We’re tired of waiting for critical problems that affect all Americans to be solved from the “top down”. It hasn’t happened in recent years. If we want things to get better, WE had better come up with some good ideas and pass them along to our elected officials.
This blog is a non-partisan attempt to propose some practical solutions to big problems. There are only a limited number of viable options to solve complex problems in most cases. The author believes that reasonable people of all political persuasions can and will make compromises to achieve results affordably.
While the author is no authority on ANY of the topics you’ll see on the blog, the suggestions you see here are based on extensive reading of books and periodicals containing information contributed by real experts as well as personal experience and innumerable discussions and debates with other knowledgeable lay people who have offered their best thoughts. I have attempted to summarize some of the best and most achievable changes presented to me.
However, if you think we’re all wet and want to propose your own plan—DO IT! Every serious contribution will be thoughtfully considered and incorporated where it makes for a better plan.
If you think some parts of a plan are good, but would alter others to be more practical or effective or less expensive or all of the above, please let us know how you would configure the additions/improvements.
If you love everything you see on a topic and have nothing you’d like to add, please let us know because:
After the presidential elections in November, we will compile all of our best ideas on all topics presented on the blog and send them off to the new Administration as well as to the most prominent and respected “think tanks” in Washington—conservative, liberal, bi-partisan and non-partisan.
We live in a country that has been built on the ingenuity, creative genius and hard work of its diverse citizenry. We are certainly being challenged now to develop policies that will work for Americans in all walks of life. Only when we successfully address our own issues will we again be the beacon guiding the rest of the world to peace and prosperity.
Hope to hear from you!
Elizabeth
Tuesday, September 30, 2008
Tuesday, September 23, 2008
Food Production Reform
The Problems: Food shortages worldwide, lack of good jobs.
The Solution: Expansion of family farms and ranches and expansion of corporate agriculture.
How to do it:
1. Solicit more agriculture commodities contracts worldwide and produce more biomass fuels.
2. Stop paving farm land.
3. As demand grows, take land out of CRP.
4. Streamline distribution (high speed electric trains, remove barriers to trade and transfer).
5. Develop more crop variations and high tech farming practices.
6. Export agriculture technology to developing nations
7. Jobs created: agriculture engineers, agronomists, plant pathologists and other related scientists, economists, veterinarians & assistants, construction workers, administrative staff, mechanics, accountants, service staff, HR personnel, implement producers and dealers with service departments.
8. High schools and colleges train people for these careers.
How to pay for it:
1. Increase trade revenues and eliminate CRP and other price supports.
2. Tax credits for agriculture will help jump start expansion, especially when large contracts overseas must be filled. The increased trade and business growth will eventually generate more tax revenue than that lost to these credits.
3. Department of Agriculture will offer matching grants to start up farms, ranches and crop exporters.
4. A percentage of the increased agricultural tax revenue will be made available for matching private investment sources to spur research and development of further agricultural advances.
The Solution: Expansion of family farms and ranches and expansion of corporate agriculture.
How to do it:
1. Solicit more agriculture commodities contracts worldwide and produce more biomass fuels.
2. Stop paving farm land.
3. As demand grows, take land out of CRP.
4. Streamline distribution (high speed electric trains, remove barriers to trade and transfer).
5. Develop more crop variations and high tech farming practices.
6. Export agriculture technology to developing nations
7. Jobs created: agriculture engineers, agronomists, plant pathologists and other related scientists, economists, veterinarians & assistants, construction workers, administrative staff, mechanics, accountants, service staff, HR personnel, implement producers and dealers with service departments.
8. High schools and colleges train people for these careers.
How to pay for it:
1. Increase trade revenues and eliminate CRP and other price supports.
2. Tax credits for agriculture will help jump start expansion, especially when large contracts overseas must be filled. The increased trade and business growth will eventually generate more tax revenue than that lost to these credits.
3. Department of Agriculture will offer matching grants to start up farms, ranches and crop exporters.
4. A percentage of the increased agricultural tax revenue will be made available for matching private investment sources to spur research and development of further agricultural advances.
Energy Reform
The problems:
1. The US is dependent on fossil fuels--a polluting and rapidly disappearing resource the need for which forces us to do business with regimes that reject modernization and citizens’ rights.
