stewardshipparty

As I stated in my last post, I am going to present my own health care plan for the benefit of my readers.  I call this proposal the Health Care Distributional Equity Act.  I want to make it clear at the outset, that this is not intended to be a comprehensive solution to the health care problem.  It is only intended to plug holes in the current system as it is and to solve some systemic problems that are more a part of the flow of American history than the growth of the health care sector of the economy. 

I take issue with the idea of the public option, in part, because I think its proponents see it as the final solution.  At this point in history, I do not believe that we have either the financial resources or the public will to achieve any sort of comprehensive solution to anything.  Our vision of America is a fluid picture, like a television in need of adjustment, and we are too diverse as a nation to establish political institutions that would ossify our world view. 

So I acknowledge that what I present today is a patchwork, nothing more.  I think it will take a step toward dealing with the issue of the uninsured and it will deal with some other health related issues as well, but it will not solve everything. 

I. Plan Principles 

My plan is guided by three principles.   The first is tax equity in health care assessments.  The second is contribution based on economic performance, and the third is independence from central control. 

Equity in tax assessment means very simply no double taxation.  The financing for this plan does not contemplate any reliance on economic wealth.  It is my opinion that for a given level of national health care system to be sustainable, it must be supported by national income, not personal assets.  Specifically, no taxes would be levied on  profits, interest on savings,  or even tax exempt revenue bonds in order to provide the funding for this plan.  Not only is this a normative position, I think it is unnecessary to do more.  Business owners would pay payroll taxes for Medicare and Social Security as they are already legally required to do but no new levies would be assessed against business owners for this purpose.

By contribution based on economic performance I mean first that everybody pays for Social Security and health care.  It is equally possible in this economy for a person with a substantial income and a very low income to pay no taxes on their income.  The payroll taxes are not designed with this in mind.  Essentially, the payroll deductions for OASDI come off the top and people don’t even realize that they have made a contribution to the Social Security system or to Medicare until they get a letter from Social Security summarizing their contributions and their potential benefits from the system.  In my plan, nothing occurs to change that component of the system.  I propose that we expand the system of financing but this expansion will be concerned with other financing sources. 

The third guiding principle for my health care plan is independence from control by the center.  Politicians from both the left and the right have benefited in the past by making the claim that the federal deficit is not nearly as great as it is by including the Social Security Trust Fund in the numbers.  I do not have the knowledge and do not make the claim that they have robbed Social Security to fund pet political projects, but is entirely possible that they could do so.  It is important when talking about the society support network, of which healthcare is a part, that the Trust Fund be removed from any possibility of political control or influence to the maximum extent possible.   

There is one way that the Democratic Party could make a contribution toward that goal.    They can modify this plan in a way that would assuage conservatives and do no harm to their stated aim of helping the uninsured.  One thing they could do would be to agree to a lockbox.  We need to make sure that the funds that go into this hugely expensive program stay with this program and that they are not diverted to other, more politically appealing projects.  The only way we can do that is by establishing a lockbox.   

My plan calls for a dedicated, completely independent account for Social Security and Health Care Administration. The U. S. Customs Service will have a key role to play in the financing of this effort.  Instructions will be written into the Statute specifically directing the responsible authorities in Customs on how to make deposits to one very large, general account.  Withdrawals will only be made by Chief Financial Officers in a precise manner and that too will be set out in the enabling legislation.  The federal government could borrow from this fund only upon the declaration of a financial emergency approved by both Houses of Congress and signed by the President.  That too will be written in the statute.

Independence from central control extends beyond the issue of financing.  I do not know that much about the Waxman Markey Bill.  I do know an issue has been made of end of life counseling by Sarah Palin and others and that has been reported in the media.  My concern is not whether or not this would lead to government assisted euthanasia or assisted suicide.  Rather, I would want to know what kind of health care plan the uninsured are supposed to have.  There is nothing like end of life counseling in my health care plan and I have thought for a long time that I had a pretty good plan.  Why would the uninsured and underemployed need end of life counseling?  It sounds to me that the taxpayer is being asked to pay for a Cadillac when most of us can’t even really afford a Yugo.  

