Health Care & The Presidential Campaign
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As CEO of Harvard Pilgrim, I find I do a fair amount of public speaking. Over the past ten days or so, I’ve been on several panels with a variety of public policy, health policy and industry types. We also represented a pretty broad collection of political philosophies - some Democrats, some Republicans, some liberals, some moderates and some conservatives.
What really struck me, though, was the amount of cross-over support several policy ideas had in the “what do we need to do about health care” arena. To listen to the media, one would conclude there is no common ground between the parties on this issue - and, frankly, a lot of the stuff the people I was with were talking about hasn’t really showed up on the national debate scene at all.
So - at the risk of over-simplifying what my fellow panelists and I talked about during these discussions - I’d offer up these four national policy ideas - all of which seemed to have pretty broad ideological support.
1) Encourage Medicare to pay more for primary care, and less for specialty care. The whole evolution of the Medicare physician fee schedule for the past thirty years has been to pay more for technology and less for time. As a result, the whole health care system pays more for technology and less for time, since all the payors shadow Medicare payment policy. This trend has resulted in more specialists, fewer primary care providers, and an increasingly fragmented care delivery system. One speaker put it this way - “As long as a dermatologist can make three times as much as a primary care provider and work half as many hours, very few medical school students are going to go into primary care.” This isn’t about picking on dermatology - but the point is a good one.
2) Start doing some Medicare demonstrations in which Medicare pays for clinical outcomes and not simply for volume. As it stands now, the whole system is primarily built on a fee for service platform - so the key to revenue generation is to do more stuff. If we ever want to encourage quality first, we have to figure out a way to pay for it - one illness at a time. Medicare is the biggest payor. More than any other, it can re-wire payment away from just paying for volume and into paying for quality.
3) Fix the relationship between Medicare and Medicaid for low-income seniors who qualify for both programs. As it stands now, neither program coordinates any of its activities or payment policies with the other, and the result is a tangled mess of incredibly expensive, overly bureaucratic ping pong between the two agencies - with the often frail, medically needy, low income senior sitting in the middle. The few times states have done demonstrations to organize and coordinate how Medicare and Medicaid serve this population, the result has been higher quality care, better health status - and HUGE SAVINGS for both programs.
4) Make living healthier lives a priority. Professor David Nash at Jefferson College has estimated that only 3 percent of Americans do the four simple things that matter most in living a healthy life:
– Don’t smoke (we’ve actually made a lot of progress on this one, and it shows)
– Eat a decent amount of fruits and vegetables
– Get some exercise (20 minutes, three times a week)
– Try to live somewhere near the “normal” weight for someone your height.
According to Nash, if merely 10 percent of Americans could pull this off, the impact on health care costs would be gigantic - in the right direction.
We talked about many other issues during these discussions, too - some of which are on the national debate agenda, but most are not. These included:
1) Cover everybody (surprise!). But on this one, the discussion focused more on having the federal government help pay for coverage expansions through Medicaid reimbursement expansions (like Massachusetts), rather than having the federal government do it themselves.
2) Do something about practice pattern variation. This one is a hot topic among the policy folks, but never gets into the public debate. Why? I suspect no one in politics wants to take on the notion that everything that’s done in health care isn’t “necessary.” Well I’ve got news for the politicians. If you want to do anything about the cost of care, you have to wrestle with this topic.
3) Squeeze the health insurance companies. Okay - I’ll be the first to admit that this one is a crowd pleaser, but at the end of the day, squeezing the insurance companies saves pennies on the dollar. Most independent studies indicate that plan administration represents less than 10% of total health care spending, so reducing it by 2-3% doesn’t really solve the problem. Every penny helps, I suppose, but no one’s going to solve the health care cost crisis by simply taking it out on the plans. There’s not enough money there to support more than a few months’ worth of medical expense trend.
4) Spend more federal research money on understanding how we apply the science we already know in the care delivery arena, and less on advancing basic science. If we really want to improve care delivery and enhance the cost/quality of the system overall, we have to start studying how and why we do what we do now, and the impact that has on outcomes. Simply advancing basic science without focusing on how we apply what we learn only answers half the question.
There were other topics as well - including transparency (but that came mostly from me). But what I found was a surprisingly large amount of common ground on what could be done. More importantly, a lot of the discussion was about improving quality and reducing the growth in medical expense trend - both of which can and should be priorities for the next President and the next Congress - with or without a federal budget deficit.
I do wish I saw more of this kind of talk in the public debates - and not just in the small-time ones I’m participating in.
Charlie,
I’m writing as someone you called “a good guy with whom I almost never agree” to say . . . I agree with you.
Massachusetts has an opportunity to propose major changes to how Medicare and other payers reimburse for services.
Section 44 of Chapter 305, the cost control bill, sets up a small commission, modeled on the pool commission you chaired in 1997, to recommend a common payment methodology across all public and private payers, including a plan for the commonwealth to seek a Medicare waiver to include Medicare in the common payment system.
According to the law, the payment model “(i) shall examine payment methodologies and purchasing strategies, including, but not limited to, alternatives to fee-for-service models such as blended capitation rates, episodes-of-care payments, medical home models, and global budgets; pay-for-performance programs; tiering of providers; and evidence-based purchasing strategies, (ii) recommend a common transparent payment methodology that promotes coordination of care and chronic disease management; rewards primary care physicians for improving health outcomes; reduces waste and duplication in clinical care; decreases unnecessary hospitalizations and use of ancillary services; and provides appropriate reimbursement for investment in health information technology that reduces medical errors and enables coordination of care.”
In other words, what you said.
We think a President Obama or McCain would be interested in letting a state try out a new model of Medicare reimbursement.
The Commission was supposed to be up and running by Sept. 15, and we hear they are still going through the steps needed to name the parties. We’re hoping they can quickly get this on track to do the hard work required.
Also, section 38 of the law directs EOHHS to maximize enrollment in dual eligible plans, such as SCOs, for people with both Medicare and Medicaid, in order to coordinate care better for people who face a complex push-pull from 2 different programs.
Brian Rosman
Charlie - I think you hear very little in terms of specifics on healthcare from the Presidential candidates because problems like Medicare are probably beyond fixing at this point. By doing nothing for so long, we are already in the beginning stages of the baby boomers aging into Medicare and the country facing sixty two TRILLION dollars in future unfunded Medicare liabilities. Couple this with a rising unemployment rate (i.e. decreased payroll taxes) and an overall drop in both federal and state tax revenues and you have Medicare costs rising out of control while federal income is being drastically reduced. The problem is actually becoming much worse as each day passes. The fact that neither candidate even talks about the scope of the problem tells me thay will continue running Medicare as usual while both parts of Medicare head towards insolvency. Again, I applaud your efforts but this may be “too little, too late” given how big the Medicare problem has become and the inability of any politician to even address the issue in public. If people think the current bailout is bad, wait until they are faced with the size and scope of the Medicare financial problems a few years down the road (not to mention Social Security).