2. We lack good paying jobs for both high school and college grads (yes, they’re related, keep reading).
The solutions: More responsible short term solutions while we work on sustainable, alternate fuel sources for our future. These alternative energy sources include:
1. Giant solar collectors in the West and Southwest (NV, AZ, NM, parts of UT, CA, TX)
2. Giant wind farms
3. Giant wave farms in coastal states
4. Hydroelectric plants
5. Biomass fuels
How to do it:
1. Develop interim sources of energy i.e. natural gas, nuclear, coal -> coal gasification).
2. Conservation – if you use more, then you pay more for electricity and fuel. (Could do a private citizen cap and trade program as well as corporate—see below.)
3. Reduce oil use to match what we/Canada produce (no imports).
4. Within four year 25% of all our energy is clean and we do whatever it takes to get there.
5. Congress passes clear, tough, but achievable emissions standards and companies are issued credits to the allowable limits.
6. Companies under their quota sell excess credits to the feds. Companies over their limit purchase credits from the Feds at a premium. The surplus revenue helps to fund development of alternative energy resources: wind farms, solar collectors, hydroelectric plants, etc. (Items 1. & 2. are a new twist on “cap and trade”.)
7. Cost sharing of alternative energy production by public and private entities to produce electricity that is cabled to regional stations in USA and under both oceans for export (if possible—if not technically feasible, we export the equipment required for other nations to launch their own alternative energy production).
The Advantages:
1. Energy independence.
2. A cleaner environment.
3. Inexpensive, renewable energy supplies forever.
8. Jobs created: engineers, architects, CAD programmers, scientists, computer techs, administrative staff, HR specialists, construction workers, mechanics, accountants, international relations specialists, service staff (food, maintenance, grounds and landscaping, etc.)
9. High schools and colleges develop training programs specifically designed for energy plants to graduate skilled employees.
How to pay for it:
1. Reposition some military spending (see military section).
2. Use emissions credit revenues to provide cost sharing grants to private sector companies.
1. The US is dependent on fossil fuels--a polluting and rapidly disappearing resource the need for which forces us to do business with regimes that reject modernization and citizens’ rights.
2. We lack good paying jobs for both high school and college grads (yes, they’re related, keep reading).
The solutions: More responsible short term solutions while we work on sustainable, alternate fuel sources for our future. These alternative energy sources include:
1. Giant solar collectors in the West and Southwest (NV, AZ, NM, parts of UT, CA, TX)
2. Giant wind farms
3. Giant wave farms in coastal states
4. Hydroelectric plants
5. Biomass fuels
How to do it:
1. Develop interim sources of energy i.e. natural gas, nuclear, coal -> coal gasification).
2. Conservation – if you use more, then you pay more for electricity and fuel. (Could do a private citizen cap and trade program as well as corporate—see below.)
3. Reduce oil use to match what we/Canada produce (no imports).
4. Within four year 25% of all our energy is clean and we do whatever it takes to get there.
5. Congress passes clear, tough, but achievable emissions standards and companies are issued credits to the allowable limits.
6. Companies under their quota sell excess credits to the feds. Companies over their limit purchase credits from the Feds at a premium. The surplus revenue helps to fund development of alternative energy resources: wind farms, solar collectors, hydroelectric plants, etc. (Items 1. & 2. are a new twist on “cap and trade”.)
7. Cost sharing of alternative energy production by public and private entities to produce electricity that is cabled to regional stations in USA and under both oceans for export (if possible—if not technically feasible, we export the equipment required for other nations to launch their own alternative energy production).
The Advantages:
1. Energy independence.
2. A cleaner environment.
3. Inexpensive, renewable energy supplies forever.
8. Jobs created: engineers, architects, CAD programmers, scientists, computer techs, administrative staff, HR specialists, construction workers, mechanics, accountants, international relations specialists, service staff (food, maintenance, grounds and landscaping, etc.)
9. High schools and colleges develop training programs specifically designed for energy plants to graduate skilled employees.
