<p class="MsoNormal"><span style="">07- Medicare and
Health Insurance Reform </span></p>
<p class="MsoNormal"><span style=""> </span></p>
<p class="MsoNormal"><span style="">Ok dad, we'll leave
you alone on the medicare<span style=""> </span>and health
insurance reform issue….<span style=""> </span>this is one of
your passionate areas.<span style=""> </span>"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.</span></p>
<p class="MsoNormal"><span style="font-size: 9pt;"> </span></p>
<p class="MsoNormal">USA Medicare economics as detailed in<span style=""> </span><a href="http://www.kaiseredu.org/tutorials_index.asp">http://www.kaiseredu.org/tutorials_index.asp</a>
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<span style="">
</span>(25,000 or more per year) cost of beneficiaries (10% of those
covered)<span style=""> </span>use<span style=""> </span>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.<span style=""> </span>This is predicted to drive<span style="">
</span>the very fundamentals of financing healthcare<span style=""> </span>from critical to flat-lining. </p>
<p class="MsoNormal"> </p>
<p class="MsoNormal">In Saskatchewan Health care consumes 95% of every tax dollar
collected for 2008.<span style=""> </span>Education at 2
billion (22.7% of the 8.57 Billion dollar provincial budget) more had
better<span style=""> </span>live up to its potential to
enable the citizens to lower their short and long term health care costs to the
treasury.<span style=""> </span>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.<span style=""> </span>I would be absolutely<span style=""> </span>helpless to reliably compare<span style=""> </span>hearsay with state of the art science
without being able to read the research.<span style="">
</span>If I had one suggestion to enhance the potential of achieving a
"Saskatchewan longevity dividend" to reduce the accelerating cost<span style=""> </span>from 6 billion<span style=""> </span>to a flat-line<span style=""> </span>or
even<span style=""> </span>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.</p>
<p class="MsoNormal">Medicare must leverage knowledge, e-education<span style=""> </span>and telemedicine in order to free up
resources of<span style=""> </span>people, equipment ,
procedures and materials to enhance wellness.<span style="">
</span>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.<span style=""> </span>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<span style="">
</span>have handled it like a "Y2K" and fixed it before it hits.<span style=""> </span></p>
<p class="MsoNormal"> </p>
<p class="MsoNormal">The Canadian rationing method of waiting lists and
limiting<span style=""> </span>numbers of procedures
available<span style=""> </span>is<span style=""> </span>unethical<span style=""> </span>where a
globally distributed pool of resources exceeds the number of paying customers
.<span style=""> </span>This drives<span style=""> </span>medical tourism.<span style="">
</span>According to <a href="http://www.singaporemedicine.com/">http://www.singaporemedicine.com</a><span style=""> </span>"5 myths of Medical Tourism)<span style=""> </span>415,000 customers accessed<span style=""> </span>high quality, low (20% of north American
comparable) cost,<span style=""> </span>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<span style=""> </span>nursing home alternatives.</p>
<p class="MsoNormal"> </p>
<p class="MsoNormal">Telemedicine delivered electronically by linking<span style=""> </span>the physician live (ex; from India by point
to point broadband uplink) to a telemedicine rural or urban Saskatchewan site
for<span style=""> </span>medical consultation<span style=""> </span>interactivity service access is a way to
bring increasing speed, power and efficiency to service capacity<span style=""> </span>while<span style="">
</span>reducing per patient costs for medicare.<span style=""> </span>Internet based "surgery by wire" is<span style=""> </span>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 .</p>
<p class="MsoNormal"> </p>
<p class="MsoNormal">If the rich assume the risks of "beta testing" deregulated
leading edge technology<span style=""> </span>that may be
occasionally dangerous and lethal instead of wildly efficacious<span style=""> </span>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<span style="">
</span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span>predominantly
on Medicare?<span style=""> </span>Micheal Moore in "Sicko"
dramatizes the "6/94 moral hazard gap" of a mixed public private medical
delivery system trying to deliver "fairness".<span style="">
</span>"Sin Taxes" represent a prepayment of a future deductible<span style=""> </span>due to high risk behavior.<span style=""> </span>Conversely I propose the<span style=""> </span>notion of a "capped" tax
deduction/credit<span style=""> </span>for documented
expenditures for planned preventative health measures. Public coverage of the
cost of "Individual Health management plan" creation , monitoring<span style=""> </span>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. </p>
<p class="MsoNormal"> </p>
<p class="MsoNormal">In Saskatchewan<span style="">
</span>economic calculations are done behind closed doors and medical criteria
for drug coverage are created.<span style=""> </span>I
propose , for pharmaceuticals a system-wide<span style="">
</span>proposal to buy drugs on an "efficacy-based pricing" model.<span style=""> </span>By that I mean the value of the disease to
be treated or cured<span style=""> </span>would differ from
patient to patient based on medical criteria.<span style="">
</span>Multiplying the number of people in each criteria /group by a
"progressive bid"<span style=""> </span>price for the drug
based on the value of the same drug for use in treating each different
criteria<span style=""> </span>would create an average<span style=""> </span>composite per dose value for the public
payor to cover.<span style=""> </span>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.<span style=""> </span>That is not fair, or ethical but
is a worldwide accepted practice.<span style=""> </span>A
model where all possible customers are served is more desirable.<span style=""> </span>If the cost is negotiated between drug
company and medicare using the "efficacy based pricing" matix all medically
necessary prescriptions can be covered.<span style="">
</span>The drug company benefits as well as the maximum number of sales for
high cost drugs X "efficacy value"<span style=""> </span>will
maximize its ability to extract gross revenue overall.<span style=""> </span>All non-Sask Health Card customers pay the
Manufacturer's Suggested Retail Price<span style="">
</span>independent of this so the market is not distorted or skewed.</p>
<p class="MsoNormal"> </p>
<p class="MsoNormal">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<span style=""> </span>sustainability.<span style=""> </span>This will be covered in the next piece on
disability.</p>
<p class="MsoNormal"> </p>
<span style="font-size: 12pt; font-family: "Times New Roman";">You may send your feedback attention "Pharmer Mo" at <a href="mailto:extropian.pharmer@gmail.com">extropian.pharmer@gmail.com</a></span><br clear="all">
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