Economic Solution for the US Health Insurance and Health Care Crisis the American Way


The health care and health insurance dilemma in the United States has permeated and corroded the heart of America's quality of life. Our politicians and legislators are scrambling to find both state and federally mandated solutions to one of the most costly problems facing our nation today. . Documentaries like Sicko starring Michael Moore and countless TV and newspaper articles call for change. As the endless inflation of medical services and prescription drugs continues, the insurance bureaucracy is stepping up, raising premiums and degrading the quality of health insurance coverage for most Americans. Pharmaceutical companies are under constant scrutiny to offer more competitive prices, but compared to other countries that have chosen to implement cost controls that meet the perceived needs of their respective societies, most We are not facing any regulations. So, in the face of such a negative equation, how can a capital-driven society like the United States redesign its healthcare system and maintain the theology of 'choice' and 'capital market competition'? And how do we do that without killing more Americans?

Answering these questions requires considering what works and what doesn't, both in American society and in other societies where socialized medicine is the norm. The problem many self-made American businessmen have with socialized programs is the ability of such programs to denigrate social progress and distance themselves financially and physically from our independent roots. To help health insurers continue to support billions of dollars of investment (a key pillar of our financial framework) and to continue to care for every American who gets sick, we We must fundamentally change the risk of transferring such health problems. Regular premiums from taxpayers for the financing of collective systems. The solution I propose, described in relatively simple terms in this article, is that independent insurance providers remain independent hospitals and doctors, and pharmaceutical companies insure all Americans while maintaining a competitive edge. They form a baseline architecture that allows them to maintain a certain level of profitability.

Offer architecture

I propose his three-tier system for health insurance, prescription drugs, and healthcare providers of all kinds.

I. Insurance method

Providing every American with 100% of her health coverage while keeping insurance companies profitable requires a combination of socialized healthcare and the net effect of American free trade. The federal government should create a fund much like a reinsurance company. Most insurance companies, whether healthcare or commercial, have large reinsurance contracts and policies with large amounts of capital. A classic example is Berkshire Hathaway's 'General RE', which underwrites some of the world's largest global insurances in niche markets. Simply put, the federal government must take an opposite approach to the non-profit, heavily taxed Medicare and insurance systems by creating the world's largest reinsurance vehicle. The reinsurance sector is funded by A) a percentage of all health insurance premiums from all health insurance plans and B) her 1.5% income tax increase for all Americans. From this point on, all health insurance providers will be entitled to all policies, including a) full coverage for prescriptions, b) coverage for all doctor visits, and c) full coverage with no overage for major medical services. You need to get the basic level of

From an actuarial point of view, don't kill Americans' health insurance premiums. All working Americans earning $16,000.00 or more annually must pay scaled premiums of the same category and type as "basic insurance." Award criteria are based on gross personal or household income based on current employment. But they have just turned the entire insurance industry into his one big "group plan" with risks spread across the country. Using the ratio of healthy Americans to those in need of services at any given time, this simplistic approach reduces basic insurance premiums to levels affordable to all wage earners, made available free of charge to individuals and low-income households. Those who meet the low-income criteria receive the same basic insurance as everyone else and are required to apply for coverage with any private insurance company. The Federal Renewable Fund will pay all insurers a minimum base amount equal to the amount they receive from paying customers. Under the 'Bundes-RE' model, all policies receive 30-35% of the base premium of a private insurer. The base premium and the amount each individual must pay will be set by the new EE Treasury Actuarial Commission, but will be seldom adjusted. Once the percentage is established, it becomes law, and an across-the-board 1.5% tax increase will serve primarily as a buffer for the low-income and poor.

Insurers differentiate themselves by adding marketing and packaging features to their basic policy for customers. Since it is not an option, there is no difference in terms of providing inferior insurance. The basic policy for everyone is major health insurance under California standards with 100% coverage of all co-payments and deductibles. To earn additional coverage, health insurers offer more elite services, placing them in an even better position than the basic position for customers willing to pay for additional features. must be guaranteed. This causes the following things to happen in logical order:

  •  The federal government invests premiums and actually makes a profit, much like insurance companies do in their reinsurance sector. Risk is shared among all Americans who can afford the premium. Premiums are minimized due to the larger group size and lower risk for the insurer. A combination of a small federal tax hike to secure dollar volume and grow accounts, and receiving RE premiums and investing them, makes this federal program easily profitable and policy free if needed. provides an opportunity to adjust the

  • Insurers can reduce risk and simplify and streamline basic coverage for key health services. All rules apply to all insurers (old and new), so competing on important but “extra” products to improve insurance quality for insurers able to provide additional services I can. Auto-participation of REs in basic components of the policy significantly reduces large payments.