Charlie – I think you all should try to implement episode pricing, at least for expensive surgical procedures. Paying more for primary care is also a good idea but I think it should be coupled with an attempt to, over time, reward the cost-effective doctors the most and penalize the high utilizers. I think one way to track utilization would be to focus on drug prescribing patterns and the cost of referrals for imaging and/or the cost of imaging performed on the doctor’s own equipment. Some means of risk scoring the patient panel would also be necessary. Tiering seems to work well to mitigate utilization of the most expensive prescription drugs. I see no reason why it couldn’t work if we tiered doctors and hospitals as well. Blended capitation sounds good in theory, but I think it is too hard for providers to accurately forecast their costs unless the patient population is extremely large. At the end of the day, we have to find effective ways to reward value (defined as health outcomes per dollar spent) and not just resource utilization which is what CMS has done historically.
Charlie- I would be interested in your and your viewers thoughts on the below proposal currently making the rounds in washington as it pertains to MA. With roughly 76 ERs, construction costs are roughly $152 million. MA population of 6.5 million would generate $195 million, or $60 million more than it would cost to run yearly. Capacity would easily be 1.5 million visits per year. Possibilities unlimited. Its kind of like “mass transit” for health care. Not to worry such a program is illegal in MA under the current insurance statues. I wonder if the candidates are watching.
National Access to Episodic Health Care Act
(Introduced in House & Senate)
S 2009 IS
H 2009 IH
111th CONGRESS
1st Session
S. 2009
H. 2009
To put forth a granting mechanism, provide funding for construction and establish parameters for basic levels of service in the first national interconnected Episodic Health Care System for all the people of the United States.
In the House and Senate of the United States
January 31, 2009
Ms. RS and Mr. DS (for themselves) introduced the following bill in the Senate; Ms. RR and Mr. DR (for themselves) introduced the following bill in the House; read twice in each chamber and referred to multiple select committees in both houses.
A BILL
To put forth a granting mechanism, provide funding for construction and establish
parameters for basic levels of service in the first National Interconnected Episodic Health
Care System for all the people of the United States.
Be it enacted by the Senate and House of Representatives of the United States of America in
Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘National Access to Episodic Health Care Act’. (NAEHCA)
SEC. 2. FINDINGS.
Congress makes the following findings:
(1) Americans are expected to spend $2,600,000,000,000 on health care in
2009, up from $1,900,000,000,000 in 2005 and projected to continue at.
6-7% increase per year for the foreseeable future.
(2) US emergency rooms had 115,000,000 visits in 2005, 12% were
admitted to the hospital. 101,200,000 visits were not admitted.
Expenses paid by all payers for care rendered in all emergency rooms in
the United States for patients seen and discharged, (not admitted to the
hospital) are expected to exceed $40,000,000,000 in 2009, up from
$17,313,000,000 in1999. These figures do not include administrative costs.
(3) Despite this large influx of funds, the number of people who leave
U.S. emergency rooms before seeing a provider have increased by 75% in
the last 8 years to 2,300,000 people per year. Of those 2.3 million people,
4% were estimated to need admission to the hospital at the time of their
visit.
(4) A rapidly increasing practice in US hospital emergency rooms exists
where the presenting medical acuity of a patient is declared non-emergent
and they are “triaged out” of the emergency room to seek health care in
another venue. Many of these patients, for various reasons, do not have
the means to seek care in another venue and must wait until their
conditions worsen to receive care.
(5) 158,000,000 Americans are covered by employer-sponsored health
insurance and another 14,000,000 buy their own individual health
insurance. Rising health insurance costs jeopardize the ability of
employers, employees and individuals to maintain coverage and is
potentially a public health risk to the citizens of the United States.
(6) One in every 6 people in the United States, or approximately 50,000,000
Americans, (Equal to the population of England or the number of all Americans west of the Mississippi River minus Texas, California, Washington and Wyoming) lacked health insurance in 2008. This number is expected to increase as health care costs rise. Excess numbers of death in this population due solely to the lack of insurance and therefore access to adequate care is estimated at 18,000 citizens per year.
(7) The Medicare program under title XVIII of the Social Security Act
(42 U.S.C. 1395 et seq.) provide health insurance to 44,200,000 elderly
and disabled Americans in 2008, while the Medicaid program under title
XIX of the Social Security Act (42 U.S.C. 1396 et seq.) provided care for
59,000,000 low income children and their parents, pregnant women and
low income elderly individuals in 2008. Federal and State government
expenditures for both programs were approximately $682,000,000,000.
Out-of-pocket expenditures, secondary insurance/pension payments and
other third party payments contribute another $380,000,000,000 in this
population. Future financial projections show the Medicare Act will fall
into insolvency by 2018. Medicaid will push the States into larger
unsustainable budget deficits.
(8) Approximately 85% of the U.S. citizens will experience a health expense
this year. One out of seven Americans (44 million people) will seek care
in a US hospital emergency room in 2008. Millions more pay for their
episodic health care in urgent care centers, retail clinics, community
health centers, and primary physician offices. Medical expenses paid
out of pocket by U.S. citizens is increasing every year, especially for those
age 65 and over.
(9) At the present time no national system, with or without an interconnected
electronic medical record system, exists to provide episodic care to all the
citizens of the United States regardless of their age, insurance, or
economic status.
(10) Secondary to the previous findings, future demographics and financial projections, Congress finds that health care in the United States of America, as presently delivered, demanded and paid for is not sustainable. Health care costs directly limit job creation outside the health care sector, inhibits America from competing in the global economy; threatens the solvency of individuals, families, companies, and pension funds. Government health care costs place catastrophic financial burdens on local, state and federal governments. Costs for health care and indirectly access to care place the lives of Americans in unwarranted and avoidable danger. Health care costs have become a threat to the National economy. Secondary to these findings et al., health costs are considered by Congress to pose a threat to the security of the United States of America.
(11)The establishment of a National Episodic Health Care System, whose
electronic medical records are totally interconnected, is deemed vital to
the health and financial security of citizens of the United States and
in the National interest.
SEC. 3 PURPOSE.
The purpose of this Act is:
(1)To establish a funding mechanism and protocols where every county in the United States may petition funds from the Federal government for the construction of State-of-the-Art Urgent Care Centers.
(2)Establish the basic levels of service each individual center must provide
to the people residing in said counties. The centers need not be limited to
the established levels of service, but must provide them to obtain funding.
