comes up with additional information about that specific doctor. Some of the additional information would include, but not limited to:

This makes it possible for every American to find the best provider that fits that American’s specific criteria, but also at the lowest cost. All of us want the best at the lowest cost. This would make it possible to do that with health care.

 

 

You no longer have a limited list of “contracted providers” to choose from. You can choose ANY provider in your geographical area. This tool makes it possible for you to find the perfect provider for you, but at the lowest cost.

 

 

The providers that charge the most would not have as many patients, encouraging those “expensive” providers to either, 1) justify their excessive rates, 2) lower their rates, or 3) go out of business. Regardless of what they do, this lowers the cost of healthcare products and services to a market-sustainable level that makes providers and patients happy.

 

 

 

B. Telehealth Service

An emerging and growing segment of the health care industry is telehealth services. Telemedicine and Telehealth services is defined as “the use of electronic information and telecommunications technologies to support and promote long-distance clinical health care, patient and professional health-related education, public health and health administration. Technologies include videoconferencing, the internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications.”[11]

 

 

It includes Live Videoconferencing (2-way audiovisual link between the patient and provider). This is a much more cost effective way to manage health care costs. The savings could be as much as $100 each time you use telehealth services instead of an office visit with your doctor.

 

 

“Looking at the commercial market, this study found that the average estimated cost of a telehealth visit is $40 to $50 per visit compared to the average estimated cost of $136 to $176 for in-person acute care.”[12]

 

 

“Patient issues are able to be resolved during the initial telehealth visit an average of 83 percent of the time."[12]

 

 

This is just another form of savings for the American family trying to save on the cost of healthcare.

 

 

 

VII. CONCLUSIONS

By overhauling the entire system, we are able to drive down costs to a market-sustainable level, provide savings for businesses, employees, the government, and even the providers. The headaches of choosing a health plan every year are gone, as are the majority of paperwork in the providers’ offices. Most providers would get paid at the time services are rendered. We cut out the middle man which only served to drive up costs. We are providing the same level of care for our poor as we do for our workers. We are saving taxpayers hundreds of billions of dollars each year. We are taking care of the high risk people and the people with high health care needs. Pre-existing conditions are no longer a life sentence. We make health care more accessible for the busy, modern family. We eliminate discrimination based on Medicaid status. We protect and insulate our seniors from high premiums and are beginning to treat them with the dignity and respect they deserve. We overhaul healthcare to make sense in the 21st century. Common sense, user-friendly, seamless, low cost, compassionate, modernized, and wholesale healthcare for everyone! That’s the Freedom Health Plan!

 

 

Sources:

 

[1] The Henry J. Kaiser Family Foundation, Average Annual Single Premium per Enrolled Employee for Employed-Based Health Insurance: 2017, https://www.kff.org/other/state-indicator/single-coverage/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D, accessed October 7, 2018.

[2] The Henry J. Kaiser Family Foundation, Average Annual Family Premium per Enrolled Employee for Employed-Based Health Insurance: 2017, https://www.kff.org/other/state-indicator/family-coverage/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D, accessed October 7, 2018.

[3] Trusted Choice, https://www.trustedchoice.com/health-insurance/coverage-types/catastrophic-major-medical/, accessed October 8, 2018.

[4] Centers for Medicare & Medicaid Services, “NHE Fact Sheet: Historical NHE, 2017”, https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nhe-fact-sheet.html, accessed January 28, 2019.

[5] Medicaid.gov, Monthly Medicaid & CHIP Application, Eligibility Determination, and Enrollment Reports & Data, September 2018, https://data.medicaid.gov/Enrollment/2018-09-Updated-applications-eligibility-determina/hbh7-cy5y/data, accessed January 28, 2019.

[6] Henry J. Kaiser Family Foundation, Medicare, Cubanski, Juliette and Neuman, Tricia, “The Fact on Medicare Spending and Financing”, Figure 2 (“Medicare Benefit Payments for Part A, B, and D, 2007 and 2017”), https://www.kff.org/medicare/issue-brief/the-facts-on-medicare-spending-and-financing/, published June 22, 2018, accessed October 25, 2018.

[7] Medicare.gov, Part B Costs: How Much Does Part B Cost?, https://www.medicare.gov/your-medicare-costs/part-b-costs, accessed January 28, 2019.

[8] Medicare Matters, National Council on Aging, How Much Does Medicare Part D Cost?, https://www.mymedicarematters.org/costs/part-d/, accessed January 28, 2019.

[9] Social Security Administration, Research, Statistics & Policy Analysis, “Monthly Statistical Snapshot, December 2018”, Table 2: “Social Security benefits, December 2018”, citing: Social Security Administration, Master Beneficiary Record, https://www.ssa.gov/policy/docs/quickfacts/stat_snapshot/, accessed October 25, 2018.

[10] U.S. Department of Health & Human Services, “HHS Poverty Guidelines for 2019”, in effect as of January 11, 2019, https://aspe.hhs.gov/poverty-guidelines, accessed January 28, 2019.

[11] The Office of the National Coordinator for Health Information Technology (ONC), “Telemedicine and Telehealth”, https://www.healthit.gov/topic/health-it-initiatives/telemedicine-and-telehealth, accessed October 25, 2018.

[12] Yamamoto, Dale H., Assessment of the Feasibility and Cost of Replacing In-Person Care with Acute Care Telehealth Services, December 2014, http://connectwithcare.org/wp-content/uploads/2014/12/Medicare-Acute-Care-Telehealth-Feasibility.pdf, accessed October 25, 2018.