If in fact there are such things as mental health benefits in this bill, supposedly to help the unemployed, but primarily to help liberal politicians, then that is going to be an enduring problem of the system that the Democrats create.  I myself have been unemployed a number of times and can see that it is a highly streesful condition.  But a lot of people won’t see it that way.  We need to make sure that this program covers the basics and only the basics.  Supposedly, this is a stop gap program.  We all look for the day that many people will be able to rejoin many other Americans in the work force and this nightmare of no health benefits will be behind us. 

Part II.  The Program for the Uninsured 

I think it is very important that we achieve a national consensus on what should be included in a national  health care plan supported by tax revenues and what is not.  That is one of the key elements of my plan for a national insurance program to cover the uninsured.  I would propose that we establish a national website for this program.  Any changes in the basic agreed elements of this plan would be placed on the website and a poll would be taken.  If a very large number of the visitors to the site vote to put a particular program change to a vote, the proposal would be held in abeyance until the next, off Presidential year, general election.  It would then be placed on the ballot along with the various candidates for Congress and state races. 

I am, as I have indicated before, seeking to establish a new party.  I am also a conservative.  But I believe very strongly in the principle of majority rule.  I believe further that on very important issues such as healthcare must be decided by the majority, not just by their paid, professional representatives.  Thus, a key element of my plan for reform of the healthcare sector of the economy is participant participation.  We must all be involved in deciding what we will do as a nation and what we will not do.     

The second key element to my health care plan is my rather unique proposal for financing the health care for the uninsured.  In a manner of speaking I think that foreigners should do it.  We have a very serious concern with the cost of this program.  It is my opinion that the first step in any federal program start should be a financing source.  We do not have any clear and concise statement on how and who is going to pay for this plan.  

My plan is to pay for this program principally by a levy on imported manufactured goods.  I consider it extremely important that we recoup taxes that were not paid on a decade or more of cheap imported goods.  It is to me completely obvious that American manufactured goods could never be as cheap as goods made overseas because overseas manufacturers don’t have to support the social overhead cost of our society as our employers and employees do.  But while they don’t make a contribution to the Social Security or Medicare Trust fund, they can sell their goods in our markets.  We need to reach a point in this society where we live by the principle that everyone pays into the Social Security Trust Fund. 

So my source of funding for the uninsured is a five percent levy on the imputed value of the imported manufactured goods.  This would be assessed on the landed value of the cargo when it touches land in American ports.  The funds collected from this levy would be paid by U. S. Customs into a Master Reserve Match Account.  When I make references to the Reserve Match or Reserve Match account later in this post, the term will refer to funds collected from this excise on imports.       

I would add a quick qualification to this financing proposal.  I do not think that we can or should include bulk commodities, specifically petroleum, in this excise.  Taxation of commodities is generally not subject to any kind of a payroll tax.  Also, if this tax were levied on a commodity such as petroleum it would simply pass through to consumers.  I would only recommend that we include petroleum products if the barrel price of oil fell down to $20 or less.  That is most unlikely.

With that qualification in mind, I can now proceed to present my mechanism for making sure that uninsured Americans have some basic health coverage for themselves and their families.  The instrument for distributing health care benefits to the uninsured would be a regional network of benefit administrators.  I would propose that we establish dot-Org organizations on regional lines such as the New England Benefit Administrator, the Southern California Benefit Administrator, the New York City Metro Benefit Administrator and so on.  Each of these benefit administrators would process claims and make payments due on medical services provided according to a menu of services available to group members.   In my vision, these organizations would be claims organizations.  In fact, they could be attached to the employment services divisions of the several states, and be incorporated into the claim process for the unemployed.  Reimbursement to these organizations could be accomplished by federal block grants, which are by now a well established instrument of the policy of the federal government.

Group membership in these organizations would be determined by geography.  The only solid requirement for this program would be a valid, provable address.  There may in addition be certain income qualifications for the deductibles that are now ingrained in our medical system. 

A member of one of these groups, if employed, would pay into a designated medical fund the amount of 1.25% of gross salary.  This supplementary payment would function and be treated just like the standard deductions for Medicare and Social Security that are always deducted from every payment made to employed wage earners. This is part of the rationale for the geographical mapping of memberships.  Wage earners would make a supplementary payment to the program.  Families would not.  The idea behind this is that all all earned income will make a contribution to the upkeep of this health care system. 