How to pay for it:
1. Reposition some military spending (see military section).
2. Use emissions credit revenues to provide cost sharing grants to private sector companies.
Monday, September 22, 2008
Education Reform
Education is the basis for all human progress. This country still leads the world in advanced learning. Our colleges and universities remain the most desirable for post secondary students worldwide. However, it has long been recognized that basic education in America is in large part failing to graduate enough students from high school and to deliver a useful education to many who do graduate. An alarming proportion of students are not competent (or even FUNCTIONAL) in reading, math and expressing themselves on paper (intelligible writing). Education spending doesn’t even make the top 10 on the list of Federal spending priorities. Not that all it takes to fix a broken K-12 is to throw money at it, however, a continuing deficiency in foundational public education has already taken its toll on our economy and will ultimately destroy the advantage we enjoy in higher education. In addition, high schools of the 1930s – 1960s had the responsibility of teaching life skills and marketable skills to their non-college-bound graduates. High schools of the past took that responsibility seriously with technical classes, agricultural classes, work-study programs and homemaking classes. Many high School graduates today have few decent long-term prospects and, along with many college grads, are considered both inexperienced and “unskilled” when they graduate.
These problems are complicated for an increasing number of students by obstacles outside the classroom ranging from lack of support to neglect and abuse.
The following thoughts are submitted to attack the troubles that afflict our education system:
Teachers:
1. Pay them decently! (How can we as a society justify paying entertainers, corporate execs and professional athletes tens of millions of dollars when the average teacher is an income bottom feeder in most states? We must attract the best and the brightest to teach our children. If an average college grad can earn more selling cell phone service plans than teaching kids, there’s something wrong.)
2. Require standardized credentials for all teachers nationwide (excluding subs). Teachers could then have a “national” license and could operate professionally in all states.
3. Require continuing education and minimal personal fitness levels (for able-bodied, of course) to advance.
4. There should be a tri-annual evaluation process conducted by a revolving 4 person board comprised of a peer teacher, an administrator, a parent and a community leader—all of whom would be given training in evaluation of educational best practices. Students would present input to the board on each teacher evaluated. This way 1/3 of all instructors would be evaluated each year and ALL teachers would go through the process every 3 years. The board would also adjudicate conflicts between teachers and parents when they arise. (Today’s teachers have little protection from idiot parents who threaten them or refuse to admit a serious problem affecting their child.)
5. NO TENURE!
6. There should be teacher recognition programs on the local, state, regional and national levels for various outstanding achievements (Those awards should ideally be linked to pay increases and establishing a priority position when requesting plum teaching assignments).
Students:
1. School should be safe, with an adequate physical plant and adequate supplies.
2. Eliminate suspension or expulsion (except in extreme cases and then they go to the Alternative School [or “reform school”!]). Appropriate restitution would be mandatory for most offenses against people and property.
3. A community service class would be part of every student’s graduation requirement.
4. PE DAILY (like actually MOVING) + lifetime fitness ed, sex ed and drug, alcohol, gambling, video game and other “addictions” ed. (If parents object to this, they will be required to provide this information to their children who will need to pass a proficiency exam to graduate.)
5. 4/4 work study programs for those who have selected a career path in high school – School 4 hours, work experience 4 hours for juniors and seniors. This would give them the “experience” they need to attract a decent job right out of high school or sample the career that they wish to pursue in college or tech school.
6. Core “proficiency tracks” meaning EVERYONE must pass standardized tests in reading, writing, math through algebra, computer operation, one foreign language, history and science. (The standardized tests would need to be reworked to adequately test these skills.)
7. There would then be “elective” choices like 4/4 or college prep classes or trade prep classes – i.e., high schools do a pretty good job with agriculture, mechanics, basic computer skills, clerical classes and could probably offer some pretty unique courses (this could fit with a public school voucher system – kids would go to the HS that had classes of interest to them so all HS’s in the district wouldn’t need to have all offerings).
8. All students would be assigned to a counselor who must see them at least 2x/semester and career counseling would be mandatory for juniors and seniors.
9. All schools would have food service for at least 2 meals (full pay and subsidized depending on need).
10. All schools would offer a safe place to study after school until 10 pm (or make arrangements with a neighborhood library or community center for same).
11. At least one school in each district would operate a “safe house” for student emergencies and for triaging students in crisis.
12. Remedial and special ed teachers would travel throughout the district.
13. Enrichment programs would be available to the brightest students after hours in a library or community center (so each school wouldn’t need its own, but the best students wouldn’t be “isolated” in a traditional magnet school).