II. Prescription Drug Costs

Making the Federal RE the “payer” of most medical transactions for drugs and medical services has also created a need for a private approach to controlling the cost of drugs and other prescriptions. This is a sensitive issue. Because the cost of developing the drug allegedly got out of hand when it later became irrecoverable at a high price.

Currently in the form of the Federal RE, which is a payer/customer to pharmaceutical companies, together with the federal government, drug prices must strike the right balance to allow development and free trade, but are reasonable to purchase. The federal government's mission is to prevent monopolies. A monopoly is not defined as a single manufacturer of a product (or drug) that is the sole source of a particular product. A monopoly is defined as a one-stop-shop charging prices that may harm our society and stifle competition. Standards should be developed for the maximum payment allowed for each category of (generic) drugs and medical supplies. This is an ever-changing and intensive work that is very continuously performed by Federal RE employees. The aim is never to set a price, but rather to give a collective price to a drug, using fluctuating actuarial and monetary scales, and taking into account all aspects of the product's novelty. is to decide the maximum amount you allow to spend on Unfortunately, if a drug company doesn't meet these maximums, the drug won't be available until they're flexible. Adding supplements to "basic insurance" that covers expensive, cutting-edge drugs Americans could get the drugs, but basic plan owners couldn't. Pharmaceutical companies are therefore forced by demand to lower their rates, at least to some extent. This part of the plan cannot be changed to appease certain parties. Because if you change it, the whole purchasing system will collapse. But groups currently looking to help low-income victims can focus on the precious few who don't have timely access to cutting-edge products.This funding is guaranteed by the Federal RE. It is not intended to be This does not mean that alternative private or public avenues cannot be rearranged to provide percentage assistance in the minority of cases requiring modern, non-affordable medicines.

III. Treatment Under Federal RE Conditions

All Americans now have access to medical care, and in most cases even prescriptions are covered. But now that every clinic and every major hospital is ready to fill with patients, how do we manage the clinically insane costs of running that clinic or hospital? Federal RE You can fend off socialized prescriptions by creating strong buyers in your marketplace and setting simple cost overrun standards that are non-negotiable and consistent. But clinics, hospitals, and emergency rooms didn't get cheaper. All Americans have (at least) the best kind of major health insurance they can buy back for the day, so it should not be surprising that over time, the billing system and related bureaucracy will become more streamlined. Unfortunately, however, medical costs have little to do with the actual cost of surgery, and all have to do with how much different hospitals and clinical administrators can charge in each situation. Over-regulating the pricing of each procedure mimics the socialized politics of a country you don't want to be.

I would argue that a geographically mapped system could be applied to avoid overcharging in the same way the maximum was set in point B above. What constitutes a price premium is determined by a Federal RE commission. This is determined in much the same way that drugs are banned when the costs are unjustified for both insurance companies and governments. With 100% of the US population insured on Basic (unless they foolishly "opt-out"), our customers are now double processors for the Federal RE and their respective private insurers. If a particular clinic's costs are poorly controlled by today's standards, the quality of care will suffer significantly if the business unit cannot charge what it wants and what was previously paid by insurance companies. However, if a healthcare provider were to ensure 100% continuity of payments through its depositor system, with simplified processing and few false delays, then in practice it would not be possible in a world of constant billing disputes and zero consistency. Oversight boards, like prescribing boards, are made up of qualified federal RE professionals who understand the true economics of a hospital or clinic. I'm here. Strong price premiums well above single digits are not and will not be tolerated. A lot of money is still spent on the procedure (especially in the early stages when the system is brand new). But the key to price control is not price control when the system matures, but reducing the cost of running a single hospital. Clinics where payments for services are instant. That's right... there is no reason to withhold funds under the new program once services have been provided. Medical billing is made easy and the incredible amount of money spent on the corrections system can be cut at any facility. The speed of payments to healthcare providers is a key factor in overall success. The same goes for a fairly large and very intimate accounting system for tracking abuse. Frequent audits will replace much of the previously cumbersome insurance company claims and become more frequent in hospitals. A strong government role in regularly auditing each facility is indeed a pillar of this plan, and we will elaborate on who, how and how often to conduct the audits in a later article.

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