Medicare for All is the Best Choice for National Health Policy Reform

The Supreme Court Decision

The Supreme Court's recent decision to basically maintain the The Affordable Care Act was merely an attempt to restore legitimacy to the court. Following the very political decisions of Bush v. Gore and Citizens United, the High Court could ill afford another ideologically based decision, hence John Robert's vote to affirm The Affordable Care Act nearly intact.

Aside from Chief Justice John Robert's need to avoid the complete devolution of public confidence in the SCOTUS, the Affordable Care Act itself while offering some benefit in a fairly limited set of circumstances, effectively secures the reign of "The Corporation" (Health Insurance Industry), over the financing of health care in America.

In light of this new paradigm, it is now up to Americans of every stripe to ensure that the public be accorded the choice of a publicly financed plan added to the menu of "choices" in the health care exchanges that provides truly comprehensive and affordable access to health care.

Predictably though promised, this is a goal which the Affordable Care Act as presently structured, does not in the aggregate accomplish. A Medicare for All Plan such as the one which I envision, will fulfill this unmet promise of The Affordable care Act.

"The Option" as I have described it here, is designed to expand what is already in place, as well as improve in a variety of ways, the federally administered and publicly financed health insurance program that is Medicare. As everyone knows, the government does not finance Medicare... the public does.
In my plan, citizens of ANY age could enroll themselves and their families in Medicare, paying a "premium" based on their ability to pay. The affordable "premium" would be indexed according to taxable income, with a maximum cost cap providing comprehensive care which is affordable and accessible to ALL Americans.

Please review and SHARE the associated link with your friends and neighbors!
Health Care Reform, The Final Step

As a health care professional, (ARNP) and as a candidate for Congress I have previously advocated for a National Health Care Policy that incorporated an expansion of opportunity for enrollment into the Medicare program. As a candidate for congress in 2012, I stand firm in continuing to advocate for Medicare for ALL.

The American health care system is broken. There are nearly 50 million Americans without health insurance, and 18,000 people die every year as a result. Health care costs are skyrocketing and premiums are up 90 percent since 2000. Even families with insurance are often unprotected from catastrophic events... when insurers fight legitimate claims, impose coverage caps, and seek excuses to revoke coverage when its needed most.

Half of families entering bankruptcy are driven there by high medical costs. Many people who have health insurance are "underinsured" and postpone needed health care because of their meager coverage. [Census Bureau, 2007; IOM, 2002; KFF, 2006; Warren et. al., 2005; Consumer Reports, 2007]

The Greatest Obstacles To Change are:

BIG INSURANCE, CORPORATE HEALTH CARE

& their Elected Representatives in Washington

Now more than ever, the health insurance industry needs to be kept honest. While companies have an obligation to treat their customers with fairness and dignity, more often than not health insurance companies put their own profits and executive pay/perks first. The greatest obstacle to progress e.g., Medicare for All, are the insurance companies and their paid operatives in The United States Congress and The White House.

We MUST act together to elect people who will stand on behalf of the People United. In no area is this more important than the battle to control the LARGEST CASH FLOW IN THE WORLD... The American Health care System.

In doing so, Each of Us MUST personally engage in the process to retake OUR POLITICAL SYSTEM!

The People United Will Defeat The Big Money Insiders!
Insurance Industry Abuses

The current health care system is broken, often letting down even families who have insurance and believe that they are covered. The abusive behavior of the insurance industry includes but is not limited to the following:

Designing confusing forms and procedures that make it very difficult for patients to claim benefits that they deserve and forcing patients to hire paperwork consultants. [Pryor et al, 2007; NY Times, 10/13/2005]

Using complex and unfair rules to cancel insurance policies after people get sick, despite accepting past payments. California regulators fined one insurer, Blue Cross of California, $1 million for violating state rules and abusively canceling insurance policies from 2004 to 2006. Another insurer, Health Net, paid bonuses based upon the number of patients whose policies were canceled for technicalities. [Pryor et. al, 2007; Sacramento Bee, 8/29/2007; LA Times, 3/28/3006 and 11/9/2007]

Wrongly denying medical treatment needed to live and covered by insurance. [Wall St. Journal, 11/16/2007]

Charging more for "out-of-network" physicians at "in-network" hospitals, leading patients to unwittingly incur thousands of dollars in bills despite trying to follow the rules. Bureaucratic delays associated with health care insurer's process to provide approval for medically necessary procedures interfere with patient care. Such delays in care associated with corporate bureaucracy can and do cause harm to patients. I have seen it!

Creating an untenable business environment marked by excessive/costly delays in approvals of procedures which utilize such tactics as engineering insurance billing centers with so few employees that telephone "wait times" to speak with a representative are obscenely excessive. 20-30 minute wait times are NOT unusual! Such strategies are designed to lead to failed attempts at obtaining approvals that then fall through the cracks which then become uncovered because they were never approved. Failing that then we have the tactic of retroactive denial whereby insurance companies deny reimbursement after treatment that was formerly approved is delivered, leaving the physician/provider "holding the bag."