Freedom Health Bill

I. UNLEASHING THE FUNDS

 

 

In order to reinvent our health care system, we have to ensure that there are funds available for the new plan. This requires us to separate healthcare from employment by stipulating that employers would no longer provide health insurance for their employees. However, there MUST be a key requirement that the employers would be required to funnel 80% of their “healthcare savings” back to their employees in the form of higher wages and salaries.

 

 

What most people do not understand about health insurance that you receive through your employer is that the employer often pays 60% - 85% of the cost of the monthly premiums (77.7% for single plans[1], 72% for family plans[2]). Some employers pay higher percentages, some pay lower percentages. These numbers are the national averages. Nationally, it costs an average of $530.67 per month for a single plan and $1,557.25 per month for the family plans. If you have health insurance premiums coming out of your paycheck and your deductions over the course of a month do not equal these amounts, that’s because your employer is paying the rest of that monthly premium for you.

 

 

So, if you have $500 coming out of your paychecks each month, via payroll deductions, your employer is probably paying $1000 per month towards that monthly premium, totaling $1500 per month in premiums for your family plan. Obviously, if employers no longer provide the health insurance, the company will be saving a TON of money. But, we would require that they funnel the majority of those savings back to their employees via raises in wages and salaries.

 

 

It may sound complicated, but it isn’t. Businesses file taxes and they itemize all of their expenses. The company only needs two numbers to calculate how much this raise would be.

 

 

      A = Total Annual Cost of Healthcare Premiums Paid on Behalf of All Employees Combined                                         

      B = Multiply “A” by 0.8 (which is 80%) to get the amount of money going back to employees                                 

      C = Total Number of Hours Worked per Year by All Employees (regardless if they had the employer insurance or not,       regardless of whether they were even eligible) (This also includes FT, PT, Temp, Seasonal, Hourly, Salary, etc.)

 

 

Formula: B/C = Amount of Raise per Hour for each Employee in the company

 

 

This means that EVERYONE in the company gets a raise. If your manager gets a $2 per hour raise, so do you. If the employee is a salary employee, the “per hour” raise is simply multiplied by 2080 (40 hrs/week * 52 weeks/year). In this scenario, the salary employee would get a $4,160 per year raise, or about $80 extra per week.

 

 

Based on my calculations, it appears that the average employee would get about $2 - $4 per hour raise. Even with a mere $2.50 per hour raise, this translates into an extra $400 per month or an extra $5,200 per year!

 

 

However, that is not where the benefits end. Not only would you get a raise, but you would no longer have health insurance premiums being deducted from your paychecks. So, if you currently have $500 being deducted from your paychecks during a month, that money is also back in your paycheck. Adding your $400 per month raise and the $500 you are saving on premiums, you have an extra $900 in your pocket each and every month. Of course, you don’t have health coverage either. But, hang in there. We will get to that in a moment.

 

 

Another requirement under the Freedom Health Plan is that these new wages and salaries are required to be the new baseline for the company’s wages and salaries. This protects the employee in the event that he or she is making $15 per hour, then goes up to $17 per hour after the changes, but gets fired so the company can hire someone else at your lower, former wage of $15. The new wages and salaries will be required to remain the same, or higher, for all future employees.

 

 

End Result: Average American worker will have an extra $900 per MONTH in his or her pocket!

 

 

 

II. MAJOR MEDICAL & HEALTH SAVINGS ACCOUNT = 2 PART HEALTH CARE

Since people will no longer have health insurance through their employers, they need coverage from somewhere else. We can completely re-invent "HealthCare.gov" as an “information only” website that has all the valuable information every American would need. It would consist of at least three different sections (possibly more) – Major Medical, Health Savings Accounts, and Health Care Blue Book. Let’s go through each one of these.

 

 

 

A. Major Medical Plans

The first section of "HealthCare.gov" would be for Major Medical plans. You would be able to go into this section of the website and compare Major Medical plans side by side, based on searchable criteria, like deductible, premium amount, coinsurance, maximum out-of-pocket, lifetime limits, and so forth.

 

 

 

When you find the plan you like best and which suits your needs best, click on the link for that plan. Instead of you applying through the government (middle man), you are re-routed to that insurance company’s website and the page specific to that particular plan. Then you purchase that Major Medical plan directly from the insurance company.

 

 

First, all of the Major Medical plans would need to be “Nationwide Plans”, which means that you can use that insurance anywhere in the United States. You will not be limited geographically to only one location. We are a much more mobile society in the 21st century, so we need Major Medical that fits with our mobility.

 

 

Second, these Major Medical plans would cover any dependent up to age 26. This provides coverage for adult children who are in college and still building a foundation in their lives and it will act as a transition from “mom & dad’s plan” to getting onto the adult child’s own Major Medical plan.

 

 

Third, these Major Medical plans cover all of those big health care expenses – accidents, heart attacks, emergency room visits, expensive tests, and so much more. These Major Medical plans would NOT normally cover office visits, routine labs and x-rays, most prescriptions, and other minor health care products and services. They would only cover the BIG expenses.

 

 

Fourth, whichever plan you choose, you can stay with that plan for as long as you would like, even your entire life, if that’s what you want to do. It would be like your cell phone carrier or auto insurance company, where you can change anytime you want, but you don’t have to change. For many people, they would choose once and stay with that plan for their entire life, never again feeling the need to re-evaluate their options. Under our current system, most people have to re-evaluate their health insurance every year. This plan is truly a one-and-done choice, unless you decide to shop around for a better deal at some later date.

