Improving U.S. Health Care

The 'Public [CATASTROPHIC CARE] Option'

Funding & Cost-Reduction Methods

An Open Letter to Congress

(2009 Aug blog post)

Some slight changes or additions to this page may be made later,
to clarify points or to add positive-suggestions, such as more ways
to build 'positive motivations' into the U.S. health care system.

Home page > Blog menu > This page on a Public Option and proposals for its funding

An Open Letter to Congress :


Here are COST-REDUCTION and FUNDING methods -- 4 main points.

02 Aug 2009

Dear [Congress-person name goes here] --- and staff:

I am writing to express SUPPORT for a PUBLIC (catastrophic-care health-insurance) OPTION ... that is, assuming such an option would provide the catastrophic coverage that almost all citizens are missing in their private health insurance plans.

I am quite willing to help make a better national health insurance system AFFORDABLE, by signing on for a large DEDUCTIBLE in return for CATASTROPHIC coverage. (See list of affordability suggestions below.)

There is a 'donut hole' at the TOP of most private health plans. The private plans cover most of the lower-cost stuff that I could afford to pay, but they conveniently find ways to abandon the customer if they have a major problem such as kidney failure or cancer --- just as the grandmother and mother of Obama found out.

I do not know why the Republicans are so adamantly against a 'public option'. They say the government can't run anything. If the government is as bad as they say it is, then the 'public option' plan will be so poorly run that people will return to their private health plans. The public option will then wither away.

Also, I cannot understand why Democrats, like Sen. Feinstein of CA, abandon the public option (as she proclaimed in mid-July 2009, before the bills were even available for public view) at the slightest sign of resistance from the Republicans.

I can only deduce that she is on the take from the 'pharmaco-insurance-AMA-medical-industrial complex', just as most of the Republicans are.

In my view, almost 100% of Republicans have sold their souls to lobbyists --- and about 95% of Democrats have. (See Baucus below.) That percentage difference is about the only 'real' difference that I see between Republicans and Democrats.

A few seemingly 'upright' congress-people are about the only people who give me some hope for this country --- for example, Senator Dorgan ND and Senator Leahy VT, during the Sep2008-to-now economic-crisis. They are among the few congress-people who distinguish the Democratic party from the Republican party.

I saw Democratic Senator Baucus (Montana) announce to the press, with a gaggle of Republicans standing behind him, that Americans are not interested in health care reform unless it is bi-partisan.

Well, he certainly doesn't speak for me. I am interested in REAL health care reform. It does not matter how that REAL reform comes about. It can be all-Democratic, bipartisan, or even Martian.

The main thing that Americans DON'T want, when you look at the end result, is they don't want another patched-together bill that looks like it was put together by a bunch of Congress's lobbyist benefactors.

There's a proper response to that sort of behavior, that has been causing low public ratings of Congress for decades now. It's called 'TERM LIMITS FOR CONGRESS'. Eight years and out. Let the lobbyists have to buy out some new people. Things are just too cozy up there now --- for too many years now.

A particular problem for the new health plan is how to make it affordable (for taxpayers and clients). That requires two things: (1) KEEP COSTS DOWN, and (2) PROVIDE FUNDING for the remaining costs.

Here is an overview of suggestions, to do that.


Build MOTIVATIONS into the system so that the 'CONSUMER' will not need health care any more than absolutely necessary.

    For example, for all but the down-and-out, REQUIRE A DEDUCTIBLE, of at least, say, $500 per year.

    Also, IF THERE ARE TO BE PREMIUMS paid by citizens who are not in the down-and-out category, give them the option to have several deductible levels (say $500, $2,500, and $10,000 per year - indexed to inflation), with correspondingly LOWER premium levels, so that they have a choice in premium levels versus the amount of financial risk they wish to take.

    NOTE that in any of these deductible choices, the 'clients' still have CATASTROPHIC health care coverage.

    OTHER MOTIVATIONS should include

    • higher premiums (or deductibles) for the OBESE-AND-OVERWEIGHT --- roughly $500, annually, for every 20 pounds over-weight.

    • higher premiums (or deductibles) for SMOKERS. Their categorization as smokers could be based on some test such as a tissue swab or blood test, for a certain level of tars and nicotine, if their qualification as a non-smoker comes into question.

Build MOTIVATIONS into the system so that the 'PROVIDERS' (doctors and hospitals and insurance companies and pharmaceutical companies and medical suppliers, and contributors to ill-health, such as sugar-food companies) are FINANCIALLY MOTIVATED to actually MINIMIZE the need for health care INTERVENTIONS.

    This is a challenging area that needs much thought, but Obama's pronouncments of rewards for 'good outcomes' would be helpful.

    For example, hospitals could be rewarded on the basis of good reviews from patients of the past year. (It probably would not be good to work from a database of 'medical errors', since such data would most likely be under-reported by hospitals --- just as they do now.)

