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Friday, August 28, 2009

E-MAIL FEEDBACK ON THE WASHINGTON POST LETTER

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JC, Your letter to the Wash Post (8/23) is well done and very substantial. Where are you getting your stats?
Carmelita W. (Nurse)


Response to Carmelita:

The stats about Canada for that Washington Post letter came from a well-footnoted book about health care around the world. It's called Lives at Risk, by Goodman, Musgrave, et al. It's an eye-opener of a book! Goodman is an established health care expert who has been writing books on the subject since before it became a super-hot political topic. :) Here's a link if you'd like to buy a copy:




JC Leahy
RN, BSN, MA, ACLS
Sigma Theta Tau's "100 Most Extraordinary Nurses" Award

Thursday, August 27, 2009

LETTER TO THE EDITOR: WASHINGTON POST, AUG. 23, 2009

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Dear Washington Post Editor:
In his article of August 4 ("For Doctors, Rationing Care is Standard Practice"), infectious-disease Dr. Manoj K. Jain's thesis is that America is "rationing care, just like the Canadians and British, with long wait times." Americans would do well to understand that Dr. Jain is way off base!!! Canadian and British health-care rationing differ in both degree and type from the "rationing" that occurs in the United States.

Dr. Jain shows no appreciateion for the extreme severety of rationing in Canada or Britain as compared with the United States. Dr. Jain does not mention that, in terms of availability of health care technology per 100,000 of population, of the 29 member OECD nations, Canada ranks dead last!!! Dr. Jain does not mention that for Canadians, it is easier to get an MRI for one's dog than for one's self. Nor does he mention that, while 40% of Oregon's hospitals can offer transplant services, in nearby British Columbia the figure ZERO percent. Nor does Dr. Jain mention that while 40% of Oregon hospitals can save your life with coronary balloon angioplasty, only 1 in 10 British Columbia hospitals can. Nor does he mention that, by the Canadian government's own admission, 20-30% of Canadians in queue for coronary bypass surgery have grown too unstable to tolerate the surgery, while waiting. That doesn't count those who have been removed from the queue because they died while waiting. The Canadian and British health care systems are designed to ration health care by preventing the existence of technological equipment, facilities, and specialists. In the United States, on the other hand, what Dr. Jain calls "rationing" relies much more on the very sort of case-by-case evaluation-of-benefit that Dr. Jain actually describes in his article.

Canada's single-payor health care system is a severe disaster for those who are actually sick!!!That is why Canadians spend a billion dollars per year for US health care. Canadian and British health care rationing differs in both degree and type from rationing that occurs in the United States. For Dr. Jain to equate United States and Canadian/British health care rationing shows a fundamental lack of understanding.

JC Leahy, RN, BSN, MA, ACLS
2009 "100 Most Outstanding Nurses" Award, Washington, DC
Director, Health Professionals for Meaningful Change
jcleahy@jaitoday.com

REAL ESTATE MARKET INFORMATION

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This interesting video is submitted by Joaquin Beltran, Silver Spring, MD

http://vimeo.com/3261363

Wednesday, August 26, 2009

ALERT: JOB HUNTERS: BIG JOB FAIR TO BE HELD AT FORT MEADE, MD

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JOB HUNTERS, ALERT !!!

Fort Meade, Maryland, is apparently booming.!!! Your job hunting may be simplified by attending a major job fair to be held there Wednesday, Septempber 9, from 9 am till 2 pm. Both government and contract jobs are inicluded. CLICK HERE FOR DETAILS

QUESTION: WHAT ABOUT HEALTH CARE IN EUROPE ???

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This question come from James Louloudes, Silver Spring, MD

QUESTION:

Regardless of political views, I found it interesting that Canada is claiming major problems with their Health Care System. (See the link to a Fox News article, below.) I didn't see this listed in any of the major news papers and thought it to be odd since it's a very hot topic these days. I wonder how European countries are faring?

http://www.foxnews.com/story/0,2933,539943,00.html?test=health

ANSWER:

Well, James, the Fox News article is certainly informative. I would add that Canadians who view their own health as "fair" or "poor," 54% (which is to say, Canadians who are actually sick) say that a shortage of health care professionals and hospital beds is the "biggest problem" with their health care -- compared to 5% in the United States. Actual treatment statistics bear out their perceptions: Only 5% of US patients have to wait more than 4 months for surgery, compared to 27% in Canada (and 36% in Britian, and 23% in Australia, and 26% in New Zealand, by the way).

I can tell you that a number of European countries have had their own serious problems with their single-payer national health insurance -- in fact, there has been pressure to actually back away from the single-payer model. According to Goodman et al., Lives at Risk, page 10, "Despite official rhetoric, over the course of the past decade almost every European country with a national health care system has introduced market-oriented reforms and turned to the private sector to reduce the costs of care and increase the value, availability and effectiveness of treatments. In making these changes, more often than not these countries looked to the United States for guidance." They give a long list of examples. Check out that book, especially pages 10 -11 for details!

JC Leahy
RN, BSN, MA, ACLS
2009 "100 Most Outstanding Nurses" Award, Wash, DC
Director, Health Professionals for Meaningful Change

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Tuesday, August 25, 2009

HUMOR: "AN ACTUAL PASSPORT LETTER"

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This is from the internet. Supposedly, it's an actual letter to the passport office -- but who knows? All I can tell you for certain is that it made me laugh. :) --- JC Leahy

Dear Sirs,

I'm in the process of renewing my passport, and still cannot believe
this. How is it that Radio Shack has my address and telephone
number and knows that I bought a cable t.v. from them back in 1987,
and yet, the Federal Government is still asking me where I was born
and on what date.For Christ sakes, do you guys do this by hand?
My birth date you have on my social security card, and it is on all
the income tax forms I've filed for the past 30 years. It is on my
health insurance card, my driver's license, on the last eight damn
passports I've had, on all those stupid customs declaration forms
I've had to fill out before being allowed off the plane over the last
30 years, and all those insufferable census forms that are done at
election times.

Would somebody please take note, once and for all, that my
mother's name is Maryanne, my father's name is Robert and I'd be
absolutely astounded if that ever changed between now and when
I die!!!!!! I apologize, I'm really pissed off this morning. Between you
an' me, I've had enough of this bull----! You send the application to
my house, then you ask me for my f------ address.

What is going on? You have a gang of Neanderthal ---holes workin'
there! Look at my damn picture. Do I look like Bin Laden? I don't
want to dig up Yasser Arafat, for s--- sakes. I just want to go and
park my ass on a sandy beach. And would someone please tell me,
why would you give a s---- whether I plan on visiting a farm in the
next 15 days? If I ever got the urge to do something weird to a
chicken or a goat, believe you me, I'd sure as hell not want to tell
anyone!

Well, I have to go now, 'cause I have to go to the other end of the
city and get another f------ copy of my birth certificate, to the tune
of $60. Would it be so complicated to have all the services in the
same spot to assist in the issuance of a new passport the same
day?? Nooooo, that'd be to damn easy and maybe makes sense.
You'd rather have us running all over the f------ place like chickens
with our heads cut off, then find some ---hole to confirm that it's
really me on the damn picture - you know,the one where we're not
allowed to smile?! (bureaucratic f------ morons) Hey, you know why
we can't smile? We're totally pissed off!

SignedAn Irate Citizen.

P.S. Remember what I said above about the picture and getting
someone to confirm that it's me? Well, my family has been in this
country since 1776 ........I have served in the military for something
over 30 years and have had security clearances up the ying
yang........However, I have to get someone 'important' to verify who
I am - you know, someone like my doctor WHO WAS BORN AND
RAISED IN INDIA !

Sincerely,You Sure In The Hell Should Know Who

And we want them to run health care?!?


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Thursday, August 20, 2009

THE LEAHY HEALTH CARE REFORM PLAN


We the People
, demand a more sustainable health care system that gives us fair service for fair price. We demand a health care financing system that lets each of us, with the advice of our doctors and families, secure our own health care destinies in with freedom of choice!!

