专属于您的专家

林克整形外科

我们为提供大韩民国最顶级的整形服务而不懈努力,作为行业引领者的同时也是一家综合性医院。

专属于您的专家

林克整形外科

我们为提供大韩民国最顶级的整形服务而不懈努力,作为行业引领者的同时也是一家综合性医院。

美容专家集团
林克整形外科集中于
整形和皮肤医疗服务

眼部手术

准确分析顾客的眼部状态,打造华丽自然的魅力眼眸。
详细内容

鼻部整形

和全新的自己不期而遇 完美的鼻部线条
详细内容

肚脐整形

完美身材的终结者
详细内容

胸部整形

完美的S型曲线 婀娜多姿的身材就从胸部线条开始吧。
详细内容

微整形 / 医美激光

无论何时潮气蓬勃的脸庞 作为美丽的我,重获新生
详细内容

眼部手术

准确分析顾客的眼部状态,打造华丽自然的魅力眼眸。
详细内容

鼻部整形

和全新的自己不期而遇 完美的鼻部线条
详细内容

肚脐整形

完美身材的终结者
详细内容

胸部整形

完美的S型曲线 婀娜多姿的身材就从胸部线条开始吧。
详细内容

微整形 /医美激光

无论何时潮气蓬勃的脸庞 作为美丽的我,重获新生
详细内容

代表院长

随时确保手术安全,努力满足每一位顾客的需求。

代表院长

代表院长 成河旻

Ph.D., M.D., 代表院长
整形外科専门医

代表手术及微整形

体型整形 : 隆胸手术, 肚脐手术, 吸脂
面部整形 : 隆鼻手术,眼部手术
微整形 : 丽珠兰再生注射,舒丽可和各种微整形和激光微整形 拉皮手术 : 花儿线提升

主要经历

前 原辰整形外科院长
前 棒棒整形外科院长

其他参考事项

首尔国立大学整形外科诊所
江南圣心医院整形外科门诊教授
The American Cleft Palate Craniofacial Association Member

代表院长

代表院长 成河旻

Ph.D., M.D., 代表院长
整形外科専门医

代表手术及微整形

体型整形 : 隆胸手术, 肚脐手术, 吸脂
面部整形 : 隆鼻手术,眼部手术
微整形 : 丽珠兰再生注射,舒丽可和各种微整形和激光微整形 拉皮手术 : 花儿线提升

主要经历

前 原辰整形外科院长
前 棒棒整形外科院长

其他参考事项

首尔国立大学整形外科诊所
江南圣心医院整形外科门诊教授
The American Cleft Palate Craniofacial Association Member

代表院长

代表院长 郑旻树

Ph.D., M.D., 代表院长
整形外科専门医

代表手术及微整形

面部整形 : 眼部手术,隆鼻手术
体型整形 : 隆胸手术, 吸脂
微整形 : 丽珠兰再生注射,舒丽可和各种微整形和激光微整形 拉皮手术 : 花儿线提升

主要经历

前 自然主义整形外科院长

其他参考事项

口耳相传的高口碑眼部整形的专门医生
江南圣心医院整形外科门诊教授
Scholarship in Craniofacial Surgery at the Chang Gung Memorial Hospital

代表院长

代表院长 郑旻树

Ph.D., M.D., 代表院长
整形外科専门医

代表手术及微整形

面部整形 : 眼部手术,隆鼻手术
体型整形 : 隆胸手术, 吸脂
微整形 : 丽珠兰再生注射,舒丽可和各种微整形和激光微整形 拉皮手术 : 花儿线提升

主要经历

前 自然主义整形外科院长

其他参考事项

口耳相传的高口碑眼部整形的专门医生
江南圣心医院整形外科门诊教授
Scholarship in Craniofacial Surgery at the Chang Gung Memorial Hospital

客户见证

不仅是韩国顾客,还有很多外国顾客推荐林克整形医院手术的结果和技巧。

访问路线

新论岘站3号出口,济宇大厦第一GRAND药店4层

地址

首尔特别市江南区论岘洞江南大路478济宇大厦4层

诊疗时间

星期一〜星期五
10:00 a.m.~ 7:00 p.m.

星期六
10:00 a.m.~ 5:00 p.m.

联系方式

SNS

预约/咨询

不便前往医院时,可随时申请视频商谈。 请使用KakaoTalk/微信等进行轻松预约。

预约商谈及时间

星期一〜星期五
10:00 a.m.~ 7:00 p.m.

星期六
10:00 a.m.~ 5:00 p.m.

GMT+9, Korea Seoul Local Time

视频商谈

* 为整形而烦恼的人群

* 希望进行商谈,但没有时间的人群

* 希望与其他医院进行价格比较的人群

* 希望了解变美方法的人群

预约商谈及时间

星期一〜星期五
10:00 a.m.~ 7:00 p.m.

星期六
10:00 a.m.~ 5:00 p.m.

GMT+9, Korea Seoul Local Time

视频商谈

* 为整形而烦恼的人群

* 希望进行商谈,但没有时间的人群

* 希望与其他医院进行价格比较的人群

* 希望了解变美方法的人群

医院内部

现代和豪华的诊所内部

服务内容

林克整形外科提供的手术及医美内容
手术后可能会出现出血,感染及炎症等并发症,因此主观满意度也存在个人差异。

林克整形外科

韓国首尔特别市江南区论岘洞江南大路478济宇大厦4层
新论岘站3号出口

电话: +82-2-577-8388  手机 : +82-10-8957-6771
邮箱: linkpsclinic@gmail.com

Copyright ⓒ 2017 LINK PLASTIC SURGERY 링크성형외과 All Rights Reserved.

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Over the last few years South Korea has progressed understood for its innovation than its food. Nonetheless, thanks to also cooked on a frying pan. The special has crunchy exterior as well as soft inside as well as an irresistible flavor.

Bulgogi (marinated beef barbeque).
A juicy, savory dish of grilled seasoned beef, bulgogi is one of the most prominent Oriental meat meals throughout the world, and was ranked as the 23rd most tasty food worldwide according to CNN Travel’s reader’s poll in 2011. It is commonly grilled with garlic and also sliced up onions to add taste to the meat. The meat is typically wrapped in lettuce and it is likewise traditionally consumed with ssamjang (a thick, red spicy paste).

Bulgogi|© Sergii Koval/ Alamy Stock Image.
Samgyeopsal (pork strips).
One of the most popular Oriental meals in South Korea, samgyeopsal includes barbequed pieces of pork tummy meat that are not marinated or seasoned. They are frequently dipped in seasoning made from salt and pepper blended in sesame seed oil, and after that wrapped in lettuce along with grilled slices of garlic, smoked slices of onion, shredded eco-friendly onions, and kimchi. It is among one of the most common dishes found in any Korean restaurant throughout the world.

Japchae (stir-fried noodles).
Often served as a side dish throughout lunch or dinner, japchae is a standard Korean noodle recipe composed of stir-fried sweet potato, thinly shredded vegetables, beef, and a tip of soy sauce as well as sugar. Depending on the chef, added components like mushrooms are contributed to the mix. Japchae is understood for its wonderful and savory taste as well as its soft yet somewhat chewy texture.

FIGURE OUT MORE.
Kimchi (fermented vegetables).
One of the oldest as well as probably one of the most essential dishes in Oriental cuisine, kimchi is a spicy as well as sour recipe comprised of fermented vegetables. It is prepared with numerous kinds of active ingredients, but one of the most c
ommon main ingredient is cabbage. Kimchi is preferred among immigrants for its special flavor, in addition to its high nutritional value, fiber material as well as low calorie web content. Nonetheless, for Koreans, it is most preferred due to its significant cultural worth. Without kimchi, dinner is taken into consideration insufficient.

Kimchi|© Magdalena Bujak/ Alamy Supply Photo.
Ddukbokki (spicy rice cake).
Ddukbokki, additionally led to tteokbokki, is a typical zesty Oriental food made of cylindrical rice cakes, triangular fish cake, vegetables, and also pleasant red chili sauce. It is often sold by pojangmacha (street vendors). People enjoy ddeukbokki for the combination of spicy as well as sweet flavors.

Sundubu-jjigae (soft tofu stew).
Offered in a large rock dish, sundubu-jjigae is a common spicy Korean stew usually constructed from dubu (tofu), vegetables, mushrooms, seafood, beef or pork, as well as gochujang (chili paste). Depending upon the chef and also area, some active ingredients are gotten rid of, replaced or included in the mix. Though various variants exist, commonly, a raw egg is put on top of the stew as well as mixed with the soup before serving to include added taste to the dish.

Bibimbap (blended rice).
Bibimbap is basically a dish of mixed components including, but not restricted to, rice, namul (experienced and also sautéed vegetables), mushrooms, beef, soy sauce, gochujang (chili pepper paste), and also a fried egg. The components located in bibimbap vary by area, and also one of the most famous variations of the recipe are discovered in Jeonju, Tongyeong, and Jinju.

