Sunday, October 11, 2009

Health Insurance Reform from an INDEPENDENT PERSPECTIVE.

Hiding in and around all of the rhetoric and political posturing is the reform of health insurance and subsequently health care in America. The parties that be in Washington are in full attack mode and are rampant for the implementation of the socialization of the health care system.

The current Medicare/Medicaid system (CMS) is a federalized program,(http://www.americansolutions.com/cgi-bin/mt/mt-cp.cgi?__mode=view&id=196938&blog_id=2) this is very evident when you look at how Medicare and Medicaid are structured and managed. Medicaid is administered on a state level but its funding is federal and based like all of Medicare dollars on the census. Medicare is national Major Medical insurance paid by your payroll taxes for part A and monthly premium for part B. So lets stop here first and recognize that Washington is already in the health insurance business and has been since 1965. Lets evaluate their 44 year operating history as you would any business to determine if you were the owner their overall performance! ( And you are the owner of this business mr.and mrs. taxpayer)

1. Funding: the government is running out of money because they are paying out more than bringing in and we all know how well our government does living on a budget! http://waysandmeans.house.gov/hearings.asp?formmode=printfriendly&id=1303
The CMS has suffered from fraud and abuse for so long that we now pay outside vendors to retreive lost and embezzled funds!
The CMS completed a three year demonstration project to demonstrate the use of recovery audit contractors (
RACs) in identifying and correcting underpayments and over payments and recouping over payments in the Medicare FFS program. The demonstration was initiated in the three states with the highest Medicare utilization rates (California, Florida, and New York) and expanded in the summer of 2007 to include Massachusetts, South Carolina, and Arizona. For the demonstration project, the CMS provided the RACs with all the claims paid between FY 2002 and FY 2007. The RACs reviewed the claims to see if they were correctly coded, medically necessary, and consistent with the Medicare billing rules, or for potential Medicare Secondary Payer occurrences where a beneficiary has access to another Group Health Plan insurer and Medicare should not have paid the claim as primary. As of March 27, 2008, RACs collected $992.7 million in overpayment's and refunded $37.8 million in underpayments.
Section 302 of the Tax Relief and Health Care Act of 2006 makes the RAC Program permanent and requires CMS to implement the program in all 50 states no later than January 1, 2010. The CMS has initiated a full and open competition to hire four permanent RACs. Each RAC will be responsible for identifying and correcting improper payments in approximately one-quarter of the country. The CMS awarded the contracts in October 2008 and is initiating a gradual implementation nationwide. The CMS and the RACs will provide extensive outreach to the provider community during implementation.


2. Management: This is the 2008 federal management chart from CMS.
http://www.cms.hhs.gov/CFOReport/Downloads/2008_CMS_Financial_Report.pdf
And they are overseen and budgeted and are administered by the Health Care Finance Administration (HCFA) of the Department of Health and Human Services. (CONGRESS AND THE SENATE). Obviously if you read the first analysis they are the most incompetent of managers and based on how this current regime deals with public entities owing TARP money and dismissing private sector management for lesser malfeasance, THEY SHOULD ALL BE FIRED!

3.Growth Projections: This is why the liberal socialists are salivating over the single payor system. The next 20 years are going to see 78 million Boomers join Medicare and if you are actually reading the CMS research material in this blog then you will realize THEY SPENT THE MONEY ALREADY PAID IN FOR THEM!

SCHIP and MEDICAID have robbed Peter to pay Paul and their kids and grand kids and great grand kids and great great grand kids. This country has now had 4 generations of families ( yes direct lineage blood relatives) on federal assistance programs.
The socially aware liberal elite in Washington has felt it more important to provide for those that are defrauding the system than HONOR IT'S OBLIGATIONS!
They have also diverted funds thru FEMA to pay for costs associated to health care from natural disasters and catastrophe's. The problem with that is FEMA suffers from more fraud than CMS, 35 cents out of every FEMA dollar goes to Fraud and Waste! So there is explosive growth but NO FUNDING to support that growth. And with unemployment in double digits and NO NEW TAXES how do you pay for it? REDUCE COSTS AND RAISE TAXES!

4. Market Share: The only way to increase revenue when your marketplace is wiped out is to control more of the MARKET! If you eliminate the competition then you are in CONTROL and set the rules based solely now on your corporate practices. So lets again review how our Government has done historically in what is called governance or how they do when in Charge.

