[ExI] Longevity Dividend Course OP-ED Assignment 07

Fri Jun 6 15:31:02 UTC 2008

07- Medicare and Health Insurance Reform

Ok dad, we'll leave you alone on the medicare  and health insurance reform
issue….  this is one of your passionate areas.   "Oh my goodness gracious
me, Holy swamp of quicksand and alligators, I'm liable to loose a leg, get
mangled or be swallowed alive this time " says I.

USA Medicare economics as detailed in
http://www.kaiseredu.org/tutorials_index.asp show medicare costs 14% of the
USA federal budget and covers only 43 million of 320+ million and requires
159 billion or 3,765 per person average out of pocket expenditures to get
benefits. The highest cost  (25,000 or more per year) cost of beneficiaries
(10% of those covered)  use  69% of 2006 total budget. By 2018 medicare
trust fund reserves will be used up and as the taxpayer to beneficiary ratio
drops from 4/1 to a projected 2.4/1 for 78.6 beneficiaries in 2030.  This is
predicted to drive  the very fundamentals of financing healthcare  from
critical to flat-lining.

In Saskatchewan Health care consumes 95% of every tax dollar collected for
2008.  Education at 2 billion (22.7% of the 8.57 Billion dollar provincial
budget) more had better  live up to its potential to enable the citizens to
lower their short and long term health care costs to the treasury.  University
Students and Alumni all have access through the PAWS portal to a very good
database of professional, technical and scientific scholarly journals to
empower decision making.  I would be absolutely  helpless to reliably
compare  hearsay with state of the art science without being able to read
the research.  If I had one suggestion to enhance the potential of achieving
a "Saskatchewan longevity dividend" to reduce the accelerating cost  from 6
billion  to a flat-line  or even  reduced cost it would be to provide
University of Saskatchewan PAWS portal full-text scientific journal access
to every person with a Sask Health card.

Medicare must leverage knowledge, e-education  and telemedicine in order to
free up resources of  people, equipment , procedures and materials to
enhance wellness.  Without this a universal longevity dividend will remain
publicly unfundable , unsustainable and unavailable except for that 1%
superwealthy who can defy the world in order to take care of number
one.  Self-directed
preventative care in consultation with health care professionals is where I
propose health care head so that when the crunch hits in 2025 that we  have
handled it like a "Y2K" and fixed it before it hits.

The Canadian rationing method of waiting lists and limiting  numbers of
procedures available  is  unethical  where a globally distributed pool of
resources exceeds the number of paying customers .  This drives  medical
tourism.   According to http://www.singaporemedicine.com  "5 myths of
Medical Tourism)  415,000 customers accessed  high quality, low (20% of
north American comparable) cost,  efficient, efficacious goods and services.
The industry projects 4 billion revenue for 2012 excluding permanent luxury
full-service medical ocean-cruise-liner type of outsourced  nursing home
alternatives.

Telemedicine delivered electronically by linking  the physician live (ex;
from India by point to point broadband uplink) to a telemedicine rural or
urban Saskatchewan site for  medical consultation  interactivity service
access is a way to bring increasing speed, power and efficiency to service
capacity  while  reducing per patient costs for medicare.  Internet based
"surgery by wire" is  soon to become commercially available. Use of this
technology enabled model to maximize doctor's capability to operate, by
spreading all the doctors over all the patients globally is logical .

If the rich assume the risks of "beta testing" deregulated leading edge
technology  that may be occasionally dangerous and lethal instead of wildly
efficacious  this reduces the time from discovery to generic mass marketing
and cheap broad availability of healthcare innovations for the middle class
and poor who depend

                         predominantly
on Medicare?  Micheal Moore in "Sicko" dramatizes the "6/94 moral hazard
gap" of a mixed public private medical delivery system trying to deliver
"fairness".  "Sin Taxes" represent a prepayment of a future deductible  due
to high risk behavior.  Conversely I propose the  notion of a "capped" tax
deduction/credit  for documented expenditures for planned preventative
health measures. Public coverage of the cost of "Individual Health
management plan" creation , monitoring  and implementation by appropriate
individually chosen health professionals can be funded by spending a portion
of the current value of the projected future risk reduction dividend.

In Saskatchewan  economic calculations are done behind closed doors and
medical criteria for drug coverage are created.  I propose , for
pharmaceuticals a system-wide  proposal to buy drugs on an "efficacy-based
pricing" model.  By that I mean the value of the disease to be treated or
cured  would differ from patient to patient based on medical criteria.
 Multiplying
the number of people in each criteria /group by a "progressive bid"  price
for the drug based on the value of the same drug for use in treating each
different criteria  would create an average  composite per dose value for
the public payor to cover.  Currently if for example , a high cost
anti-cancer drug is available, a medicare committee decides how many doses
at the market price the province will buy and sets out to analyse the
statistics to see what criteria would allow just the right number of
prescriptions to use up that estimated budget for that particular drug.  That
is not fair, or ethical but is a worldwide accepted practice.  A model where
all possible customers are served is more desirable.  If the cost is
negotiated between drug company and medicare using the "efficacy based
pricing" matix all medically necessary prescriptions can be covered.  The
drug company benefits as well as the maximum number of sales for high cost
drugs X "efficacy value"  will maximize its ability to extract gross revenue
overall.  All non-Sask Health Card customers pay the Manufacturer's
Suggested Retail Price  independent of this so the market is not distorted
or skewed.

I have not even touched on methods to enhance future health in order to
reduce future costs and increase current service availability to ensure
Medicare  sustainability.  This will be covered in the next piece on
disability.

You may send your feedback attention "Pharmer Mo" at
extropian.pharmer at gmail.com
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