Paramount among the requirements will be the willingness of the
participating counties to have their centers’ ELECTRONIC MEDICAL RECORD SYSTEMS interconnected with all other participating counties in the United States and that all the citizens in one participating county be able to access the centers in another participating county when circumstances dictate.
(3) To establish funding for the various federal agencies to monitor the
National EMR grid such as; CDC, FDA, NIH et al.
(4) For the people: (not limited to, but including)
(a) Freeing citizens from financial concerns in seeking their
episodic and urgent health care.
(b)Provides people options where to receive episodic care no matter where the need may arise for themselves or their families anywhere in America.
(c) Allow greater freedom and choice in how Americans wish to
secure and pay for their and their families overall health insurance
needs.
(d) Reduce their out of pocket health expenditures.
(e) Provide greater communication between their primary care
physicians and urgent care providers.
(f) Establishes centers for information on; health care, points of access
to care available in their own counties of residence, their illness,
evidenced based care, health insurance, health literacy and
pharmaceutical information.
(g) Decreased morbidity and mortality.
(5) For the providers: (not limited to, but including)
(a) Better patient care with detailed patient visit reports in their
offices by e-mail or fax within 24 hrs of their patients visits
to one of the centers anywhere in the US.
(b) Relief of after hours patient care.
(c) Assistance with their patients P4P accounting system.
(d) Improve Hospital revenues on admitted patients from centers
with direct admission and accompanying preliminary testing.
(e) Decreased uncompensated care at every level.
(f) Decompression of Emergency room traffic
(g) Decompression of Federal Qualified Health Center traffic.
(h) Dissemination of evidenced based health care information,
advertising of physician office services, scheduling appointments,
and increasing their patient base.
(i) Assist new physicians and health care workers in paying off their
medical education debt.
(6) For the Payers: (not limited to, but including)
(a) Conservative estimates of 40% saving ($24,000,000,000) on
Emergency room cost per year the first year of full participation.
(b) Greater control of healthcare inflation, at least in this sector of
health care, providing greater savings every year.
(c) Allow greater creativity in insurance packaging/offers to US
Citizens making health insurance less expensive to all.
(d) Dissemination of insurance information.
(7) National Security
This program establishes the first National Interconnected Health
Grid where one currently does not exist.
A National interconnected health care grid enables multiple
federal and state agencies to monitor for outbreaks of disease from all
causes, drug reactions and public health research. Such a system
allows greater response to man made and natural disasters, rapid
vaccination and information dissemination.
SEC. 4 EPISODIC CARE CENTERS:
Services provided and basic specifications of each center to be constructed
locally and funded by Congress include but not limited to:
(1) Building shell and floor plan:
(a) Waiting room with space available for information Kiosk.
(b) Reception area.
(c) 8-10 examination/procedure rooms.
(d) Provider dictation/information center.
(e) X-ray room generator and digital processor room with internet capabilities.(PACS).
(f) Medical Laboratory with a laboratory information system.(LIS)
(g) Adequate storage and refrigeration space.
(h) Staff room.
(i) On site self contained electrical generator capability so site may
continue full functional capacity in the event of power loss for
any reason.
(j) EMR soft & hardware:
Must be capable of but not limited to the following:
(1) Each center must be “paperless” with on/off site storage
of files.
(2) Patients should be able to register electronically at the
Centers and from home via the internet if they desire.
(3) Real time wait to be seen times posted on the internet.
(4) Electronic dictation and records, voice activated preferred but not necessary. Must be wireless.
(5) E-prescription services.
(6) Visit copies sent via e-mail or fax to whoever the patient authorizes.
(7) Laboratory and x-ray information systems.
Results must be able to be viewed over the internet by
patients.
(8) Real time data mining capabilities.
(9) Connected to local hospitals’ and Community Health Centers’ patient data systems. Private physicians with EMRs may connect at their discretion.
(10)All centers must be capable of being tied into the
National Medical Record system.
(11)All connections must meet all security requirements.
(2) Services, including but not limited to:
(a) All general urgent care services and conditions not requiring
emergent care, invasive diagnostic testing or invasive
procedures. Each center will be capable of serving at least 60%
of the visits currently seen in US emergency rooms.
(b) All centers must be ACLS/PALS certified and capable for
adult and pediatric patients.
(c) Laboratory capabilities, CLIA certified, Chemistry,
Hematology, Coagulation, Urinalysis and rapid
screen testing for Strep, influenza, Pregnancy, et al. as
determined by CLIA.
(d) Digital X-ray generation and processing with PACS system.
(e) Direct admission protocols to local hospitals.
(f) Visit reports including Physician dictation, lab and x-ray
reports, P4P criteria and status of patient, evidence based
treatment and follow up information sent via e-mail or fax
in 24 hours to primary care physician any where in the US.
Assistance in scheduling of patients from clinic to office
for appointments. May be done electronically for those
physicians who wish to connect to system.
(g) Services provided will be free of charge to all citizens
currently residing in participating counties. If a covered
citizen requires care when outside his county of residence
care will be rendered at no charge if the county in which they
are seeking care is also a participating county any where in
the United States. Charges to citizens who resided in a
nonparticipating county who wish to obtain care in an
urgent care center of a participating county will pay costs
. as determined by the county health centers governing body.
(h)The capacity of each center shall be at least 15,500 visits
per year unless a waiver is granted.
SEC 5. FUNDING:
Total cost of the program for construction of all centers in the US
and construction of the national information system shall not exceed
$10,000,000,000. Program will run over 5 years with $2,000,000,000 available each year for construction. Expected cost for each center is expected to be
$2,000,000 each if construction is new. Costs maybe reduced if
centers already existing and meeting all qualifications can be bought
out right or leased and retrofitted. Counties will be limited in the first round of funding to one center for every emergency department within their boundaries. Specifications for each center shall
contain the following , but not limited to:
(a) Capacity of at least 15,500 visits per year, unless waived.
(b) All service capabilities as stated above and to be determined.
(c) Located as close to existing emergency rooms in the
County as possible. (approximately 3,900 emergency rooms
In the U.S.)
(d) Conform to local building codes.
(c) Meet all biological waste disposal criteria.
(d) Meet all provisions of the American’s with Disabilities
Act of 1990.
(e) Meet all energy reduction specifications. Must have on site
emergency electrical generation capabilities to run
at full service capacity during usual hours of operation
for 3 days time.
Congress and the various federal agencies will be responsible solely for the
construction of , initial equipping of the centers, connections to the national
grid and costs for maintaining/monitoring the national health information
system.
Before funding is granted for construction, EACH COUNTY MUST SUBMIT A PLAN FOR FUNDING THE ONGOING COSTS TO RUN THE CENTERS CONSTRUCTED IN THEIR COUNTY. This is a well known process to all counties in the US and similar to other Congressional requirements for funding similar projects, i.e. Federal mass transit funding. Expected costs to the counties to run all the centers constructed in their county at the specified levels of service and capacity is approximately $25-$35 for each citizen in the county per year.
