American Manifesto Part Three: Health Care Section Two

 American Manifesto Part Three: Health Care Section Two

Here are some real steps to bring some sanity to the system.

Funding

Use federal income taxes and the elimination of Medicaid and Medicare taxes, as well as the re-direction of all the costs associated with governmental employee’s heath care to fund and divert dollars into a national “single payer” style heath care system for all U.S. citizens regardless of age or employment status.  All of the money currently paid to health insurance companies by employees and employers would be freed to fund a universal program.  Health insurance premiums are basically an employee/employer tax now anyway.  The tax would be progressive with income level and fully restricted for health care.  There would also be AGI linked co-pays and deductibles with co-pay floors and ceilings for services.

Single-payer “health insurance” is now a benefit provided to all U.S. citizens and is paid through our federal income taxes tracked by our adjusted gross income to determine our deductible and co-pays.  This eliminates the ability to exclude, except for non-citizens.  We can capitalize on advances in information technologies in an organized universal system to get doctors paid and appointments fulfilled.  We could also include discount factors for military and full coverage for direct service injuries.

Guaranteeing health coverage regardless of employment status will not give healthcare to the non-working, it will give healthcare to the middle class.  The non-working and medically-impoverished forced to qualify to survive are the only non-disabled people who can qualify for Medicaid now or people who are retired and using the Medicare system.  The cost of this portion of the population’s healthcare is already being paid by the American people, except through a giant inefficient bureaucracy that requires state-based administrative filters and a spider-web of billing networks designed to increase billing hours to the federal government in hope of collecting a portion of what is billed. 

Cost Control

Who cares if we can bill for a service, did the service need to be provided?  If the facility is not paid based on billing out units, but on standard cost basis with doctors on a salary-type system, then facilities can focus on care and not what kind of insurance plan the patient has.  Insured patients don’t give a fuck what the test or pill costs.  There is no linkage, beyond deductibles.  That is why a universal system should have IRS adjusted gross income (AGI)-linked flexible annual deductibles with average test charges computed on national data for each procedure costs.  Reconcile the co-pays to an additional quarterly income tax withholding through the individual’s employer in the following period or direct payments for the unemployed or retired based on floor-based co-pays based on lifetime historical earnings.  Dependents follow tax elections.  Communicate charges via the web-based infrastructure.

The fluctuating AGI linked co-pays are born by the taxpayer and provide incentive for each American to monitor their own health care costs.  People can choose higher or lower costs facilities depending on specialty care utilized or chosen when choice is possible.  Each annual tax return will reconcile total withholdings with total tax owed.  Co-pays are set by the local facility within a range set by the federal government to manage their own costs given what doctors they choose to hire. 

That administrative cost of current government healthcare system’s filters are not only the wasted government employee time in processing qualification and computing and releasing payment disbursement forms, but the fact that private doctors have to service the patient whether the government pays them or not.  Doctors get frustrated with the government’s natural action in the current system to push the costs on to another facility. 

A wider encompassing system where the government can not pass the cost on to the patient or another insurance company will provide healthcare providers with a more consistent expectation of the compensation they will receive and allow provider budgeting to be more reliable and force the government’s hand (us) towards encompassing solutions that are most effective in a common digital web-based accounting environment.  (One could argue that the path to universal and better health care is not in the advancement of medicine, but in the advancement of accounting to mitigate the chaos of the potential variables interacting in a single confined system.)

The federal government will allocate a standard per capita health care budget to each state as a total based on census data.  Each state will manage those dollars by allocating budgets to facilities in that state from the total.  States can elect to create centers of excellence or however they see fit.  Payments to fund the facilities can not be service-dependent.  The allocation is gross, meaning facilities are not provided an incentive to run more tests to make more money.

Whoever shows up at that facility shows up.  The state will then look at the data of where resources are needed and adjust funding quarterly.  The exception is that a U.S. citizen not from that state will be charged an out of state premium through the IRS co-pays, which will then be refunded to the facility based on the service through the individual via the individual’s IRS linked bank account used for all tax filings. (This is only possible in a web-based universal national health care accounting system and is probably constitutional based on interstate commerce.)

The state-level of the system acts as the funding “insurance company” for internal budgeting purposes for facility-level management decisions.  The facilities could compete with each other based on patient health and wellness ratios based on the dollars put into the facility, to acquire more focused funding through the state (i.e. to become the primary cancer care center within a geographic area.) 

In this case states could partner, if amicable, given the confluence of common geography and the often arbitrary nature of state borders forcing otherwise inefficient accounting for the nation.  States could also use their out-of-state additional copay agreements as a way of managing costs and prioritizing national healthcare dollars so that arbitrary geographic state lines, like those in New Jersey, Pennsylvania, and Delaware can coordinate to reduce costs, rather than operating redundant facilities near state borders.

Census-based analytics should prompt the state-level government to focus funding to urban and rural family practice facilities and urgent care centers on need.  Urgent care centers and regional facilities could offer a lower-cost option for much of the healthcare delivery methods than a hospital emergency room, which in the current system is some people’s only option.  Facility-based IRS deductible and copay procedure charges would provide incentive to use lower cost facilities.

At certain thresholds or procedures in care such as x number of visits in a year or significant medical procedures charges could interface with the IRS and create a potential additional tax burden for individuals based on their usage of the medical system and their adjusted gross income and historical earnings for older individuals.   This along with flexible AGI-linked deductibles could be used as a realistic way of linking the ability to pay with living in an unhealthy lifestyle in some instances.  This would equate to a second tax and emulate a traditional deductible.  This would integrate consumer-vested interest to be cognizant of the costs we create.  This would also offer Congress and the American taxpayers a variable contingent to usage to control expenses and funding. 

We need to get the idea that “universal health care equals everyone has ‘free’ health care” out of our preconceptions.  

A tax credit for each taxpayer and dependent for receiving an annual physical or the equivalent of at least seeing a doctor at least once a year would also provide incentive for preventative care in an organized and free market-driven manner.

Such an addendum to the system is a slippery slope in the administrative linkage it creates, however it may have a place in funding the system by penalizing people for their own poor lifestyle choices when they are the root of additional health costs in some instances.  Simple linkages like evidence of certain drug use through blood tests, obesity ratios and failure to follow preventative procedures recommended and provided by the government healthcare providers could trigger IRS tax burdens or the reduction of other benefits (poverty subsidies), which would not be life altering but would correlate an individual’s lifestyle choices with their tax input to promote macro-level wellness.  These annual physicals could assist the greater system by catching higher cost health issues early and allow doctors to document a baseline in the event cancer or other diseases develop at a later point.

Macro Economic Rationale

Keynesian economic theorists would argue against free market invisible hand thinkers who bombard us with the wonders of private healthcare and the diversity of the free market meeting the variety of healthcare needs of our society.  What we have now is not even close to a free market. 

Contrary to the traditional nature of free market economic theory, the way we get closer to a “free market” with healthcare is to move towards a single-payer-style universal heath care system, not away from it.  Only in a modernized web-based universal system will we truly have a chance to choose to get care where and when we want.  (We may still be limited, but at least we can foster the potential.) Universal linkages allow facilities to communicate charges to patients via impacts on our IRS-linked deductibles and variable procedure dependent co-pays.

Free market thinkers in an ideal world would be able to buy health insurance or healthcare like buying a set of golf clubs or a pound of potatoes, but there is no healthcare store we can walk into and see the price and pay that offers a mutual assurance of accessibility or time on a macro level.  Health in a real population of humans can not be primarily dispensed in such a manner unless we adopt some Ayn Rand-war on altruism and let poor-sick people rot in the street.  Therefore a Keynesian-view is far more pertinent to find the proper role of government to provide the mutual assurances that a private system can not ensure.

Digital Solutions

We could use a driver’s license or passport along with social security numbers as a basis to create medical ID’s.  Linking citizenship to healthcare through the digital IRS could interlink efficiencies throughout our government.

We could issue medical identification cards based on social security numbers to electronically track entire medical histories.  We could even create a new unique numeric codification to maintain privacy over SSN#’s.  What doctors has a person seen, their notes, procedures performed, medications taken in cloud-based data universe accessible to the physicians, tech’s, pharmacists, and therapists could all be documented based on scanning a card in a wallet, a chip in a cell phone, or a piece of jewelry with a microchip stored in it to identify an incapacitated body.