Of course, this small contribution of 1.25 percent of qualified recipients would make at best a minor contribution to the cost of health care for the group.  This is where the Reserve Match from the foreign sector of the economy comes in.  The central account that collects the levy on imports would periodically provide reimbursement to the various benefit administrators in order keep the accounts in balance.  These funds may be distributed on a basis to match revenue generated from international sales or they may be distributed on a per capita basis. 

It may not be possible to balance the accounts of this system based strictly on the international levy and the wage earner contribution.  In that case, supplementary disbursements from the general Treasury fund may be required.  In my vision for health care, these payments would be made by supplementary appropriations approved by the Congress.  There would be no scheduled disbursements.  This provision is intended to improve the oversight on this program. 

Also, I would note that these benefit adminstrators would not be considered price setting organizations.  The critical error of liberalism in its approach to health care reform in the total emphasis on controlling demand by fiat.  Democrats want to use the power of the federal purse and federal disbursements from that purse to lean on insurance companies and that way force the insurance companies to lean on medical providers. 

The Democratic Party is indirectly trying to use price controls to solve a supply problem.  Not only will that approach not work, it will make things worse.  If you don’t believe that, ask Jimmie Carter about his experience with trying to control inflation and how well his Whip Inflation Now (WIN) program actually worked.  

My plan over time will introduce the price system to the health care sector.  The economic shock of going full market pricing would be so great that it would send the sector into an immediate tailspin.  I would propose that we implement a price system into the sector over a period of time.  I will describe this portion of my plan more fully in the section on Medicare.  

To conclude this section of my post, I would note that the  menu of services available with the program would be limited and basic.  There would be a prescription benefit program, emergency services, diagnostic and therapeutic services.  Elective services would be extremely limited in this proposal.  However, I would seek to ensure that there was provision for natal and prenatal care. 

Part III.  The Program for the Insured

My plan would not leave out those Americans that do have insurance benefits.  During the implementation phase of this health care plan, there would only be limited, additional benefits for Americans who are already members of some type of health care program.  However, there would be some benefits for this cohort of the population as well. 

What I would propose for this group is that their contribution to the Social Security system remain  unchanged at the onset of this system.  They would have the option, however, of increasing their payroll, pretax deductions up to 10% of their income.  These deductions would go toward supplementary health care or Social Security benefits such as annuities or long term care policies.  

Eventually, it is my hope that we will transition the health care sector to a system of benefit adminstrators on the distribution side of the industry. There will come a day and there should come a day when underwriting profit, or loss, has no menaing in terms of annual income paid into the claim reserves.  I think it is meaningless to speak of a reserve fund for claim losses in the sense that this is done in other sectors of the insurance business.  The monies paid into a claim fund for health care will be used.  There may be some funds left over, but eventually all the deposits to these reserve accounts will be paid out to medical service providers. 

True insurance will eventually be a supplement and a decision.  The benefit administrators in this component of my plan may be permitted to underwrite supplementary policies.  They would all be required to provide the same basic coverage, as an option, but individuals would have other options.  Benefit administrators would be permitted to offer variable copays, and various supplementary policies for those dissatisfied with the basic level service.  In that end of the market, the benefit administrators would operate as traditional insurors.  

Eventually, I would like to change the financing of the basic reserves and put that financing issue on a universal, and equitable basis.  My ultimate goal is to establish a franchise fee system.  Every business enterprise in America would be granted a franchise to do business in this country.  That franchise system would involve every legal business enterprise in the country including all importers.  Every business organization would be required to pay a fee of an estimated two percent of total revenues, net only of discounts and allowance.  That would provide all the financing needed to support the healthcare system, particularly if we implement the supply side changes in the health care sector that I advocate. 

I will acknowledge that there are some issues with respect to the ultimate aim.  This system taxes sales.  The current system taxes payrolls.  In effect, some will argue that highly capitalized industries will be adversely affected by this change.  My only rejoinder to that comment is that if everyone is treated the same, then the impact of paying for the health care system will be neutral with respect to its economic impact.  I am sure that there will be many debates about this component of my plan, but I want to end this section by emphasizing once again that this is an incremental plan.  We build trust in a new vision for America by taking small steps.  The programs covered in this section of the plan are just a few of those small steps.    