THE PLAN -- Your humble nurse recommends revolution, a non-violent revolution of the little people. There are just too many vested interests for meaningful health care reform to happen any other way. I ask that each of us throw off our Clark Kent suits and become individual super heroes fighting for this just cause. Here’s the plan. For want of a better name, I’ll call this the Leahy Plan:

1. Reform Health Care Cafeteria Plans – Congress already allows employees to save pre-tax money for their health care expenses through what they call "cafeteria plans." Money is simply withheld from your paycheck and never gets taxed - ever. It goes into a savings account that you may spend. This reduces your income taxes and gives you tax-free savings to pay medical bills. Many employers make these plans available. There is little or no cost to the employers. At my work, for example, I can sock away $5,000 per year tax-free. The Lex Luthors of Congress, however, have embedded a poison pill. It is that if I don’t spend all of my $5,000 by the end of each year, it is confiscated!! I lose it!! What a ripoff!! Step one is to remove the use-it-or-lose-it provisions of health care cafeteria plans! Let unused balances carry forward with no more poison pills, and let them be managed by the employees just like they manage their 401k’s.

2. Create Corresponding Plans for the Self Employed - Set up health savings plans for the self employed which correspond to the health care cafeteria plans for employees. Money deposited to such a plan may be deposited with any of the institutions that can be IRA custodians, including banks. The savings balances will be a powerful shot in the arm to banking and the rest of the beleaguered financial sector. To the extent that the self-employed person has a profit, money deposited to such a plan will be a deductible expense that will appear on the business page of the tax return – the Schedule C. Thus, the self-employed entrepreneur will save on state and federal income taxes and also self-employment taxes. Don’t believe anyone who tells you we have tried this before. Nothing like this has ever been tried! This will be a powerful shot in the arm to the small-business sector. Because small business provides the vast majority of jobs, it will be a shot in the arm to employment in America.
3. Mandate Health Care Savings - Collectively, the plans contemplated in #1 and #2 we will call, for want of a better name, Neighbor Bill Accounts. Every man, woman, and child in America who is legally employed will be required to contribute not less that 9% and not more than 15% of his gross earnings to a Neighbor Bill Account. Every self-employed person will be required to deposit the same percentages to Neighbor Bill Account based on Schedule C gross margin, but only to the extent that there is a business net profit.

4. Provide for Management and Expenditure of Health Care Savings - We will be free to manage and invest our Neighbor Bill Account funds just like 401k’s. If we die, the funds will pass to our heirs. If we wish to spend money for health care, we will use a special VISA debit card. This VISA debit card will be spendable exclusively at places that exclusively sell health care services or products. For example, your VISA debit card could be used at a hospital, a doctor’s office, a healthcare-only website, or a healthcare-only counter at a local pharmacy. Using a simple VISA card will free doctors and hospitals of their claims-processing nightmare. Insurance administration costs will fall to near zero.

5. Provide for Control by the Little People - At their owners’ discretion, Neighbor Bill Accounts may be used to pay for one’s own health care expenses – or one’s spouse, or child, or brother, or niece, or mother-in-law, or lover, or significant other, or even for the health care expenses of a neighbor. The only restrictions will be that (1) funds may only be used for health care, (2) with an important exception I’ll detail below, funds may not be used to pay health insurance premiums, and (3) the owner of the funds may not receive any sort of goods, services, tax deductions, or other kickbacks for paying others’ health care expenses. The reward for such payments is simply not to be in this world.

6. Tax Employer-Provided Health Insurance - Currently, if an employer provides health insurance to employees, the employer is allowed a tax write off for 100% of the insurance cost; and, the employee does not have to include the corresponding amount in his taxable income. This asymmetry is unusual in the tax code and amounts to a special subsidy of employer provided third-party-reimbursement-type health care. This subsidy has created the current societal reliance on employer-provided health insurance. Remove the subsidy. This will gradually free employers of their nightmarish burden of health care costs In the meantime, it will also generate tax revenues.

7 Mandatory Catastrophic Health Care Insurance - Every man, woman, and child in America who has a Neighbor Bill Account must pay for private catastrophic health care insurance. This is the only type of insurance premium that may be paid out of Neighbor Bill Account funds. People with families must have policies that cover their children and non-working spouses. Health care expenses in excess of a high deductible amount will be covered in full by these insurance policies. The annual deductible amount will be $10,000 per person or 5% of the beginning-of-year balance of their Neighbor Bill Account, whichever is higher. The $10,000 amount will be indexed for inflation each year. This universal, mandatory private catastrophic health care insurance will be a shot in the arm to the beleaguered insurance industry while protecting the little people from financial wipe-out. The cost to Government will be around zero.
8 Simple Tort Reform - A shockingly large percent of health care services are performed not for clinical expediency but to shelter providers from malpractice trial lawyers. This artificially increases demand for health care services, mis-allocates resources, and drives up prices Additionally, the cost of malpractice insurance and huge malpractice awards drive up prices for health care. Congress will reform this paradigm by simply legislating that if you sue anyone in Federal court for malpractice or negligence, and you fail to win on at least one single point, you will pay half of the defendant’s legal fees and other associated costs This way, people with slam-dunk-valid claims will be free to pursue them in court, but others will think twice before filing frivolous lawsuits. We, the Clark Kents of America, must force our individual state governments enact that identical rule for state courts.

9. Restrict Employer Write off of Health Insurance Expenses - Currently, certain business expenses are not fully deductible for income taxes. For example, business meals generally are only 50% deductible. In like way, make the employer’s expense for employee health insurance only 50% deductible. This will produce tax revenues and gradually encourage the shift away from employer-provided third-party-payment plans to individually-controlled-and-safeguarded Neighbor Bill Accounts.

10 Abolish the Self Employed Health Insurance Deduction - The Neighbor Bill Account deduction replaces the Self Employed Health Insurance Deduction. The former encourages third-party-payment plans, while the latter is individually controlled.

11 Maintain and Strengthen Medicare-Medicaid - Medicare and Medicaid must continue to be the safety nets for those who need them. However, Medicare and Medicaid are ripe for eventual collapse because (1) the population is aging, and (2) they are third-party-payment plans. We can save Medicare and Medicaid with the following just and simple rule: Anyone who has a balance in a Neighbor Bill Account must use those funds before tapping Medicare or Medicaid. This will relieve pressure on Medicare-Medicaid resources, and save the safety nets for those who need them.

The Leahy Plan will gently sweep away our failed health-care financing system. The royalty of the health care financing will be de-throned. The future will be free to blossom. Vast sums of money will be set aside for health care and safeguarded by vigilant owners. Catastrophic health insurance will protect us from financial wipe-out. Medicare and Medicaid will protect the poor and the elderly. Most payment processing will be as simple as swiping a VISA card. The little people will spend or save health care resources as they think wise. They will never again be told that treatment they desperately need is not covered by the plan, or can only be obtained by lengthy waiting for complicated appeals. Employers will no longer stagger under the burden of health care costs. Job-creating small employers will get their second wind from a reduction of their income and self-employment taxes. Large employers, over time, will have the crushing burden of employee health care expenses lifted from their shoulders. Medicare and Medicaid will be secured. Doctors and hospitals will be cured of the expensive headache of filing and collecting insurance claims. They will, however, need to produce price estimates and bills that patients can understand and accept.

The future is exciting. It only requires is that you – personally – somehow, in your own way, with your own talents, stop masquerading Clark Kent, get off your haunches and make it happen – starting now, starting today. To Nancy Pelosi, Barack Obama and Hillary Clinton, we must say: YES WE CAN!!!!
 

Saturday, August 15, 2009

A NURSE'S PLEA FOR HEALTH CARE REFORM

By JC Leahy, RN, BSN, MA
Sigma Theta Tau's "100 Most Extraordinary Nurses" Award

It breaks my heart to see the Media's portrayal of legislators bracing for health-care forums. In tenor and content, the media portray Congress as under siege by angry mobs. My own local paper complained that these mobs are "more intent on being heard, than asking questions about the Democrats' proposals." It gave front-page voice to assertions that those with different ideas are "hard-right tea-baggers and birthers." How polarizing! What we need is a calm discussion.

Make no mistake, health care has not failed in America!! Medical professionals have crafted the finest health care system in the world. We know this because the sickest from around the world fly to American hospitals and specialists when their personal chips are down. I know. I'm a registered nurse. I work in hospitals evey day.

What actually has failed in America is the health care FINANCING system. Health care financing's failure, in turn, has created failures with health care distribution and delivery . These failures have killed many Americans, including my neighbor Bill.

Let's attempt to understand the health care financing and distribution system by understanding underlying fundamentals. Fundamentals define the system. Focus your attention. This is really important to you and your family.