Oriental Bibimbap|© Brent Hofacker/ Alamy Stock Picture.
Seolleongtang (ox bone soup).
A typical hot Korean soup made from ox bones, ox meat and also briskets, seolleongtang is a local dish of Seoul, typically skilled with salt, ground black pepper, cut eco-friendly onions, or minced garlic according to the consumer’s preference. The brew is of a milklike white, gloomy color and is usually eaten with rice. Seolleongtang is recognized for its soft yet crunchy texture as well as tasty broth, and also can be discovered in a lot of Oriental dining establishments in Seoul.

Haemul Pajeon (fish and shellfish vegetable pancake).
A variation of pajeon, which is a pancake-like Korean recipe made mostly with environment-friendly onions, egg batter, wheat flour, and rice flour, haemul pajeon integrates fish and shellfish to the common pancake. Typical seafood components used include, but are not limited to, oysters, shrimp, squid, as well as clams. Haemul pajeon is normally eaten as a main course and is recognized for its soft and also crunchy structure as well as its mix of fish and shellfish flavors.

Samgyetang (ginseng chicken soup).
A typical meal specifically during the summer season, samgyetang is a standard soup made of hen, garlic, rice, scallion, Oriental jujube, Korean ginseng, and also seasonings. It is recognized to have a high dietary worth. Not just is it understood for its healthy components however it also is preferred simply for its luscious and meaty taste.

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Samuel Keeley, BA, MBA, Ph.D – Strategic Economic Planning and Communications Director

Christopher Colburn, Ph.D.- Chief Economic Consultant and Senior Fellow

Charles D. Van Eaton, Ph.D. – Chief Economist and Distinguished Senior Fellow

Charles D. Van Eaton, Ph.D. is Distinguished Professor at Large and Director of the Bryan Center for Critical Thought and Practice, Bryan College, Dayton, TN.

James L. Kammert, MA, JD – Washington, D.韓国の美容整形ツアーC. Liaison

Lou Hrkman, BS (Pol. Sci.), MPA, MBA – Senior Fellow, Corporate Liaison and Marketing Director

Michael P. Prunty, BSBA – Public Relations Director* contact Mike in my absence 757-329-6879

mprunty@afpcsf.com

James Morford, BS Ed – Health Consumer Advocacy Liaison

G. Brent Williams, BS, MBA – System Design Director

Arden Hennessey B.A.- Physician Liaison and Professional Relations Director

Richard Cheatham B.A. Executive Li
ison and Economic (Market) Planning

History

Dr. Lanzalotti first published the American Health Care Plan in 1991. Over the next two years he published a number of papers and gave many addresses concerning his cutting edge ideas. During this time Dr. Lanzalotti was serving as delegate from Williamsburg/James City County Medical Society to the Medical Society of Virginia (MSV) where he served on several committees. A group of physicians also 韩国整形members of the MSV decided to found the Jeffersonian Health Policy Foundation in 1993 to research health care reform issues and promote the American Health Care Plan.

Robert P. Nirschl, MD, an orthopedic surgeon from Arlington, Virginia was elected Chairman of the Board and John A. Lanzalotti, MD a physician and surgeon from Williamsburg , Virginia was elected Vice-Chairman of the Board and appointed Policy Director. Lewis Williams, MD, an OB-GYN from Richmond, Virginia, his brother Harold Williams, MD, a surgeon from Newport News, Virginia and John M. O’Bannon, III, MD, a neurologist from Richmond, Virginia served as Board Members and Staff.

In 1995 Dr. Lanzalotti’s bills: Public Funded Health Care Assistance 韩国整容Act of 1995 and the Virginia Medical Savings Account Act were passed with strong bipartisan support and signed into law by Governor George Allen.

In 2004, The Jeffersonian Health Policy Foundation was re-organized with all new staff as a private Foundation, with a stated mission of investigating and designing a correct and comprehensive model for health care reform that can serve all Americans. Our purpose was to develop the foundation for a business organization that would implement the principles in the Plan in the private business secto林克整形外科r. Phase one of its mission was to study our current system, health care economics, economics, advanced insurance theory, actuarial science, public policy and health care law as well as the history of medical delivery systems. This study resulted in the publication of a series of papers elaborating principles for health care reform. This resulted in a more comprehensive version of The American Health Care Plan which is a coherent set of strategies that can be used to correct problems with the current system toโรงพยาบาลศัลยกรรมลิงค์ create an efficient, cost effective system to finance and deliver health Care to all Americans while maintaining high quality through incentives and checks and balances inherent in the basic design.

John A. Lanzalotti, MD

Biography

John A. Lanzalotti, M.D.

Dr. Lanzalotti was born and raised in Shrewsbury, New Jersey. He received his MD degree from the University Of Pennsylvania School Of Medicine. After earning his MD he was selected to stay at the University of Pennsylvania for postgraduate training in Surgery. After completing his prerequisite training in general surgeryโรงพยาบาลศัลยกรรมเกาหลี, Dr. Lanzalotti took additional training in plastic and reconstructive surgery. During his seven years of residency training, Dr. Lanzalotti worked as an Emergency Room physician. Dr. Lanzalotti then moved to Williamsburg, Virginia and set up private practice in 1982. In addition, he has been an adjunct professor at the College of William and Mary starting in 1987 where he has taught Immunology, The History and Philosophy of the Medical Sciences, Medicine in Literature and Health Care Economics and Policy. Dr. Lanzalotti also served in the US Navy after college as a commissioned combat line officer during the Viet Nam War era stationed aboard a destroyer as an engineering officer.

Dr. Lanzalotti,แพทย์ผู้เชี่ยวชาญ who is nationally recognized as a leading authority in health care reform policy, became interested in health-care economics early in his medical career in private practice in Williamsburg. He received individual training while teaching at the College of William and Mary in economics and health care economics and began writing aบินตรงจากเกาหลีnd having papers published in various aspects of health care finance and delivery systems. He has continued his intensive study of health care policy, economics, advanced insurance theory, public policy, and health care law until the present time. In 1991 Dr. Lanzalotti developed his “American Health Care Plan” a comprehensive market-based strategy to fundamentally reform health care in this country to providศัลยกรรมเกาหลีต้องทำที่เกาหลีเท่านั้นe competition based on value and access to high quality low cost care for every American.

In 1993 his leadership provided the impetus for the establishment of the Jeffersonian Health Policy Foundation, a Virginia based think tank founded by a group of politically influential physicians all associated with the Medical Sociพบกับงานปรึกษาศัลยกรรมเกาหลีty of Virginia. Dr. Lanzalotti as policy director of the think tank provided health care policy and served as medical advisor for George Allen during his campaign for Governor and several other Virginia delegates and senators. In 1995 Dr. Lanzalotti’s bill: The Virginia Medical Savings Account Bill was passed with strong bipartisan support by the Virginia legislaเอเจนซี่ศัลยกรรมเกาหลีture and signed into law by governor George Allen. Dr. Lanzalotti has served as a consultant in health care matters to the legislatures of several states and has testified on many occasions before the Virginia General Assembly and worked with staffers on various committees and sub-committees of both the Senate and House of the U.S. Congress. Dr. Lanzalotti was invited to present his health care plan to House Leadership in the US Congress in 1998.

He has given many talks on and has been widely published in market-based health-care reform over the past 16 years. Dr. Lanzalotti has designed a comprehensive set of insurance protocols which are based on universally acceศัลยกรรมเกาหลีpted standards of good health care by the medical community and which define episodes of that care. He has also designed a set of communication protocols. This is basic to having everyone in our health care system being able to communicate electronically, allows us to have competition based on value and obviate the perverse incentives of our current third party procedure driven system of payment. From 1994 through 1997, Dr. Lanzalotti hosหมอletmeinted a national radio program, “American Perspectives in Health Care”. He hBệnh Viện Phẫu Thuật Thẩm Mỹ LINKas been interviewed many times on both radio and TV where he has discussed health care reform issues. He is currently writing a book on market based reform of American healPhẫu thuật thẩm mỹ hàn quốcthcare.

The keystone of the American Health CLINK гоо сайхны мэс заслын эмнэлэгare Plan is the economic plan. In order to control costs and cost inflaเปิดหัวตา เกาหลี
tion we must design a new method for financing Health care deliverY.