Part IV.  Active Medicare Recipients

I think trust is the most important element in any program changes that might affect the Medicare System in some adverse manner.  People who live on fixed incomes with very limited budgets and very high expenses for healthcare are understandably suspicious of any tinkering of the system.  My plan does not change the basic Medicare Program at all.  The people who pay into the Social Security Trust Fund would continue to pay into the Trust Fund.  The percentage share of the payroll taxes that go to Medicare would not be altered.  With the many changes that are being discussed, I think it is important to reassure Medicare recipients that nothing will change to affect their piece of the pie.  I think the Democrats have done a very poor job in communicating that message to seniors, if in fact it is even true that nothing will change. 

One of the changes I would propose is intended to reassure seniors that their rights as program participants would be unaffected. The payroll tax that funds Social Security and Medicare has a cut off.  Income in excess of approminately $100,000 is exempt from this tax.  I would propose that we double the income base for this tax from its current level to $200,000.  I would leave disbursements to Social Security and Medicare unchanged as to their relative shares of this tax, which would imply that the funds available to Social Security recipients would also increase. 

I think the health care proposal of greatest interest to Medicare participants would be my proposal for a clinical trial insurance program.  It is my  personal conviction that within five years, this program would reduce the cost of prescription drugs by about 30%.  My funding proposal for this program is for a $5 billion reserve.  That reserve would be funded from general Treasury accounts.  Like all, government guaranteed insurance programs, the clinical trials insurance program can be self sustaining if it is a well managed process. 

I will have more to say on the clinical trials insurance program in a later post.  However, I think now would be a good time to note that the initial health care reform bill will have language to strengthen patent rights of prescription medicine.

Medicare participants will play a key role in the health care reform process.  Medicare recipients will be the first people in America to use what I call the Electronic Medical Auction System (EMAS).  The medical auction system will be the first real attempt to use the price system in the health care sector in decades.  A diagnosis from a general practicitioner or specialist for a specific course of treatment or surgery will be encoded into an electronic offer and submitted to an online auction system. This offer will contain either an excerpted or complete medical history of the patient. 

I cannot put any price tag on the EMAS system at this time, even a conjectural one.  The idea of an electronically transmitted medical history has been much discussed in the media for some time.  The electronic auction system and the electronic medical history will have to go hand in hand and be implemented simultaneously.  In terms of the financing of this sytem, I would only note that the financing for such a system should come out of general Treasury revenues, in my opinion.  Eventually, we will all benefit from an auction process for healthcare.  I am sure many of the readers of this post can cite any number of examples of savings from online auction services such as Ebay and Priceline and on and on. Once we have the medical auction system in place, then more people will benefit and we will be able to realize and document considerable cost savings in health services. 

Medicare recipients will be in the vanguard because Medicare is the only true approximation of a price system we have in this country.  Medicare sets the prices that it will pay for a vast variety of services and establishes deductibles and standards of measurement for such services.  Health care insurors do the same thing for their customers to a much more limited extent, but the information is generally proprietary and not widely disseminated.  For a price system to function properly, information has to be available to the market paticipant.  That is the element Medicare has that we can use to begin to start building a national price system for healthcare services. 

The other element we need in order to build a price care system for healthcare is market access.  A consumer may know of a plumber who does excellent work and who would charge a third less neighborhood plumbers.  But that knowledge is of no benefit if the plumber in question lives more than a hundred miles away from the consumer.  What we really need to start making Medicare a true market system is a travel benefit.  We need to develop a standard scale of reimbursement for a patient and a travel companion for Medicare.  It is my position that as long as the travel benefit and the cost of the required, and Medicare approved procedure, is 20% less than  the estimated cost of the procedure done locally, we are better off by approving the travel to have the procedure done less.  It will save the fund money.  

The practice called medical tourism is already a well established procedure.  As we extend this option to Medicare recipients in a formal way, I think we need to exercise some control over this process.  Consequently, I would also propose a Medicare Facilities Fund.  I think we should offer general Treasury guarantees on the interest paid on a Medicare bond fund whose principal would be provided by Medicare recipients.  The federal guarantee would cover an interest return of two points over prime on an invested fund of up to five billion dollars.  This fund would be used in part to build what I call the Sainte system of medical treatment and recovery centers to be located in the Caribbean.  American doctors could rent time at these facilities and treat their patients in attractive and comfortable settings. 

