Responsibility #44

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=2 height=110 BGCOLOR="#666699" TEXT="#080000" bgproperties="fixed" background="04900840erlcjm.png"> <div> <FONT SIZE="5" COLOR="#FFFFFF" FACE="Arial" ><B>NATIONAL SECURITY--Structural,Moral,Economic,Domestic,International</B></FONT><B>     |     </B><A HREF="index.htm" TARGET="_top" TITLE="NATIONAL SECURITYStructural,Moral,Econom"><U><B>home</B></U></A></div> <div> <A HREF="id33.htm" TARGET="_top" TITLE="Responsibility Contents"><U>Responsibility Contents</U></A>   |   <A HREF="id34.htm" TARGET="_top" TITLE="Responsibility 1"><U>Responsibility #1</U></A>   |   <A HREF="id35.htm" TARGET="_top" TITLE="Responsibility 2"><U>Responsibility #2</U></A>   |   <A HREF="id36.htm" TARGET="_top" TITLE="Responsibility 3"><U>Responsibility #3</U></A>   |   <A HREF="id37.htm" TARGET="_top" TITLE="Responsibility 4"><U>Responsibility #4</U></A>   |   <A HREF="id38.htm" 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to President, et al,"><U>Health Care Letters to President, et al, 8/24/94</U></A>   |   <A HREF="id123.htm" TARGET="_top" TITLE="Arguments for Delay in Enactment of a He"><U>Arguments for Delay in Enactment of a Health Care Bill</U></A>   |   <A HREF="id124.htm" TARGET="_top" TITLE="Post WORLD WAR IIPost COLD WAR Deja Vu"><U>Post WORLD WAR II--Post COLD WAR Deja Vu</U></A>   |   <A HREF="id125.htm" TARGET="_top" TITLE="Responsibility 89"><U>Responsibility #89</U></A>   |   <A HREF="id126.htm" TARGET="_top" TITLE="Responsibility 90"><U>Responsibility #90</U></A>   |   <A HREF="id127.htm" TARGET="_top" TITLE="Responsibility 91"><U>Responsibility #91</U></A>   |   <A HREF="id128.htm" TARGET="_top" TITLE="Responsibility 92"><U>Responsibility #92</U></A>   |   <A HREF="id129.htm" TARGET="_top" TITLE="Responsibility 93"><U>Responsibility #93</U></A>   |   <A HREF="id130.htm" TARGET="_top" TITLE="Responsibility 94"><U>Responsibility #94</U></A>   |   <A HREF="id131.htm" TARGET="_top" TITLE="Responsibility 95"><U>Responsibility #95</U></A>   |   <A HREF="id132.htm" TARGET="_top" TITLE="Responsibility 96"><U>Responsibility #96</U></A>   |   <A HREF="id133.htm" TARGET="_top" TITLE="Responsibility 97"><U>Responsibility #97</U></A>   |   <A HREF="id134.htm" TARGET="_top" TITLE="Responsibility 98"><U>Responsibility #98</U></A>   |   <A HREF="id135.htm" TARGET="_top" TITLE="The Structure of Our Nation is Unsound"><U>The Structure of Our Nation is Unsound</U></A>   |   <A HREF="id136.htm" TARGET="_top" TITLE="Ltr. to Editor, 3/19/96, Property Taxes "><U>Ltr. to Editor, 3/19/96, Property Taxes and Education Funding</U></A></div> <div> </div> </td> </tr><tr> <td valign="top" width=190 BGCOLOR="#CCCCFF" TEXT="#080000" background="04311c00egdysm.png"> <bR> </td> <td valign="top" height=370 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> Responsibility #44</div> <div> (written prior to July 1992)</div> <bR> <div> To the People of the of the United States of America:</div> <bR> <div>      In the last essay we began the outline of <U>The American JUST </U><U>Health Care System (JUST).</U>  In that paper it was provided that:</div> <bR> <div> 1. Health care benefits paid by employers would be subject to individual income taxes as though they were salaries and wages.  This places all citizens on an equitable basis, with no subsidies.</div> <div> 2. Insurance industry would be required to base medical insurance premiums on the universe of policy insureds, not group by group (company by company).  Individuals and small business employees would be covered and priced on the same basis as employees of covered large businesses.  Covered large businesses would be protected from rate increases due to adverse experience of only their group of employees.</div> <div> 3. Individuals would not lose their coverage, nor be faced with significantly increased premiums, upon change or loss of jobs.</div> <div> 4. Insureds would not lose their coverage or change risk basis should their insurance company go out of business.</div> <div>      Now let us develop the outline of <U>JUST</U> further.  </div> <div> 5. A federal law would require that all citizens and residents be covered by at least a standard minimum policy.</div> <bR> <div>      This would result in the desired USA universal health care.  With the other particulars proposed for JUST, it will delineate the costs to and risk bearing of the various involved parties (insureds, insurers, health care industry, and governments).</div> <bR> <div> 6.     In concert the government, the health care and the insurance industries establish and maintain a standard minimum policy, plus a small number of standard optional policies.  Employers offering medical benefits, or individuals, can elect the standard minimum or a more extensive standard policy.</div> <bR> <div> Having set a floor for universal coverage at the standard minimum policy, we have retained the right for insureds to balance what they get (extent and convenience of medical service, limiting the risk of unreimbursed costs), with the premium expense they wish to afford.  