Universal federally-owned software packages could be designed to interface a strip-card reader technology similar to credit cards to interface with smart phones, laptops and other hand-held devices that could proliferate throughout the medical industry.  With advancements, biometric readers for retinas or finger prints may also be able to be used to pull up data in the future. 

This data would save an exponential amount of administrative time in filling out and processing forms and allows for a new paradigm in how we process and retain medical information as well as saving lives.  Voice recognition software has already replaced written patient charts in many hospitals. 

The maximum benefits of free-flowing digital data are only possible once the legal hurdle of insurance companies is overcome.  Insurance companies deny care based on medical histories.  This currently mandates the presence of laws like HIPAA to in essence protect our medical identities from insurance providers.  This hampers the flow of an individual’s information, which increases the total cost of care.

We take our digital identity to the doctor or hospital.  We check in.  We get seen.  We get treatment, a prescription, or diagnosis.  We can use the fingerprint as further identity confirmation, especially for high dollar procedures.  We leave without paper work, but we do create a refined digital trail.  We can make appointments on our smart phone where we want based on available options shown on a universal website. 

Digital processing centers coordinate with the IRS.  We do not have to go to the emergency room for a stomach ache.  The doctors do not have to check judgment at the door to see if our insurance company will cover what the doctor recommends.  Doctors do not need to push a certain drug on us because they are getting partially funded by that company or got laid by the sorority-ex-stripper sales rep.  Physicians recommend and treat us with what makes sense to get us better within protocols.  The versatility of such an open system would allow for more innovation in the methods of distributing heath care, not less.

Doctor’s scheduling non-emergency medical care could be facilitated in a more organized manner than people booking an appointment for 10:30 and not getting seen until 12:30, because appointments could be monitored all the way through and updated in a twitter-like disbursement of waiting times through a universal website, allowing in some cases you to leave the waiting room after check-in, run errands and return based on a web-based next available system through texts, emails or automated call backs. 

We could use GPS wrist bands to track the location of patients, to be used in equations built into the source code of the system given logistical bottle neck computations for operations management to compute wait times, appointment availability, and ultimately the variable priced charged for access to that facility based on actual demand.  Agencies could also hand out beepers similar to restaurants or use cell phone texts, but the idea of GPS linked wrist bands may allow a computer to do the work of multiple humans at lower total cost.  You can also use GPS on the doctor to reconcile total time in proximity to that patient’s wrist band to compute face to face service time linked back to the service codes linked to that patient.  All of these statistics can be used by facilities to compare physicians, similar patients, times of day and other factors to manipulate availability of services and feed into the computations for the federally computed variable per service copays.  We could finally be working smarter not harder.

WeCare.gov, the “Facebook” of Medicine,

With an open internet portal appointment database that can link providers together, emergency room locations and waiting times can be posted on line through Google maps at a common healthcare website that facilitates all medical appointments.  Solutions to sort patients become user-driven.

Doctors could present biographies, pictures and skill sets through you-tube-type videos for patients to get a feel for who they want to see.  A doctor could be registered as a person’s primary doctor in order to facilitate a system of priorities for the sake of consistency and the maintenance of medical records, but that should not affect compensation to the doctor.  It would however provide an indication to the medical facility on where more and less doctors may be needed.

Doctors can have online appointments and schedules because everyone is in the same system.  Collective motivation to provide better care could utilize universally beneficial technological advancements, which can be funded across institutions and spread fixed costs.

Specialized equipment and medical machines can be more easily shared by facilities to reduce costs when competitive market factors between facilities are reduced.  This specialized equipment’s availability can be communicated to the public and more efficiently allocated on an as-needed basis in non-emergency situations. 

If there are more than one open MRI machines in a market, the consumer can see that number two is overbooked and number one is in the same general area and fits her schedule better.  In the past, the owners of those two machines due to separate profit motivation would not provide this information to the consumer.  They would hoard patients.  Inefficiency and more medical and time costs would be created.  Extrapolate this concept out to every form of therapy, rehabilitation, basic check-up, a parent taking their kid in for basically antibiotics, blood screenings, plasma donation etc.

How many people are booked at each local doctor would be public information.  Patients without preferences could sort themselves out into available times in the system days in advance when possible and updated in real time based on check-ins, check-outs, and cancellations.  Doctors could be more capable of honoring a system of appointments like reservations, because there is no incentive for the doctor to hoard patients.  We could avoid logistical nightmares of ten appointments in a one hour period for non-emergency needs.  One federally-developed software could be used by all doctors without creating per-user software licensing costs.  Think about how web-reservations changed the airline industry.

The lost hours in waiting rooms across the country are part of the medical costs we all bear.  Medical leave time is paid by employers including our government, which is us, as tax payers.  A fifteen minute actual meeting with a doctor that takes three hours costs us all.  We need to put the logistics in the hands of the patients and not a single receptionist putting people on-hold to data-entry information, reading hand-written charts and leaving a patient in a dark limbo of an eleven a.m. appointment. 

We could have a website and call centers with screeners linked into the site run by massive Big-Data Centers secured by the U.S. military, probably on pre-existing military bases in some feasible logistical instances.  Call centers could be anywhere.  Put the mainframes holding the data on the bases.

Innovations more feasible in an open system could generate walk-in clinics with video conferencing including schools, community centers, senior centers, nursing homes, group homes for the disabled, shopping malls, hotels, stadiums or any place where people gather.  These technologies would combat problems of doctor and specialist scarcity and patient density with simple healthcare needs with a dynamic user-driven solution. 

Patients could register in advance for community events in an organized method with more complete information on when to schedule non-emergency healthcare.  All we would need is an internet portal for some levels of care and an internet portal with a lower paid nurse practitioner to facilitate the diagnosis based on the doctor patient discussion. 

These open ended portals are not currently feasible because of the administrative hurdle that insurance companies create for the average person to utilize walk-in care in an expedited format, combined with legal risks exacerbated by the current disaggregated system blurring standard acceptable practices.  We could utilize a waiver of a right to sue a physician as part of the video teleconference based on limitations of not being able to detect medical issues more easily detectable if the patient and doctor had been in the same physical room.  This addendum would insulate doctors and be elected based on patient choice. 

Patients could conduct Skype-type conferences from their home or workplace to simply talk to known qualified physician anywhere in the country while legal risk could be mitigated.   This could reduce the medical leave time in some cases from say three hours to twenty minutes. 

Lower cost appointments could be handled verbally and on camera remotely, extracting them from the assembly line of medical needs, and allow higher cost medical needs to flow through on-site facilities.  These elections could all be driven by patients based on the known-impact to our IRS co-pays, deductibles, our actual medical needs, and our available time.  The system does not have to be perfect, but it should be better. 

This type of user-driven sorting option would help alleviate many stereotyped concerns having to wait six months for a doctor’s appointment under images of socialized European or Canadian medicine.  (I wonder who tries to put these images in our heads and why?  How many campaign contributions did the A.M.A. and the Chamber make last year?)

It makes little sense other than profit motivations to have to make the same appointment to get antibiotics for a cold or to ask a medical question, as you would for a more serious consultation.  There has to be segmentation.  The primary reason that does not occur now is that physicians want to bill insurance companies for full visits regardless of how much the visits are needed.  Doctors hoard appointments.  (I still get postcards in the mail and phone call reminders to keep my appointment.  God forbid I feel I am better and don’t allow my doctor to double-dip my HMO for a follow up.) 

The American Medical Association (A.M.A.) wants it that way.  If a doctor is paid the same regardless for x hours of work from a single-payer system rather than per patient from x number of systems then this obstacle could be overcome.

How many times do we go to the doctor because we feel under the weather and all we really need or receive is a prescription based on speaking with a doctor?  The nurse may take the x-ray, blood sample or swab.  How much time in our healthcare system is wasted based on a doctor making chit chat to rationalize charging what they charge for what could be done in five minutes instead of an hour?  (Who is the only party capable of sorting out these potential savings; we are.  We must free ourselves.)

How much more sense would it make to conduct an appointment over the web for the more simple health needs or questions and then schedule the follow-up blood test at a lower cost diagnostic facility which the doctor would probably send us to now anyway?  Simple videos or captioning built-in texts to web-conferencing to inform patients that doctors and patients are encouraged to focus on the pertinent medical issues rather than small talk, because although nice, it costs both sides of the equation tax dollars, and limits the amount of good the doctor can produce towards our humanity’s health.   