14. Every school would “adopt” a sister school in another country and do two projects/year (in addition to basic communication) aimed at their sister school.
Community:
1. Encourage student aide and volunteer programs with “bonuses” from the community – like community service awards, discount memberships and merchandise certificates, basic commodities and supplies for the indigent and “points” toward Habitat for Humanity and other such help programs.
2. Encourage the purchase of “extras” that would improve the educational experience (supplemental books and videos, specialized equipment, a learning laboratory or a district rec center with staff, etc.) by giving the philanthropic wealthy (and anyone else who wishes to participate) substantial tax write-offs and credits (Fed, state, and local) for contributing to a community school FOUNDATION that would allocate funds throughout the district as needed.
Federal Funding: Obviously cutting back on our military overreach would just about solve the federal funding issues, especially where accountability standards (as above) are strictly enforced – a la No Child Left Behind only with money and a real plan. I would also mandate that every state “pork” project carry an EQUAL AMOUNT OF FEDERAL EDUCATION FUNDING and see how many of those slip through!
These problems are complicated for an increasing number of students by obstacles outside the classroom ranging from lack of support to neglect and abuse.
The following thoughts are submitted to attack the troubles that afflict our education system:
Teachers:
1. Pay them decently! (How can we as a society justify paying entertainers, corporate execs and professional athletes tens of millions of dollars when the average teacher is an income bottom feeder in most states? We must attract the best and the brightest to teach our children. If an average college grad can earn more selling cell phone service plans than teaching kids, there’s something wrong.)
2. Require standardized credentials for all teachers nationwide (excluding subs). Teachers could then have a “national” license and could operate professionally in all states.
3. Require continuing education and minimal personal fitness levels (for able-bodied, of course) to advance.
4. There should be a tri-annual evaluation process conducted by a revolving 4 person board comprised of a peer teacher, an administrator, a parent and a community leader—all of whom would be given training in evaluation of educational best practices. Students would present input to the board on each teacher evaluated. This way 1/3 of all instructors would be evaluated each year and ALL teachers would go through the process every 3 years. The board would also adjudicate conflicts between teachers and parents when they arise. (Today’s teachers have little protection from idiot parents who threaten them or refuse to admit a serious problem affecting their child.)
5. NO TENURE!
6. There should be teacher recognition programs on the local, state, regional and national levels for various outstanding achievements (Those awards should ideally be linked to pay increases and establishing a priority position when requesting plum teaching assignments).
Students:
1. School should be safe, with an adequate physical plant and adequate supplies.
2. Eliminate suspension or expulsion (except in extreme cases and then they go to the Alternative School [or “reform school”!]). Appropriate restitution would be mandatory for most offenses against people and property.
3. A community service class would be part of every student’s graduation requirement.
4. PE DAILY (like actually MOVING) + lifetime fitness ed, sex ed and drug, alcohol, gambling, video game and other “addictions” ed. (If parents object to this, they will be required to provide this information to their children who will need to pass a proficiency exam to graduate.)
5. 4/4 work study programs for those who have selected a career path in high school – School 4 hours, work experience 4 hours for juniors and seniors. This would give them the “experience” they need to attract a decent job right out of high school or sample the career that they wish to pursue in college or tech school.
6. Core “proficiency tracks” meaning EVERYONE must pass standardized tests in reading, writing, math through algebra, computer operation, one foreign language, history and science. (The standardized tests would need to be reworked to adequately test these skills.)
7. There would then be “elective” choices like 4/4 or college prep classes or trade prep classes – i.e., high schools do a pretty good job with agriculture, mechanics, basic computer skills, clerical classes and could probably offer some pretty unique courses (this could fit with a public school voucher system – kids would go to the HS that had classes of interest to them so all HS’s in the district wouldn’t need to have all offerings).
8. All students would be assigned to a counselor who must see them at least 2x/semester and career counseling would be mandatory for juniors and seniors.
9. All schools would have food service for at least 2 meals (full pay and subsidized depending on need).
10. All schools would offer a safe place to study after school until 10 pm (or make arrangements with a neighborhood library or community center for same).
11. At least one school in each district would operate a “safe house” for student emergencies and for triaging students in crisis.