 

 

According to Trusted Choice, Major Medical plans range from $30 - $300 per month, with the average premium being $176 per month.[3] Even if you get the $300 per month type of Major Medical Plan and use part of your extra $900 to pay for it, you will still have an extra $600 each month in your pocket.

 

 

1. Transparency

The health insurance companies have to report their rates to the government annually to be on "HealthCare.gov" portal. This provides full transparency, including who the contracted providers are for that particular plan.

 

 

2. Basic or With Riders

Although this is only Major Medical coverage, without preventative or routine care benefits, the insurance companies would be permitted to offer “riders” for the Major Medical plans. These “riders” would cover additional services, but with additional costs. The riders would be completely optional for the consumer, but often pricey. Examples of riders would be: 1) 3 office visits per year for an additional $20 per month, 2) 5 mental health visits per year for an additional $30 per month, and so on. This would ease the transition from the insurance model to this new health care model for people who are nervous about this new health care system and want the security of preventive insurance.

 

 

3. Pre-existing

People with pre-existing conditions cannot be turned down. People with pre-existing conditions would pay a little more, but that would be capped at 50% higher than the regular premium. So, if the regular price for a particular plan is $200 per month, the person with a pre-existing condition would pay $200 - $300 per month for that plan. This allows the burden of high risk people to be shared among all people (with pre-existing and without pre-existing), but with the high risk patient taking on a larger burden than the patients without pre-existing. This is a compassionate, but fair burden sharing.

 

 

Pre-existing would no longer be a lifetime sentence under the Freedom Health Plan. If the patient has not needed treatment for at least 5 years, the patient’s former diagnosis is merely a part of the patient’s medical record and history, but no longer considered a pre-existing condition for coverage. The patient would no longer pay the higher premiums and would have his or her monthly premium reduced to the regular (base) level.

 

 

The patient would have to continue with regular check-ups and exams to document that the pre-existing condition no longer exists. Two prime examples are below:

 

 

Childhood asthma: The patient battled with asthma as a child, but as he or she grew up, he or she “outgrew” the asthma. Maybe the patient changed his or her lifestyle to reduce the effects of asthma, reducing the incidents and/or severity of the attacks. If the patient continues regular check-ups, but has not needed any treatment for at least 5 years, the condition is considered “resolved” and is no longer a pre-existing condition.

 

 

Cancer: The patient is diagnosed with cancer and gets treatment. The cancer, thankfully, goes into remission. The patient keeps going to his or her oncologist for check-ups and tests, but the cancer remains in remission for over 5 years. The patient requests that the oncologist share the records regarding the check-ups and test results with the insurance company so the patient can get the lower (base) rates again.

 

 

4. Lapse in Coverage

People who have gone 60 days or longer without a major medical plan would pay up to 50% higher for their plans for 12 months. This is to encourage people to get and maintain a major medical plan. After the 12 months of higher rates, the rate would drop back down to the regular (base) monthly premium.

 

 

5. Incentive for HSA and Preventive Maintenance

Consumers who also show that they have a HSA and have at least one (1) physical per year are eligible for a 10% discount on their premiums for 12 months, renewable each year.

 

 

This encourages consumers to maintain a Major Medical Plan, a HSA, and engage in prevention by having regular checkups.

 

 

The discount rate is “flexible”, meaning that we could make the discount a little higher, but anything lower than 10% would be too nominal (small) to be an incentive for preventive care and investment into an HSA.

 

 

6. Tax Deductible

The premium payments are tax deductible when you file taxes each year.

 

 

7. One Caveat

Some people may think that they would only need the inexpensive Major Medical plan and not get an HSA, relying on going to the emergency room whenever they need care. To discourage this costly practice, there would be one caveat built into this plan. Hospitals would be allowed to deny non-emergency services IF the patient can reasonably get care from a doctor’s office and it is during normal business hours.

 

 

There would be exceptions to this rule, such as when the condition is not critical, but it is after normal office hours (defined at Monday – Friday, 8am – 4pm) AND the condition runs the risk of becoming critical by the time normal business hours resume.

 

 

An example would be someone who has been suffering with symptoms of the stomach flu and has not been able to eat or drink water for hours, not seeking treatment because he or she thought it would pass. Now, the patient is showing symptoms of dehydration (dizziness, lightheadedness). If it is 10am on a Tuesday (and not a holiday), the emergency room would be able to deny care and advise the patient to go to a doctor’s office. However, if it is 10pm on a Friday night, the emergency room would be required to treat the patient because this situation has a great likelihood of becoming critical before a doctor’s office will office in 2 ½ days.

 

 

B. Health Savings Accounts

The second section of "HealthCare.gov" would be for the Health Savings Accounts (HSAs). These are basically a bank (savings) account that you manage. In this section of the "HealthCare.gov" website, you compare HSAs side-by-side, based on the criteria that are important to you (interest rates, services covered under that HSA account, minimum amount to sign up, minimum balance needed to maintain account, penalties, fees, etc.).

 

 

Again, when you find the HSA you want and click on it, you get re-routed to that financial institution’s website and the page specific to that HSA. You set up your HSA with that financial institution, not through the government. They will send you a card that looks like a credit card, but it will have “HSA” on it.

 

 

You can contribute as little or as much as you want and as frequently or seldom as you want. You can even use part of your income tax return to fund it for the year or part of the year.

 

 

You get to choose how you want to fund your HSA. Families that need more office visits, labs, x-rays, prescriptions, and other minor health care products and services would need to put more money into their HSA to ensure that there is enough to cover those expenses. If you have a fairly healthy family that doesn’t go to the doctor much, doesn’t require many prescriptions, you may not want to put as much into your HSA. It’s highly personalized.

