"rx for u.s. healthcare reform" - a position paper from tanc

Copyright © 2009, Trans-American Alliance for a National Consensus (TANC) ALL RIGHTS RESERVED

www.transamericanalliance.org

T r a n s - A m e r i c a n A l l i a n c e f o r a N a t i o n a l C o n s e n s u s ( T A N C )

Rx for U.S. Healthcare Reform

A Proven Model for NON-PROFIT “Universal Healthcare”

Provides a Solution for Widespread Enactment

Thousands of residents of Wise, Va., and Los Angeles seeking Thousands of residents of Wise, Va., and Los Angeles seeking

free exams and medical/dental treatments offered by the allfree exams and medical/dental treatments offered by the all--

volunteer Remote Area Medical (RAM) organization. volunteer Remote Area Medical (RAM) organization.

http://www.transamericanalliance.org/


By Michael A. Freeman Executive Director, TANC

I t’s right under the noses of President Obama and members from both major

parties of Congress, and they may not even know it or have simply over-

looked it: There is a practical, self-sustainable model and ready-made solution for

the reform of America’s teetering healthcare system. And the federal Medicare sys-

tem helped create it.

It is a little-known federally-funded Medicare program that has successfully covered

a segment of the Senior Citizen population for nearly a quarter-century in an innova-

tive partnership with NON-PROFIT health insurance organizations. And it is one of

the best kept secrets and a relatively tiny sliver of American healthcare.

Operating under the Medicare Advantage Prescription Drug Program (MA-PD),

which are standard ―Part D‖ Medicare payments from senior citizens’ accounts typi-

cally dedicated for prescription drug plans, is a special classification of ―Social Man-

aged Care” — an entire suite of extensive

healthcare services. These so-called ―Social

HMOs‖ stand to serve as shining models for a

―national non-profit health insurance system‖

and offer broader applications for the general (under-65) American population — an

innovative, new paradigm to potentially convert and reform our cost-spiraling FOR-

PROFIT/PRIVATE Health Insurance system.

As this position paper attempts to illustrate, the

model for ―Social HMOs” set an outstanding

template for what low- to no-cost, NOT-FOR-

PROFIT health insurance can do to alleviate and

reverse the ever-escalating costs and gaps in

coverage for an estimated 47 million uninsured

Americans. The more altruistic and humane

principles that are the basic tenets of these

NON-PROFIT, senior-based ―Social HMOs,‖ if

adapted and broadened out for the ―general‖

under-65 population, could bring badly needed

relief to the many millions of other ―insured‖

Americans who live in dire fear of their FOR-

PROFIT/PRIVATE carriers raising their deducti-

ble payments, co-pays on hospital stays, issuing

outright DENIALS on critical life-saving medical procedures, and routine policy revo-

cations for discovering ―preexisting conditions‖ — all of which can have a devastat-

ing economic impact on American families.

T r a n s - A m e r i c a n A l l i a n c e f o r a N a t i o n a l C o n s e n s u s ( T A N C )



A Self-Sustaining, Ready-Made NON-PROFIT Model for

“Universal Healthcare” is Achievable at Little Cost

“Of all forms of inequality, injustice in healthcare is the most shocking and inhumane.”

— Rev. Dr. Martin Luther King, Jr. (1966)

Remote Area Medical (RAM), a Nashville-based non-profit medical relief organization, stands at the vanguard of providing “mobilized” treatment

events across the country — attracting tens of thousands of Americans who can’t obtain or afford FOR-PROFIT/PRIVATE health insurance cover-age.


http://www.ramusa.org/


Under proposals from President Obama and Sen. Max Baucus (D-MT),

chairman of the Senate Finance Committee sharing half of Congress’ load

on healthcare reform, both have laid out plans for some kind of national or

state ―Insurance Exchanges‖ in which FOR-PROFIT/PRIVATE health insurance

carriers would be placed into ―competitive, low-cost pools‖ for consumers to

choose which plans best fit their needs and what they can afford. But, the Presi-

dent and Congress would find a much more affordable, minimally government

budgeted and much lower cost solution in fostering the creation of a NON-PROFIT

health insurance pool, which is already an operational, more justifiable “Social

HMO” model for future healthcare reform than long-standing FOR-PROFIT insurance

models.

The hallmark of these non-profit “Social HMOs,” originally authorized by Congress’

enactment of the Deficit Reduction Act of 1984 and the federal government’s ex-

pansion under the Omnibus Reconciliation Act of 1990, feature minimal to no out-

of-pocket cost health insurance premiums guaranteeing affordable, equitable and

humane access to healthcare services.

Originally constructed to serve as an ―alternative nursing care‖ system that keeps

senior citizens from being prematurely forced into nursing home facilities, these

NON-PROFIT health insurers formally operate under the banner of being Social

Managed Care Plans; an organization that provides the full range of Medicare

benefits offered by standard Managed Care Plans plus additional services which

include care coordination, prescription drug benefits, chronic care benefits covering

short term nursing home care, a full range of home and community based services

such as homemaker, personal care services, adult day care, respite care, and medi-

cal transportation. Other services that may be provided include eyeglasses, hearing

aids, and dental benefits. These plans offer the full range of medical benefits that

are offered by standard Managed Care Plans plus chronic care/ extended care ser-

vices. Membership offers other health benefits that are not provided through Medi-

care alone or most other FOR-PROFIT/PRIVATE-SECTOR senior health plans.

There are four NOT-FOR-PROFIT, Social Managed Care Plan organizations — SCAN

Health Plan of Southern California, Elderplan of Brooklyn, New York, Kaiser Health

Foundation of the Northwest (Portland-Vancouver metropolitan area, Salem, Ore.,

and Longview, Wash.), and Health Plan of Nevada of Las Vegas — that secured MA-

PD funding from Medicare in servicing several hundred thousand Seniors with

broad inpatient/outpatient and preventive health insurance coverage in their re-

spective regions.

The longest running of these ―Social HMOs‖ is the not-

for-profit SCAN Health Plan (www.scanhealthplan.com),

otherwise known as the Senior Care Action Network,

founded in 1977 by a group of Long Beach, Calif. area

seniors angered about some short-comings in the elder

healthcare sector. With the backing and help of area

doctors and other medical/caregiver practitioners join-

ing their management staff, SCAN secured its first MA-PD funding from Medicare to

offers health insurance and seniors-based healthcare services in 1985.



A Proven Model for NON-PROFIT “Universal

Healthcare” Provides a Solution for Enactment

"One of the central public policy ques-tions for U.S. citizens today is whether the richest nation on earth will continue to allow millions of poor people to exist with-out health insurance. To do so violates bibli-cal justice. How can any Christian read what the Bible says about the poor and what Jesus says about the sick with-out hearing a divine call to demand that every person in this nation, starting with the poor, have access to health insurance?"

— from "Just Generos-ity" by Ronald Sider, founder of Evangeli-cals for Social Action

http://www.scanhealthplan.com/



http://www.scanhealthplan.org/


Today, SCAN provides insurance coverage and other wellness/preventive

healthcare services to over 110,000 seniors in seven Southern California

counties. Over the last year or so, SCAN has expanded its non-profit ser-

vices to senior residents of Maricopa County (Phoenix) in Arizona and has

drawn up plans to launch shortly in Northern California — potentially doubling

its number of Senior subscribers within the next year or two.

