American Health Reform Act 2009

The American Health Reform Act 2009

America’s health care system is fueled with innovation, and pioneering discoveries leading to the cure, treatment and intervention of the most challenging diseases in the history of man. The unique economic structure of this country weaves the interconnection of the different factors the feeds and sustains the economic growth and promotes the discoveries of new ideas that changed the history of science and medicine. With this advancement comes the compassion and the struggle of every physicians, health care provider and educators to reach out to all the people in disseminating new knowledge and cure. Since America is still considered quite a young country in comparison to the rest of the world, such efforts remained to be perfected and polished to reach the optimum potential that this system and country can achieve. Our ultimate goal is to be free of the burden of health care cost and provide the best quality health care for all the people in this country. Such goal can be achieved through some of the following key features:

Improvement of the quality of life through an effective preventive care program, free preventive care coverage for all;
Empowerment of the people through knowledge, access and control of their own health care portfolio;
Effective communication and efficient dissemination of new discoveries, best clinical practices and treatments, and other information that promotes the improvement of the quality of life of the patients and growth of the system as a whole;
Economically sustainable health care system powered by the inherent strength of the different stakeholders, and the alignment of their mutual interests that promotes synergistic growth - a win-win for all;
Preserve the best of the current system - flexible option;
Health saving system that builds foundation towards financial independence of health care cos;
Provides solution to the financial problem of Medicare;
An equitable, timely and quality health care system the address the needs of all Americans, including the 47 Millions uninsured;
Effective and efficient Central Network System (CNS) design that eliminates unnecessary bureaucracy;
Promotes innovation, collaboration and economic growth;
Offers incentives such as tax exemptions or credits instead of tax increase;
Promotes personalized medicine and depositories of effective treatment protocols and guideline;
Works effectively in rural and urban areas of America;
Provides real solution in eliminating health disparities representing all racial groups in America;
Empowers each individual with the right to choose and the right to life;
Eliminates barrier for the health insurance access of people with preexisting conditions;

Basic Implementation Principles

Sustainable Healthcare System Model: The fundamental and basic structure of the health care system is based on the alignment of the interest of the different stakeholders that promotes synergistic growth. A system based on a delicate combination and balance between the negative and positive rights of an individual and his/her responsibilities to the welfare of other stakeholders engage in the system. The system is based on understanding the fundamental factors that will provide incentives to the different stakeholders to perform their optimum task and contribution in the system with minimum enforcement and barriers.

Emphasis on Preventive Care (Benefits to ALL): Insurance for all will not be able to resolve the health care needs of the poor. As most of the current 47 Million uninsured are eligible to a basic Medicaid system but cannot and/or will not access this system until absolutely necessary through our Emergency facilities. An annual preventive care visit to a physician could dramatically decrease the need of Emergency visits for all Americans.

A free annual preventive care visit to a physician should be a major component of all standard insurance benefits for Americans. Although it is quite understandable that difficulties exist for the poor and underserved groups from factors such as transportation, time and lost wages, it is, however, essential to note that their well-being and health is their responsibility and their actions impacts the rest of the nation. Thus with the rights comes the responsibility for the underserved groups to take advantage of the free preventive care visit available for them in this program. The program subsidizes the insurance cost of the people below a certain poverty level. The subsidy is renewable every year and initiated through their first annual free preventive care visit to a physician. A decrease in the cost and number of major catastrophic care would eventually decrease the burden in the insurance companies and our entire health care system, thus providing the people a better leverage in reducing insurance premium.

A portable medical electronic record for the system will keep track of the enrollment and medical history of individual participants. This will address the need of people who have no permanent residence and relocate more often than average Americans. Repetitive tests due to lack of health record history for the uninsured and homeless is one of the major contributions for high health care cost. Security in the access of these records will be ensured in order to protect the rights and privacy of the patients. All access to these health records by a third party (physicians, nurses, etc) will be based on patient’s consent (or authorized family members in cases of patient’s incapacity to make a decision). These records will be maintained in the Central Network System (CNS), a fully independent agency, using a system with a defined security structure to prevent access of unauthorized individuals to sensitive information. Insurance companies and employers will not have access to health results and risk assessments of the individuals. The Central Network System will facilitate the communication of benefits and service between the patient-physician and insurance companies. Access to insurance provider and enrollment to the CNS program could be accomplished in the physician’s office through automated, on-line and national standardized forms.

