Health care Reform: Overhaul or upgrade?

The United States has the best health care system in the world. No one will argue that point. The debate is that the cost of health care is too much and not enough people can afford the premiums being charged by private sector insurance companies. These statements are facts. There are many changes that need to made within the private sector that can save millions if not billions of premium dollars to consumers and taxpayers. The changes and savings can come from many components of the health care system but the most glaring and easiest to fix is abuse and malpractice. I do not have to go into much detail on this fact because I believe the Americans that have had to deal with these issues have warned us all to be very loudly over the last couple of decades to question your doctor extensively when lives and livelihoods are at stake. I make these general comments to lead up to what I believe would be an intelligent and less political answer to fixing the big problem,which is, how we as a country can lower costs and cover more Americans with health insurance without mortgaging our children future.

If we allow the government to control what doctors we see, and what tests should be done, and what pill is more cost effective to take, and what life is beneficial to save, then we have given government the ability to control even more of our lives. I believe that no matter what party affiliation you may be, your freedom to choose is a right you will refuse to give up.

The best idea I have been associated with to deal with health care reorganization deals with the problem much more realistically and affordably.

• Insurance companies, Dr. offices, hospitals,claim departments and all other entities plagued with abuse mandate and police these issues and eliminate them saving millions and billions as Obama has stated several times.
• Cap the amount insurance companies are liable for in max out of cost expenditures in catastrophic cases and have the government pick the overage. By government I mean raising taxes slightly.
• This catastrophic relief would enable insurance companies to lower premiums and inject richer benefits into the plans they offer.
• This relief and resulting lower premiums would immediately allow many millions of Americans to afford coverage. Not all 47 million of the current uninsured would benefit from this because there are still 12 to 13 million people that would not be able to afford coverage due to income.
• The remaining 12 or 13 million people could be covered by the government in a variety of ways. There are billions of unspent Tarp funds that will probably not be used at all for the economic crisis due to the fact that eventually the economy will turn around. I will say that I do not think that these funds should be spent to provide top of the line insurance coverage but it would provide hospitalization and preventive care and help with drug cost(a topic for a whole other issue.) Good basic coverage would be 100% more than these people have now.

You read that I said raise taxes slightly. I am willing to pay a small tax increase to radically and effectively change health care and make it more effective and efficient and affordable to as many that want to have health coverage. What I do not want is to pay a tremendous tax increase for the rest of my life and more than likely my children's life and have the government be in even more control of our lives than they already are. An overhaul is over-the top and will take choice out of your hands and reduce the quality of care that has made us the country with the best health care in the world. My suggestion would be to everyone that is truly concerned about this issue to read the 1000 page document outlining what President Obama wants to push through as quickly as possible because your Congressman and Senators have not. When they take their Summer break and come back to their constituents to have their town hall meetings, you will be aware and informed and prepared to communicate your demands. If people would actually do this, the final result and Bill that is signed will be what the people want and need instead of what the government wants you to believe you need. You may not agree with the idea presented here and that is fine, but ideas are what we need to give to our Congressman and women and our Senators instead of being told what we are going to get from people that ever have to worry about health care for the rest of their lives. I guarantee that not one of our politicians will be choosing a plan from the government exchange if the Bill passed today as it stands!

Baby Boomers get ready....

I have been paying close attention to the events and conversations swirling around the last few weeks on Healthcare Reform as many have been doing. If there are no changes to the health care system, baby boomers are still going to be facing challenges when it comes to health care. It would be wise to keep the pulse of your current health care and make sure and speak to your agent about your plan and make sure it is going to be the best fit for you and your family. No one is able to tell yet what the final changes will entail but I personally believe no matter what there will be significant changes. The landscape of healthcare is destin to change and needs to change but as we all know not everybody wins even if the majority is happy with those changes. I will be speaking and staying close to a few people that I know that are very well connected to the Bill and will report anything I learn in this blog. It is going to be a very interesting Fall session!

Stay Healthy Stay Informed

James Cardin

Why do I have to qualify for Individual health coverage when I come off of a group plan?

This question gets asked of me several times a day. Most of the time people are very frustrated and do not know why they are getting declined for health coverage when their group plan ends. The answer is that Individual and Group plans are different in many ways. Small group and Large group plans have very little underwriting done on there applicants because everyone in the group is going to pay for everybody else and their ailments.

Individual plans are underwritten with only the applicant and his family conditions and are rated accordingly. You can be declined.

Other options may be available like COBRA and you will have to contact your Human Resource Department for the details on your situation.

Stay Healthy Stay Informed

James Cardin

What will your Healthcare look like in 5 years?

I think it would be very wise to stay on top of the developments to Healthcare Reform over this summer. The impact and consequences of this bill will be dramatic regardless of whether it works or not. I will continue to follow the progress and post as much as possible to keep everyone informed. The following article gives good insight into some possibilities that may occur once the bill is in place.

Stay Healthy Stay Informed,

James Cardin

(CNN) -- Five years from now, there's an excellent chance you won't have the same health insurance you have (or don't have) right now. That's because members of Congress are gearing up to reform the U.S. health care system, and unlike in 1993 when then-first lady Hillary Clinton tried her hand at changing the medical system, this time the important players -- doctors, insurance companies, pharmaceutical manufacturers -- seem to be on board. You heard a lot about health care reform this week, and you'll be hearing even more in the months to come. It's an incredibly confusing, complex issue, so in this week's Empowered Patient, we break it down for you with 10 frequently asked questions about health care reform.

Overhauling health care is key to U.S. economic stability, President Obama tells doctors Monday.

