"Rx for U.S. Healthcare Reform" - A Position Paper from TANC
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"Rx for U.S. Healthcare Reform" - A Position Paper from TANC

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The central theme of this 23-page position paper is a little-known, 25-year-old Medicare Advantage Prescription Drug (MA-PD) program which has FOSTERED the creation of NON-PROFIT "Social Managed Care" ...

The central theme of this 23-page position paper is a little-known, 25-year-old Medicare Advantage Prescription Drug (MA-PD) program which has FOSTERED the creation of NON-PROFIT "Social Managed Care" organizations, such as Southern California's burgeoning SCAN Health Plan, in providing NO- to LOW-COST health coverage in broad menu of care service -- at mere fractions of what FOR-PROFIT "Big Health Insurance" carriers charge for lesser coverage areas, higher deductible and higher out-of-pocket co-pay costs.

In other words, these handful of so-called "Social HMOs" provide a STELLAR MODEL and CASE STUDIES in how NON-PROFITS -- fostered and encouraged by the Federal Government -- can provide TRUE "Nonprofit-based Insurance Exchanges" to force down the artificially-inflated pricing of health insurance premiums from monopolistic FOR-PROFIT, "Big Heath Insurance" for the general under-65 population. Most notably, this "Social HMO" structure is NON-INVASIVE, requires minimal to no government intervention and no day-to-day management involvement and are a proven model for LOW-COST, ACCESSIBLE AND EQUITABLE healthcare!

Please view/download and pass this position papers to your state and federal "elected" representatives to let them know there is NO justifiable reason to keep getting HOSED by the CRIMINAL BUSINESS PRACTICES of "Big Health Insurance."

Thank you for your time and letting me share this vitally important information.

Sincerely,

Michael A. Freeman, Executive Director
Trans-American Alliance for a National Consensus (TANC)
URL: http;//www.transamericanalliance.org
Email: michael.freeman@transamericanalliance.org

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"Rx for U.S. Healthcare Reform" - A Position Paper from TANC "Rx for U.S. Healthcare Reform" - A Position Paper from TANC Document Transcript

  • Trans-American Alliance for a National Consensus (TANC) Rx for U.S. Healthcare Reform A Proven Model for NON-PROFIT “Universal Healthcare” Provides a Solution for Widespread Enactment www.transamericanalliance.org Thousands of residents of Wise, Va., and Los Angeles seeking free exams and medical/dental treatments offered by the all- volunteer Remote Area Medical (RAM) organization. Copyright © 2009, Trans-American Alliance for a National Consensus (TANC) ALL RIGHTS RESERVED
  • Trans-American Alliance for a National Consensus (TANC) Rx for U.S. Healthcare Reform A Self-Sustaining, Ready-Made NON-PROFIT Model for “Universal Healthcare” is Achievable at Little Cost www.transamericanalliance.org By Michael A. Freeman Executive Director, TANC “Of all forms of inequality, injustice in healthcare is the most shocking I t’s right under the noses of President Obama and members from both major parties of Congress, and they may not even know it or have simply over- looked it: There is a practical, self-sustainable model and ready-made solution for the reform of America’s teetering healthcare system. And the federal Medicare sys- and inhumane.” tem helped create it. — Rev. Dr. Martin It is a little-known federally-funded Medicare program that has successfully covered Luther King, Jr. a segment of the Senior Citizen population for nearly a quarter-century in an innova- (1966) tive partnership with NON-PROFIT health insurance organizations. And it is one of the best kept secrets and a relatively tiny sliver of American healthcare. Operating under the Medicare Advantage Prescription Drug Program (MA-PD), which are standard ―Part D‖ Medicare payments from senior citizens’ accounts typi- cally dedicated for prescription drug plans, is a special classification of ―Social Man- aged Care” — an entire suite of extensive healthcare services. These so-called ―Social HMOs‖ stand to serve as shining models for a ―national non-profit health insurance system‖ and offer broader applications for the general (under-65) American population — an innovative, new paradigm to potentially convert and reform our cost-spiraling FOR- PROFIT/PRIVATE Health Insurance system. As this position paper attempts to illustrate, the model for ―Social HMOs” set an outstanding template for what low- to no-cost, NOT-FOR- PROFIT health insurance can do to alleviate and reverse the ever-escalating costs and gaps in coverage for an estimated 47 million uninsured Americans. The more altruistic and humane principles that are the basic tenets of these NON-PROFIT, senior-based ―Social HMOs,‖ if adapted and broadened out for the ―general‖ Remote Area Medical (RAM), a Nashville-based non-profit medical relief organization, stands at the vanguard of providing “mobilized” treatment under-65 population, could bring badly needed events across the country — attracting tens of thousands of Americans relief to the many millions of other ―insured‖ who can’t obtain or afford FOR-PROFIT/PRIVATE health insurance cover- Americans who live in dire fear of their FOR- age. PROFIT/PRIVATE carriers raising their deducti- ble payments, co-pays on hospital stays, issuing outright DENIALS on critical life-saving medical procedures, and routine policy revo- cations for discovering ―preexisting conditions‖ — all of which can have a devastat- ing economic impact on American families. Copyright © 2009, Trans-American Alliance for a National Consensus (TANC) ALL RIGHTS RESERVED
  • Page 3 Rx for U.S. Healthcare Reform A Proven Model for NON-PROFIT “Universal Healthcare” Provides a Solution for Enactment Under proposals from President Obama and Sen. Max Baucus (D-MT), chairman of the Senate Finance Committee sharing half of Congress’ load www.transamericanalliance.org on healthcare reform, both have laid out plans for some kind of national or state ―Insurance Exchanges‖ in which FOR-PROFIT/PRIVATE health insurance carriers would be placed into ―competitive, low-cost pools‖ for consumers to choose which plans best fit their needs and what they can afford. But, the Presi- dent and Congress would find a much more affordable, minimally government budgeted and much lower cost solution in fostering the creation of a NON-PROFIT "One of the central health insurance pool, which is already an operational, more justifiable “Social public policy ques- HMO” model for future healthcare reform than long-standing FOR-PROFIT insurance tions for U.S. citizens models. today is whether the The hallmark of these non-profit “Social HMOs,” originally authorized by Congress’ richest nation on enactment of the Deficit Reduction Act of 1984 and the federal government’s ex- earth will continue to pansion under the Omnibus Reconciliation Act of 1990, feature minimal to no out- allow millions of poor of-pocket cost health insurance premiums guaranteeing affordable, equitable and people to exist with- humane access to healthcare services. out health insurance. To do so violates bibli- Originally constructed to serve as an ―alternative nursing care‖ system that keeps cal justice. How can senior citizens from being prematurely forced into nursing home facilities, these any Christian read NON-PROFIT health insurers formally operate under the banner of being Social what the Bible says Managed Care Plans; an organization that provides the full range of Medicare about the poor and benefits offered by standard Managed Care Plans plus additional services which what Jesus says include care coordination, prescription drug benefits, chronic care benefits covering about the sick with- short term nursing home care, a full range of home and community based services out hearing a divine such as homemaker, personal care services, adult day care, respite care, and medi- call to demand that cal transportation. Other services that may be provided include eyeglasses, hearing every person in this aids, and dental benefits. These plans offer the full range of medical benefits that nation, starting with are offered by standard Managed Care Plans plus chronic care/ extended care ser- the poor, have access vices. Membership offers other health benefits that are not provided through Medi- to health insurance?" care alone or most other FOR-PROFIT/PRIVATE-SECTOR senior health plans. — from "Just Generos- There are four NOT-FOR-PROFIT, Social Managed Care Plan organizations — SCAN ity" by Ronald Sider, Health Plan of Southern California, Elderplan of Brooklyn, New York, Kaiser Health founder of Evangeli- Foundation of the Northwest (Portland-Vancouver metropolitan area, Salem, Ore., cals for Social Action and Longview, Wash.), and Health Plan of Nevada of Las Vegas — that secured MA- PD funding from Medicare in servicing several hundred thousand Seniors with broad inpatient/outpatient and preventive health insurance coverage in their re- spective regions. The longest running of these ―Social HMOs‖ is the not- for-profit SCAN Health Plan (www.scanhealthplan.com), otherwise known as the Senior Care Action Network, founded in 1977 by a group of Long Beach, Calif. area seniors angered about some short-comings in the elder healthcare sector. With the backing and help of area doctors and other medical/caregiver practitioners join- ing their management staff, SCAN secured its first MA-PD funding from Medicare to offers health insurance and seniors-based healthcare services in 1985. Copyright © 2009, Trans-American Alliance for a National Consensus (TANC) ALL RIGHTS RESERVED