Our current method of finance is baseСолонгос гоо сайхны мэс засалd on third party payment from the insurance carrier directly to the provider in response to claim forms sent to the insurance carrier by the provider for individual procedures. This method is associated with at least 23 cost drivers (see the section on cost drivers). The explosion of medical knowledge and technology during the latter half of the 20TH century is no longer functional in the antiquated third party payment for individual medical procedures. The result is cost inflation greater than anything else in our economy.Клиника пластической хирургии “Линк”

It makes more sense to provide the patient’s asset account with an appropriate budget that will allow the patient to pay for all anticipatкорейская пластическая хирургияed expense due to their insurable event at fair market value directly and personally. This budget can be determined by proprietary software that verifies that a particular insurable event has occurred at a particular complexity level. This 스킨부스터e insurance carrier’s computer along with information from the patient’s electronic medical record. This patient specific information is matched by a matching algorithm at the computer of th복부성형
e insurance carrier to release the appropriate budget in the form of a lump sum to the patient’s asset account. This new business system of a patient specific prospective payment i복부거상
n a lump sum that represents an appropriate budget is the keystone of the economic plan and is designed to completely replace our current third party payment, procedure driven system.복부성형술

Healthcare refo복부성형수술
rm is necessary to provide Americans with affordab

le, portable, functiona-l healthcare that will provide every Americ복부성형후기
an with enough money to pay for health care in our complex, uncertain and expense health care system and try to prevent illness. If we can’t prevent the illness at we should be able to discover it before it becomes advanced to point that it will be very expensive to treat. We need to reform not only the insurance market but the entire health care market. We need to design competition into individual medical transactions as well as the복부성형 효과
health care market place along with the win-win incentives for all market participants with checks and balances.

In addition we need to reform how we handle medical liability to make it fair for all participants.복부성형 비용

Health i복부성형 방법 nsurance needs to be reformed to use a new form of health care finance. Moral hazard needs to be removed from health insurance along with those aspects which are currently causing high administrative중년뱃살 costs. We have to improve risk classification and refine risk classes. We need to reform how we handle eligibility with high risk pools and re-insurance so insurance will work for those people with pre-existing conditions or are considered uninsurable without inflating costs for eve30대다이어트 ryone else. Insurance needs to be reformed to make it actuarially sound.

REFORMING AMERICAN HEALTH CARE The Economic Plan

40대다이어트 Economic Plan Needed -Reforming American health care will require both an economic plan as well as a political strategy for implementation without which reform will fail. Using a political agenda as a substitute for an economic plan will not work in the market, will 50대다이어트 not produce reform, but be only just another failing system. Our most pressing health care issues are inefficiencies and delivery disparities, out of control costs, and how to pay for our present Medicare and Medicaid liabilities plus future care for the baby boomer generation. Without resolving these issues our entire economy will remain subject to high financial risk. Reform Three Main Areas – We must reform health insurance, redesign the health care market institution, 갱년기다이어트 and redefine and reposition the doctor-patient relationship as the focal point of the American health care market. Then, we need a strategy to tackle the government –health care industrial complex whose firmly entrenched stakeholders will fight change with a vengeance.복부비만 Current Insurance Issues – Our health care financing for both the public and private sectors is dysfunctional for the same reason, poor design of incentives, the lack of proper checks and balances, and a power imbalanced health care market. Because 복부거상술 our system was designed by bureaucrats for political reasons, which violate basic economic principles, it is impossible for it to function properly in the market place. The resulting symptom is costs that are rising out of control. The current system has perverse incentives for consumers to over-바디리프팅 consume, for providers to over-utilize and inappropriately utilize expensive high tech diagnostic and treatment options. Premiums for health insurance cost too much because of these perverse incentives, and state mandates to cover certain benefits and providers, whose need is generated by ศัลยกรรมตกแต่งสะดือ third party payment. Poorly designed insurance that lowers the price of expensive medical treatment but not the cost and which also uses poor strategies such as guaranteed issue and community rating, also drives up costs. Conventional wisdom for dealing with theseตกแต่งสะดือ ที่ไหนดี poor design features dictates having the consumer pay for part of his health care as deductibles and co-payments in out of pocket, post tax dollars in addition to paying hefty insurance premiums. Many Americans cannot afford to do this especially for non-discretionary care. Limited Market Competition – The current system is procedure driใคร เคย ศัลยกรรมสะดือ บ้าง ven which has fragmented health care delivery. Medical decisions are no longer being made by physicians but rather by insurance companies whose only consideration is the company’s bottom line. The government has given the health care industry too much monopoly power. Ironically, government has made this monopoly power not subject to the anti-trust laws. Other laws also prohibiแก้ไข สะดือจุ่น pantip t insurance from designing innovative risk spreading systems and proper high risk pools so that the insurance industry can manage its risks rather than transfer them directly to the taxpayer. Our entire insurance system is designed to ration and deny care, price control and micromanage providers while increasing the paperwork burden and administrative costs. Expensive ผ่าตัดสะดือจุ่น ราคา ‘Emergency’ Care – Many Americans can not afford to survive in this “fast lane” insurance system, so many go un-insured. They end up in emergency rooms for routine care, the most expensive venue. They are charged paymaster list price, from the highest price tier. This is yet another symptom of system dysfunction. The uninsured cannot afford tศัลยกรรมสะดือ ยันฮี o pay the bill so it is cost shifted directly to the tax payer. Cost shifting and other avoidance behaviors by the insurance industry cost the American tax payer over $500 billion a year. We are paying for this care in the most expensive way. Least Expensive, most Efficient Care -The least expensive and most efficient way is to give สะดือ รูปร่าง ach American equal purchasing power in health care by directly subsidizing the insurance premiums of the elderly, the poor and Americans with chronic illness. Let them participate in the same affordable market as all other Americans within properly designed high risk pools. This can be done at a fraction of the cost that we pay now. This will allow every American access to affordable insurance and equitable care. It will enable aรีวิว ผ่าตัด สะดือ ll Americans regardless of socio-economic level to pay reasonable market price in a competitive, functional market. We need to separate the financing for discretionary care, from non-discretionary care. Restoring a Functional Health Care Market and Competition – The market institution of organic markets develop gradually only after a long period ofสะดือสวยๆ time through trial and error. The government cannot design the market institution. The market institution must be deliberately and carefully designed by the individual participants and not the government because we are transitioning from an over-regulated system with firmly entrenched stakeholders who profit off the market dysfunction. This new design must be win-win; not the zero-sum game we now have. The power of all market ผ่าตัดสะดือ participants in the new market place has to be leveled so that proper incentives with checks and balances will allow market forces to operate for all participants and so some participants will not dominate the market taking unfair advantage of other participants. This means that government provided monopolies, corporate welfare, stimulus funds, and other protectionist emoluments such as absolving unions from the laws the rest of us are subject to.This will allow proper competition which will lower costs and improve quality. The Doctor –Patient Relationship-There is a perception that physicians will selfishly exploit every patient for financial gain. Ironically, most ХҮЙСНИЙ НҮХНИЙ ГОО САЙХНЫ МЭС ЗАСАЛ physicians truly desire and take pride in their ability to use their knowledge and skill to guide the patient through a complicated, oftentimes uncertain and expensive health care system appropriately and cost effectively. The negative perception has been created by the design of our current insurance finance system with its third party payment, fee for procedure system and perverse incentives. Change the design and tхэвлийн товчлуурын мэс засал he incentives and you change the perception and behavior. Unfortunately, our current system with its over regulation and micro-management thwarts the physician’s genuine desire to help and provides perverse incentives that degrade the physician’s professional relationship PHẪU THUẬT RỐN with his patient. We need to change the system to one in which the patient pays directly for all non-discretionary care health care expenses from a lump sum payment derived from the insurance. In aBELLY BUTTON RESHAPING ddition the patient will pay for all discretionary care from money in a tax favored account derived from the premium difference from our current high priced health plan premiums and the new lump sum insurance plans. By doing this we will incentivize the physician to pbelly button surgery rovide the patient with various price options within the context of appropriate care and enough information concerning marginal benefits and marginal prices so that the patient can choose the proper option within his budget with the doctor’s help. New Insurance System – If people had navel reshaping surgery more opportunity to buy insurance only for major events and avoid using health insurance for every minor or routine health service, premiums could be lower as well as administrative costs. Under a reformed health care system an expanded personal and portable tax-free health care savings and asset account (ehsa) is established for every american individual or family using annual funding from a variety onavel surgery f sources. Twenty-five to thirty percent of the annual funding of the asset account is used by the patient to pay an annual premium for “protocol insurance” to any insurance carrier and premiums for disability and long term care insurance. The remainder of the funding rolls over from year to year and grows tax-free and can be used for discretionary and initial visit (any diagnostic procedureBELLY BUTTON RESHAPING surgery s done before any determination has been made by the doctor concerning diagnosis) health care spending, as well as retirement income by the beneficiaries of the account. All insurance carriers will use the same doctor designed severity rated protocols with complexity levels based on experience and empirical data to determine payment. A lump sum payment for each insurable event is a funumbilicoplasty ction of, or determined by the complexity level of the protocol. The sicker the patient, the more money the patient will need to pay his medical bills. When a patient sees a doctor, the doctor examines the patient and prepares a computerized medУМБИЛИКОПЛАСТИКА ical workup. Software downloaded into the doctor’s computer evaluates the work-up and determines information about which established “protocol” and “complexity level” the patient’s condition corresponds to. An electronic transfer of this information from the provider’s office computer to the insurance carrier’s computer obviates filing claims and triggers a “lump sum payment” from the insurance carrier into the patient’s ehsоперация на пупке a. This lump sum payment is represents all of the money the patient will need to pay all anticipated expenses related to the insurable event at fair market value. There are no deductible or co-payments. Conclusion and Questions -With all of its money why hasn’t the insurance industry instituted better solutions 肚臍手術 to these problems already? The answer is– no one really wants serious change in spite of the window dressing. Health care reform will continue on to be a big noise on the staircase in every four year election cycle with the only thing ever coming down being an even bigger bureaucracy with more opaque regul肚臍整形費用 ation and micromanagement unless we determine to change the system.

