Privatized National Health Care—A Plan

About 30 years ago, a friend and I sat at lunch and talked about an idea he had about a national health plan that would cost taxpayers virtually nothing. We bounced ideas back and forth and then left. I continued thinking about it and made several modifications. However the basic premise remained the same.

Using simple numbers, assume the U.S. population to be 300,000,000. Congress will grant the six largest health insurance companies limited anti-trust immunity, similar to that enjoyed by professional baseball. This would apply to other insurance companies with whom the original six companies may choose to sub-contract.

Congress would also set up regional oversight committees, consisting of representatives from ALL professions, but with a voting majority belonging to lay persons. Those committees, in turn, would appoint representatives on a rotating basis to meet nationally to review possible abuses in the system.

The only other thing Congress has to do is pass legislation establishing the severest possible penalties for any and all individuals involved in cheating, bringing profit for themselves and/or the company they work for. I suggest 20 years in prison for the first offence without possibility for parole for all people involved AND supervisors who knew or should have known about their activities, including CEO’s. It is called accountability and necessary with dealing with billions of dollars.

The main companies, without tax dollars, will divide the population as evenly as possible. This would mean about 50,000,000 people per company. There would be mechanisms to “tweak” the number of individuals from all socioeconomic groups, health risk categories and age groups.

Why would this work? Even at only $10.00 per person per month, each company would bring in $500,000,000.00 per month or 6 billion dollars per year. That number could be higher if necessary, but this is a lot of money (why penalties have to be so harsh for cheating). With this amount of income, the six companies have tremendous purchasing power and can actually dictate process to the drug companies and other suppliers to health care facilities, etc.

There would be plenty of money for more doctors, to cover ALL conditions and actually provide preventative health care (good for their bottom line).

What about those who just can’t afford $10.00 per month per family member? This is where religious, civic and charitable organizations come in. Again, there would be NO TAX DOLLARS.

There will be profit for all of the insurance companies. They will pay regular taxes just a those paid by any other business. There will also be a Congress generated stipulation that at least 50% of the corporate profits (after taxes) have to be re-invested in the U.S. economy.

Every man, woman and child would be covered. Every form of treatment would be covered on an equal basis.

Of course, the amount could be higher than the $10.00 mentioned. Then again, it wouldn’t be but a small fraction of what is currently proposed. In truth, most people do not use their health care policy during a 12 month period. The possibility for profit is staggering, in spite of an aging population. The average citizen will be healthier and doctors, not HMO’s will once again practice medicine. They can prescribe tests and medicines that are necessary. People will not have to choose between food, rent, gasoline and medications. Doctors will once again be able to be reimbursed a reasonable fee for their services.

This is a template. It can work. The weakest link appears to be Congress. This plan was submitted to Congressmen Kolbe and Giffords. It was also sent to Senators Di Concini and McCain. A patient of mine is an attorney really tried to tear the plan apart. He finally said, “This could actually work”. He called his son, a lobbyist in Washington, D.C. (actually living in Phoenix) and asked him to check into this. A few days later, the son called to say that the plan had been floating around Congress for about 20 years.

It is reasonable that members of Congress could be concerned. After all, for the most part after passing a few regulatory laws, the government is out of the picture. They would certainly resent the thought that they would have to be part of the same insurance coverage that every other American has.

It is reasonable that the insurance industry would neither like the accountability aspects nor the requirement about re-investment of profits into the American economy.

For certain the pharmaceutical companies and other suppliers wouldn’t like it because they could no longer have total control over what they can charge for their products.

No doubt there will be many of our citizens won’t like this plan mainly because they are human and Americans. They resist anything just because they able to.

A patient of mine was a member of the American Arbitration Association. He said the measure of whether arbitration was successful was the reaction of the participants. If all parties walked away a bit dissatisfied, then the arbitration process was very successful. Based upon these criteria, this national health insurance plan is an excellent option.

Perhaps a more united voice could get Congress to actually pay attention to what their constituents suggest. Perhaps those who read this, lending their voices, are what it will take.

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Health Insurance, a matter of life and death.

An Interesting Dilemma

We frequently read, see, hear that the Insurance Industry is suffering and there is a need to keep raising premiums. The policies seem to cost more but cover less. The driving force for this is, of course, the need to provide “decent profits” for stock holders.

As a result of this insatiable need for more net income, the Insurance Industry has taken over our health care system. My primary care doctor eloquently stated, “At first I was a doctor. Then I became a provider. Now I am a f***ing data entry clerk.” A doctor’s choice for tests, procedures and prescriptions are largely controlled by the insurance provider.
In order to maximize profits, premiums have gone up as have co-pays. At the same time, reimbursements to doctors and other health care facilities have steadily gone down.
Most recently, United Health Care has DEMANDED that doctors accept a reduction in reimbursement by an ADDITIONAL 25%. Most offices, having to deal with previous reductions in reimbursement, have been operating on a very narrow margin of profit.

