Saddlebrooke Republican Club

American Issues Discussion Group

An Alternative Approach to Universal Health Care 

by Richard Brinkley 

 

The Saddlebrooke Republican Club believes that universal healthcare can be achieved without creating a government health plan that will force private health care plans from the market; that increases access to quality care; that provides for effective tort reform; that increases competition without the false choice of a government health plan; that lowers cost; and that provides for health plan metrics to measure financial, operational and clinical performance.

Our position expands upon and is more comprehensive than the “House GOP’s Solutions Group Outlines Health Care Plan to Increase Affordability, Accessibility Availability.”  The Solutions Group’s reforms are designed to (1) make quality health care coverage affordable and accessible, regardless of pre-existing conditions; (2) protect Americans from being forced into a draconian Government health care plan that will eliminate employer sponsored coverage for 100 million Americans; (3) retaining the freedom for all Americans to choose the health plan that best meets their needs; (4) ensure that medical decisions are made by physicians, not government bureaucrats; and (5) promoting prevention, wellness and disease management programs. This position paper builds on the Solutions Group effort and takes it to the next level.

 

Health Plan Market Place

1.  Protecting the health care market place from predatory pricing by a government health plan and increasing competition calls for the following changes:

2.  Provide for only private sector health care plans. This eliminates the onerous cost of a government health care plan using a Medicare template and reflecting even worse financial results. The Government is assigned an oversight and facilitation role.

3.  Provide for private health care plans to compete across state lines.

4.  Provide for a reasonable level of health care benefits not to exceed or equal to those benefits received by Congress.

5.  Provide the Federal Employee Health Care Plan as the vehicle to expand health care universally. If the plan is good enough for Congress it should suffice for all Americans.

6.  Provide for Medicare, Medicaid, TriCare and SCHIP health plans to be folded into the expanded Federal Employee Health Care Plan (to be renamed at a later date).

7.  Provide for a Government oversight and facilitation role in providing a central source and/or regional sources for individuals to compare health plan benefit designs and costs in choosing a health care plan.

8.  Provide for participating health plans to insure only United States citizens and non-citizens legally residing in the United States.

 

Lower Costs Without Reducing Medicare Benefits – In order to eliminate health care overspending, unnecessary costs and defensive medicine must be eliminated:

9.  Provide for tort reform by capping health care law suits to $500,000 per occurrence.

10. Provide for the restoration of $500 billion to Medicare financing.

11. Provide for extending tax savings to individuals who do not have employer-provided health insurance but purchase health insurance in the “individual market.”

12. Provide immediate financial assistance for health care coverage to low and modest income Americans, including pre- and early retirees, through refundable and advanceable tax credits.

13. Provide for HHS to combine audit and support staff from the Federal Employee Health Plan, Medicare, Medicaid, TriCare, and SCHIP health plans to establish appropriate programs to eliminate waste, fraud and abuse.

14. Provide for health savings accounts and flexible spending arrangements as well as creating new tax benefits to offset the cost of long-term care premiums.

15. Provide financial help to care-givers who provide in-home care for a loved one.

Provide for states, small businesses, associations and other organizations to band together to obtain health care benefits at lower costs.

16. Provide for the elimination of means testing in all health plan pricing.

17. Provide for keeping President Obama’s promise to the American People that the costs of universal coverage will not add to the Federal deficit.

18. Provide for HHS to implement a plan to convert all medical records to electronic medical records.

19. Provide for folding Medicare, Medicaid, TriCare and SCHIP health plans into the expanded Federal Employee Health Care Plan; aggregating health plan populations allows spreading of risk over a larger base.

20. Provide, for those participating health plans, hospitals and medical groups requesting, software code for the Veterans’ Administration electronic medical system free of charge.

21. Provide barriers preventing the Federal Government, either intentionally or not, from committing acts that will force participating health plans to increase premiums.

 

Increase Access to Quality Care – In order to increase access to quality care, barriers to access must be eliminated:

22. Provide for the elimination of pre-existing conditions and medical underwriting by all participating health plans.

23. Provide for guaranteed issue of coverage by participating health plans.

24. Provide for restricting the Government from issuing “best practices” guidelines; provide for participating health plans to encourage provider groups to agree to “best practices” for all participating plan providers.

26. Provide for restricting the Federal Government from accessing participating health plan electronic or paper medical records.

27. Provide for restricting the Federal Government from tampering with physicians’ adherence to the Hippocratic Oath.

28. Provide for participating health plans to guarantee access to quality care, to include sufficient physician specialties and facilities to warrant timely access to providers.

29. Provide for HIPAA regulations regarding Private Healthcare Information (PHI) to remain in force.

30. Provide that all Americans can choose their own providers.

31. Provide for allowing dependent to remain on their parent’s health policies up to the age of 25 (this could reduce uninsured Americans by up to 7 million).

32. Provide that participating health plans shall have benefit designs that span the spectrum of high benefit to low benefit, i.e., high benefit plans would include medical, pharmacy, dental, vision, orthodontics, mental health, complementary or alternative health care, while low benefit plans may only provide medical, pharmacy, and dental.

33. Provide for prevention and wellness programs by health plans by giving employers and insurers greater flexibility to financially reward employees who seek to achieve or maintain a healthy weight, cessation of smoking, and manage chronic illnesses.

34. Provide incentives for the addition of 54,000 primary care physicians to meet the addition of 46 million uninsured Americans in order to avoid rationing health care for the rest of America.

35. Provide incentives for specialty physicians, Advanced Nurse Practitioners, Physician Assistants, and Registered Nurses to complement the increase in primary care physicians.

36. Provide for participating health plans to cover out of area urgent and emergent care, to include outside of the United States.

37. Provide for encouragement of home care and independence for patients rather than forcing individuals into institutionalized settings.

38. Provide for end of life support and care through increased access to quality hospices.

 

Participating Health Plan and Government Reporting – Participating health plans shall be required to publish monthly and quarterly summary financial and administrative reports, along with an annual detailed financial report audited by an approved auditing firm. All participating plans shall employ an ombudsman and have formal grievance programs:

39. Provide monthly and quarterly financial reports shall highlight medical loss ratios and administrative costs in dollars and as a percent of premium.

40. Provide quarterly and annual grievance reporting, to include but not be limited to: name of complainant, type of complaint (e.g., administration or clinical), date when complaint received, date of notification that complaint was received, resolution of complaint, and date of resolution.

41. Provide that all clinical grievances must be investigated by the health plan’s Medical Director or clinical staff directly reporting to the Medical Director.

42. Provide for the Government to create standard reporting templates on participating health plan quality, financial, and operational metrics to provide patients with the best information on which to base health plan and medical decisions.

43. Provide for standardized provider reimbursement schedules upon aggregating the Medicare, Medicaid, TriCare and SCHIP populations under the Federal Employees Health Care Plan.

44. Provide for participating health plan reporting, in the aggregate using sanitized data on physician ordering of tests and costs subsequent to tort reform enactment; provide for the Government to publish individual health plan and aggregate results.

45. Provide for participating health plan quarterly and annual reporting of metrics used in improving cost containment objectives.

46. Provide for participating health plans to issue public report cards on each physician by specialty to provide patients with the best information possible on which to choose his or her physician.

47. The US Government shall in no way interfere with the rights of States to place limits on health care lawsuits or interfere with States implementing tort reform.

For a PDF version of the position paper,  click here.