The US Federal government spent more than $808 billion in 2007 on health care (medicare, medicaid, Federal workers, VA hospitals, etc.). If you divide that number by every American citizen, that comes out to $2640 per capita. If that $808 billion in Federal health expenditures were utilized as an 80% subsidy for a single-payer health care system then the Federal government and its citizens would be spending approximately $3300 per capita, which would be a higher per capita expenditure than in Ireland, Japan, Italy, Spain, Singapore, the UK, Canada, Sweden, Australia, Germany, and France, all with higher health rankings than the US according to the World Health Organization. So the US Federal government already spends enough money on an annual basis to provide quality health insurance for every American without any private health insurance dollars at all, if these Federal dollars were used as efficiently as they are in most other advanced nations.
Its my argument that a Federally subsidized health insurance credit card system is the best way to utilize the health care dollars currently spent by the Federal government. And in order to implement such a system, I would do the following:
First I'd immediately replace the current Medicare system with a Federally subsidized Senior Care credit card insurance system for all American citizens 67 years and older:
Senior Care credit card:
No purchase fee for seniors , $10 user fee, 80% Federal subsidy, <$25 (final payment), $25, $50, $75, $100 fixed monthly payments. Maximum unsubsidized debt: $25,000 $10 late payment fee $100 delinquent payment card reactivation fee Monthly payments for unsubsidized debt on health care credit cards for seniors:
$25 per month for unsubsidized debt of $300 or less $50 per month for unsubsidized debt of more than $300 to $900 $75 per month for unsubsidized debt of more than $900 to $1800 $100 per month for unsubsidized debt of more than $1800 to $25,000 So if you're a senior and you use your Senior Care card to pay for a simple $200 physical check up, 20% of those charges would be billed to your from the HHS (The United States Department of Health and Human Services) plus a $10 user fee. So you'd be charged $40 for a $200 physical check up plus a $10 user fee ($50: $25 per month for two months). That's it!
If you're a senior paying $100 per month for medicine, $20 of debt plus a $10 user fee would be added to your monthly credit card debt. If you had to use your card to pay for a very expensive procedure like a $50,000 for a hip replacement and short hospital stay, the HHS would charge you $10,000 ($100 per month for nearly the next 7 years until monthly payments would finally go down to $75 per month for a year, then $50 per month for another year, and finally down to $25 per month). Of course, you could always use your card to get your hip replacement in an HHS approved country like the UK which would cost you only $2800 instead of $10,ooo ($14,000 charge to the HHS) or $2400 in France ($12,000 to the HHS) or $1200 in India ($6000 to the HHS). Secondly, I'd provide all parents and guardians, both citizens and permanent residents, in the United States with the opportunity to purchase Child Care credit cards from the HHS for a $50 purchase fee (this would be charged to the card):
Child Care credit card:
$50 purchase price, $10 user fee, $10 late payment fee 80% federal subsidy, <$10 (final payment), $10, $20, $30, $40, $50 fixed payments Maximum unsubsidized debt: $100,000 $50 delinquent payment card reactivation fee Monthly payments for unsubsidized debt on children's health insurance credit cards:
$10 per month for unsubsidized debt of $120 or less $20 per month for unsubsidized debt more than $120 to $360 $30 per month for unsubsidized debt more than $360 to $720 $40 per month for unsubsidized debt more than $720 to $1200 $50 per month for unsubsidized debt more than $1200 to $100,000
If you use a Child Care card for a $200 dollar check up for your child, the HHS would charge you, the parents and purchasers of the card $40 plus a $10 user fee ($10 per month for 5 months). Need $5000 braces for your 12 year old? The HHS will charge you $1000 dollars ($40 per month for 7 months, followed by $30 per month for a year, $20 per month for the next year, and $10 per month for the final year). What if your child's medical credit card still has debt on it even after he or she becomes an adult. Well its not their debt. Its your debt. And you have to continue paying off their unsubsidized debts until their gone no matter how many months or years it takes. So if the poor health of the child your brought into the world accumulates very high medical debts on the Child Care card you purchased, be prepared to pay $50 per month for many years after your child has become an adult (this system is affordable but not free!).
Third, Federal employees, veterans, and military personal would be immediately issued Adult Care credit cards: Adult Care credit card:
$1000 purchase price (charged to the card), $20 user fee, $10 late payment fee 80% federal subsidy, <$25 (final payment), $25, $50, $75, $100 fixed monthly payments Maximum unsubsidized debt: $25,000 $100 delinquent card reactivation fee Monthly payments for unsubsidized debt on health care credit card for adults:
$25 per month for unsubsidized debt: $300 or less: $50 per month for unsubsidized debt: more than $300 to $900 $75 per month for unsubsidized debt: more than $900 to $1800 $100 per month for unsubsidized debt: more than $1800 to $25,000 Non Federal employees could purchase the card for $1000 (charged to the card after it is ordered). Private employers would also be given the opportunity to purchase the Adult Care card for their employes. A $1000 dollar one time purchase fee for employees would obviously be a lot better than paying the private health insurance companies $4700 on average per employee every year. Unions might also insist that employers pay for the purchase an Adult Care card for a spouse ($1000) and children ($5o for each child).