Equitable and Affordable Insurance with Variable Options to Meet Participant’s Needs (Financing, Benefits to Patients) (One size does not fit ALL!): Standard features such as free annual preventive care (including dental, vision, mental health, health education credit and assessment, etc.) visit and a component of a catastrophic care to cover the needs of an individual over the span of his/her lifetime. These standard features will be included in the minimum standard benefit reflecting the needs of the majority of Americans, as evaluated over a period of time, with additional options available, tailored to individual’s need. Entry to the program is independent of preexisting condition. CNS, the federal and state government will leverage the cost of these premiums for the people in order to optimize the cost savings of the system.

Small business owners and their employees, self-employed individuals, employees of large corporations and federal government, and the current uninsured can choose between the different providers and options in the insurance exchange. The overall base premium (for all options) should reflect additional 20-30% of a cumulative individual health savings account (IHSA) components that would provide the participants with additional reward savings in meeting and maintaining his/her annual health and wellness goals. The IHSA account will be maintained and managed for the individual (in similar manner as the retirement account) and the program by an independent Central Network System. Interest from the trust fund (with sufficient funds) could be used to pay future insurance premium for the individual. Individuals could transfer the benefits/trust funds to their heir after their death.

Eighty percent of uninsured individuals in US live in household with an employed individuals. Breyer’s plan will extend the tax exemptions and coverage to secondary families such as parents and children in student status. Tax exempt and credit structure will be set up and optimize to provide incentives for an individual (and their employers as an optional partner) to sponsor and buy in affordable insurance to uninsured secondary family members living in the same household. Children will be covered by the parent’s insurance while in student status and one year grace period after school (while finding an employer- sponsor). Such option would provide not only affordable insurance to approximately 20%-34% of our uninsured but will also provide enrollment of these individuals in the individual health savings account (iHSA) and additional tax credit to sponsors.

Breyer’s plan does not require mandatory health insurance. Uninsured who are in high income bracket (20%-25% of uninsured) who choose not to buy insurance through the program will have to provide a set savings bond of at least $20,000 - $50,000 to cover a future catastrophic incident. Since a portion of the individual health savings account in Breyer’s model goes as donation to the underserved and uninsured, this approach will ensure a fair system where the individual donation will go to help the poor and uninsured and not the rich who skip paying insurance and later on will get the benefit from other people’s sacrifice and efforts.

A defined and clear guideline will be established consistent with taxable income and tax payment/credit structure to provide subsidy to insurance coverage for individuals who are below 400% poverty line. Unemployed individuals will be covered in this subsidized insurance program. Financing will be provided through a portion of the individual savings (20 cents for every dollar saved) acquired through leverage with insurance companies (lower premium) and pharmaceutical industries (lower drug cost). A small co-payment (between $20-$50) will be established depending on the poverty level above 200%. The program will not require any out of pocket expenses from individuals, such as increase in taxes but will provide tax exemptions and credit on the IHSA and donated funds to the uninsured (Please see the Breyer's Model).

Veterans and their families who are not eligible for veteran hospital benefits (since VA health benefits are limited to war related injuries) will be able to enroll in the private insurance program and, with the consent and support of the Department of Veteran Affairs, can access the state-of-the-art facility of the VA Medical Centers or go to other hospitals of their choice. A federal program will be available for federal employees through choice of different private insurance and options. Culturally appropriate financial and infrastructure support will be provided to the Native American Indian Health System.

Benefits to Participating Hospitals, local clinics and other health care institutions: All private and public hospitals, local clinics and other health care institutions who participated in the various programs of Breyer’s plan (preventive, cost reduction through effective, efficient and quality health care) will receive subsidy for their uninsured enrolled in the program.