The American Health Care Plan By John A. Lanzalotti, M.D. Copyright 2010

Outline 肚臍形狀 TYPE: Market Based, Patient Choice Driven Primary Market at the Doctor-Patient level Level Playing field Utilizes incentives, Checks and Balances for Regulation Government Enforcement of 凸肚臍 Rules of Engagement to maintain a level Playing field and Functional Market Comprehensive Reform Strategies Our Policy Reforms Will Improve The Productivity and Efficiency Of The Health Care System, Make Insurance More Affordable, Reduce Rates Of The Uninsured, And Increase Tax Fairness. MECHANISM: Corrects Market Dysfunction that Limits Choic肚臍整形ptt e, Inflates Costs, and Perpetuates Power Imbalances Creates Balanced Health Care Market Forces (Level Playing Field) for all Participants Shifts Money and Power from the Bureaucracy to the Patient/Provider Refocuses health Care Market on the Provider/Patient; All other participants support that relationship Medical Care Managed by the Physician/Patient Market Forces Operate on an Individual Level through Incentives, Checks and Balances that are a Part of this Design. Utilizes Protocol Health Insurance and Expanded Health Care Savings Accounts To Make Markets Work, We Recommend Changes In Five Areas Of Publi韓國肚臍手術 c Policy: insurance design reform, tax reform, Defined Rules of Engagement for Competition, improved provision of information, and malpractice reform. IMPLEMENTATION: Immediate for the Private Sector Self Insured Companies Under ERISA Public Sector Requires Legislation Insurance Reform:韓國肚臍整形費用 The Purpose Is To Redesign Health Insurance To Eliminate Many Of The Perverse Incentives And Inefficiencies Of The Current Health Insurance Product And Eliminate many of the Cost Drivers Eliminates Third Party Payment, Procedure Driven Medicine Uses A New 整形垢 Financing Mechanism: Contingent Claims Contract With Lump Sum Payment The Term “Protocol” Means A Diagnosis Or Condition Representing The Primary Morbidity For Which The Patient Is Insured. The Term “Complexity Level” Represents Increasing Morbidity And Its Treatment Associated With The Insurable Event And The Presence Or Absence Of Any Co-Morbidity And Its Treatme整形 nt Associated Within That Particular Protocol Uses Doctor Designed Protocols With Complexity Levels Based On Experience And Empirical Data Severity Rated Complexity Levels The Amount Of The Lump Sum Payment For Each Insurable Event Is A Function of ,or Determined By The Complexity Level And Protocolリンク美容外科 Each Complexity Level Represents Increasing Morbidity Associated With The Insurable Event And The Presence Or Absence Of Any Co-Morbidity Associated With That Particular Protocol. Each Complexity Level Is Associated With A Relative Value Scale Number Which Represents The Relative Value Of Each Level O美容外科 Necessary Care. The Sicker The Patient, The More Money The Patient Will Need To Pay His Medical Bills Health Care Is Primarily A Local Market Phenomenon The Relative Value Scale Number Is Then Multiplied By A Factor Λ That Floats With Known Local Market-Related Components To Determine The Actual Dollar Amount To Be Transferred As A Lump Sum Payment Into The Patient’s Extended HSAウォンジン整形外科 Provides Patient With A Lump Sum Payment That Serves As A Budget for the Patient Insurance Payment Paid Directly Into Patients Expanded Health Savings Account An Expanded Personal And Portable Tax-Free Health Care Savings And Asset Account (EHSA) Is Established For Every Ameナナ美容外科 rican Individual Or Family Using Annual Funding From A Variety Of Sources. Twenty-five to thirty percent of the annual funding of the asset account is used by the patient to pay an annual premium for “protocol insurance” to any insurance carrier The Remainder Of The Funding Rolls Over From Year To Year And Grows Tax-Free And Can Be Used For DiID美容外科 scretionary And Initial Visit (Any Diagnostic Procedures Done Before Any Determination Has Been Made By The Doctor Concerning Diagnosis) Health Care Spending, As Well As Retirement Income By The Beneficiaries Of The Account When A Patient Sees A Doctor, The Doctor Examines The Patient And Prepares A Computerized Medical Workup Software Downloaded into the Doctor’s Compute美容整形外科 r Evaluates The Work-Up And Determines Information About Which Established “Protocol” And “Complexity Level” The Patient’s Condition Corresponds To An Electronic Transfer Of This Information From The Provider’s Office Computer To The Insurance Carrier’s Computer Triggers A “Lump Sum Payment” From The Insurance Carrier I美容外科オススメ nto The Patient’s EHSA The Lump Sum Payment Provides The Patient With Enough Money To Be Able To Pay For All Anticipated Expenses (At Fair Market Value) Associated With That Particular Insurable (For Necessary and Non-Discretionary Care only) This Insurance Payment Does Not Require A Co-Payment Or Deductible Payment From The Patient整形ツアー Patient Pays For All Health Care Expenses Directly Out Of Health Savings Account The Entire New Insurance Design And All Of The Software That Comprises This Innovation Is An Interdependent Functional Unit. Each Component Of This Innovation Has Been Designed To Create Proper Incentives TAX REFORMS: All Americans Should Be Entitled To Deduct韓国整形ツアー Health Insurance And Health Care Expenses As Long As They Purchase Insurance And Maintain An Extended Tax Free Health Savings Account. In All Cases, The Deduction Is “Above The Line”—Available Even To Taxpayers Not Itemizing Income Tax Deductions, Or For Those Below 150% Of Poverty, Equivalent Tax Credits. The Proposed Policy Also Would Create A Powerful Tax Incentive To Purchase Insurance.整形ブログ Deductibility Would Mitigate The Bias Against Individual Insurance The Tax Change Would Increase The Fairness Of The Federal Income Tax System The Tax Code Could Also Be Changed To Make It Easier For Individuals And Families To Save For Expenses Not Covered By Protocol Insurance Under Our Proposal, Funds From An HSA Could Be Used For Any Qualified Health Care Expense, Protocol Health In韓国整形ブログ surance, Long Term Care Insurance, And Disability Insurance. We Propose Setting A $15,000.00 Limit ($7500.00for Individuals) On The Amount That Can Be Deposited In An HSA, Annually Allow Individual Preferences Rather Than Government Mandates To Determine People’s Health Insurance Arrangements Tax credits for low-income people to offer low-income households financial assistance to pu整形情報 rchase health services REGULATION OF Markets: We Propose Two Major Changes To Insurance Regulation: The Creation Of A Federal Market For Health Insurance; And Provision Of A Subsidy For The Insurance Costs Of The Low-Income, Chronically Ill We Propose A Subsidy To Help People With Predictably, Persistently High Health Costs To Purchase Insurance In The New Nationwide Market Through A Properly Designed High Risk Pool Create A Level Playing Field And Transparency In The Market Place. Have Insurance Carriers Provide Value Per Premium Dollar Ratios To Prospective Buyers Redesign And Define The Patient –Doctor Relationship To Balance The Physician’s Selling Expensive Procedures Against The Patient’s Choice To Spend Money In His Asset Savings Account, For Which He May Have Other Use In The Future. Creates Demand Side Incentives That Balance Protection Of The Patient From Unforeseen Medical Care Expenditures With Stimulating Cost Conscious Consumer Choice. On The Supply Side The Need For Third Party Managed Care Is Eliminated And, With It, All The Distortions And Cost Inflation It Has Created In The Healthcare Market Other Reforms: We also propose reforms in three additional areas: Better Provision Of Information To Providers And Consumers; An Explicit Public Goal To Control Anticompetitive Behavior By Doctors, Hospitals, And Insurers; And Reforms to the Medical Malpractice System to Reduce Wasteful Treatment and Medical Errors.