The most important underlying fundamental is the principle of third-party reimbursement. Third-party reimbursement is the wellspring from which failure flows. Look at it this way: When folks buy a new automobile, 100% of them want to know how much it costs. They may haggle. They may shop around. They will consider the price, the automobile's benefits, and their available funds. They will also consider other things on which they want to spend money, such as food, mortgage payments, clothing, recreation, etc. In the end, they may decide to buy a different kind of new car, or to buy a used car, or to keep using their existing car. They may even decide to rely on public transportation. That is why General Motors and Chrysler could not simply jack up prices to recover their bloated union health care costs. It's called competition in a free market.

Free market competition in health care has not failed. On the contrary, it has actually not been tried. For example, in my nursing career, including clinic, intensive-care, and medical/surgical hospital units, I have cared for approximately 8,000 patients. Unlike buyers of automobiles, fewer than 10 of my 8,000 patients or their families have ever even asked what their hospital services would actually cost! No, I don't mean 10 percent; I mean 10. Only one of them, a desperate father, ever whipped out his VISA card and offered to pay. Why is this figure not 100 percent, as with automobiles, groceries, movie tickets, or almost anything else? The reason is that most health care expenses in America are paid not by the patient/family buyer to the doctor/hospital seller. Instead, most expenses are paid by some third party – usually an insurance company or government program. Only 5% of hospitals' income flows from patients or their families. At the time they make actual buying decisions, most patients and families don't shop around or haggle because they don't much give a hoot how much it costs!! This leads to over-consumption of health care. Over-consumption artificially raises demand and leads to rising prices, rising total costs, and rising health insurance premiums. Prices will tend to rise until the system collapses. We see this collapse in the General Motors and Chrysler bankruptcies and in Wal Mart's urgent advertising for health care reform.

Another way to look at the problem of third-party reimbursement is to consider that, in principle, doctors and patients who are unconcerned about cost could spend an almost unlimited amount of money on every headache in America.. That would be a tremendous mis-allocation of resources. Here's a real-life example of how this works. I, myself, went to see an ear-nose-throat specialist and asked him to evaluate my persistent cough. He put a small endoscope down my throat to see what was there, and said to me: Don't worry!  It is merely a mild case of gastroesophageal reflux disease (GERD)!  Just stop eating dinner so late at night, cut down on your coffee drinking, and take these pills once a day until you are better! I had imagined cancer, so I was pleased with my good fortune. My primary physician, however, steeped in the tradition of malpractice lawsuits, was less than jubilant. He said, "It may, indeed be GERD, but there are other possibilities. Why not eliminate them? Why not have a chest x-ray? Why not a chest CT? Why not a pulmonary function test? Why not a cardiac consult and an echocardiogram? And, indeed, why not an esophagastroduodenoscopy? And in case the problem is just a simple case of GERD, why not redouble the number of pills you are taking? And, indeed, why not? I had health insurance. I was in-network. It would cost me nearly nothing to spend $10,000 of health care resources. And, just to be safe, I did. As it turned out, the problem was a simple case of GERD. This is the way health-care resources are spent in America.

Of course, third-party payers do not sit idly by while doctors and patients make such profligate spending decisions. In an effort to control health care costs, third-party payers resort to disguised rationing. This is the second fatal flaw of health care financing.  They don't call it rationing. Folks wouldn't stand for rationing! Third-party payers disguise rationing with complex rules, waiting lists, and health insurance claim denials. For another real-life example, take my neighbor Bill.  Bill was a really nice guy.  He was a productive citizen.  He was fairly young. He had a wife and two sons, a shiny black car, and a pretty little house. He took reasonably good care of himself. When Bill got sick, his doctor said that what he really needed was a lung transplant. Bill thought he had pretty fine health insurance. He had been paying money into it for years, and he felt that he was about due for a little payback. And so, he filed for insurance pre-approval of a lung transplant. To his surprise, his insurance company was very sorry, but it did not consider lung transplants, actually, to be health care at all! No, lung transplants were more like experimental procedures. Bill's insurance didn't cover experimental procedures. Sure, lots of lung transplants had been performed successfully. Bill could appeal, said the insurance company, but unfortunately, an appeal would take time and money. I visited Bill at home. He died waiting in his living room for health care. The cause of Bill's death was health care rationing.

Health care financing's third fatal flaw is restriction of fixed costs. As every accountant knows, before the first patient is even evaluated, there are certain costs that must be paid simply to have a hospital open and available with equipment and staff for patient care. Accountants call these "fixed costs." They include such things as the cost of the building, the cost of medical equipment, and the cost of a basic complement of administrative and clinical staff. As each patient is treated, the hospital must recover not only the direct cost of actually treating another patient and processing his insurance claims, but also fixed costs. If fixed costs are not recovered, the hospital eventually cannot continue to offer health care. This is a mathematical certainty.

Third-party payers restrict fixed costs in two ways: by regulation, and by simply refusing to pay for them. Yes, big players in the health care financing jungle can simply refuse to pay for legitimate fixed costs. The biggest gorilla in the jungle is Medicare-Medicaid. Having the muscle of government, Medicare-Medicaid simply sets reimbursement rates that are too low for health care providers to recover their fixed costs. The next biggest gorilla in the hierarchy of the jungle are the private insurance companies. They use their muscle to extract low reimbursement rates – not as low as those of Medicare-Medicaid, but still, not enough to recover the balance of fixed costs. What's a poor hospital to do? It must recover all of its fixed costs to continue serving patients! Who will pay for the balance of fixed costs? The obvious answer is: all the little people of the jungle. Health care analysts refer to this phenomenon as "cost shifting."

The individual patient who comes to a health care provider expecting to pay a fair price for his own treatment is in for a rude shock. Take, for example, my friend Lisa. Lisa's doctor suspected that she might have Lyme disease. He sent her to a medical lab company to have blood drawn and tested for Lyme disease plus some other basic blood chemestry tests. When the lab company sent the bill, it did not realize that Lisa had health insurance. The bill was $950. After Lisa phoned and recited her insurance information, the lab company sent a revised bill priced at her insurance company's reimbursement rate: a total of $135, which insurance paid in full.  We can only imagine how low the Medicare-Medicaid rate would have been!!! The really sad part is that if Lisa did not have health insurance, the lab company would have wanted the full $950! It would have sicced its collection agency on her, ruined her credit, and taken every practical legal measure to extract $950. Even sadder is this: The average little person in this predicament is sufficiently torpid that she does not even realize she has just been raped by a large gorilla!!

Another way that third-party payers restrict fixed costs is by sheer regulatory fiat. This is often accomplished by the "certificate of need" process. Unlike most individuals who can simply go to the store and buy a loaf of bread, hospitals often need pre-approval to buy certain items. Approval is called a "certificate of need." If the third-party payer is a government, or a big enough gorilla to influence a government, it can restrict fixed costs by simply refusing to issue a certificate of need. If the certificate of need is denied, health care costs are aborted. What a scheme! The effect is to reduce health care costs by reducing health care availability, and then for those health care facilities which do exist, shift the costs to the little people!!

In summary, our current health care financing system must be changed because of the fundamental way it is set up. Consumers attempt to consume health care services with no point-of-sale concern for the price. This increases demand. As every economist knows, when demand increases, other things being equal, providers naturally want to raise prices. Third-party payers resist increases by regulatory fiat and low reimbursement rates. This has the effect of shifting costs to the little people, who may find their credit ruined, their wallets emptied, and their homes consumed by artificially high medical or long-term care bills. Meanwhile, health care providers are under siege by the powerful trial lawyers, constantly under threat of large malpractice lawsuits. High malpractice awards and malpractice insurance premiums naturally have to be passed on. This, again, raises health care prices. Third party payers further attempt to control rising costs by rationing - delays, denials, and complexity. The resulting mismatch between needs and resources allows the healthy man to spend an extra $10,000 on a minor cough that has already been diagnosed, while his sick neighbor dies in his living room without care.

Health care financing reform is the most important legislative issue of our lifetimes. How can the Media possibly believe that the citizens' role is merely to ask questions about what one party or another is planning to do? The Obama/Pelosi plan is based upon third-party-payment health-care financing. This is like old leftovers rewarmed. This approach has failed. We know it has failed because it is collapsing under its own weight, bringing along with itself our employers and our jobs. Doing more of the same thing, with greater intensity, will not produce a better result!! As in life in general, what got us here just won't get us there, no matter how we wish!! So let's talk about it calmly, without deamonizing each other? Okay?