 

 

The great thing about the HSAs is that you get to use it for a much broader assortment of health care products and services. Just some of the products and services that you can use your HSA for include (but are not limited to):

The bottom line is that it is your money and you have the exclusive right to determine what medical products and services you want to spend it on. Your care no longer will be dictated by some insurance company.

 

 

To use your HSA, you swipe your HSA card and the “medical” products and/or services are deducted from your HSA and paid to the provider. If you are at the grocery store and buy Tylenol and groceries, you swipe the HSA card first and it deducts the cost of the Tylenol, leaving the grocery balance, which you pay for like you do now.

 

 

You get to manage your HSA just like you manage your other expenses in life – food, utilities, and housing, to name a few. Of course you need a nifty tool to help you make those health care decisions such as who is the best provider for YOU. We will get to that in a moment. But first, the details of the HSA account:

 

 

1. Interest

The HSA would be an interest-baring account. This money can grow for you.

 

 

2. Rolled Over

The HSA can be rolled over from year to year, allowing the consumer to accumulate a large sum over time. This would allow young adults to contribute monthly for decades, and if used sparingly, it would result in plenty of money to cover out-of-pocket health related expenses in the later years of his or her life, when much more medical care will be needed.

 

 

3. Merged / Divided

The HSA can be merged (such as when two people marry) and divided (such as in the event of a divorce, where the HSA would be divided based on the divorce agreement or judgment by a divorce judge).

 

 

4. Willable

The HSA can be willed to beneficiaries. This way, the money is never “lost”, but can continue to be used by whomever the consumer chooses, even after death. The amount being willed can all be transferred to the beneficiary’s HSA account, or it can be split between the beneficiary’s HSA and a cash payment. However, at least 50% of the willed amount must be transferred to the beneficiary’s HSA, with 50% or less being available in cash payment.

 

 

An example would be if John Doe dies with $80,000 in his HSA, leaving it to his 2 children. Each child gets $40,000, of which at least $20,000 must go into the child’s HSA account. However, the child would be able to take any amount up to $20,000 in cash payment, with the rest going into the child’s HSA. Child #1 may want $10,000 in cash and put $30,000 in his HSA, while his sister (child #2) may want $20,000 in cash and put $20,000 in her HSA.

 

 

Minor Beneficiary: If a beneficiary is still a minor, 100% of the amount the beneficiary has been willed needs to be transferred into the minor’s HSA account to ensure that the minor has funds for medical purposes.

 

 

5. Adjustments

The consumer can adjust his or her contributions at any time, giving themselves the ultimate in flexibility.

 

 

6. Pauses in Contributions

The consumer can even stop making contributions without affecting the HSA account. The money is still there and available, can be used for products and services, and will never be lost or restricted, unless there is a lack of funds.

 

 

7. Tax Deductible

The contributions to the HSA are tax-deductible.

 

 

III. MEDICAID:  FROM SERVICE PROVIDER TO FUNDS PROVIDER

Medicaid would go from providing health care services to providing the money for health care products and services. Medicaid recipients would receive a monthly “award” amount based on income and family size, but the family would manage those funds just like everyone else. The Medicaid recipient would have a Major Medical plan that he or she chooses, and have a HSA that he or she chooses.

 

 

Medicaid would pay the premium amount for the recipient’s Major Medical plan and put the remaining balance into the recipient’s HSA. As an example, if the Medicaid recipient is “awarded” $580 per month, and the recipient has a Major Medical plan with a $300 per month premium, Medicaid would pay that $300 premium directly to the insurance company and deposit the remaining $280 into the recipient’s HSA account.

 

 

Consumer Control: The Medicaid recipient would manage his or her own HSA just like everyone else. There would not be a special Major Medical plan, or HSA, for Medicaid recipients. Medicaid recipients would have the same options to choose from as everyone else. The only difference is that the government is making the payments and/or deposits.

 

 

Seamless & Non-Discrimination: This makes it possible to keep the same Major Medical plan and HSA account throughout your entire life. You can change jobs, go on Medicaid, go off of Medicaid, continue to change jobs, and have the same Major Medical plan and HSA account. This provides seamless coverage throughout life. Because there are no special plans or ID cards for the Medicaid recipients, providers would not be able to tell if you funded your HSA yourself or if Medicaid funded your HSA. This eliminates discrimination based on economic status.

 

 

Breaking Point: There is one caveat that would also need to be in place, which is a “breaking point” for Medicaid’s contribution to a recipient’s HSA. If the recipient has at least $5,000 in his or her HSA, that month’s contribution is forfeited. For example, if the recipient usually gets $200 per month deposited into his HSA each month, but has $5,010 in his HSA on June 6th (his disbursement date), Medicaid will not make the June deposit into the HSA (but they would still pay the premium on the Major Medical Plan). But, if he goes to the doctor or gets a prescription during the month of June and by July 6th, his HSA is at $4,900, Medicaid will make his $200 July deposit into his HSA, but he would not get the “back pay” from June because that was forfeited.

 

 

The point of that is to ensure people have plenty in their HSA, but without the government (taxpayers) helping people who do not need the help. For most people, having at least $5,000 in your HSA is enough to handle most medical needs.

 

 

We can provide a minimum of $500 per Medicaid household, with the average Medicaid household receiving $750 per month (between Major Medical premiums and HSA deposits). This puts Medicaid recipients right on par with other working individuals who are self-funding their Major Medical and HSAs. But, the real beauty of this is that we can provide this at half the cost of Medicaid.