Counties without a current hospital or large enough population to sustain running even one center may apply for funding under a variance of the rule and in conjunction with the Department of Health and Human Services.
Each county must also establish a governing body to administer the centers.
Revenues collected for the purpose of operating, maintain and administering said centers must be held separately from other county revenue funds.
SEC. 6 ROLE OF FEDERAL GOVERNMENT
Congress has established the following as the role to be played by
the Federal government in establishing and maintaining the elements
of this Act. (to include, but not limited to)
(a) One time funding for construction and initial equipping of the
episodic health care centers.
(b) Ongoing funding of various federal agencies for the maintenance,
monitoring and research of the National health information grid.
(c) Congress directs the Congressional Budget Office to investigate
the above Act for cost analysis, budget rules of the Congress and
long term projections of the effect on health care delivery and costs.
(d) Congress further directs the multiple various agencies; CDC, FDA,
HHS, CMS, FEMA, et al, to provide input and comment on their
roles, estimated funding requirements and implementation on the
above Act.
SEC. 7 ROLE OF LOCAL GOVERNING BODY
Congress mandates and confers the following requirements and responsibilities
to the local governing bodies which must be created to obtain funding for
construction. (to include, but not limited to)
(a) To maintain the basic levels of episodic care as established by this
Act. Higher levels of service and additional services may be
established by the county citizens and governing bodies. These
additional services will be at the discretion of the county citizens
and will not constitute an encumbrance on Congress.
(b) To establish the mechanism for the collection of revenues to
pay salaries, maintain building and equipment, administer and
provide to their citizens said level of basic services. The revenues
collected will be the sole possession of the governing bodies established under this act and the citizens they serve. No state, county or any other local governing entity may make claim to or incorporate into their general funds the revenues so collected.
Existing estimates of costs to each citizen within the boundary of
a county to be $25-35 per year. After payment of such fee, persons
are entitled to care at any center within the county and any center in
any other participating county in the United States free of any other
costs.
(c) To maintain a listing of citizens residing within the county’s
borders and therefore eligible to receive care at the centers.
Said listings must be available to all other participating counties
to allow reciprocal participation among their citizens. Only
citizens of the United States will be eligible for care under this Act.
Foreign nationals and citizens of counties not participating will be
able to receive care at the centers under the rules, regulations and
costs to be determined by the local governing bodies.
As passed by the Congress and sent to the President of the United States for his consideration, comment and approval, this day.
EXECUTIVE SUMMARY
Ironically, the costs of health care in America are rapidly becoming a leading detrimental
factor to the health of its citizens, regardless of their age, race or economic status. Every year that passes reveals ever greater costs to the many different payers. These escalating costs result in employers struggling to pay for employees’ health insurance. More of our citizens are going without insurance and basic health care. Local, state and the federal government budgets are reeling under the costs to provide health care to over 1/3 the population of America.
No matter how you look at future projections of demands and costs for health care, it is
quite apparent that the present method of supplying and paying for health care in America is unsustainable. America is not alone in this predicament. Costs are accelerating around the world and improved quality is a concern for all nations. Many industrialized countries are grappling with how to meet their populations increasing demand for Urgent Health Care. What the tipping point is regarding the percentage of GDP devoted to health care and a country’s economic viability is unknown. Many feel that it is rapidly approaching in America. For many of our fellow countrymen and their families, the 18,000 Americans that are estimated to die every year because of a lack of health care, that point has already arrived.
Health care reform in America has been going on for over 100 years. Health care delivery
is basically the same as it was at the beginning of the 20th centaury although the technology is much more advanced. The third party payment system, employer provider insurance, exploded during and after World War II. State sponsored insurance has been growing for over forty years. These and other changes have brought us to where we are today. America has the greatest health care in the world, but only if you know how and where to get it, pay for it and hope the system works as planned. Health care in America is not a system by definition, but a piecemeal, nonintegrated collection of payers, providers and information. Even when you have the money and knowledge to access the system a good outcome is not a certainty. Strains on system capacity result in greater amounts of patient misinformation, lack of information and medical error which increase costs, morbidity and mortality regardless of a patients intelligence or wealth.
Today, with a presidential election looming, healthcare is again coming to the forefront.
The proposals presented mainly attempt to address the cost of procuring health insurance
and are divide into 2 main camps. One plan championing “free market” principles and individual responsibility and the other based on “Universal Coverage”. Both are based on good hypotheses and have an emotional appeal to different segments of the country. Both have their deficiencies. Neither addresses the concerns of access and system capacity. They minimally address the information gaps at all levels. Whether they will decrease health care costs is a hotly debated issue. Neither addresses the looming issues on Medicare and Medicaid.
What role does the “National Access to Episodic Health Care Act” play in the overall plan to provide less expensive, quality health care in America? How will it address the above concerns and what does the NAEHCA do?
The “Act” as proposed provides the American people, county by county, throughout the United States a choice. There are no mandates of how people would pay for, seek and meet this specific area of their health care needs, their urgent or episodic health care. The demand in America for this type of care has been increasing rapidly over the last 10 to 20 years. The need for episodic care is evident by the rapidly growing numbers of emergency room visits, urgent care centers and newer retail clinics to meet the demand. Care delivered by these various entities is vastly more expensive then the system proposed by the Act. None of the various providers are interconnected. They also cannot expand their services the way this proposed system would be able to. The Act provides savings and incentives for all parties concerned in providing, receiving and paying for health care.
NAEHCA establishes a program where the People in any county in America either through referendum or their elected officials will be able to establish an episodic health care system in their county. The Federal government provides the funds for the construction and capital costs for initial equipment in each center. Each center will on average cost the $2,000,000 to construct and equip. The centers are then turned over to the “governing body” established by the People in each county to run and maintain the centers. Construction costs to the federal government for establishing and equipping a center near every emergency room in the country, 3,900 centers, are $7,800,000,000. In 2005, the federal and state governments paid for 51,000,000 visits to emergency rooms alone in the U.S. Only about 19% of the visits required immediate or emergent care. This doesn’t include episodic care paid for in other ambulatory care settings. This one time payout pales in comparison to the savings such a system would generate and the saving would become larger every year. Likewise, all payers of these types of visits would reap large savings by such a program. Private insurers and workman’s compensation insurers would also benefit with large savings. Together they had 48,000,000 visits to U.S. emergency rooms in 2005 of which only about 15% were immediate or emergent. Perhaps a Public-Private partnership to fund the initial construction and equipping of the centers could be arranged since all payers would benefit? Out-of-pocket expenses paid by the citizens of the United States for their ER/Urgent care needs has increased every year, with the elderly making the highest cash payments. When fully constructed the system could easily handle over 60,000,000 urgent/episodic care visits per year and its full capacity approaches 100,000,000 visits per year.
