New ideas about Health care delivery

IS IT TIME TO RETHINK THE CURRENT HEALTH CARE DELIVERY MODEL?

 DO NOT GIVE UP FREEDOM, CHOICE AND CONTROL

 

 

 

The system we have today for health care delivery is the same idea that started 6 decades ago, you pay a premium for insurance and the insurance company pays for the service. This is true whether it is private insurance companies or government run insurance. Hardly anyone pays for their own health care directly and most don't even pay the premium. This system tends to remove incentives by consumers to be conscious of costs. There have been moves to increase deductibles, co-pays and  consumers share of the premium in an effort to encourage consumers to be conscience of cost savings, but it has been largely ineffective.
 

There are moves being made by health care providers to get out of the insurance based system. One idea that is being used on a limited basis is called Boutique Medicine or Concierge Medicine, were a doctor or group of doctors now charge a limited number of clients an annual fee and then provide health care. They no longer take payments from Insurance, Medicare or Medicaid. Another that I have heard about is  Clinic's run by Orthopedic doctors that have a flat rate of say $300.00 cash for their diagnosis and evaluation, then a flat rate price of around $8000.00 for a knee replacement. These are pure free market ideas that eliminate insurance and cut the costs of business and red tape. This same system is available in some other countries like India where you can have open heart surgery in the $10,000 range including your stay there. Sadly those who espouse government run healthcare believe that such practices would be made illegal and all providers would need to work for the government. While these providers now are limited and small in number, if allowed and encouraged they could begin to encourage competition in health care, they advertise their prices and open up some options to consumers.
 

Of course, there always is the problem of those who do not have the resources to be part of such a plan. Why not eliminate Medicaid, and in a cooperative effort expand the clinic system that has been around forever in America. These clinics would be administered by a local hospitals, they would be staffed by nurse practitioners and interns, overseen by doctors. They could also encourage qualified volunteers. Citizens under a certain income would be assigned a clinic and charged a monthly premium based on income. They would also pay a set amount say $20.00 per visit. These clinics would take care of minor injuries, immunizations, evaluations etc. and distribute common drugs like antibiotics. They would be subsidized if necessary by former Medicaid money. They would be encouraged to be self supporting as much as possible. More serious problems would need to be moved on to another facility. This could possibly provide better health care because of its availability. We are seeing Hospitals expanding local care facilities now.

 

Whatever reforms are to made should include a group of random selected providers who are not affiliated with any lobbying group or special interest and engage in listening sessions to see what reforms would help providers cut their costs. Doctors now have large staffs just to keep track of regulations, paperwork and claims. This all raises costs. Why not have one universal form that everyone can use to file a claim. Malpractice insurance often costs $250,000 a year, this needs to be addressed. This could be replaced by an independent group that investigates malpractice in a professional way and makes recommendations as to ratings on doctors and penalties.

There is and has been a lot of pressure to go to a government run system, Medicare for all they say. They fail to address the problem that the subsidizing of Medicare by private insurance through cost shifting has been a large factor in the rising cost of health care. Does anyone really believe that the medical profession will attract the best and the brightest if they will be working for a large government run bureaucracy that will do its hiring and promotions with an eye to social engineering as much as good health care. You can bet that would be the end of all malpractice claims as most government entities are immune from such claims. You can also bet that at certain age, whether it 75 or 80, your access to care will become limited. Americans spend $3.8 trillion on health care a year. This is very close to the entire budget of the Federal Government, which has not balanced a budget since 1969, shortly after the passage of Great Society spending programs. To finance a government run health program could result in  possibly a 30% increase of the Federal budget. Also a 30% rise in taxes. While it is true that the money is spent one way or another, this needs to be a last resort as once the move is made to government health care it will never be reversed. Rather than these large comprehensive reforms that often slip in political ideology and special interest motives, we need to address targeted solutions one thing at a time. It should be an evolution not a revolution.

Are we better off since ACA.?

HAS ACA DAMAGED OUR HEALTH CARE?

REFORM IS IMPERATIVE

Before introduction of the Affordable Care Act the majority of Americans had a very positive view of the quality of health care. The problem was the cost, which really did not have any realistic connection to the rest of the economy. Let's face it, without insurance, very few people could afford major surgery or extended hospital stays. We were told that the problem was the uninsured, and to bring down the costs we would mandate everyone buy health insurance and force all employers with over 50 employees to purchase insurance. At the same time the mandated coverage was expanded to include many services that could never be used by the policy holders. Insurance companies were also mandated to not use actuarial tables to set prices. Usually young groups of policy holders paid less than older folk. The idea was to force the young to subsidize the older. You could also purchase insurance on-line from exchanges.