Individual Mandate: Insurance is not mandatory to everyone. However, to prevent high income individuals from skipping the insurance premium cost and taking advantage of the system’s benefit in times of needs, individual savings bond (@ minimum of $20,000), to cover catastrophic incident, would be required for high income individuals (based on taxable income adjusted to the cost of living for a given state) who selected not to buy insurance in the program.

Employer Requirements: Employer will be provided a tax exemption for employee sponsored benefits and additional tax credit for extending sponsorship to secondary family members. Employers will receive the savings proportional to their contribution in the employees’ overall insurance premium. A similar formula as specified in the Breyer’s model will be applied in their contribution to the uninsured and in their corresponding tax credit.

Expansion of Public Program (Solution to Medicare Bankruptcy): A portion of the current stimulus fund of $630 Billion and left over Medicare funds for seven years (Medicare funds left until 2017) could be used to subsidize individuals above 65 years of age who are currently in Medicare while the rest of the population can slowly transition their Medicare contribution to their IHSA for their own individual health care benefits. Thus providing a solution to the unsustainable structure of Medicare and a path for independence of future health care cost for the individual (A more detailed and optimized system (amount and timing) could be acquired and simulated with a given software resources/program).

Premium Subsidies to (Benefits to) Employers: Tax exemption and credit will be available to employers for employee’s benefits. No tax increase but additional savings that can be use to enhance employee’s benefits. Small businesses and self-employed individuals would be able to access an affordable insurance premium that is currently just available to large corporations and federal programs. CNS programs would be available to employees to improve health and work performance.

Benefit Design: An annual preventive care (includes services that the American Medical Association and/or other medical associations considered essential in early prevention of diseases, i.e. vision, dental, mental health, podiatry, mammogram, lab tests, pre-natal care if applicable, etc. ) is free for ALL. A minimum standard benefit of equivalent or greater value from the benefits currently enjoyed by majority of Americans (such as the Blue Cross/Blue Shield Standard Plan and the Standard Federal Employees Health Benefit Program, FEHBP). Additional options are available for long-term disability and types of long term care services. An additional component of the standard plan would be an optional tax credit and/or benefit for (preventive) health and wellness education program and assessment.

Benefits to Private Insurance: A Guaranteed insurance of close to 330 Million Americans every year. National support through CNS and all stakeholders for preventive care and efficient, effective and quality health care improving the health and quality of life for all. Support from CNS, federal and state agencies, scientist and health professional through depositories of effective clinical practices, more standardized cost of medication and services, innovative approach and effective treatment will be available resources to all. Additional public support programs for nutrition and wellness classes for the poor through existing programs, e.g. USDA food stamps and nutrition programs. CNS will coordinate programs with CDC, VA, NIH and other national health associations to expedite the dissemination of programs that will enhance risk assessment, prevention and treatment of various disorders. Together with various public and private organizations CNS will provide an efficient bridge in the translation of new discoveries and best practices from a bench to clinics and hospitals. These programs will drastically reduce administrative and catastrophic health care cost for insurance companies.

Benefits to Pharmaceutical Companies: Twenty five percent of the cost for pharmaceutical company’s drug discovery, and development is focused on marketing and dissemination of information. CNS will facilitate the dissemination of new discoveries in new drugs and technologies through its participating hospitals, physicians and health professionals remarkably reducing the cost of marketing and dissemination for the company. Such activities will be done in coordination with the participating public agencies such as FDA, NIH, CDC, etc.

CNS will also provide a national depository or listing of clinical trials for new drugs and technologies so as to provide options for individual participants to access innovative approach, medication and studies through out the nation. It would be the individual’s choice to participate in any of the listed clinical trials based on the health benefits that study would provide. This connection will be facilitated by CNS through close communication with Food and Drug Administration and other collaborating agencies (CDC, NIH and others public and private agencies) that would provide accurate and reliable information to everyone regarding the risk and health benefits of the discoveries. This would reduce the inefficiencies in the recruitment and retention of participants in evaluating the effectiveness of treatments and other intervention procedures. Reduction in the administrative, evaluation and dissemination cost for the development of drugs will help pharmaceutical companies in reducing the cost of medication in this program.