  • Page 4 Rx for U.S. Healthcare Reform A Proven Model for NON-PROFIT “Universal Healthcare” Provides a Solution for Enactment Today, SCAN provides insurance coverage and other wellness/preventive healthcare services to over 110,000 seniors in seven Southern California counties. Over the last year or so, SCAN has expanded its non-profit ser- www.transamericanalliance.org vices to senior residents of Maricopa County (Phoenix) in Arizona and has drawn up plans to launch shortly in Northern California — potentially doubling its number of Senior subscribers within the next year or two. A key ingredient of SCAN’s success is its broad Southern California-area roster of 17,000-plus registered ―in-network‖ doctors and specialists and over 150 hospital choices. SCAN’s remaining care menu is quite broad and impressive to include other inpatient hospi- tal care; outpatient doctor/hospital care; at-home care; emer- gency admittance and transportation services coverage; a pre- scription brand/generic drug program; vision services; dental coverage; hearing; other no- to low-cost co-pays on a variety of screenings and exams; and a wide array of preventive and health-and-wellness services — features necessary for senior care but MUCH GREATER than what could be found in either standard Medicare and so-called “Cadillac Plans” from PRI- VATE/FOR-PROFIT insurance carriers for the general under-65 population. Most notably, out-of-pocket costs, or so-called co-pay ex- penses to senior subscribers, come at mere fractions in the two SCAN Health Plan choices — ―Classic‖ and ―Option‖ plans. For example, an in-hospital stay of 1 day to 150 days incurs out-of-pocket costs of up to $2,300 under the standard Medi- care plan while SCAN’s ―Classic‖ plan has a maximum co-pay deductible of $400 and the ―Options‖ plan has a $0 co-pay deductible In fact, if you peruse either of SCAN’s two plans (on both facing pages), most of the benefit categories feature $0 co-pays/deductibles and hit a maximum of $100 for select care services. Adding frosting to the NON-PROFIT case, my next-door neighbors, a senior-aged married couple and long-time SCAN policy holders, both sing its praises by exclaiming that they have ―guaranteed‖ emergency care/hospital coverage on a ―worldwide basis‖ if they go travelling abroad. Additionally, my neighbors boast that they have an individual ―Personal Care Representative‖ who has been assigned to each of them for the duration of the SCAN memberships. They also empha- sized they have ―never‖ had to deal with a disputed or denied claim from SCAN, and their Personal Care Representative ―always handled outside billing issues‖ that either arose from hospital or doctor/specialist procedures. Perhaps the most intriguing figure comes from a Wikipedia.org estimate that SCAN earns $1.3 billion in revenue from its direct billings to Medicare, which translates to Copyright © 2009, Trans-American Alliance for a National Consensus (TANC) ALL RIGHTS RESERVED
  • Page 5 Rx for U.S. Healthcare Reform A Proven Model for NON-PROFIT “Universal Healthcare” Provides a Solution for Enactment a premium cost of roughly $98 per month for each of its 110,000 sub- scribers or $1,181 per year for its full array of covered services — al- though Medicare’s database factors in the potential additional surcharge www.transamericanalliance.org of up to $56 per month for SCAN’s Special Needs Plan (SNP) subscribers and other ―options-based‖ premium charges. Still, the no-out-of-pocket- cost premiums SCAN offers translate to little more than $2.00 above the ―minimum‖ base $96 per month Medicare deducts from seniors’ accounts (about $1,157 for all of 2009). Better yet, the most startling fact in this is that SCAN and the three other major NON-PROFIT health insurance carriers participating in the MA-PD program provide much higher levels of premium coverage and at lower co-pay/deductible costs and ―in-Medicare‖ monthly premium fees ($96 per month) — at about one-fifth (20%) to one-quarter (25%) of the cost of an average $400 to $500 per month (or $4,800 per-year premium average) of what FOR-PROFIT/PRIVATE health insurance carrier charges on a premium for an indi- vidual policyholder in the general under-65 population, ac- cording to World Health Organization data. If FOR-PROFIT/PRIVATE health insurance carriers label their so-called top-of-the-line plans as ―Cadillac Premiums,‖ than several ―Social HMOs‖ including SCAN’s Medicare-based plans for seniors should be coined the ―Rolls-Royce Premi- ums‖ of health insurance. It just proves that a greatly ex- panded menu of benefits and lower deductibles and co-pays are very achievable at a fraction of the monthly/yearly costs of what FOR-PROFIT/PRIVATE health insurers offer. An online trip to Medicare’s state-by-state and plan-specific website (http://www.medicare.gov/MPPF/Include/ DataSection/ComparePlans/BenefitsAtAGlance.asp) reveals a convenient database for searching out a wide array of mostly FOR-PROFIT/PRIVATE health insurance carriers that offer senior ―option‖ plans. Some of the plans are spon- sored by the American Association of Retired People (AARP), but they originate from FOR-PROFIT, pay subscription plans (outside of standard Medicare-provided health insurance) typically featuring considerably higher co-pays/deductibles and far fewer coverage areas. If you really want to get a true gauge of how seniors in Southern California value their SCAN health plans, just give a read of a May 2001 article in The Christian Science Moni- tor. At the time, TCSM reported that SCAN garnered highly favorable ratings from Consumer Reports, which found that 96 percent of SCAN subscribers would ―never leave the plan‖ and 98 percent said they would recommend it to their senior friends. Basi- cally, these NON-PROFIT ―Social HMOs‖ like SCAN offer as great or greater selection Copyright © 2009, Trans-American Alliance for a National Consensus (TANC) ALL RIGHTS RESERVED
  • Page 6 Rx for U.S. Healthcare Reform A Proven Model for NON-PROFIT “Universal Healthcare” Provides a Solution for Enactment of ―in-network‖ doctors, specialists and hospitals than what FOR-PROFIT/ PRIVATE insurers comparably offer. Ratings from Medicare’s own online database typically rank both SCAN www.transamericanalliance.org Health Plans — ―Classic‖ and ―Options‖ — each with scores of 4 out of 5 stars when it comes to handling ―member complaints and those staying with the pro- gram.‖ The same numbers of stars are accorded to SCAN for the prescription ―drug pricing and patient safety‖ category as well. Similarly high ratings were attributed to other NON-PROFIT ―Social HMOs‖ like Elderplan and Kai- ser Foundation Health Plan of the Northwest. The lone ―Social HMO‖ on the East Coast is Elderplan (http://www.elderplan.org), a Brooklyn-based non-profit founded 23 years ago and operating under the auspices of the Metropolitan Jewish Health System, serving just over 15,000 seniors in the five boroughs of New York City. Although it operates on a much smaller scale than SCAN, Elderplan’s five plan options similarly offer $0 co- pay and deductible features across the board to a nearly identical menu of ―in-network‖ inpatient, outpatient and at-home services. Kaiser Health Foundation of the Northwest offers a pair of HMO plans, Senior Advantage Basic and Senior Ad- Non-profit “Social HMOs” offer coverage at Public “Medicare-minimum” vantage, but each have respective $39 and $99 rates, so it’s likely the savings would be greater than the 25% in the fur- monthly add-on premium charges and generally higher thest right-hand bar if it would be operated as a “Non-Profit Insurance co-pays and deductibles than what SCAN and Elderplan Exchange” — not solely as “For-Profit/Private Exchanges” proposed by Congress and the White House. offer as ―Medicare-minimum‖ premium values. The slightly higher co-pay/deductible levels and additional premium charges are somewhat in keeping with other FOR-PROFIT/PRIVATE carri- ers offering Medicare exchange plans. Kaiser Health Foundation of the Northwest is a non-profit organiza- tion that is a MA-PD spinoff from the other FOR-PROFIT Kaiser Permanente healthcare subsidiaries. Health Plan of Nevada also offers ―Medicare mini- mum,‖ no outside monthly cost premiums, but does charge a low- to higher-range of co-pays/deductibles and offers fewer coverage areas to about 25,000 sen- ior members in the southern and northern regions of the state. However, FOR-PROFIT insurance giant Unit- edHealth Group acquired Health Plan of Nevada’s over- all under-65 health insurance business (serving close to 500,000 subscribers overall) in early 2008, but was required by the U.S. Justice Department to divest own- ership of the NOT-FOR-PROFIT ―Social HMO‖ senior Allowing FOR-PROFIT, “free-market” forces to go unregulated has proved disastrous — while government “incentivized” NON-PROFIT ventures like care arm of the company to be fall into compliance with Medicare-based “Social HMOs” have proved hugely beneficial to Senior the deal. It is not immediately known if the ―Social Citizens. HMO‖ has yet been fully divested from the UnitedHealth Group-owned parent company or discontinued entirely. Copyright © 2009, Trans-American Alliance for a National Consensus (TANC) ALL RIGHTS RESERVED