Other expenses generated and paid by the Federal government would be for the maintenance and monitoring of the national episodic care center health grid. Various federal authorities such as the CDC, FDA and NIH would be able to monitor the grid for outbreaks of illness, drug reactions and perform public health research. Areas of low vaccination rates could be targeted. Populations with low achievement of evidenced based preventative health measures and their primary care physicians could be contacted
and the quality of their health care increased and physician’s P4P increased. All centers would have internal electrical capabilities for 3 days allowing continued health care during natural disasters, areas important to FEMA and Homeland Security.
The figure of $10,000,000,000 established by the Act to pay for construction and initial equipment may seem unprecedented. The federal government will pay $1,500,000,000 to close 7% of the hospital beds in New York state alone over the next 4 years. The Genome Project, the sequencing of the human gene structure cost more than $5,000,000,000,000. Estimated savings to all payers in the system approaches $24,000,000,000 in the first year and will increase every year. These savings maybe dwarfed by those achieved through changes in the costs of health insurance, the increased overall health of the American citizen and boost to the overall US economy which will occur as a result of enacting this bill.
Although a national episodic health care system will provide billions of dollars in savings
to the various payers of such care, both in direct payouts and processing expenses, the greatest benefits would be to the people of the United States. With such a system in place the citizens of a participating county each pay on average $30 per year, about 8 cents per day. This entitles them to go not only to any of the established clinics in their own counties, but any other clinic in any other participating county and as often as needed. The level of service provided is at least equal to that provide by a hospital based urgent care center. Direct out-of-pocket saving to the public is in the billions of dollars. For $30 per year the person’s episodic health care needs are removed from their overall health insurance costs. This allows them to purchase other health insurance at a reduced cost. Insures would be able to expand and individualize health insurance plans with greater freedom and cost. Such a system alleviates people’s concern for their costs of urgent care. These concerns prevent people from seeking care early on in the disease process and cause unnecessary and more invasive care later on. Those people who still wish to receive their care in an emergency room or other setting may do so but they and their insurance carrier will incur the cost. There are no mandates where people must seek their care. For those people traveling on vacation, business or migrating for the season their episodic care is easily and readily available and at no additional cost except the $30 dollars per year they paid in their home county, providing they seek care in another participating county. The cost savings are only the beginning of the benefits such a system would provide. Availability of health information, direct admission to the hospital if needed, assistance with health and insurance information, increase evidenced based care are only a few. The people in the county may wish to increase the types of services available at their county clinics and by referendum or through their governing bodies provide emergency dental care or psychiatric care. This is health care organized at its most basic level, the county. Money collected does not leave the county but pays for jobs and services in the county. This is not government health care or mandates, but managed by “Governing Bodies” made up of people living within the county.
Financially, this plan works in every Metropolitan Service Area of the country where approximately 85% of all ER visits occur. (Try the formula in your county). Take the number of emergency rooms located in your own county. Using this as the number of episodic health care centers erected in your county, multiply the number of centers by $1,800,000 which is the amount of money required to run each center for a year. Multiply the total population, number of people living in your county, by $25-$35 which gives you the total amount of money collected in your county each year. The formula works for every county with a population greater than 50,000 in the US. As an example, the nation’s capital will be used. Washington D.C. has 8 emergency rooms. It would cost $14,400,000 to operate the 8 centers constructed. The 2006 population estimate for Washington D.C. is 581,530 people. With each citizen paying $30 per year, $17,445,900 would be raised. This is more than enough funds to run the centers which at a minimum would provide 124,000 visits per year and a capacity approaching 200,000 visits per year.
Once constructed and connected, the possibilities of providing care, reducing costs and increasing the quality of care to each individual in America and the country as a whole depends only on what the people in each individual county can imagine and are willing to pay for. For the first time in America, healthcare, at least their episodic health care, delivery will be directed not according to insurance status or income, age or employment status, but by all the people in a given community for the common good, much like their transportation needs are coming to be met.
The future of how we in America plan to provide and pay for health care is uncertain.
Regardless of the plan that will be implemented, market based, single payer, some mixture of existing plans, or the status quo, NAEHCA and the system that it creates will make the delivery and cost of health care more efficient and less expensive for every single American regardless of their economic or social standing. The Act does not replace providers but enhances their abilities to provide care. These facts hold true for either presidential candidate’s plan or the Patient-Centered Medical Home Model put forth by AAFP, AAP and ACP. If for no other reasons than those, the “NAEHCA” deserves to be debated in the halls and on the floors of Congress.
National Access to Episodic Health Care Act
(Introduced in House & Senate)
S 2009 IS
H 2009 IH
111th CONGRESS
1st Session
S. 2009
H. 2009
To put forth a granting mechanism, provide funding for construction and establish parameters for basic levels of service in the first national interconnected Episodic Health Care System for all the people of the United States.
In the House and Senate of the United States
January 31, 2009
Ms. RS and Mr. DS (for themselves) introduced the following bill in the Senate; Ms. RR and Mr. DR (for themselves) introduced the following bill in the House; read twice in each chamber and referred to multiple select committees in both houses.
A BILL
To put forth a granting mechanism, provide funding for construction and establish
parameters for basic levels of service in the first National Interconnected Episodic Health
Care System for all the people of the United States.
Be it enacted by the Senate and House of Representatives of the United States of America in
Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘National Access to Episodic Health Care Act’. (NAEHCA)
SEC. 2. FINDINGS.
Congress makes the following findings:
(1) Americans are expected to spend $2,600,000,000,000 on health care in
2009, up from $1,900,000,000,000 in 2005 and projected to continue at.
6-7% increase per year for the foreseeable future.
(2) US emergency rooms had 115,000,000 visits in 2005, 12% were
admitted to the hospital. 101,200,000 visits were not admitted.
Expenses paid by all payers for care rendered in all emergency rooms in
the United States for patients seen and discharged, (not admitted to the
hospital) are expected to exceed $40,000,000,000 in 2009, up from
$17,313,000,000 in1999. These figures do not include administrative costs.
(4) Despite this large influx of funds, the number of people who leave
U.S. emergency rooms before seeing a provider have increased by 75% in
the last 8 years to 2,300,000 people per year. Of those 2.3 million people,
4% were estimated to need admission to the hospital at the time of their
visit.
(4) A rapidly increasing practice in US hospital emergency rooms exists
where the presenting medical acuity of a patient is declared non-emergent
and they are “triaged out” of the emergency room to seek health care in
another venue. Many of these patients, for various reasons, do not have
the means to seek care in another venue and must wait until their
conditions worsen to receive care.