I see this myself in my office, though our staff is so well trained and working under strict controls that we rarely lose a charge. This is not the case with many physician groups however. Inadequate billing controls can quickly result in financial insolvency leading to the fiscal failure of the practice. The macro goal of the Accountability Care Organization framework in The Affordable Care Act being to drive physicians out of independent practice and into an employee relationship out of financial necessity and frustration.

Creating procedural barriers and paperwork that keep doctors from providing needed care.

Address the issue of Medical Malpractice specifically addressed in detail elsewhere on my website.

Lack of Competition: In 299 of 313 markets surveyed in 2007... ONE health plan controls at least 30 percent of the market for health maintenance organizations and preferred provider organizations. In the 12 years preceding this study, the Department of Justice had only challenged two of more than 400 insurance company mergers. Obviously there is a BIG PROBLEM with the Justice Department!

At one point there was a merger pending in Nevada that would have placed 80 percent of the state's HMO market in the hands of one insurance company. High levels of market consolidation raises concerns that the insurance market may not be competitive, hurting the health care system. [AMA, 2007; Velazquez, 2007]

Huge Levels of Executive Pay: As premiums skyrocket and some patients are denied care they need, insurance company CEOs are often paid tens of millions of dollars a year. In 2006, it was reported that the CEO of one of the world's largest insurers, United Health Group, had been awarded an astonishing $1.1 billion in stock options, enough to cover roughly 750,000 uninsured children with health insurance for one year. [AFL-CIO, 2007; NY Times, 10/16/2006]

In Standing for Families' Rights to Basic Insurance, I would propose new laws to prevent such abuses, stronger enforcement of insurance rules, and more competition and choice in insurance markets including the Medicare for All option. Americans will no longer be on their own against insurance companies.

Greg Silver, M.D., John Russell, MS/ARNP-C, MBA, and Mark Adams, J.D., MBA Discuss Single Payer Health Care

...and its very real advantages over the current system.

Great first hand information on how the Insurance Industry restricts care, physician practice and interferes with care delivery.

Advocating for Tough New Insurance Laws

Insurance that Is Always There: Stop insurance industry "rescissions," the practice of dropping individuals from insurance for technical reasons after they need their coverage. I will advocate for a "guaranteed issue law" requiring insurance companies to sell insurance to everyone, regardless of their pre-existing conditions, and preventing from denying coverage after a condition develops.

A Fair Price for Good Insurance: Today, insurance companies continue to charge certain occupations and individuals with preexisting conditions more for insurance, such as police officers, firefighters, and construction workers. Many insurers are moving to set higher premiums prior to implementation of some new rules associated with the Affordable Care Act, weak though they may be.

I would advocate for ending this practice, requiring community rating so that ALL people have access to the "Private Insurance Market" at a fair price. Competition from the Medicare For All option would help to ensure this.

Ensure that Premiums Help Patients: Enacting health care reform to expand insurance to ALL families also requires establishing new rules so insurance companies cannot continue charging hardworking families excessive premiums, while pocketing the savings. My plan would require insurers to spend at least 85 percent of their premiums on patient care as several states and the Affordable Care Act already do. The plan will force insurers to cut wasteful spending and pass savings on to families and employers.

Empower Consumers: I would advocate for removing the mystery in WHAT insurance companies cover... ala Medicare "Advantage" plans. New "truth-in-insuring" rules would require insurance companies to be transparent and honest about what they will ultimately cover. "Sales Pitch" that I will advocate for will set standards on explaining and advertising private insurance products as well as understandable medical bills.

Guaranteed Comprehensive Benefits: Some states mandate that insurance companies must provide benefits like preventive care to children,100 paid days of in-patient Rehab/Skilled Nursing Care as well as screening tests like mammograms and colonoscopy. Some insurance companies leave out these common-sense procedures. Under the Medicare for All Plan, every American who chooses to enroll in the plan will have comprehensive benefits including preventive care and important tests no matter their income or economic strata.

Creating a Bill of Rights for Patients and Providers: Now more than ever, Americans need a Patients' Bill of Rights for insurance and managed care companies. In 2001, a bill providing for a Patient Bill of Rights, passed the Senate, but was eventually blocked by insurance company lobbyists. As your congressman, I will advocate for incorporating an updated Patient Bill of Rights to solidify the protections discussed in 2001 and reflect today's need to reform insurance companies' practices.