A key ingredient of SCAN’s success is its broad Southern California-area roster of

17,000-plus registered ―in-network‖ doctors and specialists

and over 150 hospital choices. SCAN’s remaining care menu

is quite broad and impressive to include other inpatient hospi-

tal care; outpatient doctor/hospital care; at-home care; emer-

gency admittance and transportation services coverage; a pre-

scription brand/generic drug program; vision services; dental

coverage; hearing; other no- to low-cost co-pays on a variety of

screenings and exams; and a wide array of preventive and

health-and-wellness services — features necessary for senior

care but MUCH GREATER than what could be found in either

standard Medicare and so-called “Cadillac Plans” from PRI-

VATE/FOR-PROFIT insurance carriers for the general under-65

population.

Most notably, out-of-pocket costs, or so-called co-pay ex-

penses to senior subscribers, come at mere fractions in the

two SCAN Health Plan choices — ―Classic‖ and ―Option‖ plans.

For example, an in-hospital stay of 1 day to 150 days incurs

out-of-pocket costs of up to $2,300 under the standard Medi-

care plan while SCAN’s ―Classic‖ plan has a maximum co-pay

deductible of $400 and the ―Options‖ plan has a $0 co-pay

deductible In fact, if you peruse either of SCAN’s two plans

(on both facing pages), most of the benefit categories feature

$0 co-pays/deductibles and hit a maximum of $100 for select

care services.

Adding frosting to the NON-PROFIT case, my next-door

neighbors, a senior-aged married couple and long-time SCAN

policy holders, both sing its praises by exclaiming that they

have ―guaranteed‖ emergency care/hospital coverage on a

―worldwide basis‖ if they go travelling abroad. Additionally, my

neighbors boast that they have an individual ―Personal Care

Representative‖ who has been assigned to each of them for

the duration of the SCAN memberships. They also empha-

sized they have ―never‖ had to deal with a disputed or denied

claim from SCAN, and their Personal Care Representative

―always handled outside billing issues‖ that either arose from

hospital or doctor/specialist procedures.

Perhaps the most intriguing figure comes from a Wikipedia.org estimate that SCAN

earns $1.3 billion in revenue from its direct billings to Medicare, which translates to








a premium cost of roughly $98 per month for each of its 110,000 sub-

scribers or $1,181 per year for its full array of covered services — al-

though Medicare’s database factors in the potential additional surcharge

of up to $56 per month for SCAN’s Special Needs Plan (SNP) subscribers

and other ―options-based‖ premium charges. Still, the no-out-of-pocket-

cost premiums SCAN offers translate to little more than $2.00 above the

―minimum‖ base $96 per month Medicare deducts from seniors’ accounts (about

$1,157 for all of 2009).

Better yet, the most startling fact in this is that SCAN and

the three other major NON-PROFIT health insurance carriers

participating in the MA-PD program provide much higher

levels of premium coverage and at lower co-pay/deductible

costs and ―in-Medicare‖ monthly premium fees ($96 per

month) — at about one-fifth (20%) to one-quarter (25%) of

the cost of an average $400 to $500 per month (or $4,800

per-year premium average) of what FOR-PROFIT/PRIVATE

health insurance carrier charges on a premium for an indi-

vidual policyholder in the general under-65 population, ac-

cording to World Health Organization data.

If FOR-PROFIT/PRIVATE health insurance carriers label their

so-called top-of-the-line plans as ―Cadillac Premiums,‖ than

several ―Social HMOs‖ including SCAN’s Medicare-based

plans for seniors should be coined the ―Rolls-Royce Premi-

ums‖ of health insurance. It just proves that a greatly ex-

panded menu of benefits and lower deductibles and co-pays

are very achievable at a fraction of the monthly/yearly costs

of what FOR-PROFIT/PRIVATE health insurers offer.

An online trip to Medicare’s state-by-state and plan-specific

website (http://www.medicare.gov/MPPF/Include/

DataSection/ComparePlans/BenefitsAtAGlance.asp) reveals

a convenient database for searching out a wide array of

mostly FOR-PROFIT/PRIVATE health insurance carriers that

offer senior ―option‖ plans. Some of the plans are spon-

sored by the American Association of Retired People (AARP),

but they originate from FOR-PROFIT, pay subscription plans

(outside of standard Medicare-provided health insurance)

typically featuring considerably higher co-pays/deductibles

and far fewer coverage areas.

If you really want to get a true gauge of how seniors in

Southern California value their SCAN health plans, just give

a read of a May 2001 article in The Christian Science Moni-

tor. At the time, TCSM reported that SCAN garnered highly

favorable ratings from Consumer Reports, which found that

96 percent of SCAN subscribers would ―never leave the

plan‖ and 98 percent said they would recommend it to their senior friends. Basi-

cally, these NON-PROFIT ―Social HMOs‖ like SCAN offer as great or greater selection





http://www.medicare.gov/MPPF/Include/DataSection/ComparePlans/BenefitsAtAGlance.asp

http://www.medicare.gov/MPPF/Include/DataSection/ComparePlans/BenefitsAtAGlance.asp





of ―in-network‖ doctors, specialists and hospitals than what FOR-PROFIT/

PRIVATE insurers comparably offer.

Ratings from Medicare’s own online database typically rank both SCAN

Health Plans — ―Classic‖ and ―Options‖ — each with scores of 4 out of 5 stars

when it comes to handling ―member complaints and those staying with the pro-

gram.‖ The same numbers of stars are accorded to SCAN for the prescription ―drug

pricing and patient safety‖ category as well. Similarly high ratings were attributed to

other NON-PROFIT ―Social HMOs‖ like Elderplan and Kai-

ser Foundation Health Plan of the Northwest.

The lone ―Social HMO‖ on the East Coast is Elderplan

(http://www.elderplan.org), a Brooklyn-based non-profit

founded 23 years ago and operating under the auspices

of the Metropolitan Jewish Health System, serving just

over 15,000 seniors in the five boroughs of New York

City. Although it operates on a much smaller scale than

SCAN, Elderplan’s five plan options similarly offer $0 co-

pay and deductible features across the board to a nearly

identical menu of ―in-network‖ inpatient, outpatient and

at-home services.

Kaiser Health Foundation of the Northwest offers a pair

of HMO plans, Senior Advantage Basic and Senior Ad-

vantage, but each have respective $39 and $99

monthly add-on premium charges and generally higher

co-pays and deductibles than what SCAN and Elderplan

offer as ―Medicare-minimum‖ premium values. The

slightly higher co-pay/deductible levels and additional

premium charges are somewhat in keeping with other FOR-PROFIT/PRIVATE carri-

ers offering Medicare exchange plans. Kaiser Health

Foundation of the Northwest is a non-profit organiza-

tion that is a MA-PD spinoff from the other FOR-PROFIT

Kaiser Permanente healthcare subsidiaries.

Health Plan of Nevada also offers ―Medicare mini-

mum,‖ no outside monthly cost premiums, but does

charge a low- to higher-range of co-pays/deductibles

and offers fewer coverage areas to about 25,000 sen-

ior members in the southern and northern regions of

the state. However, FOR-PROFIT insurance giant Unit-

edHealth Group acquired Health Plan of Nevada’s over-

all under-65 health insurance business (serving close

to 500,000 subscribers overall) in early 2008, but was

required by the U.S. Justice Department to divest own-

ership of the NOT-FOR-PROFIT ―Social HMO‖ senior

care arm of the company to be fall into compliance with

the deal. It is not immediately known if the ―Social

HMO‖ has yet been fully divested from the UnitedHealth

Group-owned parent company or discontinued entirely.





