Health Care

Health Care, a Plan

health care

Our administration and representatives are negotiating the terms to take over our health care system, in the belief that it is too expensive, and will cripple our economy if the costs are not controlled.  The human element is the plea to cover people that do not have insurance, so they will have access to the best care money can buy.

Rather than plow ground that has been plowed by writers more gifted than I, my focus is how to provide health care to uninsured citizens.  If this is a national priority, let's not destroy the health care system that stands between us, and the grim reaper in the process.

As a former County Commissioner, I had the responsibility to oversee and fund the county health department.  This health care facility provided basic services to many who could not afford (or chose not to pay for) access to private care.

County health departments exist throughout the nation, working quietly to benefit society's poorest citizens.  Free or reduced price, health care is already being provided depending on your ability to pay.

The present discussion is about building a new bureaucracy and restricting health access for everyone.  Why not increase the funding for County Health Departments around the nation?

In exchange for this added charitable benefit, the uninsured could only be treated at hospital emergency rooms after hours, and only if hospitalization was required.  Hospitals would bill the county health department for any services provided, at the lowest negotiated group network price.  Hospital emergency rooms would no longer be required to accept anyone who walked in their door.

Funding should be allocated by population on numerical bases, and disbursed to each congressional district.  The Federal Government's role would end at this point.  Each Congressional District would have a local board, composed of one commissioner from each county.

These district boards would be responsible to distribute the funds to each County Health Department for the best impact in their area.  County Health Departments would have to expand to enhance services, but continue to provide basic health services for the uninsured or poorest citizens.

To access these services, citizens would have to:
  • Prove citizenship (are we going to provide free health care to THE WORLD?)
  • File a copy of last year's 1040 (verifies income)
  • Prove residency (avoids shopping location)
  • Develop other local regulations sensitive to local voter wishes.
To increase insurance participation, let individuals deduct insurance premiums up to $3,600 per head of household, and $2,000 per dependent on their federal taxes.  Let companies deduct insurance benefits on the same schedule.

Require insurance companies to accept citizens with pre-existing conditions.  This would have two caveats:
  •  90 day exclusion period if the pre-existing condition was not covered by insured's previous policy, or if they did not have insurance.
  • Citizens would not be able to "insurance shop" for better coverage on pre-existing conditions.  Previous coverage would apply for 90 days on any pre-existing condition.
In exchange for society offering this benefit, health care has become a responsibility to everyone.  If society is providing "free" care to the poorest citizens, then those that can afford health insurance must be required to:
  • Purchase basic insurance in the open market, or
  • Pay an insurance surcharge on their federal income tax return of 25% the maximum health insurance deduction available to those that buy insurance.
With this health reform plan, we accomplish a few beneficial goals, and avoid some the worst outcomes.
  • The costs are clearly stated in the federal budget, as a transfer to congressional districts for health care.
  • We stop health care for non-citizens.
  • We eliminate cost shifting onto insurance premiums.
  • The health care benefit is restricted to county health departments, and basic health care. 
This benefit is not intended to grant access to the "best health care money can buy" for everyone, but to put in place a safety net under our poorest citizens, until they get back on their feet and can afford the health care they would like for themselves and provide for their families.

Some may have a concern about the exclusion of non-citizens in our coverage by the nation's taxpayers.  If a non-citizen seeks medical assistance at any county health department or hospital, they must first sign an "agreement to deportation" document.

After being treated, they will be immediately deported by the County Sheriff.  The county health department will fund the cheapest transportation to a hospital in their home country.

A few general points need to be emphasized:

  • Health care is expensive because of government expanding coverage to new illnesses: i.e.: alcoholism, mental illness.
  • Health care is expensive because of tort lawyers.
  • Health insurance is expensive because of low deductibles. 
Addressing these three issues will slow the growth in health care costs. Removing non-payers from the health care system will eliminate cost shifting, lowering health care costs to everyone.

Medicare and Medicaid should be required to pay the lowest negotiated network price for any services.  This would further reduce the cost shifting that currently distorts the market.  It also sets reimbursements at a localized cost rate, rather than a one-size-fits-all standard.  It takes the power away from the government to promise more and pay less by force.

A side note:

If Oh! Bama is successful in gaining a public option for health insurance; it must be a standalone agency without any support from taxpayers.  Wouldn't it be fun to watch bureaucrats try to compete with private insurance companies?  I always laugh when politicians say the government needs to "keep the insurance companies honest."

Government subsidies should be equal to the "premiums" they do not collect from citizens covered.  In other words, only the premiums would be subsidized by the government.  The public option (government bureaucracy) would have NO legislation that tilted the playing field for them to compete.  They would have to negotiate fees with health care providers, just like everyone else.  If they did not pay fairly, providers could choose not to do business with them.  With an absolute wall to legislation or money, this charade would be over quickly and we could return to a free market.

By: John Dalt

Why Did Energy Expenditure Differ Between Diets in the Recent Study by Dr. Ludwig's Group?

As discussed in the previous post, a recent study by Dr. David Ludwig's group suggested that during weight maintenance following fat loss, eating a very low carbohydrate (VLC) diet led to a higher metabolic rate (energy expenditure) than eating a low-fat (LF) diet, with a low glycemic index (LGI) diet falling in between the two (1).  The VLC diet was 30 percent protein, while the other two were 20 percent.  It's important to note that these were three dietary patterns that differed in many ways, and contrary to claims that are being made in the popular media, the study was not designed to isolate the specific influence of protein, carbohydrate or fat on energy expenditure in this context. 

Not only did the VLC diet lead to a higher total energy expenditure than the LF and LGI diets, the most remarkable finding is that it led to a higher resting energy expenditure.  Basically, people on the VLC diet woke up in the morning burning more energy than people on the LGI diet, and people on the LGI diet woke up burning more than people on the LF diet.  The VLC dieters burned 326 more calories than the LF dieters, and 200 more than the LGI dieters.

It's always tempting to view each new study in isolation, without considering the numerous studies that came before it, but in this case it's essential to see this study through a skeptical lens that places it into the proper scientific context.  Previous studies have suggested that:
  1. The carbohydrate:fat ratio of the diet has little or no detectable impact on energy expenditure in people who are not trying to lose weight (2, 3).
  2. The carbohydrate:fat ratio of the diet has little or no detectable impact on energy expenditure in people who are being experimentally overfed, and if anything carbohydrate increases energy expenditure more than fat (4, 5).
  3. The carbohydrate:fat ratio of the diet has little or no detectable impact on energy expenditure during weight loss (6, 7, 8), and does not influence the rate of fat loss when calories are precisely controlled. 
This new study does not erase or invalidate any of these previous findings.  It fills a knowledge gap about the effect of diet composition on energy expenditure specifically in people who have lost weight and are trying to maintain the reduced weight.

With that, let's see what could have accounted for the differences observed in Dr. Ludwig's study.
Read more »