Billing Issues for Physicians and Providers: It is also time to protect doctors and hospitals from insurance company abuses. By making it difficult for health care providers to collect on their claims, insurance companies make it difficult for patients to access the care they need. Complex forms, long hold times on the phone, and inappropriate denials of payment for needed treatments are just some of the insurance company tactics that continue to prevail today. Some insurance company's patients are not accepted by physicians and other health care providers strictly because of the inadequate, troublesome and costly practices of certain companies.

Standardize Medical Claims Forms: I will advocate the enactment of strict rules for insurance companies that would make it easier for doctors and hospitals to get paid for and deliver needed care. A standardized medical claims form would dramatically streamline the medical claims process for providers and patients.

Maintaining Accountability: All Americans need and deserve a strong line of protection against insurance companies. I advocate legislation to revolutionize the individual and small group insurance markets within the health insurance market structure, the primary goal of which will be to negotiate plans and carefully enforce protections for families. I will also advocate that the Department of Justice work with states to oversee insurance markets.

Create an Advocate for Patients: In California, when a patient has a dispute with a managed care company, the state reviews the case to make sure the insurance company acted within the law. Every patient deserves an advocate when he or she needs it. I will look to models like California's to work to build a national resource within the law, for regular people to get the help they need in negotiating with insurance companies, ACO's and HMOs.

I would also advocate that we establish a medical home for Americans with chronic diseases, ensuring that these patients have a primary care doctor/health care provider who can advocate on behalf of the patient, against insurance companies for needed care.

Increase Competition

Stop Insurance/Health Care Company Monopolies: I will apply rigorous standards and advocate to block corporate mergers that could harm consumers, doctors and hospitals.

I will advocate on behalf of health care consumers that the U.S. Department of Justice conduct an immediate and comprehensive review of the health insurance market and make recommendations on the best means to ensure a competitive and fair health insurance marketplace.

Where monopolies or near monopolies already exist, I will advocate for breaking them up to ensure competition. I would also revisit the insurance industry exemption to the nation's Antitrust laws.

In this video I explain Medicare for All to a Protester outside Tampa Congresswoman Kathy Castor's office in August 2009. It's funny how he agrees with my proposal once he hears what Medicare for All really is all about...

The Medicare For ALL Plan!
As I envision it

New Competition for Private Insurers: My Health Care Reform Plan creates new choices for American families. The invigorated "Marketplace for Health Care" will be available to everyone who does not enjoy a comparable health insurance benefit from their employment or public program, in addition to employers who choose to join, rather than offer their own insurance plans. Families and individuals will choose the plan that works best for them.

The marketplace for health care will include the "option of Universal Enrollment in Medicare irrespective of age.

Direct Benefits, a Brief Summary

"The Option" as I have described it here, is designed to expand what is already in place, as well as improve in a variety of ways, the federally administered and publicly financed health insurance program that is Medicare. As everyone knows, the government does not finance Medicare... the public does.

As I envision it, my plan very simply merely builds in efficiency by broadening the pool of potential participants, while also spreading health care costs over a larger more diverse group as well; In exactly the same manner as do the so-called private plans of a corporate nature. Each derives its revenue stream in large part through premiums.

The efficiency inherent in potentially/likely adding a very large cohort of younger and on average financially contributing participants who use much less in the way of health care services on an annual basis than the current pool of largely age 65 and older current enrollees, will substantially bolster the fiscal stature of the program. In addition, as part of the transition, discontinuing the Medicaid program over time will also add efficiency in both cost and enhanced access to care by those who currently fall into the Medicaid cohort.

Medicare will become much more efficient than it has ever been, when its risk pool is significantly broadened by allowing the younger and healthier cohorts of our population to enroll in the program. When this occurs, the often discussed fiscal issues will disappear nearly overnight... as average and median utilization rates fall dramatically as aggregate lesser users of health care services i.e., the young, broaden the risk pool of the program, in turn contributing net positive premium dollars to Medicare coffers thus achieving a more balanced cost/risk portfolio. The result of which is merely basic insurance industry logic.

Greater Opportunity and Security

The American people will have the opportunity and the security of knowing that they CAN have access to affordable and comprehensive health care without paying a cost that is disproportionate to their level of income. They will instead enjoy the peace of mind of having full and affordable access to the complete menu of health care services while also ensuring the financial solvency of this invaluable program for present and future generations to come. My program will absolutely eliminate socio-economic distinctions in access to the full spectrum of medically necessary health services.

Benefits to Employers Outweigh Costs

The result of implementing the Medicare for All Plan qualitative differences between socio-economic groups will diminish over time while also leveling the playing field for Small Business with that of Big Business. In the world marketplace as well, this program when fully implemented, will also level the world playing field for American business overall... in that the lifting of the burden of excessive health care costs from the back of business will positively alter the comparative cost paradigm of America versus its foreign competition.