 

 

In 2017 (most recent data), we spent $581.9 BILLION on Medicaid.[4] In September 2018, there were 73,420,626 people enrolled in Medicaid.[5] This is a cost of $7,925.56 per Medicaid recipient ($660.46 per month per person). With the average American household of 2 – 3 people, that would be an average monthly Medicaid household cost of $1,320 – $1,981 (avg. $1651). This is about twice the monthly household amount under this proposed plan.

 

 

In essence, we would be providing much better health care to our Medicaid recipients, but at half the cost, saving taxpayers approximately $290.95 BILLION per year! Doesn’t better care for half the price sound good for everyone?

 

There would be some additions to the requirements for Medicaid though.

 

 

A. Drug Testing

As long as the recipient is on Medicaid, the recipient would be subjected to spontaneous drug testing. If the recipient tests positive, he or she would be directed to treatment programs (paid for by Medicaid) in order to continue receiving benefits. The goal is to help out those who are going through rough times, not to finance an addiction. Yet, we will provide the assistance needed to help the person recover from addiction. This is not meant to be a punishment, but to act as an aid to achieving better health.

 

 

B. Job Seeking & Volunteerism

All adults (non-disabled, non-pregnant, and capable of working), must prove attempts to find employment, and commit to volunteer a minimum of 10 hours per week. The volunteer jobs can be coordinated through the recipient’s case worker.

 

This keeps the Medicaid recipient engaged in society and helps them to maintain a work ethic. It also combats depression that can set in after prolonged unemployment.

 

 

C. Time Limits

We would also have the option to set time limits for receiving Medicaid to discourage people from becoming reliant on Medicaid. The goal is for able-bodied adults to work and contribute to society as a whole. Medicaid is a tool for helping people through life’s rough patches.

 

 

 

IV. SPECIAL CIRCUMSTANCE PATIENTS

Although this plan would provide great coverage for the normal family, there are some people that have much higher monthly health care costs and the typical HSA amounts would not be enough to cover their health care costs. I refer to these patients as “special circumstance patients”. People who have high monthly health care expenses would apply for “Special Circumstance Medicaid” to assist them with their higher costs, even if they would not qualify for regular Medicaid.

 

 

If your monthly medical costs are high, you apply for this specialized “Medicaid.” Even if you do not qualify for regular Medicaid, you may qualify for this Special Circumstance Medicaid because it is based on your needed medical costs minus (-) your reasonable contribution to your HSA. If your costs are $1000 per month, but you can only afford to put $300 into your HSA each month, you would get a “special circumstance” Medicaid award of $700 - $800 deposited into your HSA each month that you qualify. You would still provide your typical $300 deposit into your HSA.

 

 

This is a supplemental plan, specially tailored to those with higher health care needs. This either supplements your personally funded HSA or it may supplement your regular Medicaid. Either way, you WILL be taken care of one way or another.

 

 

But, how will we be able to pay for these extra payments? Since we are saving over $290.95 Billion per year on regular Medicaid, we can use some (maybe $30 Billion - $50 Billion) of that to fund this specialized, supplemental Medicaid. Yet, we will still save a LOT on Medicaid.

 

 

 

V. MEDICARE

Medicare has four parts for it. Part A is the hospitalization/major medical part, for when you go into the hospital or need expensive treatments. Part B is for most other medical care (office visits, labs, x-rays, etc.). Part C is just a combo plan that includes Part A and Part B. Part D is the prescription plan, for all of your prescriptions. Since Part C is a bundle of Parts A & B, we don’t have to specifically address it. We will stick to Parts A, B, and D.

 

 

Medicare costs for Part B for 2017 was $309 Billion.[6] Medicare costs for Part D for 2017 was $100 Billion.[6] In 2017, Medicare Parts B and D combined cost taxpayers $409 Billion.

 

 

Medicare serves a vital need in the community by providing health care for our elderly. We can save money without touching Medicare. Medicare stays exactly the same as it is now, but with one simple caveat. You cannot sign up for Medicare Part B or Medicare Part D if you have at least $5,000 in an HSA account. However, you can sign up for Medicare Part A, regardless of how much you have in an HSA.

 

 

However, once your HSA account dips below $5,000, you sign up for Medicare Parts B & D. Notice that you “sign up”, not “apply”. You do not need it “apply”, as long as you are Medicare eligible under the age qualifications, you are already eligible. It’s just a matter of the amount in your HSA account.

 

 

This is not a limit on Medicare recipients. No benefit is being taken away. For example, if you have $10,000 in your HSA, you use that to pay for your office visits, labs, x-rays, and prescriptions. But, before that HSA is fully depleted, you are already on Medicare Parts B & D. You are simply using your HSA first, saving taxpayers billions of dollars each year.

 

 

How will this affect Medicare in the future? In the beginning, not much will be affected. But, as time marches on and the years pass, fewer and fewer people will need Medicare Parts B & D, for longer periods of time in their twilight years.

 

 

Example 1: John and Sue are 60 years old. They will be Medicare eligible in 5 years. That’s not a lot of time to build an HSA account. They may have $3,000 in their HSA by age 65. At age 65, they sign up for Medicare Parts A, B, & D because they do not have more than $5,000 in their HSA. They are basically unaffected by the one and only change to Medicare by this bill, just as the current recipients are unaffected.