12. Remedial and special ed teachers would travel throughout the district.
13. Enrichment programs would be available to the brightest students after hours in a library or community center (so each school wouldn’t need its own, but the best students wouldn’t be “isolated” in a traditional magnet school).
14. Every school would “adopt” a sister school in another country and do two projects/year (in addition to basic communication) aimed at their sister school.
Community:
1. Encourage student aide and volunteer programs with “bonuses” from the community – like community service awards, discount memberships and merchandise certificates, basic commodities and supplies for the indigent and “points” toward Habitat for Humanity and other such help programs.
2. Encourage the purchase of “extras” that would improve the educational experience (supplemental books and videos, specialized equipment, a learning laboratory or a district rec center with staff, etc.) by giving the philanthropic wealthy (and anyone else who wishes to participate) substantial tax write-offs and credits (Fed, state, and local) for contributing to a community school FOUNDATION that would allocate funds throughout the district as needed.
Federal Funding: Obviously cutting back on our military overreach would just about solve the federal funding issues, especially where accountability standards (as above) are strictly enforced – a la No Child Left Behind only with money and a real plan. I would also mandate that every state “pork” project carry an EQUAL AMOUNT OF FEDERAL EDUCATION FUNDING and see how many of those slip through!
Thursday, September 18, 2008
Health Care Reform
Since the ill-fated efforts of the Clinton Administration to pass a universal health care bill, middle class Americans have continued to strain under the weight of health care costs increasing annually well beyond the normal rate of inflation. Access to affordable health care has become increasingly elusive. The burden to American families has already become unbearable in many cases and will rapidly approach crisis for millions more within the next few years. Insurance costs alone for a family of 4 range between $500 - $1,500/MONTH! That does NOT count out of pocket costs for deductibles, copays and uncovered expenses.
I understand that the health care crisis is complex and multi-faceted. Higher expectations and demands for quality care on the part of consumers; more costly technology; too few health care professionals; the aging population; uncollectible bills; the outrageous cost of malpractice insurance (and lack of tort reform) and other problems all contribute to the high costs of care. However, there has not been any genuine effort made by Congress/the Executive Branch to tackle this convoluted social disaster that touches all Americans. If all Americans had the Congressional health plan, this would not be an issue.
Ideally, any successful plan must use the delivery systems in place as much as possible. “Socialized Medicine” a la Canada, Great Britain or Germany is surely not the answer for Americans. However, with some creative thinking, our nation’s policy makers could come up with a workable solution—or at least make a good start at fixing this problem. Since no answers seem to be forthcoming from Congress, here are a few suggestions.
The U.S. offers the finest health care in the world, bar none. It is based primarily on private sector health care providers compensated through a private, insured payer system. There is nothing wrong with this model, in my view. But, here’s where it could be dramatically improved with some help from Congress:
1. EVERY working individual would contribute 5% of wages (up to the taxable wage base) toward their own health care and automatically become an insured “member” as a condition of employment. Individuals outside the standard employment environment would contribute 5% of taxable income up to the wage base. They could opt out of “membership”, but the consequence would be: a) medical service providers would NOT be required to give care without proof of cash payment and b) the “non-member” could not sue a care giver.
2. EVERY employer would contribute an additional payroll tax of 5% on each employee. The “pool” of payroll tax money comprised of employee and employer dollars would be used to purchase medical coverage for all employees. Any excess funds could be used to offset deductibles, copays and unreimbursed medical expenses or simply added to the employee flex plan pro rata.
3. What this would do is provide an infusion of capital into the health care system and all employed individuals would have a “stake” in health care issues. This would also increase the pool of insured individuals and spread risks over more people. Currently, the uninsured are largely the young, healthy, low-wage earners who could drastically improve the risk pool if they were a) included in it and b) helping to pay for it. This major initiative will pay for items 4. and 5. below and could possibly augment first dollar care for employees whose employers make cost effective insurance choices.
4. Tax CREDITS should be offered to employers who subsidize medical insurance costs beyond a basic minimum. Now those costs for employees are tax deductible, but an additional CREDIT could be offered to encourage more generous private employer participation.