About the author: JC Leahy is a registered nurse in Washington, DC. He blogs at jaitoday.com

Sunday, August 9, 2009

HOW TO CONTACT YOUR CONGRESSMAN !!!


To email any (or all) congressman go to:


https://writerep.house.gov/writerep/welcome.shtml


Do it now. Do it often. It's your right!!!

LETTER TO THE EDITOR, GAZETTE NEWSPAPERS, MARYLAND, 8/9/09

August 9, 2009

VIA FAX: 301-670-7183

Mr. Kent Weiss, Editor
The Gazette
9390 Comprint Court
Gaithersburg, MD 20877

Dear Mr. Weiss:

It broke my heart to read the Gazette's front-page article August 7, about how legislators are bracing for upcoming health-care forums. Your tenor and content portray Congress as under siege by angry mobs, which you say are "more intent on being heard, than asking questions about the Democrats' proposals." You give voice to assertions that those with different ideas are an angry mob of "hard-right tea-baggers and birthers." How polarizing!

Lee Iacocca once said that many American employers would go bankrupt if America did not enact meaningful health care reform. His words were prophetic. Many employers today are, in fact, under siege by uncontrolled health care costs. This includes US Postal Service, staggering under a monumental health care burden.. Ronald Wineholt, vice president of the Maryland Chamber of Commerce just last week voiced concern that mandates on employers, of which Obamacare has many, could cause businesses to lose control of costs. Clearly, we have to do something, do it ASAP, and do it right. This will take calm discussion.

Health care care financing reform is the most important legislative issue of our lifetimes. How can you possibly believe that the citizens' role is merely to "ask questions" about what one party or another is planning to do? Obamacare is based upon third-party-payment health-care financing, rewarmed. This approach has failed. We know it has failed because it is collapsing under its own weight, bringing along with itself our employers and our jobs. Doing more of the same thing, with greater intensity, will not produce a better result!! As in life in general, what got us here just won't get us there, no matter how we wish!! So let's talk about it, without demonizing each other? Okay?

Yours sincerely,
Nurse JC Leahy
RN,BSN, MA, ACLS
Silver Spring, MD
Nurse Leahy blogs at jaitoday.com

Saturday, August 8, 2009

HEALTH CARE MANIFESTO FOR CHANGE !!!


By Nurse JC Leahy
RN, BSN, MA, ACLS
"100 Most Outstanding Nurses Award," 2009, Wash., DC

Make no mistake, health care has not failed in America. Nurses, doctors, hospitals, and drug technology companies have crafted the finest health care system in the world. We know this because the sickest from around the world fly to American hospitals and specialists when their personal chips are down.

Actually, what has failed is America's system for health care FINANCING. Health care financing’s failure, in turn, has created failures with health care distribution and delivery . These failures have killed numerous Americans, including my neighbor Bill. We know that the system has failed because it is collapsing under it’s own weight. Lee Iaccoca once stated that many American employers would go bankrupt unless health care were reformed. His words were prophetic. Health care financing weighs heavily on Americans and our employers. Why do you think Wal Mart is advertising for immediate health care reform?


Rather than you and I getting lost in the mind-numbing complexity of the current health-care financing system or President Obama's 1017-page proposal for changes, let's attempt to understand the system by understanding some broad, underlying fundamentals. Fundamentals define the system. Focus your attention. This is really important to you and your family.

The most important of these fundamentals is the principle of third-party reimbursement. Third-party reimbursement is the wellspring from which failure flows. Look at it this way: When folks buy a new automobile, 100% of them want to know how much it costs. They may haggle. They may shop around. They will consider the price, the automobile’s benefits, and their available funds. They will also consider other things on which they want to spend money, such as food, mortgage payments, clothing, recreation, etc. In the end, they may decide to buy a different kind of new car, or to buy a used car, or to keep using their existing car. They may even decide to rely on public transformation. That is why General Motors and Chrysler could not simply jack up prices to recover their bloated union health care costs. It’s called competition in a free market.


Despite what Obamacare reformers tell you, competition in health care has not failed. On the contrary, it has actually not been tried. For example, in my nursing career, including clinic, intensive-care, and medical/surgical hospital units, I have cared for approximately 9,000 patients. Unlike buyers of automobiles, fewer than 10 of my 9,000 patients or their families have ever even asked what their hospital services would cost! No, I don’t mean 10 percent; I mean 10. Only one of them, a desperate father, ever whipped out his VISA card and offered to pay. The reason for this is that most health care expenses in America are paid not by the patient/family buyer to the doctor/hospital seller. Instead, most expenses are paid by some third party – usually an insurance company or government program. Only 5% of hospitals’ income comes from patients or their families. At the time they make specific buying decision, most patients and families don’t shop around or haggle because they don’t much give a damn how much it costs!! This leads to over-consumption of health care. Over-consumption artificially raises demand leads to guaranteed rising prices, rising total costs, and rising health insurance premiums. Prices will tend to rise until the system collapses. We see this collapse in the General Motors and Chrysler bankruptcies and in Wal Mart’s urgent advertising for health care reform.

Another way to look at the problem of third-party reimbursement is to consider that, in principle, doctors and patients unconcerned about cost could spend an almost unlimited amount of money on every headache in America.. That would be a tremendous mis-allocation of resources. Here's a real-life example of how this works. I, myself, went to see an ear-nose-throat specialist and asked him to evaluate my persistent cough. He put a small endoscope down my throat to see what was there, and said to me: Don’t worry, JC. It is only a mild case of gastroesophageal reflux disease (GERD)! You need only stop eating dinner so late at night, cut the infernal coffee, and faithfully take these pills until you are better! I had imagined worse, so I was pleased with my good fortune. My primary physician, however, steeped in the tradition of malpractice lawsuits, was less than jubilant. He said, "It may, indeed be GERD, but there are other possibilities. Why not eliminate them? Why not have a chest x-ray? Why not a chest CT? Why not a pulmonary function test? Why not a cardiac consult and an echocardiogram? And, indeed, why not an esophagastroduodenoscopy? And in case the problem is just a simple case of GERD, why not redouble the number of pills you are taking? And, indeed, why not? I had health insurance. I was in-network. It would cost me nearly nothing to spend $10,000 of health care resources. And, just to be safe, I did. As it turned out, the problem was a simple case of GERD. This is the way health-care resources are spent in America.

Of course, third-party payers do not sit idly by while doctors and patients make such profligate spending decisions. In an effort to control health care costs, third-party payers resort to disguised rationing. This is the second fatal flaw of health care financing. Mind you, they don’t call it rationing. Folks wouldn’t stand for rationing! Third-party payers disguise rationing with complex rules, waiting lists, and health insurance claim denials. For another real-life example, take my neighbor Bill. Bill was a nice guy. He was fairly young. He had a wife and two sons, a shiny black car, and a pretty little house. He took reasonably good care of himself. When Bill got sick, his doctor said that what he really needed was a lung transplant. Bill believed that he had pretty fine health insurance. He had been paying money into it for years, and he felt that he was about due for a little payback. And so, he filed for insurance pre-approval of a lung transplant. To his surprise, his insurance company was very sorry, but it did not consider lung transplants, actually, to be health care at all! No, lung transplants were more like experimental procedures. Bill’s insurance didn’t cover experimental procedures. Sure, lots of lung transplants had been performed successfully. Bill could appeal, said the insurance company, but unfortunately, an appeal would take time and money. I visited Bill at home. He died waiting in his living room for health care. The cause of Bill’s death was health care rationing.

Health care financing’s third fatal flaw is restriction of fixed costs. As every accountant knows, before the first patient is even evaluated, there are certain costs that must be paid simply to have a hospital open and available with equipment and staff for patient care. Accountants call these "fixed costs." They include such things as the cost of the building, the cost of medical equipment, and the cost of a basic complement of administrative and clinical staff. As each patient is treated, the hospital must recover not only the direct cost of actually treating another patient and processing his insurance claims, but also fixed costs. If fixed costs are not recovered, the hospital eventually cannot continue to offer health care. This is a mathematical certainty.

