This is not a typical blog. My posts will be edited and maintained.

Please note that these posts concern all levels of government, not just federal.

Wednesday, July 22, 2009

Healthcare reform, Part 2

The US military:
• Armed Forces retirees should be provided full coverage for all medical expenses from any available care provider.
• Active-duty Armed Forces members should be offered the best public coverage available with minimal copays ($10/visit), low patient percentage (90/10), low out-of-pocket maximum ($1,000/year), no lifetime maximums, and all the frills (included annual wellness exam, vision exam and correction, dental exam, dental correction shares percentage/maximum OoP with medical).
• Effects of duties should be covered in their entirety and separately from personal insurance for the life of the member. For example, a member who suffered loss of hearing in the performance of duties should be provided associated regular exams, correction, and any recommended supplies for life, without regard to length of service or discharge status.

Any reforms should be first enacted at a state level.
Any federal reforms must only be enacted after this point for the purpose of standardization ("regulation").

Public options of healthcare insurance:
• Any public insurance options should compete with private insurance with no subsidies or tax-based funding. No legislation should favor public options, restrict private options, or limit access to private options in any manner.
• Low-income households should be provided the lowest option offered in place of Medicaid.
• Unemployed individuals with a history of employment who are actively seeking employment should be provided the lowest option in addition to any unemployment insurance .
• Government employees under the jurisdiction of the coverage will be provided the lowest option. They may elect to increase their coverage level at their own expense. State representatives will be included in any state option, and federal representatives (United States Senate and Congress members) will be in cluded in any federal option..
• Coverage must be provided for all licensed service providers, whether they be public or private, and for any procedure such service provider advises as medically prudent or necessary. If such a licensed provider does not accept insurance, coverage must provide prompt reimbursement to the insured of any reasonable and customary costs when accompanied by an itemized bill.
• Precertification may be required for non-emergent situations. Procedures may not require more than one day (24 hour) precertification.

Private insurance reforms:
• Individuals and businesses may obtain insurance from providers in any state, provided such coverage meets or exceeds state minimum requirements.
• Lifestyle-oriented coverages should not be mandated. Examples include coverage for maternity, sexually-transmitted diseases, alcohol or drug rehabilitation, counseling, and elective abortion. Such coverages should be at the option of the insurer or subscriber.
• Pre-existing conditions may not prevent coverage or increase premiums.
• Any individual who leaves his/her present employment with employer-provided insurance may transfer any or all coverages to private plans at the same premium rates charged by the insurance provider. In clarification, in the event the employer paid all or part of any premiums, the individual will assume payments of the full premium amounts unless alternative arrangements are made between the parties.

Public and private options:
• If a procedure requires a second opinion, the insurer may not require specified providers be used for the second opinion. The expert opinion of the insured's medical service provider must be accepted and may not be overruled by employees, agents, or contractors of the insurer.
• New and experimental procedures must be accepted on the recommendation and second opinion of the medical service providers of the insured.
• Insurance providers must provide payment to service providers within thirty (30) days of billing.
• Rates billed or negotiated between the insurer and the service provider as part of a business relationship must be accepted as payment in full. If the insurer and the service provider are business affiliates, no portion of any bill may be passed to the insured as being in excess of reasonable and customary. Any disputes in relation to bill details or costs must be resolved between the insurer and the service provider. As an example, if an insurance provider partners with a certain healthcare organization, the details and fees of any member service provider must be accepted as reasonable.
• A service provider who operates in a relationship with a business partner of the insurer must be accepted as in-network with that business partner. As an example, services provided by an anesthesiologist in a partner hospital for a service provided by that hospital cannot be considered out-of-network. A doctor operating in a member office must be deemed in-network with the office unless such separation is clearly stated.
• In cases multiple networks may apply, the greater benefits to the insured will prevail.
• Details of precertified services may not be refused payment unless the care provider specifies such products or services were elective.

Edited 2009/08/16

Healthcare reform, Part 1

Tax deductibility.
All healthcare expenses should be tax-deductible to the taxpayer. Insurance payments, pharmaceutical purchases whether prescription or over-the-counter, vitamins and other non-medical health supplements, wellness exams, fitness equipment or club memberships should all be deductible, provided they are purchased for the benefit of the taxpayer's immediate household or as charitable gifts.