  • Page 7 Rx for U.S. Healthcare Reform A Proven Model for NON-PROFIT “Universal Healthcare” Provides a Solution for Enactment That is why it is so vitally important for any ―true‖ healthcare reform to take place in this country, our government needs to step up and use the weight of its legal authority to untangle FOR-PROFIT/PRIVATE health insur- www.transamericanalliance.org ance carriers from a future ―Universal Healthcare‖ system. Given the ongo- ing criminality of FOR-PROFIT/PRIVATE health insurance practices, where Americans are either DYING or currently suffering from GROWING TERMINAL ILL- NESSES due to DENIED CLAIMS, there is NO constitutionally justifiable reason why American lives are being weighted or balanced ver- “Both the President‟s and Baucus‟ plans still sus the model of MAXIMIZING AND MINIMIZING fundamentally fail to address how the FOR-PROFIT/ RISKS so entrenched into our long-standing FOR- PRIVATE health insurance industry has been PROFIT/PRIVATE system up to today. artificially inflating the prices of premiums (most In his speech to a joint session of Congress on likely due to covering excessive executive September 8, Pres. Obama reiterated a verbal-only compensation, bloated administrative overhead and proposal to create a ―non-profit insurance ex- an overstated emphasis on maximizing earnings and change,‖ conceivably featuring a pool of FOR- profit margins) while increasingly chipping away at PROFIT/PRIVATE health insurance carriers for con- coverage options and placing higher co-pay and sumers to pick the ―most competitively priced deductible burdens on the backs of consumers. plan‖ that fits their needs. On September 16, Sen. Essentially, it is a „middleman‟ system where the Baucus then released his ―Chairman’s Report,‖ an consumers pay more but get less in return.” $856 billion, 10-year plan, that would similarly fea- ture a ―State Insurance Exchange‖ program and FOR-PROFIT/PRIVATE-based healthcare ―cooperatives.‖ This is just pouring more taxpayer money into the pockets of cor- rupt FOR-PROFIT/PRIVATE carriers, who were the same $4 million contributors to Sen. Baucus’ latest fundraising dinner last May. While sounding and appearing like po- tentially attractive, reasoned proposals, both the President’s and Baucus’ plans still fundamentally fail to address how the FOR-PROFIT/PRIVATE health insur- ance industry has been artificially inflat- ing the prices of premiums (most likely due to covering excessive executive com- pensation, bloated administrative over- head and an overstated emphasis on maximizing earnings and profit margins) while increasingly chipping away at cov- erage options and placing higher co-pay and deductible burdens on the backs of consumers. Essentially, it is a Under The Commonwealth Fund’s study offering three different healthcare plan scenarios, it is ―middleman‖ system where the consum- an inescapable fact that offering up a “Public Plan” based on Medicare rates — such as that the long-term projected savings of up to $56 billion by 2020 — would be most ideally maxi- ers pay more but get less in return. mized under a nonprofit-based “Health Insurance Organizational” proposed by TANC. Medicare already runs an ―exchange- like‖ system where senior consumers can choose from a pooled menu of largely Copyright © 2009, Trans-American Alliance for a National Consensus (TANC) ALL RIGHTS RESERVED
  • Page 8 Rx for U.S. Healthcare Reform A Proven Model for NON-PROFIT “Universal Healthcare” Provides a Solution for Enactment FOR-PRIVATE/FOR-PROFIT coverage plans, with the American Association of Retired People (AARP) even serving as a clearinghouse/sponsor for lower-cost ―Medicare Health Plans.‖ But many of these ―exchange‖ option plans — coming from such Big Health Insurance companies as UnitedHealth www.transamericanalliance.org Group, CIGNA, Aetna, Coventry, Wellpoint, Anthem Blue Cross/BlueShield and Humana — are still priced considerably higher, with additional ―out-of- pocket‖ monthly premium charges and other higher Medicare ―estimated costs‖ compared to what the handful of NON-PROFIT ―Social HMOs‖ charge in most cases to be ―Medicare-minimum‖ base rates. (The most noticeable differences in Medi- care’s customizable/comparable database comes from what FOR-PROFIT/PRIVATE insurance carriers typically charge in additional ―out-of-pocket‖ monthly premium fees, higher co-pays and deductible costs, and generally offer consid- erably smaller menus of ―covered‖ care services.) Plain and simple, the excessively high levels of executive compensa- tion for PRIVATE/FOR-PROFIT insur- ance, bloated administrative over- head costs and the 20%-plus profit margins of the Big Insurance Carri- ers (please refer to the accompany- ing charts), truly reflect the inordi- nate disparity of what they charge versus what NON-PROFIT carriers can charge on a much lowered-priced, feature-rich basis. It is also an accurate re- flection of the grossly inequitable, unethical and often CRIMINAL business practices of FOR-PROFIT insurance and why Americans are literally ―paying through their teeth‖ for less healthcare. Additionally taking into account the outright DENIALS of medical proce- dure claims for at-risk patients and the often arbitrary revocations of premium holders for have what Big Insurance deems are ―preexisting conditions‖ to meet the ―business model‖ of MAXIMIZING PROFIT AND MINIMIZING RISKS common with Big Health insurance, are wholly UNETHICAL and frequently MORALLY CRIMINAL…purely on a Constitutional Law basis. In these proposed ―exchange systems,‖ where some lower-income/disadvantaged Americans will conceivably have the ability price out ―low-cost‖ insurance premiums but may actually face paying ―penalties‖ for not having coverage under Baucus’ original plan, there are still massive inequities in what being laid out in both the Congressional and White House proposals. Even the President has not elaborated Copyright © 2009, Trans-American Alliance for a National Consensus (TANC) ALL RIGHTS RESERVED
  • Page 9 Rx for U.S. Healthcare Reform A Proven Model for NON-PROFIT “Universal Healthcare” Provides a Solution for Enactment on how to get the Big Health Insurance Carriers to seriously modify and reform their business practices away from their historical strategies of monopolizing/consolidating the marketplace with exploitive and punitive actions directed at American consumers. www.transamericanalliance.org In fact, I am not even sure if the President realizes it yet, but his marginal- ized, verbal-only vision of a ―non-profit insurance exchange‖ carries merit, but it ac- tually should be broadened out to mandate that Health Insurance Carriers can only reform their CRIMINAL business practices by dropping their exploitive and predatory PRI- VATE/FOR-PROFIT status and instead adopting NON-PROFIT roles going forward. And that NON-PROFIT organizational model, which once flourished when religious hospitals and family clinics were founded in America during the 18th to early 20th centuries, is something that could have broader applications beneficial to other segments of healthcare in America to- day. For those reasons, our non-profit citizens’ ad- vocacy and ―Direct Democracy‖-based organi- zation, Trans-American Alliance for a National Consensus (TANC), is proposing that the Presi- dent and Congress crafts healthcare reform legislation that 1) funds and fosters the crea- tion of NON-PROFIT health insurance carriers in structures similar to Medicare’s ―Social HMO‖ organizational architecture; and 2) presents FOR-PROFIT/PRIVATE Big Insurance carriers the opportunity to convert to NON-PROFIT status or face the consequences of not par- ticipating in the ―exchange pro- gram‖ and facing the specter of U.S. Justice Department and Con- gressional ―criminal investigations‖ into DENIAL-based patient deaths, the alarming rise of terminal ill- nesses, debilitation, and other needless suffering in other cases. This is a time when Congress, the White House and other federal in- vestigatory agencies need to live up to their Constitutional oaths to uphold the law and end this long- standing corrupt pattern of busi- ness practices in the healthcare industries — the only thing Big Health Insurance will yield to is if Copyright © 2009, Trans-American Alliance for a National Consensus (TANC) ALL RIGHTS RESERVED
