Healthcare in America: The Fix, pt. 6

Good day, family and friends!

Today, we're going to look at that evil competition thing.  I use the word "evil" because that's how the progressive socialists view competition, and that is how competition is being taught to our children in many public schools these days.  Okay, maybe they don't call it "evil," but they do constantly disparage competition through both word and example.  But I will go into that in more detail in a future post.  Right now, I want to focus on how competition can make our current healthcare system better.

The first way would be to restore what our Founders believed to be one of the most fundamental aspects of the USA: that our Republic is a union of (currently 50) individual states, not a nation-state divided into administrative regions.  The Xth Amendment to the Constitution states, "The powers not delegated to the United States by the Constitution, nor prohibited to it by the States, are reserved to the States respectively, or to the people."  In simple terms, it says that, if the Constitution doesn't specifically say the Federal Government has jurisdiction over something, then the citizens of each State can make their own decisions about how to handle a particular subject.  In other words, the States were to be allowed to have their own community standards, their own 'flavor,' as long as what they did did not violate the Constitution.  The Liberty of American citizens allowed them to 'vote with their feet' on the environments of the individual States; i.e. they were free to up and move themselves and their businesses out of States with oppressive or untenable environments and go to States that have a more favorable environment without having to apply for permission or visas.  The only requirement was that they were expected to follow the local laws of their new home.

Over the last 40 years, however, there have been incremental steps toward marginalizing the Xth Amendment and homogenizing the States until they are indistinguishable, one from the other.  As our country has been slowly marched toward an all-powerful central national government, the States have been forced into a 'one size fits all' mentality in many issues.  Every time one of our 'political heroes' calls for us to 'level the playing field' or 'lower the bar' to correct some perceived inequity, it ends up as a lowering of standards and an attempt to bring everyone down to the lowest common denominator.

You are probably asking, "What does this Civics lesson have to do with Healthcare?"  Well, over the last 75 - 80 years, the professional political class that has arisen in our Republic has stifled competition in both healthcare coverage and delivery in pretty much every State.  Lobbyists have managed to get laws passed in each State that favors only a handful of the hundreds of insurance companies. (Look back at my analysis of the Affordability of Healthcare.)  And remember what the State of New York did to Dr. Muney when he tried to offer his patients a low-cost subscription service?  What We the People need to do is make it clear to our representatives in government that we are tired of them pandering to special interest groups and that they need to start representing the People and upholding the Constitution.  What this means to Healthcare is an end to special-interest set-asides and corporate welfare that stifles competition.  The extent of government interference in any commerce venture should be limited to these questions:

1. "Do any of the tenets of the contract or business agreement put public safety or health in jeopardy?"
2. "Do the contractual obligations defined in the contract or business agreement violate the Constitution or any Laws?"
3. "Have any of the parties in this contract violated the terms of the contract?"

Beyond that, the various levels of government have no business interfering in what is essentially a matter of Commerce; i.e. the relationship between a citizen, their insurance company, and the healthcare providers.  If this were the environment in which the healthcare industry were allowed to reside, it would thrive and we would probably see healthcare costs drop by at least 17%, possibly as much as 27%.  Getting rid of special-interest set-asides would permit competition amongst all of the medical insurance providers in every State.

When this sort of open competition is in place, the Citizens would once again be able to "vote with their feet" and the State with the best, most cost-effective offerings would be the winner.

Next time, more on Competition.

Until then, best regards...



© James P. Rice 2011, 2014

Healthcare in America: The Fix, pt. 5

Good day, family and friends!

Let's plow right ahead...

Once again, depending on whose data you choose to use, Insurance Fraud perpetrated by both patients and physicians account for between 3% and 10% of the cost of healthcare every year. This has resulted in insurance companies creating "Benefits Coverage Panels" made up of non-medical personnel making medical decisions which, in turn, often result in patients being denied treatment based solely on cost and "likelihood of fraud" statistical models and not on the medical data.

I propose two different options for putting medical decisions back into the hands of those most concerned with the results of the decision...the patient and the patient's physician:

1) While I do believe that private insurance companies do have the right and the fiduciary duty to take every legal, ethical, and moral action they can to minimize costs and protect their bottom line, I do not believe that accountants and lawyers are qualified to make decisions as to whether or not a medical procedure is necessary. Therefore, I suggest that medical professionals from all specialties, as part of their professional licensing, be required to serve a minimal amount of time every year on a regional independent board that reviews case histories for the insurance companies and determine whether or not a procedure is medically necessary and should be covered. This would allow medical decisions to be made by qualified medical professionals. It would also allow for insurance companies to reduce their costs by not maintaining the permanent staffing necessary for the "Benefits Coverage Panels", even allowing for the contribution to a central funding pool that would be used to compensate the medical professionals for their time.

