<![CDATA[Haley2024 the Movement - Blog on Health Care]]>Sun, 28 Apr 2024 13:42:23 -0400Weebly<![CDATA[The CRA Structure Will Thrive in a Pandemic Scare]]>Sun, 22 Mar 2020 19:49:27 GMThttp://haley2024.org/blog-on-health-care/the-cra-structure-will-thrive-in-a-pandemic-scare
​On March 22nd, 2020, the world is going through the Coronavirus scare.  Most people think that this is a time for the government to step up.  In fact, the most significant steps are being taken by the private sector.  While the government is and should be stepping up, the current government structure is inhibiting many innovative business/healthcare/charity/employment/financial/education/other models.  
​The CRA Structure allows a competition of governance, competing to become the best at creating solutions to substantial problems.  This CRA Structure also allows a representative body with executive power to handle some things that need to be done across the board.  Separating all governmental authorities into thirty Sectors allow top elected leaders to have 100% focus on just their Sector.
​However, the CRA Structure leaves most issues at the CRA level, and the vast majority of matters facilitated through CRA’s.  The CRA Structure allows CRA’s to be heavily involved or very lightly involved in regulating and mandating its members.  The Rating Floors could come in very useful.      
​Every Charity Economy, CRA and CRA organization would have a competition for the best planning, and implementation of everything listed below and much more.  The Rating System will rate and inform from a wide variety of perspectives.  Rating Floors could be raised in certain areas.  Both Health Care Sectors will have Sector Boards, which will have the authority with a 70% vote to govern over all CRA’s within the Sector only after trying Rating Floors.
​While the current president and governors are taking down some barriers to solutions, most obstacles remain.  Current labor laws make it hard to repurpose labor.  Licensing requirements inhibit a rapid increase in supply.  A lot of information and misinformation is out there, and people have a hard time trusting news sources.  We do not have the organizations needed to deal with spikes in demand.   
​The current government is looking at sending thousands of dollars to every American.  This is wildly irresponsible.  With tens of millions of people having their hours cut or totally losing their jobs, production is way down.  Our capital stock is taking a big hit.  When the government borrows trillions of dollars from capital stocks, for mostly consumption, our capital stock dwindles even further. 
​Our capital stock is directly tied to our ability to recover.  With a lower capital stock, we are going to be able to buy shovels versus backhoes.  Meaning, our productivity suffers, therefore our average income and standard of living.  Below, I address many issues related to people in hard times. 
​Money should always go from the people to the government and never from the government to the people.  This obviously excludes people working for government or government buying products and services.  It is an economic truth that the government must first take from the people to give to the people.  Increased tax rates lower economic activity.  The role of prices ensures that everyone pays taxes.  All taxes harm the poor the most.   
​The competitiveness of the CRA Structure allows dozens of government responses and hundreds and even thousands of private sector responses.  With about a dozen CRA’s doing their own models, the inferior methods would quickly fade, and the better processes would be improved. 

The Charity Economy

​The Charity Economy will play a significant role in crisis situations.  Every person will be a member of a Charity CRA, thus associated with a Charity Economy.  They will also be part of the Sector Board Charity Economy.  The Charity Economy will have a spreadsheet on all its members’ education, certifications, talents, equipment, and abilities.  This includes people and businesses.  Non-profit organizations, like clubs, scouts, churches, schools, among others, would be able to list their skills and abilities.
​The Charity Economy could quickly staff up for-profit businesses with established contracts or quickly put new arrangements together.  Many models would be considered in good times, so the correct models could be chosen when an issue arises. 
In non-crisis times, many people will learn how to be managers.  Current managers, teachers, stay at home mothers, and retired folks would be ideal.  A proper hierarchy and protocols will be established.  These ‘managers’ would be behind their computer screen with every tool and app available.  These managers would quickly build teams of adequate size and ability. 
​At the current date in late March 2020, unemployment is spiking.  These people and these businesses could be rapidly repurposed for the new temporary economy until the crisis is over, and the normal economy can be reestablished.  With roughly a dozen Charity Economies competing to do the best jobs, inadequate protocols will quickly be replaced.  The goal of a Charity Economy is to get people back into the regular economy as soon as possible. 
​The current national guard and FEMA addresses some of these concerns.  The CRA’s in all Sectors certainly will utilize the talents of the national guard and FEMA.  Some of these assets would be in the Military Sector and others in the Police Sector.  Many private sector businesses would take over these assets and contract with many of these and other Sectors.  The Sector Boards would ensure all areas are covered.   

Teenagers

One of the great ideas within the CRA Structure is that people need to start taking on their citizen’s responsibilities at the age of 13.  They are required to take out law enforcement, court, and prison contracts with a minimum financial obligation.  Starting at the age of 13, everyone must contribute roughly 5% of their earnings to charity through a CDA, with a minimum of approximately $1,200 a year.  The military is funded by sales taxes.
These two more substantial commitments and the requirement to start paying CRA and RA fees would create a minimum of roughly $3,000 per year in obligations.  All these obligations could be paid for with labor hours in the Charity Economies, CRA’s, RA’s, directly with companies, among other places.  It is likely that the first couple of years in the early teens would be training, on the job preparation, and learning the skills to be productive in the future. 
​A person’s Identity CRA would provide record-keeping on abilities and certifications.  There are 10’s of millions of teenagers in America.  If they do many courses of training and certifications, all documented in their Identity CRA spreadsheet.  These teens could quickly be put on teams to enhance capabilities when big things happen.  Imagine if millions of teenage girls could quickly be matched to families needing child-care when the schools shut down.  Planning in good times is key.          

The Rating System

​The Rating System would inform.  Having a competitive system requires a wide variety of perspectives.  The common man would quickly see the majority opinion and those with extreme views.  People will see many write-ups on the history of past predictions and every RA’s opinion about those opinions.  Every Sector having a complete Rating System will focus every RA to just their expertise.  This will create checks and balances.    