  • Page 10 Rx for U.S. Healthcare Reform A Proven Model for NON-PROFIT “Universal Healthcare” Provides a Solution for Enactment know the federal government is going to use its full weight of its authority to uphold laws and enact serious reform to re-regulate their business prac- tices. Given that total healthcare costs currently eat up to 17% of the United States’ Gross Domestic Product (GDP), or roughly $2.5 trillion of www.transamericanalliance.org nearly $15 trillion in total GDP for 2009 (according to World Health Organiza- tion estimates), the world’s most expensive healthcare system will eventually implode under the sheer weight of its excesses and lead to an even greater public health crisis/catastrophe in the near future. On that front, TANC has formed a pair of Facebook ―Cause Groups,‖ the most critical being a ―Petition for the Federal Government to Open CRIMI- NAL INVESTIGATIONS into DENIED Patient Deaths” (http:// apps.facebook.com/causes/340854/54103574?m=611088da) to compel our government not to let this long-standing pattern of criminality in the health insurance industry go unpunished. Secondly, TANC ideally hopes the proposals laid out in this position paper can be used as springboard for our Facebook Cause Group initiative to “Petition for a CITIZENS’ SUMMIT on U.S. Healthcare Reform” (http:// "Every person has the apps.facebook.com/causes/332619/54103574) to lay to out a set of proposals right to adequate for a truly OPEN PUBLIC-FORUM debate — a draft bill-making process for American health care. This right citizens to offer as template and blueprint for our ―elected‖ representatives to pos- flows from the sanctity sibly follow as “THE WILL OF THE AMERICAN PEOPLE.” Even if our federal gov- of human life and the ernment chooses to dismiss this summit and draft bill, it will forever be on-the- dignity that belongs to record where American citizens decided the future direction of Healthcare Reform all persons, who are should go! made in the image of If the health insurance industry does concede that its business practices need God... Our call for drastic reform and it abides by new government regulatory actions, TANC has set health care reform is forth detailed recommendations for the Congress and the White House — at the rooted in the biblical very least — to SET MINIMUM PROFIT MARGIN CAPS and LIMITS ON EXECUTIVE call to heal the sick and COMPENSATION AND BONUSES for the PRIVATE/FOR-PROFIT Health Insurance to serve 'the least of Carriers. The other major option the federal government can present is that a these,' the priorities of funding program based on new, minimal corporate taxes and a special tax assess- justice and the princi- ment on companies producing and distributing ―unhealthy/addictive consumable ple of the common products‖ be used to help fund their conversion into NON-PROFIT Health Insurance good. The existing pat- Organizations (HIOs). terns of health care in the United States do no To accomplish steps necessary for the NON-PROFIT conversion of Private/For-Profit meet the minimal stan- Health Insurance, TANC is proposing the following preliminary scenarios: dard of social justice 1) De-list FOR-PROFIT/PRIVATE-SECTOR Insurance Companies from and the common good." stock exchanges and Re-File under ―Non-Profit Articles of Incorpo- — Resolution on Health ration‖ — Much in the same way the federal and state government Care Reform, U.S. Catho- issue interest-bearing bonds, the federal government can serve to lic Bishops, 1993, com- guarantee bond funds to participating Private-Sector Insurance ing before the Clinton Carriers an exchange in expediting the buyback of shares from Administration's failed large institutional investors, hedge funds and individual share- efforts at achieving U.S. holders in these publicly-held corporations. By unlocking them- healthcare reform. selves from the control of large shareholders, some of whom own Copyright © 2009, Trans-American Alliance for a National Consensus (TANC) ALL RIGHTS RESERVED
  • Page 11 Rx for U.S. Healthcare Reform A Proven Model for NON-PROFIT “Universal Healthcare” Provides a Solution for Enactment large blocks of stock and exercise considerable control of ―voting‖ shares and seats on the Board of Directors for these Big Insurance corporations, the government is effectively alleviating the health insurance carrier of typical outside ―marketplace pres- www.transamericanalliance.org sures‖ to meet certain per-share earnings and profit projections – in addition to eliminating ―conflicting agendas‖ and ―hostile take- over‖ scenarios, sometimes those arising internally from their own Board of Directors and/or large-block shareholders. "To be without health insurance in this coun- 2) The federal government forms the temporary FEDERAL NON- try means to be with- PROFIT HEALTHCARE CONVERSION ASSISTANCE CORPORATION out access to medical with the mandate of helping Health Insurance Companies and care. But health is not potentially other FOR-PROFIT Healthcare entities un-tether them- selves from outside investors and other marketplace-driven forces a luxury, nor should it — The mission of this federal program will be solely to assist par- be the sole possession ticipating FOR-PROFIT Health Insurance Carriers with bond-issue of a privileged few. We funding to buyback the publicly-traded shares from major institu- are all created b'tzelem tional investors and individual shareholders. Once buyers of elohim — in the image these bonds (including investors and non-profit foundations, etc.) of God — and this reach maturity and can be paid off (within the next 5 to 10 years), makes each human life the government can effectively liquidate/disband the FEDERAL as precious as the next. NON-PROFIT HEALTHCARE CONVERSION ASSISTANCE CORPORA- By 'pricing out' a por- TION once all the conversions are completed. tion of this country's population from health 3) The buyback of publicly-traded shares, with the assistance of gov- care coverage, we mock ernment-backed bonds can be timed to mature in 5 years to 10 the image of God and years, or less — This would allow the once-publicly traded/for- destroy the vessels of profit Health Insurance Carrier to recoup all costs related to the God's work." buyback share plan as well as covering any other debts incurred by the organization before converting to NON-PROFIT status. Mon- — Rabbi Alexander ies from the government bond issues will also allow for a sliding Schindler, Past Presi- scale of a 5% to 25% premium to be paid over the Health Insur- dent, Union of American ance Carrier’s ―current‖ per-share stock market price, which will Hebrew Congregations be based on any potential negative short-falls some shareholders (1992) may still incur from what they originally paid on a per-share basis. This is to make sure both the investor/shareholders, lien holders and the company are reimbursed and properly covered at or slightly above their original investments — so it effec- tively un-encumbers Health Insurance Carriers from any outside FOR-PROFIT interests and outside marketplace forces. 4) Upon their incorporation as NON-PROFIT Health Insur- ance Organizations (HIOs), participating insurance carriers will still be able to service their roster of current premium- holding customers on their existing levels of premium cov- erage but able to do it closer in line with lower cost Medi- care-based rate structures — The maintaining of premium subscriptions with the HIO’s current roster of customers will also address concerns some consumers have about being forced into ―universal access‖ Public-Option plans offered to low- Copyright © 2009, Trans-American Alliance for a National Consensus (TANC) ALL RIGHTS RESERVED