(9) 158,000,000 Americans are covered by employer-sponsored health
insurance and another 14,000,000 buy their own individual health
insurance. Rising health insurance costs jeopardize the ability of
employers, employees and individuals to maintain coverage and is
potentially a public health risk to the citizens of the United States.
(10) One in every 6 people in the United States, or approximately 50,000,000
Americans, (Equal to the population of England or the number of all Americans west of the Mississippi River minus Texas, California, Washington and Wyoming) lacked health insurance in 2008. This number is expected to increase as health care costs rise. Excess numbers of death in this population due solely to the lack of insurance and therefore access to adequate care is estimated at 18,000 citizens per year.
(11) The Medicare program under title XVIII of the Social Security Act
(42 U.S.C. 1395 et seq.) provide health insurance to 44,200,000 elderly
and disabled Americans in 2008, while the Medicaid program under title
XIX of the Social Security Act (42 U.S.C. 1396 et seq.) provided care for
59,000,000 low income children and their parents, pregnant women and
low income elderly individuals in 2008. Federal and State government
expenditures for both programs were approximately $682,000,000,000.
Out-of-pocket expenditures, secondary insurance/pension payments and
other third party payments contribute another $380,000,000,000 in this
population. Future financial projections show the Medicare Act will fall
into insolvency by 2018. Medicaid will push the States into larger
unsustainable budget deficits.
(12) Approximately 85% of the U.S. citizens will experience a health expense
this year. One out of seven Americans (44 million people) will seek care
in a US hospital emergency room in 2008. Millions more pay for their
episodic health care in urgent care centers, retail clinics, community
health centers, and primary physician offices. Medical expenses paid
out of pocket by U.S. citizens is increasing every year, especially for those
age 65 and over.
(9) At the present time no national system, with or without an interconnected
electronic medical record system, exists to provide episodic care to all the
citizens of the United States regardless of their age, insurance, or
economic status.
(10) Secondary to the previous findings, future demographics and financial projections, Congress finds that health care in the United States of America, as presently delivered, demanded and paid for is not sustainable. Health care costs directly limit job creation outside the health care sector, inhibits America from competing in the global economy; threatens the solvency of individuals, families, companies, and pension funds. Government health care costs place catastrophic financial burdens on local, state and federal governments. Costs for health care and indirectly access to care place the lives of Americans in unwarranted and avoidable danger. Health care costs have become a threat to the National economy. Secondary to these findings et al., health costs are considered by Congress to pose a threat to the security of the United States of America.
(11)The establishment of a National Episodic Health Care System, whose
electronic medical records are totally interconnected, is deemed vital to
the health and financial security of citizens of the United States and
in the National interest.
SEC. 3 PURPOSE.
The purpose of this Act is:
(1)To establish a funding mechanism and protocols where every county in the United States may petition funds from the Federal government for the construction of State-of-the-Art Urgent Care Centers.
(2)Establish the basic levels of service each individual center must provide
to the people residing in said counties. The centers need not be limited to
the established levels of service, but must provide them to obtain funding.
Paramount among the requirements will be the willingness of the
participating counties to have their centers’ ELECTRONIC MEDICAL RECORD SYSTEMS interconnected with all other participating counties in the United States and that all the citizens in one participating county be able to access the centers in another participating county when circumstances dictate.
(7) To establish funding for the various federal agencies to monitor the
National EMR grid such as; CDC, FDA, NIH et al.
(8) For the people: (not limited to, but including)
(a) Freeing citizens from financial concerns in seeking their
episodic and urgent health care.
(b)Provides people options where to receive episodic care no matter where the need may arise for themselves or their families anywhere in America.
(c) Allow greater freedom and choice in how Americans wish to
secure and pay for their and their families overall health insurance
needs.
(f) Reduce their out of pocket health expenditures.
(g) Provide greater communication between their primary care
physicians and urgent care providers.
(f) Establishes centers for information on; health care, points of access
to care available in their own counties of residence, their illness,
evidenced based care, health insurance, health literacy and
pharmaceutical information.
(g) Decreased morbidity and mortality.
(9) For the providers: (not limited to, but including)
(a) Better patient care with detailed patient visit reports in their
offices by e-mail or fax within 24 hrs of their patients visits
to one of the centers anywhere in the US.
(b) Relief of after hours patient care.
(c) Assistance with their patients P4P accounting system.
(d) Improve Hospital revenues on admitted patients from centers
with direct admission and accompanying preliminary testing.
(e) Decreased uncompensated care at every level.
(f) Decompression of Emergency room traffic
(g) Decompression of Federal Qualified Health Center traffic.
(h) Dissemination of evidenced based health care information,
advertising of physician office services, scheduling appointments,
and increasing their patient base.
(i) Assist new physicians and health care workers in paying off their
medical education debt.
(10) For the Payers: (not limited to, but including)
(a) Conservative estimates of 40% saving ($24,000,000,000) on
Emergency room cost per year the first year of full participation.
(b) Greater control of healthcare inflation, at least in this sector of
health care, providing greater savings every year.
(d) Allow greater creativity in insurance packaging/offers to US
Citizens making health insurance less expensive to all.
(d) Dissemination of insurance information.
(7) National Security
This program establishes the first National Interconnected Health
Grid where one currently does not exist.
A National interconnected health care grid enables multiple
federal and state agencies to monitor for outbreaks of disease from all
causes, drug reactions and public health research. Such a system
allows greater response to man made and natural disasters, rapid
vaccination and information dissemination.
SEC. 4 EPISODIC CARE CENTERS:
Services provided and basic specifications of each center to be constructed
locally and funded by Congress include but not limited to:
(2) Building shell and floor plan:
(a) Waiting room with space available for information Kiosk.
(b) Reception area.
(c) 8-10 examination/procedure rooms.
(d) Provider dictation/information center.
(e) X-ray room generator and digital processor room with internet capabilities.(PACS).
(f) Medical Laboratory with a laboratory information system.(LIS)
(g) Adequate storage and refrigeration space.
(h) Staff room.
(i) On site self contained electrical generator capability so site may
continue full functional capacity in the event of power loss for
any reason.
(j) EMR soft & hardware:
Must be capable of but not limited to the following:
(1) Each center must be “paperless” with on/off site storage
of files.
(2) Patients should be able to register electronically at the
Centers and from home via the internet if they desire.
(3) Real time wait to be seen times posted on the internet.
(4) Electronic dictation and records, voice activated preferred but not necessary. Must be wireless.
(5) E-prescription services.
(6) Visit copies sent via e-mail or fax to whoever the patient authorizes.
(7) Laboratory and x-ray information systems.
Results must be able to be viewed over the internet by
patients.
(8) Real time data mining capabilities.
