Simple Solution for the Health Insurance Exchange


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Simple Solution for the Health Insurance Exchange

  1. 1. A Solution for the Insurance Exchange 03/08/2010
  2. 2. Why is Healthcare so Complicated? Laws Services Information Restrictions Research Technology Litigation Medical Schools Protocols Medicaid Private Health Regulatory Private Practice Hospital Insurance Research Medical Services Equipment Terms & Veterans Medical Liability Conditions Patient Patient Services Devices Diagnostic Responsibility Products Medicare Risk Diagnostic Liability Diagnostic Services Therapists Insurance Equipment Pharmaceuticals Gov’t Funded Research Reimbursement Enablers Interaction of many industry segments to provide what patient sees as healthcare
  3. 3. Can We Afford Universal Healthcare for All? The Budget Deficit is Dwarfed by the National Debt The National Debt is Dwarfed by the Unfunded Mandates of Existing Entitlement Programs We Simply Cannot Afford Another Entitlement Program
  4. 4. Paying for Free Healthcare • 1/3 of GDP From Public Sector – Taxes Fund Government Sector – Higher Taxes Stifle Growth – Net Lower Tax Revenue – Higher Unemployment Higher Taxes Exacerbate Problem – There is no Free Healthcare
  5. 5. No New Taxes Taxing Employer Paid Healthcare Plans will Have the same negative effect on Tax Revenue.
  6. 6. Patient Relationships and Responsibilities Physician Hospital Services Posted Prices for Services Posted Prices for Services Require Posting on Web Discount for patients that pay at time of service (TOS) Patient Be aware of prices Pay at time of service Health Insurance Diagnostic Services Consistent Standards Posted Prices for Services Plan Pricing Discount for Payment at TOS Option Pricing Offer Discounts for Patients that file paperwork Offer discounts for patients that pay at TOS
  7. 7. It is More Cost Effective if Government Runs the Plan • The President Estimated Health Insurance Companies Profits in 2009 - $12B • CBO – Medicare Fraud and Abuse (F&A) – $60B in 2009 • Industry F&A 1% and Average profit 5.6% • Computes to $2B industry F&A • Net: Non-profit, government run Medicare cost the US tax payers $46B last year versus industry run healthcare • This Does not Even Take Into Account the Government's Lower Productivity and Labor that IRS Requires to Collect Taxes Government Run Translates into Higher Cost
  8. 8. Health Insurance Exchange • Government Guaranteed Health Plan – Implemented By Insurance Contractor – Periodically Selected via Competitive Bid Process • Capped Profits and Open Books • Basis of Estimate Provided • Compliant with Federal Acquisition Regulations • Insurance Available Nationwide – Plans and Options Will Be Defined in the Terms and Conditions • Allows Flexibility in Refining Plans • Options for Lifetime Maximums • Identifies Pre-existing Conditions for Which Premiums May Be Increased • Provides Insurance Pool for Individuals and Small Business. • Guarantees Health Insurance for High Risk Individuals – Will Not Be Free – Government Picks Up Premiums if Catastrophic Illness Occurs • Medicare Should Be Switched to a Similar Implementation
  9. 9. Regulatory Reform • Reform FDA regulations to be more in line with European Standards • Accept European Approved Drugs and Devices • Implement Compensation Board – Compensation Schedule For Adverse Effects • Allow Companies to Facilitate Off Label Use • Mandatory Jail Time for Executives that Intentionally Put Public at Risk • Let Doctor and Patient Make the Quality of Decision • Eliminate Onerous HIPAA Privacy Laws – Apply Same Laws as Financial Institutions Allows More Treatment Options in a More Timely Manner
  10. 10. Back-up Slides
  11. 11. Useful Links • • • • • •
  12. 12. Useful Links • pass.html?showComment=1267921721140_AIe9_BGD3f0pWQgvARUBDm2gNZX4lmES0dHQ6ctdslVZ57gfhemb2pU7c4Ca1Z kjedmuHLebxsaTA4nm_USwgg11LdX04TF2eGAW2A0iciQHK85VjsDnUNhkv5pt3EAe7CzucD_l28CoxrDrd1dconqB7HtDXTj12p 06q3mZN-mUl2Kq0hcqOUtrmMbSlDNZb- UlHRf0oN10n_ZSJWC7cYW3QmPMTWYsNb_dD653ZaxLewuGw0_Ys3aC8NDKcdZRJXV3j_p3XaOx#c5939458995751086490