Health Care Reform 

by

Carlton Harker 

Overview 

The essence of this suggested national health care reform program is to (a) balance the needs and privileges of the involved entities; (b) be guided by relevant Constitutional principles; (c) use the Blue Book to obtain newly-created pricing and practice guidelines; (d) rely on the many advantages of high tech (i.e., Websites, Internet, computers, databases); (e) involve and engage all health care entities and (f) alleviate the urgency for health care-related tort reform.  With the variables defined and measured by the Blue Book, there should be created a national predictive economic model by which an estimate of the succeeding years national health care costs, stratified as follows, will be provided:

• Payer (government, employer, beneficiary, other)
• Nature of care (basic/subacute, chronic/acute and serious)
• Before and after administrative costs.

Central to this suggested health care reform-program is the Health Care Blue Book.  For more discussion, see www.nationalhcreform.com.  

Discussion 

Health Care Blue Book 

The relevant ingredients of the Blue Book which are necessary to the suggested health care reform are as follows: 

1. Standardized, revised and updated health care classifications
• Nature of care (basic, subacute, elective, chronic, acute, serious)
• Settings of care (triage, retail medicine, ambulatory, hospital, etc.)
• Providers of care (physicians, hospitals, etc.)
• Payers of care (government, employer, beneficiaries, other).

2. Pricing and practice guidelines stratified by nature, settings and providers of care.

3. Technologies
   The reforms herein suggested will not be achieved without full use of these recent technological advances:
   • Computer-embedded Websites
   • New data transmission methods (Internet, e.g.)
   • National medical records database
   • National health care economic model
   • User codes for beneficiaries, and providers and payers (limited).

Requisite National Legislative Action 

Congress should initially legislate the following: 

1. Each state is strongly encouraged to enact a play-or-pay law where a minimum schedule of benefits is mandated.  Failure for a state to enact such law would result in some federal financial punitive action such as the reduction in Medicaid funding which is federally-provided. Such minimum benefits shall be an HDHP with an annual maximum per covered person of $Y, adjusted for inflation; such benefit may be offered as a option; participant costs are 100 % paid by plan sponsor; covered dependent costs are shared. 
   
   
2. The Blue Book shows those health conditions that will be treated in the same manner as ESPD: in exchange therefore, plan sponsors will pay a Medicare surtax of X %.  Examples include. 
   
   
3. Any plan sponsor contributions to provide secondary benefits to any health care plan (including Medicare) shall be taxable to the beneficiary.  
   
   
4. Rx benefits offered by a PBM (i.e., plastic card plan) must be offered only as a freestanding plan. 
   
   
5. All plan contributions must be Z % annually expended as claims, claims-related expenses or claim reserves.  Amounts in excess of this threshold shall not be deductible. 
   
   
6. Coverage Accessibility Changes
   Three changes to existing laws which would expand coverage accessibility are as follows:
   
   • Association Health Plans should be permitted.
   • Employer-sponsored, workplace-based, employee-pay-all health plans should be treated as ERISA-governed plans.
   • Self-funded death benefits should receive IRC §101(a) tax advantages if provided through any must and not just an IRC §501(c) (9) trust.

National Acceptance of Certain Health Care Practices 

A number of health care practices should be given special encouragement (legislatively or otherwise) because of their special potential contribution to health care reform. 

1. By more aggressive triage, encourage or direct health care to the lowest cost and most accessible entry-points.

2. Foster the advancement of the practice of pharmacy and physician-extenders but only if a national database of medical records is (or will be) a reality.

3. Internationalize Rx prices and/or eliminate the brand-generic differences as being in conflict with our national trade/commerce laws.

4. Establish a national standard of health care rationing standards applicable to all payers (i.e., Medicare and private plans).

Political Implications 

The essential political aspects of this proposed health care reform program are as follows: 

1. Make as few changes to the present system as possible seeking a broad political consensus.  The employer-sponsored plan should remain centerpiece albeit with significant modernization.

2. These goals must be deemed essential
• Uninsured individuals must be dramatically reduced in number.
• Health costs as a percent of the GDP must be reduced.
  
3. Modernization of our health care must be started
   • National Blue Book
     Deals with benchmark fees and guidelines stratified by payers, care settings and nature of care.
   • Application of high tech
     Maximize the application of computer-embedded Websites, Internet transmission, national health records database, etc. 
     
4. The suggested reform attempts in every way to harmonize the conflicting constitutional principles of (a) promoting welfare and establishing justice with (b) rights of posterity and role of the Commerce Clause.  Constitutional principles are those accepted currently and not those enunciated by many of the early framers.  That is, (a) would be equal to (b) as opposed to (a) being dominated by (b). 
   
   
5. The joining of forces by both Medicare and the private plans is needful because the anticipated reforms of Medicare will help the private plans and vice versa.  Both suffer from systemic (though different) problems within our health care system.  Some health care rationing is essential, but it must be nationally supported and publicly proclaimed on the appropriate Website. 
   
   
6. A by-product of the suggested reform program would be a partial solution to our medical malpractice and medical errors problems. 
   
   
7. By and large, the expected response of the populace will be as follows:
   • “There is much of the reform package that I like; also much that I don’t like”
   • “I understand the logic of modernizing the health care system but I do not wish to change my physician relationships”
   • “I am not ready to go high-tech but that the accessibility of pharmacy care and retail medicine is appealing”
   • “Any negatives with the reform program are minor compared with not having  my employer 25 the plan sponsor”.