(What if we set up this video-conference system and sold consultations to some foreign countries and provided free-humanitarian aid to others?  What if we could do this for our remote military overseas?  Mental health verbal counseling sessions could be revolutionized.  )

The reality is we should be able to email a doctor from our phone or home with a description of our ailment.  That data should go to the local doctor’s tablet on his or her inbox in preparation for our appointment.  Text verbalization software should be available to read our emails to doctors to save time. 

The doctor could email us back template based responses the federally-designed software could provide like Watson on Jeopardy that could include you tube-like videos with a doctor or that specific doctor discussing some of the potential pertinent information regarding our question or issues.  Key words in the email could trigger links based on the Watson software for the patient to peruse.  We could also have an email center of doctors coordinating with the Watson software to send the response to us and the local doctor to process if desired.  This way the logistics of the local doctor do not create backlogs and less training is needed on a macro-level.  This could also potentially create 24/7 throughput.

This would lead up to when we actually get in the office the doctor has the reminders ready and possibly the targeted videos to watch on handed-out tablets with ear phones in the waiting room that can be carried into the patient rooms. 

Our local Doogie Howser is a cerebellum to decipher the digital swarm of medical data around us.  As in education, debt, taxes, and most things the solution is in the synthesis.

Why would patients use templates on the web instead of going in for a real doctor?  A patient’s time is valuable.  When we correlate the economic savings via the linked co-pay with a lower cost avenue (the web) into the system, patients will sort themselves based on their medical needs and personal finances.

All of these advances in healthcare are more efficiently accomplished with federally designed software systems to meet our common goals.  These systems are infinitely more unachievable with for-profit-incentive road blocks littering our path confining medical assets.  When the funds go through one tax system, products and systems that benefit every doctor’s office in America are possible, because the care of the total human American population is prioritized rather the financial success of a specific facility or private insurer’s population of patients.

Health Insurance Portability and Accountability Act (HIPAA)

As America progresses in the digital retention of medical records it is probable that if the potential loss of health coverage was eliminated from the equation HIPAA issues concerning privacy of medical records would decrease as a national concern.   We could implement voluntary personal waivers of administrative privacy red-tape created by HIPAA allowing a person to hold his or her own medical records in a file on their cell phone or in a database at the hospital facilitated accessed by their medical identification card or number. 

The average person does not care what someone else’s medical history is.  It is a concern to that person and their relatives because of a desire for better health paired with a fear of being exploited by private health insurers.  We know insurance companies will drop our or our grandma’s ass the first chance they get.  If there is basically one health system sorting all our data around, the ability to get doctors pertinent information in a digital format in a timely manner seems more feasible in the absence of private insurance companies.

Lives could be saved, along with money, if emergency doctors did not have to default to the universal blood type or had access to a life’s history of medical data in a click.  Facilities could get info electronically from our cell phones or digital card stored in a bracelet even if we were found passed out.

This universal system would eliminate all private health insurance companies in the United States in a complete paradigm shift. 

Focus on Wellness not Reimbursement

Community health outreach events would be much easier to facilitate under open care policies for the dissemination of care like flu shots, heart screenings and healthy lifestyle training such as exercise programs or green-eating focusing on health and not payment arrangements.  Citizens could be signed up for email and text alerts for the occurrence of events given their zip code.

School lunch programs could better coordinate health standards.  We would be more motivated to kick the corporate sponsorship and subsidies out of our public schools.  We currently short change our children with “cheaper” less-healthy food.  The poor eating habits we set in youth continue to drain the healthcare system in our adulthood.  We would open our eyes not only to our interlinked asset of health, but a mutual motivation of reducing collective costs through the promotion of our own health.

If we are all in the same healthcare boat, there is a greater mutual rationale to promote global wellness.  We should not let companies like Nestle, Frito Lay, and Coca Cola bribe away our children’s nutrition, just like we should not let pharmaceutical companies bribe our doctors.  If we do not legislate against this we will continue to succumb to greed over long-term health and ignore the cost externalities these short-term monetary savings choices appear to create, which we inevitably incur over the long-term on a macroeconomic level.  See our national debt as exhibit A.

If kids want to eat junk, then let them bring their lunch, but if taxpayers are paying for the lunch, particularly through USDA subsidies for kids, the poor, or the elderly than taxpayers should provide fewer choices, but better options.  The food costs of the programs will increase, but the total taxpayer costs will decrease with lower long term health care costs.  Only in a universal system are the taxpayers assured that this savings will be encompassed back to the taxpayers and not to private health insurers.

I have audited USDA programs.  The facility operators are given menu order forms with boxes of frozen to-be-delivered goods: chicken nuggets, hamburger patties, pizzas, French fries, fruit bathing in syrup, buns.  The actual cooking in many instances is replaced with start on a microwave or oven in an overwhelming number of kitchens.  We can link these food purchases in with the SKU web-based databases discussed in part eight on taxes, to reduce costs and promote health.

We need more cooks not fast-food operators.  Cooking this food does require a bit more ingenuity or old-school common sense depending on perspective.  With the use of the internet the USDA could plan a menu in every elementary, secondary, and high school with a cafeteria for every state in the country with consideration of local food supplies, alternating ingredients and diets.  Local input could adapt to this plan based on available options.

The government could put a laptop in every school kitchen with internet access our tax dollars already fund.  This is worth the investment and will pay for itself through lower lifetime health care costs, which under a universal system we are all mutually motivated to mitigate.

The web content could have a step by step video with a chef guiding the worker on how to prepare each day’s meal with the planned ingredients shipped to or allowed to be purchased by that school for that month.  Hell, allow Food Network to make a reality show about the nation’s chefs.  We can create a win-win to design the whole menu by letting Scripps Networks profit off the commercials and good will created. 

Basically a system like this balances American farming, with contracts the government could make with food companies for specific ingredients scheduled and filled in advance.  Start subsidizing healthy vegetables and organic options over cows and pigs to give kids and the poor better access to real food to compete with the fry oil and sugar syrups. 

Not every kid in America would be eating the exact same in-season meal on the same day, but within a month every kid in a similar school district would have had that meal x number of times.  Videos with the chefs could be replayed and used repeatedly.  The overall predictability of such a system would lead to cost efficiencies.  The training videos would make the jobs of the workers more stimulating and lead to better cooks, but food costs will be higher than now.

What is a school lunch program in Somalia or Haiti like?  Every day we eat is a day to be thankful.  Some kid above first grade that demands soft drinks and French fries can watch videos on other parts of the world until his appetite changes or the school board members quit being shills taking mob money from Frito Lay.  Candy bars, Coke, and Doritos need to be banned from public purchase in schools.  We spoil the young and pay for the diabetes and lower worker productivity of the obese later.

The instructional cooking videos could be used in high school culinary classes to prep for meals to be served the next day in for-credit classes.  Even if a student does not want to be a chef, each person needs to learn how to cook.  If American kids learn how to cook, odds are they will be more self-sufficient, have better eating habits and be healthier human beings.  This lowers the tax burden on all of us in a universal healthcare system.  Cooking is at the heart of self-sufficiency, not the drive through lane at McDonalds.  Parents can choose for their kids.

We can also mitigate the cost differential between cheap publically-traded companies’ fast-food solutions, by integrating some of those same companies to compete to provide nutrition-focused commodity-style publically-bid products for the U.S.D.A. to acquire that will not allow fecal-based fructose fatty short-term hybrid “food” to enter the competition.  We can maintain a spectrum of choices by integrating food supplies, nutritional balance and limiting choices for students to save taxpayer cost. 

The biggest hurdle to cooking in America comes from the changes in our family structures.  We pay a price when a television commercial answers the question, “What am I going to eat for dinner tonight?”  People tend to be planning adverse.  Deciding what to cook is almost as big a hurdle as cooking.  Fast food is a quick and an inexpensive response on a short term level, but tremendously costly on a macro-level.  People love fast food because ever since McDonalds came up with order by number one, two, three; America’s menu decisions have been truncated into barking out a single numeric marker for their dietary Pavlovian intake.

The Transition

Private hospitals may have to be brought into the governmental system through laws akin to eminent domain.  Owners of these facilities may be forced to be bought out by the government or basically go out of business as a traditional medical entity.  It would take a massive undertaking to determine what is fair.  There will be inevitable inefficiencies and injustice to some to create the new more fair system for more in the long run. 