The standardization of scopes of coverage will assist the insureds in deciding on a carrier, and the "Health Care Clearing House" (yet to be proposed) in interpreting and administering the coverage. </div> <div> 7. Comparable to life insurance, now that the criterion will be womb to tomb medical insurance, the insurance industry can provide a standard variety of ways to levy premiums.</div> <div> Like term life insurance, automatically renewing term medical insurance could have premiums increasing with age.  In this case, it would be wise for the premiums for the standard minimum policy, to become level at full disability retirement or age 65.  Similar to whole life insurance, a level premium could be offered for life.  There could also be a paid-up at full disability or age 65.</div> <bR> <div> 8. A moot suggestion would be to have premium rebates annually based on limited medical bills by each individual or family.</div> <bR> <div> This could help the spiralling costs of the health system, by decreasing unnecessary doctor and hospital visits, or the performance of unnecessary tests.  It could backfire by letting the lack of preventative treatment escalate into more serious medical problems.</div> <div> 9. Require companies, which have predicated employment on medical coverage in retirement, to currently fund their future obligations.</div> <div> This would relieve the risk to employees, that their companies would renege on this retirement benefit through benefit curtailment or elimination, merger, bankruptcy, sham reorganization, going out of business, etc.  </div> <div> For retirees, this could be met by the employer paying net present value for an annuity with the insurance company at the time of retirement.  For active employees, a reserve in trust could be set up for the retirement benefit.  The employer would pay into the trust annually the net present value required to reach the projected annuity cost at retirement.  </div> <div> The requirement is fair to the employer, in that each employee is a factor of production.  Like other factors, payment for services (and supplies) are due soon after delivery.  Retirement benefits are an accrued liability, rendered in lieu of higher wages and salaries (reference the origin of this benefit in World War II, see Responsibility #43).</div> <div> 10. Establish a <U>Health Care Clearing House</U> (HCCH) to serve as the middleman between the medical industry and the insurance industry.</div> <bR> <div> The principal role of HCCH would be to receive the claims from health providers, and charge the insurance companies for them. This has been a particularly inefficient and nagging (to put it mildly) function for all involved.  HCCH would receive a claim, </div> <div> check it against the policy, and pay the provider within 30 days. In parallel, it would bill the insurance company, and require reimbursement within 30 days.  </div> <div> HCCH would have in its data bank the policies by individual.  Since standard policies would have been imposed on the industry, difference in interpretation would be minimized.  Claim justification paperwork would normally stop at HCCH.</div> <div>   </div> <div> By exception, the provider or the insurance company could object to the HCCH decisions; but the rule would be "pay first, argue later", with appropriate costs and penalties to inhibit obstructions to an efficient system.</div> <div> The HCCH concept would result in much leaner and consistent organizations.  It would result in less frustration, greater timeliness in the completion of the claims cycle, and especially reductions in administrative costs.  The offices of health providers would have to cope with only one organization, HCCH, rather than an indefinite number of insurance companies.  </div> <div> HCCH could be organized with "Account Managers", who would be assigned a finite number of provider-insurance company pairings. With FAX machines, telephone hot lines, computers, standard policies, and relatively stable relationships; the response time and cost for coverage decision, claim, and payment should be markedly enhanced.  Insurance companies should be able to reduce their claims processing staffs, down to the few required for the infrequent exception to HCCH decisions.</div> <div> The centralization and standardization achieved through HCCH can pay big dividends, in the monitoring and analysis of the health care and insurance industries.  It will accumulate a great deal of accessible data on health care and costs thereof, to individuals, from particular providers, reimbursed by which insurance companies.  This could be supplemented by a requirement, that providers and insurers submit periodic information on the condition of their businesses.  With these data bases, analyses could: (1) provide useful information on health conditions and trends; (2) help identify further savings in health care costs; (3) preclude self-dealing doctors; (4) put a big dent in health care fraud.</div> <bR> <div> There are several special topics on health care which are reserved for the next essay.</div> <bR> <div>                     Publius IV</div> <bR> <div> <A HREF="id78.htm" TARGET="_top" TITLE="Responsibility 45"><U>Responsibility #45</U></A></div> <div> Back to: <A HREF="id33.htm" TARGET="_top" TITLE="Responsibility Contents"><U>Responsibility Contents</U></A></div> </td> </tr></table></body>