Here are some ideas on legislation to ensure people will have reasonable coverage.
Acceptance
• No one can be turned down for any reason, especially pre-existing conditions.
• Coverage cannot be turned down for any reason, , except fraud or dual coverage, though policy holders may decide to switch.
• The doctor and patient decide on what the treatment, based on the recommendations by the doctor.
• Limits will be placed on what people can sue for. If a reasonable offer is made before the court case begins, the looser will pay the opposing parties double court costs.
Management
• Should an insurance company fail then these policies will be split amongst the remaining insurance companies. They will be split based on the relative size of the companies, the larger companies taking a ratio more of the policies. The policies will be taken by a simple, blind draw.
Costs
• The difference between the top and bottom monthly fee for insurance will not exceed 100%. For example, if the lowest monthly cost is $100, then the most expensive option will be $200, no matter what the reason (excluding the fines and fees outlined below).
• Each state will organize all of the insurers for covering the costs of claims more than $500,000. Once the initial claim exceeds this amount, then the claim will be paid by the state catastrophic (CAT) claim fund. All insurance companies will contribute based on the number of policies they have in that state.
• A national catastrophic claim fund will be started to cover claims that exceed $1,500,000. All insurance companies will contributed based on the number of policies they have nationally.
• Basically, the two catastrophic claim funds means that there are no limits on treatments (except that heroic measures, defined as beyond a statistical model of less than 25% success, may not be fully covered, depending upon discussions between the insurer, doctor and patient).
• Any insurance profits over 10% will be split 50% to Medicare and 25% to the state’s and national CAT funds. Losses can be carried forward 5 years to reduce profits for the purpose of this split.
Fees/Fines
• If you don’t go to a GP for an annual physical, the “fine” would be $200
• If you don’t follow the directions of you GP, there is a “fine” of $100
• For products that can impact the health, a license will need to be purchased:
o Cigarette purchase license, $50
o Chewing tobacco purchase license $50
o Alcohol purchase license $50
• Weight has a significant impact on health, so the following annual fines will be in place (based on measurement better than BMI like fold calipers or immersion):
| Doctor’s Rating | Fine |
|---|---|
| Underweight | $5.00 per lb |
| Overweight | $5.00 per lb |
| Obese | $10.00 per lb |
• General fitness, if you can’t run 1 mile in less than 10 minutes, there is a $150 fine assessed yearly.
Leadership
We expect business and political leaders to actually lead by example. Here are the guidelines for fee and fine payments listed above:
• Healthcare workers will pay double
• Local, civic, state and national politicians will pay triple
• Doctors will pay quadruple
• Business leaders (AVP/ director level and above) will pay triple
Quality
• Each location that performs health care services (hospitals, medical devices and other locations) will publically publish quality numbers like:
o Infections
o Mistakes
o Number of services/ products provided
o Customer ranking (Net Promoter Value)
User Payments
• Each user will have the equivalent of an HSA account to cover off the first $1500 of fees. For those under a certain income level, the rollout will give those people the initial $1500 credit those people the initial $1500 on their income tax return. Those that make too little income to be taxable at, or above $1,500 on the year of claim, will receive reimbursement upon proof of payment.
• Doctors and health care providers will provide cost estimates for treatment options that would include ALL costs. This information will be part of the discussion with the doctor and patient.
• They payment of the first $1500 and seeing all of the bills are a critical part of controlling costs. People will pay attention when they are paying and the costs will be exposed to everyone that is incurring them.
• Quality ratings of potential service providers will be discussed with the patient.
• All costs for a given visit or treatment will be combined on a single bill to be given to the patient.
Single Patient Record
• To help defray costs, the health care and insurance providers have until Dec, 2010 to have all of a patients records in a single, integrated form. For example:
o All prescriptions would be shown, so inappropriate or excessive medications will be obvious
o All treatments, observations and notes will be visible
o All information will be readable by the patient and any of their health care providers
o Note that all information that is currently gathered now will be covered:
X-rays, cat scans, interview notes, nursing observations
• Fines
o Insurance companies will pay $500/day/claim for information not in this system
o Health care providing institutions (hospitals, dentists, pharmacies, etc) will pay $1000/patient for each missing piece of information
o Doctors who are overseeing treatment will pay $200/patient for each missing piece of information
o Care givers will pay $25 for each missing piece of information
• Security/treatment of information
o Treatment, DNA or other diagnostic information cannot be used to disqualify someone from employment or insurance
o Only the patient and people involved with the treatment may see the information. HIPPA rules would apply.
o In the case of multiple systems, they will be able to seamlessly transfer the data securely.