Health Insurance to begin with is not health insurance at all. It is actually sickness insurance. Most all insurers in the United States pay for sickness and injury. In general they never pay for wellness care. There are all kinds of reasons for how insurers operate which I will post in subsequent posts. I will always keep my postings short and to the point. And I will try to illuminate how health insurance should work.
For this post I will simply state that health insurance is simply a bank account guided by a fancy deposit and withdrawal agreement called a health insurance contract. Typically health insurers invest premiums that are deposited by patients (the insurers’ clients. The insurer then pays health insurance claims from accumulated premiums and investment returns. At the end of the annual insurance policy period the insurer retains any excess money left after the payment of all claims for the policy period. The insurer then either pays the stockholders and / or insurer executive’s bonuses. The process of adding premium for medical claims then starts all over again typically at a higher rate than the year before.
This is the way it is today. It does not have to be that way. In fact in near past insurers did not operate the way they do today. I will explain more in the next posting.
Thursday, March 11, 2010
Sunday, August 10, 2008
Health Insurance Confused with Health Care
At a recent meeting with Representative John Conyers and his staff, his office hosted an open session to discuss polling results about health care issues. Strikingly the
polling organization reported that access to health opinions differed based on the wording framed in the questions. The Polls that were conducted by Lake Research Partners pointed out that while Americans want access to care for everyone they do not want government sponsored health care.
So it seems that we have battles brewing between health care advocates over the means to pay for health care. But one thing is certain that while most people want no part of the current health insurance system they are equally against government health care insurance.
I side with those who want to build health care access infrastructure and health care finance in our communities, providing health care access for everyone cradle to grave. I am not at all interested in the national debate over how to replace an inefficient and wasteful system of health care finance with a government sponsored plan that creates even larger issues for access to health care.
polling organization reported that access to health opinions differed based on the wording framed in the questions. The Polls that were conducted by Lake Research Partners pointed out that while Americans want access to care for everyone they do not want government sponsored health care.
So it seems that we have battles brewing between health care advocates over the means to pay for health care. But one thing is certain that while most people want no part of the current health insurance system they are equally against government health care insurance.
I side with those who want to build health care access infrastructure and health care finance in our communities, providing health care access for everyone cradle to grave. I am not at all interested in the national debate over how to replace an inefficient and wasteful system of health care finance with a government sponsored plan that creates even larger issues for access to health care.
Saturday, July 26, 2008
Health Care Access Requires Innovation
My spouse Dr. Christine Copple has invested a lifetime in improving human health care. She trained in England and at Cold Spring Harbor in New York on Long Island. She has worked along side multiple Nobel Laureates. Her work in herpes, the basis of her PhD thesis will perhaps earn her the prize. She however does not rest on her laurels.When she finished her medical training in England and her PhD work at Cold Spring Harbor she realized that working at the bench would confine her talents to one health issue at a time. She decided at the urging of Dr. Barbara McClintock to enter the business side of health care. Thus her journey began first in scientific publishing, followed by work in the private sector on medical devices and stem cell medical applications. She took a detour for a three year period from the private sector working for Dr. Rita Colwell as the University of Maryland Bio Technology Liason.She made this choice to help pay back the country that gave her opportunities to work in fields not readily available to her in the U.K. She later returned to the private sector as the President of ASMR a for profit division of the American Society for Microbiology. It is a limited scope venture fund where she learned the venture business. Currently she is assisting new biotechnology companies develop new drugs, new devices to detect counterfeit drugs and nano-technology.
In these trying economic times she believes that our best technology development times are ahead. More about her work in my next post.
In these trying economic times she believes that our best technology development times are ahead. More about her work in my next post.
Saturday, July 19, 2008
Health Insurers should be responsible for their actions
Employee Retirement Security Act (ERISA) - Preemption Exclusion - Stepping Stone to All Access Health Care ©™
Currently, the Employee Retirement Security Act precludes most all litigation against and regulation of health insurers nationwide. A Federal Bill, which ends health insurer immunities, would enhance patient access to health care and health care insurance.
There are 50 States Attorney Generals whose hands are tied by ERISA that unhindered would be in the position to litigate against health insurers for civil and criminal infractions. The general public would regain its legal rights to sue health insurers for "bad faith" and health insurance contract breach.