Third-party payers restrict fixed costs in two ways: by regulation, and by simply refusing to pay for them. Yes, big players in the health care financing jungle can simply refuse to pay for legitimate fixed costs. The biggest gorilla in the jungle is Medicare-Medicaid. Having the muscle of government, Medicare-Medicaid simply sets reimbursement rates that are too low for health care providers to recover their fixed costs. The next biggest gorilla in the hierarchy of the jungle are the private insurance companies. They use their muscle to extract low reimbursement rates – not as low as those of Medicare-Medicaid, but still, not enough to recover the balance of fixed costs. What’s a poor hospital to do? It must recover all of its fixed costs to continue serving patients! Who will pay for the balance of fixed costs? The obvious answer is: all the little people of the jungle. Health care analysts refer to this phenomenon as "cost shifting."

The individual patient who comes to a health care provider expecting to pay a fair price for his own treatment is in for a rude shock. Take, for example, my friend Lisa. Lisa’s doctor suspected that she might have Lyme disease. He sent her to a medical lab company to have blood drawn and tested for Lyme disease plus some other basic tests. When the lab company sent the bill, it did not realize that Lisa had health insurance, and the bill was $950. After Lisa phoned and recited her insurance information, the lab company sent a revised bill based on her insurance company’s reimbursement rate: a total of $135, which insurance paid in full One can only imagine how low the Medicare-Medicaid rate would have been!!! The sad thing is that if Lisa did not have health insurance, the lab company would have wanted the full $950! It would have sicced its collection agency on her, ruined her credit, and taken every practical legal measure to extract $950. Even sadder is this: The average little person in this predicament is sufficiently torpid that she does not even realize she has just been raped by a large gorilla!!

Another way that third-party payers restrict fixed costs is by sheer regulatory fiat. This is often accomplished by the "certificate of need" process. Unlike most individuals who can simply go to the store and buy a loaf of bread, hospitals often need pre-approval to buy certain items. Approval is called a "certificate of need." If the third-party payer is a government, or a big enough gorilla to influence a government, it can restrict fixed costs by simply refusing to issue a certificate of need. If the certificate of need is denied, health care costs are aborted. What a scheme! The effect is to reduce health care costs by reducing health care availability, and then for those health care facilities which do exist, shift the costs to the little people!!

In summary, our current health care financing system must be changed because of the fundamental way it is set up. Consumers attempt to consume health care services with no point-of-sale concern for the price. This increases demand. As every economist knows, when demand increases, other things being equal, providers naturally want to raise prices. Third-party payers resist increases by regulatory fiat and low reimbursement rates. This has the effect of shifting costs to the little people, who may find their credit ruined, their wallets emptied, and their homes consumed by artificially high medical or long-term care bills. Meanwhile, health care providers are under siege by the powerful trial lawyers, constantly under threat of large malpractice lawsuits for the sin of honest human error. High malpractice awards and malpractice insurance premiums naturally have to be passed on. This, again, raises health care prices. Third party payers further attempt to control rising costs by rationing - delays, denials, and complexity. The resulting mismatch between needs and resources allows the healthy man to spend an extra $10,000 on a minor cough that has already been diagnosed, while his sick neighbor dies in his living room without care.

Focus with me on two more related points, please. First, I want to tell you that I have been reading health care reform books for a number of years and I have noticed that some of. the words do not mean what you think they mean. This is important. For example, if I said to you that bread cost too much and I wanted to reduce the cost of bread, you would probably think that I wanted to reduce the price per loaf of bread. However, in the realm of health care financing, they don’t talk about price; they talk about cost. It’s not the same thing. In the health-care system analogy, the principal way of reducing the cost of bread is to either give you less bread or to make sure the supermarket only collects a dime for each loaf of bread it delivers to you. Either way, you get less bread. Key point: price and cost mean different things. Health care reformers talk about costs, not prices. Theoretically, the health care reformer could reduce the cost of your bread to zero by simply not giving you any bread! The problem is that when they reduce the cost, you eventually pay the price. Having learned from Marie Antoinette’s misfortune, however, the wise health care regulator would never say, "Let them eat cake!" but rather would provide just enough bread to avoid revolution.

Secondly, Democratic health care reform plans are not revolutionary. Au contraire! They are sooo reactionary! They are a stubborn blast from the past!! This is because they base their reforms on propping up the failed idea of third-party payment. In fact, their STATED ultimate goal is to have a single, third-party payer: the government, itself!!! The most crucial problem with today's health care system is that third-parties are responsible for most of the payments while doctors and patients attempt to make the buying decisions without concern for price. It is from this wellspring that nearly all of the other problems I outlined above cascade. Rather than changing this paradigm, Democratic health care reform proposals merely tinker with catastrophe by placing the biggest gorilla – the Federal Government – in charge. The goal, as Hillary Clinton will cheerfully tell you, is to have a "single payer system," in which the Federal government is the third-party payer. You've probably seen the video of Barack Obama on TV, so you know that this is his ultimate goal, too. Sheer, stupid muscle will not change the health care financing paradigm. As with the General Motors and Chrysler "rescues", Barack Obama and Nancy Pelosi are attempting to prop up and prolong systems that have already failed. If it has failed, let it go, so that exciting things of the future may blossom! As they say about life in general, what got us here won’t get us there!!

We the People want a more sustainable health care system that gives us fair service for a fair price! We want a health care system that lets each of us, with the advice of our doctors and families, control our own health care destinies!!

THE PLAN -- Your humble nurse recommends a health-care revolution of the little people. I recommend that each of us throw off our Clark Kent suits and become individual super heroes fighting, non-violently, for this just cause. Here’s the plan. For want of a better name, I’ll call this the Leahy Manifesto:

1. Reform Health Care Cafeteria Plans – Congress already allows employees to save pre-tax money for their health care expenses through what they call "cafeteria plans." Money is simply withheld from your paycheck and never gets taxed - ever. It goes into a savings account that you may spend. This reduces your income taxes and gives you tax-free savings to pay medical bills. Many employers make these plans available. There is little or no cost to the employers. At my work, for example, I can sock away $5,000 per year tax-free. The Lex Luthors of Congress, however, have embedded a poison pill. It is that if I don’t spend all of my $5,000 by the end of each year, it is confiscated!! I lose it!! What a ripoff!! Step one is to remove the use-it-or-lose-it provisions of health care cafeteria plans! Let unused balances carry forward with no more poison pills, and let them be managed by the employees just like they manage their 401k’s.

2. Create Corresponding Plans for the Self Employed - Set up health savings plans for the self employed which correspond to the health care cafeteria plans for employees. Money deposited to such a plan may be deposited with any of the institutions that can be IRA custodians, including banks. The savings balances will be a powerful shot in the arm to banking and the rest of the beleaguered financial sector. To the extent that the self-employed person has a profit, money deposited to such a plan will be a deductible expense that will appear on the business page of the tax return – the Schedule C. Thus, the self-employed entrepreneur will save on state and federal income taxes and also self-employment taxes. Don’t believe anyone who tells you we have tried this before. Nothing like this has ever been tried! This will be a powerful shot in the arm to the small-business sector. Because small business provides the vast majority of jobs, it will be a shot in the arm to employment in America.
3. Mandate Health Care Savings - Collectively, the plans contemplated in #1 and #2 we will call, for want of a better name, Neighbor Bill Accounts. Every man, woman, and child in America who is legally employed will be required to contribute not less that 10% and not more than 15% of his gross earnings to a Neighbor Bill Account. Every self-employed person will be required to deposit the same percentages to Neighbor Bill Account based on Schedule C gross margin, but only to the extent that there is a business net profit.

4. Provide for Management and Expenditure of Health Care Savings - We will be free to manage and invest our Neighbor Bill Account funds just like 401k’s. If we die, the funds will pass to our heirs. If we wish to spend money for health care, we will use a special VISA debit card. This VISA debit card will be spendable exclusively at places that exclusively sell health care services or products. For example, your VISA debit card could be used at a hospital, a doctor’s office, a healthcare-only website, or a healthcare-only counter at a local pharmacy. Using a simple VISA card will free doctors and hospitals of their claims-processing nightmare. Insurance administration costs will fall to near zero.