    Similarly, doctors could be rewarded on the basis of good reviews from patients of the past year. (A simple 0 to 5 point rating from each patient would suffice.)

    Their rating could be applied to the standard pay-out for a given procedure. For example, a surgeon who had a 90 percent rating for the previous year would get 90 percent of the standard pay-out for a surgical procedure. And a surgeon who had a 30% rating for the previous year would get 30 percent of the standard pay-out for any surgical procedure he/she performs in the current year.

    Rewarding phamaceutical companies properly, to optimize the health of the country, is a tough one. Those companies are currently motivated to sell as many drugs as they can ---

    • irrespective of whether the drugs are really needed and effective,

    • even if the side-effects out-weigh the benefits,

    • even if improved-diet-and-a-little-more-exercise would be a better first-action option in place of many drugs, like cholesterol-lowering (and triglyceride-lowering) drug courses.
      [It's the triglycerides, stupid .... A.M.A. ... more so than cholesterol.]

    One possible approach is to have ratings of efficacy drugs based on reviews from patients who took them. These ratings would determine a factor to be applied to a standard price of the drug, which was based on the cost of manufacturing the drug and a standard allowance for research costs for development of the drug.

    And there are end-of-life cost issues :

    Unfortunately, the way the system is now, the 'care providers' are motivated to get the most money they can out of aged seniors who are on their death beds. There seems to be no good outcome at death, other than minimizing the pain and suffering. How do you measure a 'good outcome' at death, to reward 'providers'?

    One possible approach is to put a ceiling on the insurance-pay-out that can be paid to the provider --- say a fixed amount per person per day of care.

    The aim should be to motivate both low-costs and relatively good quality of life at, and up to, death.

On Immovable Objects :

Many 'providers' (doctors, hospitals, pharmaceutical companies, health insurance companies) are going to lobby tooth-and-nail to kill any REAListic health plan --- a health plan that includes motivations for the 'clients' such as those suggested above (significant deductibles/premiums for over-weight or smoking clients). With such motivation provisions, it is quite likely that the 'clients' will not need the services or products for those 'providers' --- not nearly as much as currently.

There is an unholy alliance here --- neither the 'providers' nor the 'clients' are going to like deductibles (but for different reasons).

On the subject of premiums, the 'clients' are not going to want them (they want 'free' health care). And the 'providers' do not care about the premiums. That is the government's duty to find a way to collect the premiums from the 'clients'. The 'providers' just want to make sure they get their pay-out at the back end of the health pipeline.

So there is a lot of political resistance to both deductibles and premiums.

Furthermore, the health insurance 'providers' are not going to like competing with a plan that guarantees catastrophic coverage.

Moreover, in the 'unhealth providers' category, sugar-and-starch food companies (and tobacco companies) will not be happy with the funding suggestions below --- taxes to help fund health care --- 'it's-bad-for-your-health' (you'll-put-your-eye-out) taxes.

IF there is nothing in the plan to reward the 'health providers' financially --- and if their income prospects are likely to go downward from where they are now, 'providers' are going to be dead set against any health care system that is good for the citizens of the country.

The crushing irony here is that almost any health care system that is good for the general citizenry is bad for the 'providers'. The major challenge is to find a system that has something in it for the 'health providers'.

    (But let us not shed too many tears for them. They are going to make out just fine in almost any scenario. Suck it up, guys.)

For example, we want to reward good products from the pharmaceutical companies, such as cancer cures and malaria vaccines/killers. But, for things like Thalidomide and Vioxx --- no reward at all.

    (And no 'get-out-of-lawsuits-free' card from Congress. In most cases, a lawsuit is the only way a damaged person, or surviving dependents, can get some kind of help. Sneaking 'protect-one-party-but-not-the-other' things like this into a health care bill, as Republicans and Dems repeatedly do in many other areas, is counter-productive and not good for the 'general welfare'.)

Most other 'developed' countries (such as Japan, Canada, European) have better health systems than ours in almost every measure --- costs, medical errors, birthing-deaths, type-2 diabetes and other diet-related illnesses. And yet most of them have thriving pharmaceutical industries and physicians associations. It would be good to look at how those societies provide some 'motivators-that-help-the-general-welfare' to their 'provider' segments.

Something like a 5-year tax credit to companies that develop a DISTINCTLY MEASURABLE health-care improvement --- such as a vaccine or a cancer cure --- might be one approach to try. But better 'rewards' are needed. THINK! (me and you)

B. PROVIDING FUNDING for remaining costs :

KEEP THE Cost-and-Funding ACCOUNTING for the federal health system, including the 'public option', SEPARATE from other government programs --- so as to be able to tell when the system is getting out of balance --- that is, so as to be able to tell when costs are out-weighing the sources of funding --- premiums, special taxes (such as tobacco and sugar taxes, see below), etc.

    For example, the cost-and-funding accounting for the Social Security (retirement) system is kept fairly distinct from other federal accounting. Similarly, the accounting for any federal health system needs to be kept separate.

