rx for u.s. healthcare reform (2010) - full presentation

8/15/2019 Rx for U.S. Healthcare Reform (2010) - Full Presentation

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Copyright © 2010, Trans-American Alliance for a National Consensus ALL RIGHTS RESERVED

Please read our posit ion paper at http://www.transamericanalliance.org

Beyond The CLOSED-FORUM in Congress

Healthcare Reform in America:


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Copyright © 2016. Americans for Nonprofit Universal Healthcare (ANUH) & Michael A. Freeman ALL RIGHTS RESERVED

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The Faces of Uninsured AmericansDesperately Seeking Affordable Care


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What the Huddled Masses”

Could NOTGet at Hospitals and Family Clinics


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NONPROFIT-based Health Insurance/Care Plans are theBEST WAY to Reverse the Artificially High Pricing from

the Antitrust-Exempt, For-Profit Insurance Carriers

Start by Finding a LOW-COST Community Health Provider at…

Go to www.communityplans.net to find local carriers!• AANHC represents over 30 nonprofit state/community healthplans. Visit www.nonprofithealthcare.org for a list of plansand hyperlinks to their websites.

• 83% of nonprofit-based health plans, according to a J.D.Powers survey1, had above-average customer satisfactionscores — compared to a 47% satisfaction score for For-Profit/Big Health Insurance plans.

J.D. Powers survey

http://www.communityplans.net/http://www.communityplans.net/


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NONPROFIT-based Health Insurance/Care Plans are theBEST WAY to Reverse the Artificially High Pricing from

the Antitrust-Exempt, For-Profit Insurance Carriers


Go to www.communityplans.net to find local carriers!• ACHP represents over 16 nonprofit state/community healthplans. Visit www.achp.org for a list of plans and hyperlinks totheir websites.

• 11 of 16 ACHP member community nonprofit plans ranked inthe Top-10 in each of the Commercial, Medicare and Medicaidcategories of healthcare, as measured by NCQA in 2006.*

* National Committee of Quality Assurance, in association of the U.S. News & World Report



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Low-Income Families Who Qualify for MedicaidCoverage Can Also Find Higher Quality Coverage in

Nonprofit Community Health Plan Organizations

The Association for Community Affiliated Plans offer:


Go to www.communityplans.net to find local carriers!

• ACAP represents 45 not-for-profit health plans in 24 states

• Six member community health organizations were voted

America s Best Health Insurance Plans” in an annualranking report completed by U.S. News & World Report andthe National Committee for Quality Assurance (NCQA)



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TANC is Now Offering a NATIONAL DATABASEof Nonprofit Insurance Organizations

Featuring an online database/directory of over 150 NonprofitHealth Insurance Organizations in 45 states across thecountry to locate and hyperlink to in your state for LOWER-COST and BROADER COVERAGE health plans.

http://www.transamericanalliance.org

Trans-American Alliance for a National Consensus (TANC)

http://tinyurl.com/ya8t89


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Social HMOs”

are the Best-Kept Secrets as LOW-COST Nonprofit Health Insurance for Seniors andExemplary Models for the Entire U.S. Population

Medicare Advantage Prescription Drug”

(MA-PD) Social HMOs:


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Congress Created & Fostered Nonprofit-

based Social HMOs”

a Quarter-Century Ago! The creation of Social Managed Care Plans (aka “Social HMOs”) was

enacted by Congress under the Federal Deficit Reduction Act of 1984.

Although a tiny niche of the Senior health insurance system, thehandful of “Social HMOs” have been operating as a sub-classificationof the Medicare Advantage Prescription Drug (MA-PD) program —

helping to relieve Medicare of the logistical and financial costs ofmanaged senior care.

Among the “Social HMO” roster, leading the nonprofits is SCANHealth Plan of Southern and Northern California, Elderplan of the 5boroughs of New York City and Kaiser Permanente of the Northwest

(Oregon and Washington state).


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* SCAN Health Plan has a contr act with Medicare to bill for the standard”

base-rate premium deduc tion ($96.40 per mont h in 2009) automatically

deducted from the individual s Medicare account; additional month ly charges might be incurr ed, including for Special Needs Patients.” + The“ Connections” plan has contracts through b oth the federal Medicare and state Medi-Cal programs for billing and reimbursement.