5. Provide for Control by the Little People - At their owners’ discretion, Neighbor Bill Accounts may be used to pay for one’s own health care expenses – or one’s spouse, or child, or brother, or niece, or mother-in-law, or lover, or significant other, or even for the health care expenses of a neighbor. The only restrictions will be that (1) funds may only be used for health care, (2) with an important exception I’ll detail below, funds may not be used to pay health insurance premiums, and (3) the owner of the funds may not receive any sort of goods, services, tax deductions, or other kickbacks for paying others’ health care expenses. The reward for such payments is simply not to be in this world.

6 Tax Employer-Provided Health Insurance - Currently, if an employer provides health insurance to employees, the employer is allowed a tax writeoff for 100% of the insurance cost; and, the employee does not have to include the corresponding amount in his taxable income. This asymmetry is unusual in the tax code and amounts to a special subsidy of employer provided third-party-reimbursement-type health care. This subsidy has created the current societal reliance on employer-provided health insurance. Remove the subsidy. This will gradually free employers of their nightmarish burden of health care costs In the meantime, it will also generate tax revenues.

7 Mandatory Catastrophic Health Care Insurance - Every man, woman, and child in America who has a Neighbor Bill Account must pay for private catastrophic health care insurance. This is the only type of insurance premium that may be paid out of Neighbor Bill Accont funds. People with families must have policies that cover their children and non-working spouses. Health care expenses in excess of a high deductible amount will be covered in full by these insurance policies. The annual deductible amount will be $10,000 per person or 5% of the beginning-of-year balance of their Neighbor Bill Account, whichever is higher. The $10,000 amount will be indexed for inflation each year. This universal, mandatory private catastrophic health care insurance will be a shot in the arm to the beleaguered insurance industry while protecting the little people from financial wipe-out. The cost to Government will be around zero.
8 Simple Tort Reform - A shockingly large percent of health care services are performed not for clinical expediency but to shelter providers from malpractice trial lawyers. This artificially increases demand for health care services, mis-allocates resources, and drives up prices Additionally, the cost of malpractice insurance and huge malpractice awards drive up prices for health care. Congress will reform this paradigm by simply legislating that if you sue anyone in Federal court for malpractice or negligence, and you fail to win on at least one single point, you will pay half of the defendant’s legal fees and other associated costs This way, people with slam-dunk-valid claims will be free to pursue them in court, but others will think twice before filing firvilous lawsuits. We, the Clark Kents of America, must force our individual state governments enact that identical rule for state courts.

9. Restrict Employer Writeoff of Health Insurance Expenses - Currently, certain business expenses are not fully deductible for income taxes. For example, business meals generally are only 50% deductible. In like way, make the employer’s expense for employee health insurance only 50% deductible. This will produce tax revenues and gradually encourage the shift away from employer-provided third-party-payment plans to individually-controlled-and-safeguarded Neighbor Bill Accounts.

10 Abolish the Self Employed Health Insurance Deduction - The Neighbor Bill Account deduction replaces the Self Employed Health Insurance Deduction. The former encourages third-party-payment plans, while the latter is individually controlled.

11 Maintain and Strengthen Medicare-Medicaid - Medicare and Medicaid must continue to be the safety nets for those who need them. However, Medicare and Medicaid are ripe for eventual collapse because (1) the population is aging, and (2) they are third-party-payment plans. We can save Medicare and Medicaid with the following just and simple rule: Anyone who has a balance in a Neighbor Bill Account must use those funds before tapping Medicare or Medicaid. This will relieve pressure on Medicare-Medicaid resources, and save the safety nets for those who need them.

Implementation of the Leahy Manifesto will gently sweep away our failed health-care financing system. The royalty of the health care financing will be de-throned. The future will be free to blossom. Vast sums of money will be set aside for health care and safeguarded by vigilant owners. Catastrophic health insurance will protect us from financial wipe-out. Medicare and Medicaid will protect the poor and the elderly. Most payment processing will be as simple as swiping a VISA card. The little people will spend or save health care resources as they think wise. They will never again be told that treatment they desperately need is not covered by the plan, or can only be obtained by lengthy waiting for complicated appeals. Employers will no longer stagger under the burden of health care costs. Job-creating small employers will get their second wind from a reduction of their income and self-employment taxes. Large employers, over time, will have the crushing burden of employee health care expenses lifted from their shoulders. Medicare and Medicaid will be secured. Doctors and hospitals will be cured of the expensive headache of filing and collecting insurance claims. They will, however, need to produce price estimates and bills that patients can understand and accept.

The future is exciting!! It only requires is that you – personally – somehow, in your own way, with your own talents, stop masquerading Clark Kent, get off your haunches and make it happen – starting now, starting today. To Nancy Pelosi, Barack Obama and Hillary Clinton, we must say: YES WE CAN!!!!
 
Why don't you begin by signing up for a free "subscription" to JAI TODAY - use the "Follow" option at the left. You can also contact Nurse Leahy at jcleahy@jaitoday.com And...everything takes money...you can help with a contribution sent to PO Box 87, Spencerville, MD 20868 Thanks for reading!!

Very Sincerely
Nurse JC Leahy
RN, BSN, MA, ACLS
"100 Most Outstanding Nurses Award," 2009, Wash., DC
 
 

Congressional Budget Office Cost Estimate for H.R. 3200

Here's the full text of the Congressional Budget Office's cost estimate for HR 3200, America's Affordable Health Choices Act of 2009. Read it, weep at home, and then attend your nearest community tow-hall meeting for a calm discussion with your senators and representatives !!! Don't be a Clark Kent about this...be a Superhero! :)

CLICK HERE
FOR THE CONGRESSIONAL BUDGET OFFICE COST ESTIMATE FOR H.R. 3200

AMERICA'S AFFORDABLE HEALTH CHOICES ACT OF 2009



Very Sincerely,
Nurse JC Leahy, email jcleahy@jaitoday.com
RN, BSN, MA, ACLS
"100 Most Outstanding Nurses Award," 2009, Wash., DC
email jcleahy@jaitoday.com

HERE'S THE FULL TEXT OF THE OBAMACARE BILL H.R. 3200

Here's the full 1017-page text of the Obamacare Health Care Bill, H.R. 3200, "America's Affordable Health Choices Act of 2009." I urge that we all read it carefully and then attend the town meeting nearest you for a calm discussion with our senators and representatives! Don't be a Clark Kent about this -- be a Superhero !!!!


CLICK HERE
FOR THE FULL TEXT OF H.R. 3200
America's Affordable Health Choices Act of 2009


Very Sincerely,
Nurse JC Leahy
RN, BSN, MA, ACLS
"100 Most Extraordinary Nurses Award," 2009, Wash., DC
email jcleahy@jaitoday.com

Wednesday, August 5, 2009

WHAT'S THE TAX WRITEOFF FOR BUYING A NEW BUSINESS VEHICLE?


Question from Steve, Baltimore, Maryland
: What's the income tax write-off if I buy a new vehicle for my business ?

Answer:

Steve, it used to be that if you bought any new business equipment, you had to "depreciate" it over a set number of years. Nowadays, however, you can probably take advantage of "Section 179" of the IRS Code. Under section 179, 100% of the cost of new business equipment up to a total dollar limit can can be deducted on your income tax return. Originally, this dollar limit was $10,000, but Congress increased it over the years and for 2009 the Section 179 limit stands at $250,000. You can purchase up to $250,000 of business equipment and write it off in the same year!! What a great incentive for small business capital investment!!!!

There, however, some limitations. For one thing, of all the equipment has to be new to you -- it can be new or used -- but "new" to you. Second, as with many tax incentives, if Congress classifies you as a "fat cat," you don't get the tax incentive. As they say, your tax incentive is "phased out." Most "fat cat" phaseouts are based on adjusted gross income. The Section 179 phaseout, however, is based on the total amount of equipment you purchased that year. For 2009, the phaseout begins at $800,000. Obviously, an $800,000 limit doesn't affect a small business that just wants a new delivery vehicle.

For vehicles, however, there are special limitations. Your new vehicle has to be the sort that you would not want to use for personal purposes. If it has a gross weight of 14,000 lbs. or more, you're home free. Otherwise, it has to have a gross weight of 6,000 lbs. AND meet one of these tests to escape the limits:
  • Seats more than 9 passengers behind the driver.
  • Equipped with an open cargo box of at least 6 ft.
  • Equipped with a closed cargo box not accessible from the vehicle's interior
  • Has a fully enclosed driver compartment and load carrying device, AND does not have seating behind driver’s seat, AND has no body section protruding more than 30 inches ahead of the leading edge of the windshield. Whew!!
If the vehicle doesn't meet the above criteria but weighs more than 6,000 lbs., you can still claim the Section 179 writeoff, but it will be limited to $25,000. For example, if you buy a $100,000 Hummer for your business, you write off $25,000 in the first year and depreciate the balance of $75,000 as normal depreciation.