This is one of those hard truths that America has not had the honesty to face in its recent history, but it is the only way a national healthcare system will be created is if the obtuse ill-fitting elements of the old system are eliminated.  Most of these facilities are technically non profit organizations anyway.  These could be moved into the government without actual payments based on contracts, because they are already so dependent on governmental funding for their existence and have often been subsidized by the taxpayers for their creation and net assets.

However, the hospital and the doctors and the nurses are not going anywhere.  It is much like when a large company is acquired.  There will be corporate-culture issues and inevitably each hospital or facility and doctor’s office should retain a great deal of its own culture due to the autonomy of locally-managed facility boards and management working under the software systems and reimbursement structures set by the taxpayers.

The main thing that should change is how everyone gets paid.  Instead of paying our health insurance company $500 to $1,500 more in premiums every month and paying Medicare on our taxable income and our employer matching each of these, we would pay a dedicated federal income tax.  Employers could take their end of the savings to pay out higher wages or as they saw fit.  Wage rates would have to adapt voluntarily inside private institutions unless we implement an employer-portion of the tax to create a mutual assurance if we decided that was preferable.  Since employers currently pay such a considerable potion through employer-portion of health insurance premiums this employer-tax is probably unavoidable.

The employer-tax would probably have to have a standard per-hour lower amount for minimum-wage employers to not disrupt the low-wage labor markets.  Although lower-wage humans have the same medical costs as higher-wage humans, there would be a disproportional impact if this is not factored in.  The tax could be also reconciled with employers through quarterly rebates for part-time employees.  The tax could also be linked to employee income on a progressive basis similar to the employee portion.

If we hold the government and ourselves accountable for the system we might actually get healthcare for our income tax.  Where now we get?

In all scenarios, the software must be properly designed and tested before attempting any transition.

Private Practioners

Private practioners will for the vast majority become government contract workers.  The government would still make it legal to be a self-employed practicing medical care, but those facilities would receive zero taxpayer dollars.  Plastic surgeons for cosmetic purposes or non-mandatory medical procedures like Lasik would all be privately owned and totally separate from the universal system.  They have medical laws, but financially they might as well be selling automobiles. 

People who want to circumvent the universal system to purchase traditional medical services would have the freedom to go to privately owned non-taxpayer funded facilities that would have to practice common medical practices as they do now.  But those facilities would not be permitted to accept medical insurance private or governmental.  Those businesses would be required to have up-front pricing, but also no responsibility to care for someone unwilling to pay that price, even in an emergency.  Those patients would have to go to the universal system. 

Wealthier members of America who want to effectively “cut in line” with concerns that their appointment or service was taking too long to get, could be serviced by the private sector in a free market solution that meets that market niche.  A universal system will probably create situations where people die waiting for care.  Our current system does that now, but at least this way we are not preventing natural human behavior by criminalizing free enterprise. 

Just like marijuana should be legal.  Abortion should remain legal.  Somebody who doesn’t feel they have two weeks or two months to wait for a particular specialist or service should be allowed to have the free market independent of the government decide whether it is profitable for a doctor to try to address the need of the man or woman who is blessed with the assets willing to “cut in line.”  We should never forget the lessons of prohibition.

I could also see non-wealthy people who want to see a nurse practitioner or a doctor in a lease space in Wal-Mart, pay forty bucks or something moderate to see them like many of the uninsured do now if a universal option was unavailable.  I am all for keeping these options legal.  Just don’t make the taxpayers fund it and don’t allow private insurance companies to subsidize it.  However versions of that lease space in a Wal-Mart will probably actually be part of the new system, not typically separate.

As long as the taxes to fund an effective universal system are being collected, then the universal system is only aided by the existence of a side system.  The problem would come if the American people choose fear, cut the taxes, castrate the universal system and jump ship for me-first health care based on lobbying efforts of private medical facility interests to make bank.  (Oh wait that is what we have now, except we hide it behind health insurance companies.)

Doctors

Doctors would be hybrid-providers.  As contract workers, doctors, whether it was in a small or large facility would be paid a salary from the government just like a police officer or a teacher and not by the patient, crime victim or student.

Doctors will still have the option of choosing the location of the hospital or facility they work at or the group of doctors they work with, but what the doctor charges for their services will be more regulated.  Physician’s total income will have a lower ultimate value, but the predictability of a medical industry employee’s work flow should be more reliable.  Electronic systems would more evenly distribute the workload of healthcare providers across multiple systems by allowing easier transfer of employees between systems and greater sharing of information to solve medical problems and meet shortages and diminish overages in labor supply. 

The total compensation cap for doctors may be limited and prevent doctors from earning millions of dollars, but a reasonable system should allow doctors to be paid a very good living commensurate to encourage future doctors to enter the medical profession.  The cost of operating a private medical practice would also go down because the doctor would not have to hire x number of billing specialists to handle all the 31 flavors of insurance company bullshit.  We would now have one flavor of bullshit.  The magnitude of this opportunity should continue to encourage doctors to pay to go to medical school.

Doctors would be paid a salary to work at a facility as contract employees, not government employees, (but if we have universal health care and end defined benefit retirement, what does it really mean to be a government employee?)  The negative ramifications of contract employment will be mitigated. 

We are all self-employed.  We are our only client.  The days of an employer guaranteeing lifetime employment are gone.  Generation X accepts this.  The days of tenure and seniority guarantees are gone.  The only employer that still does that is apparently the government.  Most people will change jobs more frequently as the speed of technology adapts business into changing paradigms and this includes doctors.

The facility will get funded through the state from federal tax dollars based on the number of patients and the level of care of those patients in a matrix that would facilitate a common health system through out the country that is tracked through the web portal.  The web portal would put restrictions on the work load of doctors to not allow the facilities to overburden the doctors.  The facility functionally gets paid more for serving more taxpayers in statistical-based budgeting on state-level allocations, but the doctor does not.  Note each service is used as a consideration in the gross-budgeting allocation by the state to the facility.  The facility does not use the activity to create a bill to create a direct per service revenue stream.

The design of this digital system, like the design of the educational system we will discuss later, should be designed based on the logic and needs of doctors by doctors within a non-profit incentive paradigm.  Educators should design the education system.  Doctors, nurses, medical specialists, and researchers should design the medical system.  Computer scientists will do the technical work and probably be able to share linkages between the infrastructures of the two systems, but we have to allow field experts to guide their own fields. 

Otherwise lawyers who we call “Congress” design systems.  Law is about effective arguing, not the truth or math.  We wonder why all congress seems to do is bicker.  The first step in all of this is to begin the conceptual planning with these groups and then the digital foundation.  Unfortunately this will take years.  Every day we waste bickering or ignoring inevitable healthcare realities is more debt.

(This blog is, but one man coming from a human perspective with a concentration in accounting offering his ideas.  Cost, economics, accounting, these are the skeleton for any of these systems to flourish or perish, given the tenacity in which we attach ourselves to money.  These are important, but surely our collective can encompass not only greater insight into the business of these discussions as well as the substance of a specific industry of health care, education or democracy.  It is however, inherent that the common bind comes back to the dollar.)

Medical Facilities

Medical facilities will have the benefit of allocating patients based on the patient’s discretion to pursue the best care in our own determination.  This will lead to patients scheduling appointments with the doctors that meet our needs.  Based on the interest in those doctors, management of the facilities may elect to pay doctors in a salary system with optional bonuses for reaching wellness goals within their patient group, such as to quit smoking, attend fitness centers, lower cholesterol, lower blood pressure, end drug addictions or other basic human health measurements.  These bonuses should be a portion and not an overriding factor in doctor compensation and should be optional based on the facility.  Boards will have the ability to judge a lack of interest in a doctor’s services the same way a private facility would and replace the physician if need be. 

Doctors should have more regulated schedules with maximum hours in a work week depending on their area of need.  To accomplish this more physicians will be needed and doctors will have to be encouraged to enter the profession, but if we are spreading the compensation out as an industry and eliminating private insurers the idea of budgeting such an adapted medical workforce is more feasible. 

Local facility governance boards for larger facilities would be empowered to make higher and fire decisions just as they do now for government and private hospitals.  The federal government is only a funding source, not management.  Doctors will design the practical aspects of the system, computer experts will design the bones to operate what doctor’s design, and the American taxpayers will fund the system through our tax dollars with open-ended input to guide our interaction with the system through digital-tablets inside the facilities and the web outside the facilities. 