Allowing FOR-PROFIT, “free-market” forces to go unregulated has proved disastrous — while government “incentivized” NON-PROFIT ventures like Medicare-based “Social HMOs” have proved hugely beneficial to Senior Citizens.

Non-profit “Social HMOs” offer coverage at Public “Medicare-minimum” rates, so it’s likely the savings would be greater than the 25% in the fur-thest right-hand bar if it would be operated as a “Non-Profit Insurance Exchange” — not solely as “For-Profit/Private Exchanges” proposed by Congress and the White House.

http://www.elderplan.org/



That is why it is so vitally important for any ―true‖ healthcare reform to

take place in this country, our government needs to step up and use the

weight of its legal authority to untangle FOR-PROFIT/PRIVATE health insur-

ance carriers from a future ―Universal Healthcare‖ system. Given the ongo-

ing criminality of FOR-PROFIT/PRIVATE health insurance practices, where

Americans are either DYING or currently suffering from GROWING TERMINAL ILL-

NESSES due to DENIED CLAIMS, there is NO constitutionally justifiable reason why

American lives are being weighted or balanced ver-

sus the model of MAXIMIZING AND MINIMIZING

RISKS so entrenched into our long-standing FOR-

PROFIT/PRIVATE system up to today.

In his speech to a joint session of Congress on

September 8, Pres. Obama reiterated a verbal-only

proposal to create a ―non-profit insurance ex-

change,‖ conceivably featuring a pool of FOR-

PROFIT/PRIVATE health insurance carriers for con-

sumers to pick the ―most competitively priced

plan‖ that fits their needs. On September 16, Sen.

Baucus then released his ―Chairman’s Report,‖ an

$856 billion, 10-year plan, that would similarly fea-

ture a ―State Insurance Exchange‖ program and

FOR-PROFIT/PRIVATE-based healthcare ―cooperatives.‖ This is just pouring more

taxpayer money into the pockets of cor-

rupt FOR-PROFIT/PRIVATE carriers, who

were the same $4 million contributors to

Sen. Baucus’ latest fundraising dinner

last May.

While sounding and appearing like po-

tentially attractive, reasoned proposals,

both the President’s and Baucus’ plans

still fundamentally fail to address how

the FOR-PROFIT/PRIVATE health insur-

ance industry has been artificially inflat-

ing the prices of premiums (most likely

due to covering excessive executive com-

pensation, bloated administrative over-

head and an overstated emphasis on

maximizing earnings and profit margins)

while increasingly chipping away at cov-

erage options and placing higher co-pay

and deductible burdens on the backs of

consumers. Essentially, it is a

―middleman‖ system where the consum-

ers pay more but get less in return.

Medicare already runs an ―exchange-

like‖ system where senior consumers can choose from a pooled menu of largely





Under The Commonwealth Fund’s study offering three different healthcare plan scenarios, it is an inescapable fact that offering up a “Public Plan” based on Medicare rates — such as that the long-term projected savings of up to $56 billion by 2020 — would be most ideally maxi-mized under a nonprofit-based “Health Insurance Organizational” proposed by TANC.

“Both the President‟s and Baucus‟ plans still fundamentally fail to address how the FOR-PROFIT/PRIVATE health insurance industry has been artificially inflating the prices of premiums (most likely due to covering excessive executive compensation, bloated administrative overhead and an overstated emphasis on maximizing earnings and profit margins) while increasingly chipping away at coverage options and placing higher co-pay and deductible burdens on the backs of consumers. Essentially, it is a „middleman‟ system where the consumers pay more but get less in return.”




FOR-PRIVATE/FOR-PROFIT coverage plans, with the American Association

of Retired People (AARP) even serving as a clearinghouse/sponsor for

lower-cost ―Medicare Health Plans.‖ But many of these ―exchange‖ option

plans — coming from such Big Health Insurance companies as UnitedHealth

Group, CIGNA, Aetna, Coventry, Wellpoint, Anthem Blue Cross/BlueShield

and Humana — are still priced considerably higher, with additional ―out-of-

pocket‖ monthly premium charges and other higher Medicare ―estimated costs‖

compared to what the handful of NON-PROFIT ―Social HMOs‖ charge in most cases

to be ―Medicare-minimum‖ base rates. (The most noticeable differences in Medi-

care’s customizable/comparable database comes from what FOR-PROFIT/PRIVATE

insurance carriers typically charge in additional ―out-of-pocket‖ monthly premium

fees, higher co-pays and deductible

costs, and generally offer consid-

erably smaller menus of ―covered‖

care services.)

Plain and simple, the excessively

high levels of executive compensa-

tion for PRIVATE/FOR-PROFIT insur-

ance, bloated administrative over-

head costs and the 20%-plus profit

margins of the Big Insurance Carri-

ers (please refer to the accompany-

ing charts), truly reflect the inordi-

nate disparity of what they charge

versus what NON-PROFIT carriers

can charge on a much lowered-priced, feature-rich basis. It is also an accurate re-

flection of the grossly inequitable, unethical and often CRIMINAL business practices

of FOR-PROFIT insurance and why Americans are literally ―paying through their

teeth‖ for less healthcare.

Additionally taking into account the

outright DENIALS of medical proce-

dure claims for at-risk patients and

the often arbitrary revocations of

premium holders for have what Big

Insurance deems are ―preexisting

conditions‖ to meet the ―business

model‖ of MAXIMIZING PROFIT

AND MINIMIZING RISKS common

with Big Health insurance, are

wholly UNETHICAL and frequently

MORALLY CRIMINAL…purely on a

Constitutional Law basis.

In these proposed ―exchange systems,‖ where some lower-income/disadvantaged

Americans will conceivably have the ability price out ―low-cost‖ insurance premiums

but may actually face paying ―penalties‖ for not having coverage under Baucus’

original plan, there are still massive inequities in what being laid out in both the

Congressional and White House proposals. Even the President has not elaborated







on how to get the Big Health Insurance Carriers to seriously modify and

reform their business practices away from their historical strategies of

monopolizing/consolidating the marketplace with exploitive and punitive

actions directed at American consumers.

In fact, I am not even sure if the President realizes it yet, but his marginal-

ized, verbal-only vision of a ―non-profit insurance exchange‖ carries merit, but it ac-

tually should be broadened out to mandate that Health Insurance Carriers can only

reform their CRIMINAL business practices by

dropping their exploitive and predatory PRI-

VATE/FOR-PROFIT status and instead adopting

NON-PROFIT roles going forward. And that

NON-PROFIT organizational model, which once

flourished when religious hospitals and family

clinics were founded in America during the

18th to early 20th centuries, is something that

could have broader applications beneficial to

other segments of healthcare in America to-

day.

For those reasons, our non-profit citizens’ ad-

vocacy and ―Direct Democracy‖-based organi-

zation, Trans-American Alliance for a National

Consensus (TANC), is proposing that the Presi-

dent and Congress crafts healthcare reform

legislation that 1) funds and fosters the crea-

tion of NON-PROFIT health insurance carriers

in structures similar to Medicare’s ―Social HMO‖ organizational architecture; and 2)

presents FOR-PROFIT/PRIVATE Big

Insurance carriers the opportunity

to convert to NON-PROFIT status or

face the consequences of not par-

ticipating in the ―exchange pro-

gram‖ and facing the specter of

U.S. Justice Department and Con-

gressional ―criminal investigations‖

into DENIAL-based patient deaths,

the alarming rise of terminal ill-

nesses, debilitation, and other

needless suffering in other cases.

