Addressing some of the questions
#1 Medicare does not process payments to
providers- They contract with private companies to do that and those companies
may be insurance companies but the important thing to note is that the reason
the claims are processed for 3% is that the work is contracted to private “for
profit companies”.
#8 Medicare or any system must audit for
fraud and there may cases of bogus providers billing Medicare for services not
used but coded in such a manner as to facilitate payments. Providing
electronic audits of the data stream can identify those providers who attempt
to milk the system by understanding it and then attempting to beat it. It
may be the number of claims filed using a particular code that based on the
population matrix is to high which then triggers further investigation.
Any system without safeguards is to invite corruption. We have designed a data
base which records by drug or service code processed payments to check for
price variance on identical things and to different patients by provider.
The logic is to catch processing errors and to ensure compliance with the law
that requires the same price be charged for identical items to all of our
subscribers.
The items covered are what are already is in
current law as deductible medical expenses listed in many IRS publications applicable
to personal income taxes deductibles and the rules which govern HSA, HRA and
FSA medical reimbursement accounts. Cosmetic items are not allowed under
current rules.
Paul Double
-----Original Message-----
From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] On Behalf
Of Davis, William MD
Sent: Thursday, March
23, 2006 5:40 PM
To: [email protected]
Subject: RE: [Winona]
Medical-loss ratios of largest for-profit insurers
I started a reply but I must have hit the
wrong key so I will try again. I find Paul’s idea very
intriguing. It provides a single payer system with universal
coverage. The poor pay little or nothing and the rest pay up to 7.5% of their
income on medical care. I like the smart cards but I would suggest
eliminating the insurance companies as middle-men for the processing and just
have the federal government pay directly. They would issue the card and
it would kick in when the person reached the 7.5% deductible for the
year. There are a few issues that would need to be decided. What
types of care would not be covered (cosmetic, etc.). How the fee schedule
would be established. Very interesting! Paul, please explain
in more detail #8. I don’t understand that step. Bill
William Davis MD
[EMAIL PROTECTED]
507.454.5050 ext 623
825 Mankato Ave
Winona MN 55987
"Two seconds is too long!"
Neal Patterson CEO Cerner Corp
From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] On Behalf
Of Paul Double
Sent: Wednesday,
March 22, 2006 9:10 AM
To: Online Democracy
Subject: [Winona]
Medical-loss ratios of largest for-profit insurers
A single payer can be simple
1) Every tax payer would be required
to spend 7.5% (Current IRS Disallowance) of the reported taxable income in the
prior year which becomes their deductible for the current year. Medical
expenses include Chiropractic, Dental, Medical, Medical Supplies, Non Traditional,
Prescriptions, Psychological and Vision
2) Everything over the 7.5% is paid
by the government as catastrophic coverage.
3) All purchases are tracked with a
smart card to insure the deductible is paid which is charged at the time of
first use in the then current year based on the prior tax year filing.
The current cycle year is July 1- June 30 based on calendar years for
establishing the tax year base for the deductible. This allows the period
January to June for taxes to be processed for the prior year and the data to
roll into the data base establishing the base line for the deductible.
4) The Federal government contracts
the payment processing to providers, the same as they currently do for
Medicare, for 3% or less.
5) Coverage is afforded at birth to
age 65. Medicare remains the same except Part D is added using the
Medicare 3% payment system eliminating insurance.
6) The cost less than $1.50 per
month times each person’s age, adult or child paid for by either an
employee or employer tax.
7) All federal employees and Congress
would become a part of the plan with no exceptions.
8) Cost control of providers is achieved
with electronic hard data based on actual payment processed.
The solution is logical, affordable and easy
to put in place. The political will to do it is not yet there!
Paul Double