The income level of patients or the racial demographics of patients would also have no impact on the funding of a facility.  But the per capita usage of a facility would be correlated with the state allocation of funding, much like changes to how all government entities should be financed that we will discuss in a later section on debt.

As discussed earlier as a means of funding the system it will be relevant to link individual usage to the IRS, but I think it is imperative that no American should have to force going bankrupt because we got cancer or paralyzed.  These worst-case type costs need to be spread out.  The additional costs that should be linked to an individual are ones tied to known poor health choices related to smoking, drug abuse, poor eating habits and lack of exercise.  Even in these instances the cost burden would only be a portion. 

An inverse way to do this is to offer tax credits for good health: blood pressure, fat, body mass index, ability to jog a mile in under a certain time based on age and weight, swimming lap times.  The exercise method of obtaining the credit could be chosen by the taxpayer from amongst options offered by a facility and reassessed annually based on the age and gender of that patient. 

The government could have contracted facilities in health clubs to measure these variables for taxpayers or take them at the annual physical that taxpayer gets a credit for attending.  The easiest may be to use health clubs already connected to hospitals.  It’s simple.  If you are unhealthy you don’t get it.  If you are disabled you probably won’t get it, but if we let doctors set the standards based on gender and age, it is in our best interest to give someone $500 a year or more to be healthy based on age, height, and gender standards.

Proving good health can often be simpler and less expensive through rewards than substantiating poor-health decisions through fines.  Tax everybody more and then rebate the difference, rather than tax everybody less and charge more to the “fatties.”  It is logistics.  It is not perfect, but maybe more feasible.  Facilities could be audited and subject to random inspection, however if we limit the facilities offering the credit we can limit the cost of this audit control.  The credit could also be cross referenced to data obtained in actual medical facilities during regular check-ups through Big Data auditing to disqualify people.

Legal Costs

One of the greatest deterrents to the current medical profession is the overwhelming administrative burden and the litigious environment of mal practice insurance.  By eliminating the health insurance companies and qualification-based governmental programs the administrative hindrances would be vastly reduced.  Doctors would not be limited as to what is reimbursable by an insurance company to determine the best way to heal a person or detect problems earlier on in the process, which would inevitably lead to fewer lawsuits.

The ability to spread the mal-practice insurance burden across the entire system would ease pressure on the individual doctor.  Doctor’s insurance rates would be more similar to a police officer.  A police officer may or may not get terminated based on a criminal or civil case, but that police officer is not paying out individual malpractice insurance for the potential liability for the fact that his or her taxpayer funded profession may deal with life or death issues that may produce litigation.  The profit reduction in this insurance sector of our economy would help reduce this gap in treating the insurance risk in a more logical manner. 

Facilities will have the freedom to terminate bad doctors and not be crippled by any sort of tenure system or pay based on strictly years of service.  Doctors will be able to spend stages of their careers at different facilities.  Physicians can negotiate to desired facilities from apprenticeship to veteran stages.  The system at its heart must be based on quality of healthcare based on promoting wellness, not profitability for the facility.  Since over charging the patient is not possible, facilities will not be encouraged to order extra tests to run up the bill.  Hippocratic oaths should guide care; if we can’t trust Hippocratic oaths we might as well throw away our humanity right now.

Doctors should be automatically covered in a form of governmental malpractice insurance with their contract employment.  There may or may not be an associated premium.  There could be addendums based on the past history of that doctor.  The motivation of the system should be to provide the best healthcare and not having doctors overly concerned with getting sued.

Doctors do make mistakes out of professional negligence.  Patients affected should be able to seek compensation.  The universal system should result in a more unified structure of the methods in which medicine is practiced in this country and ultimately provide clearer definitions of standard practice in a given situation.  However standard medical practices have been evolving and documented from the beginning of man, whether we ever have a single payer system in America or not, those practices are inherent to the human body and its biology rather the financing mechanism paying the facility.

If an IBM “Watson” type cloud-based database is implemented as a standard guide, results of which could be cached in a patient’s digital file.  This stratification should help weed out many of the frivolous and time hoarding lawsuits from our legal system and focus on helping the injured rather than punitive actions.  Punitive actions are less warranted given we are in one system and the one government can adapt the design of system or fire the employee who displayed the reckless or negligent behavior which created the patient injury.  However, if we supersede the absolute of a digital advisory over the will of an experienced human in the absolute in a legal or practical application, we will equally dam ourselves.  The solution is the synthesis.

The Pharmaceutical Industry

Drug companies need to have profit incentives in order to encourage research, but how much research is done by the drug company?  How much is done by public universities supported by the National Institutes of Health (NIH)?  Why should drug companies market on television to tell us what drugs we need?  When we have a symptom, a doctor should recommend the drug he or she thinks we need, not us.

We can ban advertising of cigarettes on television because of the harm the “drugs” can cause and their influence on children.  Cigarettes are drugs, prescription and over the counter medications are drugs.  Prescription drugs abuse exists.  The cascading effect of buying one more drug to treat the side affects of another drug keeps rolling and rolling up the costs for the American people. 

The parallel exists, but people smoke as a recreational activity, people take prescription drugs to cure illness.  It seems logical that if we ended Ads for prescription drugs on television, the costs of drugs would be lower, because by their nature they exist to increase the profit of the pharmaceutical company.  The allocation of those drugs to cure illness would be based on medical evidence not patient exposure to commercials to cure broke-dick-exploited fears of losing hair or penis. 

Drug companies air commercials on television to increase their stock price.  Big Pharma can pool the expenses into statistics used to sustain their industry and validate the prices charged to taxpayers.  They advertise inside our doctor’s offices for the same reason.  Shouldn’t our doctors have an independent mind and actually focus on the best drug at the lowest cost for us?  What is a doctor’s independence worth to us as a society?  What is the lack there of costing us in higher prescription drug prices, additional medical procedures and poorer overall health?

If a patient prefers a particular medically-equivalent drug over another after discussing it with their doctor, the differential in co-pay between those drugs should be communicated to the patient at the time of service.  If the patient would like to choose the more expensive of the two, the patient encompasses the majority of that differential cost through their IRS linked co-pay.  In this situation lower-income individuals would see more significant disparities in prescription co-pays than higher income individuals, meaning if you are poor the lower cost drug may be “free” or a very small copay of say four dollars.  The higher cost drug may be $50.  For the higher income person the lower cost drug might be $25 and the higher cost drug might be $55.  This type of pricing system links medicine to reality and puts medically equivalent decisions in the hands of patients when it is medically possible under the discretion of a doctor.

As an industry drug companies either hide or use creative accounting to insulate their industry from having to rationalize the price they charge for drugs compared to the limited amount drug companies actually spend on non-taxpayer funded research and development and the major amount they spend on marketing. 

In marketing Big Pharma excludes what the industry deems to be educational expenses by funding side contractors to create continuing educational programs required by medical licensing boards to “teach” doctors about new drugs.  Fundamentally this is advertising to the doctors on top of us sitting on our sofas at home trying to watch the NFL or Oprah.  The “education” is often massively biased towards the drug companies funded behind the scenes in the examples and statistics presented by the organizations creating the seminars and classes. 

There are far more drug sales reps for every doctor in this country.  The pressure from basic bribery in free meals, products and drug samples pilled on residents, doctors and interns is enormous.  One doctor can drive a massive amount of product in the insatiable-profit pharmaceutical industry. 

We need to restrict drug advertising to a single central forum inside the website WeCare.gov labeled as paid information to show to the public and doctors and the manufacturer’s own website.  Everyone has the opportunity to see everything about the drugs.  Doctors are informed, advertising costs are limited.  Ban all drug reps from personal contact with any contracted medical physician as a finable act.  All contact must be electronic through the website, which could include webinars. 

Allowing the drug companies to operate in the current manner, shifts a doctor’s potential prioritization to the party they deal with every day, Pfizer and Glaxo-Smith-Kline, not us.  Why when we get a prescription from a doctor don’t we have the opportunity to discuss with our doctor the five medications that may all be feasible and what the drugs will cost us, including chemically-equivalent generics? 

The first reason is the costs we are all paying and the profit the drug companies are all making is mucked up by the shroud of the insurance companies and our individual “situations.”  The second is most of us are not medical experts and don’t know jack, it should be up to the doctor.  In the smaller population of scenarios where we could make a decision we nor our doctor rarely have up-front prices.