Let me know if you have further questions, Steve!!

SUBSCRIBE: USE THE "FOLLOW" OPTION IN THE LEFT COLUMN -- IT'S FREE !!

Monday, August 3, 2009

A NURSE'S MANIFESTO - HEALTH CARE REFORM

By Nurse JC Leahy
RN, BSN, MA, ACLS

Question: Who is JC Leahy, and why should I listen to him about health care reform?

Answer: JC Leahy is a hospital registered nurse masters-educated accountant Federal income tax expert. Hmm....that’s unusual. So let’s just hear what this guy has to say.

We the People, in order secure for ourselves and our decedents, liberty to choose our health-care destinies, demand a more sustainable health care system that gives us fair service for fair price, and we demand a health care system that lets each of us, with the advice of our doctors and families, secure our own health care destinies in accordance with our own freedom of choice!!

THE PLAN -- Your humble nurse recommends revolution, a non-violent revolution of the People. I recommend that each of us throw off our Clark Kent suits and become individual super heroes fighting for this just cause. Here’s the plan. For want of a better name, I’ll call this the Leahy Plan:

1. Reform Health Care Cafeteria Plans – Congress already allows employees to save pre-tax money for their health care expenses through what they call a Flexible Spending Account (FSA). Money is simply withheld from your paycheck and never gets taxed - ever. It goes into a savings account that you may spend. This reduces your income taxes and gives you tax-free savings to pay medical bills. Many employers make these plans available. There is little or no cost to the employers. At my work, for example, I can sock away $5,000 per year tax-free. The catch is that the Lex Luthors of Congress have embedded a poison pill in Flexible Spending Accounts.  If I don’t spend every cent of my $5,000 by the end of each year, it is confiscated!! I lose it!! The company that admiisters the FSA gets to keep my money!! What a sick ripoff!! We need  to remove the use-it-or-lose-it provisions of health care FSA's! Let unused balances carry forward with no more poison pills, and let them be managed by the employees just like they manage their 401k’s.

2. Create Corresponding Plans for the Self Employed - Set up health savings plans for the self employed which correspond to the health care cafeteria plans for employees. Money deposited to such a plan may be deposited with any of the institutions that can be IRA custodians, including banks. The savings balances will be a powerful shot in the arm to banking and the rest of the beleaguered financial sector. To the extent that the self-employed person has a profit, money deposited to such a plan will be a deductible expense that will appear on the business page of the tax return – the Schedule C. Thus, the self-employed entrepreneur will save on state and federal income taxes and also self-employment taxes. Don’t believe anyone who tells you we have tried this before. Nothing like this has ever been tried! This will be a powerful shot in the arm to the small-business sector. Because small business provides the vast majority of jobs, it will be a shot in the arm to employment in America.

3. Mandate Health Care Savings - Collectively, the plans contemplated in #1 and #2 we will call, for want of a better name, Neighbor Bill Accounts. Every man, woman, and child in America who is legally employed will be required to contribute not less that 10% and not more than 15% of his gross earnings to a Neighbor Bill Account. Every self-employed person will be required to deposit the same percentages to Neighbor Bill Account based on Schedule C gross margin, but only to the extent that there is a business net profit.

4. Provide for Management and Expenditure of Health Care Savings - We will be free to manage and invest our Neighbor Bill Account funds just like 401k’s. If we die, the funds will pass to our heirs. If we wish to spend money for health care, we will use a special VISA debit card. This VISA debit card will be spendable exclusively at places that exclusively sell health care services or products. For example, your VISA debit card could be used at a hospital, a doctor’s office, a healthcare-only website, or a healthcare-only counter at a local pharmacy. Using a simple VISA card will free doctors and hospitals of their claims-processing nightmare. Insurance administration costs will fall to near zero.

5. Provide for Control by the Little People - At their owners’ discretion, Neighbor Bill Accounts may be used to pay for one’s own health care expenses – or one’s spouse, or child, or brother, or niece, or mother-in-law, or lover, or significant other, or even for the health care expenses of a neighbor. The only restrictions will be that (1) funds may only be used for health care, (2) with an important exception I’ll detail below, funds may not be used to pay health insurance premiums, and (3) the owner of the funds may not receive any sort of goods, services, tax deductions, or other kickbacks for paying others’ health care expenses. The reward for such payments is simply not to be in this world.

6 Tax Employer-Provided Health Insurance - Currently, if an employer provides health insurance to employees, the employer is allowed a tax write off for 100% of the insurance cost; and, the employee does not have to include the corresponding amount in his taxable income. This asymmetry is unusual in the tax code and amounts to a special subsidy of employer provided third-party-reimbursement-type health care. This subsidy has created the current societal reliance on employer-provided health insurance. Remove the subsidy. This will gradually free employers of their nightmarish burden of health care costs In the meantime, it will also generate tax revenues.

7 Mandatory Catastrophic Health Care Insurance - Every man, woman, and child in America who has a Neighbor Bill Account must pay for private catastrophic health care insurance. This is the only type of insurance premium that may be paid out of Neighbor Bill Account funds. People with families must have policies that cover their children and non-working spouses. Health care expenses in excess of a high deductible amount will be covered in full by these insurance policies. The annual deductible amount will be $10,000 per person or 5% of the beginning-of-year balance of their Neighbor Bill Account, whichever is higher. The $10,000 amount will be indexed for inflation each year. This universal, mandatory private catastrophic health care insurance will be a shot in the arm to the beleaguered insurance industry while protecting the little people from financial wipe-out. The cost to Government will be around zero.
8 Simple Tort Reform - A shockingly large percent of health care services are performed not for clinical expediency but to shelter providers from malpractice trial lawyers. This artificially increases demand for health care services, mis-allocates resources, and drives up prices Additionally, the cost of malpractice insurance and huge malpractice awards drive up prices for health care. Congress will reform this paradigm by simply legislating that if you sue anyone in Federal court for malpractice or negligence, and you fail to win on at least one single point, you will pay half of the defendant’s legal fees and other associated costs This way, people with slam-dunk-valid claims will be free to pursue them in court, but others will think twice before filing frivolous lawsuits. We, the Clark Kents of America, must force our individual state governments enact that identical rule for state courts.

9. Restrict Employer Write off of Health Insurance Expenses - Currently, certain business expenses are not fully deductible for income taxes. For example, business meals generally are only 50% deductible. In like way, make the employer’s expense for employee health insurance only 50% deductible. This will produce tax revenues and gradually encourage the shift away from employer-provided third-party-payment plans to individually-controlled-and-safeguarded Neighbor Bill Accounts.

10 Abolish the Self Employed Health Insurance Deduction - The Neighbor Bill Account deduction replaces the Self Employed Health Insurance Deduction. The former encourages third-party-payment plans, while the latter is individually controlled.

11 Maintain and Strengthen Medicare-Medicaid - Medicare and Medicaid must continue to be the safety nets for those who need them. However, Medicare and Medicaid are ripe for eventual collapse because (1) the population is aging, and (2) they are third-party-payment plans. We can save Medicare and Medicaid with the following just and simple rule: Anyone who has a balance in a Neighbor Bill Account must use those funds before tapping Medicare or Medicaid. This will relieve pressure on Medicare-Medicaid resources, and save the safety nets for those who need them.

The Leahy Plan will gently sweep away our failed health-care financing system. The royalty of the health care financing will be de-throned. The future will be free to blossom. Vast sums of money will be set aside for health care and safeguarded by vigilant owners. Catastrophic health insurance will protect us from financial wipe-out. Medicare and Medicaid will protect the poor and the elderly. Most payment processing will be as simple as swiping a VISA card. The little people will spend or save health care resources as they think wise. They will never again be told that treatment they desperately need is not covered by the plan, or can only be obtained by lengthy waiting for complicated appeals. Employers will no longer stagger under the burden of health care costs. Job-creating small employers will get their second wind from a reduction of their income and self-employment taxes. Large employers, over time, will have the crushing burden of employee health care expenses lifted from their shoulders. Medicare and Medicaid will be secured. Doctors and hospitals will be cured of the expensive headache of filing and collecting insurance claims. They will, however, need to produce price estimates and bills that patients can understand and accept.

