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Health Care
Health care has become synonymous with nightmare in this great country of ours. All because we started something and we do not know how to finish it. There are so many reasons why our health care system has become the joke of the century. Politics, litigation, greed, fraud, abuse, mismanagement, and insurance lobbying are some of the things we will discuss. A great country such as the United States should be the leader in providing proper health care to its citizens and be an example to the rest of the world, yet we lag in this department. There have been books written, documentaries made, discussions and arguments held (private and public). Candidates make promises, but we have not gotten anywhere yet. We still have over 50 million uninsured; it is the biggest expense for the government, employers, and house-holds.
Politics: The two major parties, Republican and Democrat, have fought over what program to adopt and which lobbyist to satisfy for decades now. Some want universal health care, some private health care; others do not care. Everyone has a proposal. No one has a way to pay for it or the guts to push for it. It has become nothing but rhetoric, a bone thrown to the public to show they are doing something about it.
Litigation: A sue-happy country where we have more lawyers than doctors and nurses, we tend to sue anybody for anything every chance we get to score the big money. It is true and a requirement that doctors should do a good job, and they should be liable for mistakes they make. But we sue for the littlest things and expect large sums of money in return. In most cases, doctors and hospitals find it more feasible to settle for large sums of money rather than go to court, due to the length of time and extra costs involved besides the hours and hours of time these doctors have to be absent from their practice to attend court. This has caused outrageous amounts of money that insurance companies charge doctors and hospitals for liability, malpractice, and so forth. We have to set fines and assign dollar amounts for each type of damage these doctors cause and be done with it. Why should your middle finger be worth more than mine? They do the same job. Unless you have proof that your middle finger is used for something other than the normal functions and it is essential for you to have that finger because you rely on it for your livelihood. In that case, we should pay you for training to use one of the other fingers to do the same job as the lost finger.
Greed: Unfortunately, greed has two solid legs in this health care business. Most of us are greedy. Everyone wants to make the most money. Insurance companies want to make more money, hospitals and doctors want to make more money, and even the patients want to make more money. Some patients even look forward to some doctor making a mistake so they make more money.
Fraud: a direct result of greed. It is amazing to meet billing secretaries who work seven days a week, ten to twelve hours a day preparing bills for one doctor to be sent to insurance companies as claims. Let us assume a doctor works nine straight hours a day, five days a week. He is supposed to spend fifteen minutes on a patient. That makes for four patients an hour. That adds up to thirtysix patients a day, 180 patients a week. These billing secretaries are printing hundreds of bills a week for this one doctor. This is due to a broken system where one insurance company has no way of knowing how many patients this doctor sees, and how many times for the same thing in a certain period. So the doctor can bill fifty to sixty visits to this insurance company, and another set to another, and another to another. Most doctors are billing insurance companies for patients they have not even seen. Sometimes they send bills where the patient has passed away some time ago, yet they get paid for those services. Yes, insurance companies send some verification to patients for them to complete and return randomly, but how many patients are really taking the time to return that envelope? Or better yet, how can the patient return that envelope if he is already dead? Fraud, unfortunately, is not limited to the doctors. To no surprise patients are committing fraud—not all, but too many. There are an untold number of fraudulent activities by patients. Some even go as far as using one’s Medicare for another person. Some pharmacies use it for medication patients do not even need or use. Medical-supply stores furnish people’s homes, offer clothes and TVs, radios and so forth and charge it to Medicare and Medicaid. These are all costs that the insurance companies end up paying for and ultimately charge us.
Mismanagement: The system is mismanaged top to bottom. Too much paperwork is involved, which consumes a lot of time from the doctor, the secretaries and, yes, the billing department. Ours is a country with all the technological advances, and yet we have not come up with a system where one card can carry each patient’s medical information usable by any insurance company, while increasing security and privacy. A patient could be assigned a personal identification number, and fingerprint readers could be employed to identify the right patient. If the likes of Visa and MasterCard can do it, why can’t the government or the insurance companies coordinate and offer this and charge the cost of the card to the companies? One input will be enough to bring a patient’s records up to date, cut overhead and in turn reduce expenses and cost. Having one processing center will enable us to monitor how many patients are seen by one doctor at a time, and will again result in a reduction in cost, expenses, and fraud. As with any credit card, until the consumer has swiped his card at the vendor’s place of business and received authorization, the vendor cannot charge that card for services they did not provide and get authorized. We need the doctors and hospitals, and we have to protect them and cut their costs so we can have decent service at a low cost both for us and them. Fraud committing doctors and patients are not only costing us, but they are also costing the more honorable ones, too.
