Reimagining the Future

I've some thoughts on a replacement for the Affordable Care Act. I originally thought when ACA was first proposed that Medicare should be expanded and was roundly criticized. I still think that expanding Medicare would be a good place to start for universal health care as the bureaucracy is already in place. Get rid of Worker's Compensation and use their budget and employees to fill the gaps that the current Medicare bureaucracy doesn't have or will need since there will be no need for WC since everything would fall under the healthcare umbrella. Result: smaller government, no need for further funding, and less red tape for workers injured on the job. No need for networks or the red tape that go with all that because they are all American citizens in need of healthcare. No need to hire more government workers since the workers from Workers' Comp are already trained and can be shifted to the expanded Medicare division. Streamlining shouldn't be an issue as long as bureaucracy antics are stopped. For instance, padding a budget to make sure you have the funds for overtime in case you need overtime by requiring mandatory overtime to spend the budget you already have in order to justify a budget hike the next fiscal year.

At any rate, Medicaid would no longer be necessary either since a universal health care plan based on Medicare with the resources, skills, and knowledge of the already existing Medicare bureau would cover welfare recipients since they are citizens and thus entitled to universal health care under the expanded Medicare umbrella. Deal with Medicaid in the same manner as WC by using trained employees to fill slots in the expanded Medicare division and divert funds from Medicaid to cover the UHC (universal health care) plan. Smaller government, same budget, and utilizing the existing personnel and expertise. Result: consolidation of health care services to the people.

People could purchase insurance based on far more competitive rates since health insurance will no longer be mandated by law. Insurance companies will have to restructure their current plans and costs in line with the UHC as will hospitals and providers to reflect the changed landscape of UHC for all citizens. Welfare will be reduced since Medicaid will no longer be part of the bureaucracy or the welfare system. By reducing costs across the board in the health care industry and resetting the insurance business by taking them out of the overall health care costs, we can begin working on lowering the cost of drugs and streamlining medical care.

The biggest complaint about universal health care is what would happen to the health care industry and insurance. Take insurance out of the equation and re-allocate budgets and costs in line with expanded Medicare, get rid of Medicaid and Workers' Comp and use their resources and funding to cover expanded Medicare, and we will see a better regulated health care industry overall.

Granted, I'm not a bureaucrat, but I have worked in the health care industry for over 30 years in insurance, claims, workers' comp, medicaid, medicare, and in hospitals and doctors' offices so I have gained some insight into the problems and some solutions. It doesn't take a bureaucrat to fix the problems of bureaucracy but talking with the people who have worked in and with the red tape that gums up the works. I have solutions for the homeless issue as well and it doesn't include banning them from the streets with an 'out of sight, out of mind' mentality, but a plan that will rehab high crime areas, repurpose resources, retrain the homeless, and give them education and skills to get back into the mainstream based on my own experience being homeless for a short period of time in the 1980s and looking at the problems first hand. We do not need more government, we need common sense solutions to the issues on the ground. Less political rhetoric and more elbow grease and common sense solutions.

I am offering something other than empty wishes and anger. As an American citizen, this is my ante for the common pot.

That is all. Disperse.

There is Always Blood

It's happened to you and it's happened to me. The car goes in because there's a noise in the engine and the minute you pull into the repair bay the mechanic starts adding up random numbers in his head. He needs to get braces for his youngest girl's teeth and his son needs new shoes and football equipment, and there's college coming up like a speeding car in the rear window. Suddenly, the little noise in the engine becomes a major repair job.

It's expected in a way because the auto repair business is a for profit concern. The mechanic has to make money, as do the bank holding the mortgage on his shop, the utility company, the phone company, and everyone else that keeps his business in business. You are a cog in that wheel.

It's the same with medical expenses. The doctor needs to pay off the student loans that got him or her through medical school, internship, and residency, and the cost of all the equipment to set up shop or dues to the American Medical Association (AMA), and hiring people to answer phones, type reports, file, fix coffee, sit with patients while the doctor examines them, utilities, phones, computers, etc., etc., etc. The doctor expects to make a profit, too.

And then there are hospitals, which seem increasingly more interested in the bottom line than actual health care. Full beds mean revenue which means the stockholders get a big return on their investment and the hospital gets to keep running. And then there are the pharmaceutical companies testing out their drugs in human trials, lots of space age technology to look inside the body and see what's going on, etc., etc., etc. The thing about technology is that one test is never enough. Where there is one, there will also be 3 or 4 or 10 more. And that's just the standard tests, like EGDs, colonoscopies, mammograms, and CT scans. There are thousands of tests and doctors like to use as many of them as possible because more complex tests means more money which is good for their children's future and getting those snazzy new golf clubs and that sports car.

Not all doctors are more interested in the bottom line than in taking care of their patients, but I often wonder which side of the fence they would land on. Diversified stock portfolios, rental properties, vacation homes, maids, drivers, etc., etc., etc. Hospitals are as bad and often worse. That whole full bed means revenue is only good for as long as the hospital makes money on them, and turning over patients is often like turning over pancakes to see if they are done, and the cook is a nervous Nelly that wants the pancakes to cook faster and faster.