Benefits to Physicians and Health Professionals: CNS will work with NIH, CDC and other public and private agencies to provide resources, medical information and technical support for physicians in urban and rural areas regarding new and effective treatments and discoveries. Telemedicine and ready access to specialist will be provided through this network. CNS will also help facilitate the transition of technology and approach to personalized medicine. Inter-individual biological differences exist and thus there will be no mandatory protocol. Best clinical practice protocols and results of effective treatment studies would be available in CNS depositories in order to guide physicians in making informed decisions. Breyer’s plan promotes integrated approach on health care through collaboration and communication between physicians and health care professionals beyond geographical barriers, all within the goal of providing the optimum care the patient deserves. Physician’s decision based on well founded and supported knowledge, and readily available support from other experts in similar and complementary fields will reduce the uncertainty and risk involved in malpractice lawsuits.

An efficient communication infrastructure between the different health institutions and professionals will also provide further support for CDC and NIH in promoting and implementing studies that would resolve some of the problems in the health of the American people. Breyer’s plan of centralized network will provide efficient infrastructure and further support on CDC’s and NIH’s initiatives for a more comprehensive NHANES and Framingham studies that would provide more information on the prevalence, risk and effective treatment of different diseases in various ethnic groups in the nation. Understanding of the risk and prevalence of the different disorders such as cancer, diabetes and other diseases would enable health care professionals to better implement preventive care and treatment.

Physician’s in remote areas do not have ready access to the state-of-the-art discoveries in medical treatment and technology. CNS depository will be the means to bring this innovation in the rural and remote areas through training, support to physicians and other health professionals, while utilizing as much of the existing resource and infrastructure.

State Benefits and Function: Since each state has different demographics, resources and infrastructure, CNS will work with local state health agencies to design and implement programs depending on the states resources and infrastructure. The dynamic changes and flux in the different resources and needs of each state will be closely monitored by state agencies. Corresponding adjustment in the national CNS system will be performed based on the state quality assessment-feedback and national process optimization approach. Progress and effective health care reform from each state will be evaluated based on their starting baseline. Private insurance and service options may differ between states but the same guidelines (in overall cost and benefits) will be observed.

Cost Containment: CNS will leverage the reduce cost of insurance premiums and drugs for 330 Million Americans. A minimum standard insurance premium will be established equivalent or higher in benefits to the current standard Blue Cross/Blue Shield or Federal Employee Benefit Plan (with free annual preventive care). Several payment plan variations and option of this standard plan would be available to address the financial needs of the people. Additional savings will be maintained by CNS and will be placed in individual accounts through participation and accomplishments in the preventive care programs. Participating hospitals that report an effective, efficient and quality health outcome for their patients gets the corresponding savings through subsidy to their uninsured. Results and outcome for cost effective and quality care for patients can be evaluated through multiple follow up and efficient recording of health results of patients. Thus electronic medical data and history will guide not only the physicians in prevention and diagnosis but also provides the patient of a portable medical record and control of their own health. Information summaries and results of available studies in the service cost, effectiveness of existing treatment and medication will be available to patients, physicians and other health professionals for their review and evaluation. Strict penalty will be placed on fraud and corruption in the system. The CNS in collaboration with agencies in a state, federal, and private institutions will set up guidelines, routine audit checks and oversights of each participating group in this system.

Health Disparities: CNS will work with US Census, CDC and NIH towards programs such as NHANES and Framingham studies to evaluate the risk, prevalence and effective interventions for various diseases for all the groups (African Americans, Asian Americans, Caucasians, Latinos, Native American Indians, Pacific Islander) represented in the American population. Over sampling of groups will be implemented in order to provide statistically valid health information, especially for small under represented ethnic groups.

Central Network System: The Central Network is independent of any entity (Government, insurance and health care providers) and provides not only insurance leverage but also effective communication (personalized medicine), treatment, clinical, scientific guidelines and services in coordination with other private and public agencies - An integrated approach necessary to run a complex system. CNS structure will consist of an oversight board consisting of representatives from all stakeholders and external advisers.