The proposed Health Reform bills in both Houses of Congress should be scrapped.  Neither bill does anything real
for health care reform in this country or addresses the immoral, unethical, and inhuman practice of denying
coverage to the sick or delaying treatment of the covered thus prolonging or promoting pain, suffering, and
premature death, all for increased profits.  That is the private insurance system we have today.  A prosperous
society requires a healthy, productive population.  Therefore, it is in our self-interest as a nation to ensure the
health of our citizens.  I believe the best, most cost effective way to accomplish this is through a
semi-autonomous single payer system.  My proposed plan is budget neutral, cannot be raided by Congress, provides
universal coverage, provides choice in coverage, encourages innovation in treatments and wellness, and promotes
bending the cost curve down.

Let’s start with some of the basic facts. 

1)	The percentage of the population that is uninsured is estimated to be about 46.3 million in 2008 or 15% (Pu). 
2)	About 46 million for 2009 or 15% are on Medicare. 
3)	About 43.5 million in 2008 or 14% on Medicaid (http://www.kff.org/medicaid/7606.cfm). 
4)	About 176.3 million in 2008 or 56% that have employer based insurance, (Pi)
(http://www.commonwealthfund.org/Content/Publications/Testimonies/2009/Sep/Changing-Course-Trends-in-Health-Insurance-Coverage-2000-2008.aspx).

That is 100% of 312.1 million people. 

There is some dispute regarding the actual overhead of private insurance companies compared to Medicare. The value
ranges from as high as 27 cents / premium dollar(Richmond Times Dispatch
http://www2.timesdispatch.com/rtd/news/opinion/commentary/article/ED-MILL12_20090710-195604/279279/) to 16 cents/
premium dollar (Regulating Health Insurance
http://regulatinghealthinsurance.blogspot.com/2007/10/what-goes-into-cost-of-health-insurance.html)  more of every
premium dollar than does Medicare (Oi). According to Center for Medicare and Medicaid Services (CMS) using a
PricewaterhouseCooper 2006 report and a National Association of Health Underwriters (NAHU) 2008 report 14% of
premiums are used for non-medical expenditures.
(http://www.legis.state.pa.us/cfdocs/legis/TR/transcripts/2009_0041_0010_TSTMNY.pdf). However, I find this
difficult to believe because of the resistance to the proposed 20% and 15% limits for overhead expenditures in the
Senate bill. How many more people could be covered by reducing the overhead and profit of private insurance to
Medicare?

Pn= % of the population that can be covered.
Pi= % of the population with employer based coverage.
Oi= the difference in overhead of Medicare and private insurance (27% to 16%).
Ni= the new premium cost as a % of the current private premium dollar (73% to 84%).
Pi*Oi/Ni =Pn
or
 56%*27%/73% = 21% of the population at the high end or 65 million people
or
56%*14%*/86% = 9.1% of the population at the low end or 28.5 million people

Per these figures the worst we would achieve would be the addition of about 28.5 million people and at best 65
million people of the 46.3 million currently uninsured , just by switching premium payments and coverage to
Medicare for all and not changing any of the current payments structures for services, pharmaceuticals, or
equipment.  These calculations do not address the savings that can be gleaned from increased productivity, by
promoting early intervention, decreases in emergency room visits, reduction in bad debt, and reductions in the
prolonged denial/appeal processes in the current system. Factor in that the majority of the uninsured are working
and they and their employers could contribute toward their premiums using sliding scale subsidies and the
worst-case scenario of 17.8 million remaining uninsured could be covered easily.

I suggest the following changes to Medicare:

1)	Independent board appointed by the President and confirmed by Congress to administer Medicare. Board composed of
medical professionals; doctors, nurses, researchers, ethicists, and economists with emphasis on the first four.
2)	Multiple coverage plans with appropriate premium rates, with a minimum plan to cover routine check-ups, acute
illness, wellness services, prescription and catastrophic needs.
3)	Income based sliding scale on premium payments, both individual and employer.
4)	Premiums paid directly to Medicare.
5)	Reimbursement rates to health care providers should be set to the standard "Customary and reasonable" rates used
by insurance companies today minus 10%. (base rate). 
6)	Performance based bonuses for health care providers with better outcomes up to 30% of base rate. (Incentive to
develop better treatments and practices, fewer secondary infections, fewer re-admissions due to re-lapse or in
complete recovery, etc.). This could result in a reimbursement of 117% of today’s rate for the most efficacious
treatments.
7)	Reimbursements based on local considerations not just on one national rate.
8)	Congressional oversight and detailed, internet published, periodic statistical, accounting, and treatment
assessment reports.
9)	Panel proposed changes to coverage to require an up or down vote by Congress after a 60-day public review period
(posted to the internet).

This program would still encourage innovation, would remedy the problem of Medicare underpayment, and would protect
the populace from an unaccountable bureaucracy. This is a real starting point for Healthcare reform. There are many
details to be worked out like the sliding scales and compensation to private healthcare insurance stockholders. The
net loss of jobs in the insurance sector will need to be addressed through retraining programs, though I anticipate
this to be minimal except at the top management level. I propose handling abortion funding by requiring two plans.
One does not cover abortion and has the subsidy rate applied to the whole premium. The other is identical with the
exception of abortion coverage and only the premium of the sister plan is eligible for subsidy.

I believe we should try this approach and let the Republicans and blue dog Democrats filibuster through the
mid-term elections. Let the people vote on this issue. It is the closest thing we have to a referendum system. This
is the only poll that counts on current opinion of the American public. If more progressives win, the reform will
pass. If more conservatives win, they can propose their own reform plan. Either way, we must move quickly to avoid
the health insurance and the healthcare system becoming the one sure cause of the collapse of the entire economy.