Select SCAN Coverage Areas &Monthly Rates/Co-Pays for Seniors

Benefits Overview

$0-$2.95 Co-Pay on Generics

$0-7.40 Co-Pay Brand Drugs

Contracted PharmacyPrescriptions: 1-31 days

$0-$10 Co-Pay on Generics

$47-100 Co-Pay Brand Drugs

$0 Co-PayDiagnostic Tests, X-Rays & Lab Services

$0 Co-Pay

$0 Co-Pay: Al l DaysIn-Patient Hospital Care$0 Co-Pay: Al l Days

$0 Co-Pay Per PCP$0 Per Specialist

Doctor Office Visits$0 Co-Pay Per PCP$0 Per Specialist

$0 Per Month + Monthly Plan Premium$0 Per Month *

Classic”

Plan Benefits/Services In-Network Connections”

Plan

http://www.scanhealthplan.org/http://www.scanhealthplan.org/


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* Elderplan has a contr act with Medicare to bill for the standard”

base-rate premium deduction ($96.40 per month in 2009) automatically deducted from

the individual s Medicaid/Medicare account ; additi onal monthly charges might be incurred, including for Special Needs Patients.”

Select Elderplan Coverage Areas &Monthly Rates/Co-Pays for Seniors

Benefits Overview

$0 Per Month *Monthly Plan Premium$0 Per Month *

$0 Co-Pay on Generics

$25 Co-Pay Brand Drugs



$25 Co-Pay Brand Drugs

$0 Co-Pay

$80 Co-Pay Radiology

Diagnostic Tests, X-Rays & Lab Services

$0 Co-Pay

$80 Co-Pay Radiology

$100 Co-Pay: Days 1-7

$0 Co-Pay: Days 8-90In-Patient Hospital Care$100 Co-Pay: Days 1-7


$0 Co-Pay Per PCP$0 Per Specialist

Doctor Office Visits$5 Co-Pay Per PCP$20 Per Specialist

Elderplan Classic I”

Plan Benefits/Services In-Network Elderplan Classic II”

Plan


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* Kaiser Permanente has a contract wit h Medicare to bill for the standard”

base-rate premium deduc tion ($96.40 per mont h in 2009) automatically

deducted from the individual s Medicaid/Medicare account ; in addition to charging additi onal monthly charges, includin g for Special Needs Patients.”

Select Kaiser Permanente of the Northwest(Oregon and Washington state) Coverage

Areas & Monthly Rates/Co-Pays for Seniors

Benefits Overview

$99 Per Month *Monthly Plan Premium$39 Per Month *


100% Co-Pay Brand Drugs



100% Co-Pay Brand Drugs

$0 Co-PayDiagnostic Tests, X-Rays & Lab Services

$0 Co-Pay


$0 Co-Pay: All Other DaysIn-Patient Hospital Care$250 Co-Pay: Days 1-4

$0 Co-Pay: All Other Days

$20 Co-PayDoctor Office Visits$30 Co-Pay

Senior Advantage Basic”

Plan Benefits/Services In-Network Senior Advantage”

Plan


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Escalating Single Individual & FamilyHealth Insurance Coverage Costs

Source: Kaiser Family Foundation/HRET Survey of Employer-Sponsored Health Benefits , 1999-2009


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Spiraling Worker and EmployerInsurance Contribution Costs

Source: Kaiser Family Foundation /HRET Survey of Employee-Sponsored Health Benefit s, 1999-2009


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What Would NONPROFIT Health Insurance SavingsTranslate to for Individuals & Employers?

Today, an overall $9,000 annual average forHealth Insurance coverage (from “individual” and“family” premiums) to insure 160 million

Americans translates to roughly $1.4 trillion in

health insurance expenditures annually. The $3,000 or so per-year overall premium

average with nonprofit “Social HMOs” healthinsurance would conversely translate to a $480

billion annual national expenditure. Nonprofit-only insurance would SHAVE two-thirds

off today’s $1.4 trillion in national Private/For-Profit insurance expenditures.


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Like Consumers & Employers, the U.S.Government is Getting HOSED, Too!


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A Result of the Antitrust-Exempt Status”

: Half of theStates are Monopolized by 1 or 2 BIG Health Insurers


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U.S. Health Spending is DOUBLE and QUADRUPLEVersus Upper- to Lower-Income Nations


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Fat Profits for Big 6”

of HealthInsurance, Even in a Down Economy


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Big Health Insurance

s Maximizing Profits & MinimizingRisks

”

Business Model = Many Unnecessary DEATHS!