The marketplace for health care as I envision it will include... "THE Option" that permits Americans of ALL ages to "Buy-In" to Medicare. In my Public Option/Medicare for ALL Plan, people could choose between continuing with their employer based private/corporate insurance plan, or decide instead to enroll in the public "Medicare for All" option.

Employers would be permitted to cover the associated single or family "Medicare for All" premium cost calculated on the taxable income of the employee or couple/family as denoted on the patient's annual income tax filing with the IRS.

Therefore, the cost to "The Employer" for providing a Health Access Insurance Benefit through the Medicare for All Plan would be variable for each employee dependent upon individual earnings i.e., a maintenance worker would have a lower cost for equivalent coverage than an Engineer or Management staff due to the fact that their earnings would differ. In each instance, the cost to the employer in covering the Medicare for All Plan for a given employee would most likely be lower than an equivalent plan by a private insurer.

"The Employer" could also choose to cover any supplemental plan that covered employee deductibles and co-pays, again calculated based on the employees IRS W-2 taxable income.

I will advocate for a discount to be accorded to "The Employer's" cost of from 5-10% of any supplemental deductible/co-pay coverage insurance premium covered as a benefit on behalf of the employee against the Medicare for All premium cost to "The Employer."

In my plan, citizens of ANY age could enroll themselves and their families in Medicare, paying a "premium" based on their ability to pay. The affordable "premium" would be indexed according to taxable income, with a maximum cost cap providing comprehensive care which is affordable and accessible to ALL Americans.

"Designed" with a maximum cap on premium cost that would ensure for example, that someone such as BILLIONAIRE Warren Buffett would NOT pay any more for his premium than say your average MILLIONAIRE professional baseball player.

For The Individual or Sole Proprietor

The plan as described above would apply equally to the individual or sole proprietor. Thus the sole proprietor can now find affordable Health Care coverage through Medicare for All. Medicare for All as is Medicare today would be entirely portable, free of "Network" constraints, restrictions and associated additional costs.

I envision this plan at a minimum, to be at least 40% less expensive than any comparable private insurance alternative due to inherent efficiencies associated with eliminating insurance company direct/indirect costs, as well as systemic private insurance industry related inefficiencies on many levels. These efficiencies are evident and well documented in the Medicare that Americans over age 65 enjoy today!

Improving The Financial Solvency of Medicare

John exposes the false arguments presented by Vice Presidential Nominee Paul Ryan meant to scare people into believing that Medicare is dead and must be replaced by vouchers for corporate insurance. We already have a voucher plan and it's called Medicare Advantage which does not work when you really get sick. The Ryan Plan advocated for by Incumbent Gus Bilirakis is: "Just Don't Get Sick!"

Medicare's current and projected financial outlook is less than optimal, without some adjustment to its financial mechanism. It is however, no where near as bad as Mr. Ryan would have you believe. Mr. Ryan as you know is a tool of the health insurance industry as his FEC financial reporting clearly depicts. (See the Video above) Currently, the demographic that describes Medicare's population of enrollees is largely composed of people who on the whole, are greater than average utilizers of health care services in violation of fundamental insurance theory.

The "New Medicare" as I envision it, will prosper, as my plan broadens the natural composition of the insured population to include younger people who are on average, minimal users of health care services. These new younger/healthier enrollees will however through their premiums, dramatically strengthen the fiscal status of Medicare, while simultaneously stimulating the momentum for what amounts to a single payer universally accessible health care option throughout this country.

The INSURANCE Industry... DOES NOT WANT THIS!!!!!

Insuring The UN-Insured

Considering those who are unable to pay a premium, their status as non-paying patients will change. They will be enrolled in the "Medicare for All" public fund as a matter of course, as publicly subsidized patients as far as their Medicare premiums are concerned, but fully paying patients from the perspective of providers and facilities that provide health care services. ALL patients will be responsible for some calculated level of co-pay associated with their annual premium related to their taxable income.

Cost-Benefit of Eliminating Medicaid

Given that many physicians will not accept Medicaid due to the fact that it costs more to bill Medicaid than the physician receives in payment, Medicaid should be eliminated with patients transitioned over to the Medicare for All Plan.

There will be cost and management efficiencies associated with eliminating a portion of the overhead associated with two separate agencies being rolled into one. States may continue to pay a significant portion of the cost of covering a patient via Medicare. In my opinion, such a cost would most likely be less than the current cost of covering a patient under Medicaid.

In Summary

The benefits of following a policy of reform plan similar to the one I describe here that it is difficult to imagine why such a plan had not been put forward sooner. The reality however defies the facts, in that logic will never prevail when endemic corruption in our legislative bodies defy comprehension because the politicians respond most fervently to stimuli much more dear to them than fact and logic... BIG DOLLARS!

It is our responsibility to work around the money so that we can enjoy the benefit of having elected officials that truly represent US, NOT just BIG Business!

Source