Insurance lobby: All lobbyists should be banned. The name lobbyist has become a very dreadful name. We should, however, have insurance and other industry professionals included in our government alongside representatives who are knowledgeable in these same important consumer industries since Congress is not. Once centralized, many of the problems will be solved. The system can trigger a red flag if a questionable number of patients are seen by a single doctor. Duplicate charges will be eliminated in patient billing, pharmaceutical orders, and medical supply deliveries.
How to Pay for Health Care
Whether we like it or not, want to or not, we are all paying for it one way or another. It is better at least to take control of it and have all of us pay for it in a fair way. In the taxation portion of this book, we will relieve employers from the responsibility of paying for health care and pass the savings along to all employees through an 8 percent pay raise across the board. Since we have given a raise of 8 percent, cut the taxes, and simplified life, the general public will have more cash on hand. We have to calculate what health care costs are per county. Each county will divide health care expenses by sales, including food, and come up with the ratio, adding this to the sales tax counties charge. This way everyone is participating in paying for health care. It may not be proportionate to individuals, but it will be proportionate to amounts spent per individual, since the higher income earner spends more on higher-cost products such as expensive cars, clothing, and other luxury items. Monies collected for health care should be used to purchase insurance. The county should act or put in place an independent committee to oversee the health care issues and act as any corporation by negotiating and bargaining with insurance companies and providers for the best services and prices. In this way, we maintain the competition between insurance companies. The county offers basic services and hospitalization with minimum co-pay through the insurance companies. Also, they can negotiate for other programs and offer these to the public. Anyone who chooses can pay an additional premium for more services, such as a preferred provider organization (PPO) and out-of-contract services, just like employees in many corporations do. The universal card specifies which service and co-pays the client has chosen. This way everyone is covered; the rich are paying a little more through the higher priced purchases on the high end, and the poor pay according to their status; however, they all pay equally on a percentage basis. If that would create a problem, we can refine it and make it such that any house-hold with an annual income over $150,000 (for a family), or $75,000 (for an individual) qualifies for the PPO version automatically and calculations are made accordingly for the state health care expense. This way neither the poor nor the rich will complain about fairness. As for collecting the sales tax, it has become a challenge for counties. The sales tax has its own problems. It is another instance where fraudulent activity is costing the counties billions of dollars, which could be used to help in the funding of this health care proposal. The counties do not have the necessary resources to control and monitor the sales-tax fraud because of the enormous number of businesses under their jurisdiction.
Most of us do not pay as much attention to how a cashier is punching the numbers on most of the products we buy, especially at the corner store or a mom and pop shop that we often frequent. If we did, we would notice many of the following when shopping: When you purchase a can of soda, a bottle of beer, or a pack of cigarettes, the cashier usually will punch in the total cost plus tax as one number instead of punching the cost and the register charging the tax to get the total purchase price. For example, if a can of soda is priced at 55 cents and the tax is 5 cents, the cashier will punch in a straight 60 cents as if it is a non-taxable purchase. It has also happened that many store owners keep the cash register open and skip punching in the entire sale; that helps them cheat the IRS on income tax and the counties on sales tax. Five cents for you and me probably does not mean much, but when these stores have hundreds of clients a day and nowadays the smallest item costs at least 50 cents the sales tax adds up to a pretty decent amount and it is not too farfetched to assume that this will add up to billions of dollars that neither the IRS nor the counties will collect.
There are thousands and thousands of small businesses who sell taxable merchandise and quite a large number of them have found this loophole to cheat on their income taxes and sales taxes. This is costing the federal government, the state government, and the counties hundreds of billions of dollars. Due to the large number of small businesses operated by individuals or small partnerships, it has become impossible for any government agency to monitor this practice. Yes, inspections are made on a random basis but the magnitude of the problem is such that the majority escapes getting caught.
However, there is a perfectly effective way of controlling this and collecting those billions without as many inspectors. It is simple yet effective. We have used this method very effectively with gasoline sales, and we can borrow the same system to collect the sales taxes in advance from the wholesalers who add the sales tax on the cost of goods. This will allow the government inspectors to inspect a much smaller number of businesses (the wholesalers) instead of millions of small business owners. This will also provide a pretty good idea of how much business each small business is doing and help the government figure out their real income. It does not take much to recover these monies, balance the budget, and pay for health care.
The Benefits:
1. All Americans will be covered under this program.
2. There will be no need to raise taxes; it will be funded by recovering monies that are owed to the government but are not collected due to fraud.
3. Insurance companies will remain intact and compete for business; insurance costs will be reduced due to elimination of many fraudulent activities by patients, doctors, and pharmacies.
4. Insurance companies will have an additional 35 to 50 million clients, and many of them are young.
5. It will even cover our veterans and provide a better service. This, in turn, will take that responsibility away from Veterans Affairs and cut on expenses and bureaucracy.
6. There will be no need for Medicare or Medicaid. It will save the government money.
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