I posted about this in a thread titled TB Geek regarding my insurance proposal. The link to part of what I wrote there: GeekSpeak Thread

Health Care Reform Proposal - (this is my own idea - looking for vetting, opinions, additions, questions - NOT partisan) (I TRIED to get this into outline structure but this is as good as I could get it without spending hours at it. I can send it to anyone who wants via e-mail or try to post it in my blog, Up the Food Chain).

1. Issue Health Care Cards
....a. Issued by the Federal Government but distributed by the States
.........i. Through already existing infrastructure
.............1. i.e. Drivers License bureaus and
.............2. On-line
.....b. Credit type card that specifies the discount for which the holder is eligible

2. Eligibility
....a. Currently uninsured with no access to health care insurance or access to spouse's health care insurance
........i. No person with access to health care insurance through employer or from spouse or parent is eligible
....b. Not Medicare eligible

3. Discounts
....a. Doctor offices, facilities and hospitals offer deep discounts (estimated 60%-70% discounts)
........i. Almost no paperwork involved
........ii. Medical offices, hospitals, post their base pricing and Health Care Card discounted (cash payment) amounts prominently in offices and on-line (hard copies available in offices)
.............1. i.e. Office visit $100,
.................a. Discounted amount $40 (cash at time of service),
.................b. Special Low Income (LI) Discounted amount $20
......................i. Government pays $10.
.............2. i.e Surgery – Surgeon, anesthesiology, OR, Post Anesth care, hospital room (1 day) - $10,500 (Could be covered under Major Medical - see Major heading 11.)
.................a. Discounted Amount $3,675,
.................b. Special Discounted amount $1575,
.......................i. Government pays $1050
....b. Cost of low income participants is spread around with medical offices and hospitals, etc. giving up profit (but still covering costs) and government picking up the tab for the difference to cover the medical facility, physician costs.
.........i. Since minimal paperwork is involved, no additional staff is required.
.........ii. Indigent patients should be spread around among all providers.

4. Discount eligibility determination
....a. Income tax return
....b. Proof of loss of job
....c. Assets are not a determinant unless participant has home and other possessions valued in excess of $250,000

5. Providers
....a. Medical Offices
....b. Hospitals
....c. Short-term care facilities
....d. Other (radiology, anesthesiology, etc. practices)
,,,,e. Dental offices
....f. Optometrists
....g. Pharmacies
....i. Discounts for drugs
........1. To be listed on formulary, pharmaceutical companies would have to discount drugs (Still thinking this one through)

6. Funding
....a. Participant pays cash at time of service.
....b. For lower income participants, medical providers agree to deeper discounts up to a level of 10% above their cost for staff and supplies
....c. Participants at designated levels of low income (poverty level and below) receive government subsidies up to 100% for persons with little or no-income and little or no assets.

7. Bureaucracy & paperwork
....a. Minimal
....b. No insurance filings (except for those carrying Major Medical)
....c. No paper filings with government
....d. Minimal records kept in on-line database
........i. Health provider
........ii. Patient name
........iii. Patient SS#
........iv. Patient address
........v. Date of Visit or Procedure
........vi. Code (used by providers for insurance so can serve use here, too)
.......vii. Full price
.......viii. Discounted amount charged
.......ix. Amount paid by patient
.......x. Amount owed by government to provider (in cases where subsidies provided)
......xi. Date government issues payment
......xii. Date payment received by provider
....e. Visit/procedure records and signature of patient receiving treatment available for spot check audits by government

8. Non-competitive with insurance companies since only uninsured with no access to insurance are eligible

9. Heath and Human Services oversees
....a. Provides enrollment training to States
....b. Provides auditors (for fraud checks)

10. Fraud penalties
....a. Loss of medical licenses (in the case of doctors)
....b. Mandatory prison terms
....c. Exorbitant fines for hospitals and other facilities

11. Major Medical
....a. Copay and Deductible
........i. Deductible choice for participant (annual but not per incident)
............1. $100 - $10,000
.......ii. Copay
............1. 10% after deductible met
....b. Policies
........i. Pre-existing conditions covered
........ii. If M.D. orders, insurance must pay
............1. Can require 2nd opinion (not by doctor of their choice but from a pool
....c. Pool of Insurance Companies handles Major Medical so that risk/benefit is spread out among a group of insurance companies
....d. Coverage by insurance companies mandatory for carriers and participants
....e. Funding
........i. Participants pay premium set by government actuaries
............1. Carriers may contest but once approved, government sets any rate changes
.......ii. Premiums for lower income participants
............1. Range from $0 (below poverty level) % based on their income level.
....f. Risk spread out
........i. Coverage for all citizens (currently without insurance) mandatory
........ii. Participation mandatory