This is a time when Congress, the

White House and other federal in-

vestigatory agencies need to live

up to their Constitutional oaths to

uphold the law and end this long-

standing corrupt pattern of busi-

ness practices in the healthcare

industries — the only thing Big

Health Insurance will yield to is if








know the federal government is going to use its full weight of its authority

to uphold laws and enact serious reform to re-regulate their business prac-

tices. Given that total healthcare costs currently eat up to 17% of the

United States’ Gross Domestic Product (GDP), or roughly $2.5 trillion of

nearly $15 trillion in total GDP for 2009 (according to World Health Organiza-

tion estimates), the world’s most expensive healthcare system will eventually

implode under the sheer weight of its excesses and lead to an even greater public

health crisis/catastrophe in the near future.

On that front, TANC has formed a pair of Facebook ―Cause Groups,‖ the

most critical being a ―Petition for the Federal Government to Open CRIMI-

NAL INVESTIGATIONS into DENIED Patient Deaths” (http://

apps.facebook.com/causes/340854/54103574?m=611088da) to compel

our government not to let this long-standing pattern of criminality in the

health insurance industry go unpunished.

Secondly, TANC ideally hopes the proposals laid out in this position paper

can be used as springboard for our Facebook Cause Group initiative to

“Petition for a CITIZENS’ SUMMIT on U.S. Healthcare Reform” (http://

apps.facebook.com/causes/332619/54103574) to lay to out a set of proposals

for a truly OPEN PUBLIC-FORUM debate — a draft bill-making process for American

citizens to offer as template and blueprint for our ―elected‖ representatives to pos-

sibly follow as “THE WILL OF THE AMERICAN PEOPLE.” Even if our federal gov-

ernment chooses to dismiss this summit and draft bill, it will forever be on-the-

record where American citizens decided the future direction of Healthcare Reform

should go!

If the health insurance industry does concede that its business practices need

drastic reform and it abides by new government regulatory actions, TANC has set

forth detailed recommendations for the Congress and the White House — at the

very least — to SET MINIMUM PROFIT MARGIN CAPS and LIMITS ON EXECUTIVE

COMPENSATION AND BONUSES for the PRIVATE/FOR-PROFIT Health Insurance

Carriers. The other major option the federal government can present is that a

funding program based on new, minimal corporate taxes and a special tax assess-

ment on companies producing and distributing ―unhealthy/addictive consumable

products‖ be used to help fund their conversion into NON-PROFIT Health Insurance

Organizations (HIOs).

To accomplish steps necessary for the NON-PROFIT conversion of Private/For-Profit

Health Insurance, TANC is proposing the following preliminary scenarios:

1) De-list FOR-PROFIT/PRIVATE-SECTOR Insurance Companies from

stock exchanges and Re-File under ―Non-Profit Articles of Incorpo-

ration‖ — Much in the same way the federal and state government

issue interest-bearing bonds, the federal government can serve to

guarantee bond funds to participating Private-Sector Insurance

Carriers an exchange in expediting the buyback of shares from

large institutional investors, hedge funds and individual share-

holders in these publicly-held corporations. By unlocking them-

selves from the control of large shareholders, some of whom own





"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 princi-ple of the common good. The existing pat-terns of health care in the United States do no meet the minimal stan-dard of social justice and the common good."

— Resolution on Health Care Reform, U.S. Catho-lic Bishops, 1993, com-ing before the Clinton Administration's failed efforts at achieving U.S. healthcare reform.



large blocks of stock and exercise considerable control of

―voting‖ shares and seats on the Board of Directors for these Big

Insurance corporations, the government is effectively alleviating

the health insurance carrier of typical outside ―marketplace pres-

sures‖ to meet certain per-share earnings and profit projections –

in addition to eliminating ―conflicting agendas‖ and ―hostile take-

over‖ scenarios, sometimes those arising internally from their own

Board of Directors and/or large-block shareholders.

2) The federal government forms the temporary FEDERAL NON-

PROFIT HEALTHCARE CONVERSION ASSISTANCE CORPORATION

with the mandate of helping Health Insurance Companies and

potentially other FOR-PROFIT Healthcare entities un-tether them-

selves from outside investors and other marketplace-driven forces

— The mission of this federal program will be solely to assist par-

ticipating FOR-PROFIT Health Insurance Carriers with bond-issue

funding to buyback the publicly-traded shares from major institu-

tional investors and individual shareholders. Once buyers of

these bonds (including investors and non-profit foundations, etc.)

reach maturity and can be paid off (within the next 5 to 10 years),

the government can effectively liquidate/disband the FEDERAL

NON-PROFIT HEALTHCARE CONVERSION ASSISTANCE CORPORA-

TION once all the conversions are completed.

3) The buyback of publicly-traded shares, with the assistance of gov-

ernment-backed bonds can be timed to mature in 5 years to 10

years, or less — This would allow the once-publicly traded/for-

profit Health Insurance Carrier to recoup all costs related to the

buyback share plan as well as covering any other debts incurred

by the organization before converting to NON-PROFIT status. Mon-

ies from the government bond issues will also allow for a sliding

scale of a 5% to 25% premium to be paid over the Health Insur-

ance Carrier’s ―current‖ per-share stock market price, which will

be based on any potential negative short-falls some shareholders

may still incur from what they originally paid on a per-share basis.

This is to make sure both the investor/shareholders, lien holders

and the company are reimbursed and properly covered at

or slightly above their original investments — so it effec-

tively un-encumbers Health Insurance Carriers from any

outside FOR-PROFIT interests and outside marketplace

forces.

4) Upon their incorporation as NON-PROFIT Health Insur-

ance Organizations (HIOs), participating insurance carriers

will still be able to service their roster of current premium-

holding customers on their existing levels of premium cov-

erage but able to do it closer in line with lower cost Medi-

care-based rate structures — The maintaining of premium

subscriptions with the HIO’s current roster of customers will

also address concerns some consumers have about being

forced into ―universal access‖ Public-Option plans offered to low-





"To be without health insurance in this coun-try means to be with-out 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 por-tion of this country's population from health care coverage, we mock the image of God and destroy the vessels of God's work."

— Rabbi Alexander Schindler, Past Presi-dent, Union of American Hebrew Congregations (1992)




income individuals and families. Moreover, current policy-holders

will benefit from LOWER MONTHLY/ANNUAL PREMIUM COSTS due

to the NON-PROFIT restructuring of health insurance, in addition

to likely seeing their DEDUCTIBLE and CO-PAYMENT cost contribu-

tions greatly reduced or eliminated. Employer-compensated will

also great benefit from lower individual and family plan premium

costs, much as described above.