Into this mix comes the Big Guilt Trip -- why doesn't America have universal health care yet? Why haven't they joined the rest of the world and jumped on the bandwagon of socialized medicine? Probably because it wouldn't make much money for the doctors paying off student loans and the hospitals paying huge dividends to the stockholders. Or maybe it's because of the socialized in socialized medicine.

Americans must want the poor and indigent to die without a doctor's care because otherwise we would have had socialized medicine by now. After all, the rest of the world (not all of it, just the socialized parts) has jumped on the socialized medicine bandwagon and we should, too. That sounds an awful lot like the arguments I used on my parents when I was a teenager. "Everyone else is going to the parties after the prom. Why can't I?"

I imagine because America isn't a follower and because universal health care has been packaged badly. There's also the question of Medicaid and Medicare, both of which have been in place since the 1960s as part of the whole food stamp, aid to dependent children, and medical care package that we bought when Johnson was president. That was supposed to cover things. Don't forget Blue Cross/Blue Shield insurance that covered everything, and then came the HMOs to muddy the waters, and now it's providing health care for illegal aliens because it's the right thing to do.

HMOs seemed like such a good idea at the time. I had one; it was United Health Care, and I loved it. Low co-pays and $5 prescriptions that almost reminded me of health care when I was growing up as an army brat, except without the co-pay and paying for prescriptions. There was no cost and I got the best health care in the world, a lot of times from doctors serving a term or two in the military to pay for their medical education.

Then came the greed and insurance companies started denying medical claims because of pre-existing conditions (the ones that had been identified and treated by another insurance company or before there was an insurance company). Then came people hopping from one insurance company and HMO to the next to get the best deal. The services dwindled. The co-pays increased and prescriptions cost $50 to $150 or more a piece instead of that $5 or $10 for quality medication.

Insurance companies paid out less and demanded more, demanded higher deductibles while providing less protection and even less service. Medicaid still worked and so did Medicare, but Medicare recipients had to have another insurance company, and often 2 or 3 insurance companies to cover what Medicare didn't cover, and Medicare covered less and less and cost more and more of that slender social security check the 3rd of each month. People started taking less medication which, considering the side effects and questionable efficacy of the main medication, wasn't such a bad idea.

Into this wrangling over pre-existing conditions and dwindling service for a greater cost comes the Big Guilt Trip. We have to have universal socialized health care so that no person is left behind. Sounds a lot like the "No Child Left Behind" program that graduates stupid children who know only the answers to a test and no longer learn anything useful or become infected with a thirst for knowledge that takes them beyond the books and the classes.

We must get in lockstep with the rest of the world and provide health care for everyone, even the illegal aliens who creep across our borders to have their children in America so they can get Welfare, Aid to Dependent Children, and Medicaid. Do you wonder why Americans balk at the terms "Universal Health Care" and why they fight so hard not to fall into step with the other socialized countries of the world? We've been down this primrose path before and it has not turned out well. We've been bilked, cheated, and raped -- and no one suggested or offered lubricant either.

What looks like heartless Americans denying basic health services to the neediest among us, who by the way have good health care through Welfare and Medicaid (I've done the paperwork when I worked in insurance and doctors' offices and I know what is paid out), is a big case of "NO MORE" from people who are tired of the runaround and bills that go through Congress with so much pork and legalese it is difficult to even find the part about what is and is not covered in this universal health care plan, and the method of our continuing rape sans lubricant. We are understandably wary.

So, here's my proposal. A simple health care plan with low co-pays, say $20, and affordable prescriptions, say $10 no matter what the medication is, and everyone is covered. No fancy legalese, no pork, no hassle, and no legislative sleight of hand or BS. Everyone is covered and there are no ifs, ands, or buts about it. There is no clause that says mental health care is limited to 6 sessions per year or that birth control and other well care measures are strictly forbidden. Everything is covered, including dental, and the government takes 2% of everyone's income to cover the cost. There are no oversight committees and no forms to fill out for insurance. Everyone gets paid and everyone gets the health care they need.

It's a simple plan and there will be no riders, no hidden clauses, and no microscopic writing. Everyone gets on board and we do not get some retooled socialized medical plan from some other country disguised as the next best thing, and that is something else Americans are wary of -- imported, retooled, and refitted socialized medical plans from other countries.

We weren't given our independence. We fought a bloody war for it. And we were the first country to fight Britain for our independence, although not the first country to fight for its independence from a colonial nation. We were born in blood and we will likely die in blood, and it takes us a while to get what we want. It's in our nature not to trust anything that is offered with us (or offered with a guilt trip) like a man handing out candy to children from a van or SUV. We know better than to take the candy and to give the man a wide berth.

We'll get there to the everyone has socialized medicine party but we will get there in our own way and our own time and . . .

there will be blood.