 

 

Example 2: Jim and Mary are 45. They have 20 years before they become Medicare eligible. They are able to put $400 per month in their HSA, totaling $4,800 per year. They use an average of $1,500 per year for their medical expenses. They are saving $3,300 per year in their HSA. Since they have 20 years until they are Medicare eligible, they will have saved $66,000 (principal only, interest would make this significantly higher) in their HSA by the time they are Medicare eligible. If Jim and Mary are in good health, eat right, and exercise, that $66K could last 5 – 10 years before it gets down to only $5,000 left. Jim and Mary just saved taxpayers over $60,000 over the past 5 – 10 years. That may not seem like a lot, but when you multiply it by millions of people, it begins to add up to significant savings for the taxpayer.

 

 

Example 3: Mike and Kate are 25 year old newlyweds. They are just starting out in life after college. They contribute about $300 to their HSA each month in anticipation of well-baby and well child visits in the future. They are contributing $3,600 per year and use an average of $1,500 per year over the next 40 years (less during childless years and during empty nest years, more during childrearing years). That’s a savings of $2,100 per year for 40 years, or $84,000 (principal only, interest would make this significantly higher) in their HSA at the age of retirement. Mike and Kate will save the taxpayers from more than half of their post-retirement medical expenses!

 

 

Now, this could be even higher if Mike and Kate increase their HSA contributions, have lower costs over the years, inherit any HSA money from their parents, and of course, there is the interest that will accrue over this time period, which has not been factored in.

 

 

All future amounts are calculated in today’s dollars, because even as costs may go up due to inflation, incomes typically also go up, making it possible to contribute even more per month. All amounts would be expected to increase in similar fashion.

 

 

Reducing Medicare Premiums:

Medicare recipients pay monthly premiums for their Medicare Parts B, C, and D out of their monthly Social Security checks. These recipients have already paid into Medicare for decades, and now that they are seniors they have to pay again in order to have Medicare. This is an assault on our elderly.

 

 

The 2019 premiums for Medicare Part B range from $135.50 – $460.50 per month.[7] The average estimated monthly premium for Medicare Part D for 2019 is $33.19.[8] This is a combined monthly premium of $168.69 - $493.69 per month. The average Social Security monthly benefit for a retired worker is $1414.37.[9]

 

 

This reduces our seniors’ meager $1,414.37 income to around $1,245.68 per month. This is an annual $14,948.16, which is approximately 11.6% below the federal poverty level for a household of 2 people.[10]

 

 

This Freedom Health Plan will make Medicare more solvent as time goes on, ensuring that we take care of our seniors even better in the future than what we are currently. Many of our seniors are living in poverty already. Charging them for Medicare (which they have already spent decades paying for) is kicking them when they are down. Our seniors deserve to be treated better, with more honor and dignity.

 

 

 

VI. MANAGING YOUR HEALTH CARE

As we leap into the 21st Century with advanced technology, we can now bring that advanced technology into the field of healthcare, to give the 21st Century Family the resources to make healthcare easier, and more affordable.

 

 

The first tool, Health Care Blue Book, provides you with the information needed to find the absolute best provider for YOU, but at the most reasonable cost. The second tool, Telemedicine, incorporates a wide variety to technologies to make access to health care providers easier and make that access more mobile, for the busy family on the go.

 

 

Both of these modern tools allow for the cost of health care to decrease, while improving access to providers. Providers are better able to manage their time, so they can treat more people in less time. Everyone wins.

 

 

 

A. Health Care Blue Book

The third section of "HealthCare.gov" would be “Health Care Blue Book”. This is where you can compare providers of health care services. You go to this section of “HealthCare.gov” and put in the criteria that matter to you and your family, such as zip code, distance you are willing to travel outside your zip code for health care, and a type of service. This pulls up a list of all the providers in that geographical area and lists them by the prices that they charge for that particular service.

 

 

Above the list of providers, there is a bar that shows the lowest amount and highest amount charged for that service in that geographical area. It also lists a “fair market value” for that service. The providers in the provider list would be color coded. It would look a little like this:

The providers in the green section charge “at or below Fair Price”. The providers in the yellow charge “slightly above Fair Price”. And the providers in the red charge “Highest Price”. As you can see from the example above, the range is $39 - $101+, with the Fair Price at $58.

 

Price is not the only way to choose a provider. There are many other criteria that each of us has for choosing a provider. The consumer can click on any of the providers listed below the Price Bar and a “pop-up window” comes up with additional information about that specific doctor. Some of the additional information would include, but not limited to:

This makes it possible for every American to find the best provider that fits that American’s specific criteria, but also at the lowest cost. All of us want the best at the lowest cost. This would make it possible to do that with health care.

 

 

You no longer have a limited list of “contracted providers” to choose from. You can choose ANY provider in your geographical area. This tool makes it possible for you to find the perfect provider for you, but at the lowest cost.

 

 

The providers that charge the most would not have as many patients, encouraging those “expensive” providers to either, 1) justify their excessive rates, 2) lower their rates, or 3) go out of business. Regardless of what they do, this lowers the cost of healthcare products and services to a market-sustainable level that makes providers and patients happy.

 

 

 

B. Telehealth Service

An emerging and growing segment of the health care industry is telehealth services. Telemedicine and Telehealth services is defined as “the use of electronic information and telecommunications technologies to support and promote long-distance clinical health care, patient and professional health-related education, public health and health administration. Technologies include videoconferencing, the internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications.”[11]

 

 

It includes Live Videoconferencing (2-way audiovisual link between the patient and provider). This is a much more cost effective way to manage health care costs. The savings could be as much as $100 each time you use telehealth services instead of an office visit with your doctor.