The Mandate to Debate

There is currently a lot of mistrust of information.  People do not want to trust the politicians from the other party.  There is a lot of reasons for suspicion from all party-affiliated politicians or pundits.  Experts with degrees and fancy titles wildly disagree on many issues.  It would be beneficial if the top 1,000 experts from a wide variety of disciplines and experiences determined the top 10 or 20 questions and have debates online.  These top 1,000 experts would come proportionally from each Rating Agency.     
​One of the mandates of an official RA is the mandate to debate the other RA’s.  Misinformation surrounds all events.  RA’s would employ experts in their Sector.  Science is often very debatable.  The interpretation and the full context of science are profoundly unsettled.  These experts, to some degree, would post questions.  The 1,000 experts would narrow the issues down with votes and debates.  All points would need a score from the other experts.    
The common man, politicians, and business leaders would quickly see how many experts agree with each issue.  There would be people designated to keep things simple with links for greater write-ups.  The Media and Communications Sector’s Rating System will have an easy to understand rating on the press.  The press and media teams from all RA’s would likely rate on truthfulness, context, fairness, and other relevant factors.   

Taxes

​The Parent Sector Board, with a 70% vote, could establish a temporary tax to fund a specific Sector Board.  The Parent Sector Board could require an increase in CRA fees, so the funding stays at the competitive CRA level.  The likely first step is a Rating Floor increase on funding every members’ CRA to deal with the issue. 
In a pandemic situation, the Health Care Sectors would need quick funding.  All members mandated to fund their CRA an additional $100 could bring $30 billion quickly.  CRA’s that keep that type of assets in reserve would likely be rated high.  The Parent Sector Board could temporarily increase the mandated charity contribution percentage and minimum.      

Monetary and Fiscal Policy

​Sound money is far superior to government-created paper without inherent value.  Currency is a service that allows people to trade a universal good for a specific product.  The free enterprise system provides the best services.  Sound money is a certificate of ownership of items of real value such as land, stocks, bonds, commodities, and precious metals.  Haley2024 calls for about a dozen Financial Competitive Regulatory Agencies that regulate their member banks to issue their own currency.
​Having competition of roughly a dozen ‘central-banks’ means losing monopoly control.  The competition will quickly show healthy and inferior results.  As assets gain or lose value, it will promptly be realized within the value of money.  CRA Asset Portfolios making bad decisions will lose units of currency, and those making wise decisions would gain units.  Just like everywhere else within the free market, poorly run businesses lose their ability to control labor hours.  Yielding those labor hours to better-run companies.    
​All deficit spending needs to be tied directly to a future detailed tax.  That tax creates worth, thus an asset within a currency portfolio.  Most terms on those tax contracts will specify a higher tax rate when the overall tax rate is increased to compensate for the Laffer Curve effects.  This will restrain excess spending paid for with tomorrows money.  
Currency is a service from free enterprise’s invisible hand keeping a ledger that facilitates one-sided provision, yet two-party trades at different times, at different values, and the services provided going to and from the universe of all traders in proportion to each person’s provision.

Interest rates are the price of the use of capital over time.  Prices are always the best method of distributing goods, thus the best way to allocate capital.
​The role of prices is highly valuable to achieve the proper levels of goods and services.  Prices are also the best way to allocate products and services.  Anti ‘price gouging’ laws do significant damage.  People truly need to learn the benefits of increased prices in crisis times, so attitudes and opinions can allow prices to work.  The hostility to increased prices does real harm in allowing additional supplies and services to enter the marketplace.   
​There are hundreds of price controls within the current government and the Federal Reserve.  These price controls, which include price distortions from mandates, bans, government spending, taxes, and favorable or unfavorable treatment of select people/businesses and sectors of the economy, do significant damage to the benefits of the role of prices. 

To Those with Financial Hard Times

​The first line of help will be your rainy-day funds and the insurance you bought, such as unemployment and medical, which is now private.  Your Charity Economy would be high on the list.  Terms of unemployment insurance are likely to include rapid entrance to the Charity Economy.  You could sell a percentage of your income, or a straight dollar figure, for the next several years to a Monetary Asset Portfolio in exchange for currency right now (personal loan).
Your family could play a big part.  Finally, as a last resort, you can go to a Charitable Distribution Association (CDA) with your needs.  They can assign you to a Charity Assessor Organization (AO), where they will use their subjective determination to provide you with assistance. 

Some Basic Ideas

​The 3.5 million schoolteachers in America have a four-year bachelor’s degree.  Each one of them should have a semester of nursing school within their education degree.  This would come in handy in ordinary times within the classroom.  However, in a pandemic, when health care needs overwhelm the 3.1 million RN’s, these teachers can be repurposed into health care.  To keep skills current and refreshed, these teachers could have ongoing healthcare education, assist at hospitals, doctor’s offices, and home health in the summer months. 
​To handle the spike in demand situations, many professions could cross-train.  For an increase in security spikes and to give year-round security in schools, many teachers should go through the police academy.  They could do police shifts in the summer months to keep their training up.  Many more cross-training opportunities are available. 
​Every school has classrooms that could double as hospital rooms.  Other suitable rooms within businesses should be considered.  Nursing homes are already set up similar to hospital rooms.  Plans should be made to bring in needed supplies, machines, and personnel, so hospitals are not overwhelmed.  Telemedicine would increase capabilities. 
The elderly have more significant vulnerabilities to illnesses.  Teenagers should set up and maintain the elderly with video-chat with many apps.  The elderly have experience and wisdom in many professions.  With many people repurposed in their jobs, the elderly could watch over, mentor, direct, and educate repurposed labor.   The elderly need companionship and a sense they are needed.    
Businesses with established teams of managers and employees that must shut down because of a loss of business should be given new suitable tasks.  Planning well ahead of time would be useful. 