2) Periodic review of cases denied by the insurance companies to make certain there is a legitimate medical reason for denying the coverage, as long as the patient met all the other requirements for coverage in their policy. These reviews could be handled by the same regional boards proposed in Option 1.

These independent regional review boards would serve to reduce fraud on both sides of the fence. By not having a vested interest in the case, they can objectively look at each case and determine: whether or not it is a legitimate medical procedure, based on the patient's medical history and current medical status; whether or not the physician prescribing the procedure is merely feeding a hypochondriac's condition to fatten their bank account; whether or not the doctor and patient are working together to out and out defraud the insurance company; or even whether or not the insurance company is attempting to defraud the patient by selling them a policy, then issuing 'rubber stamp' denials in order to avoid paying out on claims. The boards will also reduce the operational costs of the insurance companies...part of which the companies would most likely pass on to their consumers in a competitive market, reducing the cost of healthcare coverage for consumers.

Next time: Competition...it does a body good!

Until then, best regards...



© James P. Rice 2011

Healthcare in America: The Fix, pt. 4

Good day, family and friends!

As I mentioned last May, "identifying a problem without offering solutions is just bellyaching." So, with that in mind, let me begin to lay out my suggestions for addressing the issues facing the best healthcare system in the history of mankind...

The first place we have to start is with Tort Reform. As previously noted, out of control litigation in this country accounts for between 19% and 27% (depending on which study you choose to believe) of healthcare costs every year. Getting the ambulance-chasing shyster weasels and the morally-deficit shiftless scammers under control will knock off a fifth of the cost of providing healthcare and healthcare coverage to physicians, clinics, hospitals, and insurance companies.

The first step to this end is to restore Personal Responsibility to the basic tenets of our legal system:

Allow judges and juries to consider "reasonable expectations" when deliberating on the merits and evidence of a case. (id est: if one orders hot coffee and it arrives steaming, there is a reasonable expectation that spilling it on one's self may result in one's flesh being scalded);

If an attorney or law firm accepts a case that is tenuous at best, and brings it before the courts, and that case is deemed by the presiding judge to be without merit and is dismissed, and that there was no intent to defraud on the part of the plaintiff, then the attorney or law firm (and not the plaintiff) will be required to reimburse the defendants all legal expenses, including lost wages and travel expenses, that they incurred;

If an attorney or law firm knowingly accepts a case that is bogus or outright fraudulent and brings it before the courts, then the attorney or law firm will be subject to the same criminal penalties as the plaitiffs, and, along with the plaintiff, will be required to reimburse the defendants all legal expenses, including lost wages and travel expenses, that they incurred;

I believe that human life is sacred and priceless and that a dollar amount cannot be attached to it. I also believe that the tragic loss of a family member should never be viewed as a bonanza by their survivors. Having stated this, however, I do believe that families should be reimbursed for the loss of a loved one due to negligence or criminal activity. To this end I believe that an equitable way to determine this reimbursement should be as follows:

If the victim is under 68 years of age (10 years shy of the average life span of a citizen of the United States): The age of the victim subtracted from 68 times the average annual total compensation (including value of benefits) someone of the same age/career/educational level in the same federal congressional district can expect to make before retirement times 133% plus any rescue/medical expenses incurred by the family as a result of the event that led to their loved one's death plus legal costs.

Or, as a formula: [(68-A)x1.33W]+MEDX+LEGX = Compensation

(for example: A 42 year old man with a Bachelor's degree who has been working as a Customer Service manager in the computer industry in federal Congressional District Texas-31 dies through the negligence or outright incompetence of a surgeon. To determine the compensation his family should receive, the formula would be: [(68-42)x($46,280x1.33)]+MEDX+LEGX or $1,600,362.40 plus any medical/rescue and legal expenses the family incurred from this tragedy.)

If the victim is 68 years of age or older (10 years shy of the average life span of a citizen of the United States): The average annual total compensation/retirement income for someone of the same age/career/educational level in the same federal congressional district times 3 plus any rescue/medical expenses incurred by the family as a result of the event that led to their loved one's death plus legal costs.

Or, as a formula: 3W+MEDX+LEGX = Compensation

(for example: A 72 year old retired Mechanical Engineer who, thanks to diligently saving money and contributing to a retirement fund, has an annual retirement income of $75,000, dies through the negligence or outright incompetence of a surgeon. To determine the compensation his family should receive, the formula would be: 3x$75,000+MEDX+LEGX or $225,000 plus any medical/rescue and legal expenses the family incurred from this tragedy.)

It may seem as if these formulas place a greater value on the younger person than on the older. Quite the contrary; these formulas are designed to be completely neutral and not attempt to establish any sort of relative value on the lives of these two individuals. Instead, the formulas are merely designed to compensate the survivors for potential loss of family income due to the negligence or incompetence of the surgeons in question. The survivors of the younger victim would have lost 20 - 25 years of his contributions to the family income while the survivors of the older victim would still have the retirement savings he (or she) had established and worked to create, so they would not be facing a financial crisis as a result of the tragedy.

