The Republican Plan:
15 Common Sense Health Care Reforms
By Robin Lumb
 

1.       No reform is acceptable that doesn.t put patients in charge. Under Obama-Care, a lot of people will be making decisions about your health care; it.s too bad you won.t be one of them. Republicans believe that patients. rights must always come first.

2.       What we call .health insurance. is actually prepaid medical care. It.s like having auto insurance that pays for routine oil changes, brake jobs and tires. This approach makes insurance unnecessarily expensive. Using the tax incentives that already exist, Americans should be encouraged to purchase Major Medical Insurance to protect against the financial consequences of a high cost illness or injury. The enormous amount saved could then fund personal Health Savings Accounts.  

3.     Personal Health Savings Accounts put patients in control. These interest bearing accounts would be funded with pre-tax dollars, just like health insurance, and would provide the money needed to pay policy deductibles and out-of-pocket expenses. Unspent savings would accumulate from year to year and could help provide protection for a lifetime. 

4.     Reform the tax code to create a level playing field by extending the tax benefits of employer sponsored health insurance to every American. People who buy their own health insurance deserve the same tax break as everyone else.  

5.     Reform private health insurance with 5 common sense changes to make health insurance products less expensive, easier to buy and more responsive to consumer needs: 

*        Affordability: Eliminate all insurance mandates at the State and Federal level to allow Americans to buy the specific types of insurance products they want. Don.t force people to buy policies with benefit and provider mandates they don.t need; mandates that drive up insurance costs by as much as 50%.  

*        Portability: Your health insurance policy should belong to you, not your employer. Employers who pay all or most of the cost of an employee.s health insurance will continue to pay their portion, especially if the cost of insurance can be brought under control. But the insurance policy must belong to the employee. Making insurance portable also eliminates the .job-lock. that keeps workers from seeking better jobs with better pay.

*        Availability: Allow health insurance companies to operate across state lines. Companies that operate regionally or nationally can create larger pools and will have correspondingly lower costs. People in Florida should be able to purchase health insurance from any licensed insurance company in the U.S. willing to provide coverage.

*       Accountability: Develop pricing models that reward people for healthy behaviors. Most chronic disease, a key contributor to high levels of health care spending, is caused by poor lifestyle choices that include smoking, unhealthy eating habits and other behavioral factors. Consumers who avoid, or who are willing to change, risky behavior should get a break on health insurance.

*      Insurability: Encourage the adoption of .Health Status Insurance.. This product would guarantee the long-term affordability of health insurance by protecting against risk reclassification that could result from a change in health status. This type of insurance would pay a benefit sufficient to purchase the health insurance needed to cover an individual.s future medical care.

6.     Require all health care providers . doctors, hospitals, laboratories, etc. . to post the price of every service. Cosmetic surgery is a great example of how price competition can drive down costs. Because cosmetic surgery is almost always paid out-of-pocket, patients are quoted prices upfront.  As a result, the inflation adjusted price for a common schedule of procedures actually decreased 12% between 1993 and 2005 despite a six-fold increase in demand.

7.     Create financial incentives for hospitals and physicians to provide integrated patient care; a treatment approach where providers coordinate all aspects of patient care for specific types of chronic disease. Duke University Medical Center used this approach for patients with congestive heart failure and cut costs by 40% in just one year. Unfortunately, Duke was compensated using standard reimbursement formulas that paid only for the medical services that were actually provided, not for any of the savings produced by making other medical services unnecessary.

8.     Reform tort liability laws to discourage frivolous lawsuits. For those wishing to pursue claims without incurring large legal bills, create a structured system of mediation and binding arbitration. Otherwise, losers should be required to pay the legal costs for both sides. Cap damage awards for pain and suffering, but not actual damages such as medical costs and lost income. Create special courts for medical malpractice cases using judges trained in this area of the law. Make other common sense reforms so that defendants with only limited responsibility cannot be sued for the entire amount of a claim.