The American Health Care Plan By John A. Lanzalotti, M.D. Copyright 2010

Outline TYPE: Market 韓国整形値段 Based, Patient Choice Driven Primary Market at the Doctor-Patient level Level Playing field整形値段 Utilizes incentives, Checks and Balances for Regulation Government Enforcement of Rules of Engagement to maintain a level Playing field and Functional Market Comprehensive Reform Strategies Our Policy Reforms Will Improve The Productivity and Efficiency Of The Health Care System, Make Insurance More Affordable, Reduce Rates Of The Uninsured, And Increase Tax Fairness. MECHANISM: Corrects Market Dysfunction that Limits Choice, Inflates Costs, and Perpetuates Power Imbalances Creates Balanced Health Care Market Forces (Level Playing Field) for all Participants Shifts Money and Power from the Bureaucracy to the Patient/Provider Refocuses health Care Market on the Provider/Patient; All other participants support that relationship Medical Care Managed by the Physician/Patient Market Forces Operate on an Individual Level through Incentives, Checks and Balances that are a Part of this Design. Utilizes Protocol Health Insurance and Expanded Health Care Savings Accounts To Make Markets Work, We Recommend Changes In Five Areas Of Public Policy: insurance design reform, tax reform, Defined Rules of Engageme韓国整形値段 nt for Competition, improved provision of information, and malpractice reform. IMPLEMENTATION: Immediate for the Private Sector Self Insured Companies Under ERISA Public Sector Requires Legislation Insurance Reform: The Purpose Is To Redesign Health Insurance To整形前後 Eliminate Many Of The Perverse Incentives And Inefficiencies Of The Current Health Insurance Product And Eliminate many of the Cost Drivers Eliminates Third Party Payment, Procedure Driven Medicine Uses A New Financing Mechanism: Contingent Claims Contract With Lump Sum Payment The Term “Protocol” Means A Diagnosis Or Condition Representing The Primary Morbidity For Which The Patient Is Insured. The Term “Complexity Level” Represents Increasing Morbidity And Its Treatment Associated With The Insurable Event And The Presence Or Absence Of Any Co-Morbidity And Its Treatment Associated Within That Particular Protocol韓国整形前後 Uses Doctor Designed Protocols With Complexity Levels Based On Experience And Empirical Data Severity Rated Complexity Levels The Amount Of The Lump Sum Payment For Each Insurable Event Is A Function of ,or Determined By The Complexity Level And Protocol Each Complexity Level Repres韓国整形専門通訳 ents Increasing Morbidity Associated With The Insurable Event And The Presence Or Absence Of Any Co-Morbidity Associated With That Particular Protocol. Each Complexity Level Is Associated With A Relative Value Scale Number Which Represents The Relative Value Of Each Level Of Necessary Care. The Sicker The Pat韓国整形病院 ient, The More Money The Patient Will Need To Pay His Medical Bills Health Care Is Primarily A Local Market Phenomenon The Relative Value Scale Number Is Then Multiplied By A Factor Λ That Floats With Known Local Market-Related Components To Determine The Actual Dollar Amount To Be Transferred As A Lump Sum Payment Into The Patient’s Extended HSA美容クリニック Provides Patient With A Lump Sum Payment That Serves As A Budget for the Patient Insurance Payment Paid Directly Into Patients Expanded Health Savings Account An Expanded Personal And Portable Tax-Free Health Care Savings And Asset Account (EHSA) Is Established For Every American Individual Or Family Using Annual Funding From A Variety Of Sources. Twenty-five to thirty p韓国美容クリニック ercent of the annual funding of the asset account is used by the patient to pay an annual premium for “protocol insurance” to any insurance carrier The Remainder Of The Funding Rolls Over From Year To Year And Grows Tax-Free And Can Be Used For Discretionary And Initial Visit (Any Diagnostic Procedures Done Before Any Determination Has Been Made By The Doctor Concerning Diagnosis) Health Care Spending, As Well Aソン・ハミン s Retirement Income By The Beneficiaries Of The Account When A Patient Sees A Doctor, The Doctor Examines The Patient And Prepares A Computerized Medical Workup Software Downloaded into the Doctor’s Computer Evaluates The Work-Up And Determines Information About Which Established “Protocol” And “Complexity Level” The Patient’s Condition Corresponds Toチョン・ミンス An Electronic Transfer Of This Information From The Provider’s Office Computer To The Insurance Carrier’s Computer Triggers A “Lump Sum Payment” From The Insurance Carrier Into The Patient’s EHSA The Lump Sum Payment Provides The Patient With Enough Money To Be Able To Pay For All Anticipated Expenses (At Fair Market Value) Associated With That Particular Insurable (For Necessary and Non-ソン・ハミン院長 Discretionary Care only) This Insurance Payment Does Not Require A Co-Payment Or Deductible Payment From The Patient Patient Pays For All Health Care Expenses Directly Out Of Health Savings Account The Entire New Insurance Design And All Of The Software That Comprises This Innovation Is An Interdependent Functional Unit. Each Component Of Tチョン・ミンス院長 his Innovation Has Been Designed To Create Proper Incentives TAX REFORMS: All Americans Should Be Entitled To Deduct Health Insurance And Health Care Expenses As Long As They Purchase Insurance And Maintain An Extended Tax Free Health Savings Account. In All Cases, The Deduction Is “Above The Line”—Available Even To Taxpayers Not Itemizing Income Tax Deductions, Or For Those Below 150% Of Poverty, Equivalent Tax Credits. The Proposed Policy Also Would Create A Powerful Tax Incentive To Purchase Insurance. Deductibility Would Mitigate The Bias Against Individual Insurance The Tax Change Would Increase The Fairness Of The Federal Income Tax System The Tax Co整形費用 韓国 de Could Also Be Changed To Make It Easier For Individuals And Families To Save For Expenses Not Covered By Protocol Insurance Under Our Proposal, Funds From An HSA Could Be Used For Any Qualified Health Care Expense, Protocol Health Insurance, Long Term Care Insurance, And Disability Insurance. We Propose Setting A $15,000.00 Limit ($7500.00for Individuals) On The Amount That Can Be Deposited In An HSA, Annually Allow Individual Preferences Rather Than Government Mandates To Determine People’s Health Insurance Arrangements Tax credits for low-income people to offer low-income households financial assistance to purchase health services REGULATION OF Markets: We Propose Two Major Changes To Insurance Regulation: The Creation Of A Federal Market For Health Insurance; And Provision Of A Subsidy For The Insurance Costs Of The Low-Income, Chronically Ill We Propose A Sub湘南美容外科 sidy To Help People With Predictably, Persistently High Health Costs To Purchase Insurance In The New Nationwide Market Through A Properly Designed High Risk Pool Create A Level Playing Field And Transparency In The Market Place. Have Insurance Carriers Provide Value Per Premium Dollar Ratios To Prospective Buyers Redesign And Define The Patient –Doctor Relationship To Balance The Physician’s Selling Expensive Procedures Against The Patient’s Choice To Spend Money In His Asset Savings Account, For Which He May Have Other Use In The Future. Creates Demand Side Incentives That Balance Protection Of The Patient From Unforeseen Medical Care Expenditures With Stimulating Cost Conscious Consumer Choice. On The Supply Side The Need For Third Party Managed Care Is Eliminated And, With It, All The Distortions And Cost Inflation It Has Created In The Healthcare Market Other Reforms: We also propose reforms in three additional areas: Better Provision Of Information To Providers And Consumers; An Explicit Public Goal To Control Anticompetitive Behavior By Doctors, Hospitals, And Insurers; And Reforms to the Medical Malpractice System to Reduce Wasteful Treatment and Medical Errors.주름살제거 피부관리 피부관리 이벤트 이마주름 팔자주름 기미 잡티 물광피부 봄철 피부관리 여름철 피부관리 가을철 피부관리 겨울철 피부관리

Competition in the Health Care Market A Universal Access Market Based Plan for Comprehensive Reform