  • Page 12 Rx for U.S. Healthcare Reform A Proven Model for NON-PROFIT “Universal Healthcare” Provides a Solution for Enactment income individuals and families. Moreover, current policy-holders will benefit from LOWER MONTHLY/ANNUAL PREMIUM COSTS due to the NON-PROFIT restructuring of health insurance, in addition to likely seeing their DEDUCTIBLE and CO-PAYMENT cost contribu- www.transamericanalliance.org tions greatly reduced or eliminated. Employer-compensated will also great benefit from lower individual and family plan premium costs, much as described above. 5) ―Universal Access‖ will also be a mandatory requirement as a re- sult of a Health Insurance Organization’s NON-PROFIT, TAX- EXEMPT STATUS, meaning a ―Public Option‖ program will be made available to low-/no-income Americans who can’t afford to obtain coverage on a reviewed, as-needed basis — By tap- ping into a special 1% or 2% general U.S. Corporate Healthcare Tax levy, which could bring in anywhere from $140 to $280 billion annually in an- nual revenues (depending on the state of the economy and final dollar- generation figures from annual Gross Domestic Product totals) to help cover non-profit HIOs offering the same kind of individual and family premiums offer to its regular customers. Currently, cor- porations pay the equivalent of 2.5% of the Gross National Product, or roughly $378 billion in corporate taxes in 2008 while ―individual‖ American taxpayers paid roughly 8% of the GDP or roughly $1.2 trillion in individual taxes. So, if corporations pay an additional 1% to 2% corporate tax (rather than individual taxes), they will still realize much larger immediate sav- ings to their bottom-line expenses through a drastically reduced NON- PROFIT health insurance system. Addi- tionally, due to the disproportionately large burdens placed on the healthcare system by unhealthy/addictive consum- ables — tobacco, alcohol, fast foods, sweetened beverages, candy/ confectionery products, and packaged snack foods — could be assessed a spe- cial 5% to 10% corporate tax based on their gross sales revenue volume, possi- bly raising between $25 billion to $50 billion in new tax revenue to help subsi- dize a ―Public Option‖ program (see the accompanying chart). These unhealthy/addictive consumables account for the greatest Copyright © 2009, Trans-American Alliance for a National Consensus (TANC) ALL RIGHTS RESERVED
  • Page 13 Rx for U.S. Healthcare Reform A Proven Model for NON-PROFIT “Universal Healthcare” Provides a Solution for Enactment burdens and biggest public health risks that require inordinately larger public/private expenditures from America’s healthcare system budgets. So, the producers and distributors of these un- healthy/addictive consumables should shoulder an additional tax www.transamericanalliance.org levy as part of ―social responsibility‖ to help assist in funding a ―Public Option‖ system, which originates from a ―10% Reform” healthcare reform tax proposal submitted by Facebook Friend, Andy Freeman (no relation). Currently, it is estimated that there are 47 million uninsured American citizens, so on a cost-level comparable to ―Medicare-minimum‖ base rates (for Senior Citizens), the full rolls of ―uninsured‖ being extended ―Public Option‖ premiums could come to a total cost of $188 billion annually with an average ―non-profit‖ premium adjusted to a cost of $2,500 to $3,000 per year – in reverse of the ongoing trend of $4,800 to $6,000 annual costs for individ- ual premiums and upwards of $12,000 to $14,000 annually for family premiums that are UNATTAIN- ABLE for low-income families on an out-of-pocket basis. 6) Limits on senior management/executive salaries and bonuses — One of the key driving forces for the escalating costs of healthcare in this country is the ever-escalating rise in senior manage- ment executive pay and administrative overhead costs. Currently, the top Chief Executive Officers (CEOs) of the ―Big 6‖ of Health Insurance — CIGNA, UnitedHealth "The health of a society is Group, Aetna, Humana, Wellpoint and Coventry — take home an truly measured by the average of $11 million in pay annually (see chart on page 8), but quality of its concern and care for the health stock options typically carry overall compensation into the HUN- of its members... The DREDS OF MILLIONS OF DOLLARS once shares are exercised for right of every individual sale. For example, UnitedHealth CEO Steve Hemsley took home to adequate health care $3.2 million in pay for 2008 but his unexercised stock options are flows from the sanctity valued at $744 million, translating to roughly $700 out of each of human life and that UnitedHealth customer’s monthly bill paid on a premium for one dignity belongs to all hu- year, according to SickforProfit.com. Despite the groundswell of man beings... We believe public criticism over excessive CEO pay in this country (especially that health is a funda- in light of the federal government bailouts of corporate institutions mental human right failing to immediately address excessive executive pay and bo- which has as its prereq- nuses), the average CEO across all U.S. industries took home uisites social justice and $10.8 million in total compensation annually — about 364 times equality and that it the pay of the average American worker ($29,670 per year), ac- should be equally avail- cording to an Associated Press survey of 386 of the top Fortune able and accessible to 500 companies. All of this points to why healthcare costs are ris- all." ing faster in the United States than in any other countries in the -— Imam Sa'dullah Khan, world — largely due to excessive, undue executive costs, bloated The Islamic Center of administrative overhead and investor/marketplace pressures to Southern California maintain fat profit margins. Under a new NON-PROFIT Health In- surance structure, executive compensation should be capped at Copyright © 2009, Trans-American Alliance for a National Consensus (TANC) ALL RIGHTS RESERVED
  • Page 14 Rx for U.S. Healthcare Reform A Proven Model for NON-PROFIT “Universal Healthcare” Provides a Solution for Enactment 3% to 10% of their current average, or about $300,000 to $1 mil- lion per year, and maybe at 3% to 6% of current levels for other senior-level management below CEO. www.transamericanalliance.org 7) Each of these freshly converted NON-PROFIT Health Insurance Organizations (HIOs) will begin search processes for a new, ―independent‖ Board of Directors, inclusive of medical practitio- ners, caregivers, first-responders and other non-profit hospital/ family clinic administrators — The proposed composition of these Boards will effectively help guide newly-converted NON-PROFIT Health Insurance Organizations to gather input and direction of how to better interact in a more responsive and efficient manner by observing a newly- created ―UNIFORM HEALTH INSURANCE IN- DUSTRY STANDARDS” for the processing of medical billings and claims with hospital and family clinic administrators, in addition to at- home caregiver and rehab services. Uniform standards for the claims and billing proc- esses will greatly cut down on the red-tape and hassles many hospitals and family clinic physician centers deal with currently in a patchwork, haphazard and non-uniform PRI- VATE/FOR-PROFIT system insurance carriers undertake in states across the country – ef- fectively reducing hourly manpower costs in trying reconcile bill- paying claims procedures. 8) To insure and maintain compliance on a newly structured national UNIFORM INSURANCE INDUSTRY STANDARDS, it would be advis- able to form ―independent‖ HEALTH SER- VICES PROVIDER AND PEER REVIEW BOARDS to regularly review Health Insur- ance Organizations’ compliance with various claims and billings reconciliation processes — These kind of board re- views, which can be conducted on an open hearing basis, can also allow any policy subscribers (either ―paid‖ or ―publicly-subsidized‖ subscribers) to reg- ister any complaints and concerns to an ―ombudsman-like panel‖ regarding is- sues that need to be addressed and cor- rected with these new NON-PROFIT Health Insurance Organizations. Some partisans within the PRIVATE/FOR-PROFIT Health Insurance industry will likely be reticent and clearly reluctant to consider a NON-PROFTIT organizational model, but given the roughly 75-year history of their resistance and lobbying efforts against Health- Copyright © 2009, Trans-American Alliance for a National Consensus (TANC) ALL RIGHTS RESERVED