5) ―Universal Access‖ will also be a mandatory requirement as a re-

sult of a Health Insurance Organization’s NON-PROFIT, TAX-

EXEMPT STATUS, meaning a ―Public

Option‖ program will be made available

to low-/no-income Americans who

can’t afford to obtain coverage on a

reviewed, as-needed basis — By tap-

ping into a special 1% or 2% general

U.S. Corporate Healthcare Tax levy,

which could bring in anywhere from

$140 to $280 billion annually in an-

nual revenues (depending on the state

of the economy and final dollar-

generation figures from annual Gross

Domestic Product totals) to help cover

non-profit HIOs offering the same kind

of individual and family premiums offer

to its regular customers. Currently, cor-

porations pay the equivalent of 2.5% of

the Gross National Product, or roughly

$378 billion in corporate taxes in 2008

while ―individual‖ American taxpayers

paid roughly 8% of the GDP or roughly $1.2 trillion in individual

taxes. So, if corporations pay an additional 1% to 2% corporate tax

(rather than individual taxes), they will

still realize much larger immediate sav-

ings to their bottom-line expenses

through a drastically reduced NON-

PROFIT health insurance system. Addi-

tionally, due to the disproportionately

large burdens placed on the healthcare

system by unhealthy/addictive consum-

ables — tobacco, alcohol, fast foods,

sweetened beverages, candy/

confectionery products, and packaged

snack foods — could be assessed a spe-

cial 5% to 10% corporate tax based on

their gross sales revenue volume, possi-

bly raising between $25 billion to $50

billion in new tax revenue to help subsi-

dize a ―Public Option‖ program (see the accompanying chart).

These unhealthy/addictive consumables account for the greatest







burdens and biggest public health risks that require inordinately

larger public/private expenditures from America’s healthcare

system budgets. So, the producers and distributors of these un-

healthy/addictive consumables should shoulder an additional tax

levy as part of ―social responsibility‖ to help assist in funding a

―Public Option‖ system, which originates from a ―10% Reform”

healthcare reform tax proposal submitted by Facebook Friend,

Andy Freeman (no relation). Currently, it is estimated that there

are 47 million uninsured American citizens, so on a cost-level

comparable to ―Medicare-minimum‖ base rates (for

Senior Citizens), the full rolls of ―uninsured‖ being

extended ―Public Option‖ premiums could come to

a total cost of $188 billion annually with an average

―non-profit‖ premium adjusted to a cost of $2,500

to $3,000 per year – in reverse of the ongoing

trend of $4,800 to $6,000 annual costs for individ-

ual premiums and upwards of $12,000 to $14,000

annually for family premiums that are UNATTAIN-

ABLE for low-income families on an out-of-pocket

basis.

6) Limits on senior management/executive

salaries and bonuses — One of the key driving

forces for the escalating costs of healthcare in this

country is the ever-escalating rise in senior manage-

ment executive pay and administrative overhead

costs. Currently, the top Chief Executive Officers

(CEOs) of the ―Big 6‖ of Health Insurance — CIGNA, UnitedHealth

Group, Aetna, Humana, Wellpoint and Coventry — take home an

average of $11 million in pay annually (see chart on page 8), but

stock options typically carry overall compensation into the HUN-

DREDS OF MILLIONS OF DOLLARS once shares are exercised for

sale. For example, UnitedHealth CEO Steve Hemsley took home

$3.2 million in pay for 2008 but his unexercised stock options are

valued at $744 million, translating to roughly $700 out of each

UnitedHealth customer’s monthly bill paid on a premium for one

year, according to SickforProfit.com. Despite the groundswell of

public criticism over excessive CEO pay in this country (especially

in light of the federal government bailouts of corporate institutions

failing to immediately address excessive executive pay and bo-

nuses), the average CEO across all U.S. industries took home

$10.8 million in total compensation annually — about 364 times

the pay of the average American worker ($29,670 per year), ac-

cording to an Associated Press survey of 386 of the top Fortune

500 companies. All of this points to why healthcare costs are ris-

ing faster in the United States than in any other countries in the

world — largely due to excessive, undue executive costs, bloated

administrative overhead and investor/marketplace pressures to

maintain fat profit margins. Under a new NON-PROFIT Health In-

surance structure, executive compensation should be capped at





"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 hu-man beings... We believe that health is a funda-mental human right which has as its prereq-uisites social justice and equality and that it should be equally avail-able and accessible to all."

-— Imam Sa'dullah Khan, The Islamic Center of Southern California




3% to 10% of their current average, or about $300,000 to $1 mil-

lion per year, and maybe at 3% to 6% of current levels for other

senior-level management below CEO.

7) Each of these freshly converted NON-PROFIT Health Insurance

Organizations (HIOs) will begin search processes for a new,

―independent‖ Board of Directors, inclusive of medical practitio-

ners, caregivers, first-responders and other non-profit hospital/

family clinic administrators — The proposed composition of these

Boards will effectively help guide newly-converted NON-PROFIT

Health Insurance Organizations to gather input and direction of

how to better interact in a more responsive

and efficient manner by observing a newly-

created ―UNIFORM HEALTH INSURANCE IN-

DUSTRY STANDARDS” for the processing of

medical billings and claims with hospital and

family clinic administrators, in addition to at-

home caregiver and rehab services. Uniform

standards for the claims and billing proc-

esses will greatly cut down on the red-tape

and hassles many hospitals and family clinic

physician centers deal with currently in a

patchwork, haphazard and non-uniform PRI-

VATE/FOR-PROFIT system insurance carriers

undertake in states across the country – ef-

fectively reducing hourly manpower costs in trying reconcile bill-

paying claims procedures.

8) To insure and maintain compliance on a newly structured national

UNIFORM INSURANCE INDUSTRY STANDARDS, it would be advis-

able to form ―independent‖ HEALTH SER-

VICES PROVIDER AND PEER REVIEW

BOARDS to regularly review Health Insur-

ance Organizations’ compliance with

various claims and billings reconciliation

processes — These kind of board re-

views, which can be conducted on an

open hearing basis, can also allow any

policy subscribers (either ―paid‖ or

―publicly-subsidized‖ subscribers) to reg-

ister any complaints and concerns to an

―ombudsman-like panel‖ regarding is-

sues that need to be addressed and cor-

rected with these new NON-PROFIT

Health Insurance Organizations.

Some partisans within the PRIVATE/FOR-PROFIT

Health Insurance industry will likely be reticent

and clearly reluctant to consider a NON-PROFTIT organizational model, but given

the roughly 75-year history of their resistance and lobbying efforts against Health-







care Reform (dating back to the World War II efforts of the Franklin D.

Roosevelt Administration), more vigorous publicly-generated petition and

legislative efforts need to be taken today.

Somewhere lost in the hysterics and vitriol that has marked the national

Healthcare Reform debate in America is a serious, reasoned and sane explora-

tion of how to craft a ―Universal Healthcare‖ system that somehow answers and

assuages fears from some corners about a ―Government-run, Socialist Healthcare

System.‖ It may surprise some congressional Re-

publicans, most of whom think ―Big Government‖

and ―Socialized Healthcare‖ are the inevitable re-

sults of a reformed healthcare system, that TANC’s

non-profit proposal is similarly based on the premise

that the federal government should NOT be involved

in the day-to-day operational management of health

insurance and healthcare services in this country.

Given the growing divisions and rancorous allega-

tions being tossed within the halls of Congress and

the White House in this largely CLOSED-DOOR/

CLOSED-FORUM debate and legislative proposal

process, it is particularly understandable why the

various political factions and BIG HEALTHCARE LOB-

BIES and other well-funded special interest groups

have disseminated a head-dizzying array of MISIN-

FORMATION, PROPAGANDIZING, STIGMATIZING and

DEMONIZING about ―Universal,‖ ―Single-Payer‖ and so-called ―Public Option‖

healthcare systems — particularly against those already being practiced in over 50

countries around the world today.

