The solution to this problem is to provide a hybrid medical insurance system: a  single payer, private / public system called UNIMED, which would be patterned on the Medicare plan that has been so successful since the Johnson administration.  Health insurance would be public, but the services would be provided by private health providers, in the same way that Medicare can be used to pay for any Doctor or Hospital at present.  

UNIMED is Universal Medicare, paid by a payroll deduction which would replace the Medicare deduction.  If additional insurance is needed, private Unimed Plus plans can be configured to meet the special needs of individuals who desire services or coverages not provided under Unimed.  Coverages would  be defined by a social / political process, not by a profit seeking private model.

In order to move toward a Unimed plan, we must make the true cost of health care known to all employees.  Employers should not be allowed nor required to carry any health insurance at all.  All employer paid health insurance costs must be made transparent to each employee, clearly stated on their pay checks, in detail.  Once the People know how much their employer actually pays for their health insurance, the transition to a maximum of 10% of family income as a Unimed deduction on their paychecks will be more acceptable. In fact, in the majority of cases, the Unimed deduction would probably reduce their total health insurance cost.  

It is time to end the paternalistic employment relationship that has allowed employers to disenfranchise the workers in the USA for so long.  No health insurance is "free", no employer provides "free" health insurance.  This fallacy has lead to the abuse of our medical system, since some folks think they  "get it for free, y'know".      We do need to move to a global economy with a level playing field, including the rights of workers.  Many worker's rights have been neglected in our business dominated country but are guaranteed in other nations.  Even  Guatemala, a so-called banana republic,  has far more comprehensive workers rights than the USA.

By going to a single payer Unimed plan, we could achieve enormous cost savings over our present "system".  Billions, if not trillions of dollars can be saved each year.    A Universal Health Insurance plan covers every citizen, from cradle to grave, regardless of his/her medical condition, socio-economic status or employment situation.  

Those  person's visiting the USA  on  tourist visas and other non-resident aliens would be required top carry a type of temporary Unimed insurance which they must purchase before they enter the USA.   Those persons who work in the USA,  but who have not been awarded their residency, must also pay the Unimed payroll deduction.  We must leave the cybernetic details for later, suffice it to say that the Unimed system we propose is tight, secure and financially sound.

Eliminate Redundancies

The following plans are redundant once Unimed replaces all private and public health insurance plans in the USA:

Co-Insurance In what amounts to a legacy of the chaos that led to the formation of over 2500 Health Insurance Plans in the USA, all co-insurance overlaps would be eliminated.  These coverages arise from private plans that both spouses take out for each other and/or for their dependents, resulting in overlapping coverage for some family members.  Some people are insured two or more times, which is obviously redundant.  When family centric medical insuance is implemented with the Unimed plan, this ludicrous situation will disappear.

Medicaid Since all citizens and residents will have Unimed coverage, the Medicaid plan is  also redundant and could  be folded into Unimed, saving a huge amount of money formerly allocated to the Medicaid  administration budget and to each health provider's Medicare billing and financial assistance staff.

CHIPS Insurance  This plan would also become redundant, since all children would be covered under Unimed.  The cost of this program is funded primarily from taxes and fees paid by the tobacco companies in settlements reached with each state.  The state legislatures would support the Unimed plan if they are rewarded with a large increase in discretionary funds, which could then be directed toward the rehabilitation of substance abusers, including tobacco smokers, who are addicted to a substance that produces an enormous social cost.

Workmen's Comp Medical Insurance At present, all US employers are required to provide medical insurance for their employees under the Workmen's Compensation  plan.   Removing the Workmen's Comp medical payments clause would save employers large amounts of money, which they would have to pass on to their employees as a pay raise, in the amount shown on their payroll health cost disclosure.  Democratic Politicos can rest assured, lawyers would still be protected, since workmen's comp would be used only to pay out  tort cases involving loss of wages or pain and suffering caused by a workplace accident.