9.     Make routine primary care more available and less expensive. Expand the number of walk-in clinics and urgent care centers, staffing them with Nurse Practitioners and Physician Assistants. These highly trained and licensed professionals work under a doctor.s supervision and are trained to diagnose and treat common illnesses like ear infections, strep throat and influenza. They can also administer injections, perform health screenings and write prescriptions. In a primary care setting, some experts claim that Nurse Practitioners and Physician Assistants could do 60% to 70% of the work presently being done by an MD.

10.  Eliminate state permitting requirements that prevent the construction of new health care facilities. 35 states require these special permits, called .Certificates of Need., artificially restricting supply and impeding innovation. The damage is immense. The 15 states without these requirements have 83% of all specialty hospitals, the very hospitals we need to provide the .integrated patient care. that will cut costs.

11.  Increase medical school enrollment for primary care physicians of all kinds. Build new medicals schools, expand existing ones and recruit International Medical Graduates. Until Florida State University opened its medical school in 2001, no new medical school had come on line in the U.S. in twenty years. The Association of American Medical Colleges, which says we need to increase medical school enrollment 30% by 2015, has recently granted preliminary accreditation to Texas Tech University, the University of Central Florida and Florida International University for their new medical schools. This is only a start.

12.  Medicare and Medicaid fraud cost at least $100 billion a year, yet government does little to curtail this abuse. We should create specially trained and licensed fraud bounty hunters to ferret out this kind of criminal activity; rewards should be paid to anyone providing information leading to a conviction. These awards should be substantial and heavily advertised so that everyone knows about them. Penalties for fraud should be significantly increased. 10 year minimum jail terms are entirely appropriate for any patient or provider conspiring to defraud American taxpayers. Because fraud tends to occurs in patterns, a major cash award should be offered to any person or business that can create computer software capable of detecting the type of transactions that are likely to be fraudulent.

13.  Overhaul Medicaid to improve program quality and reduce costs. Federal funding should be distributed to the states in the form of block grants so that each state can implement the reforms best suited to its needs. These reforms should include the following: States should either contract with private health insurance companies to provide Medicaid patients with Major Medical Insurance coverage or they should issue vouchers so that Medicaid recipients can purchase this coverage on their own. For routine doctor.s office visits, laboratory testing and basic prescription drugs, Medicaid recipients should be issued debit cards with fixed monthly amounts that can be used only at licensed facilities. For those who demonstrate the need, additional credits can be added to the debit card during the month. Require Medicaid recipients to attend special training classes each month on disease prevention, behavior modification and fraud detection. Start reforming Medicaid the same way welfare was reformed in the 1990s so that healthy Medicaid recipients are either moved into the workforce or begin performing useful community service to earn their benefits.

14.  Extend health insurance coverage to the medically indigent. The medically indigent are those who earn too much to qualify for Medicaid but are unable to afford private health insurance on their own. We recommend the use of vouchers, issued on a sliding scale, to cover the difference between what an individual can afford to pay and the actual cost of insurance coverage.  These recipients must be able to demonstrate they are budgeting responsibly to cover the cost of medical care and not spending discretionary income on non-essential purchases.

15.  Expand Community Health Care Centers to serve more of the medically indigent and with a wider variety of primary health care services. These federally aided centers currently operate from over 5,000 sites and provide primary health care services for 17 million low income Americans, including about 6 million of the uninsured. Community Health Centers accept Medicare, Medicaid and SCHIP reimbursements and charge those without insurance according to a sliding scale. We should use special incentives to encourage all public and non-profit hospitals to sponsor at least one full service Community Health Care Center within their service area.

      Robin Lumb is the health care policy analyst for the Duval County Republican Party
and the organizer of the party's recent forum on health care reform.  Robin recently spoke
at our July 5th Freedom Rally and you can read another article by Robin a the follwoing link.

Reform, What Reform?