DR. BEN GRABER
FORUM
Liberal vs conservative, a familiar war. Unfortunately the vast majority of Americans are neither. Maybe it's time to develop a forum for everyone else and stop giving all the attention to unilateral points of view.
:
C
Ben Graber
2929 University Drive
suite 202
Coral Springs, FL 33065
United States
ph: 954-345-4528
fax: 954-755-8075
alt: 954-345-4536 fax
GRABERCA
Ben Graber's Recommendation for Healthcare Reform
Ben Graber's outline for health reform legislation
Alternative Health Reform Plan for Congress to consider
Medicare cost reduction and maintain services
Provider driven managed care plan to compete with private medicare plans on quality and cost structure. All plans available annually for patient review , comparison and enrollment( see Florida’s Medipass program for details)
-Freeze Medicare premiums at age 75 for all seniors.
-Cap care at $5 million total per patient.
-Provide catastrophic plan at $ 5 million deductible for Medicare as an elective plan.
-Eliminate donut hole in Part D
-Reduce costs through negotiations with pharmaceutical companies.
-Consider removing research and development costs from wholesale drug pricing
-expand medicare program to age 55 and over (adjust costs upward to reflect realistic working members premiums.)
-mandatory Arbitration for all malpractice cases to reduce fear of lawsuits and defensive medicine practices by physicians and risk managers.
-new payment structure for provider payments with goal cost reduction for administration
Medicaid
- increase federal share to 75% and 25% for states
-implement provider driven manged care plan to compete with private Medicaid HMO’s( Medipass)
-protect pediatric care, catastrophic care and chronic pediatric care programs
-protect transplant programs and teaching hospitals
-increase fees for primary care and reduce fees for routine specialty care. Increase surgical fees.
-improve fraud surveillance
-smart card enrollment of all clients
-separate nursing home care into a separate budget.
-create a Medicaid buy in program for up to 300% of poverty on a sliding scale for those who cannot afford private insurance.
-mandatory arbitration for all malpractice claims
Private insurance
-standardize claims systems
-tighten the definition of health insurance plan to discourage small exploitive companies.
-provide for standardized premiums throughout the system to spread high risk groups exposure.
-Shorten time frame for pre-existing conditions to six months.
-limit deductibles to maximum of $1000 to prevent inability to access system
-limit copays to maximum $100 to prevent discouraging seeking care.
-create guidelines for testing based on diagnosis..to prevent “shot gunning”by providers who use testing to screen rather then clinical techniques.
-create standards for guarantee issue of insurance
-allow monthly mandatory draw from paycheck to pay premiums to prevent defaults and periods of interrupted coverage.
-allow for $5 million cap on care costs and availability of a $5 million deductible catastrophic reinsurance plan thereafter.
-allow annual well care exam at no co pay for all clients.
Pharmaceutical industry
Eliminate cost differential between U.S. and the rest of the world.
Hospital industry emergency care
Mandate primary care clinics adjacent to each ER for urgent care patients to avoid expensive ER costs. Triage area needs to be established in each ER to screen patients. A Screening fee will be provided. These clinics need to operate 24hr/7 days. It can be a contracted service.
Ambulance Care
Criteria for emergency pick up needs to be established to avoid excessive abuse of 911 calls.
Cost shifting
-eliminate all cost shifting to the private insurance premiums to cover governmental discounts and programs and uncompensated care(hidden tax on private premiums)
Provider driven managed care plan to compete with private medicare plans on quality and cost structure. All plans available annually for patient review , comparison and enrollment( see Florida’s Medipass program for details)
-Freeze Medicare premiums at age 75 for all seniors.
-Cap care at $5 million total per patient.
-Provide catastrophic plan at $ 5 million deductible for Medicare as an elective plan.
-Eliminate donut hole in Part D
-Reduce costs through negotiations with pharmaceutical companies.
-Consider removing research and development costs from wholesale drug pricing
-expand medicare program to age 55 and over (adjust costs upward to reflect realistic working members premiums.)
-mandatory Arbitration for all malpractice cases to reduce fear of lawsuits and defensive medicine practices by physicians and risk managers.
-new payment structure for provider payments with goal cost reduction for administration
Medicaid
- increase federal share to 75% and 25% for states
-implement provider driven manged care plan to compete with private Medicaid HMO’s( Medipass)
-protect pediatric care, catastrophic care and chronic pediatric care programs
-protect transplant programs and teaching hospitals
-increase fees for primary care and reduce fees for routine specialty care. Increase surgical fees.
-improve fraud surveillance
-smart card enrollment of all clients
-separate nursing home care into a separate budget.
-create a Medicaid buy in program for up to 300% of poverty on a sliding scale for those who cannot afford private insurance.
-mandatory arbitration for all malpractice claims
Private insurance
-standardize claims systems
-tighten the definition of health insurance plan to discourage small exploitive companies.
-provide for standardized premiums throughout the system to spread high risk groups exposure.
-Shorten time frame for pre-existing conditions to six months.
-limit deductibles to maximum of $1000 to prevent inability to access system
-limit copays to maximum $100 to prevent discouraging seeking care.
-create guidelines for testing based on diagnosis..to prevent “shot gunning”by providers who use testing to screen rather then clinical techniques.
-create standards for guarantee issue of insurance
-allow monthly mandatory draw from paycheck to pay premiums to prevent defaults and periods of interrupted coverage.
-allow for $5 million cap on care costs and availability of a $5 million deductible catastrophic reinsurance plan thereafter.
-allow annual well care exam at no co pay for all clients.
Pharmaceutical industry
Eliminate cost differential between U.S. and the rest of the world.
Hospital industry emergency care
Mandate primary care clinics adjacent to each ER for urgent care patients to avoid expensive ER costs. Triage area needs to be established in each ER to screen patients. A Screening fee will be provided. These clinics need to operate 24hr/7 days. It can be a contracted service.
Ambulance Care
Criteria for emergency pick up needs to be established to avoid excessive abuse of 911 calls.
Cost shifting
-eliminate all cost shifting to the private insurance premiums to cover governmental discounts and programs and uncompensated care(hidden tax on private premiums)
Ben Graber
2929 University Drive
suite 202
Coral Springs, FL 33065
United States
ph: 954-345-4528
fax: 954-755-8075
alt: 954-345-4536 fax
GRABERCA