A recent Harvard Medical Study (Sept.2009) cited 44,800 Americans unnecessarilyDIE due to inadequate or no healthinsurance coverage.

In 1997, a New England Journal of Medicinehad estimated 100,000 needless American

deaths for citizens lacking quality insurancecoverage and none at all.


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Bonuses”

for Rescissions/Cancellationsof Health Insurance Policies, Yes!


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Maintaining Profits, Minimizing Risks, Inflating Prices, andShift ing Co-Pay/Deductibles, and meeting Wall Street

Earnings/Profit Estimates – An Exploitive, Criminal Marriage


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DENIALS”

on Medical Claims: Meet Sarah Palin

sTrue Death Panels

”

— Big Health Insurance!

Nataline Sarkisyan

PBS’s Bill Moyers’ interview with former

CIGNA executive Wendell Potter, a

whistleblower who speaks in detail of Big

Insurance industry practices, offered the

most riveting and shocking behind the scenes

details about CIGNA s foot-dragging andlong-standing DENIALS on medical claims,

including the circumstances involved with

the death of Nataline Sarkisyan.

http://www.sickforprofit.com/http://www.pbs.org/moyers/journal/07102009/watch2.html


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Even Cuts in Federal/State Medicaid Agencies Can Lead to Policy Rescissions


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Melanie Shouse, A Healthcare Reform Advocate,Died Denied Chemotherapy Claims by Anthem


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Of the 50 million-plus Americans* without HealthInsurance, High-Population States Hit Hardest

* Estimates of remaining uncovered Americans, based on U.S. Census Bureau data (Sept. 16, 2009), stood at 46.3 million uninsured Americans. However, with an estimated 14,000 Americans losing coverage every day, the ongoing, most up-to-date calculations from theCenter for American Progress is that the total of uninsured Americans is around 51.5 million people as of January 9, 2010.


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Up to 70 Countries with Forms of UniversalHealthcare

”

— not in the U.S. though!

Single-Payer Universal Healthcare Systems

Other, Various Forms o f Universal Healthcare Systems

No Forms o f Universal Healthcare or No Data Available

Universal Healthcare world map courtesy of Wikipedia.org (through December 2009)


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Today

s Congress: A Byzantine, ArcaneClosed-Door Legislative Process On HCR


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The Worst”

Congress that Big Healthcareand Insurance Contributions Can Buy

TOTAL HEALTH LOBBY CONTRIBUTIONS (1989-2010)

P liti l S ti i t W i h I O S h


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Political Satirists

Weigh-In On SarahPalin

s Death Panel”

Visions

A Befuddling Array of Congressional Healthcare


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A Befuddling Array of Congressional HealthcareReform Bill Proposals — All Leaving BIG HEALTH

INSURANCE

s Monopoly Intact!

Patient Protection and Affordable Care Act” (S. 3590)

Affordable Health Care Act”

(H.R. 3962, Rep. John Dingell, D-Mich.)

America

s Healthy Future Act”

(S. 1796, Sen. Max Baucus, D-Montana)

America

s Affordable Health Choices Act of 2009”

(H.R. 3200)

Healthy Americans Act”

(S. 391, Sens. Ron Wyden, D-Oregon, RobertBennett, R-Utah)

The Medicare for All Act” (H.R. 676, Single-Payer Bi ll ,” Rep. John

Conyers, D-Ohio)

Access to Insurance for all Americans Act” (H.R. 3438, Rep. Darrell Issa,R-Calif.)

Patients Choice Act” (H.R. 2520, Rep. Paul Ryan, R-Wisc.)


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Two Remaining Senate & House Proposals tobe Reconciled for Congressional Passage?

Affordable Health Care for America Act (H.R. 3962):

5.4% surtax on incomes over $500,000for ind ividuals and $1 million forfamilies.

Public Option coverage for low-income Americans. Medicaid expanded to 150%of the Federal Poverty Level.

Single National health insuranceexchange with both private and PublicOption plans; States can run their ownexchanges under federal guidelines.

CBO Cost Estimate: $1.050 trill ion over

10 years. Proposes covering 29 to 30 million

Americans, but could leave over 20mill ion uninsured. *

Patient Protection and Affordable Care Act (S. 3590):

Increases Medicare payroll tax from1.45% to 2.35% on incomes over $200,000for indiv iduals and $250,000 for fami lies.