 

 

“Looking at the commercial market, this study found that the average estimated cost of a telehealth visit is $40 to $50 per visit compared to the average estimated cost of $136 to $176 for in-person acute care.”[12]

 

 

“Patient issues are able to be resolved during the initial telehealth visit an average of 83 percent of the time."[12]

 

 

This is just another form of savings for the American family trying to save on the cost of healthcare.

 

 

 

VII. CONCLUSIONS

By overhauling the entire system, we are able to drive down costs to a market-sustainable level, provide savings for businesses, employees, the government, and even the providers. The headaches of choosing a health plan every year are gone, as are the majority of paperwork in the providers’ offices. Most providers would get paid at the time services are rendered. We cut out the middle man which only served to drive up costs. We are providing the same level of care for our poor as we do for our workers. We are saving taxpayers hundreds of billions of dollars each year. We are taking care of the high risk people and the people with high health care needs. Pre-existing conditions are no longer a life sentence. We make health care more accessible for the busy, modern family. We eliminate discrimination based on Medicaid status. We protect and insulate our seniors from high premiums and are beginning to treat them with the dignity and respect they deserve. We overhaul healthcare to make sense in the 21st century. Common sense, user-friendly, seamless, low cost, compassionate, modernized, and wholesale healthcare for everyone! That’s the Freedom Health Plan!

 

 

Sources:

 

[1] The Henry J. Kaiser Family Foundation, Average Annual Single Premium per Enrolled Employee for Employed-Based Health Insurance: 2017, https://www.kff.org/other/state-indicator/single-coverage/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D, accessed October 7, 2018.

[2] The Henry J. Kaiser Family Foundation, Average Annual Family Premium per Enrolled Employee for Employed-Based Health Insurance: 2017, https://www.kff.org/other/state-indicator/family-coverage/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D, accessed October 7, 2018.

[3] Trusted Choice, https://www.trustedchoice.com/health-insurance/coverage-types/catastrophic-major-medical/, accessed October 8, 2018.

[4] Centers for Medicare & Medicaid Services, “NHE Fact Sheet: Historical NHE, 2017”, https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nhe-fact-sheet.html, accessed January 28, 2019.

[5] Medicaid.gov, Monthly Medicaid & CHIP Application, Eligibility Determination, and Enrollment Reports & Data, September 2018, https://data.medicaid.gov/Enrollment/2018-09-Updated-applications-eligibility-determina/hbh7-cy5y/data, accessed January 28, 2019.

[6] Henry J. Kaiser Family Foundation, Medicare, Cubanski, Juliette and Neuman, Tricia, “The Fact on Medicare Spending and Financing”, Figure 2 (“Medicare Benefit Payments for Part A, B, and D, 2007 and 2017”), https://www.kff.org/medicare/issue-brief/the-facts-on-medicare-spending-and-financing/, published June 22, 2018, accessed October 25, 2018.

[7] Medicare.gov, Part B Costs: How Much Does Part B Cost?, https://www.medicare.gov/your-medicare-costs/part-b-costs, accessed January 28, 2019.

[8] Medicare Matters, National Council on Aging, How Much Does Medicare Part D Cost?, https://www.mymedicarematters.org/costs/part-d/, accessed January 28, 2019.

[9] Social Security Administration, Research, Statistics & Policy Analysis, “Monthly Statistical Snapshot, December 2018”, Table 2: “Social Security benefits, December 2018”, citing: Social Security Administration, Master Beneficiary Record, https://www.ssa.gov/policy/docs/quickfacts/stat_snapshot/, accessed October 25, 2018.

[10] U.S. Department of Health & Human Services, “HHS Poverty Guidelines for 2019”, in effect as of January 11, 2019, https://aspe.hhs.gov/poverty-guidelines, accessed January 28, 2019.

[11] The Office of the National Coordinator for Health Information Technology (ONC), “Telemedicine and Telehealth”, https://www.healthit.gov/topic/health-it-initiatives/telemedicine-and-telehealth, accessed October 25, 2018.

[12] Yamamoto, Dale H., Assessment of the Feasibility and Cost of Replacing In-Person Care with Acute Care Telehealth Services, December 2014, http://connectwithcare.org/wp-content/uploads/2014/12/Medicare-Acute-Care-Telehealth-Feasibility.pdf, accessed October 25, 2018.

Our motto on the Great Seal of the United States is "E Pluribus Unum" which is translated as "out of many, one". It means that out of many states, we have come together as one nation united. It also shows how the ancestry of our citizens come from every nation in the world, but we have blended into a united society. We have over 242 years of experience uniting the world. We are united because we understand that what we have in common outweighs the things that divide us. Sharing that mission of unity with the world is what makes immigration so beautiful!

 

Immigration is one of the finest, and most unique, qualities of American life! Our history is rich with the migration of peoples from all over the world coming here and blending into one great, rich, diverse society! We are so lucky to have inherited such a mosaic of cultures, right here in our own backyards. Our generosity to welcome more and more people every year is a testament to our open hearts.

 

Our quest to continue to bring together diverse people cannot be overshadowed by ignorance. We need to also acknowledge that not every person who wishes to come here is as welcoming and compassionate as we are. To protect our great diverse population, we have laws that are designed to allow freedom-loving people to enter, while protecting us from those who wish to destroy our nation and our beloved freedoms.

 

Make no mistake about it, most immigrants love America and want to be a part of our diverse communities. But, we have a duty to protect our citizens and our legal immigrants from potential harm. Gangs, rapists, and murderers do not contribute to our communities. They must be vetted and kept out. I am committed to protecting my constituents from harm, whether foreign or domestic.