Tort reform.
Frivolous lawsuits should have all legal costs paid by plaintiff. Normal award is refund cost of procedure and correction. Awards for pain and suffering require gross negligence or harmful intent, not simple negligence, and must be directly related to the situation at hand.

Emergency care.
Provision of care:
All true emergency care should be provided at the state expense; hospitals are often not reimbursed for emergent care anyway. All services, tests and examinations performed by or on behalf of a licensed or registered emergency service provider as part of an emergency visit will be considered part of the emergency service.

Providers of care:
Emergency service providers will be licensed or registered with their respective states. They will be permitted to submit for reimbursement for emergency services at prevailing rates from the state government. All appropriate expenses will be reimbursed, and submissions will be audited at regular intervals.

User payment for non-emergency care:
Users of emergency facilities or their insurance providers will be charged for non-emergency services at prevailing rates for similar care. Patients can inquire at triage and before admission whether a particular situation is considered an emergency, and prices for services must be made available. Examples of both emergency and non-emergency situations will be posted. Several examples:

Fever of or less than than 101°Fever greater than than 101°
Small cutCut requiring stitches/other closure or tetanus inoculation
Surface bruise/abrasionBroken bone/sharp pain indicating possible fracture
Minor headache (advise visit to PCP)Serious headache, after injury, altered pupils/blood pressure
Cough (even if productiveChest pain
SneezingAbdominal pain (unless repeated ER history of gas)

Provider response time:
Except in overwhelming situations, all patients must have triage begun or offered within five (5) minutes of entry into the emergency facility. Guests must be greeted to determine if they are guests or patients. All emergency patients must be seen by a care provider within 30 minutes of triage, and all non-emergency patients must be seen by a care provider within 60 minutes of triage. Critical patients (unresponsive, extreme pain or other reaction) should be seen as soon as possible. Goal: All patients to be triaged within one minute of entry and seen by a care provider within five minutes of entry, whether or not emergent. (Care providers may be reminded that non-emergent patients are paying customers.)

Patients with possible non-emergent situations may be requested to provide contact information and insurance information (if available) prior to admission; if the situation is deemed non-emergent, payment may be due after care is complete. Critical patients will be requested to provide contact information only after the situation has stabilized, and insurance or financial information will not be requested; contact information will be used primarily for follow-up purposes.

Illegal Immigrants:
All charges accrued by residents without proof of citizenship will be charged to the resident's nation of origin, the resident will be charged with theft, and proceedings will be initiated for deportation.

All initial requests for payment must be fully itemized; initial presentation of costs may not be summarized in any way. For instance, if 20 bandages were required, a summary of "materials" is insufficient; if two analgesic pills were administered, they must be identified and not solely listed as "medications"; if a blood test is administered, the nature of the test must be specified. While code numbers may be used as well, literal descriptions are required on all items.

Records availability:
All documentation by health-care providers must be retained in an electronic format and must be made available in a readily-usable electronic format to the patient, the patient's guardian, and/or the patient's physician on request and without charge. Such records must include all diagnostic images, details of test results, and exam findings including recorded physician opinions; the only exceptions are those which state or federal law declare to be confidential to the source, such as psychiatric opinion. If printed copies of records are requested, reasonable costs may be recovered. All documentation must be kept as secure as technologically reasonable, and must be transmitted in a secure manner, including, but not limited to, encryption of file contents. Unprotected data, including file names, must not reveal any private information.

Edited: 2009/08/16

Friday, July 3, 2009

Bill clarity and openness

Bills should be limited to 30 pages in length, including all riders but not including reference data tables, unless specifically extended. Any length extension should be voted on and accepted by a simple majority, and each extension may not more than double the previous length.

All votes for or against bills should be recorded and publically published and posted online. All members' votes for or against bills, including show-of-hands votes, should be recorded.

All bills should be publically published and posted online in final form for 30 days prior to any final vote, unless the bill is voted to be urgent. Any bill to be identified as urgent should be voted as urgent and accepted by 2/3 majority, publically published and posted online in final form for 7 days, and the bill should be accepted by 2/3 majority; if either vote fails, the bill will continue as normal priority.

The only members who should be permitted to vote on a bill should have first read the bill in its entirety. All others will be counted as "Present."

Previous post title: "Only those who read a bill should vote on that bill".