5. Tax CREDITS should be offered to INSURERS who will discount their costs under a variety of conditions. For example, insurers who negotiate with a regional coalition of private employers would receive the credit; a trade association or state Chamber of Commerce would receive a “grant”. Insurers could qualify for a credit by providing reduced-cost coverage to a group of the lowest paid workers—such as fast food employees—under a “group” plan unrelated to specific employers.
6. Another option might be to eliminate for-profit insurers. For example, insurance could be provided only by private nonprofit insurers like the Blues with “grants” earned as above for cost-cutting negotiations with groups of employers.
7. A Tax DEDUCTION should be offered to physicians and other health care providers who will reduce costs to conform to a “usual, reasonable and customary” DISCOUNTED scale for their area. There should also be tax incentives given for building “Urgent Care”, “Quick Care” and “Outpatient Clinics” meeting certain requirements for low cost, but effective delivery of medical care in a community—not just for the indigent, but for the entire community with all participating private health care providers receiving some of the revenues.
8. Nurses and Physicians’ Assistants need more legal authority to provide a broader range of medical services. In some cases, these fine professionals are more capable of delivering routine care than the physicians they serve and may shift some of the patient care to lower cost providers with outstanding results for patients. (This measure, of course would require buy-in by the physician community [perhaps the trade for greater tax benefits] AND tort reform.)
9. Tort reform and malpractice reform are a must. The incidence of truly negligent or malicious malpractice is minute, yet multi-million dollar judgments are awarded daily in this country for what could only be described as medical “maloccurence”. If huge settlements were awarded only for a legitimate breach of professional responsibility, malpractice insurance premiums would plummet and a real case could be made for physicians to reduce fees and they would comply, especially when offered the tax deductions available for negotiating their charges (See 4. above). Judgments AND attorneys’ fees would be limited since attorneys constitute a monopoly in each state (known as the BAR Association). In cases of so-called malpractice, their fees should be regulated in the same way that states regulate their power companies.
10. Somewhat off the main topic, but an important consideration in this discussion is prescription drugs. It is nothing short of criminal that other countries may “pirate” our R&D and knock off drugs at low cost. Where does AARP think these medications come from? As a nation, we should be CHARGING other countries “development fees” to help offset the enormous cost of discovering and testing medications that prolong and improve the lives of people worldwide and for which U.S. companies get hammered because the high cost of prescription medication in the US.
11. Finally, a word about unemployed and retired Americans. The Medicare system has worked reasonably well for decades, but Medicaid bears a social stigma AND does not have adequate accountability features. It would be more effective to provide a health care “credit card” to the able-bodied unemployed that required a demonstrable effort to obtain legal, above the table employment to continue its use. This would have the two-fold advantage of insuring more of the uninsured unemployed and eliminating some of the money that changes hands without taxation—including gains from organized crime.
12. Not all of these suggestions are without cost, although several do bring more money into the health care system or into the tax system in general. However, none of these reforms would require a fundamental change in our outstanding health care delivery system or a large, new bureaucracy to operate. The savings achieved by reducing the number of frivolous lawsuits (and their attendant financial drain on our economy) might significantly mitigate the revenue required to implement the main parts of this program.
I understand that the health care crisis is complex and multi-faceted. Higher expectations and demands for quality care on the part of consumers; more costly technology; too few health care professionals; the aging population; uncollectible bills; the outrageous cost of malpractice insurance (and lack of tort reform) and other problems all contribute to the high costs of care. However, there has not been any genuine effort made by Congress/the Executive Branch to tackle this convoluted social disaster that touches all Americans. If all Americans had the Congressional health plan, this would not be an issue.
Ideally, any successful plan must use the delivery systems in place as much as possible. “Socialized Medicine” a la Canada, Great Britain or Germany is surely not the answer for Americans. However, with some creative thinking, our nation’s policy makers could come up with a workable solution—or at least make a good start at fixing this problem. Since no answers seem to be forthcoming from Congress, here are a few suggestions.
The U.S. offers the finest health care in the world, bar none. It is based primarily on private sector health care providers compensated through a private, insured payer system. There is nothing wrong with this model, in my view. But, here’s where it could be dramatically improved with some help from Congress:
1. EVERY working individual would contribute 5% of wages (up to the taxable wage base) toward their own health care and automatically become an insured “member” as a condition of employment. Individuals outside the standard employment environment would contribute 5% of taxable income up to the wage base. They could opt out of “membership”, but the consequence would be: a) medical service providers would NOT be required to give care without proof of cash payment and b) the “non-member” could not sue a care giver.