Recent proposed ―compromise‖ plans for instituting

some form of national Healthcare Reform have pro-

duced what many Americans and the media have

derided as either ―watered-down‖ half-measure solu-

tions or have just been flatly rejected for injecting

any kind of government-/taxpayer-financed ―Public

Option.‖

It has been estimated that roughly 22,000 American

citizens unnecessarily die annually due to either

―inadequate‖ health insurance coverage, denied/

delayed claim payouts for treatment or being unem-

ployed and unable to afford PRIVATE health insur-

ance coverage, according to Institute for Medicine

research. A recently release Harvard University

study found that up to 45,000 patient die annually

(one every 12 minutes) due to a lack of insurance

coverage and quality healthcare services. However, the National Center of Policy

Analysis, a Washington-based think tank backing a free-market/private-sector ap-








proach to healthcare, countered that the Harvard study overstated the

―death risk‖ and did not track for how long the subjects were uninsured.

On top of the current, nearly three-year-old economic recession, the most

dramatic, darkly illustrative byproduct of growing unemployment (more than

doubling from 4.7% at the beginning of 2006 to 9.7% in August 2009), the num-

ber of UNINSURED Americans has risen to an estimated 47 million American citi-

zens, according to U.S. Bureau of Labor and U.S. Department of Commerce statis-

tics. This growing number of the UNINSURED Americans has created a rising, fes-

tering public healthcare crisis — nearly universally decried by medical practitioners,

caregivers, first-responders and hospital administrators — that our ―elected‖ repre-

sentatives can’t ignore any longer…even with the roughly $2.3 billion in political

contributions by the INSURANCE LOBBY from 1998-2006 (source: OpenSecrets.org)

to maintain the status quo of America’s ―Have or Have-Not,‖ FOR-PROFIT HEALTH

INSURANCE SYSTEM.

Given the poor economic climate and the alarming rise in unemployed and unin-

sured Americans, other immense public pressure if coming down on the FOR-

PROFIT/PRIVATE health insurance over its burgeoning ―DENIALS-BASED‖ business

practices and other allegations of manipulating the marketplace, artificially inflating

pricing and shifting the costs of deductibles and co-pay charges to consumers, even

with ―employer-based‖ premiums.

Over the last few months, the California Nurses Association successfully lobbied

state Attorney General Jerry Brown Jr. to mount a full investigation into what the

group claimed were 45 million ―suspect‖ denied claims for medical treatment of

patients — unlawfully carried about by major FOR-PROFIT/PRIVATE-SECTOR health

insurance companies in the state. SmartMoney.com re-

cently reported that out of 1 billion medical claims filed

nationally with PRIVATE/FOR-PROFIT insurers, as many as

75 million claims annually are ―rejected outright, leaving

patents unable to get treatment or stuck with medical bills

that add up to at least $50 billion annually.‖

Furthermore, Sen. Patrick Leahy (D-VT) is leading the

charge on a pair of Congressional bills (S. 1681 and H.R.

3596) under the Health Insurance Industry Antitrust En-

forcement Act banner to bring an end to the 64-year-old

exemption that the health insurance industry has been

allowed to operate outside the federal Sherman Antitrust

laws — rules that ―protect consumers from anti-

competitive practices like price fixing,‖ Leahy wrote in his

email blast to the American public.

―They can pick and choose their customers and deny cov-

erage to anyone with any sort of pre-existing condition --

even acne. They can get away with dropping your coverage

when you get sick,‖ Leahy wrote. ―Passing health care re-

form with an effective public option is one key way to pro-





Please click the hyperlink with this photo for one of the most revealing, infor-mative interviews PBS‟s Bill Moyers had with for-mer CIGNA executive Wendell Potter, a whistle-blower who speaks in de-tail of insurance industry practices and with insider knowledge of CIGNA‟s foot-dragging claims DENIALS involved in the death of Nataline Sarkisyan.


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


mote competition in the health insurance marketplace, but we must

also eliminate the unjustified and unnecessary antitrust exemption cur-

rently enjoyed by insurance companies.‖

Sen. Leahy went on cite an unnamed ―recent study‖ that when one or two of

the handful of major FOR-PROFIT Big Insurance Carriers control found 94% of

the American health insurance markets across the country, it means ―every year

consumers are paying more for less coverage.‖

When insurance companies know they don’t have to compete, they don’t,‖ Leahy

added. ―When they know they can get away with raising your premiums every year,

they do. And when they know they can deny you coverage without consequence,

they'll leave you high and dry. The Health Insurance Industry Antitrust Enforcement

Act, which I introduced in the Senate in [mid-September 2009], is not the be all and

end all of necessary reform, but it is a

key way we can give consumers more

choice in the health insurance market-

place.‖

As the result of this ―DENIAL-BASED‖

private health insurance system, millions

of Americans either live in dire fear of

ever using their PRIVATE health insur-

ance plans (and risking higher premium

costs, higher deductibles or outright pol-

icy cancellations for having ―preexisting conditions‖) or having no coverage at all

and risking going into bankruptcy due to a mountain of incoming medical bills.

Wikipedia.org cited an un-sourced ―recent study‖ that found uninsured and uncov-

ered, denial-based medical expenses played a ―significant factor‖ in 60% of all per-

sonal bankruptcies filed in the United States.

Even those who thought they had good

insurance coverage took pause at the

story of Nataline Sarkisyan, a 17-year-old

Los Angeles girl who died while her health

insurance carrier, CIGNA, hemmed and

hawed over whether to pay for her live-

saving liver transplant surgery. CIGNA

deemed Sarkisyan’s badly-needed and

delayed liver transplant surgery an

―exploratory procedure‖ and this came

despite UCLA Medical specialists citing instances where they had performed the

transplant surgery successfully before. Nataline passed away while awaiting the

transplant in December 2007 — although CIGNA finally relented in approving her

claim (after massive public outcry against the insurer) just a day before she died.

Sarkisyan’s story is one that rings familiar in denial-based cases where other Ameri-

cans have died while awaiting critical life-saving surgeries and can be found, along

with other stories about prolonged, growing terminal illnesses and other suffering at





Nataline Sarkisyan

"Health security is an issue that affects all of us. Every person has a fundamental human right to quality healthcare — healthcare that is affordable, accessi-ble, and compassionate. As the nation begins to trans-form the healthcare system to one that is sustainable, it will be important that we, as a society, ensure that healthcare in the U.S. respects the dignity of every person and delivers the quality, compassionate care we expect and de-serve. Meaningful reform will require dialogue, the acceptance of diverse views and above all, compromise. With the human right of healthcare at stake, all of us must work together to make sure future genera-tions inherit a healthcare system that embraces qual-ity and compassion."

— Catholic Healthcare West's Perspective, as printed in their Health Security Index, Spring 2007



http://www.sickforprofit.com/


-risk patients have endured, at film documentarian Robert Greenwald’s

healthcare advocacy site, www.SickforProfit.com.

If all or some of the Big Health Insurance carriers reject the NON-PROFIT

conversion program model TANC is proposing here, then this federally-funded

program should be entirely focused on fostering the creation of new NON-PROFIT

Health Insurance Organizations and/or expanding the ex-

isting Medicare-based ―Social HMOs,” such as SCAN and

Elderplan, into the general under-65 marketplace. Allow-

ing greater NON-PROFIT participation will generate lower

pricing competition in the marketplace that could similarly

create new ―market-driven forces‖ to drive down the artifi-

cially inflated pricing from FOR-PROFIT/PRIVATE insurance

carriers.