Health care industries should have a Rating Floor on having excess supplies to handle spikes in demand.  This includes many of the current out of stock issues such as sanitizers, medical equipment, and personal protective equipment.  
Retired RN’s should have many part-time opportunities to keep skills fresh, so they can be a backup force.   

The ideas in the Haley2024 Blog: Robust Medical Records, could help in hundreds of significant ways. 
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<![CDATA[But! I Want to Keep My Family Plan!]]>Sat, 26 Oct 2019 02:06:15 GMThttp://haley2024.org/blog-on-health-care/but-i-want-to-keep-my-family-plan
​By Bill Haley 10/25/2019
It is the yearly health care open enrollment season, and I am not happy.  I take great pride in my family, and government regulations are firmly nudging my wife and me to have separate health insurance policies.  It is not as bad as the government offering benefits to a mother if the wage-earning father does not live with his children, but I want to keep my family plan!  I am a family man, and it matters to me! 
​My story of health insurance started back in 1993.  That year I started a new job, and my first child was born.  When my wife, Ruth, became pregnant, there was no doubt we would be a one-income family; thus, I signed up for the family plan through my new employer.  I thought it was strange that I had to change health insurance when I changed employers, so I looked into it.   

A Little History

​It turns out that in the great depression, FDR put wage controls on employers, thus removing the vital role of prices in the labor market.  Employers worked around the issue by offering health insurance benefits.  Later, when the wage controls were lifted, congress inserted a loophole in the tax code to exempt employer-provided health insurance from income taxes.  The same tax deduction was not offered to people buying health insurance separate from employment.  When tax rates were over 50%, the extra tax burden pushed the vast percentage of health insurance policies through employers.  When people interviewed for a new job, they had to consider insurance policies as well.   

The Early Years

​Two weeks after my first daughter was born, Ruth and I received some devastating news.  My sweet Emily was diagnosed with a disease that took two of my sisters away from me.  We knew that many hospitalizations were in the future, and the medications were going to be expensive.  While Ruth and I dealt with the emotions of a sick infant and toddler going to the hospital for a two-week stay every couple of months, we also dealt with health insurance and my job. 
​I was scared to death of being laid off or making a mistake where I could get fired.  My company was self-insured and was paying two to three times my salary in health care claims.  I did not dream of changing employers because the risk of preexisting condition clauses might leave my child without much-needed healthcare.  I tried not to take many days off from work because I did not want my employer looking into how much I cost the company. 
​Through the first ten years of Emily’s life, I heard of many fathers abandoning their families because of the stress of constant hospitalizations.  They were right that it was hard, stressful, and gut-wrenching.  My marriage was always strong, but I understood how the stress, heartache, and financial difficulties strained at the marital bonds.  I went strong in the other way and took great pride in being a family man.  I had three other children as well, and all four of my children needed a father and their mother.  I also needed to show them a proper husband and wife relationship.  We needed to model a healthy family.  

2004 Was the Most Amazing and Difficult Year of My Life

​Early in 2004, the doctors told Ruth and me that Emily needed to go on the lung transplant list.  That is not an easy conversation with the doctors or with Emily.  In May, the hospital sent us a letter that the insurance was not likely going to cover the VERY expensive transplant.  They were dealing with a lifetime maximum on the health insurance as well as several items surrounding a lung transplant that the insurance does not cover.  The hospital ‘strongly’ suggested that we have $500,000 in fundraising.  
​The last seven months of 2004 was full of major fundraisers averaging twice a week.  Chili-cookoffs, softball and golf tournaments, road rallies, raffles, vacation bible school, concerts, major league baseball players signing baseballs, bake sales, silent auctions, and others often raised five figures.  The schedule was grueling; however, the outpouring of love and donations touched Ruth and me in significant ways.  The amount of volunteer hours from family and friends encouraging the donations of $515,154 is a testimony of God profoundly working through His people. 

The Next Three Years

​Miraculously, the lifetime insurance limit was raised from $750,000 to $1 million as we topped $700,000.  You can not just order up the lungs when the money is there.  There was still a waiting period.  Emily was put on the list a little early, so she would be near the top of the list when she hit the crucial window of usable lung function.  If you wait until you are in that window, the window is likely to close on the bad side.  Emily continued with hospitalizations every two months and expensive daily treatments at home. 
​While I was pretty established at my job, I always had that fear that if I was separated from my employer, that my insurance would go with it.  No insurer or employer wants to sign up to cover over $100,000 per year of claims, especially with a well-publicized transplant on the horizon or new high-cost medications in the final stages of the FDA approval.  The window of useful lung function opened and closed within a day with a nasty infection.  Sadly, I received my last medical bill for Emily in April of 2008, totaling over $200,000 for her final two weeks. 

A Two-Income Family

​For the last eleven years, we became a typical medical use family.  As my three daughters became teenagers, Ruth went back to school and entered the workforce in 2014.  Ruth’s employer offered insurance, and we discovered a dilemma we had not dealt with before.  The ACA (Obamacare) forced employers to charge employees a surcharge if their spouse was also offered insurance by an employer.  The law is firmly nudging two-income families to have separate insurance by mandating a $1,200 surcharge.    
If the family decides that one insurance is better than the other, the company with the better coverage must bear the financial weight of covering the entire family, leaving the employer with low-quality insurance without any burden.  Ruth’s employer offered a good plan; however, we are a family, so we paid the surcharge.  Ruth’s employer's financial burden was lessened, and my employer paid more. 

My Daughter’s Family

​This year, I am calling my 24-year old married daughter about health insurance.  She could get insurance through Ruth’s or my employer.  My daughter’s employer is offering health insurance.  She also has options of her husband’s military reserve coverage and her husband’s employer’s health insurance, thus five options.  All the options have a cost to my daughter, but all the alternatives also have a cost or savings for each of the five employers.  Every insurance option has different doctors that are preferred and have different terms, so that is a significant factor as well.    

