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:

Non-Emergency	Emergency
Fever of or less than than 101°	Fever greater than than 101°
Small cut	Cut requiring stitches/other closure or tetanus inoculation
Surface bruise/abrasion	Broken bone/sharp pain indicating possible fracture
Minor headache (advise visit to PCP)	Serious headache, after injury, altered pupils/blood pressure
Cough (even if productive	Chest pain
Sneezing	Abdominal 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.)

Payment:

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.

Billing:

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