Auto Insurance Medical Payments Most vehicular insurance plans carry a medical payments clause that is a value added item.  These coverages are also redundant under Unimed system, since they would provide overlapping coverage for  persons involved in  traffic accidents.  There is little danger of abuse in this case, since no one would be so foolish as to cause an accident for the sake of a paid visit to his nearest trauma center.

Indigent Care Federal Grants Most hospitals in the USA rely on federal grants to pay for the care and treatment of  indigent persons.  Under Unimed, there would be no federal grants of this type, eliminating the overhead involved in the billing and administration of these funds.  Charity would also not be required, unless the Unimed coverages have  been influenced by the power of money and special interests in the legislative process. Those who are truly indigent would have their Unimed payments made directly by the system, without the need to apply for it, by using cybernetic means testing.  If there are any who claim to be indigent but are not, there would be a logical design flaw in the Unimed system, not a likely possibility in the absence of power politics.

CHAMPUS Veteran's Insurance This plan is a relic of the Century of Warfare which provided by the US Armed forces to all soldiers, marines and airmen, and to all active duty persons(?).   In many cases, overlaps can occur between Champus and private insurance, when military personnel retire from the military and are employed in private industry.  This government plan would  be redundant since the only pre-requisite for Unimed enrollment would be to be a citizen or resident of the USA, and to be alive of course.

Veteran's Hospitals The VA hospital system can be privatized and made available to all citizens under the Unimed plan.  These hospitals could become  excellent community resource in vocational and physical rehabilitation.  Unimed would cover treatment at these rehabilitation facilities nationwide,  for the entire population, not only US veterans.  Perhaps this is the way to improve the VA hospital network and to provide better treatment for all of it's patients.

Retirement Plans Since all persons would be covered by Unimed, there is no need to provide medical coverage under private pension plans. There are no pre-existing conditions, no one would be denied coverage, even persons with chronic diseases that require significant medical care after they reach retirement age.  The value of medical insurance on the pension plans should also be disclosed to employees and passed along to them as a raise when the Unimed plan is instantiated.

Since Unimed would be a single payer, universal health care plan, there would be a vast reduction in the administration and followup of the insurance billing for each patient.  At present, there are over 2500 medical insurance plans in the USA.  When this miasma is reduced to a single payer plan, there would be a corresponding simplification and streamlining of the billing and insurance claims process, resulting in a vast amount of savings.  The 2500 Insurance companies can convert to  being Unimed processors, much in the same way that Medicare is processed by private health insurance systems today.  It's just a change in software after all, not the end of the world.

Being a realist, I know we are not likely to be able to get this revolutionary  plan passed by the US congress, regardless of what party is in power.   This is a solution that assumes that the People have direct political power and do not have to rely on the services of a paid politician to represent them.   It is a cybernetic I_dea solution to an unsolvable political problem, it can be done, but not until "kingdom come".  True?

Cut Costs

If we are to go to a Universal Health Insurance plan such as UNIMED, much of what is currently in Medicare can simply be directly transitioned.  There are however known loopholes and excesses that must be corrected if we are to achieve a government sponsored universal medical insurance plan with both logic and compassion.  Some of the following items could provide significant cost savings for the tax payers, and vastly improve the health insurance system in the USA.
 

Generic-only Prescription Drugs Unimed should not cover prescription drugs as Medicare does at present.  Prescription drugs are 100% replaceable with their generic equivalents, except in those rare cases where a brand name drug has recently been introduced and there is no generic equivalent available until the drug's patent expires.  If these new drugs do in fact provide a cure, an exception to the Unimed apothecary should be provided.  If an individual desires to have prescription drug coverage, he/she can purchase a private Unimed Plus plan that provides it.

Activity Networks Much of the malpractice tort cases that go to court today arise from medical "mistakes" that are made in the health care system.  These errors in medical procedure are usually due to some small detail that was overlooked, perhaps a test that was not performed, a mistake in the drugs prescribed.  Once a diagnosis is made by the attending physician, the medical activities that must be performed on each patient should follow the AMA "best practices" activity plan, not the guidelines defined on the volumes of procedure manuals in each hospital.