The Solution

​Economics is the study of incentives, and this is just a few of the several hundred perverse incentives harming America's health care system.  The perverse incentive created by the ACA to move away from the family plan really hits me the wrong way.  Most problems surrounding health care can find their origins within government regulations.  The best solutions are not to add more regulations or fix what is there; the best solution is simply to start rapidly repealing regulations.  If you are strictly looking at the issues addressed here, let’s move away from health insurance being tied to employers.   
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<![CDATA[The Government Agrees to Pay for Medical Care: Let the Games Begin; Part 1 of 7,983]]>Wed, 10 Jul 2019 01:37:47 GMThttp://haley2024.org/blog-on-health-care/the-government-agrees-to-pay-for-medical-care-let-the-games-begin-part-1-of-7983
The Government agrees to pay for medical bills of all Americans.  They tax and put in $1 trillion in the budget.  On January 1st at 12:01 am in Maine, the first doctor bill arrives via online payments.  A regular doctor visit for a common cold was the medical service.  The first doctor charged $1 trillion for his services, and the entire budget is exhausted.  Now, most people will say that is ridiculous, it does not cost that much for one visit.  Therein lies the issue.  How much will the government pay for an appointment?  The government must set a top price.  Once the top price is set, there is no reason for a doctor to charge less than the top rate. 
Let us assume that the government set the price at $100, and doctors started making one-minute appointments.  The doctor had 20 one-minute appointments to examine 20 things about the patient.  One appointment for the nose, the next for the throat, and another for the ears.  Each finger needed to be examined, and each finger had its own appointment.  The doctor sends in a bill for $2,000 instead of $100.  The Government says that is preposterous and only pays for one appointment.  Other doctors force the issue until the government must set up standards of how long and what is included in a visit. 
Can a doctor charge for every gauze pad and every tongue depressor?  Can the nurse charge to take your blood pressure?  Can the doctor add a facility charge?  Can the doctors add fees for 2 am visits?  Can the doctor charge for a phone call with a quick question as a separate $100 visit?  Can the high cost of living areas charge more than the low cost of living areas?  Can the office staff charge for doing paperwork?   The government will be tested on each and every one of these hundreds of questions.  The government must set up standards of what they will pay. 
A doctor without many patients asks their patients to come weekly to enhance the doctor’s billing.  The government sees the potential for this abuse and now must set standards on how sick a patient must be before they are seen by the doctors.  The doctors must fight with the government continually claiming there is a medical need. 
Patients that are hypochondriacs want to go to the doctors often and learn the correct symptoms that need to be stated to be seen right away.  Other people are ignorant and do not list the proper symptoms, and their appointment is canceled or delayed for lack of medical need.  The potential for problems grows tremendously when the government decides if a patient is sick enough to be seen.   
Sometimes the government sets its payment level at a certain percentage of the bill as one of many price controls.  If a doctor wants $100 for a service and the government sets its rate at 90%, the doctor sets their price at $110.  The government sees the price increase and lowers the percentage to 80%.  The doctor counters by billing $125.  The government counters with a 50% cut and the doctor bill goes to $200. 
Sometimes the government might use reasonable and customary rates as its method of price controls.  The doctor office knows that this is a method for some payments and increase its prices very high to ensure they never bill under the maximum allowable amount.  It is common to see a medical bill of $893 for a service or medical product and the reasonable and customary price cutting that price to $47.
As one should clearly see, that once government becomes the payer, they must significantly micromanage a doctor’s office.  The government decides the price, the definition of a procedure, extras that can be charged, how sick someone must be to be seen, and hundreds of other factors. 
Business models are limited by this micromanagement.  Often, when the government decides that they will pay, the government also makes it illegal to charge patients surcharges.  Often doing business outside of government payments and control is outlawed. 
In the free enterprise system, businesses, service providers, product manufacturers, and others must continually assess their prices.  Quality changes, convenience services, additional services, and other business model changes are evaluated continuously.  Customer demands are catered to if the customers are willing to pay the price.  A new doctor might need to lower his price or work nights to gain patients.  The best doctor in town needs to increase their price to keep a manageable patient level.   
The first rule of economics is that changing circumstances change people’s behavior.  The change of who pays is a highly significant change in circumstances.  The customer (patient) no longer makes decisions based on price.  The doctors no longer have those price level tools to gain business or limit business to their level of supply.
The golden rule of, he who has the gold makes the rules, becomes very relevant.  He who pays determines who gets paid, for what services they will pay for, the qualifications to get services, and a whole host of other decisions moves from the buyer and seller of services to the payer of those services.
A government Medicaid rule allowed facility fees for MRI’s in the hospital; however, not in doctor offices.  This, along with many other similar regulations, resulted in business model changes for doctors.  Many doctor offices were bought by hospitals. 
In conclusion, the stories of business model changes are profound in many areas of health care based on government regulations and not market demands.  People often wonder why a doctor’s office does not post prices on walls, websites, or flyers.  Some of these price ‘games’ are a big part of the answer.     
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<![CDATA[The FDA]]>Sun, 24 Mar 2019 02:11:47 GMThttp://haley2024.org/blog-on-health-care/the-fda
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This started out as Sector Page in 2015.  In 2019, I am switching it to a blog post.  During those four years, the thirty Sectors have been decided, and food has its own Sector.  The pharmaceutical part of Medical has its own Sector.   
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Currently, the FDA takes years to approve new treatments or drugs.  During the wait, hundreds, if not thousands, of people can die while waiting for treatment.  The reason for this wait is that all regulatory power is in the hands of the FDA.  Competitive Regulatory Agencies would spread out the authority and make it easier to get new treatments and drugs to markets. 
Different CRA's could set different standards and Rating Floors for new products.  Some people would value long time frames and safety testing, while others would value getting treatments to people as quickly as possible.
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For example, e-cigarettes have been used in Europe to help smokers quit smoking.  However, the FDA has been threatening to ban them, because they "may" be harmful.  Because the FDA is the only organization with regulatory power, they can do this: however, different Rating Agencies could rate the e-cigarettes differently. 
One organization could put more value on the ability of e-cigarettes in order to help smokers quit smoking.  Another organization could be more worried about unknown dangers involved with the e-cigarettes.