A. AMTRAK: financially bankrupted 2 years after its creation and has never turned a profit and receives around $ 8.2 BILLION a YEAR in subsidies to operate essentially a local commuter train in the Eastern corridor of the U.S.

B. FEMA: so overrun with fraud and abuse that 4 years later after Katrina they still have debris on the ground in New Orleans and the population is just now reaching 65% of pre-storm levels.

C. U.S. Post Office: God bless the postal service but they are being administered by idiots and have been SLOW to adapt their business model to be competitive in the information age that we now live in. It was always designed to be a mail service first and meant to service the metropolitan centers of America not this new, vast and modern suburban landscape.

These 3 examples are just the most obvious, Our Government has been the epicenter of incompetence for decades, look at the CIA controversies, the Congressional and Senatorial scandals that are occurring and occurred. We have tax cheats running our finance committees and IRS.
NASA over- expenditures list is staggering in size and scope!

SO AGAIN WOULD YOU PERSONALLY HIRE ANY OF THESE PEOPLE OR THE BUREAUCRACY, THEFT, FRAUD, ABUSE AND COMPLETE INCOMPETENCE they represent TO RUN YOUR BUSINESS?

5. Summary: The federal government has failed on every demonstrateable front that they with or without this regimes guidance and insistence, that they are NOT capable of running health insurance reform or the health care reform that must come with it! So why try? That is the $64,000.00 question isn't it? Everyone has their opinion but based on just the brief information I have provided here today in this blog, the facts show one intent and purpose, total control of the market to control costs and provide funding from increasing the roles paying into Obamacare for the costs. If they force and yes they will, (THEY HAVE ZERO CHOICE IN THE MATTER) every American into the single payor system by stealth taxes called incentives and penalties for non-participation. They will also force the enrollees who lose private coverage into this system with current amendments in every bill ( YES ALL CURRENTLY HAVE THIS IN ALL OF THEM) And they will reduce the costs over time but that will only come from CUTTING BENEFITS!

Every incarnation of this bill has it required to reduce CMS costs and remove the fraud and waste well what you are not being told is that they intend to punish EVERY DR. WHO IS IN THE TOP 10% OF CLAIMS WITH CMS TO BE AUDITED AND THEN FORCED OUT OF MEDICINE OR WATCH DOGGED FOR THE NEXT 10 YEARS!


Now how do you fix it?

Make it portable by allowing all companies to sell to everyone no matter where they live .

Create a pool of dollars from every company to create a high risk fund and any insurance company that writes high risk policies uses those monies to offset the costs and keep the premiums the same as they would be for everyone else.

Stop the frivolous lawsuits the Trial Lawyers Association has spent more money per member than any other lobbying group in DC. In 2008 they contributed $3.8 million from their 4800 yes 4800 members. Your health care bought and sold by lawyers!

End the bedroom relationship of Doctors and Pharmaceutical companies, stop throwing drugs at us and give alternatives to chemical therapy.
Allow anyone in the NAFTA countries to buy their prescription drugs where ever they want and force BIG PHARMA to stop RIPPING US OFF!

And yes the insurance companies need to stop PUTTING PROFIT AHEAD OF CARE! Any publicly traded insurance company should create a public policy oversight board to review their claims for consumer advocacy! Currently that is left up to the court systems and has morphed into a full blown political show down between the two parties. It has gridlocked the N.Y. state legislature and allowed their state atty. general to go on a political witch hunt for his own gains!

So in a paragraph there is a way to fix the system but not take it over, so all of you who think that the government is up to no good, you are correct. All of you Liberals who say only the government option is the answer, go and read the facts again from CMS and the CBO and the Bills currently on both floors and then as you have been doing all along turn a blind eye to the truth of the matter and that you now have a choice to make!
DO YOU SWEAR TO UPHOLD AND DEFEND THIS COUNTRY AND THE CONSTITUTION WHICH GOVERNS ITS PEOPLE FROM ALL ENEMIES BOTH FOREIGN AND DOMESTIC?

IF NOT GET OUT OF MY AMERICA AND TAKE YOUR REGIME WITH YOU!

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Financial Services Professional specializing in health care risk mitigation and multi-layered retirment income planning.

Blood of Our ForeFathers

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