2. EVERY employer would contribute an additional payroll tax of 5% on each employee. The “pool” of payroll tax money comprised of employee and employer dollars would be used to purchase medical coverage for all employees. Any excess funds could be used to offset deductibles, copays and unreimbursed medical expenses or simply added to the employee flex plan pro rata.
3. What this would do is provide an infusion of capital into the health care system and all employed individuals would have a “stake” in health care issues. This would also increase the pool of insured individuals and spread risks over more people. Currently, the uninsured are largely the young, healthy, low-wage earners who could drastically improve the risk pool if they were a) included in it and b) helping to pay for it. This major initiative will pay for items 4. and 5. below and could possibly augment first dollar care for employees whose employers make cost effective insurance choices.
4. Tax CREDITS should be offered to employers who subsidize medical insurance costs beyond a basic minimum. Now those costs for employees are tax deductible, but an additional CREDIT could be offered to encourage more generous private employer participation.
5. Tax CREDITS should be offered to INSURERS who will discount their costs under a variety of conditions. For example, insurers who negotiate with a regional coalition of private employers would receive the credit; a trade association or state Chamber of Commerce would receive a “grant”. Insurers could qualify for a credit by providing reduced-cost coverage to a group of the lowest paid workers—such as fast food employees—under a “group” plan unrelated to specific employers.
6. Another option might be to eliminate for-profit insurers. For example, insurance could be provided only by private nonprofit insurers like the Blues with “grants” earned as above for cost-cutting negotiations with groups of employers.
7. A Tax DEDUCTION should be offered to physicians and other health care providers who will reduce costs to conform to a “usual, reasonable and customary” DISCOUNTED scale for their area. There should also be tax incentives given for building “Urgent Care”, “Quick Care” and “Outpatient Clinics” meeting certain requirements for low cost, but effective delivery of medical care in a community—not just for the indigent, but for the entire community with all participating private health care providers receiving some of the revenues.
8. Nurses and Physicians’ Assistants need more legal authority to provide a broader range of medical services. In some cases, these fine professionals are more capable of delivering routine care than the physicians they serve and may shift some of the patient care to lower cost providers with outstanding results for patients. (This measure, of course would require buy-in by the physician community [perhaps the trade for greater tax benefits] AND tort reform.)
9. Tort reform and malpractice reform are a must. The incidence of truly negligent or malicious malpractice is minute, yet multi-million dollar judgments are awarded daily in this country for what could only be described as medical “maloccurence”. If huge settlements were awarded only for a legitimate breach of professional responsibility, malpractice insurance premiums would plummet and a real case could be made for physicians to reduce fees and they would comply, especially when offered the tax deductions available for negotiating their charges (See 4. above). Judgments AND attorneys’ fees would be limited since attorneys constitute a monopoly in each state (known as the BAR Association). In cases of so-called malpractice, their fees should be regulated in the same way that states regulate their power companies.
10. Somewhat off the main topic, but an important consideration in this discussion is prescription drugs. It is nothing short of criminal that other countries may “pirate” our R&D and knock off drugs at low cost. Where does AARP think these medications come from? As a nation, we should be CHARGING other countries “development fees” to help offset the enormous cost of discovering and testing medications that prolong and improve the lives of people worldwide and for which U.S. companies get hammered because the high cost of prescription medication in the US.
11. Finally, a word about unemployed and retired Americans. The Medicare system has worked reasonably well for decades, but Medicaid bears a social stigma AND does not have adequate accountability features. It would be more effective to provide a health care “credit card” to the able-bodied unemployed that required a demonstrable effort to obtain legal, above the table employment to continue its use. This would have the two-fold advantage of insuring more of the uninsured unemployed and eliminating some of the money that changes hands without taxation—including gains from organized crime.
12. Not all of these suggestions are without cost, although several do bring more money into the health care system or into the tax system in general. However, none of these reforms would require a fundamental change in our outstanding health care delivery system or a large, new bureaucracy to operate. The savings achieved by reducing the number of frivolous lawsuits (and their attendant financial drain on our economy) might significantly mitigate the revenue required to implement the main parts of this program.
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