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Another example today is unpasteurized milk.  The FDA claims that unpasteurized milk is dangerous and can be unhealthy.  While proponents of unpasteurized milk claim it is healthier because it doesn't pasteurize milk.  
If there were multiple Rating Agencies, one could rate unpasteurized milk high because of the health benefits that come from raw milk.  Whereas another would rate it lower because of the possible dangers from milk that could spoil easily.  Consumers can decide to listen to the Rating Agency that shares their values.
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Over its 104 year history in managing food safety, the FDA has been using the same tools, regulations, and inspection techniques to make food safer.  While there were some early achievements, these tools are no longer effective at making food quality reliable.  Recommendations are advanced that would make the FDA more of a scientific problem solver, rather than a policy enforcer.
Dr. Williams' talk, "A New Role for FDA to Make Food Safer," was presented for the first time on September 27, 2010, at the Agricultural & Applied Economics Association's "Economics of Improved Safety Practices" in Monterrey, California.
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If Competitive Regulatory Agencies were dealing with drug and food safety, new ideas would be continuously tried and the best always being topped.  Ineffective or overly costly regulations will fall away.
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<![CDATA[Robust Medical Records]]>Thu, 14 Jul 2016 04:46:50 GMThttp://haley2024.org/blog-on-health-care/robust-medical-records
There are four big ideas I would like to explore. First, having a very secure, and accessible medical record with a great interactive program.  Second, exploring many new ways to add information to the record.  Third, computer Artificial Intelligence (AI) and trained personnel to analyze the data.  Forth, Specialists on demand. 
Many plans and programs described below are currently in the marketplace in a minor way.  However, government regulations are hampering these ideas from flourishing.  These ideas come from many frustrations and experience dealing with medical providers.  Tech is making many things simpler in many sectors of the economy; however, not translating into the medical field in many ways described below
People walk into a new medical provider, and they have to fill out many pages of PAPER, and they say there is a better way.  There is not enough quick or convenient communication between medical providers, and people wonder if the lack of collaboration and long delays harm the patient.  People see major inefficiencies and wonder why.  Government regulations are usually the cause of problems or hampering the solutions, whereas free enterprise removes problems.
These are just a few ideas.  Countless variations and experimentation would yield competition.  Better service and fewer costs will result.  As the system advances, people will explore additional benefits at lower cost.    
A person joins the medical service, let’s call it ‘Robust Medical Records’ or RMR.  RMR is a very secure online medical records program that employs many doctors and other medical professionals.  Some would be full time, others associated and allowing all medical providers access to the program.  
Whenever a member of the RMR walks into any new doctor or medical provider, they give the provider a name and an RMR code.  The medical provider logs-in and verifies identity with pictures among other identifiers.  Once verified, the RMR service gives the new medical provider all the necessary history. 
Medical records would be accessible to all relevant medical providers.  The medical provider would input all their data, findings and orders of medical treatment.  The medical provider could follow the progression of their treatment plan online and in real time.  Patients will have the ability to enter relevant information into the system through their smartphone (going forward smartphone means all devices).
​The program would be very interactive, allowing professionals to see the full history in many interesting forms.  Vital sign graphs, allergy information, lab results graphs over time, previous complications among many new ways to see the big picture are quick and easy to find.  Videos, pictures, ultrasounds, x-ray, dental records among other documentation will all be there.      
All of a patient’s preferred providers will be listed such as their pharmacy, home-health company, primary care, and specialists.  Any provider could communicate with the other providers through the system to coordinate care.  All notes from all providers stay in the file.  The patient and providers would be able to communicate through the system as well.  Smartphone apps would make communication very rapid.   
A patient’s complete ability to pay will be in the system.  Insurance, credit cards, charity, payroll deduction plans, credit availability among others will all be there.  A patient’s Identification company will be involved in giving relevant information and protecting a patient’s ID.  A patient sets their RMR up the first time and keeps it updated.  A patient will have full access to all charges and financial information in their smartphone app. 
A patient could see proposed treatment prices and request competitive bids or see other provider's prices on upcoming treatment.  The app has full explanations of treatment codes with alternatives.  A patient would have many interactive ways to explore previous charges to ensure the accuracy of charges.  Most providers would have all charges in the system before the patient was out of the office as well as insurance issues done immediately.  Most providers would supply quality expectations of charges before the appointment within the RMR app.
 A patient could communicate with insurance through the system and have a three-way communication with the providers and insurance or charity.  Everything will be very transparent with patients having a clear knowledge of the past and reasonable expectations of future costs.  Within hours of an appointment, a patient can see the request on the RMR app, and with a few clicks, they pay the bill. 
Much of medical care is collecting information.  The patient will be given many new opportunities to input information.  A patient would start with a complete history and input as many past medical records as possible.  Medical history specialist would assist in collecting past information and inputting it into the system.
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A great location to look for genetic issues, possibly teaming up with different companies.
A patient would be able to input information through there smartphone.  A patient enters vital signs, pictures/ videos, symptoms, concerns, and issues.  With a phone adapter, a patient could have pictures/videos of ears, nose, throat, rashes and other symptoms.   A patient could purchase many devices for their home to upload quality information to the RMR.   
If a patient is having more serious issues, more serious medical devices could be rented or bought for the home.  Many monitors and better communication at home could allow patients to stay out of or have shorter stays in the hospital. 
It is not economical to have major medical equipment in every home.  Local nurse locations, meaning strip mall stores, with a great deal of medical equipment would be an easy way to collect and upload more quality information.   Professionals online with computer AI will oversee every RMR. 
X-Rays, Oxygen Saturation levels, blood pressure, ultrasounds, blood test among many others would be available at these local nurses stations.  These nurses could specialize in being directed by doctors in examining patients live on video, to be interactive, or just with common instructions and upload the results online.   The videoed examinations are reviewed for quality assurance by the doctors.   