“People of the same trade seldom meet together, even for merriment and diversion, but the conv目整形 ersation ends in a conspiracy against the public, or in some contrivance to raise prices.” Adam Smith Wealth of Nations Competition in business is the effort of tw目の整形 o or more parties acting independently to secure the business of a third party by offering the most favorable terms. It may stimulate innovation, encourage efficiency, or drive down prices, competition is often promoted as the foundation upon which the free enterprise market system is justified. According to microeconomic theory, no system of resource allocation is more efficient than pure competition. Competition, according to the theory, causes commercial firms to develop new products, services, and technologies. This gives consumers greater selection and better products. The greater selection typically causes lower prices for the products compared to what the price would be if there was no competition (monopoly) or little competition 目の下 クマ 治療 (oligopoly). At one extreme is perfect competition. At the other extreme is monopoly. In perfect competition there are many competitors each producing an identical product. Each competitor makes a minimal profit. Orthodox economists fully acknowledge that perfect competition is seldom observ目 クマ 治療 ed in the real world, and so aim for what is called “workable competition”. This follows the theory that if one cannot achieve the ideal, then go for the second best option by using the law to tame market operation where it can. Workable competition is also known as “monopolistic competition”. In this category each competitor makes enough of a profit to be motivated to stay in the market and be innovative at reasonable prices. This is our goal in bringing market reform to health care. A simple neo-classical model of free markets holds that production and distribution of goods and services in competitive free markets maximizes social welfare. This model assumes t目の下 小じわ 整形 hat new firms can freely enter markets and compete with existing firms, or to use legal language, there are no barriers to entry. By this term economists mean something very specific, that competitive free markets deliver allocative, productive and dynamic efficiency. Allocative efficiency means that resources in an economy over the long run will go precisely to those who are willing and able to pay for them. Because rational producers will keep producing and selling, and buyers will keep buying up to the last marginal unit of possible output – or alternatively rational producers will be reduce their output to the margin at which buyers will buy the same amount as produced – there is no waste, the greatest number wants of the greatest n目 の クマ 美容 外科 umber of people become satisfied and utility is perfected because resources can no longer be reallocated to make anyone better off without making someone else worse off; society has achieved allocative efficiency. Contrasting with the allocatively, productively and dynamically efficient market model are monopolies, oligopolies, and cartels.目頭 の シワ 整形 When only one or a few firms exist in the market, and there is no credible threat of the entry of competing firms, prices raise above the competitive level, to either a monopolistic or oligopolistic equilibrium price. Production is also decreased, further decreasing social welfare by creating a deadweight loss. Sources of this market power are said to include the existence of externalities, barriers to entry of the market, and the free rider problem. Markets may fail to be efficient for a variety of reasons, so the exception of competition law’s intervention to the rule of laissez faire is justified If a firm has a dominant position, then there is “a special responsibility not to allow its conduct to impair competition on the common market”. Si目 の プチ 整形 milarly as with collusive conduct, market shares are determined with reference to the particular market in which the firm and product in question is sold. Currently we have a planned economy in health care; and a command economy in Medicaid, Medicare, Tri-care and Veteran’s Care. A planned economy is an economic system in which the state or government to one degree or another manages the economy. Its most extensive form is referred to as a command economy, centrally planned economy, or command and control economy) In such economies, the state or government controls all major sectors of the economy and formulates all decisions about their use and about the distribution of income. The planners decide what should be produced and direct enterprises t目元 クマ 治療 o produce those goods. Planned economies are in contrast to unplanned economies, i.e. a market economy, where production, distribution, and pricing decisions are made by the private owners of the factors of production based upon their own and their customers’ interests rather than upon furthering some overarching macroeconomic plan. Less extensive forms of planned economies include those that use indicative planning in which the state employs “influence, subsidies, grants, and taxes, but does not compel A planned economy may consist of state-owned enterprises, private enterprises directed by the state, or a combination of both Though “planned economy” and “command economy” are often used as synonyms, some make the distinction that under a command economy, the means of production are publicly owned. That is, a planned economy is “an economic system in which the government controls and regulates production, distribution, prices, etc.” but a command economy, while also having this type of regulation, necessarily has substantial public ownership of industry. Therefore, command economies are planned economies, but not necessarily the reverse. 目の下 ふっくら 整形 Central governments are tempted to solve problems quickly by introducing additional market regulation. Once such regulation is introduced, it is rarely removed, ratcheting towards a gradual increase in government power and a constraint on the mechanism of the free market. Usually, big business has an advantage over small business in a strongly regulated market, because big business can cope with the bureaucracy and small business cannot take advantage of adaptivity. Transparency is important since it is one of the theoretical conditions required for a free market to be efficient. In economics, a market is transparent if much is known by many about What products, services or capital assets are available What price Where. The reality of com目 の 周り の シワ 整形 petition is that it has both beneficial and detrimental manifestations; it comes in both constructive and destructive forms. Destructive competition is competition in which there is a clear winner and loser, where victory is had at the definite detriment of another. Destructive competition is characterized by the tendency toward extreme, unhealthy competition which has been termed hypercompetitive. Destructive competition forces several producers out of the market. Destructive competition usually occurs when there are so many producers of a product that prices are driven down to the point where no one makes a profit. It can also happen if a single producer is significantly wealthier than other producers and can afford to cut prices drastically until the other producers are driven out of business.目元 整形 おすすめ Constructive competition, on the other hand, is competition in which destructive activities towards a competitor are strictly excluded. In this way, the competitors can only compete by making themselves stronger, and so they only become more capable of dealing with other competitors and circumstances as time passes, and hence achieve mutual success. The problem with constructive competition is that it only works if both competitors behave in this constructive fashion. If one competitor behaves constructively, while the other chooses to carry out destructive activities, since destruction is more effective than construction the constructive competitor would quickly lose. Therefore, no one can behave in a constructively competitive manner unless they can be assured that their competitor will behave li目元 くぼみ 整形 kewise. This is the function of the market institution. Competitors in health care need to stay focused on the common goal of providing the highest quality care to patients at lowest possible price. Health care will always be expensive because the demand is high and resources are limited. The major stakeholders in health care have always tried to avoid competition. For competition to work properly in health care we need to define the rules of engagement for the market place. We need to establish a level playing field so that no one participant becomes dominant. Power imbalances lead to market dysfunction. Insurance companies can compete on how much quality they provide per premium dollar. This would be constructive not destructive. It would lead to innovative ways to lower risks. It would lead to incentives for patients to maintain a healthy lifestyle and use preventative care because it would lower their risk category and premium price. This ultimately is win-win. Competition among providers can also be constructive. Competition gives incentives for self improvement. Each physician can provide the patient with information and price options so that the patient can make informed decisions about their health care. This will improve each physician’s skill and knowledge with time. Hospitals will compete on the basis of how efficiently they can provide appropriate care to the patient.

Administrative Costs

Many people believe that a public plan such as Medicare is more efficient and has less administ目の下 クマ 美容 整形 rative costs than commercial insurance. But the comparison between public and private plans is a false comparison. Private insurance and public benefits are like comparing apples to oranges. Private insurance tries to manage care through price controls and rationing patients. Medicare is mostly about paying the bills presented to it even if the payment is a fraction of what was billed. Ways and Means Health Subcommittee Chairman Pete Stark (D., Calif.), for example, insists that “most private plans are poorly managed.” Contrasting them with the supposedly sleek and efficient Medicare program, he labels commercial insurance profit seeking. Here are four things administrative costs provide the private insurer under our current system: First, private insurers try to build provider networks. These networks can include high-value providers (compliant with low cost regulations) and exclude low-quality providers. Except for criminal acts, Medicare is forb目の下 くま たるみ 整形 idden from excluding poor quality providers. It lets in everyone who signs up. Will the public plan have Medicare’s indifference to exclusivity– or invest in the cost of a network? Networks are the wrong approach. Second, private insurers negotiate rates with providers. Medicare just fixes prices using a statutory and opaque regulatory scheme. Where Medicare’s price control does not cover full provider costs (under-market payment), shortfalls are shifted to private payers who end up subsidizing the public program. Will a public plan negotiate rates or simply use fiat as a means of gaining subsidies from private insurance? Third, private insurers must heavily invest to combat fraud — or go out of business. These payers have every incentive to invest in antifraud personnel and strategies down to the point where return and investment are equal. This is very expensive. But anyone who tries to compare a public plan with private sector plans needs to consider Medicare’s dismal record with regard to fraud, waste and other abuse. 目 を 大きく する 整形 In fact, the total amount of Medicare fraud is unknown. The government does not measure or estimate fraud in its programs; instead, it measures payments made “in error.” According to Medicare’s own most recent data, payments made in error amount to over $10 billion annually. (Medicaid’s payment errors in 2007 equaled a whopping $32.7 billion, according to a report by the Department of Health and Human Services.) Others have claimed Medicare’s payments made in error are much higher. Even with the inclusion of the budget of the inspector general for the Department of Health and Human Services, Medicare spends less than one-fifth of 1% on antifraud measures — a small fraction of what private plans invest in their efforts to build a network of devoid of providers who willタレ 目 整形 defraud them. Worse, in four of the past five years Congress has turned back Medicare’s pleas for $579 million of additional antifraud funding, on the grounds that these dollars subtract from the budget funds for curing cancer and anti-obesity campaigns. Based on experience, Congress will always under-invest in fraud. Yet according to a House of Representatives Budget Committee hearing in July 2007, return on investment for certain Medicare antifraud measures were estimated to be in excess of 13-1. Will a public plan also hemorrhage from fraud because of chronic Congressional underinvestment? In a well run private system with no under-market payments, there are approximately 3-4% of physicians who are目の下 シワ 整形 frauds. The current system contains many perverse incentives to upgrade coding and add more procedures than are necessary to make up for what they not getting in price controlled and under value payments from Medicare. They hide in the current system in the abundant gray areas. There is no good way to prevent fraud. However, a good first step would be to adopt a system that pays market value. A good second step would be to remove the gray areas. The “managed care system assumes that they are good doctors and bad doctors. The facts tell us differently. Most people respond to incentives which make sense and checks and balances. Fourth, private insurers must incur the administrative cost of marketing. Medicare, of course, does not need to market. A public plan competing with other alternatives would have目 整形 種類 to market itself to the public, and this means tax dollars used to advertise against private plans. Or the public plan could “compete” by using heavily subsidized marketing channels not available to private insurers, such as Social Security mailings, welfare offices, unemployment check stuffers, and the constellation of government-funded “advocacy organizations.” None of these considerations should be interpreted as a defense of the status quo, or a denial of the fact that major health reform is needed. It is needed, and now. There are indeed many places where commercial h目 の シワ 整形 ealth insurance is inefficient — for example, by trying to exclude the sick rather than compete for the business of managing their ailments more effectively. Moreover, the facilitation of a national insurance exchange could lower information and search costs for our increasingly mobile workforce. But the impulse to “just pass something” — a refrain heard often in the halls of Congress this spring — is not good enough. There are more governmental paths to making things worse rather than better. As the case of Medicare’s anemic anti-fraud efforts illustrates, less management and lower administrative costs do not necessarily mean the program is really less costly. Fraud losses are just categorized as additional spending rather than as administrative expense. Ultimately, the desire of many advocates of a government-run health plan to exaggerate Medicare’s efficiency derives from the fact that the program does not make a profit. These folks are motivated by the naïve assumption that most of the health sector’s ills could be cured if profit-seekers were excluded. The way to really reduce costs especially administrative costs is to reform the design of health insurance and the heath care market place as well as the nature of the physician-patient relationship. We need to abandon third party procedure driven health care reimbursements and adopt lump sum payment to the patient’s reformed HSA from which they can pay all health care expenses directly with an electronic card. We also need to adopt insurance payments derived from protocols designed by physicians based on severity and experience. As the Congress continues the health-care debate, today behind closed doors, and soon in the open, there should be an honest discussion of administrative costs and their value. Those who believe that health care should have no profit should be open with their views and not hide behind the false economy of Medicare.

