Today, we are going to examine Secretary Clinton's plan to save healthcare.
Her response began with a short preamble not about healthcare but about the Affordable Care Act (ACA), healthcare payments and health insurance and how she would weed out "fraud, waste, and abuse in any federally subsidized program" and was followed by the following four talking points.
I. IMPROVE - NOT REPEAL - THE AFFORDABLE CARE ACT
By "Improve" we assume she means expand and fund the ACA. She states that "We need to improve and strengthen the ACA through enhanced tax credits to make coverage affordable, implementation of strong measures to bring down the cost of prescription drugs, increased competition between insurers, and an aggressive campaign to increase outreach and enrollment." The large insurers are already screaming about not being able to make any profits on the exchanges, and pulling out of them altogether. Secretary Clinton's idea is to let the government pay the insurance companies directly by issuing tax credits. This doesn't reduce the cost of healthcare, it reduces the bill the less-than-fortunate individual will pay, at the expense of the rest of us. There are no new efficiencies achieved, no new ways of doing business, there is just the same old 'more government, more regulation, more complication and business as usual.'
I am absolutely positive there is a better way to fund health insurance. Stay tuned and I will tell you want it is.
II. ENSURE GREATER AFFORDABILITY FOR ALL AMERICANS
Secretary Clinton had three points to reduce healthcare costs:
- Extend a refundable tax credit of up to $5,000 per family for excessive out-of-pocket health costs. Impose a requirement on all insurers to limit out-of-pocket prescription drug costs to $250 a month on covered medications.
- Streamlining approval of high-quality biosimilar and generic drugs. That includes proposals to ensure that drug companies justify their prices, eliminate “pay to delay” practices, and allow Medicare to directly negotiate for better prices. I will also create a new Federal consumer response team charged with identifying excessive price spikes in long-standing, life-saving treatments, and give them effective new tools to respond.
- Weed out fraud, waste, and abuse in any federally subsidized program by incorporating nonpartisan ideas from such expert groups as the Medicare Payment Advisory Commission (MedPAC). I will make sure we incentivize reporting any practices that undermine confidence in programs and increase costs.
In order, let's take a look at these. Point number one is reallocating tax dollars from healthy people to insurance companies or limiting the price a provider can charge. That never worked for rent controlled apartments in New York, and it won't work here. This means more government, more government intervention, less efficiency through more people/agencies being involved in payments, less profit and a cap on drug payments. Point number two is again, more government with a new Federal consumer response team. Point number three is more of the same: expand and fund another group, the Medicare Payment Advisory Commission, and pay watchdogs. There is nothing in her first talking point that doesn't require more government, more complication, more people and more spending. This means more taxes. We need new, fresh ways of accomplishing these tasks, not more government.
III. ACHIEVE IMPROVED HEALTH AND HEALTH CARE IN AN INTEGRATED FASHION
Secretary Clinton states "We need to streamline and enhance the policies of private and public payers to move our health care system toward practices that reward high-quality, patient-centered care, improve outcomes, and reduce costs."
Yes, we do! The trick here is not to point out the correct direction, any mouse can tell you that the cat needs a bell around its neck. The real trick is to figure out how to get it done. Until I see a plan to actually achieve integrated healthcare and streamline the healthcare process, I am going to assume this is one more attempt of a politician to spin a bad situation to her advantage. We here at Sentia Health do know how to and actually have already accomplished most of what Secretary Clinton wants to do, yet clearly has no idea how to accomplish. Ideas without execution are less than worthless, they are noise that mask the sweet song of a real solution.
Here is what everyone is missing: you can't just integrate healthcare. you have to have one central repository that everyone writes to. If you simply give access to patient data, first you are going to have a security nightmare. Second, you are going to have to know where the data resides before you can query it. No, a central repository is what is needed. Then and only then can we talk about web services and integration. Of course, We know how to do that as well.
IV. SECURE TRUE INNOVATIONS IN DIAGNOSING, TREATING, AND CURING DISEASE
Precisely like the integration problem, We need a central repository of structured, complete medical data. Only then will we have the tool necessary to track trends and the efficacy of treatment over large groups and over the long term.
We've been promising that we know how to do what Secretary Clinton wants to do, and not only that, but we've done it. Here is our response to Secretary Clinton's answer, and our counter-proposal to the people of the United States:
We here at Sentia Health have designed and built a system that combines all the healthcare and insurance operations, except actually performing the procedures, into one process. Our Electronic Medical Records System (EMR) is flexible enough to document patient encounters in English and issue payment for procedures performed in near real time. ...and several other languages as well, for worldwide use. This eliminates several processes, their tools and their associated costs:
- Medical Coding
- Eligibility adjudication
- Billing
- Health Insurance waste and profit
- The need for a hospital or practice to buy and install an EMR.
Let's look at these five things and put prices on them. Medical coding is the translation of what the doctor does into codes the insurance company will pay. If the insurance company wants codes, they should provide the translation. We'll set that cost at 5% of the total. The practice doesn't know what procedures are covered by insurance until they are coded, transmitted to the insurance company, and adjudicated. That means that the efforts of the practice have gone to waste in coding and transmitting them and that the practice has to have a billing department to collect payment for rejected and underfunded claims. We'll set transmission andadjudication cost at another 5% of the total. The billing department itself probably consumes 10% of a practice's resources generating and sending bills and collecting payment once the claim is adjudicated. The ACA itself mandates that insurance companies return 80% of the premium back in benefits. That means that they waste or put in their pockets the other 20%. Installing and configuring an EMR in a hospital setting can cost hundreds of millions of dollars. The average doctor in the average practice personally spends $32,000+ per year on his or her EMR. Let's peg that cost at 5% of revenue.
Now let's do the math: 5% + 5% + 10% + 20% + 5% = 45% The traditional health insurance company either wastes or causes to be wasted 45% of every healthcare dollar spent in the United States. Since there is some overlap in some of these systems, let's conservatively say that 1/3 of the healthcare dollars are wasted by fat cat insurance companies and their pet politicians.
Sentia's EMR eliminates all of those systems and provides its EMR free of charge to any practitioner who wants to use it. We are funded by a subscription fee of $10 per insured per month. We are replacing 1/3 (45%?) of the cost of healthcare with a $10 subscription fee. The insured people must pay for the actual cost of the insurance of course, but we will publish the numbers and how our actuaries came to them on our site.
This is real innovation, this is the way to save healthcare. More taxes, more income redistribution, more oversight, more regulation has rarely helped anyone do anything. We've put the bell around the cat's neck and the man on the moon. We have a viable, streamlined, easy to use way to put aside all of the complication that currently exists in healthcare. We can do this to all the systems as well. Notice we said all the systems, not just healthcare.
If you want to hear more, contact us on the site: http://sentiahealth.com.
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