Next time, keeping bureaucrats out of medical decisions.

Until then, best regards...



© James P. Rice 2011

Healthcare in America: The Fix, pt. 3

Good day, family and friends!

Let's get right to it...

Amendment XIV, Section 1 of the Constitution states, "All persons born or naturalized in the United States and subject to the jurisdiction thereof, are citizens of the United States and of the State in which they reside. No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any State deprive any person of life, liberty, or property without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws."

In the simplest terms, this means that, if you are born in the US, or have gone through the naturalization process and are no longer subject to a foreign government, then no one can make any sort of law or regulation requiring you to pay a fee, purchase a commodity, or take any sort of test to maintain your citizenship status or to exercise your rights as a citizen. The only exception to this is in cases where a person has been convicted of a crime and either fine or imprisonment has been imposed as their punishment, or if they have had a civil penalty rendered against them.

Basically, this clause states that it is unconstitutional to require law-abiding citizens who have neither been accused of a crime, nor received a judgment against them in a civil proceeding, to purchase health insurance in order to maintain their status as a law-abiding citizen.

I know, I know. I can hear some of you out there decrying, "but what about auto insurance?!? The government dictates that we must have auto insurance in order to legally drive a car. Isn't this the same thing??"

No, it isn't. This argument is nothing but a spurious attempt to compare apples to eggplant. Here is the difference: the Right to Life is one of the unalienable Rights bestowed upon humanity by The Creator (also known as one of Nature's Laws); while driving an automobile is a privilege granted by society. The Constitution was created and designed to protect those unalienable Rights that are an inherent part of our humanity by limiting the ability of government to encroach upon and violate them. Forcing citizens to pay in any form in order to exercise one of our unalienable Rights is in direct conflict with this protection.

On the other hand, automobile insurance was created in order to help citizens more readily comply with the regulation that, before they operate any motorized vehicle on a public thoroughfare, they prove that they can and will be financially able to pay for any damage to another person, vehicle, or other property if they are found to be the cause of an accident. But it is also a misunderstanding that the government forces drivers to purchase auto insurance. Citizens actually have the options of either establishing an escrow account with the minimum balance dictated by law (I believe that, at this time in Texas, it is $100,000), or they can simply not operate a motorized vehicle.

See? Not the same thing.

Okay, I went a bit long this time. Next time, I really will start laying out my suggestions for repairing and improving the best healthcare system in the world.

Until then, best regards...



© James P. Rice 2011

Healthcare in America: The Fix, pt. 2

Good day, family and friends!

Well, now! It seems Real Life reared its ugly head. This is my first post since 30 July 2010. For those of you new to my blog, I started this series of articles in August 2009. If you want to bring yourselves up to speed, I suggest you start with my first post on Healthcare in America located at http://smellthetruth.blogspot.com/2009/08/healthcare-in-america-just-how-sick-is.html.

Now, let's continue the discussion...

Amendment X of the Constitution states, "The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people." In other words, if the Constitution does not specifically say the Federal Government can do something, then it is automatically prohibited from doing it. Not only that, but anything the Constitution does not specifically permit the Federal Government to do is the jurisdiction of the individual States, or the individual citizens themselves and can't even be touched by the Federal Government. Once again, the Founders were brilliant when they created the Constitution. They knew that it was inevitable that like-minded individuals would try to band together, gain control of the nation, and impose their personal opinions and philosophies on this country. To prevent this from happening, they created a series of checks and balances in an attempt to make certain the United States was under the Rule of Law and not the Rule of Man.

"What does this have with Public Law No. 111-148," you ask? A better question to ask is this: Where in the Constitution does it grant the Federal Government the power to...

1) ...take over (not just impose and enforce safety regulations that span all the States) an entire industry and its corollary industries?

2) ...dictate that private, law-abiding citizens must purchase a commodity in order to remain a citizen in good standing?

3) ...confiscate legally-gained income from one group of citizens and redistribute it to and supplement the lifestyles of a different group of citizens who have chosen to be less productive and focus more on personal gratification?

4) ...establish that the worth of one citizen is greater than another based on the citizen's age and ability to contribute to society?

The answer to those questions is, "No where." The Constitution does not grant any of those powers or abilities to the federal government. There are some who have tried to stretch and twist the sentence in Article I, Section 8 that grants Congress the power "to regulate Commerce with foreign Nations, and among the several States, and with the Indian Tribes"...what is commonly referred to as the "Interstate Commerce Clause"...to apply to these four areas. Only the most twisted, creative mis-interpretation of a clause written to be straight forward and self-explanatory can be used to justify such unconstitutional actions.