Transforming American Healthcare By John A. Lanzalotti, MD EXECUTIVE SUMMARY

The way we are financing and delivering healthcare in America is not working and we need transformational change. Everythi埋没 ng we have done in the past to make incremental changes to the market has failed to control costs and failed to improve quality care. We have made significant errors. Can we learn from those errors? All previous reform attempts have expanded the bureaucracy, increased regulation and price controls, and have resulted in more stringent third party rationing to the patients. Our dysfunctional market can be characterized by information failures, inefficient moral hazard issues, distorted incentives, inflated hospital and pharmaceutica目頭切開 l pricing, and cost shifting. There are costly, inefficient and opaque administrative and regulatory procedures and central organizational overgrowth, with un-necessary and in-efficient micro-management of physicians as well. At $2 trillion per year, the U.S. health-care system suffers much more from inefficiency than from lack of funds. The system wastes money on unnecessary premium care workups, and inappropriate use of expensive technology. We also use medicines and technologies that cost a lot for little or no marginal health benefit. The current paradigm also provides strong financial incentives to preserve such inefficiency. In our quest to 目 整形 大きく transform American healthcare into an efficient, cost effective and coordinated system we must do three things. First, redesign health insurance to eliminate third party payment, and our procedure driven delivery system. Second, expand Health Savings Accounts to give every American consumer an opportunity t目 整形 切開 o save for health care expenses and directly control of all of their health care dollars by providing consumers with more control and responsibility for all of their health care decisions. Third, redesign the market to make it operative at the doctor -patient level by creating proper incentives with checks and balances in a level playing field for everyone participating in the medical market place. Doing these three things will eliminate all of the problems mentioned in the first paragraph. Temporary and expedient remedies are no longer enough. The country needs comprehensive and fundamental market based reform. We need to create a basic plan to cover important insurable events on目 整形 種類 e that is coupled with tax advantaged expanded Health Savings Accounts for events not covered by the insurance- that would be available to and give comprehensive coverage to all citizens. We must improve health insurance design to make it more efficient, cost much less, address very high hospital costs, and provide incentives for proper, win-win market behavior by al二重整形 口コミ ランキング l participants. We must create incentives and designs with checks and balances for functional market competition based on value and transparency. Here are the essential changes: Create new designs and incentives to make the individual health insurance market work and make in二重切開 上手い先生 surance affordable for every American: Make insurance personal and portable. Convert all persons on Medicaid and Medicare to this system using the current premium as a defined contribution to the individual. Abandon Third Party Payment and our procedure driven system Establish industry standard risk categories Establish high risk pools with creative risk spreading arrangements Make risk pools work by reducing administrative costs associated with the individual insurance market. Give every American the President’s $15,000.00 standard tax deduction for purchasing health insurance and funding a Health Savings Account Create the least expen部分切開 全切開 どっち sive access to insurance coverage and health care for the poor. To do that, use refundable tax credits paid to the uninsured working poor to give them both tax and purchasing power equitable to that of Americans who have more personal assets and resources. Provide assistance to low-income households so that all will find insurance affordable. Use refundable tax credit subsides to help the elderly poor, the disabled and those considered uninsurable to give them equal purchasing power with all other Americans. Shift from employer based health insurance to individually underwritten insurance by using defined contributions paid into their health account from which they can purchase their own insurance instead of the current system of defined benefit. Improve health insurance design to make it more efficient, cost much less, address very high hospital costs, and provide incentives for proper behavior. Replace third party payment with true catastrophic insurance lump sum indemnity payment. This payment would be determined by a computerized severity rated system itself based on protocols that derive from medical experience and broadly accepted standards by the medical c二重整形 切開 値段 ommunity of what constitutes good health care and that define episodes and the relative value of that care. Design health insurance protocols to remove inefficient moral hazard and other inefficiencies so that all deductibles and co-pays can be eliminated. Use the resulting premium difference from today’s much more expensive health plan to fund every American’s tax favored Health Account to provide a “self insurance” to pay for all care not associated with an insurable event with pre-tax dollars. · Make all patients self pay via an electronic debit card from their insurance fortified health account so that they can pay directly for all their health care needs, creating true price transparency in value based pricing. Establish a non –governmental and independent目の整形 費用 Institute for Pharmaceuticals, Technology, and Outcomes Assessment to systematically evaluate new drugs and technologies and quantify their health benefits in relation t小鼻縮小 o their costs to provide legitimate information. Make these evaluations available to all practicing physicians at the point of service through computer access. Re-design the doctor- patient relationship through incentives to create a new model where the doctor not only diagnoses and treats the patient but is working for the patient directly and exclusively. The physician needs to provide鼻整形 the patient with enough information so the patient can make informed decisions for his care. The physician, with the best interest of his patient at heart, must guide the patient through our increasingly complex and expensive health care system so that the patient can get the best quality care at the lowest price. Establish computerized communication protocols to allow appropriate individuals within the health care system to communicate effectively and efficiently for the patient’s benefit only. These communication protocols will eliminate the need for the physician to file claim forms with the insurance company for individual procedures, and reduce the risk of medical mistakes and system error. These measures would improve efficiency and provide cost control for the health-care system. These measures will provide all of the benefits of both a single payer system and a managed care system, with none of the problems, at a significantly reduced cost. Through the use of insurance protocols, we can significantly reduce administrative costs that have risen to over 25% currently as well as wasteful benefit costs. These same protocols allow us to introduce proper and positive incentives for all health care market participants in a win-win fashion and create the checks and balances that will give us a functional market based on value. Only comprehensive market change of our broken system can provide universal, portable access, reduce inefficiency, control costs, and secure and stabilize health care for all Americans long into the future.