Local standards for medical malpractice would apply to this network system.  Similarly, I would support the establishment of across border medical facilities and treatment centers in Canada that would be permitted to provide care to Social Security participants who live in close proximity to the Canadian border.  Once again, local standards for medical malpractice would apply.  In addition to the enabling legislation discussed here, this new program start would require a commercial treaty to make sure that it does not impact on the Canadian health care system.  This measure would not result in an increase in Medicare expenditures and might in fact decrease them provided reimbursement was made in local currency rather than U. S. dollars.

Outside of Medicare funding, I would propose an initiative to establish a program of Senior games.  The idea is to offer monetary awards for competitive events for seniors that would increase the levels of exercise in a population prone to sedentary lifestyles.  It has been demonstrated that active lifestyles will lead to improved health, and may consequently lead, ever so slightly to a reduction in heatlh expenditures for this age group.

I would also make one more proposal that will affect Medicare recipients.  Hopefully, they will take the leading role in testing a new innovation that I think will dramatically reduce health care costs in the long run.  What I would propose is an educational program to train a group of college graduates with life sciences degrees to become certified diagnosticians.  These individuals would go through a Masters degree program that would essentially teach them how to operate and apply a standard software package.  This software would contain the standard symptoms for over a hundred different physical conditions.  Incorporated into the software would be the recommendations of a hundred medical doctors when faced with each of these conditions.  The certified diagnostician would use this software to render a diagnosis and identify a prescribed course of treatment.  The software will only produce a diagnosis and the associated treatment options if the proposed diagnosis meets an acceptance criterion from 80% of the medical panel backing the software.  

I will describe how this system works in more detail in a later post.  For the moment, what is important is that this innovation, if it works out on a trial basis, would provide us with the means of rapidly expanding the supply of the general, entry level diagnostician.  We could, in effect and to a limited extent, bring back the old fashioned country doctor.  On a statistical basis, I think it is obvious that we can produce more graduates of one year professional training programs than we could produce graduates of four year degree programs that required a term of residence. 

I would also note that this is intended to affect the role of the diagnostician only.  We do have nurse practictioners and physician assistants and they undoubtedly form and an important element in the American health care system.  They strengthen the treatment options available to those in need of care.  However, it is the lack of diagnosticians that is in my view a critical problem.  This newly created professional position will address that.  By expanding the supply of diagnosticians much more rapidly than we can the supply of medical doctors, we will reduce costs.  That must be the bottom line for our healthcare system. 

To start this trial training program, I would propose funding from the general Treasury in the amount of about $60 million.  This level of funding would be sufficient to develop the curriculum and train the pilot group of students.  I have no idea as to the cost of developing software such as is needed for this new position.  Reader comments on this point are solicited and would be much appreciated.        

Part V.  Long Term Care  

One of the many reason why healthcare reform can only be a patchwork designed to plug holes in the system is the issue of long term care.  In my reading on the subject, I have not come across any material that suggests upper level officialdom is giving any thought to the issue of long term care.  We typically think of long term care only in terms of a nursing home and of bed ridden elderly people.   The subject is much more complex than that.  As just one example, because we are becoming a nation of singles with limited extended family networks, a lot of people still in their working years must go to some type of assisted living facility because they cannot remain at home alone and  take care of the daily functions of living.  

For many Americans in the work place, the age of 67 is now the age at which they can qualify for full Social Security benefits.  Many of the people who reach that age are going to be female, with limited financial resources, and such limited mobility that they have to face the prospect of some type of assisted living arrangement almost as soon as they retire.  But the services for those needs are often hugely expensive and they are unlikely to become cheaper in the future without some action on the federal level.

My proposals for the fiscal side of the daunting challenge of long term care begin with a very simple commitment to research the mobility needs of the elderly.  The need for assistance with the daily routines of living kicks in when people can no longer take care of dressing themselves, cleaning their homes, cooking meals and attending to bodily functions.  Typically, people who find themselves in this condition require the assistance of some kind of provider, often on  a full time basis, just to carry out the routines of daily living.  That kind of assistance is very labor intensive and can be very expensive. 