A $200 medical check charged to your Adult Care card would cost you $40 plus a $20 user fee ($25 per month for two months plus $10 for the third and final month). If you're pregnant and are having a baby and you charge all of your doctor appointments and delivery cost on your card to a total cost of $10,000, the HHS will charge you $2000 ($100 per month for two months, followed by $75 per month for a year, $50 per month for the following year, and $25 per month for the final year of your 20% debt). What if you're a non-citizens?
Under my plan, all adult permanent US residents would be eligible to purchase a Federal Guest Care credit card:
Guest Care credit card:
$100 purchase price (out of pocket), $10 user fee, $10 late payment fee no federal subsidy, <$25 (final payment), $25, $50, $75, $100 fixed monthly payments Maximum unsubsidized debt: $25,000 $100 delinquent card reactivation fee Total Debt on health care credit card for permanent US residents:
$25 per month for a total debt of $300 or less $50 per month for a total debt of more than $300 to $900 $75 per month for a total debt of more than $900 to $1800 $100 per month total debt of more than $1800 to $25,000
The Guest Care credit card will be pretty much self financing since no Federal subsidy is provided and since user fees are also charged. The advantage to non-citizens who are living and working in the US is that they will still have the convenience of paying off their health care cost gradually over several months. I should note, however, that under my scenario, the permanent resident will still be able to purchase the same Child Care credit cards as the children of US citizens. Of course, permanent residents would still have the option of purchasing health insurance from private companies. But I would require by law that no one could work in the US without some sort of public or private health insurance.
A $200 physical would cost a Guest Care card user $200 plus a $10 user fee ($25 per month for 8 months plus $10 for the final month of payment). A $10,000 charge on a Guest Care card related to pregnancy would cost the card holder $100 in monthly charges to the HHS for at least 6 years until the next lower monthly charge would be reached. Still there are monthly premiums charged to individuals with private health insurance a lot higher than that.
But what happens if you're one of those rare individuals that ends up having extremely severe medical problems and expenses and your unsubsidized health care credit card expenditures exceed the $25,000 maximum unsubsidized debt? One option is to simply start paying down more of your unsubsidized debt ($100 in debt reduction gives you $500 in available health care credit). Another option would be to replace your Senior Care or Adult Care credit card with an HHS Critical Care card.
Critical Care card:
$150 purchase price, $150 fixed monthly payments (for the rest of your life), 5% of annual income (for the rest of your life) Maximum total outstanding debt: $1,500,000
After purchasing this card, if your annual income declines-- so will your annual additional payment to the Federal government since part of the payment is based on 5% of your annual income. However, if your annual income should increase after purchasing this card, then your annual payments will also increase. So if you should win the lotto it will be happy days for you and for the Department of Health and Human Services!
Further details on how these Federal health care credit cards will be introduced to the public and financed by the Federal government and secured against fraud and abuse will be discussed in the final part (Part 3) of this diary.
"If we do not fix our health care system, America may go the way of GM — paying more, getting less, and going broke."
President Barack Obama June 15, 2009 in front of the American Medical Association
Americans currently operate the most expensive and inefficient private-- and public-- health care systems in the world. And the astronomical and ever increasing cost of medical care in the United States is a continuously growing cancer that threatens the long term economic health of American industries and the economy as a whole.
It is estimated that private health insurance and other worker benefits add $1,000 to $1,500 to the cost of manufacturing a car in America, while it only adds approximately $150 per car in Japan. GM, however, claims health care costs added between $1,500 and $2,000 to the cost of every automobile it manufactures. The Business Roundtable, which represents the largest U.S. corporations, released a study showing that for every $100 spent in the United States on health care, a group of five of our leading economic competitors (Canada, Japan, Germany, the United Kingdom and France) spend only 63 cents.
In 2008, employer health insurance premiums increased by 5.0 percent – two times the rate of inflation. The annual premium for an employer health plan covering a family of four averaged nearly $12,700 with the annual premium for single coverage averaging over $4,700. So its pretty easy to see that the cost of providing private health insurance for American employees is putting US businesses at a substantial competitive disadvantage against other countries whose governments provide universal health insurance for their populations.