Activity networks allow multiple health providers to work on a "checklist" basis, using hand held PDA's, that follow each patient's  treatment plan, step by step, following a structure visually similar to a PERT chart.  Activity networks are multi-threaded task sequences that are assigned to different health providers, laboratories and pharmacies, each with an electronic completion verification that would in turn enable further actions by other health providers down the plan time line.

The Unimed system would not allow medical negligence cases to proceed unless it can legally be shown that the activity plan was not followed in detail for the diagnosis agreed to by the attending physicians.  No physician should be liable for a misdiagnosis if he/she followed the AMA's diagnostic discovery activity plan in determining the treatment plan that would be instantiated for the patient. 

Tort Case Limits Unimed would provide a malpractice insurance coverage to all health providers who elect to provide medical services under the plan, if they agree to follow the AMA's activity plans and have a history of quality of service. All malpractice cases would be paid from the Unimed malpractice insurance fund according to the tort judgment schedule that is in effect for the medical specialty involved. Unimed malpractice insurance limits for tort judgments would be configured by region and medical specialty.  In a perfect world, attorneys would be restricted to a 10% "cut" in medical malpractice litigation cases, from their 30 to 50% cut at present. If a medical practitioner desires to provide his/her patients with higher coverage limits, he/she can purchase a private Unimed Plus malpractice supplementary policy. 

Medical Review Board If a medical malpractice suit is filed against a health provider or hospital, the case must be brought before a local medical review board for the jurisdiction where the case was filed  The medical review board would determine if there are sufficient reasons to allow the case to go forward to the judicial system.  The medical review board must be created by a local election, and should be comprised of physicians, medical administrators, attorneys and patient ombudsmen.

Centralized Ratings System Unimed should provide a free health provider ratings and referral Internet website that would contain edited and verified reviews of participating health providers in each area, along with their credentials and area of specialization.  At present there are numerous ways to obtain physician reviews and hospital quality metrics, but they are neither verified nor centralized in one web site.

Portable Medical Records Portable health records would be available to all citizens, in the form of a portable USB flash memory chip that can be carried on their key chain.  The flash memory should contain the patient's standard XML formatted medical profile (TBD), along with any x-ray images, laboratory results, or special medical indications.   To insure HIPAA compliance, the encryption key to the flash memory chip data must be derived from the patient's own index fingerprint or other suitable biometric. 

Pharmacist Prescriptions In order to avoid unnecessary visits to their primary care physicians, pharmacists must be allowed to prescribe medications from a list of safe drugs.  These class-A drugs would not  be controlled substances nor drugs that require careful laboratory monitoring (TBD), but that are known to be safe for the condition the patient states at the pharmacy.  Other, class-B drugs would require a physician's prescription for the first use, but refills could be granted by the pharmacists for up to one year, at their discretion.

End of Life Treatment Most of the current Medicare expenses occur at the last 6 months of life.  It has been shown that there is a vast difference in the treatment given to patients who are in a terminal situation.  Unimed must provide a reasonable and humane coverage for this phase of life, including hospice care, but should not cover those medical procedures that would extend a terminal patient's life for a few more months or years.  Once a person has reached a certain age (TBD), life should be allowed to take it's course. If an individual desires to have additional end of life procedures covered, he/she may purchase a Unimed Plus plan that would provide it.

Medical Insurance in essence is a cybernetic system that requires a political will to be implemented.  We do not have a technical medical insurance problem, we have a political problem that has precluded the solution to the chaos we have at present, because our political system is based on the power of money and it's influence in Washington.  In a direct democracy, the People would have direct access to legislative power, via the Virtual Congress. We can not solve our problems if we are not allowed to at least openly discuss proposed solutions in the mainstream media. All of us are outsiders in this elitist system.

Atlanta, GA
APR 28, 2008