When these exchanges went on line, out of curiosity, I put in my son's information to get a price for insurance. The premium at that time for a bronze plan cost around $110.00 a month, but had a $6000.00 deductible and paid 60% of the cost. If you were a low income person, you would be better off to put your $110.00 in the bank, because if you didn't have $6000 you really didn't have much insurance unless it was a catastrophic event and then you would still owe 40% of the cost. Before the Affordable Care Act, I paid for my son's insurance while he was in college. I paid $100 a month from Highmark with a $1200 deductible; it paid 80% of the cost with a maximum of $3000 out of pocket. Coverage for him was more affordable before the ACA. At that time there was about a dozen providers, but I understand the situation now is much worse.  Many older people who self pay their insurance have had to drop all coverage as they cannot pay the premium. My daughter's husband has a small company, they have gone through several insurance companies since the ACA because their insurance companies keep going out of the health care business. Every time they start over, it is another group, new doctors, no continuity of care. The ACA has not only become unaffordable for working families, but has also lowered the quality of health care. The government also took over $700 billion in Medicare money and moved it to ACA to subsidize low income care and to expand Medicaid. They compounded the initial problems of rising costs and uninsured individuals by creating problems across the board. Medicaid payments to doctors have been cut so much that many doctors claim they lose money on Medicaid and will no longer see Medicaid customers. Some will no longer take new Medicare people who have not been previous patients.  

Instead of looking at other ways to lower costs, the government tried to reduce costs by forcing providers to take less reimbursement and by hoping to force the young to subsidize the system. It really is not working except for low income or no income people who are subsidized, who may have insurance, but do they really have good health care?

The easiest way to cut health care cost would be to eliminate all insurance. This would be a pure free market solution and the cost of health care after some serious chaos would settle at a realistic price linked to the real economy. Two examples are breast implants, which are not covered by insurance are now advertised as low as $2500 and Lasik eye surgery, again not covered by insurance, advertised at $250.00 and up. Both these procedures can be purchased by most anyone who wants them.  It is interesting that there is tremendous competition in uninsured items, while no one ever asks about the costs of procedures that are insured. Now I know we are not going to eliminate health insurance, but we now have two choices, rely on government controlled and paid health care or introduce more market forces and market cost reductions. Government interference in the health care business has not made things better. Can more government control make it better? We will talk about those ideas next time.

Health insurance does not guarantee health care.

 HEALTH INSURANCE STATISTICS

HAVE WE REPLACED ONE PROBLEM WITH ANOTHER?

Health insurance was mostly non-existent before World War II. Because of government imposed wage and price controls and a shortage of labor, large companies offered health insurance as an incentive to attract workers. Many of these companies were self insured and actually paid their employee's health care costs themselves. After the war, these incentives were kept. At that time they were not a large expense because health care costs were realistically priced to the economy and the earning power of most citizens. The first health care crisis that I recall was focused on the elderly retired or elderly who no longer could earn a living. At that time, health care costs still had some relation to the economy and the wages of most citizens. In 1966 Medicare and Medicaid were passed into law. Medicare was financed by a 2.9% payroll tax shared by the employee and employer. Medicaid is financed through the social security administration - the federal government pays 50% and the state pays 50%. Eligibility is determined by each state. Initially Medicare paid prevailing costs as did other insurance providers of the time. This changed in 1984, when due to rising costs, Medicare started paying predetermined reimbursements that were less than regular insurance. This started the practice of cost shifting and an increasing rise in health care costs. Providers added costs not paid by Medicare to the reimbursements paid by regular insurance. This was not widely known, but was done none the less. They also started raising prices to help to raise the negotiated prices from insurance providers and put pressure on Medicaid to raise their limits.

I can give an example from personal experience. One of my sons fell from tree and broke a bone in his shoulder in the early 1990s. I had catastrophic insurance, but not regular insurance. They paid the surgeon but only allowed the anesthesiologist $100 per procedure. There were two procedures. The doctor sent a bill for $1200 less the $200 for a balance of $1000. A friend in the administration department of the hospital found out for me that Medicare paid $110 and Blue Cross and Blue Shield paid $325. There were actually 5 rates, and self-insured or commercial insurance without a contract were the highest. It could be a lengthy story, but to sum it up I ended up paying the doctor what Blue Cross and Blue Shield would pay, $650 minus the $200 paid by my insurance or $450. The situation is probably worse today. I understand the providers' reluctance to take on Medicare directly as it would probably result in a lot of bad publicity.