 

Our immigration system is broken. The process is long and tedious. I am committed to working feverishly to simplify the process, streamline the process so people do not have to wait years to get the “okay” to enter. I am open to any and all ideas that you would like to present to me or my campaign. We are committed to keeping our diverse communities safe and growing.

 

Many argue over the amount of “illegal” immigrants we have in our country and what to do with them. I support a pathway to citizenship that is fair to the “illegal” immigrant and the American citizens. I am willing to work with the “illegal” immigrants in my district to help them complete the steps needed to apply for citizenship. We don’t have to deport all of them. Nor do we have to give them a free pass. Neither of those solutions is fair. We can find a fair solution so that we all benefit.

 

Together, we can protect our citizens and be a welcoming beacon of hope, liberty, and freedom for the world.

Solution

A society can succeed only if the individuals in the society are able to communicate effectively. When a society is operating with multiple languages, the society’s ability to communicate and share information is severely hampered. Imagine a person sees that a second person is in danger and wants to warn the person. If those two people speak different languages, neither understanding the other’s language, the message of “Watch out” will not be understood.

 

 

The same thing happens when multiple people are working on a job site, trying to complete a project. If they speak different languages, it will be difficult to complete the project in a timely manner. This affects the company they are working for and their customer(s). Money is wasted on this additional time added to the project and everyone ends up frustrated.

 

 

The smooth operation of any society, whether on the micro-level (home) or the macro-level (business, government, society as a whole), depends on the effective communication skills of the various members of that society. Having multiple languages hinders progress in any society. Having a uniform language, spoken and understood by all, provides a barrier-free, more united society.

 

There are 291,484,482 people in the United States aged 5 and older, as of October 2013.[1] Of those, 25,148,900 speak English less than “Very Well”.[1] This means that 262,335,582 speak English “Very Well”, or 91.38% of the population in the United States speaks English “Very Well”. English is the dominant language in the United States, by a very wide margin. The Census Bureau also states that “most governmental functions are in English.”[2]

 

For the smooth operation of our nation, it is in everyone’s best interest that we are all using English for all public uses. Some exceptions would be available for culture-specific enterprises, such as restaurants, where speaking in a different language is germane to the cultural experience.

 

This bill in no way limits the use of other languages in private conversations. It only applies to public services, such as government and public functions. It also provides a smoother assimilation process for immigrants who wish to make the United States their home. The sooner they learn English, the easier life will be for them in the United States and the more prosperous they will become in the United States.

 

Sources:

 

[1] United States Census Bureau, Detailed Languages Spoken at Home and Ability to Speak English for the Population 5 Years and Over: 2009-2013, October 2015 Report, http://www2.census.gov/library/data/tables/2008/demo/language-use/2009-2013-acs-lang-tables-nation.xls?#, accessed December 15, 2018.

[2] United States Census Bureau, Language Use, https://www.census.gov/topics/population/language-use.html, accessed December 15, 2018.

Our nation's infrastructure consists of our aviation, bridges, dams, drinking water, energy, levees, ports, public parks, rails, roads, schools, wastewater, and waterways. Many of these infrastructure components are at, or have past, their design life. This means that if a particular system was designed for 50 years, that system is at, or older than, 50 years. This means that many of our infrastructure components could fail at any moment. This presents a grave danger to the American public.

 

According to the 2017 Infrastructure Report Card, we need to invest $2 TRILLION over the next 10 years, or $200 Billion per year to repair our aging infrastructure. This is a lot of money, but it is money that will pay immeasurable dividends over the next 50 - 100 years. Although the cost is high, this investment will spur a massive employment market because we will need a lot of Americans to do the work to fix and replace our crumbling infrastructure. The lives preserved, the cargo saved, the money saved from lawsuits and vehicle repairs that will be prevented, and the health benefits and medical cost savings from improved drinking water and proper waste water disposal will save money for every American.

 

The current administration has already made great strides in improving our infrastructure. But, we need to do a lot more. One of my biggest concerns is quality. It does us no good if we replace our infrastructure with cheap products and materials. We need to ensure that we are using high-quality products that are designed to last 50 - 100 years, with a preference on lasting closer to 100 years.

 

Another major concern for me is when federal money is given to a State or Agency to manage the infrastructure projects, that State or Agency needs to account for every penny of that money. Congress needs to have oversight to ensure that the State or Agency isn't doing the work cheaply and pocketing the rest of the money.

 

Infrastructure is vital to each and every American. It is one of the best ways we can invest in the health and safety of our beloved citizens.

Solution:

Congress has the responsibility of determining how much of our federal money is paid out and to which entities that money will go. However, since Congress authorizes federal funds to be allocated to various entities, Congress needs to know how that money is being spent. Congress does not need to keep track of every penny, but they should be aware if the money is being used for the purpose that it was given. For instance, if $20,000,000 was authorized for a particular purpose, the receiving agency should have to prove how much of that went to companies to do the intended work, how much went to labor, how much went to materials, how much went to administrative costs, and so on.

 

We cannot allow recipients of federal funds to take the money, cut corners, and pocket the rest. Congress has a responsibility to the American people to be great stewards of the people’s money. By extension, the entities receiving federal funds (taxpayer money) need to prove that they are also great stewards of the American citizens’ money. Congress is in the best position to provide a check on these entities receiving federal funds.

 

These entities would be required to provide monthly balance sheets to Congress detailing how the money is being spent, copies of contracts with any contractors, and a breakdown showing how much was paid for labor, materials, wages, and administrative costs.