The benefit to Health Care is that those people who are denied care and / or damaged by the actions of Health Insurers would regain personal recourse against Health Insurers without having to resort to the Federal Courts. The 50 Attorneys General and Insurance Commissioners across all the states will be able to act on behalf of the people.
The National Association of Attorneys General (http://www.naag.org/site_map.php) and the National Association of Insurance Commissioners (http://www.naic.org) have expressed serious concerns over the ERISA litigation and regulatory preemption for health insurers. Concerns have been expressed by both organizations that ERISA preemptions are a root cause for Health Insurer abuses suffered by the general public.
Transparency LLC urges you to consider writing legislation that ends ERISA litigation and regulation preclusion for Health Insurers.
Alfred Jordan
Transparency LLC
Currently, the Employee Retirement Security Act precludes most all litigation against and regulation of health insurers nationwide. A Federal Bill, which ends health insurer immunities, would enhance patient access to health care and health care insurance.
There are 50 States Attorney Generals whose hands are tied by ERISA that unhindered would be in the position to litigate against health insurers for civil and criminal infractions. The general public would regain its legal rights to sue health insurers for "bad faith" and health insurance contract breach.
The benefit to Health Care is that those people who are denied care and / or damaged by the actions of Health Insurers would regain personal recourse against Health Insurers without having to resort to the Federal Courts. The 50 Attorneys General and Insurance Commissioners across all the states will be able to act on behalf of the people.
The National Association of Attorneys General (http://www.naag.org/site_map.php) and the National Association of Insurance Commissioners (http://www.naic.org) have expressed serious concerns over the ERISA litigation and regulatory preemption for health insurers. Concerns have been expressed by both organizations that ERISA preemptions are a root cause for Health Insurer abuses suffered by the general public.
Transparency LLC urges you to consider writing legislation that ends ERISA litigation and regulation preclusion for Health Insurers.
Alfred Jordan
Transparency LLC
Credit reporting is rigged against the consumer, we pay for their mistakes
Credit Reporting Companies - Preemption Exclusion - Stepping Stone to All Access Health Care ©™
Credit reporting companies, which include, Experian, Equifax and Trans Union are the guardians of the nation's credit data collection and reporting system. Each year they process billions of pieces of personal credit information worldwide.
It is generally reported that all the credit reporting agencies release credit reports for credit granting purposes that on average contain at least one reporting error or more 70 % of the time. This is an intolerable error rate for which the general public suffers.
A Federal Bill, which ends credit reporting agencies immunity from the full extent of litigation damage awards and substantial fines would enhance patient access to health care and health care insurance.
There are 50 States Attorney Generals whose hands are tied by the Fair Credit Reporting Act and The Fair Collections Act that unhindered would be in the position to litigate against credit reporting agencies for civil and criminal infractions. The general public would gain its legal rights to sue credit-reporting agencies for the full extent of the damages they cause due to non-compliance with existing law. In addition due to the seriousness personal consequences suffered from reporting errors, credit bureaus should be called to account and fined substantially for all uncorrected credit reporting errors they report to anyone.
The onus for the validity of credit information reported to anyone permitted by law to view a consumers credit report rests squarely on the credit reporting agencies themselves not on the consumer who discovers the inaccuracy. Fines for reporting inaccuracies should be similar to other federal fines that violate public interest. Federal fines for example for slamming, which is the unauthorized switching of consumers from one Telecommunications Company to another range from $40,000 to $70,000 per incident.
The benefit to Health Care is that those people who are denied care and / or damaged by the actions of credit reporting agencies could be compensated rapidly without having to resort to the Courts for credit reporting errors. The 50 Attorneys General and Consumer Regulatory Authorities across all the states will be able to act on behalf of the people reducing the burden on Federal Agencies.
The National Association of Attorneys General (http://www.naag.org/site_map.php, the National Association of Consumer Advocates (http://www.naca.net/consumer-advocates-board) and the Federal Trade Commission (http://www.ftc.gov) have expressed serious concerns over litigation and regulatory preemption for credit reporting agency abuses suffered by the general public.
Transparency LLC urges you to consider writing legislation that ends all preclusions from civil and criminal fine and liquidated damages for credit reporting agencies.
Alfred Jordan
Transparency LLC
Credit reporting companies, which include, Experian, Equifax and Trans Union are the guardians of the nation's credit data collection and reporting system. Each year they process billions of pieces of personal credit information worldwide.