    (By the way, the Social Security system is often lauded for its great computer systems and as an example of a government program that, for the most part, has been very well run. As a recent retiree, I can testify that I was pleasantly surprised at how well the system performed in my retirement year and in annual notices thereafter.

    Republicans who say that the government cannot run anything are quite mistaken. No doubt there are many examples of goverment programs that have failed and many-many examples of government unresponsiveness.

    But I would rate the Social Security system quite favorably in comparison to the 'hidden-in-the-small-print' private health insurance industry. Let the private health insurance buyer beware, I would say.)

Help FUND the federal health system, including the 'public option' (which should include catastrophic care coverage) via TAXES ON BAD-FOR-YOUR-HEALTH ITEMS --- such as TOBACCO currently --- and taxes on ADDED REFINED-SUGARS, to be implemented as soon as possible. (This should have been implemented years ago.)

    The sugarS tax would be feasible because there is a sugarS content posted (required) on all manufactured food products, in particular, for products with refined sugars added. (For example, the grams-of-sugarS-per-serving and the number-of-servings in the product is posted --- so the total sugarS content is already available. Also, the total weight of the product is on the product packaging --- products such as cereals, sweet rolls, soft drinks, pies, candies, etc.)

                     REFINED-SUGARS TAX TABLE (proposed)
            %sugars                  Tax rate
           (by weight)         (cents per gram of sugars)
           -------------       ----------------------------
              2% or less                 0
            tween 2% & 8%                0.1
             8% or more                  0.5
                   NOTE1: %sugarS measures "intensity" of sugar content
                   NOTE2: The tax rate is to be applied to the TOTAL grams
                          of sugarS in the product.

    I have a blog page showing examples of what the sugarS taxes would be, for this example tax table, for various food items.

    (No doubt the sugar-food industries will squawk. Coca-Cola, Pepsi, Hershey, Mars, etc. But surely they want a strong country --- a country of healthy citizens. Yes?)

    Besides these 'health-based' taxes on non-healthy items, further funding could come from PREMIUMS on the not-down-and-out 'clients' --- similar to the Social Security and Medicare premiums now. In fact, the Medicare premiums could become the new premiums --- since the new 'Public Option'/'Catastrophic Care' health care system would presumably replace the hodge-podge Medicare system.

In summary :

I WANT A 'PUBLIC OPTION' --- that provides for catastrophic coverage. AND, I am willing to sign up for a large deductible to HELP make the system AFFORDABLE.

No doubt there are many other citizens who would gladly make this kind of commitment in order to have dependable catastrophic health care coverage.

    [Hey, Michael Moore. Wake up. There is no such thing as 'free health care'. I think almost any rational U.S. citizen recognizes that.]

But, in order for the system to be made affordable, I think it should include TOBACCO AND SUGARS TAXES for FUNDING. And HIGHER DEDUCTIBLES AND/OR PREMIUMS should be applied to the seriously OVERWEIGHT and to serious SMOKERS --- to help lower costs.

    [Those trying to do the 'right thing', health-wise, should not be required to subsidize the smokers and junk-food-bingers.]

We need to put our heads together to find ways to MOTIVATE 'PROVIDERS' (hospitals, doctors, private insurance companies, pharmaceutical companies, medical suppliers --- even manufactured-food companies) so that they can be rewarded, even if the country were to, somehow, get a lot healthier.

    [But, weep not for them, Republicans and Democrats. In any scenario, the 'providers' can be assured that accidents, calamities, insect-and-animal-borne disease, genetic factors, STDs, wars, births, and age-related death will provide them with a permanent income stream.]

Cheers, Citizen-Taxpayer [name goes/went here]


Below is a list of the sponsor and co-sponsors of House Health Care Bill H.R. 3200,
with links to each Representative's e-mail 'Contact Me' page (in Aug 2009).

In order to send suggestions to these Representatives, it may be best to printout your suggestion and mail it to their mailing address, as found on their Contact Info pages --- especially if you are not a resident of their district. OR, provide an appropriate zip code, to get to their e-mail form page.

You can use the House's Write Your Representative page to find other members of the House.

Amazingly, there doesn't seem to be a Health Committee in the House.

A list of Senators on the HELP (Health, Education, Labor, and Pensions) Senate Committee
can be seen on the About page of the HELP Committee.

Below is a list of some of the H.E.L.P. Committee members,
with links to their e-mail 'Contact Me' pages (in Aug 2009).

Below is a list of some Virginia U.S. Congress people,
with links to their e-mail 'Contact Me' pages (in Aug 2009) :

And here is the link to the White House e-mail 'Contact Me' page.

Bottom of 'Public Option' for Health Care - Funding Methods and Cost Reduction blog page.

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Posted on 2009 Aug 03.
Changed slightly, to improve printing, 2009 Aug 22.
Changed page format slightly 2013 Apr 30.