The benefits of creating and fostering the growth of NON-

PROFIT carriers are many:

• Larger, feature-rich menus of inpatient and outpa-

tient coverage areas and prescription drug assistance

on a low- to no-cost basis available to all American

consumers.

• All medical procedures, doctor visits, preventative/at-home care and

screening exam tests are completely covered

with no chance of DENIALS or REVOCATIONS

of premiums if someone is identified with a

―preexisting condition.‖

• A large selection of in-network Primary Care

Physicians (PCPs), specialists, hospitals, emer-

gency care, family clinics, outpatient treatment

facilities, at-home caregiver services and low-

to no-cost prescription drug services.

• Even if corporations pay a 1 to 2 percent

special corporate tax to fund NON-PROFIT

healthcare, these companies will quickly real-

ize greater overhead savings with lower

―group‖ coverage policy costs — realizing that

a current ―individual‖ employee premium will

drop more than half in cost from about $6,000

annually while a typical ―family-of-four‖ pre-

mium will similarly drop by more than half from

its annual $12,000 to $18,000 range today.

• There will be NO day-to-day, ―invasive‖ in-

volvement of the federal government in ―managing‖ a NON-PROFIT

healthcare system, only badly-needed regulatory and legal oversight.





Under the 3 scenarios proposed by The Commonwealth Fund (with research from the Lewin Group), the “Public Plan” — based on setting rates at “Medicare-

minimum” levels — offers most optimal long-term reduction in federal outlays (at nearly $3 trillion) over the next 10 years. But, imagine how much higher the sav-ings would be in all-nonprofit organizational health insurance system.

http://www.SickforProfit.com



• Non-profit HIO carriers will be able to charge middle- to upper-

income consumers directly for their premiums, incrementally lower-

ing the amounts of special federal startup and long-term funding.

• Low- to no-income Americans get ―Public Option‖ coverage through

the general and special corporate taxes on ―unhealthy/addictive‖ prod-

uct categories on a reviewed, ―as-needed‖ basis.

• People who choose stay with their FOR-PROFIT/PRIVATE carriers can

stay with their option plans, but will likely also realize a considerable

lowering in monthly/yearly premium costs because of the new-found

competition from an emerging and expanding offering of NON-PROFIT

Health Insurance Organizations entering into the marketplace.

• Adoption of new ―UNIFORM INSURANCE INDUSTRY STANDARDS” will

greatly reduce or eliminate red-tape hassles that medical practitioners,

hospitals, family clinics and other caregiver services must deal with in

frequently arbitrary DENIALS on billings/pay-out claims — thus having a

―snowball-effect‖ on greatly lowering hourly administrative and outside

collection agency costs to reconcile billing statements.

• The emergence of a flourishing, growing NON-PROFIT health insurance

market could also have the ―domino effect‖ of leading to the de-listing

of other FOR-PROFIT/PRIVATE healthcare companies — rekindling the

founding spirit of ―social contract‖ non-profit, religious- and publicly-

funded hospitals and other caregiver services.

• Jobs in the health insurance and other healthcare sectors will be more

stable and secure in a NON-PROFIT organizational model — a much

more professionally and person-

ally rewarding experience would

await those who currently toil in

the FOR-PROFIT/PRIVATE arena

and switch to NON-PROFIT roles

in fulfilling a vital ―Social Con-

tract‖ dedicated to aiding the

health and well-being of Ameri-

cans.

Hopefully, more than anything, this

potential reinvigoration of NON-

PROFIT health insurance can get top-

to middle-level executives, adminis-

trators and highly-skilled medical

practitioners to look inside at a

healthcare system badly in need of

reform when it comes to overhead

costs and compensation. Reform of

the health insurance industry, like all

other sectors of healthcare, has to





"Science may have found a cure for most evils, but it has found no remedy for the worst of them all — the apathy of human beings."

— Helen Keller




do with amending internal business practices and renewing government’s

role as a regulatory/legislative oversight body — not just pouring in $856

billion dollars over the next 10 years (as Sen. Baucus proposes) without a

clear mandate and plan to truly end the unjustified FOR-PROFIT inequities

of a long-running ―Have or Have-Not‖ healthcare system.

If this country can manage to return to the ―Spirit of Collectivism‖ that was a hall-

mark and fixture in the founding of religious-based hospitals and family-based prac-

tices from a variety of Christian faiths and other denominations originally settling in

America during the 18th to early 20th centuries, then we truly have a chance to cre-

ate an American healthcare system that will be uniquely self-reliant/self-

sustainable, just, equitable and accessible for this and future generations of Ameri-

cans.

In 2003, of the roughly 3,900 nonfederal, short-term, acute care general hospitals

in the United States, the majority — about 62 percent — were NON-PROFIT, accord-

ing to Wikipedia.org. The rest included government hospitals (20 percent) and for-

profit hospitals (18 percent). Still, it has been widely reported that even not-for-

profit hospitals are being racked with higher executive and administrative costs, so

even NON-PROFIT religious- and government-backed hospitals need to address and

conform with lower, more equitable compensation structures to fulfill their ―social

contracts‖ with the American public.

In other key areas of U.S. healthcare reform, TANC is additionally proposing the fol-

lowing measures to reform America’s healthcare system:

Medical Malpractice Liability and Tort Reform — State and federal

statutes have to be legislatively amended to mandate a set structure

for the limitation of jury rewards on malpractice suits against hospitals

and medical practitioners. This will also

help to drive down the cost of malpractice

insurance for doctors and hospitals, both

of which pass those costs back to consum-

ers in what they charge for services.

• Pharmaceutical Pricing and Practices —

Prescription drug prices in the United

States are the highest in the world, accord-

ing to Wikipedia.org. The prices Americans

pay for prescription drugs, which are far

higher than those paid by citizens of any

other developed country, help explain why

the pharmaceutical industry is — and has

been for years — the most profitable of all

businesses in the U.S. In the annual For-

tune 500 survey, the pharmaceutical in-

dustry topped the list of the most profit-

able industries, with a return of 17% on

revenue and 30% operating profit margins.

The high price of prescription drugs has been typically one of the most

contentious areas of discussion in the U.S. healthcare reform de-





"When will our

consciences grow

so tender that we

will act to

prevent human

misery rather

than avenge it?"

— Eleanor Roosevelt



bates, especially given the complexities of trying to regulate big

pharmaceutical conglomerates with operations spread across the

world internationally. Areas of consideration have been tougher

federal government regulation of the pharma industry to the adoption

of a Medicare-type ―Part-D‖ prescription drug subsidization program

already offered to seniors and possibly expanded to the general under

-65 population. Coming up with an equitable solution in the ―public

interest‖ could be tough, though, with thousands of lobbyists

from the pharma lobby funneling their influence and contribu-

tions through halls of Congress and the White House in Washing-

ton, D.C. The pharmaceutical industry spent $855 million, more

than any other industry category, on lobbying activities from

1998 to 2006, according to the non-partisan Center for Public

Integrity.