It is generally reported that all the credit reporting agencies release credit reports for credit granting purposes that on average contain at least one reporting error or more 70 % of the time. This is an intolerable error rate for which the general public suffers.
A Federal Bill, which ends credit reporting agencies immunity from the full extent of litigation damage awards and substantial fines would enhance patient access to health care and health care insurance.
There are 50 States Attorney Generals whose hands are tied by the Fair Credit Reporting Act and The Fair Collections Act that unhindered would be in the position to litigate against credit reporting agencies for civil and criminal infractions. The general public would gain its legal rights to sue credit-reporting agencies for the full extent of the damages they cause due to non-compliance with existing law. In addition due to the seriousness personal consequences suffered from reporting errors, credit bureaus should be called to account and fined substantially for all uncorrected credit reporting errors they report to anyone.
The onus for the validity of credit information reported to anyone permitted by law to view a consumers credit report rests squarely on the credit reporting agencies themselves not on the consumer who discovers the inaccuracy. Fines for reporting inaccuracies should be similar to other federal fines that violate public interest. Federal fines for example for slamming, which is the unauthorized switching of consumers from one Telecommunications Company to another range from $40,000 to $70,000 per incident.
The benefit to Health Care is that those people who are denied care and / or damaged by the actions of credit reporting agencies could be compensated rapidly without having to resort to the Courts for credit reporting errors. The 50 Attorneys General and Consumer Regulatory Authorities across all the states will be able to act on behalf of the people reducing the burden on Federal Agencies.
The National Association of Attorneys General (http://www.naag.org/site_map.php, the National Association of Consumer Advocates (http://www.naca.net/consumer-advocates-board) and the Federal Trade Commission (http://www.ftc.gov) have expressed serious concerns over litigation and regulatory preemption for credit reporting agency abuses suffered by the general public.
Transparency LLC urges you to consider writing legislation that ends all preclusions from civil and criminal fine and liquidated damages for credit reporting agencies.
Alfred Jordan
Transparency LLC
Market based transactions fees adds more than $100 billion to deliver more health care
Credit Card Fair Fee Act - Stepping Stone to All Access Health Care ™© - H.R. 5546
Interchange fees charged by banks are a significant expense to physicians and other medical care providers who accept credit and debit cards as forms of payment. Fees charges to them range from 1% to 7% for every transaction. It is Transparency LLC's understanding that the Honorable Congressman John Conyers has introduced legislation, H.R. 5546 that regulates and would ensure competitive market-based fees and terms for merchants' (medical service providers) access to electronic payment systems.
The measure would save consumers and vendors billions of dollars annually. Reductions in this fee would
enhance patient access to health care from savings that could be passed along to them by providers.
Transparency LLC applauds efforts to end the monopolistic practices by financial services providers. Transparency asks that you consider providing support for this legislation.
Alfred Jordan
Transparency LLC
Interchange fees charged by banks are a significant expense to physicians and other medical care providers who accept credit and debit cards as forms of payment. Fees charges to them range from 1% to 7% for every transaction. It is Transparency LLC's understanding that the Honorable Congressman John Conyers has introduced legislation, H.R. 5546 that regulates and would ensure competitive market-based fees and terms for merchants' (medical service providers) access to electronic payment systems.
The measure would save consumers and vendors billions of dollars annually. Reductions in this fee would
enhance patient access to health care from savings that could be passed along to them by providers.
Transparency LLC applauds efforts to end the monopolistic practices by financial services providers. Transparency asks that you consider providing support for this legislation.
Alfred Jordan
Transparency LLC
Movement from the third world to our world
Simple Electronic Medical Record
Background
The Simple Electronic Medical Record (SEMR pronounced “see more”) evolved from a deep personal interest in healthcare delivery in developing countries. Volunteer physicians from developed countries provide most healthcare delivery in developing countries. At personal risk and expense these doctors take time out from their practices to run clinics in remote parts of the world. Our volunteer SEMR developers accompanied by physicians made numerous visits to Guatemala to work with the doctors on the ground to assure that the software developed would meet the patient and doctor's needs.. It became immediately evident that all the physicians in the clinics had no preexisting medical information to work with. The problem was that the clinics were being run by different groups of physician volunteers in the same villages. Most all-medical records left when the volunteers left. We realized that medical treatment could be vastly improved by simply creating medical records that would show the treating physician just what the previous physician(s) had done. We then set about creating the SEMR that creates individual medical records similar to systems used in developed nations. We realized that the challenge was not record keeping but the cost of medical record keeping. Electronic Medical Record keeping software in the United States and Europe can cost more than $250,000 for five users (aka seats) in a clinic. Annual software upgrades cost $25,000 or more. Plus there is the training expense to use the system. We had to design a system that costs a fraction of its counterparts in the developed world and at the same time had to be intuitive requiring little or no technical training. We built the system exceeding all required criteria. (www.gmproject.org)
The key elements of the system that make it the optimal solution in developing countries are simplicity of data entry and retrieval, multi-lingual capability at the push of a button, and patient identification that is independent of language.