Next time, I finish up with the violation of Amendment XIV and start laying out my own suggestions to fix Healthcare in America.

Until then, best regards...



© James P. Rice 2011

Healthcare in America: The Fix, pt. 1

Good day, family and friends!

This time, I am going to begin looking at the cure for the issues facing healthcare in our nation. As I have stipulated all along, while we may have the best healthcare system in the world, it does have some serious problems that need to be addressed. Because of this assertion of mine, I've been asked by numerous people (including one of my daughters), "if you acknowledge that the current system is broken, why do you oppose the Healthcare Reform Act that Congress passed this spring to fix it?" The short answer is this; because it's unconstitutional.

Public Law No. 111-148, formerly known as H.R.3590 - The Patient Protection and Affordable Care Act, signed into Law by President Barack Obama on 23 March 2010, violates the Article I, Section 8; Amendment IX; Amendment X; and Amendment XIV. Further, this Law dictates that, for the first time in the history of our great Republic, ordinary law-abiding citizens automatically become criminals unless they purchase a government-sanctioned commodity.

In Article I, Section 8 of the Constitution of the United States of America, it is clearly stated that, "...all Duties, Imposts, and Excises shall be uniform throughout the United States." In Part I: Subpart I: Section 2701, entitled "Fair health insurance premiums", the Law establishes variable premiums based on age and annual income. This is in addition to Subtitle E: Subpart B: Sections 1411 - 1415, which provides special tax credits and 'cost-sharing' for citizens below the government-defined 'wealth' threshold. In other words, if you choose to work hard to earn a good education, apply yourself to your career and become successful, this Law forces you to not only pay more for your healthcare coverage, but you will be subsidizing the lifestyle choices of pot-smoking, minimum-wage slackers (like the characters of Dante and Randall from the "Clerks" movies) who have chosen to never apply themselves and perpetually exist on the fringe of society.

Amendment IX of the Constitution states, "The enumeration in the Constitution of certain Rights shall not be construed to deny or disparage others retained by the people." In other words, the Constitution and the Bill of Rights highlight select Natural Rights, but by no means lists them all. One of the Natural Rights the authors of the Constitution believed we posses by virtue of our very Humanity is the Right of Property. In other words, I, and only I, am entitled to the fruits of my labors and I am the final authority on how best to enjoy those fruits, as long as it does not infringe on the Rights of another. The Founders believed that only a despot would attempt to confiscate the property of one law-abiding citizen and deliver it to another all in the name of some nebulous 'greater good.' They intentionally crafted the Constitution as they did in an attempt to prevent the sort of draconian actions by the Federal government we've seen for nearly two decades. Whether you call it "Leveling the Playing Field" or "Social Justice", the redistribution of wealth prevalent throughout Public Law No. 111-148 is a clear violation of the Right of each and every American citizen to legally strive, legally succeed, and enjoy the legal results of that legal success.

Next time, we look at where this new Healthcare Reform Act runs afoul of Amendments X and XIV



Until next time, best regards...



© James P. Rice 2010

Healthcare in America: Affordability, the Summary

Good day, family and friends!

In my past six Healthcare posts, I have been looking at the costs associated with the best healthcare system in the world. Here's what I've discovered:

> It is very expensive to get the best medical training in the world and to develop, learn, acquire, and maintain modern state-of-the-art medical technologies. Doctors start their careers as much as $800K in debt before they ever see a patient;

> While there are clear-cut cases of greed in the insurance industry and instances where profit is placed ahead of the needs of the customers (patients), these cases are in the minority and most insurance providers are struggling to stay afloat. The average profit of the 1300+ insurance providers in 2008 was only 2.2%;

> The abrogation of the Principle of Personal Responsibility from our legal system and the accompanying environment of rampant litigation account for between 19% and 27% of the cost of healthcare every year through increased malpractice insurance premiums;

> The cost of the bureaucracy created to monitor the rules and manage the paperwork of the various healthcare insurance offerings account for between 14% and 32% of the cost of healthcare every year;

> Insurance Fraud perpetrated by both patients and physicians account for between 3% and 10% of the cost of healthcare every year. This has resulted in insurance companies creating "Benefits Coverage Panels" made up of non-medical personnel making medical decisions;

> And the betrayal of trust perpetrated by our elected officials who bow to special interest pressure to create laws and regulations designed to block the normal competition of the free market economy.

These six bullet points pretty much summarize the economic challenges to making healthcare in America more affordable. Just addressing real tort reform, policy and document simplification, and seriously hammering those who intentionally commit insurance fraud could reduce healthcare costs by close to half.

Next time, I'll start in on why the Obama/Pelosi/Reid Healthcare Reform Act is most definitely NOT the answer, then I will propose my own solutions. After all, identifying a problem without offering solutions is just bellyaching.


Until then, best regards...



© James P. Rice 2010