Every patient would have a primary professional that monitors all new information in the RMR.  They could request data from home or local nurse locations.  They could alert the patient with concerns and help coordinate care with all medical providers.  All this would be visible in the smartphone app, thus creating very rapid communication.  
These professionals would oversee the treatment plan and relay necessary data to medical providers.  They would look for concerns with the information a patient uploads.  They could update or revise treatment plans.  They would coordinate with pharmacies, home health, local nurse locations and others.  They would be there 24/7 to answer questions, assess changes and take action.       
The system would have medical professionals of every type to monitor everything for cost-effectiveness, inefficiencies, efficacy, alternatives, errors, and concerns.  Routine reviews would be common.  All prescriptions for drugs would be in the system, and the system would handle refills and prescription extensions. Relevant data and orders are accessible and updated to a patient’s identification company, thus accessible (needed information only) to your employer among others such as short and long-term disability insurance.     
The computer program will be very user-friendly and allow a patient full access to their information.  There is certain doctor notes that doctors want to keep secret, and that is addressed within the system, thus giving only certain doctors that information.  
The RMR system will have a section that deals with price comparison and options on alternative medical treatments.  Individuals are smart and competent enough to make their own decisions; however, often they lack the knowledge.  This section could be very robust.  The ability to get immediate second opinions, set appointments, and have new doctors ‘sell’ an alternative treatment is in the RMR.  The Rating System would be very useful when the original and alternatives are ‘presented’ because they would have to have the ratings listed.   
In the RMR, a doctor is available on demand.  After requesting to video chat with a doctor, the system asks for certain data, and then the doctor reviews the chart and symptoms.  The doctor has a video chat with the patient and prescribes a treatment plan. Many retired medical specialist could work part-time at their home behind their computer keeping wait time down.   
 While a video chat certainly has limitations, with all the ways to upload quality data and the doctor video chatting, this could take away the need for a large percentage of in-person appointments.     
A patient’s primary professional within the RMR system would be trained to assign a patient to the specialists that are most relevant to their symptoms.  If a patient is at their general family doctor and the doctor sees a problem out of their scope of practice, the doctor could log into the system and call on that specialist for a consult while the patient is waiting. 
The specialist would review the full RMR chart and the new concern.  The specialist could order a few more tests, and with the general doctor in the room, the patient could have a consult.  The specialist could instruct the general doctor in further examinations and develop a treatment plan.  That specialist could turn it back over to the general or stay informed and involved through the RMR.   
Often a patient has multiple issues requiring multiple specialists.  This system would assist in creating specialist team meetings for patients with comorbidities.  While notes back and forth are good, a conversation with multiple specialists on a video chat, hashing out a treatment plan, is likely very beneficial.  
A mother with many children at home often has a hard time getting out to the doctor and often does not go because of the hassle of getting there for herself or her children.  Many times the doctor does not need to be physically present to assess the illness and prescribe a treatment.  If she is in this program, the ill child’s complete history is in the system.
The mother types up the symptoms, video records her child’s nose, ears, and throat.  She would Input vital signs from quality medical equipment.  The doctor reviews all the information before the 5-minute video chat and inputs a prescription into the system.  The mother goes on her RMR app and orders medicine that is ready 30 minutes later at her corner drug store.  
Next, if a patient’s local primary care doctor sees an issue that could be cancer, he requests an oncologist on demand from the system.  The oncologist reviews all the data and requests a few more tests.  The cancer doctor does a recorded video chat while instructing the family doctor to examine.  They both set up a treatment plan and agree to follow the case within the RMR system.
Third, after a sporting accident, a broken bone is possible, bruises and a rash are all present.  The emergency room seems too much.  A patient inputs all their symptoms from home.  They upload the video of the bruises and rash.  The primary provider asks the patient to go to the local nurse’s location and get an oxygen saturation levels, an x-ray and an ultrasound of that bruised rib. 
The nurse was instructed to examine while on video, and it was very interactive.  In this case, the doctors reviewing the charts did not see a great concern, however, instructed the patient to upload videos of the rash and bruises and type up symptoms every day until cleared.  In another similar case, the nurse was instructed to create a cast and made an appointment for the next day at a doctor’s office. 
Often, in the current system, it can be time-consuming and difficult getting medical records sent from one provider to the other, getting second opinions and setting up specialist appointments.   Ensuring all providers are on the same treatment plan is not easy.  Patients, in the current system, need to be highly informed on their treatment plans and skilled in coordinating their care. 
The time and money saving measures listed here are profound.  Currently, it might take many weeks or months setting up many appointments, meeting each specialist separately and transferring notes from one to another.  Travel and time off work are big issues of the current system.
Many medical providers in the current system, redo many of the same tests because they do not have access to the information from others.  Over time, the robust medical records will have the results of every test a patient has ever had.  Yes, even their surgery videos, ultrasounds of them before birth, every blood test, every vital sign, height and weight at every age, will be in the RMR.   Yes, everything, however with privacy concerns, a patient could have certain items behind additional online walls that would need the patient’s approval to access.
Because of so much medical information would be in the system digitally, medical researchers working with computer specialist would be able to have a field day with noticing patterns that would lead to better diagnoses and treatments.  Thousands of high-quality data studies are possible at low costs.   
​You can input your travel or have your smartphone to keep track of your GPS points, and the systems might detect that you crossed the path of someone else that had an infectious disease and instruct you to input symptoms or go get a blood test.  You set your privacy settings, balancing them with possible medical benefits versus the system knowing your travels.  This feature could detect outbreaks much earlier, giving vital time to limit the outbreak.    
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<![CDATA[Health insurance being tied to employment causes many problems]]>Fri, 20 Nov 2015 00:54:04 GMThttp://haley2024.org/blog-on-health-care/health-insurance-being-tied-to-employment-cause-many-problems
 Health insurance being tied to employment causes many problems.  Car insurance is a much better model.  If an employer decides they want to get rid of the health insurance benefit and just add the amount in your compensation package or have a designated amount they are willing to apply towards a premium or a health care saving account, that would be far better. 
At this point, every person would buy an individual or family health insurance plan.  Many people cite a lower cost ‘group plan’ as a reason to keep employers involved.  Lower cost group plans are a myth.  Insurance companies are by definition very large groups.  The employer versus individual tax benefit disparity would need to be fixed.  Haley2024 tax reforms suggest eliminating all deductions and lowering tax rates.
The current problems are numerous and mostly derive from government regulations.