With linked variable IRS up-front co-pays, we link cost to the consumer’s informed choice based on a medical professional’s filter.  The doctor is supposed to use his or her professional judgment to select the drug, but how can a patient be expected to believe that judgment is not biased when we allow drug companies to take on the role of lobbyists. 

Around 2010, the pharmaceutical industry averaged a profit of 18.5 percent of sales, compared to the second most profitable industry commercial banking with 13.5 percent.  The United States pharmaceutical companies comprise a $200 Billion industry in a $400 billion world market.  Americans pay more than any country. 

Based on the passage of the Bayh-Dole Act around 1980, Big Pharma was allowed to piggy-back off of publically-funded research and bring drugs to market at expansive rates.  This insulated pharmaceutical companies from the true research and development risks of failed chemical combinations to produce productive drugs.  These partnerships shifted the allegiance of these research facilities to promote higher pricing of the drugs they end up producing because of the massive royalties kicked back to the research institutions. 

The end result is that most innovative drugs come through the NIH not Big Pharma. The threat that if prices are limited pharmaceutical companies will trim research dollars to prevent life saving drugs to market is functionally empty due to the financial reality that far more is spent by drug companies to advertise or lobby for drugs rather than research them.  Prices for drugs are set based more on what the market will bare rather than the R&D costs built into them. 

Drug companies fight like hell to extend the patent lives of their products through lobbying and lawsuits and then sabotage expiring drugs to influence the public to adopt “medically equivalent” newly patented drugs.  Drugs companies only have to prove their drug is more effective than a placebo sugar pill not the current on market drug.  Why should we spend all this money in our healthcare industry for what are referred to as “Me Too” drugs which are often not better than and sometimes less effective than current drugs simply because they can earn a drug company a profitable patent?

We are blinded by the dollars in front of us.  We focus on our co-pay.  We do not think about, “Hey I did not get a raise because my employer is paying out the ass to give me health insurance.”  We don’t focus on the fact that the medical insurance community has developed countless billing computations for the same service, just so we do not think about these costs in a direct manner. 

Drug companies do not want us to think generic drugs will aid us in achieving good health just the same so we put commercials on TV to assist in their product differentiation.  This is a basic tenant of marketing and corporate profitability, not good health.  There are patent laws to reward medical research and prolong pharmaceutical product life cycles, but at the end of the day when a pill costing two hundred percent less can do the same good, what is best for America and the world? 

What is best for humanity?  If we only used generics, the research may never be done to develop medical breakthroughs for original drugs and yet we can not all afford the “name” brand?  When so much of the research is being done with our tax dollars at public universities, why don’t we go straight to generics in some cases?  There must be a rational balance.  We could accomplish this through public bid percentage quotas on a federal level between purchasing brand and generic drugs under a universal system.

Drug commercials lead to over-medication and false-health.  Basically we end up overspending on drugs we do not need for our romanticized aliments the drug companies want us to worry about and ignoring true issues that could be addressed through a focus on preventative medication like childhood obesity. 

(So often preventative medication is of no interest to the drug companies or our doctors because it involves life-style changes which the current medical system ignores because it can not profit from it.  In fact, it is more profitable for them for us to be sick, to be fat, and to achieve the profit-center that is Type Two Diabetes!  However, taxpayers inversely profit from preventative medicine through reduced health care costs, if the system were designed to encompass a nation’s total heath care cost.)

How many people in America have restless leg syndrome, erectile dysfunction, sadness labeled as depression?  How many pre-teens are hooked on Adderall and then discouraged to take Meth?  Do we really need a television commercial to tell us how miserable we are and what magic blue pill we need? 

That is not medicine.  That is the tonic salesman rolling through town with his horse and buggy hoping to pass off bubbling water as a panacea.  Drug companies label ads as consumer education to make us aware of illnesses we may not be aware we have and cattle-drive us into doctor’s offices.  That is bull; they are just trying to sell more drugs.  Our additional illnesses benefit them.  Our additional preventative wellness impoverishes them.

There are no Illegal Drugs only Controlled Substances

We should legalize currently controlled substance for sale to anyone over twenty-one years of age and regulate the price through authorized dealers based on the number of historical arrests by substance.  The more historical arrests the greater the argument to de-criminalize.  Any un-prescribed drugs have to be paid for out of pocket.  Prescribed drugs are included in universal healthcare. 

Maybe, not crystal meth; face explosions over gas-stoves to coat a brain in Clorox are so fucked up, maybe nobody can “handle” meth.  However, cocaine, heroin, at minimum marijuana, along with drugs selected based on criminal-economic global impacts to alter the economics of illegal substances to benefit our governmental budgets and the budgets of partner nations like Mexico, Colombia, and Afghanistan at the detriment of drug cartels and Al-Qaida.

If we integrate a taxpayer funding equation that must collectively fund both public safety and health and slide drug use over to a medical rather than law enforcement issue, then we can realize net taxpayer savings by combating addiction on the demand end of the equation in part with the tax dollars obtained by taking control over the supply end and the dollars we are no longer spending on prisons and police.

Under this change taxpayers are funded for recreational marijuana and cocaine.  We are not paying a criminal justice system to process potential medical problems as law enforcement issues.  We should make certain substances consumable only in our residences or designated places away from kids, like alcohol. 

An over the counter market of registered non-profits can charge a price plus taxes, with profits over audited costs funneled back to the universal health system.  Dispense cocaine and heroin through pharmacies.  Herbal drugs like marijuana and mushrooms could go through regulated dispensaries like better organized versions of the medical marijuana facilities currently in California.  These drugs could also be compounded into edible forms such as cookies, bars, lollypops, or basically some form other than smoking to reduce the carcinogens of smoke similar to tobacco as a health risk to the process of smoking rather than THC.

We can use metrics to track limits of purchases by social security number if the technology would develop to prevent individuals selling drugs outside the tax system to avoid linkages to other parts of the health system.  There is nothing stopping an adult in this country from purchasing and handing alcohol to another adult or a minor and the same is true today for marijuana or heroin. 

For those that argue America would become one giant opium den or acid lake absent the government putting the word “illegal” in front of words and putting policeman at our nations borders, I say, we each need to own our will power and be realistic about what pot and meth really are, just like sex and death.  We need to look at the actual drug usage statistics over the last thirty years and perform correlation analysis.

There is a reason a man or woman does not wake up, go to the liquor store and get drunk every day.  There is a reason people chose not to smoke cigarettes.  We know drugs in any form can fuck us up, so we choose.  We do not need the government pretending to be our father.  What we need is medical treatment for addicts, treat addiction as disease and realistic citizen education about drug effects: biologically, financially, and socially to fight demand, not supply. 

When we treat addiction with a medical system designed to reduce addiction and its corresponding costs, rather than with a public safety system that expands and profits as addiction expands, we can find a correlated solution to address the violence and economics of addiction in a manner that moves the government and our people in a single rather than opposing direction.

We could be like Wal-Mart with ammunition sales and individuals could buy as much as one wants.  We could put warnings on the box to indicate the lack of any promised medicinal benefit.  Drugs like cocaine or acid could inform ignorant humans that this drug will almost certainty lead to heart attacks, liver failure, cancer of the mouth, removal of billions of brain cell causing you to be a stupid fucking moron within possible seconds of beginning use after your brain adapts.  This purchase will preclude you access to these base expensive-ass end of life saving procedures and these associated cancers if you purchase this more than x times because we know you chose to use this when you were this age. 

Oh yeah and if you did not catch on, this concoction is like walking into on-coming traffic.  It is probably going to lead to your death, just as if you misused the millions of other prescribed legal medications.  Go ahead, have fun just do not use this while operating a motor vehicle, trying to parent children or taking on the responsibility for fellow humans because you are likely to fuck others up worse than you are fucking up your own brain.  Enjoy and thanks for the tax dollars for the federal treasury.  Have a nice day, insert smiley faced emoticon.  Reality goes on in every American neighborhood.  Nancy Reagan’s say no circle is an expensive not-funny joke that ignores reality.  The guy is snorting that line warning, dispensary or not.

(However a massive component of what would be decriminalized is marijuana, which in my opinion and as argued by countless other humans, is less harmful on a macro-level than alcohol.  So as any argument to the above as to the massive potential harm of such substances, I do not mean to imply this with pot.  I would also note that with the decriminalization of marijuana the profits and usage of many prescription drugs, that marijuana often does a better and more natural job of addressing, would decline.  This surely would be opposition to the desire of Wall Street. )

Formula for addiction: give concentrated form to hook addicts, in time dilute extrapolate profits.  Bribe TSA to ferry mules.  Cell networks battle for empires.  Dealers and police sodomize each other in parking lots, taking turns being a top or bottom.  Dollars plump cartels and public safety budgets.