The future is exciting. It only requires is that you – personally – somehow, in your own way, with your own talents, stop masquerading Clark Kent, get off your haunches and make it happen – starting now, starting today. To Nancy Pelosi, Barack Obama and Hillary Clinton, we must say: YES WE CAN!!!!
 
 
 

Sunday, August 2, 2009

HOW IS THE ALTERNATIVE MINIMUM TAX LIKE MAD COW DISEASE?

This question was asked by Dr. Reuben B, a practicing surgeon in Washington, DC. He phrased it a little differently: "What is the Alternative Minimum Tax and does it affect me?"

ANSWER:Dr. B, the Alternative Minimum Tax is like Mad Cow Disease because you can't tell for sure if you're affected without performing an autopsy. Believe it or not, the Alternative Minimum Tax (AMT) is a shadowy, alternative income tax system created by Congress to quietly take back a large slew of tax benefits to which people think they are entitled under the regular income tax system. This is very much like sneaking back at night to steal a gift that you gave during the day. In recent years, millions of mostly middle class taxpayers have been affected. The problem is so severe that the Emergency Economic Stabilization Act of 2008 included a provision to allow millions of middle-class taxpayers to escape from the Alternative Minimum Tax - for one year only.

Like Mad Cow Disease, Dr. B., there is no conclusive screening test to determine whether you are affected. You literally have to figure your income tax liability under BOTH income tax systems. Then, whichever comes out higher is what you, as a patriotic American, get to pay. The complexity introduced by the Alternative Minimum Tax goes a long way towards ensuring that the average American is unable to fill out his own tax return without resorting to a computer program and/or a tax consultant.

The list of tax write-offs disallowed under the Alternative Minimum Tax is really quite long. It includes even basic things like all of the personal exemptions for you and your entire family, the standard deductions of the taxpayers who don't itemize, the deduction for medical expenses of sick Americans, some charitable contributions, some home mortgage interest, the deduction for taxes paid to your State, and just about all of your miscellaneous itemized deductions such as investment expenses, tax preparation fees, and un-reimbursed employee expenses. The list of disallowed items really goes on and on.

If you don't like this, Email your congressman at https://writerep.house.gov/writerep/welcome.shtml and say that you want to either repeal the Alternative Minimum Tax or the regular income tax -- and keep the other. Or telephone them with area code 202 and the number listed at http://www.mass.gov/legis/memmenuh.htm. Consider calling whatever talk radio show you like. For example, Rush Limbaugh is at 1-800-282-2882.

WHO THE HECK IS JC LEAHY?

Mr. Leahy is a seasoned registered nurse currently managing a 4,000-patient-per-year outpatient otolaryngology (ENT) clinic in a major Washington, DC medical center.  He aspires to make a unique contribution to health care by combining his nursing experience with his business experience.  Mr. Leahy has degrees in Business Administration and advanced Accounting.  He also has corporate and small-business experience in budgeting, financial planning, financial management, project management, proposal writing, and administrative management.   Mr. Leahy’s nursing experience includes 10 years in bedside intensive care. 
 While managing his 4,000-patient-per-year, Mr. Leahy was able to manage his schedule to serve as Cancer Treatment Coordinator for the Otolaryngology (ENT) service of a Washington, DC medical center, Feb., 2009-May, 2012.  Mr. Leahy’s results were so dramatic that the Medical Center made a public display about his work in its Inspiration Hallway section from August 2010 until early 2012.  By creating and managing a 7-element cancer care navigation system, he helped reduce the time from initial ENT consultation to the start of treatment from an average 100 days to less than 30 days.  This is important because cancer treatments are most effective when performed early.

Mr. Leahy designed the Plan of Care Exceptions Report (POC) as one element of this 7-element care navigation and management system. The Plan of Care Exception Report (POC) went live in May 2011. It’s purpose is to quickly identify patient non-compliance and similar deviations from cancer treatment plans.  For ENT cancer patients, the report identifies all missed appointment throughout medical center.  It also gives an indicator of why the appointment was missed – patient cancelled, clinic cancelled, no-show, etc.  It calculates a reliability factor to measure how often their appointments are kept, and it also lists when the patient was last seen In the ENT Clinic and when he is scheduled to be seen next.  Deceased patients can be included or excluded, or you can print a report for only deceased patients.  The medical center is now preparing to roll out the program to other services besides ENT and  other medical centers in the region.



The Plan of Care Exceptions Report was not developed in a vacuum.  In February, 2009, the ENT Chief was grappling with serious delays in the treatment of ENT cancer.   She tasked Mr. Leahy to expedite treatment of Head and Neck cancer patients.  In response to this assignment, he created a 7-element care navigation and management system.   It’s purpose is to track, coordinate, instigate, facilitate, and educate.  The graph below shows success in reducing the average time from initial ENT consult (or other “start” event) until commencement of treatment (or negative diagnosis).   This “days-to-begin-ENT-cancer-treatment” has fallen from 100 days at the beginning of 2009 to around 30 days  as of May 31, 2012.  The improvement from 100 days to less than 30 days was dramatic enough that the Medical Center displayed a poster and graph about it in the “Inspiration Hallway” public area for nearly a year and a half, until early this year.
The Seven Elements of Expediting Cancer Treatment Employed by John Leahy for Head and Neck Cancer, February 2009 – May, 2012.
ONE: Early identification of potential cancer patients by frequent review of new consults. Here’s an example of how this benefits veterans:  While reviewing consults in early June, 2012, Mr. Leahy realized that 2 consults sounded like probable head-and neck cancer, and they both had initial ENT Clinic appointments scheduled for June 27.  I phoned both veterans and changed their appointments to June 7.  On June 7, both came to clinic and both were bona-fide ENT cancer cases.  End result: By simply looking at their consults and acting early, Mr. Leahy advanced their cancer treatments by 20 days each before they had even seen an ENT physician!
TWO:  Setting aside a block of appointments every week specifically for patients who should not wait for a “next-available” appointment, but instead should be seen on an expedited basis.
THREE: Establishing an Excel-based work breakdown structure, or plan, for each cancer patient’s prospective diagnosis and care.  Each patient’s treatment is treated as an individual project to be managed and expedited.  Each patient’s WBS-sheet also serves as a place for memos about plans, problems, and face-sheet data.  This is where Mr. Leahy tracks  what is planned and what has happend for each patient.
FOUR: Maintenance of an Outlook based task list to make sure planned elements of cancer treatment do not fall through the cracks.  A perfect example this benefits veterans happened this week.    Mr. B had been diagnosed in September 2011 with buccal SCCA, easily cured if treated early.  Mr. B had had stubbornly refused to come to the hospital for treatment.  ENT physicians had declared that no further effort was needed because the patient had refused care.  But the Mr. Leahy made an entry onto his task list to try again later .  When the “try again” task came due, he crafted and mailed to Mr. B  a special letter designed to be opened,  read carefully, and not thrown in the trash without due consideration.  Two weeks later, Mr. B phoned Mr. Leahy.  Mr. Leahy outlined the long-term danger of the cancer and  encouraged Mr. B to talk about why he was refusing care.  He confided that he was afraid.  He and  Mr. Leahy talked together about fear.  At the end of the conversation, Mr. B accepted an appointment for June 12, and agreed to not miss that appointment no matter WHAT might happen.  On June 12, he came to clinic as promised -- even though he only had one leg and needed to take a taxi with his wheelchair.  His cancer was excised then-and-there in ENT Clinic.  Days-to-Treatment: 303 – which is why that third-quarter-2011 spike in the above graph represents an accomplishment, not a setback.
FIVE: Establishment of a calendar so that we can see important elements of what is happening with all ENT cancer patients on any particular day
SIX:  Identification of non-compliant patients and other deviations from the treatment-plan using the Plan of Care Exceptions Report
SEVEN: Establishment of a repeating list of cancer patients needing post-treatment or during-treatment follow-up, with frequencies that vary from q-month to q-year.  This ensures that post-treatment Clinic follow-up visits do not fall through the cracks.
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Mr. Leahy lives in an old farmhouse in the Washington, DC suburbs.  He and his wife have four daughters.  He enjoys reading, hiking, photography, and trap shooting.