All the features of the SEMR system that make it ideal for use in developing countries are applicable (with minor modification) to any environment. Thus the SEMR is applicable to the broad spectrum of health care delivery environments from the sophisticated hospital center to community clinics to treating Medicaid patients and the uninsured.
Purpose
To enable straightforward enrollment and record keeping for Medicaid patients in Maryland, and facilitate movement towards a citizen-centric health information exchange for Maryland.
System Benefits
· Improves knowledge flow between healthcare providers, facilitating
collaboration on quality improvement and cost containment
· Provides recommendations for cost containment and policy priorities for all stakeholders
· Provides improved healthcare provision to patients including chronic care management planning
· Reduces risk of medical accidents
· Reduces fraudulent claims frequency
· Reduces medical and administrative expenses across the health care system
Core Capabilities
Integrated Patient Management
The SEMR system is specifically designed to manage all aspects of patient health care regardless of the number of different interactions the patient has with the health system.
Whether attending a primary care physician, hospital, test lab, or other out-patient facility, the SEMR system maintains comprehensive traceable records for all relevant issues relating to the patient, their condition, and care.
Background
The Simple Electronic Medical Record (SEMR pronounced “see more”) evolved from a deep personal interest in healthcare delivery in developing countries. Volunteer physicians from developed countries provide most healthcare delivery in developing countries. At personal risk and expense these doctors take time out from their practices to run clinics in remote parts of the world. Our volunteer SEMR developers accompanied by physicians made numerous visits to Guatemala to work with the doctors on the ground to assure that the software developed would meet the patient and doctor's needs.. It became immediately evident that all the physicians in the clinics had no preexisting medical information to work with. The problem was that the clinics were being run by different groups of physician volunteers in the same villages. Most all-medical records left when the volunteers left. We realized that medical treatment could be vastly improved by simply creating medical records that would show the treating physician just what the previous physician(s) had done. We then set about creating the SEMR that creates individual medical records similar to systems used in developed nations. We realized that the challenge was not record keeping but the cost of medical record keeping. Electronic Medical Record keeping software in the United States and Europe can cost more than $250,000 for five users (aka seats) in a clinic. Annual software upgrades cost $25,000 or more. Plus there is the training expense to use the system. We had to design a system that costs a fraction of its counterparts in the developed world and at the same time had to be intuitive requiring little or no technical training. We built the system exceeding all required criteria. (www.gmproject.org)
The key elements of the system that make it the optimal solution in developing countries are simplicity of data entry and retrieval, multi-lingual capability at the push of a button, and patient identification that is independent of language.
All the features of the SEMR system that make it ideal for use in developing countries are applicable (with minor modification) to any environment. Thus the SEMR is applicable to the broad spectrum of health care delivery environments from the sophisticated hospital center to community clinics to treating Medicaid patients and the uninsured.
Purpose
To enable straightforward enrollment and record keeping for Medicaid patients in Maryland, and facilitate movement towards a citizen-centric health information exchange for Maryland.
System Benefits
· Improves knowledge flow between healthcare providers, facilitating
collaboration on quality improvement and cost containment
· Provides recommendations for cost containment and policy priorities for all stakeholders
· Provides improved healthcare provision to patients including chronic care management planning
· Reduces risk of medical accidents
· Reduces fraudulent claims frequency
· Reduces medical and administrative expenses across the health care system
Core Capabilities
Integrated Patient Management
The SEMR system is specifically designed to manage all aspects of patient health care regardless of the number of different interactions the patient has with the health system.
Whether attending a primary care physician, hospital, test lab, or other out-patient facility, the SEMR system maintains comprehensive traceable records for all relevant issues relating to the patient, their condition, and care.
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