(9) Connected to local hospitals’ and Community Health Centers’ patient data systems. Private physicians with EMRs may connect at their discretion.
(10)All centers must be capable of being tied into the
National Medical Record system.
(11)All connections must meet all security requirements.
(2) Services, including but not limited to:
(a) All general urgent care services and conditions not requiring
emergent care, invasive diagnostic testing or invasive
procedures. Each center will be capable of serving at least 60%
of the visits currently seen in US emergency rooms.
(b) All centers must be ACLS/PALS certified and capable for
adult and pediatric patients.
(c) Laboratory capabilities, CLIA certified, Chemistry,
Hematology, Coagulation, Urinalysis and rapid
screen testing for Strep, influenza, Pregnancy, et al. as
determined by CLIA.
(d) Digital X-ray generation and processing with PACS system.
(e) Direct admission protocols to local hospitals.
(f) Visit reports including Physician dictation, lab and x-ray
reports, P4P criteria and status of patient, evidence based
treatment and follow up information sent via e-mail or fax
in 24 hours to primary care physician any where in the US.
Assistance in scheduling of patients from clinic to office
for appointments. May be done electronically for those
physicians who wish to connect to system.
(g) Services provided will be free of charge to all citizens
currently residing in participating counties. If a covered
citizen requires care when outside his county of residence
care will be rendered at no charge if the county in which they
are seeking care is also a participating county any where in
the United States. Charges to citizens who resided in a
nonparticipating county who wish to obtain care in an
urgent care center of a participating county will pay costs
. as determined by the county health centers governing body.
(h)The capacity of each center shall be at least 15,500 visits
per year unless a waiver is granted.
SEC 5. FUNDING:
Total cost of the program for construction of all centers in the US
and construction of the national information system shall not exceed
$10,000,000,000. Program will run over 5 years with $2,000,000,000 available each year for construction. Expected cost for each center is expected to be
$2,000,000 each if construction is new. Costs maybe reduced if
centers already existing and meeting all qualifications can be bought
out right or leased and retrofitted. Counties will be limited in the first round of funding to one center for every emergency department within their boundaries. Specifications for each center shall
contain the following , but not limited to:
(f) Capacity of at least 15,500 visits per year, unless waived.
(g) All service capabilities as stated above and to be determined.
(c) Located as close to existing emergency rooms in the
County as possible. (approximately 3,900 emergency rooms
In the U.S.)
(d) Conform to local building codes.
(h) Meet all biological waste disposal criteria.
(i) Meet all provisions of the American’s with Disabilities
Act of 1990.
(j) Meet all energy reduction specifications. Must have on site
emergency electrical generation capabilities to run
at full service capacity during usual hours of operation
for 3 days time.
Congress and the various federal agencies will be responsible solely for the
construction of , initial equipping of the centers, connections to the national
grid and costs for maintaining/monitoring the national health information
system.
Before funding is granted for construction, EACH COUNTY MUST SUBMIT A PLAN FOR FUNDING THE ONGOING COSTS TO RUN THE CENTERS CONSTRUCTED IN THEIR COUNTY. This is a well known process to all counties in the US and similar to other Congressional requirements for funding similar projects, i.e. Federal mass transit funding. Expected costs to the counties to run all the centers constructed in their county at the specified levels of service and capacity is approximately $25-$35 for each citizen in the county per year.
Counties without a current hospital or large enough population to sustain running even one center may apply for funding under a variance of the rule and in conjunction with the Department of Health and Human Services.
Each county must also establish a governing body to administer the centers.
Revenues collected for the purpose of operating, maintain and administering said centers must be held separately from other county revenue funds.
SEC. 6 ROLE OF FEDERAL GOVERNMENT
Congress has established the following as the role to be played by
the Federal government in establishing and maintaining the elements
of this Act. (to include, but not limited to)
(a) One time funding for construction and initial equipping of the
episodic health care centers.
(b) Ongoing funding of various federal agencies for the maintenance,
monitoring and research of the National health information grid.
(c) Congress directs the Congressional Budget Office to investigate
the above Act for cost analysis, budget rules of the Congress and
long term projections of the effect on health care delivery and costs.
(d) Congress further directs the multiple various agencies; CDC, FDA,
HHS, CMS, FEMA, et al, to provide input and comment on their
roles, estimated funding requirements and implementation on the
above Act.
SEC. 7 ROLE OF LOCAL GOVERNING BODY
Congress mandates and confers the following requirements and responsibilities
to the local governing bodies which must be created to obtain funding for
construction. (to include, but not limited to)
(c) To maintain the basic levels of episodic care as established by this
Act. Higher levels of service and additional services may be
established by the county citizens and governing bodies. These
additional services will be at the discretion of the county citizens
and will not constitute an encumbrance on Congress.
(d) To establish the mechanism for the collection of revenues to
pay salaries, maintain building and equipment, administer and
provide to their citizens said level of basic services. The revenues
collected will be the sole possession of the governing bodies established under this act and the citizens they serve. No state, county or any other local governing entity may make claim to or incorporate into their general funds the revenues so collected.
Existing estimates of costs to each citizen within the boundary of
a county to be $25-35 per year. After payment of such fee, persons
are entitled to care at any center within the county and any center in
any other participating county in the United States free of any other
costs.
(c) To maintain a listing of citizens residing within the county’s
borders and therefore eligible to receive care at the centers.
Said listings must be available to all other participating counties
to allow reciprocal participation among their citizens. Only
citizens of the United States will be eligible for care under this Act.
Foreign nationals and citizens of counties not participating will be
able to receive care at the centers under the rules, regulations and
costs to be determined by the local governing bodies.
As passed by the Congress and sent to the President of the United States for his consideration, comment and approval, this day.
EXECUTIVE SUMMARY
Ironically, the costs of health care in America are rapidly becoming a leading detrimental
factor to the health of its citizens, regardless of their age, race or economic status. Every year that passes reveals ever greater costs to the many different payers. These escalating costs result in employers struggling to pay for employees’ health insurance. More of our citizens are going without insurance and basic health care. Local, state and the federal government budgets are reeling under the costs to provide health care to over 1/3 the population of America.
No matter how you look at future projections of demands and costs for health care, it is
quite apparent that the present method of supplying and paying for health care in America is unsustainable. America is not alone in this predicament. Costs are accelerating around the world and improved quality is a concern for all nations. Many industrialized countries are grappling with how to meet their populations increasing demand for Urgent Health Care. What the tipping point is regarding the percentage of GDP devoted to health care and a country’s economic viability is unknown. Many feel that it is rapidly approaching in America. For many of our fellow countrymen and their families, the 18,000 Americans that are estimated to die every year because of a lack of health care, that point has already arrived.