As of 2015, Medicare had 53 million enrollees, Medicaid had 68 million enrollees for a total of 121 million -this is 37% of the US population. One hundred and thirty nine million, or 43% received health care through their employer .  Twent-two million, or 7%,  pay for own insurance in the private market and 11.7 million through ACA exchanges; 37 million or 11.4% are uninsured. The number of those insured by their employer and those who purchase their insurance has been dropping since the introduction of the ACA.  Most who purchase their own insurance had their policies cancelled due to the mandates for coverage by the ACA. Most small employers had their policies cancelled and had to renegotiate new policies that conformed to the ACA. While boasting the new enrollees in the ACA exchanges many of those were formally insured either by a small employer or paid their own insurance. The real number of the uninsured has not changed, but there are low income people who have gained insurance through Medicaid expansion or subsidized premiums of the ACA. Self-insured and older people who paid their own insurance premium are now uninsured because costs have sky-rocketed or coverage makes the policy unusable. Medicaid expansion encouraged states to raise the number to be covered by increasing the threshold from 100% of the poverty number to 133%. The federal  government pays 100% of the cost of the expansion declining to 90% in 2020. Some states feared that eventually this number will be lowered causing a funding crisis in their state.

Numbers provided by the Kaiser Foundation, U.S. health and human services. We will talk about market solutions soon.

The case against the real estate tax

TIME FOR THE REAL ESTATE TAX TO GO!

LIFE, LIBERTY AND PRIVATE PROPERTY

 

 

There was a time in America, before the income tax, that all taxes were either tariffs or a tax on acreage that in an agricultural society were an indication of ones ability to pay taxes. That has not been the case for nearly a century. So here are some reasons why it is time to eliminate the real estate tax.

 

1. Americans have long believed in the principle of private property. This was ingrained by their experience in feudal Europe where all property belonged to the King and the aristocracy. The rest of the population was allowed to keep a share of their labor for the use of the elites property. Article 1 of the Pennsylvania constitution states: All men are born equally free and independent, and have certain inherent and indefeasible rights, among which are those of enjoying and defending life and liberty, of acquiring, possessing and protecting property and reputation, and of pursuing their own happiness. The real estate tax eliminates the principle of private property, in effect all property belongs to the county and the school district, which allow the citizens to live there in exchange for paying their annual rent.

 

2. Real estate taxes are discriminatory. They force one class of citizens to pay for benefits that are enjoyed by the whole of society. The tax burden for education and county taxes should be spread out among all citizens, based on their ability to pay taxes.

3.Real estate is the single largest asset of the majority of citizens. Over the lifetime of most owners the property tax will nullify the value of this asset almost entirely. Example. $4500. annual property tax x 40 years=$180,000, on death add realty transfer tax and inheritance tax and we see there is no asset left, in effect the principle of private property has been eliminated.

4. Real estate taxes create a high basic overhead for all business's in the state, whether through direct taxes or through very high rents on commercial property. These taxes are required even when there is not a profit. This creates a competitive disadvantage for business in the state who are in competition with business in other states. This has contributed to the economic decline of Pennsylvania.

5. State contributions to school districts is now inequitable, some districts receive over 80% of their funding from the state while others less than 25%. This further puts pressure on the property taxes of those districts perceived to be more wealthy.

So, there are 5 good points as to why the Real Estate tax should be eliminated and replaced with a more equitable tax structure that is broad based and based on the citizens ability to pay.

 

Healthcare dilemma is a symptom of our society.

CAN WE HAVE RIGHTS WITHOUT RESPONSIBILITIES?

NOW THAT ALL NECESSITIES ARE RIGHTS, ARE WE IN THE PROMISED LAND?

 

 

The real problem with the health care debate is that we have come to expect everyone to pay for our health care, except ourselves. The left has been attempting to convince everyone that everyone has a right to health care. But that is not all we have a right to, we have a right to housing, food, cell phones and high speed internet.  The best way to be eligible for these rights is to be in the low income category.  And especially have children and be in the low income category.  No income makes you a loser, but low income makes you a real constituent of the government. You are there for them to pander to and it can be great.

 

So, why don't we just skip the bullshit, and get right to the matter, why don't we do away with educational system entirely and strive to be a part time minimum wage worker. Just think of the possibilities. We could spend all our free time with our favorite pastime, whether it is fishing, or tennis or computer games. Maybe we should just have a mandatory course on how to apply for government benefits. All the money saved from the educational system could be funneled into paying for and expanding the rights of everyday people. Your representative will need to expand his staff for constituent services. We can also funnel all that road money into benefits, walking and bicycles would make a healthier population and less polluted environment. Then we could do away with EPA,  and  have more money for benefits..