Being a retired doctor, I understand the business aspects of operating a health care facility. It costs “X” number of dollars to process each patient through such an office. That “X” number depends of the number of employees, their salaries, benefits, taxes, worker’s compensation premiums, building and malpractice insurance costs, rent/mortgage costs, utilities, repair and update costs as well as the costs of equipment (those lovely tables are very expensive) and disposable items such as tongue depressors, gauze, tape, gowns, toilet paper, paper towels and other items like computers, programs (which are also very expensive), paper, printer ink, postage AND MANY MORE NORMAL BUSINESS EXPENSES.
The Insurance industry, theoretically run by intelligent people, doesn’t care what it costs a doctor to process a patient. They believe having more patients go through your office results in the doctor making more money. In theory, that makes sense. In reality, it is remarkably stupid.

First of all, more patients mean LESS TIME with ALL patients resulting in decreased quality of care. Second, and for financial survival, if the reimbursement and copay are LESS than it costs to process a patient through the office, the doctor actually LOSES money with EACH PATIENT. More patients results in more loss.

As stated above, health care facilities have already significantly reduced their overhead/operating costs. They simply cannot absorb an additional decrease of 25% in income. But this is not the concern of the Insurance Industry. Their MAIN CONCERN is increasing return on investment for their stockholders and salaries of their top executives.

By the way, according to Laura Ungar, USA Today on January 19, 2016, United Health Care had a NET profit of 6.8 BILLION DOLLARS in 2015. It was $228 Million less than 2014, but hardly as bad as a stick in the eye. I was not able to find net profit report for United Health Care for 2016. However, United Health Care had estimated that in 2016 they would lose $25 million more than the year before, possibly as high as $500 million. If their estimate was correct, that would mean that in 2016 they would have a NET PROFIT of ONLY $6.3 Billion Dollars.
Speaking of Insurance, the most recent financial report from State Farm Mutual Automobile Insurance Company shows a NET PROFIT for 2016, (after taxes) of TWO BILLION, FIVE HUNDRED FIFTY-FOUR MILLION DOLLARS. This is FOUR HUNDRED AND SEVENTEEN MILLION DOLLARS MORE THAN 2015.

Allstate Insurance Company had a NET PROFIT (after taxes) in 2016 of ONE BILLION SEVEN HUNDRED AND SIXTY MILLION DOLLARS.
GEICO, admitting it had a bad year in 2016, had a NET PROFIT (after taxes) in 2016 of ONLY FOUR HUNDRED AND SIXTY MILLION DOLLARS.

On February 19, 2016 the U.S. Government announced it was giving a big increase to private insurance companies that participate in the Medicare advantage program (Medicare alternative). Based on that news, investors rushed to buy as much of the health insurance companies’ shares as they could get their hands on. By the time the market closed on Friday, February 26, 2016, just seven days later, Cigna’s stock was up 5.5% and Human’s was up a whopping 8.1%. By comparison, the Dow Jones industrial average was up just 1.5% (Wendell Potter, This would mean that United Health Care estimate of loss was probably too high.

Once again, the driving force behind automobile and home insurance is to make greater and greater income dollars for their investors. In our society, there is nothing wrong with this model.
However, when it comes to health care, THERE IS EVERYTHING WRONG WITH THIS MODEL.

Kaiser Permanente has been a non-profit health care system since 1945. It has been tremendously successful. There will always be complaints, warranted or not, about particular doctors or policies, but overall, doctors and patients are very satisfied. They have NO stockholders, NO department dedicated to stockholder issues and, by the nature of being non-profit, are required to reinvest surplus income into facilities, equipment, services, doctors and support staff.

There is no doubt that Health Care would be significantly superior to what it is if ALL health insurers were non-profit. Unfortunately, national and state leaders do not have the balls or ovaries to pass legislation concerning improving health care for ALL Americans. That, too, is understandable because the Insurance Industry supplies, through direct donations and PAC’s, enormous amounts of money to elect and reelect members of Congress and Legislatures.

It is time to make the necessary changes. It certainly will be a steep, uphill battle. American citizens cannot match the irrational amount of money given to our state and national leaders. There are some legislators who agree with the concept of quality health care for everyone and getting the Insurance Industry out of the money making business which, therefore, would take health care back to where it belongs, the doctors.