The first problem is that companies need to pay out more for insurance policies for married couples or employees with children.  Pay is not based on the needs’ of the employee, rather the worth of their work to the company.  This disparity can influence hiring decisions, thus discrimination. 
Second, family plans are complicated by two wage earning parents.  Which employer should pay?  Should the family be broken up into two plans?  Which plan should the children go on?  The regulations surrounding these issues cause many problems and create incentives/ disincentives that are often negative.
Third, should the insurance be tied to employment?  When you pick a job, you also select your insurance plan; this is not good free enterprise.  What if you like a particular job, however not the insurance plan, should that influence your job choices?  For many, it is a significant factor!  You may want high deductibles and low premiums, yet the company offers the opposite with low deductibles, and the employee portion of the premium is high.  

Some insurance plans do not include some doctors or hospitals.  Some give preferences to certain providers.  Some insurance plans include procedures that others do not.  Some have whole medical sectors covered, and others uncovered.  All insurance plans are not the same, and people have preferences.  

Fourth, health insurance is mostly one-year plans.  This is greatly influenced by government regulations.  Life insurance very often has guaranteed renewal for a certain number of years because of the nature of the insurance.  If you come down with a deadly disease or an accident significantly limits your life expectancy in November, you want that insurance the following year.
That is a real value to policyholders and wholly inadequate insurance if the insurance company can cancel just because it is a new year.  It is government regulations that create one-year policies that are the most significant contributor to the preexisting condition problem.  In the free enterprise system, life, as well as health insurance, would naturally have more value as long-term insurance plans.       
Stuck in a Job
Fifth, once an employee or their family member has an expensive medical condition that would be considered a preexisting condition to the next employer/ insurance company, that employee is stuck in that job.  If switching a job means changing health insurance, and a particular condition is not covered, an employee feels stuck in their job, thus inhibiting advancements in their career. 
Unemployable 
Sixth, when an applicant to a job has to staple their potential health care liability to their application because that company is self-insured or otherwise harmed when, a person with high health care cost is hired.  That person is significantly hampered in seeking employment.  This is still true, even if it becomes illegal to discriminate based on this factor.
A Little History
Health care insurance started to be supplied by employers because of government price control of labor in the 1930s.  As always, when the government creates price controls, people adjust other things to compensate.  Prices will be adjusted, you just have to look at many effects to see the compensation.  In this case, the government froze wages and companies trying to attract better talent offered health benefits.  
Money is very tight for employers and just because politicians state that they need to provide certain items for their employees, does not mean they have the money.  From the attached story on Obama Care, look at a common practice from employers of government mandates that just shift compensation plans.   
 His current employer was contributing five dollars per hour to his 401(K) plan. Because Obamacare forced the employer to pay higher premiums for insurance for employees (with some of the coverage unnecessary), the employer can now contribute only fifty cents per hour to our client’s 401(K) plan.
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<![CDATA[Veterans Affairs Medical]]>Tue, 17 Feb 2015 21:11:40 GMThttp://haley2024.org/blog-on-health-care/veterans-affairs-medical
So many people try to suggest ‘fixes’ for the V.A. medical system and most do not understand the central problem.  It is socialism.  Veterans earned these benefits as a condition of working for the government, many risking their lives to protect our freedom.  The government surely owes benefits.  However, veterans deserve far more significant than government controlled health care.  
There is a simple solution for those that already earned their benefits, simply a Blue Cross card.  The government should sign up with many of the top-rated health insurance companies and provide a card for each person that has earned the benefit.  Once healthcare insurance transitions to CRA’s and ratings are in place, they would contract with all companies with ratings over a certain level.   
​The government would have a base benefit amount they would provide.  People receiving the benefit would pay the difference in a shared premium, or if the insurance is less, the money placed in a health care savings account.  
Preexisting conditions are always a concern.  Currently, certain veterans are much costlier than others which is the need for insurance in the first place.  However, after a condition is known, it is hard to gain insurance again. 
​The government would have a base benefit amount they would provide.  People receiving the benefit would pay the difference in a shared premium, or if the insurance is less, the money placed in a health care savings account. 
​Insurance companies currently make annual contracts because of substantial government regulation changes that make it very difficult to have long-term contracts.  Government labor tax laws dealing with health insurance also harms prospects of long-term insurance contracts since health insurance is tied to a person’s job.    
Under Haley2024’s Military Reform, military corporations would have different compensation plans, thus different methods of doing health care or insurance.  Every health insurance plan would have different costs because they have different business models and coverages.
​The VA medical system is government supplied and as close to socialism as possible.  Socialism is the main problem.  The free enterprise system is not without problems.  However, millions of decisions by individuals within the free enterprise system results in the replacement of bad business models naturally with better models.  When consumers decide, and providers are free to experiment with ‘better ways;’ many of these problems are solved. 
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<![CDATA[Price Controls Are Driving up Health Care Costs.]]>Mon, 25 Aug 2014 04:08:44 GMThttp://haley2024.org/blog-on-health-care/price-controls-are-driving-up-health-care-costs
The current ACA (federal) and state regulations consist of tens of thousands of pages stating what cannot be tried or what must happen.  Many successful business models became illegal, and people were forced into less desirable business models.  The government mandated licenses, tax policies, mandates, limitations, and UCR (Usual, Customary, and Reasonable) rates, push up health care prices. 