Mexican death weapons make assassin kingpins.  Kidnappings for ransom create decapitation snuff fills to fund a civil war in Juarez.  $2,000 in Colombia sells for $30,000 in Mexico to $100,000 to American distributors.  Cartel violence recruits guerilla armies.  Billions of dollars go into the hands of killers.  U.S. consumption, Mexican suppliers are symbiotic parasites on each side of the border.  Cocaine submarines and double-signal remote control unmanned airplanes land tons of product on our shores.  (Who pays for Nixon’s war?)  

We can have registered pot, crack; you name it, organized dealers, put realistic labels on the drugs including links to internet videos on effects and show them on repeat in the stores.  Provide clean needles, to slow AIDS.  Show dental wastelands, bullet-hole brain scans, vacuum bag rot-lungs, car accident dead bodies, medical costs, addendums in the tax system, and rehab options.  Charge a premium and tax it enough, but not excessively to sprout bootleg sales systems.  Put profits and taxes back to the health system focusing on addiction.  Audit the facilities on a random basis.  People could still be arrested for unlicensed distribution, just like alcohol.

Employ Americans, not cartels.  Basically the average intelligent normal adult is not going to put something into our body that is going to kill us intentionally, because it is suddenly legal.  Cocaine and pot are everywhere.  Just go to any dive bar in any downtown, any high school, college or hotel.  But the fact is millions of people function just fine addicted to pot and cocaine.  Some people can handle it, some can’t.  Some people drink two beers, some drink a case. 

It is not the government’s job to let us know we might die of a heart attack if we do not read the label.  Guess what if we drink drain cleaner we might die.  If we can not be responsible for not killing ourselves, what can we be responsible for?  We can also identify most of the crack heads when they enter our emergency rooms on the front end and treat addiction as a medical problem.

People who want to smoke crack usually do not have an operable sense of self control because crack is addictive.  The lengths people go to now to get crack at times defy normal human survival instincts, but some people can maintain self-control.  Others lose it getting addicted to prescription Oxycontin.  I really do not see much of a difference except for the social stigma of the word illegal and the exploited revenue streams surrounding the substances given the natural organic nature of the globes most popular criminalized drugs. 

Feel-good laws make us feel worse.  We are numbed on a macro-level because feel-good laws are argued in matters of micro-level conscience as things “we say we would never do.”  Drink like that.  Fuck for pay.  Pay for a fuck.  Embarrassing things we would rather sweep under the rug with the roach bodies: cocaine lines, ecstasy tabs, contemplating the benefits of death over continuing to inhale another struggled breath. 

We argue about baseline illegal prostitution, drugs, Kevorkian-assisted suicide, firearms at the end of free-willed choices.  We crave order and control so we become litigious.  Criminalization does not control these choices. 

Authority figures are threatened by cannabis because free thinking leads to chaos that usurps the pacifying cultural constraints of marketed fear.  An easy to grow plant that multitudes want, that can not be exploited through profit, is mutated into exploitation by governments when the plant is criminalized.  Guess what, if we legalize pot, a shit load of people are just going to grow it at home and not be buying it from a corporation, a cartel or the government, no taxes and no profits.

What we can disrupt are the criminal economic markets that supply the swing consumers who can take drugs recreationally and not cause huge problems in society.  If we take the taxpayer’s dollars from drug consumers who would rather go to Walgreens, CVS, Wal-Mart, or an inspected and registered Pot Dispensary to buy crack rather than some guy on the street corner who has mixed the drug with God-knows-what and murders humans; then we disrupt the material majority of the criminal “illegal” drug market across the globe.  The level of restriction on the distributors is up to the voters, but odds are it would be pharmacies that elect to abide by the increased restrictions voters put on the centers and that may eliminate Wal-Mart and Walgreens due to image concerns and the presence of addicts.

Why don’t smugglers from Central America bring tequila into the United States?  Tequila can destroy families, create automobile accidents and keep a person from maintaining gainful employment.  What is the difference between tequila and crack besides the stigma?  Both can kill you and a mature adult is going to make the decision they are going to make to consume a drug or not regardless of our government.  Just as we learned under 1920’s prohibition, if we criminalized tequila, the same would reoccur as with cocaine today.

A large portion of the Central and upper South American economies are built off of supplying “illegal” drugs to United States citizens.  Drugs are to Central America, what oil is to the Middle East.  These dysfunctional economic communities are predicated on America continuing to misuse each of these products in our own economy creating a supplier opportunity within their own. 

What is the best way to fight the war in Afghanistan?  Legalize heroin and contract a purchase agreement with the Afghan government to acquire raw material poppies to sell to U.S. companies to sell in an organized trade market.  Al-Qaeda and the militants our humans fight are heavily funded by drug money.  If we kick the stool of illegal drug-money out from under their feet we can do what a bomb can not, change a culture.  The same is true in Columbia, Peru and Mexico for drugs that will not naturally grow as well in the United States.

If America legalized cocaine, heroin, marijuana and other drugs this material industry in Central America and Afghanistan would impoverish criminal masses electing to eschew government-based educational endeavors and assist Central and South American governments and our local and national security expenses to incorporate drugs into less-violent tax incorporating systems.  The local poor people in South America could work as farmers to supply the government and achieve a higher standard of living, rather than fighting outnumbered military to assist cartels.

We would save billions in our criminal justice systems addressing the violence created by these medical laws in those countries and in our own from more efficient and effective angles.  Fringe beginner criminals would be far-less incentivized to enter criminal lifestyles and far-more incentivized to obtain a real education.  Criminals don’t fear machine guns, they fear the drug legalization.

Millions of people in each of our countries fail to find work, when exiting prisons and join gangs built as surrogate “illegal” drug corporations impossible to exit via a method other than death.  If the drug suppliers are private and public corporations the gangs can not control them as easily.  Murder will decline. 

Does anyone remember the lessons of 1920’s prohibition or does our religious inferiority complex obstruct our vision of our true ability to control, solve, treat or segment the “criminal” from the medical issues related to any form of drug use.

"Prohibition goes beyond the bounds of reason in that it attempts to control a man's appetite by legislation and makes crimes out of things that are not crimes."

Abraham Lincoln

Before prohibition, before Nixon’s war on drugs, before our current mockery of a solution, was Lincoln.  The answer is so simple, but politicians use the face of children to fight the political war on drugs to boost national security budgets, because they are too afraid the average voter will not listen to a multi-tiered political argument to legalize drugs.  It is safer politically to throw money in an escalation of commitment to an ineffective solution hiding behind the words “mixed message.”

The real victims of drug use are shot by gangs profiting off the “illegal” drug trade or sidetracked through appealing profitable lives as crack salesmen compared to normalized paths through education-valued tax-system-integrated careers.  A kid ending up in an emergency room either dead or near-dead from overdosing on heroin is bad, but it is the result of an individual choice.  The gun shot victims and the kids who see no other path because crime is so pervasive in their neighborhood is a far greater crime based on a choice made by someone other than the kid.  We can not save every addict and some people we view as addicts do not need saving and are capable of their version of a normal life while taking what we currently define as a criminal act.

We utilize billions of tax dollars chasing, arresting, convicting, imprisoning and repeating these cycles because we can not simply allow what should be a victimless “crime” to be deemed legal.  Drug use is higher because of this strategy because of a mismanagement of government resources to combat drugs from a criminal rather than a medical point of focus.  We create thousands of other victims unrelated to the individual who is making what by most accounts is a negative choice.  In many ways drug criminalization is another form of neo-slavery of the poor and public safety budgets are funded like plantations ballooning the military-industrial complex to stratospheric proportions.

For those that can not resist “easy” access regulated drugs with a universal healthcare system we can treat drug addiction as a medical problem not a law enforcement issue.  “Illegal” drugs are easier to obtain now.  We could save money in public safety and allocate savings to the consumer end of the drug market and reduce drug use overall.  Vengeance-based policies fail. 

End of Life Care

In our last months or years, we can incur more healthcare costs than the cumulative total of our preceding lifetime.  This reality is the number one economic argument against private health insurers for taxpayers, given that a moderately healthy taxpayer may pay into a private health insurer for seventy years during his career.  This individual retires and enters Medicare.  The excess of premiums paid in is retained by the private insurer, while the Medicare taxes paid by that individual are often dwarfed by his health care costs over the last years of his life. 