The Japanese, however, do not seem to think so and this is one time when I think we should emulate the Japanese example to the extent possible.  The Japanese are trying to develop robotic eldercare.  Once we have a baseline of data on the mobility needs of the elderly on a daily basis, I think this nation should do the same.  I would propose a research program in what is called human factors engineering to determine what seniors are most likely to need in terms of a healing hand.  For this program, I think we should invest up to $100 million for engineering studies for this purpose.  I would follow this up by an X Prize Challenge in excess of $50 milllion for the first contestant to design a robot that can accomplish all of these activities for a four hour period.     

I would also make a proposal to be paid from general Treasury funds that we establish a new type of continuum of care, coop.  A continuum of care, assisted living facility generally offers a wide range of living arrangements for residents whose physical health runs the gamet from active independence to the intensive care most often associated with nursing homes.  These facilities are very costly and relative to the need, there are not that many of them.  I think we should expand the supply of this type of facility by establishing coops.  The federal government would simply offer a guarantee for loans for the construction and initial working capital needs of new cooperative assisted living facilities.  Affinity groups would raise the equity required for such commercial loans.  In my vision for this concept, I would propose that credit unions be allowed to originate such loans.  I will elaborate on this concept in more detail in a future post. 

Before moving on to the next section of my plan, I would note one other research program that I think the federal government ought to either fund or champion related to the issue of long term care.  Manufacturers are beginning to think about the needs of the independent senior, but not in a formal way.  In order to develop standards that manufacturers can use to base competitive production plans, I would propose an X Prize Technology Competition for urban planners and architects.  The idea behind the competition would be to design the best house for independent living.  The challenge at the federal level, which would only require leadership, would be to develop the standards needed to make sure the innovation that arise from this research meet code.

Part VI.  Smoker’s Mutual Healthcare

Many of the ideas in this proposed healthcare alternative are admittedly controversial and debatable.  This section is likely to be more controversial than most of the other ideas in this plan.  

I think that people who smoke ought to be entitled to share in the landmark legal settlement that class action attorneys entered into with the tobacco companies.  It is also my opinion, that a portion of the proceeds from any medically related healthcare class action suit ought to be returned to the healthcare trust fund, not just pocketed by attorney’s.  I consider it a very important principle of my plan that everybody pays their share of taking care of the health care system that benefits us all.

I stand to be corrected, but I do not think that the attorneys who participated in the landmark settlement with big tobacco paid anything to the Social Security Trust Fund on those settlement proceeds.  It is true that the revenues from that settlement ended up as a part of the partnership distributions and were thus recognized as income on the attorney’s federal income tax return.  But a partnership distribution only addresses the potential liability due to the IRS.  It does not account for payments that may or may not be due to the Social Security Trust Fund.  So in my plan, we will make sure that the attorney’s, and almost all the Democratic representatives in the U. S. House and the U. S. Senate are attorneys, will pay their fair share of Social Security taxes due on their earnings from the tobacco settlement. 

Whaat I would propose is that funds from this dedicated source of revenues be used to organize and fund the operational aspect of a mutual, claims paid, insurance organization for people who smoke and use tobacco.  I think we should solicit input from robacco smokers on what this dedicated mutual health care association should pay for.  Some of that will depend on how much revenue can be raised from the lawyers who benefited from the tobacco settlement.  Some of that will depend upon the preferences of the affected group and how they see matters of health. 

One thing that may be considered for this group is a mutual health insurance program.  I think that the option of obtaining a supplemental life insurance policy would be very beneficial for this group of Americans in a number of ways including health.  I think such an insurance program could be designed that would be actuarially sound provide that the top of the actuarial table did not extend beyond the lowest minimum retirement age for Social Security. 