No public option . But, Medicaidexpanded to 133% of the Federal PovertyLevel.

Instead, Feds mandate newly-createdState Insurance Exchanges to include atleast two national

”

health plans — oneof those being a private NONPROFITplan.

CBO Estimate: $871 bil lion over 10 years. Proposes providing loan assistance

”

onhealth insurance policies to 31 million Americans, but no actual Publi c-Option

”

aid.

* Estimates of remaining uncovered Americans, based on U.S. Census Bureau data (Sept. 16, 2009), stood at 46.3 million uninsured Americans. However, with an estimated 14,000 Americans losing coverage every day, the ongoing, most up-to-date calculations from theCenter for American Progress is that the total of uninsured Americans is around 51.5 million people as of January 9, 2010.


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Arrests of Single-Payer/Universal Healthcare Advocates During DC

s CLOSED-FORUM Hearings

Advocates of a “ Single Payer ” and “UniversalHealthcare ” had to make their feelings knownquickly as Sen. Max Baucus (D-MT), chairman ofSenate Finance Subcommittee holding hearings onHealthcare Reform, had security officers quicklyescort them out due to the CLOSED-DOOR natureof the HCR debate.

http://www.youtube.com/watch?v=pwrudYlwxqEhttp://www.youtube.com/watch?v=pwrudYlwxqE


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A Closed-Forum/Closed-Door HealthReform Process in Washington


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PRIORITY: Repeal of the ANTITRUST-EXEMPTStatus for Monopolistic, Big Health Insurance

Support Congressional passage of Sen. Patrick Leahy s (D-Vt.)proposed bill, The Health Insurance Industry Antitrust Enforcement Act,

for the immediate repeal of The McCarran-Ferguson Act – a 65-year-old antitrust exemption

”

bestowed upon the Health Insuranceindustry.

Central to Leahy

s bil l is stripping Health Insurance and MedicalMalpractice Insurance companies of their monopoly powers condoning flagrant antitrust violations, including price-fixing, bidrigging, and market allocations.

”

Potentially shif t or amend regulatory oversight of HealthInsurance/Medical Malpractice Insurance from state insurancecommissions to federal oversight – making sure our elected

”

representatives and the federal courts l ive up to their Consti tutionallaw obligations.


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PRIORITY: A Consumer-Driven”

MovementTowards NONPROFIT Health Insurance

Introduction and launch of“ Americans Uniting for an Independent

Nonprofit Health Insurance Exchange” as an entirely autonomous,consumer-run, national nonprofit insurance authority.

With an online database and participation of over 150 nonprofit-based“Health Insurance Organizations” (HIOs) across the United States, the

newly-formed Americans Uniting for Nonprofit Health Insurance ( AUNHI) association will look to be a “clearinghouse/exchange” forLOWER-COST health insurance available to both consumers andbusinesses of all sizes.

Short of the federal government agreeing to enforce Constitutional laws,

AUNHI will look to represent consumers in setting “Uniform Billing/Claims” practices and a standardized/industry-wide “Personal Electronic MedicalRecord-Keeping” system with participating Health Insurance andHealthcare Providers.


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Two Scenarios: A Consumer/Business-Only Movement orConsumer/Federal Government Movement

Scenario 1 — A Consumer/Bus iness-OnlyMovement for Nonprofit Health InsuranceOrganizations:

Consumers opt for Nonprofi t-based HealthInsurance by searching through an AmericansUniting for an Independent Health InsuranceExchange

”

database system.

Locate and secure community-based nonprof itHealth Insurance Organization coverage inurban or rural centers around the country.

Consumers and businesses would be able tonegotiate greatly discounted, Medicare-minimum

”

base-rate premiums with individualnonprofit carriers.

A 10-20% add-on monthly premium chargecould help to subsidize an aid program for low-income, uninsured Americans to obtaintemporary, 1 year transitional term healthinsurance coverage – placed under renewalreview on a year-to-year basis.

A set of standardized”

by-laws to beestablished between the Consumer Union andNonprofit HIOs to establish a Uniform Billing &Claims Processing System and potentially aPersonal Electronics Medical Records system

with participating nonprof it HIOs and otherhealthcare/medical providers.