 

We may be able do away with national defense spending as we wont have much for someone else to covet. Have you seen other countries try to take over Ethiopia or Somalia. We could do away with a lot of government, anything that does not provide rights and stuff for the people. All those government jobs could also be part time and minimum wage, then everyone will be eligible for rights and benefits.  Maybe that's what heaven on earth is like. Maybe we are already in the promised land. And for the non-religious, maybe there is a Shangri-La.

The best defense is a strong offense.

TRUMP ADMINISTRATION NEEDS TO GO ON OFFENSE NOW

TIME TO INVESTIGATE GOVERNMENT CORRUPTION

 

 

We see that the opposition to Trump is coordinated to disable his administration and possibly remove him from office. A change of strategy is needed. It seems the Democrats are unified in their opposition to Trump and his administration, they are intent on attacking and making accusations against anyone associated with Trump. This started early on by insinuating that Trump was compromised by the Russians, he owed the Russians money, hoped to build hotels in Russia, all claims without any substance. It was all the start of the campaign to de-legitimize Trump and his administration.  The next thing was to insist the hacking of e-mails of democrats was the work of the Russians in collaboration with the Trump campaign. The foundation for this was laid by the Obama administration as they stacked the deck with bureaucrats in the State, Justice and intelligence community. The plan is to force the resignation of Trump's inner circle and eventually Trump himself.

There is civil war being waged within the Federal government. Trump and the Republicans better get off defense and go on offense. There is lots of corruption in the House and Senate, and in the big cities of America. Lets have some scorched earth and expose the big city administrations acceptance of  Drug Cartel money. Does anyone not believe that the availability of drugs is possible without  politicians being paid to look the other way. Most of the big city Mayors are democrats and many are corrupt by third world standards. All Obama appointees or those hired during the Obama administration should be transferred to those places where they have no contact with classified data. Put them in the mail room or wherever they cannot compromise or sabotage him. While this may be excessive, there is political war now being fought within the government. Every Democrat who has ethical problems should be investigated and indicted if possible. The media executives should not be overlooked, expose their connections to political operatives and their coordination in trying to bring down Trump. Expose their unsavory personal lives  No one should be off limits. A few indictments and some convictions may convince them that the price is too high or that continued warfare may cause the whole government to be brought down. There is no need to make false accusations, there is plenty of corruption to be found.

We see that yesterday the Justice department fired all attorneys hired by Obama, this is a good start. The State department needs a cleansing as well, as employees there have been leaking and attempting to embarrass the administration. The IRS should not be spared, as they have proved to be political operatives, rather than government employees. The FBI has seemed incompetent if not politically motivated. Government employees work for the people of the country. Their first allegiance should be to their job, no matter who is in charge. If they are politically motivated to hinder their department, to sabotage the President, to do what is in the interest of their personal ideology, their party, or some other political purpose they should get another job. They should either resign or be fired. If they cannot be fired, find a nice position for them in Somalia, Yemen,  Iraq, or some small office in Topeka or Nome.

It will not take long for employees to see that this is going to be a lose, lose situation for them and they need to re-examine their priorities. If the Republicans and Trump go on the offense now, it will be the best hope for them and the country surviving.

State revenues lagging estimates

STATE REVENUES BELOW ESTIMATES FOR THE YEAR

ALL TAX CATEGORIES UNDER ESTIMATES

 

 

 

Pennsylvania Department of revenue reports tax collections are below estimates so far this fiscal year.

 

Sales tax revenues so far this year total $6.6 billion which is $126.5 million or 1.9% less than anticipated.

 

Personal Income tax revenue is $7.5 billion which is $128.1 million or 1.7% below estimate.

 

Corporate Tax revenue is $1.5 billion which is $171.1million or 10.%5 below estimate.

 

Inheritance tax revenue is $68.4 million, which is $23.1 million or 3.7% below estimate.

 

Realty transfer Tax revenue is $309.7 million which is $50.4 million or 14% less than estimated.

 

Other general fund revenue, including cigarette, tobacco, liquor and table games is $1.2 billion, which is $24 million or 2% below estimates.

 

Non-tax revenue is $292.8 million which is $73.5 million or 33.5% above estimates.

 

Motor License fund, gas, diesel, fines and fees is $1.7 billion, $18.1 million or 1 % below estimates.

 

Total revenue so far is $18 billion, which is $449.7 million, or 2.4% below estimate.

 

The fiscal year ends June, 30. so there are 4 more months left in the year and possibly this numbers will improve. The number to note is the Personal income tax which is down 1.7%. This is a good indicator of the financial health of the states citizens. Pennsylvania needs reform of it s tax policy with the focus on economic growth.