On the other end of the scale as it concerns the air we all breath, I would recommend as a part of my plan and as a part of this proposed piece of legislation, that we direct the Department of Energy, and specifically the Sandia Labs, to study whether or not ionic collectors can be usefully scaled.   It may be that the common eelctronically power filters used to clean air in residences can be place downwind from pollution sources and reduce the amount of particulates.  The most practical application of this idea as a demonstration project would be to see if an ionic tower located in Central Mexico could reduce the level of particulates flowing north from Mexico system.  Such a system, if it could be demonstrated to be at all workable, would result in a slight improvement in air quality in the Southwestern United States and that would improve health to a slight degree. For this element of my plan, I would propose a demonstration project line item  with funding not to exceed $20 million.

VII.  Bariatric Health Care 

 The goal of the previous section was not to pick on the legal beneficiaries of the legal settleemnt with Big Tobacco.  Rather, it was an extension of my believe that everyone needs to pay their fair share in order to support the health care system.  In fact, I think that the attorney’s in every other healthcare class action suit should pay a share of their partnership distributions from those suits to the Trust Fund to support healthcare.  I do not expect that a simple five percent of the attorney fees on other medical malpractice settlements would result in a substantial revenue stream.  Accordingly, I think that the revenue raised from this source should be applied to one specific legal issue.  I think we should apply these funds to deal with the issue of obesity in America. 

I think a part of these funds should be placed in a pool to cover elective bariatric surgiry.  The surgical candidate would have to be what is called morbidly obese and would also have to be willing to pay twenty percent of the total estimated cost of the procedure through recovery.  The reason for the high “copay” is an indication of desire.  The inidividual must demonstrate a strong desire in order to loose the weight and keep the weight off. 

I would also propose that part of this fund be commited to an X Prize to build a human powered generator capable of charging an electric vehicle in two hours of sustained exercise.  In my opinion, a human powered grid that would supply just one percent of the electrical power needs of a suburban community would be a highly significant innovation.  However, in this context, I think that a human powered grid would give Americans the incentive to exercise, and increasing the level of exercise in this manner could result in a significant improvement in health. 

Depending on funding availabilty from this dedicated source, I would also propose a line item in the amount of $50 million to promote the development and use cooking technology to replace or at least supplemnet, the fast food, deep fryer.  Generally, we need to develop a national goal of reducing calories from fat by at least a half.  I think that technological advances in the fast food industry can help us achieve that goal.  

Education is not my thing, and, by and large, I do not think that education should be a federal thing.  However, if sufficient funding was raised from the levy on medical malpractice attorney fees, I would propose a line item demonstration project in the amount of roughly $60 million to food as an addiction in American high schools. 

This is a debatable proposal and many may oppose it for good and just cause.  Comments on this idea and the many others are encouraged and back and forth debate is certainly encouraged.  I believe, however, that one issue is beyond debate.  Just as we must do something about healthcare, we must also do something about obesity as well.

VIII.  Other Financing Issues         

I would like to end this post with a few financial proposals related to healthcare in America that don’t deal directly with the issue of the distribution of healthcare benefits from the tax system to the public.  I have made a point that we all have to support the healthcare system.  Democratic attorneys may support the system more more than I think they do.  I am sure that comments made after I publish this article to the web will provide clarity on that issue.  I for one do not always claim that I am right and I may be in error on this point.

On another issue, I don’t think I am wrong, but I would be pleasantly surprised to be proven wrong.  As a miscellaneous provision, I would require the Congress to set up a website that would contain the W2 of every member of Congress posted online.  That way it could easily be determined if those who pass judgement on what we pay into the Social Security Trust Fund make the same payments that we do.  Are they our Representatives, or, are they their own Representatives. 

My major issue with health care has always been the supply side.  As this post is primarily about Ways and Means and the overall distribution of healthc care benefits, I will conclude with one brief not on supply.  This bill will establish what I call the Medical Guarantee Service Corporation.  It will be a financing instrument for increasing the supply of medical goods and services.  Hopefully, as a government sponsored enterprise, it can and will be self sustaining financially.  Yet it will take some time for it to reach that point.  In my proposed piece of healthcare reform legislation, I will establish this corporation and obtain authorization for the start up costs for this entity.  It is my back of the envelope estimate that the initial costs of this element of my plan will be on the order of $200 million. While that is relatively costly sum, I see this corporation as the cornerstone of a new system for with the healthcare system that the American people need.  I will have more to sway about this corporation in future posts when I once again take up a discussion of the reformation of the American healthcare system. 

Trackback URI | Comments RSS