So, remember when you hear the Insurance Industry cry about not being able to cover all citizens for health care, it is NOT that they would lose money. It IS that the number of NET BILLIONS or NET HUNDRED MILLIONS of dollars they earn could possibly be reduced. DO NOT EVER BELIEVE THAT YOUR INSURANCE COMPANY IS YOUR BEST FRIEND. They have only two best friends, dollars and investors. They are neither your good neighbor nor your good hands. They may provide good service for homeowners, renters and automobile damages. But, as with health care insurers, their most significant concern is profit.

My goal is to have more people think about our entire health care system, from insurance companies to doctors. At very least, I hope to provide a different perspective of the system. And, after intelligent consideration, realize and demand that we, as Americans, deserve a high quality health care system. Currently, we are ranked last compared to all other industrialized nations when it comes to health care. We are also the only country in that group that has FOR PROFIT management of our health care system.

Perhaps we can’t outspend the Insurance Industry, but we can make legislators believe, regardless of the money they spend on campaign advertising, that WE won’t elect them if they don’t get us high quality health care on a non-profit basis. And by non-profit, I do not mean the doctors. They are pretty much already at the non-profit status.

I hope you agree and want to help promote a grass roots movement to recapture our health care system and remove profit from determining our health status and whether/when we live or die. If so, please pass this blog on to others. It is time to stop being passive about accepting an inferior health care system. I have always believed that I/WE are either part of the solution or I/WE are part of the problem. Especially now, there can be no middle ground. Without your health, regardless of your wealth, YOU HAVE NOTHING.

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Fifteen or so years ago, as a member of the Rotary Club of Tucson Sunset, I along with others, was asked to make a presentation about the ethics of my profession. What follows is the information I presented to that group.

A 27 year old male presented at my office with severe neck and upper extremity pain. He was, at that time, a sophomore at the University of Arizona.
His x-rays showed perhaps the worst looking neck I had ever seen. He had a perfect cervical curve. Unfortunately, instead of going in the forward (lordosis) direction, it was going absolutely in the opposite, backward direction (kyphosis). (I love using technical terms so you think I am really smart).
As I recall, his treatments began in September. In November, he asked me if I would write a letter on his behalf so he could drop a class for medical reasons, rather than withdraw with a failing grade. Considering the extent of his issues, I wrote that letter on his behalf.
As time passed, he improved, but the structural issue was not, as yet, resolved. However, the frequency of his treatments decreased.
During homecoming at the U of A, his parents visited Tucson and came to my office during his scheduled appointment. While he was receiving therapy, they asked if they could speak with me. I share what they told me.

Their son was a “Wunderkind” in music, in particular, piano. His parents were convinced to send him to Europe for special training. He left home at age 10. When he left, he was an outgoing, gregarious, fun kid who loved sports. At age 16, this young man returned home, totally withdrawn, depressed, non-communicative and would not go anywhere near a piano.
His parents sent him for counseling but he would not communicate what had happened to him causing the drastic changes. While they, and I, had our suspicions, they were never discussed or confirmed. His total withdrawal was the reason he was so much older than other sophomores in his class.

Once again, in November, he came to me asking for another medical excuse letter to avoid failing another class. THIS CREATED A MAJOR ETHICAL DILEMA FOR ME. As a patient, he had significant symptomatic improvement. His follow-up care was scheduled for every three to four weeks. I realized the structural issue had not completely resolved, but he was functioning, for the most part, without symptoms. I truly struggled with this decision. I had asked him to return in one week, at which time we would discuss his request.
When the patient returned to my office, I informed him that I had written the letter and gave it to him. My reason, which I did not tell him, for this “breach of ethics” was that, an adult or adults had seriously failed him in the past. I couldn’t, in good conscience, be another adult to fail him.

As Paul Harvey used to say, “Now for the rest of the story.” That young man graduated from the University of Arizona. He took and passed (an unusual occurrence) the CPA exam on his first attempt. He got a job in Phoenix working for Arthur Anderson Company.

When that company decided to leave Arizona, he returned to Tucson. His first job here was with Thomas Davis Clinic, Tucson’s first HMO, owned by a group of doctors. During his first month, he found a $100,000 correctable mistake. He was a hero.

While here, he decided to explore a possible law degree. He took the LSAT and not only did well, he had a PERFECT SCORE. Since he loved being here, he chose to attend the University Of Arizona School Of Law. He made the Law Review during his first year, and decided to also seek his MBA degree at the same time.

The young man and his family invited my wife and me to his graduation from the MBA program. After he attended the Law School graduation, we all got together for a subdued celebration. His gift from us, because he was really tall, was a wood book stand that could be folded flat or opened and placed on a desk. That way his head/neck would not be as stressed while he was reading.
He got a job with a well-known law firm in Tucson, best known for taking newly graduated lawyers and putting them through internship that, as in medicine, works them beyond belief. They also gain an amazing amount of experience.