  • Page 15 Rx for U.S. Healthcare Reform A Proven Model for NON-PROFIT “Universal Healthcare” Provides a Solution for Enactment care Reform (dating back to the World War II efforts of the Franklin D. Roosevelt Administration), more vigorous publicly-generated petition and legislative efforts need to be taken today. www.transamericanalliance.org Somewhere lost in the hysterics and vitriol that has marked the national Healthcare Reform debate in America is a serious, reasoned and sane explora- tion of how to craft a ―Universal Healthcare‖ system that somehow answers and assuages fears from some corners about a ―Government-run, Socialist Healthcare System.‖ It may surprise some congressional Re- publicans, most of whom think ―Big Government‖ and ―Socialized Healthcare‖ are the inevitable re- sults of a reformed healthcare system, that TANC’s non-profit proposal is similarly based on the premise that the federal government should NOT be involved in the day-to-day operational management of health insurance and healthcare services in this country. Given the growing divisions and rancorous allega- tions being tossed within the halls of Congress and the White House in this largely CLOSED-DOOR/ CLOSED-FORUM debate and legislative proposal process, it is particularly understandable why the various political factions and BIG HEALTHCARE LOB- BIES and other well-funded special interest groups have disseminated a head-dizzying array of MISIN- FORMATION, PROPAGANDIZING, STIGMATIZING and DEMONIZING about ―Universal,‖ ―Single-Payer‖ and so-called ―Public Option‖ healthcare systems — particularly against those already being practiced in over 50 countries around the world today. Recent proposed ―compromise‖ plans for instituting some form of national Healthcare Reform have pro- duced what many Americans and the media have derided as either ―watered-down‖ half-measure solu- tions or have just been flatly rejected for injecting any kind of government-/taxpayer-financed ―Public Option.‖ It has been estimated that roughly 22,000 American citizens unnecessarily die annually due to either ―inadequate‖ health insurance coverage, denied/ delayed claim payouts for treatment or being unem- ployed and unable to afford PRIVATE health insur- ance coverage, according to Institute for Medicine research. A recently release Harvard University study found that up to 45,000 patient die annually (one every 12 minutes) due to a lack of insurance coverage and quality healthcare services. However, the National Center of Policy Analysis, a Washington-based think tank backing a free-market/private-sector ap- Copyright © 2009, Trans-American Alliance for a National Consensus (TANC) ALL RIGHTS RESERVED
  • Page 16 Rx for U.S. Healthcare Reform A Proven Model for NON-PROFIT “Universal Healthcare” Provides a Solution for Enactment proach to healthcare, countered that the Harvard study overstated the ―death risk‖ and did not track for how long the subjects were uninsured. On top of the current, nearly three-year-old economic recession, the most www.transamericanalliance.org dramatic, darkly illustrative byproduct of growing unemployment (more than doubling from 4.7% at the beginning of 2006 to 9.7% in August 2009), the num- ber of UNINSURED Americans has risen to an estimated 47 million American citi- zens, according to U.S. Bureau of Labor and U.S. Department of Commerce statis- tics. This growing number of the UNINSURED Americans has created a rising, fes- tering public healthcare crisis — nearly universally decried by medical practitioners, caregivers, first-responders and hospital administrators — that our ―elected‖ repre- sentatives can’t ignore any longer…even with the roughly $2.3 billion in political contributions by the INSURANCE LOBBY from 1998-2006 (source: OpenSecrets.org) to maintain the status quo of America’s ―Have or Have-Not,‖ FOR-PROFIT HEALTH Please click the hyperlink INSURANCE SYSTEM. with this photo for one of the most revealing, infor- Given the poor economic climate and the alarming rise in unemployed and unin- mative interviews PBS‟s sured Americans, other immense public pressure if coming down on the FOR- Bill Moyers had with for- PROFIT/PRIVATE health insurance over its burgeoning ―DENIALS-BASED‖ business mer CIGNA executive practices and other allegations of manipulating the marketplace, artificially inflating Wendell Potter, a whistle- blower who speaks in de- pricing and shifting the costs of deductibles and co-pay charges to consumers, even tail of insurance industry with ―employer-based‖ premiums. practices and with insider knowledge of CIGNA‟s foot Over the last few months, the California Nurses Association successfully lobbied -dragging claims DENIALS state Attorney General Jerry Brown Jr. to mount a full investigation into what the involved in the death of group claimed were 45 million ―suspect‖ denied claims for medical treatment of Nataline Sarkisyan. patients — unlawfully carried about by major FOR-PROFIT/PRIVATE-SECTOR health insurance companies in the state. SmartMoney.com re- cently reported that out of 1 billion medical claims filed nationally with PRIVATE/FOR-PROFIT insurers, as many as 75 million claims annually are ―rejected outright, leaving patents unable to get treatment or stuck with medical bills that add up to at least $50 billion annually.‖ Furthermore, Sen. Patrick Leahy (D-VT) is leading the charge on a pair of Congressional bills (S. 1681 and H.R. 3596) under the Health Insurance Industry Antitrust En- forcement Act banner to bring an end to the 64-year-old exemption that the health insurance industry has been allowed to operate outside the federal Sherman Antitrust laws — rules that ―protect consumers from anti- competitive practices like price fixing,‖ Leahy wrote in his email blast to the American public. ―They can pick and choose their customers and deny cov- erage to anyone with any sort of pre-existing condition -- even acne. They can get away with dropping your coverage when you get sick,‖ Leahy wrote. ―Passing health care re- form with an effective public option is one key way to pro- Copyright © 2009, Trans-American Alliance for a National Consensus (TANC) ALL RIGHTS RESERVED
  • Page 17 Rx for U.S. Healthcare Reform A Proven Model for NON-PROFIT “Universal Healthcare” Provides a Solution for Enactment mote competition in the health insurance marketplace, but we must also eliminate the unjustified and unnecessary antitrust exemption cur- rently enjoyed by insurance companies.‖ www.transamericanalliance.org Sen. Leahy went on cite an unnamed ―recent study‖ that when one or two of the handful of major FOR-PROFIT Big Insurance Carriers control found 94% of the American health insurance markets across the country, it means ―every year consumers are paying more for less coverage.‖ When insurance companies know they don’t have to compete, they don’t,‖ Leahy added. ―When they know they can get away with raising your premiums every year, they do. And when they know they can deny you coverage without consequence, they'll leave you high and dry. The Health Insurance Industry Antitrust Enforcement Act, which I introduced in the Senate in [mid-September 2009], is not the be all and end all of necessary reform, but it is a key way we can give consumers more choice in the health insurance market- place.‖ Nataline Sarkisyan As the result of this ―DENIAL-BASED‖ "Health security is an issue private health insurance system, millions that affects all of us. Every of Americans either live in dire fear of person has a fundamental ever using their PRIVATE health insur- human right to quality ance plans (and risking higher premium healthcare — healthcare costs, higher deductibles or outright pol- that is affordable, accessi- ble, and compassionate. As icy cancellations for having ―preexisting conditions‖) or having no coverage at all the nation begins to trans- and risking going into bankruptcy due to a mountain of incoming medical bills. form the healthcare system Wikipedia.org cited an un-sourced ―recent study‖ that found uninsured and uncov- to one that is sustainable, ered, denial-based medical expenses played a ―significant factor‖ in 60% of all per- it will be important that sonal bankruptcies filed in the United States. we, as a society, ensure that healthcare in the U.S. Even those who thought they had good respects the dignity of insurance coverage took pause at the every person and delivers story of Nataline Sarkisyan, a 17-year-old the quality, compassionate care we expect and de- Los Angeles girl who died while her health serve. Meaningful reform insurance carrier, CIGNA, hemmed and will require dialogue, the hawed over whether to pay for her live- acceptance of diverse views saving liver transplant surgery. CIGNA and above all, compromise. deemed Sarkisyan’s badly-needed and With the human right of delayed liver transplant surgery an healthcare at stake, all of ―exploratory procedure‖ and this came us must work together to despite UCLA Medical specialists citing instances where they had performed the make sure future genera- transplant surgery successfully before. Nataline passed away while awaiting the tions inherit a healthcare system that embraces qual- transplant in December 2007 — although CIGNA finally relented in approving her ity and compassion." claim (after massive public outcry against the insurer) just a day before she died. — Catholic Healthcare West's Sarkisyan’s story is one that rings familiar in denial-based cases where other Ameri- Perspective, as printed in cans have died while awaiting critical life-saving surgeries and can be found, along their Health Security Index, with other stories about prolonged, growing terminal illnesses and other suffering at Spring 2007 Copyright © 2009, Trans-American Alliance for a National Consensus (TANC) ALL RIGHTS RESERVED