In 2007, the U.S. spent $2.26 trillion on health care, or $7,439 per person. Yet, despite the fact that Americans spend more per capita on health care than any other nation on Earth, the UN World Health Organization (WHO) only ranks the US 37th on the planet as far as the quality of health of its citizens. And nearly 50 million Americans have no health insurance at all! France, on the other hand, was rated number one by the WHO despite only spending $3040 per capita in health care dollars for its citizens.
But this is nothing compared to the nation of Singapore. Singapore has a higher per capita GDP than the US and is ranked 6th in the world by the WHO as far as far as the quality of health of its citizens, yet it spends merely $1118 per capita.
Ironically, the US Federal government spent more than $808 billion in 2007 on health care (medicare, medicaid, Federal workers, VA hospitals, etc.). If you divide that number by every American citizen, that comes out to $2640 per capita which was higher than was spent per capita by Ireland, Japan, Italy, Spain, Singapore, and the UK, nations all ranked higher than the US as far as the health of their citizens by the WHO.
If that $808 billion in Federal health expenditures were utilized as an 80% subsidy for a single-payer health care system then the Federal government and its citizens would be spending approximately $3300 per capita, which would not only be a higher expenditure than in Ireland, Japan, Italy, Spain, Singapore, and the UK, but also higher than Canada, Sweden, Australia, Germany, and France, all with higher WHO health rankings than the US. And this doesn't even include the hundreds of billions of dollars annually spent by State governments on health care. So the US Federal government already spends enough money on an annual basis to provide quality health insurance for every man, woman, and child in America without any private health insurance dollars at all, if we utilized these Federal dollars as efficiently as they do in most other advanced nations.
Unfortunately, both Medicare, Medicaid and the other public and private health care systems financed by the Federal government are as fundamentally inefficient and inherently inflationary as the private health insurance systems in America. Medicare alone provided health care coverage for 43 million Americans in 2007 at a total cost of $440 billion, approximately $10,200 per recipient. That's more than four times as much as Spain spends on health care for its 46 million total population even though the health of Spaniards are ranked 7th in the world by the WHO.
Why are public and private health insurance cost so inordinately expensive in America relative to most other industrialized countries?
Himmelstein, an associate professor at Harvard and doctor at Cambridge Hospital determined that 31 cents out of every dollar spent on health care in America is for administrative cost. So out of the $2.26 trillion spent on health care in the US in 2007, approximately $700 billion dollars a year is spent on administrative cost. The total IRS budget in 2006 was less $11 billion. In Canada, administrative cost account for only 17 cents per dollar. So its obvious that our complex health insurance system in the US is costing Americans several hundreds of billions of dollars in annually in administrative waste.
Most private and public health insurance plans usually limit consumer choice of doctors, hospitals, and clinics. And once a consumer is enrolled in a health care plan there are practically no market incentives to reduce cost. And this is compounded by the fact that Americans exist in a health insurance culture where the cost of a medical procedure is rarely discussed (don't worry, your insurance will pay for it). Of course Americans and their employers end up paying for it through ever increasing monthly premiums. Guaranteed health insurance benefit packages that allow hospitals, doctors, and clinics to charge the maximum price for a medical procedure also dramatically increase the cost of health care. Hospital stays after surgery for simply monitoring patients can run into several thousand dollars on a daily basis. Medicare will pay in full for hospital stays up to 20 days, charging fixed co-payments only for the first day and for patient stays exceeding 20 days. None of these payments rise or fall in relation to the total cost of a hospital stay. So there's no incentive for a Medicare patient to seek out hospitals that charge less for a hospital stay.
The consumer also has extremely limited accessible information as to how much a medical procedure cost at a hospital or clinic. Of course, all of your investment or your employer's investment in your health insurance can be lost if you change jobs, lose your job, or that company goes out of business.
So extremely high administrative cost; extremely costly and inherently inflationary health insurance benefit guarantees associated with public and private insurance plans, and the severely limited ability of consumers with health insurance plans to price shop for the doctors, hospitals,and clinics that can provide quality health care services at the lowest price-- have in combination made health care in America easily the most expensive per capita in the industrialized world.
In order to substantially reduce the cost while increasing the efficiency of Federally funded health insurance programs in America, we need a system or systems that strongly encourages recipients to seek out the best medical care at the lowest price. And we need a system that gives consumers convenient access to what doctors, hospitals, and clinics are charging for medical check ups, examinations, and other procedures in order for consumers to make informed decisions on the cost and quality of their health care. The best way to do that, in my opinion, is to design a system that makes medical cost affordable for all American citizens-- while still expensive enough to provide consumer's the incentive to seek out the lowest prices. In other words, we need a health care system in America that makes health care affordable-- but not free!