1. Why is health care reform such a hot issue right now?
Fewer and fewer Americans have health insurance, and therefore cannot afford good medical care. Nearly 46 million Americans have no insurance, and 25 million more are underinsured. One major reason for this crisis is that many employers have stopped offering insurance to employees because of the high cost. In the United States, total health care spending was $2.4 trillion in 2007 -- or $7,900 per person -- according to an analysis published in the journal Health Affairs. The United States spends 52 percent more per person than the next most costly nation, Norway, according to the Kaiser Family Foundation. There's little debate that health care reform is necessary -- President Obama, Republican and Democratic members of Congress, the American Medical Association and America's Health Insurance Plans, which represents the insurance industry, all have agreed the system needs to be changed, although they disagree on how to do it.

2. So let's start with Obama. What are his plans for revamping the system?
A central point of the president's plan is to create a government-sponsored health insurance program that would be an option for all Americans, similar to how Medicare is now an option for Americans over age 65. He has also said he'd "like to see" prohibitions against insurers discriminating against people with pre-existing conditions, and incentives for people to use preventive services and wellness plans. Obama outlined this plan last week at a town hall meeting in Green Bay, Wisconsin, and on his Web site.

3. How does the president plan to pay for this?
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Obama said he's already identified "hundreds of billions of dollars" worth of savings in the federal budget that could help finance health care reform, such as rooting out waste, fraud and abuse in Medicare and Medicaid. He's also proposed reducing tax deductions for high-income Americans.

4. What do the Republicans think of Obama's plan?
In particular, they don't like the idea of having a government-sponsored health insurance program for all Americans. They fear employers would opt for the government-run insurance over private insurance because the government option would most likely be less expensive, but Republicans say it would also be lower quality. For information, see Senate Minority Leader John Boehner's Web site.

5. Since they don't like Obama's ideas, how would Republicans like to reform health care?
Republicans think Obama's plan is costly and will make health insurance more expensive, not less. In a plan outlined this week, House Republicans proposed individual tax breaks for buying health insurance and "pools" of states and small business to get lower-cost health care plans. They also proposed increasing incentives for people to build health savings accounts, allowing dependent children to stay on parents' policies until age 25 and encouraging employers to reward employees for improved health.

6. I'm happy with the insurance I receive from my employer. What would health care reform mean for me?
If you receive high-quality health insurance from your employer, Obama said, his plan won't change that, and you can still keep your insurance and your doctors. Republicans, however, said that if Obama gets his way, there's a good chance your employer will stop buying the private insurance you have now and instead opt for the less-expensive government plan.

7. I have a pre-existing condition and can't get health insurance. Will health care reform help me?
You have a terrible problem and you're in good company. Millions of people who don't get insurance through their employer try to get insurance on their own and are turned down because they have a pre-existing condition. Obama said at the Green Bay town hall meeting that under his reforms, no insurance plan "would be able to deny coverage on the basis of pre-existing conditions," but he didn't explain how he would force insurance companies to insure people with pre-existing health problems. Similarly, Boehner wrote on his blog that "quality health coverage must exist for every American, regardless of pre-existing health conditions," but did not explain how he would pay to insure people with pre-existing conditions.

8. How do doctors feel about health care reform?
The American Medical Association said while it believes in health care reform, "the AMA does not believe that creating a public health insurance option ... is the best way to expand health insurance coverage." The AMA has told members of Congress that doctors fear a new government-sponsored health insurance program would reimburse them at Medicare rates. "Medicare reimbursement rates have not kept pace with the cost of practice," AMA President Dr. Nancy Nielsen told CNN earlier this week. "Our Medicare rates are back at 2001 rates, and the reality is, that's not where our rent is, that's not where the electricity is. The system for paying doctors is a broken system, and everybody acknowledges it." Other doctors' groups, however, support the idea. The American Academy of Family Physicians, the National Physicians Alliance and other groups put out a statement of support this week for Obama's plan. "Having the choice of a public health insurance plan will help make health care more affordable for patients, foster greater competition in the insurance market and guarantee that quality, affordable coverage will be there for our patients no matter what happens," they wrote in a joint statement..

9. Obama has mentioned high health care costs in McAllen, Texas, several times. What's up with that?
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According to research conducted at the Dartmouth Institute, the average per person health costs for McAllen are sky-high compared with costs in other cities. In McAllen, the average Medicare beneficiary spends $15,758 per year, while the average Medicare patient in LaCrosse, Wisconsin, spends $6,412 per year. Another comparison: The cost in Miami, Florida, is $18,170, compared with $7,478 in Portland, Oregon. Dartmouth researchers believe doctors in high-priced cities tend to refer to specialists more and are more likely to put patients in the hospital rather than handling their problems on an outpatient basis.

10. How do health care costs in the U.S. compare with costs in other countries?
In the United States, every person spends on average $6,714 for health care. That's significantly higher than in the United Kingdom, where $2,760 per person is spent; or in France, where the cost is $3,449 per person; or in Canada, where medical costs are $3,678 per person, according to the Organisation for Economic Co-operation and Development. While some would argue that medical care is better in the United States than in these other countries, others would say the opposite is true. For example, the United States ranks 50th in life expectancy, and 44th in infant mortality rates, according to the CIA World Fact Book. For more on international price comparisons, see this segment » on CNN Newsroom.
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When is a pre-existing condition not a pre-existing condition?

One very important question I get asked quite often is, will my pre-existing condition or conditions be covered if I switch to another company's health plan. The answer is based on whether you have been covered for 12 consecutive months with credible health coverage prior to enrolling with the new plan. If you have been covered and you get approved on the application you submit for the new coverage then there will be no waiting period for conditions currently treated,diagnosed or medicated. If there has been a lapse of more than 30 days you could have up to a 12 month waiting period for all pre-existing conditions.