In all honesty, I don’t remember his name. I NEVER tried to track him down, although I would love to know how he is doing. In my mind, it would cheapen what I had done and what he had accomplished.

Back to the opening title of this epistle. Obviously, I have given this a great deal of thought and still do. While I realize this type of experience is atypical, nevertheless they do arise. All societies must have laws/rules. Without them any society cannot exist or survive. Then again, some laws and rules are, at best, ill conceived. At worst, they are downright stupid. I refer you to the recent episode having to do with a passenger on United Airlines and far too many Home Owner Associations.

So what happens when ethics is in conflict with humanity? I am very comfortable when I say that ETHICS MUST ALWAYS LOSE. In my opinion, if we become a nation or world where rules and laws are more important than humanity, we have really lost the reasons to live as a society and human race. And, if I am correct, God will be proud of me for putting a person before ethics.

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Bigger, Stronger, Faster


This is in response to a newspaper article I read about how much bigger, faster and stronger athletes are becoming thanks to newer and better training methods and equipment.
I begin with an analogy. You purchase a standard vehicle, new or used, from a dealership. You decide to modify it from its original configuration by installing a 500 HP engine. Then you add a racing transmission, differential and drive shaft. However, you keep the original universal joints that connect the transmission to the drive shaft and the drive shaft to the rear end.
The first time you stomp down on the accelerator, the Universal or “U” joint snaps. It does so because it is the weak link in the now super powerful vehicle you have created.

Making athletes, high school, college and professional bigger, stronger and faster is good for the games and in many ways may help protect the participants. However, as in taking medicine that can save your life, there are side effects (just watch some drug company commercials on television).There are certain parts of the body, like the original “U” joint, that cannot be made stronger. Cartilage, ligaments, tendon attachments and, for the most part, bones are examples.

For many years I have been observing athletic injuries at all levels that occur without contact. At the University of Arizona, the nation’s top football linebacker, Scooby Wright, injured his knee and foot without any physical contact. In basketball, Kaleb Tarczewski injured his ankle and had a “stress reaction” in a bone of his foot. Once again, there was no contact causing those injuries. Don’t forget Tiger Woods. He built himself to the size of a professional football linebacker. His knee and low back (multiple times) have failed him. They should not have happened at his age, in a non-contact sport.

A player was recruited to be a linebacker for the University of Arizona. He was changed to nose tackle, and pushed to gain weight. He got up to 295 pounds. He had spontaneous fractures of the cuboid bone in both feet. They occurred one at a time. The first happened in pre-season camp and the second working out after the season ended. His position was then changed for the following year and his weight dropped to 265, a more rational weight for his height (about 6’1”). He had no issues since dropping the weight.

Teddy Bridgewater, quarterback for the Minnesota Vikings NFL team, tore up his knee and missed an entire season. The injury happened without contact. There are many more examples at all levels of organized sports.

The process is to make muscles bigger and stronger with faster “twitch”. This means that the muscles contract faster and with more force. This is like adding the bigger, more powerful engine. The padding that provides a cushion between bones (cartilage) now bears more weight and faster, more frequent compression. Add a little twisting to that and that weaker area is subject to tearing. The same is true with bones of the feet. They can’t be made stronger. They are taking heavier, faster and more frequent pounding. A little twist or jump and a break can occur.

Ligaments are the parts of the body attaching bone to bone. They can’t get stronger. Have you notice how many knees, over several seasons, end up with torn ACL’s (anterior cruciate ligament)and MCL’s (medial collateral ligament)? Every season more of those injuries happen without contact? Ligaments can stretch only 4% of their length before fibers tear. Anything more than that and you have a sprain. A sprain, as compared to a strain, means that ligament fibers have torn. A lot more stretching and the ligament tears completely.

Discs of the spine are also vulnerable weak spots. They can tolerate an unpredictable amount of compression, twisting and stretching. Unfortunately, there is no way of knowing or predicting which part of a player is subject to being his or her weak link. However, will there ever be a point that an athlete is big enough, strong enough and fast enough? If one has watched the NFL Combine, it appears the answer is, no.

At this time it seems that, as with medicines, the bigger, stronger, faster philosophy will continue until or unless it is “scientifically” proven that the negative side effects are no longer worth the benefits. Unfortunately, I have yet to see any research that studied the “Weak link theory.” I don’t expect to see such research any time soon.

In summation, most people are aware of the benefits of bigger, stronger and faster. I just want to point out the possible negative side effects that have been observed during athletic competition at all levels for many years. I am not suggesting suspending strength and conditioning programs for athletes. I am suggesting consideration of the concept of when enough is enough.

Dr. Leonard Rudnick, (Retired)

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