  • Page 18 Rx for U.S. Healthcare Reform A Proven Model for NON-PROFIT “Universal Healthcare” Provides a Solution for Enactment -risk patients have endured, at film documentarian Robert Greenwald’s healthcare advocacy site, www.SickforProfit.com. If all or some of the Big Health Insurance carriers reject the NON-PROFIT www.transamericanalliance.org conversion program model TANC is proposing here, then this federally-funded program should be entirely focused on fostering the creation of new NON-PROFIT Health Insurance Organizations and/or expanding the ex- isting Medicare-based ―Social HMOs,” such as SCAN and Elderplan, into the general under-65 marketplace. Allow- ing greater NON-PROFIT participation will generate lower pricing competition in the marketplace that could similarly create new ―market-driven forces‖ to drive down the artifi- cially inflated pricing from FOR-PROFIT/PRIVATE insurance carriers. The benefits of creating and fostering the growth of NON- PROFIT carriers are many: • Larger, feature-rich menus of inpatient and outpa- tient coverage areas and prescription drug assistance on a low- to no-cost basis available to all American consumers. • All medical procedures, doctor visits, preventative/at-home care and screening exam tests are completely covered with no chance of DENIALS or REVOCATIONS of premiums if someone is identified with a ―preexisting condition.‖ • A large selection of in-network Primary Care Physicians (PCPs), specialists, hospitals, emer- gency care, family clinics, outpatient treatment facilities, at-home caregiver services and low- to no-cost prescription drug services. • Even if corporations pay a 1 to 2 percent special corporate tax to fund NON-PROFIT healthcare, these companies will quickly real- ize greater overhead savings with lower ―group‖ coverage policy costs — realizing that a current ―individual‖ employee premium will drop more than half in cost from about $6,000 Under the 3 scenarios proposed by The Commonwealth Fund (with research from annually while a typical ―family-of-four‖ pre- the Lewin Group), the “Public Plan” — based on setting rates at “Medicare- mium will similarly drop by more than half from minimum” levels — offers most optimal long-term reduction in federal outlays (at nearly $3 trillion) over the next 10 years. But, imagine how much higher the sav- its annual $12,000 to $18,000 range today. ings would be in all-nonprofit organizational health insurance system. • There will be NO day-to-day, ―invasive‖ in- volvement of the federal government in ―managing‖ a NON-PROFIT healthcare system, only badly-needed regulatory and legal oversight. Copyright © 2009, Trans-American Alliance for a National Consensus (TANC) ALL RIGHTS RESERVED
  • Page 19 Rx for U.S. Healthcare Reform A Proven Model for NON-PROFIT “Universal Healthcare” Provides a Solution for Enactment • Non-profit HIO carriers will be able to charge middle- to upper- income consumers directly for their premiums, incrementally lower- ing the amounts of special federal startup and long-term funding. www.transamericanalliance.org • Low- to no-income Americans get ―Public Option‖ coverage through the general and special corporate taxes on ―unhealthy/addictive‖ prod- uct categories on a reviewed, ―as-needed‖ basis. • People who choose stay with their FOR-PROFIT/PRIVATE carriers can stay with their option plans, but will likely also realize a considerable lowering in monthly/yearly premium costs because of the new-found "Science may competition from an emerging and expanding offering of NON-PROFIT have found a Health Insurance Organizations entering into the marketplace. cure for most evils, but it has • Adoption of new ―UNIFORM INSURANCE INDUSTRY STANDARDS” will found no greatly reduce or eliminate red-tape hassles that medical practitioners, remedy for the hospitals, family clinics and other caregiver services must deal with in frequently arbitrary DENIALS on billings/pay-out claims — thus having a worst of them ―snowball-effect‖ on greatly lowering hourly administrative and outside all — the collection agency costs to reconcile billing statements. apathy of human beings." • The emergence of a flourishing, growing NON-PROFIT health insurance market could also have the ―domino effect‖ of leading to the de-listing of other FOR-PROFIT/PRIVATE healthcare companies — rekindling the — Helen Keller founding spirit of ―social contract‖ non-profit, religious- and publicly- funded hospitals and other caregiver services. • Jobs in the health insurance and other healthcare sectors will be more stable and secure in a NON-PROFIT organizational model — a much more professionally and person- ally rewarding experience would await those who currently toil in the FOR-PROFIT/PRIVATE arena and switch to NON-PROFIT roles in fulfilling a vital ―Social Con- tract‖ dedicated to aiding the health and well-being of Ameri- cans. Hopefully, more than anything, this potential reinvigoration of NON- PROFIT health insurance can get top- to middle-level executives, adminis- trators and highly-skilled medical practitioners to look inside at a healthcare system badly in need of reform when it comes to overhead costs and compensation. Reform of the health insurance industry, like all other sectors of healthcare, has to Copyright © 2009, Trans-American Alliance for a National Consensus (TANC) ALL RIGHTS RESERVED
  • Page 20 Rx for U.S. Healthcare Reform A Proven Model for NON-PROFIT “Universal Healthcare” Provides a Solution for Enactment do with amending internal business practices and renewing government’s role as a regulatory/legislative oversight body — not just pouring in $856 billion dollars over the next 10 years (as Sen. Baucus proposes) without a clear mandate and plan to truly end the unjustified FOR-PROFIT inequities www.transamericanalliance.org of a long-running ―Have or Have-Not‖ healthcare system. If this country can manage to return to the ―Spirit of Collectivism‖ that was a hall- mark and fixture in the founding of religious-based hospitals and family-based prac- tices from a variety of Christian faiths and other denominations originally settling in America during the 18th to early 20th centuries, then we truly have a chance to cre- ate an American healthcare system that will be uniquely self-reliant/self- sustainable, just, equitable and accessible for this and future generations of Ameri- cans. "When will our In 2003, of the roughly 3,900 nonfederal, short-term, acute care general hospitals consciences grow in the United States, the majority — about 62 percent — were NON-PROFIT, accord- ing to Wikipedia.org. The rest included government hospitals (20 percent) and for- so tender that we profit hospitals (18 percent). Still, it has been widely reported that even not-for- will act to profit hospitals are being racked with higher executive and administrative costs, so prevent human even NON-PROFIT religious- and government-backed hospitals need to address and conform with lower, more equitable compensation structures to fulfill their ―social misery rather contracts‖ with the American public. than avenge it?" In other key areas of U.S. healthcare reform, TANC is additionally proposing the fol- — Eleanor Roosevelt lowing measures to reform America’s healthcare system: Medical Malpractice Liability and Tort Reform — State and federal statutes have to be legislatively amended to mandate a set structure for the limitation of jury rewards on malpractice suits against hospitals and medical practitioners. This will also help to drive down the cost of malpractice insurance for doctors and hospitals, both of which pass those costs back to consum- ers in what they charge for services. • Pharmaceutical Pricing and Practices — Prescription drug prices in the United States are the highest in the world, accord- ing to Wikipedia.org. The prices Americans pay for prescription drugs, which are far higher than those paid by citizens of any other developed country, help explain why the pharmaceutical industry is — and has been for years — the most profitable of all businesses in the U.S. In the annual For- tune 500 survey, the pharmaceutical in- dustry topped the list of the most profit- able industries, with a return of 17% on revenue and 30% operating profit margins. The high price of prescription drugs has been typically one of the most contentious areas of discussion in the U.S. healthcare reform de- Copyright © 2009, Trans-American Alliance for a National Consensus (TANC) ALL RIGHTS RESERVED
