Mar 2011 - Michigan South Asian

Page 11 MARCH 2011 Michigan South Asian
Dr. Nik’s Health Reform Bill
By Nik Nikam, M.D.
A patient of mine had a heart
attack. He underwent emergency
bypass surgery. His hospital
charges were $140,000. It
completely wiped out his savings,
and he had to take a loan
on his primary residence. Yet,
he is unable to get any type of
healthcare coverage even if he
is willing to spend $500 per
month.
He works and supports his family.
Recently, he was diagnosed
to have diabetes further complicating
his dilemma and misery.
He has to decide between feeding
his family versus purchasing
his Insulin for which he has
no prescription plan, and has to
pay retail price by cash.
Such untold stories are echoed
time and again from many of
the 47 million uninsured people,
of which 75% of them have
at least one family member
working and earning money!
It is inconceivable that this is
happening even as you read this
article in a nation that spends
17% of its GDP on healthcare.
Yet, we do not have the best
healthcare system in the world
as measured by infant mortality
among others. We have the
most expensive, fragmented,
and imbalanced healthcare
system among the richest developed
nations in the word. I
propose the following bills to
the congress to reduce social
inequality, reduce the healthcare
costs, and make healthcare
affordable by all Americans.
A majority of uninsured people
are unable to get healthcare
coverage because either the
premiums are too high or they
have a preexisting condition
which precludes them from getting
healthcare coverage.
We should break down the
healthcare coverage into two
parts namely basic coverage
and catastrophic coverage.
The basic plan will cover the
first $50,000 or $100,000. Let
the private sector compete for
this coverage, just as it is done
in the auto insurance.
This will dramatically bring
down the insurance costs to a
point where everyone can afford
it. Presently, people may
be paying excessive insurance
premiums for 20 years or more
before they really need health
services,
and when
they do
need it,
it is not
there anymore.
By this
approach,
we can
make sure
that every
American
is covered
by the basic insurance. Whether
we have a public plan or a notfor-profit
co-operative to compete
with the private sector is
not of such paramount importance,
when we focus on the a
more monumental issue such
as providing affordable healthcare
coverage to all Americans.
I strongly believe there should
be competition; not a monopoly
either by the insurance industry
or the government.
Catastrophic coverage: Let
the Federal government, along
with private sector if they desire
to participate in, pick up
the catastrophic coverage beyond
$50,000 or $100,000, for
all citizens. I believe part of the
premium received by the insurers
for the basic coverage has to
be passed on to the catastrophic
plan.
When people lose their jobs
they should be able to continue
with their insurance coverage. If
they cannot afford due to hardship,
the catastrophic coverage
should pick-up their premiums,
as it is done in Germany.
Make each employer pay for
his employees or pay health tax.
This will fund the catastrophic
pool, which can provide coverage
to those who cannot afford
basic coverage.
Remove the pre-existing stipulations
from all insurance policies
and replace them with ratings
as it is done for automobile
insurances.
Introduce DRG (diagnoses related
groups) system of payment
to all healthcare services
not only for hospitals, but also
for physicians, and all ancillary
medical services that can reduce
the healthcare costs.
Hold physicians accountable
for their billing practices. At
present, any doctor can bill for
any service under the Medicare
system. Each physician should
be credentialed to bill only for
those services (CPT codes)
for which they are trained and
qualified. This will reduce the
costs by minimizing the duplication
of tests when patients go
from PCP to specialists.
A new antibiotic may cost well
over $100. If you have an insurance
plan, you may pay only
$10, and if you do not have
insurance, you either pay the
full amount or suffer. The most
widely prescribed drug, Plavix
(a blood thinner) costs $140 for
people who have no insurance
and it may cost only $20-30
for those who have insurance
plans. Is it not a social inequality
or injustice
We should also create a not-forprofit
Pharmacy co-operative
that can collectively bargain on
behalf of millions of uninsured
people who have to pay cash
for their prescriptions.
The not-for-profit co-operative,
through membership, can introduce
benefits that are enjoyed by
the rich and famous who have
prescription plans, where they
have to pay only $10 to $30 for
drugs that would normally cost
$150 for people who do not have
prescription plans and have to
pay cash.
It is hard to imagine that a drug
manufactured by the same company
would cost much less in
Canada than it would in the United
States.
Medicare fraud costs billions
of dollars each year. Let us introduce
a Health-Zar to go after
those people and institutions that
defraud the Medicare and Medicaid
systems and put them out of
business.
City and municipalities use the
services of local legal firms to
collect taxes, penalties, interest,
and legal fees. The same approach
can be used to monitor Medicare
and Medicaid frauds.
This will not cost the Federal
government anything and they
should be able to recover billions
of dollars that can be used to fund
the catastrophic pool Introduce a
health commission consisting of
representatives from the physicians,
hospitals, pharmaceutical
industry, and others to periodically
review the policies and make
recommendations, just as the
FDA supervises the approval of
new drugs.
Administrative
costs:
The average
Medicare
administrative
cost is
3%, while
it runs into
15% to
25% of each
healthcare
premium
dollar collected from patients.
Simplification of paper work and
standardization of information required
by different providers can
simplify the paper work for patients,
doctors, and hospitals and
reduce the overall costs.
Regulation of the healthcare industry
and holding it more accountable
to the public needs
will also help to increasing the
number of people insured and
at the same time reducing the
overall healthcare cost.
There has been an explosive
proliferation of healthcare
centers especially in the major
cities which adds to the
healthcare costs.
There has to be some type of
regulation so that we do not
have a replication of an image
of four gas stations at each
major intersection, by chains
of hospitals having branches
at every major intersection.
Technology comes with its
own cost. The more technology
we use the more it adds
to the healthcare costs without
necessarily improving the
quality of life in every incidence.
In line with promoting more
primary care specialists and
covering the rural areas can
help to provide the much
needed healthcare coverage
and to possibly detect health
problems at the earliest stages
that can be treated with less
expensive options.
Promoting preventive treatments
and early diagnosis of
cancers and chronic disease
would reduce the overall
healthcare costs. That means
certain screening tests such as
routine mammograms, colonoscopies,
and stress tests
etc., should be part of a comprehensive
healthcare package.
In conclusion, if the government
introduces the two step
insurance program, provide
low cost pharmacy benefits
to those uninsured people, reduce
Medicare fraud, and administrative
costs, we should
be able to provide healthcare
coverage to all Americans.
Visit www.sugarlandheartcenter.com
and read up on,
“Nikam’s Diet,” which has
numerous articles on a hearthealthy
diet.
Nik Nikam, M.D. P: 281-265-
7567
nikam@windstream.net