Credit cards are a popular and convenient financial mechanism that private enterprise uses to make expensive items immediately affordable since the cost, including interest and fees, are spread out over a several month pay-back period. Subsidies are also an efficient mechanism for making something that is expensive more affordable for an individual. Since the Federal government already spends enough money on health care to provide universal health insurance for all Americans equal to that of practically all other industrialized nations, I believe that these funds could be most efficiently utilized to subsidize a Federal health insurance credit card system.
Under my scenario, Federally subsidized health insurance credit cards would be utilized by Americans to pay for all of their medical, medicinal, dental, and eye care services. Americans would be able to utilize these health care credit cards at any hospital, clinic, or pharmacy in America and possibly at any hospital, clinic, or pharmacy in any other country certified by the United States Department of Health and Human Services (medical tourism). The U.S. Federal government would pay private and public hospitals, clinics, and pharmacies 100% of the medical cost charged on these health care credit cards while charging Americans who utilized these cards 20% of the total cost in addition to a standard user fee.
Such a system would also provide consumers with a central online data base where health care credit card charges by doctors, hospitals, clinics, and pharmacies could be displayed (the individual patients associated with the charges would be anonymous of course) allowing consumers the ability to compare prices and medical cost. So consumer co-payments, user fees, and the ability to compare prices while selecting the doctor, hospital, or clinic of their choice at practically any place in America and possibly even over seas could dramatically reduce the cost of health care in America.
However, if such a system could eventually be run as efficiently as health insurance is in places like Japan, Spain, Singapore, or the UK then our current Federal health care expenditures could potentially be reduced by hundreds of billions of dollars annually. States would also benefit if they no longer had to pay the hundreds of billions of dollars of annual Medicaid support payments. Of course, if private industry in the US no longer had to pay trillions of dollars to the private health insurance companies any more, this would result in a titanic economic boom for the American economy which should bring in even more revenue for the Federal government. And in order to achieve all of this, all we have to do is to simply run our health insurance system as efficiently as practically all other industrialized nations do!
In the next part of this discussion, I'll describe how I believe the Federal government could implement a Federally subsidized single-payer health insurance credit card system without raising any taxes while possibly creating huge surpluses in annual Federal revenues that could be used to fund other Federal programs, reduce the Federal deficit, and even reduce our individual income taxes!
US nuclear utilities have written to Energy Secretary Steven Chu asking him why they should continue paying some $770 million annually towards the Yucca Mountain waste repository since the project has now been scrapped and no alternative has yet been proposed.
In February, the Obama administration announced that funding for the Yucca Mountain project had been reduced to all but zero and that a new plan for the disposal of the country's used nuclear fuel and high-level waste would be developed. However, licensing activities for Yucca Mountain are to continue. The result is that, although Yucca Mountain has not been officially cancelled, the USA currently has no firm plan for the disposition of over 60,000 tonnes of used nuclear fuel from power stations, as well as 20,500 tonnes of wastes from military activities.
The Nuclear Energy Institute (NEI), the US industry body, has written to Chu on behalf of its members to "express its deep concern about the federal government's failure to fully carry out the statutory obligation to implement the nuclear waste policy established almost three decades ago in the Nuclear Waste Policy Act of 1982 (NWPA)."
The NEI points out that "the NMPA remains the law and it is incumbent on the [Department of Energy] to comply with its mandates." The NWPA, it says, requires the Energy Secretary to annually review the payments made by utilities to ensure they will meet the costs of the DoE's used nuclear fuel management program. The fees can be adjusted according to this review.....
Japan is drawing up innovative plans to extract uranium from seawater in an attempt to end the country's reliance on imports for nuclear power stations.
Government-funded scientists have proposed placing huge "uranium farms" on the seabed, consisting of anchored sponges which soak up the element.
Dr Masao Tanada, of the Japan Atomic Energy Agency, has developed a fabric made primarily of irradiated polyethylene that is able to soak up the minute amounts of uranium – around 3.3 parts per billion – in the seawater.
The world's oceans contain an estimated 4.5 billion tons of uranium, around 1,000 times the amount that is known to exist in uranium mines.
Dr Tanada claims Japan's nuclear power industry could harvest the 8,000 tons it needs each year a year from the Kuroshio Current that flows along Japan's eastern seaboard.
Scientists are turning agricultural leftovers, wood and fast-growing grasses into a huge variety of biofuels—even jet fuel. But before these next-generation biofuels go mainstream, they have to compete with oil at $60 a barrel
"The knowledge that we have now is but a fraction of the knowledge we must get, whether for peaceful use or for national defense. We must depend on intensive research to acquire the further knowledge we need ... These are truths that every scientist knows. They are truths that the American people need to understand." (Harry S. Truman 1948).