There are lines of extending a life for an extra six months at some marginal quality ranging from subsistence to maximizing the opportunity for closure with our loved ones before the inevitable.  How do we put a dollar allocated value on this time when we are asking the taxpayers to fund each day like piling mounting dollars on a bonfire with an indeterminate but inevitable burning? 

There is no defensible system of decision making based on public dollars which can rationalize the placement of our elderly on figurative month-to-month lifeboats.  Those decisions have to be made using medical science.  Doctor’s recommendations on the inevitable will have to generate from standardized medical practices defensible under the law. 

Those with sufficient financial resources seeking medical assistance beyond those standards to subsidize the system should be allowed through full cost IRS-based co-pays.  However that would be an addendum to the public system of end of life medical care, but the lines have to be reasonable. 

A predetermined national system based on global morbidity rates associated with classified illnesses would provide an independent lens between funding and applying end of life medical care.  Some people refer to this as death panels; I would define this as the intersection of accounting with heroic medical procedures with a minimal probability of successfully improving or extending a human’s life.  If we see the availability for this care as a limited resource, then often the election for the taxpayers to fund a low probability procedure is at the expense of a higher probability procedure somewhere else in the system. 

Death with Dignity laws like in Oregon should be proposed as national options to every United States citizen.  Just as with “illegal” drug use, the “victim” of a self-requested euthanasia via self-administered Sepical, Seconal, or Pentobarbital is the individual demanding to be put out of his or her misery.  We put animals to sleep in this country when they are suffering towards the inevitable, why can’t a human request and receive the same reprieve from pain?  Is it because we can not talk about death the same way we can not talk about sex?  We choose fear over compassion.  Is it because some citizens wish to impinge the doctrine of their church upon our state?

Quasi-euthanasia left to the judgment calls of human doctors is a slippery slope subject to the criticism of idle children witnessing their parent’s death, but that criticism has to be tempered by the economic opportunity for those children to use their own resources to replace a rational medical decision with exorbitant daily financial commitments burdened by taxpayers.

The sentimental part of us may want to purchase an extra month long boat trip at the end of a life instead of the dignity of an Aleutian ice float.  Pre-established standards based on medical rather than emotional data prevent doctors from exhausting public dollars out of fear of being held legally liable in a court of law for not doing enough. 

It may sound taboo or crass, but we should empower patients to fund their own suicide.  Require psychological counseling, legal written approval by multiple witnesses and a waiting period, but anyone over twenty-one should be allowed to pay for a self-administered suicide, including prisoners at any point during their life, illness or not.  For those naïve enough to scoff: guns, ropes, bridges, or a barbiturate; what is more humane?  For those that bleat about not wanting their tax dollars to fund killing people, we do that shit daily now.  An individual can not retract his tax dollars to defund a war or a machine of war.  Whose taxes pay for the drones?

We can not allow the system to be paralyzed by a lack of honesty over the costs and benefits involved in the decision making process of end of life medical care and pretending the system can operate as if we had unlimited resources.  For those that argue a universal system can not tackle end of life issues, we do it every day with Medicare.

Disability Subsidization by Taxpayers

We need to restrict the length of time and criteria to earn disability through the current Medicaid system based on the ability to perform new or learn divergent trades that require mental skills over physical ones when applicable to the disability.  We can create a web infrastructure of mandated additional education and time frames for accepting work in those areas to continue receiving disability on a case by case basis. 

No one who is able to work or “volunteer” should avoid employment because it is more financially advantageous to leech off taxpayers than to become self-supportive in a divergent career path. 

This is a cross-generational issue.  Gen-X’ers know we will have multiple jobs and possibly careers.  Older Americans still cling to that one employer, one job for life entitlement fantasy.  This fantasy perpetuates the logic of perpetual disability to some degree.  Requiring a human to volunteer or apply for a job to continue supplementary taxpayer compensation is not unreasonable.  If the government coordinated with an online registered pool of private employers and non-profits through the WeVote.gov website to match disability and unemployment insurance recipients to opportunities to comply or to show evidence of applications to comply, creates a functional remedy.

No one truly harmed under a private tort with a life-altering daily-medical-cost producing injury should have to default to the public taxpayer-funded healthcare, because of tort-liability limitations.  If a doctor caused the injury the public inevitability will pay for the medical costs of the injury.  If a private company such as Chevron or Ford Motor Company caused the injury then the private company should be held liable in a manner that places the burden on the company to internalize cost externalities to the corporation and not the taxpayer.  Require payments back to the universal health system based on actual medical costs incurred and/ or estimates that will eventually be reconciled with the actual costs each year with the life of the injured party.  If the private entity goes out of business, the estimate will be retained.  This mitigates assumptions of plaintiffs just trying to get paid by linking judgments with true medical costs correlated with injuries.

Hypocrisy of Prisons

Why should prisoners get better medical attention then the general public?  Why should a man ever consider committing a felony to fight the cancer he can not afford to combat as a free man?

Being Future Focused

We have to think about where America is shifting demographically and ask ourselves; what is the best allocation of our limited resources?  Is the current system going to be able to handle the transition in our population of the Boomers retiring?  Many of these people will have to either keep working or lose their health insurance.  As the people who have health insurance age into poverty the country is going to default as the healthcare funder of the most expensive health services near the end of their lives anyway.  We will have less people in the workforce to fund these expenses by having lower payroll taxes to fund Medicare.  We will need more doctors, nurses and medical beds than ever before.

We need to shift the tax funding health costs away from payroll taxes into federal income taxes, which wealthier individuals earning retirement and investment income will still be paying.  The demographics of our population are aging.  If we can reduce the administrative burdens in the system and focus on care rather than cost, the net drain on the tax system will be less because the medical system can focus on getting people healthier rather than shifting the cost burden from one island of a system to another. 

Our current policy appears to be to burry our heads under the pillow to silence out the impending voice of tomorrow’s approaching reality, just as we are doing with social security.  We are charging the credit card of our national debt for Generation X and younger to primarily fund a broken system, because we are too afraid to be honest with ourselves to make the hard choices to step on the sensitive toes of some to band-aid what we know can not sustain itself.  We can either begin to change now or we can magnify problems with fewer workers and more sick people.

Every night when we close our eyes and slow our breathing and drift to sleep, maybe some of us with the help of a magic pill and that friendly glowing green moth floating in our window from those commercials, we all know however large or small that there is a chance we might not wake up in the morning.  We are human beings living in fragile bodies subject to eventually fall apart, rot, and expire. 

How can we be a nation willing to save “Private Ryan,” go over seas to ensure the freedom of so many foreign people, and yet our own class warfare pits us against each other to prioritize our sense of greed and self-importance over the simple practical application of health?

Healthcare has become a privileged consumer good, a status symbol on the payroll-deduction trophy room.  We hold that trophy with bitterness and resentment for how much we think we pay and other do not.  How through our hard work we are providing for our family and the weaker members of America’s hunting party need to work at bagging their trophy buck.  Viewing healthcare in the same vein as earnable goods, as a luxury S.U.V. or a 3,000 square-foot home, despite the flaws of its arrogance, is vastly ignorant to the negative externalities we create when we as a nation allow millions of us to live on that perilous edge. 

We create a de-humanized nation of resentment living in separate glass houses.  We live in the immediate and eschew our internal ethical journey to recognize our interdependence as part of the universal.  We are all so close to slipping off and losing our other golden trophies we thought were important to cash them all in to pay the bill when one of our loved ones gets really sick.  Rather than resenting paying for our neighbor’s cancer treatment, we should be thankful our son or daughter does not have cancer.  What is the grace and terror of the inverse situation worth as an American asset of mutual assurance?

I believe in the moral responsibility to care for one another.  There are lines of right and wrong.  Can these adaptations only exist in a financial utopia where monetary resources are in overabundance?  The truth is economics and morality can point in the same direction when it comes to healthcare, but it is up to us to focus on a common objective centered on love of our fellow man coupled with a financial sanity that recognizes our interrelated fates given the digital assets evolving in our midst.  There is no perfect system.  Nothing is free, but better is possible.

"Nothing truly valuable arises from ambition or from a mere sense of duty; it stems rather from love and devotion towards men and towards objective things."  Albert Einstein