Strengthening/Financially Reinforcing Medicare — Having

created the model for NON-PROFIT, ―Social Managed Care‖ pro-

grams, it would seem logical that the expansion of its Medicare

Advantage Prescription Drug program is a highly attractive and

seamless solution for relieving federal budgetary burdens on the

senior-care agency. The budget for the U.S. Department of

Health and Human Services, which encompasses budgetary/

operational oversight of Medicare, is the largest federal budget

category at $707.8 billion in 2008, according to the White House

Office of Management and Budget. Total budget outlays for

Medicare (Parts A, B & D) are expected to top $506.8 billion for

2009, a near doubling (97% increase) over its $256.8 billion

budget in 2002. According to a report by the board of trustees

for Medicare and Social Security, Medicare spent more than it

brought in from taxes in 2008, with predictions that the Medicare hos-

pital insurance trust fund will become insolvent by 2019. However, if

the federal government acts more aggressively in mandat-

ing an expansion of its successful Medicare Advantage

(Part D) prescription drug program for ―Social HMOs,‖ it

could be possible that more of the budgetary shortfall in

meeting the needs of nearly 45 million seniors in this

country could be alleviated and shifted toward direct pre-

mium contributions to innovative non-profits, such as

SCAN, Elderplan and others, outlined in this paper.

Profit should not be the overriding motivating, driving force of

American healthcare and if we can get this right, I truly believe

other American business categories rocked by scandals, corrup-

tion and other forms of mismanagement — such as banking, real

estate/housing and the automotive sectors — will have a model

for conducting business on a more sound and ethical basis go-

ing-forward. The independence and innovation of these ―Social

HMOs‖ feature the best of what NON-PROFIT, altruistic organiza-

tions offer, along with the innovations of what had once been considered sole pro-








prietorship of FOR-PROFIT, private enterprise.

However, somewhere in this CLOSED-DOOR debate on Healthcare Reform

in Washington, DC, the President and Congress seem to have shut off any

further PUBLIC EXPLORATION of new proposals, although Pres. Obama still

insists he is keeping ―an open door policy‖ on ideas from his friends in Con-

gress. But that is where the President doesn’t even realize there are other ideas

that can be explored and derived from a truly OPEN-PUBLIC FORUM

summit on healthcare that TANC is proposing. And that may be why the

President doesn’t realize that he lacks much of any kind of PUBLIC CON-

SENSUS MANDATE FROM THE PEOPLE to give him leverage he needs in

Congress.

It’s time for all Americans to look inward, question, propose and work

together on how we can do better to help each other, rather than feed-

ing off a dated laissez faire theory of a ―free-market,‖ predatory health-

care system based on the ―survival of the fittest‖ — this is intolerable

and unacceptable when it comes to balancing out the lives and well-

being of Americans.

Most notably, America’s arcane, haphazard ―Have or

Have-Not‖ system of private healthcare appears to be

built on a self-fulfilling prophecy of ethical and moral

criminality, all of which has already been rejected by the

50 or so other nations of the world practicing various

forms of ―Universal Healthcare.‖ Coming on the heels of

massive, nearly TRILLION-DOLLAR bailouts of corporate

banking, insurance and automotive institutions in this

country, it is critical our ―representative‖ federal govern-

ment proves it can still produce Healthcare Reform in the

―Public Interest‖ — not just in ―Corporate Interests.‖

Delivering on a NON-PROFIT-BASED, ―Universal Health-

care‖ system would be a triumphant, epic accomplish-

ment after 75-plus years of mostly futile struggles to at-

tain any kind of meaningful reform. It is time for America

to regain its reputation for humanity, equality and innova-

tion as an ―advanced society‖ atop the world stage.

# # #





Advocates of a “Single Payer” and “Universal Healthcare” had to make their feelings known quickly as Sen. Max Baucus (D-MT), chairman of Senate Finance Subcommittee holding hearings on Healthcare Reform, had security officers quickly escort them out due to the CLOSED-DOOR nature of the HCR debate. Please click the hyperlink to watch the YouTube video as Baucus and other committee members scoff and laugh as the advocates are rushed out the door.

“If all or some of the Big Health Insurance carriers reject the NON-PROFIT conversion program model TANC is proposing here, then this federally-funded program should be entirely focused on fostering the creation of new NON-PROFIT Health Insurance Organizations and/or expanding the existing Medicare-based “Social HMOs,” such as SCAN and Elderplan, into the general under-65 marketplace. Allowing greater NON-PROFIT participation will generate lower pricing competition in the marketplace that could similarly create new “market-driven forces” to drive down the artificially inflated pricing from FOR-PROFIT/PRIVATE insurance carriers.”


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

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


About TANC Trans-American Alliance for a National Consensus (TANC) is a Califor-

nia-based nonprofit 501[c][3] public advocacy organization dedi-

cated to establishing a national ―Electorate Legislative Consortium‖ as part

of a nonpartisan, citizen-based assembly bringing together all key segments of

society to author and enact ―consensus‖ federal legislation. The primary mis-

sion of TANC is to act as a complementary but binding ―fourth branch‖ arbiter

between the established Legislative, Executive and Judicial branches of the

U.S. government.

To convene on a local, regional and national basis through a representational

number of universities and colleges in the United States, TANC is empowered

to bring badly-needed consistency, accountability and transparency to policy-

and law-making from the federal government. Also referred to as The Alliance,

the overriding goal is to establish TANC as a nonpartisan ―ethical conscience

of democracy,‖ effectively seeking to contradict or mitigate the influence some

well-funded lobbyists, special interest groups and political action committees

hold on politicians throughout the corridors of power in Washington, D.C.

For more information and how you can participate to make ―Citizens’ Over-

sight‖ a potential fixture of future federal governance, please visit us at

www.transamericanalliance.org.

You can also make a huge difference by mailing or emailing this position pa-

per, Rx for U.S. Healthcare Reform, to your elected congressional Senate and

House representatives by searching for their email addresses at http://

www.congress.org/congressorg/directory/congdir.tt. Emails, with the PDF ver-

sion of the position paper attached, can be forwarded to the President

([email protected]), Vice President ([email protected])

and other members of executive branch-level cabinet departments can be

sent to [email protected]; and snail mail to The White House, 1600

Pennsylvania Avenue NW, Washington, DC 20500. If you have any inquiries,

suggestions or thoughts, please share them with us at Think-

[email protected].

# # #





You can also find more

information, position pa-

pers, presentations, our

draft bill for an

―Electorate Branch‖ of

government and other

research and how you

are welcome to join in

TANC membership at our

Web site (listed above) or

with our two social net-

work site portals: Our

Facebook TANC Cause

Group at http://

apps.facebook.com/

causes/249715/541035

74?m=1 and TANC

LinkedIn.com Group por-

tal at http://

www.linkedin.com/

Organization

Michael A. Freeman

Executive Director

Co-Founder

Jaimie J. Keane

Assistant Director

Co-Founder

“If FOR-PROFIT/PRIVATE health insurance carriers label their so-called top-of-the-line plans as “Cadillac Premiums,” than several “Social HMOs” including SCAN‟s Medicare-based plans for seniors should be coined the “Rolls-Royce Premiums” of health insurance. It just proves that a greatly expanded menu of benefits and lower deductibles and co-pays are very achievable at a fraction of the monthly/yearly costs of what FOR-PROFIT/PRIVATE health insurers offer.”


http://www.congress.org/congressorg/directory/congdir.tt

http://www.congress.org/congressorg/directory/congdir.tt

mailto:[email protected]







http://apps.facebook.com/causes/249715/54103574?m=1




http://www.linkedin.com/groups?gid=129546&trk=hb_side_g

http://www.linkedin.com/groups?gid=129546&trk=hb_side_g

"rx for u.s. healthcare reform" - a position paper from tanc

Health & Medicine