Second Opinions

Others propose to 'copy' from foreign plans, as the British and Canadian National Health Services (NBSs), which seem superficially ‘cheaper,’ not realizing that those also fail in their own countries, due to the same causes as their American counterpart fails. The critics don't say that the British are paying a ‘second’ insurance to 20 private hospitals so they can jump ahead of the queue, and that Canadians across the border to have special tests that are offered less in Canada. I saw in Montreal two citizens paying ‘private’ insurance to large hospitals to get ‘special’ treatment, or just more attention (personal attention) should they request it. But subsidies act the other way too. The same drugs in Canada are cheaper than in the United States, so patients in Vermont are crossing the border to buy subsidized drugs at the expense of the Canadian taxpayer. Administrative measures, called Health Care Cost Containment, with its Certificates of Need, Hospital Utilization Committees, and the action of health service authorities have mostly failed in their declared purpose.
The Diagnostic Related Groups (DRGs), in effect since 1984-5, tried to achieve some reduction in hospitalization reimbursement but did not reach its intended goal. They save money in one section and create new problems that waste money in another. State legislatures, such as in Oregon, tried dealing with the Welfare crisis by cutting services to save money for other services.
Ironically, in 1996 President Clinton was agreeing to reform Welfare by passing the mess to the States. As already mentioned above, new solutions such as Health Maintenance Organizations (HMOs), which were well known in other countries like England, since 1948, and Israel since the early '20s, were thought to cheaper and more proper for the majority of the population. But even two fifths of those were already losing money by 1998. The States, as a measure of not having any other option, are forcing Medicare and Medicaid enrollees to join an HMO, as is the case in New Jersey. Although eventually most of the future health insurance schemes may become HMOs, there is no guarantee that they will be cheaper or more efficient than the solution I am proposing here. I therefore chose to name my idea “The Ultimate Health Insurance System.” The only real consequence of the expansion of HMOs, if they really expand as most observers predict, is that the quality of medicine will be lower in many ways. Medicare covers today around 40 million+ Americans, but 'Medigaps' have developed in it, a new term for the beneficiary having to pay extra insurance to make up for the two areas where Medicare falls short: The costs of treating acute medical problems, and the costs of long-term care of chronic ailments and disability. This is after its budget was increased in 1988 by $33 billion for the ensuing 5 years. Cuts in 1990 erased most of these increases, in global numbers, which was the case in following years.
Another crisis that is seldom mentioned is already present: the huge number of uninsured people and patients with unpaid healthcare debt, causing small hospitals to close down. The crooked system has created of two separate kinds of Americans: Those protected by insurance, and those that have to fend for themselves for lack of adequate insurance. This has already produced some friction, which will only increase in the future. In the 1980's, the larger hospitals suffered most from Medicare cuts and the introduction of DRG. Today, it is the turn of the smaller hospitals. This produced another trend: large hospital chains swallowing the bankrupt or suffering small community hospitals.
I do not approach these problems in the way that they have been dealt until now, but I intend to break the vicious circle of pouring money and then sucking the life out of it piecemeal. The social entitlements of the low-income citizens are very much interrelated, and for centuries the upper ruling classes controlled and managed these entitlements. They treat the lower classes at times as servants, others through philanthropies, and in modern times with whole-sale largesse and handouts. In the past, it seemed that a country with surpluses, as we were in the ‘40s and ‘50s, and again in the ‘90s, could afford to take a few million people under its wings. It became a long term miscalculation, both numerically and in principle. Numerically it is unaffordable, and in principle the bad consequences offsets the good intentions of the reformers. Pardon, President Clinton, but you will be remembered as giving a bad example in just a few years. I regret to do a dire prophesy, but the past history always showed this the case. To analyze the factors of the health insurance crisis is not an easy task. The huge number of books and articles on the subject and the many opinions on the subject only confuse the issue. I am limiting myself to a minimal size as possible, and so what is intended in here is to try to teach the principles by which we may have a sound health insurance, that is at the same time affordable and simple for the beneficiary to conduct by him/herself, and reasonable efficient, both in management and in quality. If it could be simple as I think, to be handled by the beneficiary, the administrative costs will be negligent. The management of the internal mechanism of this plan will be easy to understand and put to work by the public itself.