Scenario 2 — A Consumer/Bus iness and FederalGovernment Union for Nonprofit HealthInsurance:

Consumers & businesses would be able tosearch through a federally-endorsed NonprofitHealth Insurance Exchange

The federal government cou ld levy a newcorporate surtax on Unhealthy/AddictiveConsumable Products

”

(i.e. tobacco products,fastfood chains, etc.), raising between $25-$50

billion annually to offer Public Option”-likesubsidization of low -income Americans whocan

t afford regular coverage.

Potentially, a 1-2% general”

surtax on all othercorporations could raise between $140 billion to$280 billi on in new tax revenues, which could beutilized for the startup

”

cost to create othernew nonprofit Health Insurance Organizationsand partially subsidize a Public Option subsidyplan as well.

A federal bond-issue program, under abannered Federal Nonprofit InsuranceConversion Corporation,

”

could also be formedtemporarily to finance the Buyback ofoutstanding public shares in the establishedPrivate/For-Profit Insurance Corporation –effectively providing an avenue for Big HealthInsurance companies to de-list from stockexchanges and become nonprofit orgs instead.


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Imagine if Producers of Unhealthy ConsumablesPaid a Special Medicare-for-All Tax


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Imagine the Creation of THOUSANDS of NewNonprofit Health Insurance Administrator Jobs!

Multiplying the number of new nonprofit, ethics-based” Health Insurance Organizations wil l have many

tangible/intangible benefits for the U.S. economy.

C f S f


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Common Tenets of Working, SuccessfulUniversal Healthcare Systems

Insurance companies must cover EVERYONE andCANNOT make a PROFIT on Basic Care Services,

butsome countries offer levels of supplemental

third-party

commercial insurance coverage in certain instances;

Every cit izen is (legally) mandated

to buy insurancecoverage and the governments pay for low-income/poorcitizens to have health coverage;

Doctors, Hospitals and Pharmaceutical providers haveto accept REGULATED, STANDARDIZED GUIDELINESON FIXED PRICING” for their services and products.Pricing levels are reviewed on agreed-upon intervals.

P th St f R i P fit


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Pathway Steps for Removing ProfitExploitation from American Healthcare

1) Repeal of the McCarran-Ferguson Act of 1945: Strip away all ofthe “monopoly powers” of For-Profit/Big Health Insurance carriers.

2) Extracting all Wall Street-based public stock exchange investment & profiteering influences: Offer federal bond-based “stock

buyback” of For-Profit /Big Insurance corporations to getinstitutional and big shareholders out of American healthcare andpaid back in whole.

3) Offer For-Profit/Big Health Insurers the opportunity to “de-list”from public stock exchanges and convert to “nonprofit-basedHealth Insurance Organizations (HIOs); or face prosecution for 70years-plus of “punitive business practices” under the “federal deathwarrant” known as the McCarran-Ferguson Act .

L d f All R li i F ith B k


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Leaders from All Religious Faiths Back Accessible

”

Universal Healthcare

"To be without health insurance in this country

means to be without access to medical care. But

health is not a luxury, nor should it be the

sole possession of a privileged few. We are all

created b'tzelem elohim — in the image of God —and this makes each human life as precious as

the next. By 'pricing out' a portion of this

country's population from health care coverage,

we mock the image of God and destroy the

vessels of God's work. — Rabbi AlexanderSchindler, Past President, Union of American Hebrew

Congregations (1992)



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”


The health of a society is truly measured by

the quality of its concern and care for the

health of its members... The right of every

individual to adequate health care flows from

the sanctity of human life and that dignity

belongs to all human beings... We believe

that health is a fundamental human right

which has as its prerequisites social justice

and equality and that it should be equally

available and accessible to all.”

— Imam

Sa'dullah Khan, The Islamic Center of

Southern California



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”


"Every person has the right to adequate health care.

This right flows from the sanctity of human life

and the dignity that belongs to all persons, who

are made in the image of God... Our call for

health care reform is rooted in the biblical call

to heal the sick and to serve 'the least of

these,' the priorities of justice and the

principle of the common good. The existing

patterns of health care in the United States do

no meet the minimal standard of social justice

and the common good." — Resolution on Health Care

Reform, U.S. Catholic Bishops, 1993.


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Please read our posit ion paper at

A Consumer-Driven”

NONPROFIT Movement to Breakthe Century-Old Criminalization of Healthcare

Healthcare Reform in America:

rx for u.s. healthcare reform (2010) - full presentation

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