Health care reform in America has been going on for over 100 years. Health care delivery
is basically the same as it was at the beginning of the 20th centaury although the technology is much more advanced. The third party payment system, employer provider insurance, exploded during and after World War II. State sponsored insurance has been growing for over forty years. These and other changes have brought us to where we are today. America has the greatest health care in the world, but only if you know how and where to get it, pay for it and hope the system works as planned. Health care in America is not a system by definition, but a piecemeal, nonintegrated collection of payers, providers and information. Even when you have the money and knowledge to access the system a good outcome is not a certainty. Strains on system capacity result in greater amounts of patient misinformation, lack of information and medical error which increase costs, morbidity and mortality regardless of a patients intelligence or wealth.
Today, with a presidential election looming, healthcare is again coming to the forefront.
The proposals presented mainly attempt to address the cost of procuring health insurance
and are divide into 2 main camps. One plan championing “free market” principles and individual responsibility and the other based on “Universal Coverage”. Both are based on good hypotheses and have an emotional appeal to different segments of the country. Both have their deficiencies. Neither addresses the concerns of access and system capacity. They minimally address the information gaps at all levels. Whether they will decrease health care costs is a hotly debated issue. Neither addresses the looming issues on Medicare and Medicaid.
What role does the “National Access to Episodic Health Care Act” play in the overall plan to provide less expensive, quality health care in America? How will it address the above concerns and what does the NAEHCA do?
The “Act” as proposed provides the American people, county by county, throughout the United States a choice. There are no mandates of how people would pay for, seek and meet this specific area of their health care needs, their urgent or episodic health care. The demand in America for this type of care has been increasing rapidly over the last 10 to 20 years. The need for episodic care is evident by the rapidly growing numbers of emergency room visits, urgent care centers and newer retail clinics to meet the demand. Care delivered by these various entities is vastly more expensive then the system proposed by the Act. None of the various providers are interconnected. They also cannot expand their services the way this proposed system would be able to. The Act provides savings and incentives for all parties concerned in providing, receiving and paying for health care.
NAEHCA establishes a program where the People in any county in America either through referendum or their elected officials will be able to establish an episodic health care system in their county. The Federal government provides the funds for the construction and capital costs for initial equipment in each center. Each center will on average cost the $2,000,000 to construct and equip. The centers are then turned over to the “governing body” established by the People in each county to run and maintain the centers. Construction costs to the federal government for establishing and equipping a center near every emergency room in the country, 3,900 centers, are $7,800,000,000. In 2005, the federal and state governments paid for 51,000,000 visits to emergency rooms alone in the U.S. Only about 19% of the visits required immediate or emergent care. This doesn’t include episodic care paid for in other ambulatory care settings. This one time payout pales in comparison to the savings such a system would generate and the saving would become larger every year. Likewise, all payers of these types of visits would reap large savings by such a program. Private insurers and workman’s compensation insurers would also benefit with large savings. Together they had 48,000,000 visits to U.S. emergency rooms in 2005 of which only about 15% were immediate or emergent. Perhaps a Public-Private partnership to fund the initial construction and equipping of the centers could be arranged since all payers would benefit? Out-of-pocket expenses paid by the citizens of the United States for their ER/Urgent care needs has increased every year, with the elderly making the highest cash payments. When fully constructed the system could easily handle over 60,000,000 urgent/episodic care visits per year and its full capacity approaches 100,000,000 visits per year.
Other expenses generated and paid by the Federal government would be for the maintenance and monitoring of the national episodic care center health grid. Various federal authorities such as the CDC, FDA and NIH would be able to monitor the grid for outbreaks of illness, drug reactions and perform public health research. Areas of low vaccination rates could be targeted. Populations with low achievement of evidenced based preventative health measures and their primary care physicians could be contacted
and the quality of their health care increased and physician’s P4P increased. All centers would have internal electrical capabilities for 3 days allowing continued health care during natural disasters, areas important to FEMA and Homeland Security.
The figure of $10,000,000,000 established by the Act to pay for construction and initial equipment may seem unprecedented. The federal government will pay $1,500,000,000 to close 7% of the hospital beds in New York state alone over the next 4 years. The Genome Project, the sequencing of the human gene structure cost more than $5,000,000,000,000. Estimated savings to all payers in the system approaches $24,000,000,000 in the first year and will increase every year. These savings maybe dwarfed by those achieved through changes in the costs of health insurance, the increased overall health of the American citizen and boost to the overall US economy which will occur as a result of enacting this bill.
Although a national episodic health care system will provide billions of dollars in savings
to the various payers of such care, both in direct payouts and processing expenses, the greatest benefits would be to the people of the United States. With such a system in place the citizens of a participating county each pay on average $30 per year, about 8 cents per day. This entitles them to go not only to any of the established clinics in their own counties, but any other clinic in any other participating county and as often as needed. The level of service provided is at least equal to that provide by a hospital based urgent care center. Direct out-of-pocket saving to the public is in the billions of dollars. For $30 per year the person’s episodic health care needs are removed from their overall health insurance costs. This allows them to purchase other health insurance at a reduced cost. Insures would be able to expand and individualize health insurance plans with greater freedom and cost. Such a system alleviates people’s concern for their costs of urgent care. These concerns prevent people from seeking care early on in the disease process and cause unnecessary and more invasive care later on. Those people who still wish to receive their care in an emergency room or other setting may do so but they and their insurance carrier will incur the cost. There are no mandates where people must seek their care. For those people traveling on vacation, business or migrating for the season their episodic care is easily and readily available and at no additional cost except the $30 dollars per year they paid in their home county, providing they seek care in another participating county. The cost savings are only the beginning of the benefits such a system would provide. Availability of health information, direct admission to the hospital if needed, assistance with health and insurance information, increase evidenced based care are only a few. The people in the county may wish to increase the types of services available at their county clinics and by referendum or through their governing bodies provide emergency dental care or psychiatric care. This is health care organized at its most basic level, the county. Money collected does not leave the county but pays for jobs and services in the county. This is not government health care or mandates, but managed by “Governing Bodies” made up of people living within the county.
Financially, this plan works in every Metropolitan Service Area of the country where approximately 85% of all ER visits occur. (Try the formula in your county). Take the number of emergency rooms located in your own county. Using this as the number of episodic health care centers erected in your county, multiply the number of centers by $1,800,000 which is the amount of money required to run each center for a year. Multiply the total population, number of people living in your cou
We do not want government running health care. All of their programs now have over runs. Why do we think a new program will be any better? A government should not be telling us where to go for health care. Governments build roads and build bombs. Other than that, they do nothing well. The costs of roads and bombs are always higher that the original estimates. WE do not want a government stooge telling us how to take care of ourselves. The government can go take a hike. This is a take over on a massive front.