  • Page 21 Rx for U.S. Healthcare Reform A Proven Model for NON-PROFIT “Universal Healthcare” Provides a Solution for Enactment bates, especially given the complexities of trying to regulate big pharmaceutical conglomerates with operations spread across the world internationally. Areas of consideration have been tougher www.transamericanalliance.org federal government regulation of the pharma industry to the adoption of a Medicare-type ―Part-D‖ prescription drug subsidization program already offered to seniors and possibly expanded to the general under -65 population. Coming up with an equitable solution in the ―public interest‖ could be tough, though, with thousands of lobbyists from the pharma lobby funneling their influence and contribu- tions through halls of Congress and the White House in Washing- ton, D.C. The pharmaceutical industry spent $855 million, more than any other industry category, on lobbying activities from 1998 to 2006, according to the non-partisan Center for Public Integrity. Strengthening/Financially Reinforcing Medicare — Having created the model for NON-PROFIT, ―Social Managed Care‖ pro- grams, it would seem logical that the expansion of its Medicare Advantage Prescription Drug program is a highly attractive and seamless solution for relieving federal budgetary burdens on the senior-care agency. The budget for the U.S. Department of Health and Human Services, which encompasses budgetary/ operational oversight of Medicare, is the largest federal budget category at $707.8 billion in 2008, according to the White House Office of Management and Budget. Total budget outlays for Medicare (Parts A, B & D) are expected to top $506.8 billion for 2009, a near doubling (97% increase) over its $256.8 billion budget in 2002. According to a report by the board of trustees for Medicare and Social Security, Medicare spent more than it brought in from taxes in 2008, with predictions that the Medicare hos- pital insurance trust fund will become insolvent by 2019. However, if the federal government acts more aggressively in mandat- ing an expansion of its successful Medicare Advantage (Part D) prescription drug program for ―Social HMOs,‖ it could be possible that more of the budgetary shortfall in meeting the needs of nearly 45 million seniors in this country could be alleviated and shifted toward direct pre- mium contributions to innovative non-profits, such as SCAN, Elderplan and others, outlined in this paper. Profit should not be the overriding motivating, driving force of American healthcare and if we can get this right, I truly believe other American business categories rocked by scandals, corrup- tion and other forms of mismanagement — such as banking, real estate/housing and the automotive sectors — will have a model for conducting business on a more sound and ethical basis go- ing-forward. The independence and innovation of these ―Social HMOs‖ feature the best of what NON-PROFIT, altruistic organiza- tions offer, along with the innovations of what had once been considered sole pro- Copyright © 2009, Trans-American Alliance for a National Consensus (TANC) ALL RIGHTS RESERVED
  • Page 22 Rx for U.S. Healthcare Reform A Proven Model for NON-PROFIT “Universal Healthcare” Provides a Solution for Enactment prietorship of FOR-PROFIT, private enterprise. However, somewhere in this CLOSED-DOOR debate on Healthcare Reform in Washington, DC, the President and Congress seem to have shut off any www.transamericanalliance.org further PUBLIC EXPLORATION of new proposals, although Pres. Obama still insists he is keeping ―an open door policy‖ on ideas from his friends in Con- gress. But that is where the President doesn’t even realize there are other ideas that can be explored and derived from a truly OPEN-PUBLIC FORUM summit on healthcare that TANC is proposing. And that may be why the President doesn’t realize that he lacks much of any kind of PUBLIC CON- SENSUS MANDATE FROM THE PEOPLE to give him leverage he needs in Congress. It’s time for all Americans to look inward, question, propose and work together on how we can do better to help each other, rather than feed- ing off a dated laissez faire theory of a ―free-market,‖ predatory health- care system based on the ―survival of the fittest‖ — this is intolerable and unacceptable when it comes to balancing out the lives and well- being of Americans. Most notably, America’s arcane, haphazard ―Have or Have-Not‖ system of private healthcare appears to be built on a self-fulfilling prophecy of ethical and moral criminality, all of which has already been rejected by the 50 or so other nations of the world practicing various forms of ―Universal Healthcare.‖ Coming on the heels of massive, nearly TRILLION-DOLLAR bailouts of corporate banking, insurance and automotive institutions in this country, it is critical our ―representative‖ federal govern- ment proves it can still produce Healthcare Reform in the ―Public Interest‖ — not just in ―Corporate Interests.‖ Delivering on a NON-PROFIT-BASED, ―Universal Health- care‖ system would be a triumphant, epic accomplish- Advocates of a “Single Payer” and “Universal Healthcare” had to make their feelings known quickly as Sen. Max Baucus (D-MT), ment after 75-plus years of mostly futile struggles to at- chairman of Senate Finance Subcommittee holding hearings on tain any kind of meaningful reform. It is time for America Healthcare Reform, had security officers quickly escort them out to regain its reputation for humanity, equality and innova- due to the CLOSED-DOOR nature of the HCR debate. Please tion as an ―advanced society‖ atop the world stage. click the hyperlink to watch the YouTube video as Baucus and other committee members scoff and laugh as the advocates are ### rushed out the door. “If all or some of the Big Health Insurance carriers reject the NON-PROFIT conversion program model TANC is proposing here, then this federally-funded program should be entirely focused on fostering the creation of new NON-PROFIT Health Insurance Organizations and/or expanding the existing Medicare-based “Social HMOs,” such as SCAN and Elderplan, into the general under-65 marketplace. Allowing greater NON-PROFIT participation will generate lower pricing competition in the marketplace that could similarly create new “market-driven forces” to drive down the artificially inflated pricing from FOR-PROFIT/PRIVATE insurance carriers.” Copyright © 2009, Trans-American Alliance for a National Consensus (TANC) ALL RIGHTS RESERVED
  • Page 23 Rx for U.S. Healthcare Reform A Proven Model for NON-PROFIT “Universal Healthcare” Provides a Solution for Enactment About TANC www.transamericanalliance.org Trans-American Alliance for a National Consensus (TANC) is a Califor- nia-based nonprofit 501[c][3] public advocacy organization dedi- cated to establishing a national ―Electorate Legislative Consortium‖ as part of a nonpartisan, citizen-based assembly bringing together all key segments of society to author and enact ―consensus‖ federal legislation. The primary mis- Organization sion of TANC is to act as a complementary but binding ―fourth branch‖ arbiter between the established Legislative, Executive and Judicial branches of the Michael A. Freeman Executive Director U.S. government. Co-Founder To convene on a local, regional and national basis through a representational Jaimie J. Keane number of universities and colleges in the United States, TANC is empowered Assistant Director to bring badly-needed consistency, accountability and transparency to policy- Co-Founder and law-making from the federal government. Also referred to as The Alliance, the overriding goal is to establish TANC as a nonpartisan ―ethical conscience of democracy,‖ effectively seeking to contradict or mitigate the influence some You can also find more well-funded lobbyists, special interest groups and political action committees information, position pa- hold on politicians throughout the corridors of power in Washington, D.C. pers, presentations, our draft bill for an For more information and how you can participate to make ―Citizens’ Over- ―Electorate Branch‖ of sight‖ a potential fixture of future federal governance, please visit us at government and other www.transamericanalliance.org. research and how you are welcome to join in You can also make a huge difference by mailing or emailing this position pa- TANC membership at our per, Rx for U.S. Healthcare Reform, to your elected congressional Senate and Web site (listed above) or House representatives by searching for their email addresses at http:// with our two social net- work site portals: Our www.congress.org/congressorg/directory/congdir.tt. Emails, with the PDF ver- Facebook TANC Cause sion of the position paper attached, can be forwarded to the President Group at http:// (president@whitehouse.gov), Vice President (vicepresident@whitehouse.gov) apps.facebook.com/ and other members of executive branch-level cabinet departments can be causes/249715/541035 sent to comments@whitehouse.gov; and snail mail to The White House, 1600 74?m=1 and TANC LinkedIn.com Group por- Pennsylvania Avenue NW, Washington, DC 20500. If you have any inquiries, tal at http:// suggestions or thoughts, please share them with us at Think- www.linkedin.com/ TANC@transamericanalliance.org. ### “If FOR-PROFIT/PRIVATE health insurance carriers label their so-called top-of-the-line plans as “Cadillac Premiums,” than several “Social HMOs” including SCAN‟s Medicare-based plans for seniors should be coined the “Rolls-Royce Premiums” of health insurance. It just proves that a greatly expanded menu of benefits and lower deductibles and co-pays are very achievable at a fraction of the monthly/yearly costs of what FOR-PROFIT/PRIVATE health insurers offer.” Copyright © 2009, Trans-American Alliance for a National Consensus (TANC) ALL RIGHTS RESERVED