5/13/2009

HealthCareUS-3

1) VOUCHERS -- Each person gets a yearly voucher to pay for the actuarial cost of their basic Health Care that can be used to purchase Health Insurance from any conforming health care insurance vendor.
  • The actuarial cost = The median cost based on the risk factors, e.g. Age, Weight, Gender... for the person and the area in which the person lives, to provide the health care for that individual

  • A conforming vendor = An insurance company who will accept all people and provide full payment for the covered treatments.

  • Note: The Government, e.g. Medicare will be the default vendor but the vouchers will be augmented, primerally by having the goverment provide centrallized billing, payment, approval free, so that the other insurers will be able to make a reasonable profit from just providing equivalent service and can increase their profit by providing extras such as:
    • Additional insurance -- Coverage for additional services can be offered at additional charges.
    • Reduced medical treatment costs -- Any savings will be shared 50% 50% by the patient and the insurance company, see 2)
    • Wellness support -- Any improvement in the patients risk factors will lead to a 50% - 50% savings for the first 5 years to the insurance company and the patient, and after that 50% to the patient.
    • etc.
2) SAVINGS -- Any savings in treatment costs will be shared 50/50 by the patient and the insurance company.
  • The patient and the insurance company can negotiate with the medical provider to obtain less expensive (equivalent) treatment,

  • Such negotiation may be done with medical providers within the area, or by getting the treatment in other less costly areas throughout the world from certified facilities.

  • Any savings will be shared by the patient and the insurance company so that both have "skin in the game", while still assuring that no one is denied treatment.

  • Similarly: The insurance company can pay for wellness services, e.g. Weight Reduction, Cholesterol Drugs... and any reduction in risks will be shared for 5 years even if the patient enrolees in another plan. After 5 years the patient continues to be rebated 50% of the risk savings.
3) ADMINSTRATION -- The Government will offer to do all the Record Keeping, Billing, Paying, Results collection, etc. at no charge.
  • This will be a mechanical process which will, in no way determine the HealthCareUS policies

  • This is estimated to currently cost the insurance companies 10-30% of their costs and thus will be a "hidden" subside to the independent insurers.

  • Obviously, if the insurance company has negotiated a different rate, they can get a rebate from the medical provider to be shared with the patient.

  • Any rebates will be reported to the government to be used to adjust the median costs for next year's vouchers.

  • This will centralize the Doctors billing and approval for the HealthCareUS procedures so that the Doctors paper load is decreased.

  • The results of the procedures will also be reported to the government so that the Cost/Benefit for various procedures can be computed by them or other interested parties.

  • This will also allow the quality of medical care can be made available to the insurers and the patients so that they can determine which providers to support.

  • If an insurance company is accepting HealthCareUS vouchers then it must at least report the costs and results of their services.
4) COVERAGE -- The procedures covered by the HelthCareUS will be determined as those that have highest benefit within the amount of money allocated by the government/tax payer.
  • Note: Any additional procedure can be covered by additional insurance or by direct payment for the patient, as is done now

  • Note: Any plan must determine which procedures they will cover, so does HealthCareUS, but in this case, those procedures are determined by the amount of money that we democratically determine to spend and then by the procedures that are most cost effective, rather than by some bureaucrat or CEO.
5) GRANDFATHERING -- Any current plan will be "grandfathered" in except that the tax benefit will be limited to the Voucher amount and any tax benefit over 50% of the voucher will be available only if the current plan provides at least the coverage of the HealthCareUP plan.

Also see:

Labels: ,

1 Comments:

Blogger Mike Liveright said...

Conforming Doctors

Note: I did make it clear that the base cost of any treatment would be the median rate in the area:

Thus conforming Doctors would have to charge no more that the average doctor, in that area, for a treatment, and this is the cost that will be used as the base for the "Share Our Savings" computation.

9:12 AM  

Post a Comment

<< Home