LLHIS

LLHIS

We have had Obamcare  (ACA otherwise known as the Affordable Care Act aka unAffordable Careless Act).  Lost in the morass was COBRA, which was a good idea and very poorly implemented.  Now the Republicans have tried with the American Health Care Act- and failed.

Therefore, I offer Loony Larry’s Health Insurance Solution (LLHIS)

  • Obamacare is repealed- all of it
    1. The 1,900 or pages of it that had to be passed before we could know what was in it
    2. The 50-60 offices and boards, and agencies it created
    3. The 46,000 pages of regulations created in (2) above
  • Limit the bureaucracy
    1. 435 adjutants – one for each congressional district
      1. Monitors costs from hospitals in district
      2. All hospitals submit monthly report on standardized format
  • Each adjutant has copy of a program to read reports (est. cost to write program-using Senior System Architects with no government experience– would be $150,000)
  1. Adjutants would be able to determine variance in costs for same items, procedures and medications
  2. If excessive variance is found, (variance from rural to metropolitan can be 17%, from metropolitan to metropolitan no more than 15%, from rural to rural no more than 9%).  Rural is defined as less than 150,000 population, metropolitan  higher.  Then variance is to be referred to
  1. State Cost Control bureau (50 of them, one for each state)
    1. Each state creates laws, injunctions, penalties, fines etc. for all medical facilities in their state. They may determine what is the fraud that is most prevalent in their area.
    2. Guidelines may be generated by the U.S. Government if the states refuse to do so within 9 months of passage of this bill
  2. Product Research
    1. One individual from each district- must be medical professional (meet part time to be determined by them but no less than once every other month)
    2. Study current state of research by
      1. Pharmaceutical companies
      2. Medical research centers
      3. Foundation grants
  • Determines that the needs of individuals in their area are being meet by research
  1. Pharmacy Board
    1. Two individuals from each state (non-professionals) and one professional physician from each state
    2. To meet at least quarterly
    3. Monitor prescription costs and determine what is so high that patients are choosing to avoid buying as prescribed.
    4. Suggests which medications should be subsidized further
  • Analyzes pharmaceutical cost to bring new drug to market
    1. Determines if cost/benefit ratio is within guidelines
      1. Guidelines created by U.S. Government
    2. Determines if insurance/patient subsidy is necessary
  • All persons currently in hospitals, being treated by physicians, physical therapists, occupational therapists will continue to be covered under their existing plan
    1. The customer will continue to pay existing premiums unless
      1. It is an Obamacare package with premiums or deductibles above average for policies in area according to the districts adjutant
      2. The LLHIS will pay the difference until the customer has the opportunity to select a reasonable policy for their needs
  • Individuals with “pre-existing” conditions
    1. “pre-existing” is defined as prior to the implementation of LLHIS
    2. “pre-existing” is a condition an individual has that is not catastrophic, terminal or life-threatening but has had for a period of time and requires normal medications
    3. Catastrophic, terminal or life-threatening diseases are covered in a special LLHIS pool that covers all medically necessary treatments
  • Insurance companies may sell policies across state lines
    1. Group policies can be sold to similar markets across states, i.e. garage mechanics can be in a group, paramedics can be a group, etc.
    2. Individuals can get a group policy by joining with other individuals but only within a state
      1. Brokers may sell insurance policies but have sales commissions limited by U.S. Government guideline
  • Policies can be:
    1. Wellness
    2. Catastrophic
    3. Both
    4. Riders will be allowed for a patients individual needs and subsidies may exist
      1. Cancer
      2. Heart
      3. Congenital defects
      4. Diabetes
  • Policies can be bought for elective surgery but at a higher cost

Medicare, Medicaid and the Veterans Administration openly admit to $95 BILLION dollars in fraudulent claims EACH year.  A special position to be known as cost containment  lawyer will be appointed from each district.  They will be paid from the first $5 billion saved.  The next $30 billion will go into the pre-existing fund, the next $30 billion saved will be split between paying insurance subsidies and pharmacy subsidies, the final $30 billion saved will go into research to assist patients in medicines needed, therapy needed Durable medical goods, etc.  It is expected that this should take approximately three years to clean up.  After this then Congress should appropriate the before wasted funds for the now needed useful funds.  The final step will be that the lawyers will have devised laws and procedures to insure that this fraud does not continue.

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