 Licenses for medical providers and licenses for educational institutions teaching medical providers create monopoly effects, which yield higher medical cost.  Every government mandate adds to the cost.  
 
Tax policy encourages businesses to take over the responsibility of buying health insurance from their employees, yielding great harm to the role of prices.  When employers take part of an employee’s compensation plan to pay for health insurance, the employee does not want to lose that part of their compensation by buying health insurance in the open market.  Employees cannot competitively shop for the health insurance they want.  This lack of competition allows insurance premiums to remain high.  The government’s legal ban on selling health insurance without certain provisions keeps premiums high.  
 When someone is looking for a job or considering leaving their current job, they must consider health insurance.   When someone has to lose their insurance because they switch jobs, they run into issues of gaps in coverage and preexisting conditions when they get the next job.  Because many companies are self-insured, applicants (or the applicant's dependents) with medical issues are at significant risk of discrimination.    Health insurance being tied to employment cause many problems 
The thousands of pages of prohibitions of beneficial health care or health insurance models are astounding.  Government bureaucrats and politicians literally make something illegal and then complain that the free enterprise system will not provide that particular product or service they prohibited by law.  For example, guaranteed renewal policies, which solves preexisting condition issues, are often illegal. 
 
In the free market, customers need to agree to a new program.  Customers need to choose to buy that product or service.  Businesses compete to serve customers the best.  Government is taking away most options and doing great harm. 
If the government decides to cover medical bills and puts $1 trillion into the budget to cover the cost and one doctor sends a bill for one doctor visit in the amount of $1 trillion, America’s budget is exhausted for just one patient on the first day.  Obviously, they will not pay that bill.  If the government is going to run an insurance model, they must have a system of price controls.
 
​Price controls do great harm.  When the government hires doctors and administrates health care, that is just a different type of price controls.  When the government becomes too large of a buyer of healthcare products or personnel, they distort the role of prices.  In an effort to reduce the price, they push them up.
Most insurances have network negotiated pricing.  The government does the same.  This pricing is price controls, plain and simple.  Price controls always have the results of higher prices, lower quality, lower supply, and long lines.  First, let us recognize that all the insurances and the government have different price levels.  Health care providers overprice things in order to ensure that they are above the highest reimbursement level, knowing they will write off the difference, thus receiving maximum funding.  
Many insurers pay a certain percentage, thus health providers factor that in and provides an incentive to go much higher on price.  For the poor and uninsured, this makes health care out of reach without the government or insurance.  This gaming of the system dramatically drives up the prices.  Hospitals also play games with emergency room fees.

The government’s mandate that everyone must be treated at ER’s means that those with insurance pay for those without insurance.  High ER fees also mean higher write-offs on hospital tax forms resulting from those that cannot pay.  Hospitals can also show the government a more considerable dollar amount of unpaid ER visits when they are asking for government money.  While the mandate is useful, so people are not turned away, there are better ways of handling the poor or uninsured.    
The examination of the results of Medicare and Medicaid price controls are insightful.  Many doctors stop accepting Medicaid because of the low reimbursement rates, which means the lower supply of doctors and longer lines for patients. The higher quality and more experienced doctors have a large enough clientele of privately insured patients.  The less experienced and lower quality doctors take government-insured patients.  Therefore, price controls decreased the quantity and quality of providers.
Government provision of health insurance also incentivizes the number of means-tested Medicaid qualifiers.  People who rely on Medicaid cannot afford to increase their hours or pay rates over the Medicaid limitations for fear of being uninsured.  This benefit cliff and need for insurance entrap too many people in poverty.      
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<![CDATA[If you do not want the poor to obtain something: mandate insurance covers it.]]>Sat, 29 Mar 2014 00:14:08 GMThttp://haley2024.org/blog-on-health-care/if-you-do-not-want-the-poor-to-obtain-something-mandate-insurance-covers-it
The structure created by current law creates health care inflation for those items that are covered by health insurance.  Those items not included in insurance and “shopped” by the consumer for price, has seen higher quality and lower prices. 
If a health care provider is being reimbursed by insurance, they have likely signed on to their reasonable and customary payments.  In an effort to capture the highest price on each item, and knowing they will have to accept the negotiated price, the price will be set high.  Other insurance companies will just cut a certain percentage off the bill. 
Naturally, health care providers will raise their prices very high so that they can still make a profit even with the percentage discount.  Providers ‘play’ whatever game is necessary and insurance companies catch on and demand deeper percentage discounts, leading to providers increasing the costs again.  This often prices 'covered' items out of reach of the poor.
A lot has been said about “A War on Women.”  While a few women might be benefited by insurance covering birth control, many of the less wealthy women without insurance are harmed by raising prices created by the mandate that birth control is included.
Different health care CRA's and health insurance CRA's could come up with different policies to see which could work the best to keep prices down.  It is apparent to some, although not to those making the regulations that price controls drive up costs.

One CRA could have insurance that paid out "reasonable and customary prices," and also not mandated that providers take that as payment in full.  Which is to say, the patient could pay the difference, thus creating a “shopping” effect to keep prices down.  All doctors would be “In Network.”    

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<![CDATA[Libertarian Health Care Policy ]]>Fri, 28 Mar 2014 23:45:57 GMThttp://haley2024.org/blog-on-health-care/libertarian-health-care-policyThe Libertarians health care plan has a lot of useful items in it.  This could be the base for one of the CRA's that health professionals could choose from.  This CRA would be rated and those ratings posted. 
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