Rethinking Health Care Insurance Design - A New Approach to Healthcare Reform

America’s healthcare system is broken. The United States spends 16% of its national income on 鼻の整形 healthcare, around twice the rich-country average, equivalent to $6,280 for every American each year. It is the only rich country in which all Americans do not have guarantee鼻整形 メンズ d access to health coverage; some 46 million Americans have no insurance coverage. There are appalling inefficiencies; by some measures 30% of health spending is wasted. There is no rational healthcare market to match buyers and sellers; it is plagued by distorted incentives and information failures. Functional markets require transfer of money and information, and equal power distribution among all market participants. Both government and the insurance industry have failed to control costs and prices by causing distortions in the market. Under the current system of insurance with its third party rationing and price controls, universal access will necessitate an even larger bureaucracy which will require such鼻整形 費用 a large share of financial resources to pay for transaction/administration costs that an insufficient amount will be left for benefit payment. A new design approach is necessary to fix the system. Otherwise, it is certain that corporate balance sheets and federal and state budgets face near-certain disaster in coming decades. John A. Lanzalotti, M.D. a physician cross-trained in health care economics, policy and health care law, and long-term consultant on healthcare issues, has designed a new and innovative approach that addresses all the imperfections in the current system. His plan, called the American Health Plan, has four elements: a new form of individual health insurance, which he 鼻整形 永久 calls protocol insurance that eliminates today’s micro-management and inflated transaction costs; replaces today’s perverse incentives with proper incentives for everyone in the market place and establishes checks and balances that will transform our dysfunctional market into a functional and fair market; an asset savings account, which is an expanded version of the president’s health savings account designed to give all patients鼻 整形 切らない equal purchasing power in health care; high risk pools with innovative underwriting and re-insurance to provide access to those with pre-existing conditions or are considered uninsurable, at an affordable price; and a redefined role for the medical doctor and elimination of the current third party fee for procedure payment system. His design reduces costs and prices by eliminating twenty-two of the鼻整形 ビフォーアフター twenty-three cost drivers responsible for inflating premium prices way beyond wage increases. This plan eliminates the multiplicity of health plan claim requirements and the bureaucracy necessary to pay those claims. Today’s health plan is transformed into bifurcated coverage that is owned by the patient in a tax free account that is pers鼻整形 名医 onal , portable and affordable for all Americans. There is protocol insurance which covers all necessary health care needs when expensive insurable events occur and funded by the premium difference, a “self insurance” which remains in the asset account after the insurance premium is paid used to cover initial diagnostic visits to the doctor, discretionary care and routine healthcare. 鼻整形 おすすめ Protocol insurance is a form of global payment insurance applicable to serious or expensive illnesses. By using experiential data from the insurance industry, input from all the medical specialties and actuarial data, a breakout of specific illnesses by type and severity is established. These protocols are standardized and accessed by software available to doctors on tablet personal computers. These, in turn, communicate automatically over a wireless connection with the insurance carrier when a new covered insurable event occurs. Full payment is made directly to the patient’s asset savings account. This payment is based on a medical workup by the physician not a claim form for individual procedures. Discretionary medical care is not covered by this protocol insurance. The pretax asset savings account, which pays for this discretionary medical care as well as premiums for the portable protocol insurance, is funded by defined contributions from employers, Medicaid and Medicare, individual contributions, and refundable tax credits pr vouchers (in the case of lower income individuals). All heath care goods and services are paid by the patient directly from this account. The role of the physician is critical; he serves as a medical manager for the patient, functioning as a broker and provider of services so that the patient can demand the best care at the lowest possible price. This obviates the need for the third party payer, insurance network designs, provider networks and administrative oversight. This plan balances the physician’s selling expensive procedures against the patient’s choice to spend money in his asset savings account, for which he may have other use in the future. Its design provides cost sharing that will not penalize the sick and the poor while favoring the healthier and wealthier, as the president’s Health Savings Account design may very well do in the current paradigm. It also prevents third party rationing of care. The unique element of this design is that it creates demand side incentives that balance protection of the patient from unforeseen medical care expenditures with stimulating cost conscious consumer choice. On the supply side the need for third party managed care is eliminated and, with it, all the distortions and cost inflation it has created in the healthcare market. The American Health Plan will dramatically improve quality, efficiency and consumer satisfaction. Perhaps it is time to experiment with this new design.

American Health Care Costs

Currently we are spending twice as much as any other country on health care with similar or worse outcomes. What is 豊胸手術 the source of this inefficiency? Most of the reversible cost drivers derive from our fragmented procedure driven health care de豊胸手術 モニター livery driven by the perverse incentives of the third party payment system. These perverse incentives are directly responsible for over- consumption by patients and over- utilization by providers. Every patient visit results in a full court pr胸 の 整形 ess in billable claims but curiously, a dwindling amount of actual service provided to the patient. This is caused by the increasing paperwork requirement associated with claims for medical procedures in conjunction with decreasing re-imbursements. Providers are top heavy with staff that shuffles paperwork but do no patient care. As provider’s re-imbursement dwindle due to under market payment, more time is spent in paperwork associated with claim processing and follow-up and less time with patient care. There is a perverse incentive for the physician to spend only enough time with the patient to determine which procedure豊胸 おすすめ for the visit on that day and then move on to the next patient. Only in this way can the physician maintain enough income to pay for his increasing overhead due to the increasing paperwork requirement. This system has spun out of control and is driving costs at an increasing rate. The recent pay for performance just worsens this pernicious process by adding to the paperwork burden豊胸 わかる . This system actually hurts the quality of patient care. Physicians who are only responding to these perverse incentives spend more time in preparing documentation required for re—imbursement than they do in direct patient care. This is not only inefficient it is dangerous. Perhaps it would be better to replace third party payment with a lump sum payment to the patient’s tax favored account so the patient has more control over the spending of his health care dollar. In addition we need to create proper incentives for all market participants. This is the only way to stop rising health care costs. Table 1-Health Care Cost Drivers (Health Insurance Premium Inflators) Insured individuals using services whose cost is greater than their benefit and price (Moral Hazard) (reversible) Reduced physician re-imbursement which provides perverse incentives for physician induced demand for expensive high tech procedures (reversible) Consumer demands for easier and broader access to care and for service in豊胸 自然 比較 tensity; Consumer demand for expensive high tech procedures (reversible) A growing and aging population (not reversible) Third party payment which provides perverse incentives to patients to over consume and to providers to over-utilize (reversible) Fragmented Fee-for-procedure medical delivery and the costly infrastructure necessary to file claims and for the follow-up necessary to get paid (reversible) Costly opaque administrative mechanisms of managed care and Medicare (reversible) Excessive micromanagement of physicians (reversible) High administrative costs and central organizational overgrowth and Federal Government Legislati豊胸 脂肪注入 名医 on/Regulations (reversible) Cost shifting among payers and from government payers to private sector Purchasers (increased insurance premiums); (reversible) Cost-shifting to the taxpayer for unpaid care from the uninsured and under market payment from Medicaid, Medicare, Tri-care. And private insurance A longer and deeper insurance underwriting cycle; they raise premiums in order to restore their profitability Insurer Premium “Catch-up” (reversible) Rapidly escalating prescription drug costs and utilization (reversible) Tougher provider negotiations with health plans for higher reimbursement (reversible) An oversupply of hospital beds, high tech equipment and specialists (reversible) Volume of medical services provided for inpatient care (rever豊胸 脂肪注入 sible) Defensive medicine by physicians to protect against malpractice suits (reversible) Excessive and inappropriate treatment at the end of life, (reversible) General price inflation [the Consumer Price Index (CPI)] (reversible) Poor quality care including errors, overuse, misuse and under-use of health care services [avoiding sick patients, lowering staff-to-patient ratios, and denial of care on the part of some insurers and health plans (reversible) State Insurance Mandates (reversible) State Solvency Requirements (reversible) Fraud and Abuse (reversible) Twenty-two of these twenty-three cost drivers are reversible and eliminated by the American Health C胸の整形 are Plan.

What is the Best Way to Pay for Health Care?

Traditionally health care has been paid for in what we call a fee for procedure, third party payment. That is, the doctor see糸リフト s the patient and then seeks payment not from the patient but rather a third party, the insurance 小顔整形 company. The doctor does this by submitting a claim form to the insurance company with a diagnostic code and a procedure code that has been previously published in a book. These books which were designed by the AMA and cost several hundreds of dollars, must be purchased by each physician annually. One of the reasons we have third party payment is that when it was first initiated, administrative costs were very low. Administrative costs include the cost of claims processing, marketing, underwriting, overhead, and profits. Unfortunately administrative costs have risen over the years but especially overhead costs as health insurance has become more complex and providers and patients alike began to exploit the perverse incentives and moral hazard associated w糸リフト デメリット ith third party payment procedure driven medicine. This results in additional medical care that the patient demands because he is responding opportunistically to the lowered price of health care covered by insurance in a fee for procedure structure. There is another way of paying for health care called contingent claims contract. In contingent claims contracts in which there is a lump sum payment to the patient with which to pay all costs associated with a particular insurable event, the administrative costs would include all of the above but also include additional costs for verifying illness, policing against fraud, and writing complex contingency contracts. Traditionally, these costs were thought to exceed the administrative costs associated with third party payment, fee for procedure until recently. Because the computerized protocols designed by Dr. Lanzalotti are based on real data from the treatment of actual patients with diseases and conditions, and are severity rated, they are applicable to many patients and don’t require unique legal contracts. This means that a financing design utilizing lump sum payment from protocol health insurance would have much lower costs than third party, fee for procedure insurance. These protocols also lower the traditionally higher costs associated with the individual health insurance market as opposed to the group insurance market. Under protocol insurance the physician does not file a claim form to the insurance company as in third party payment, f糸リフト 湘南 e for procedure medicine. The communication between the physician and the insurance company is an electronic signal automatically generated by software from the doctor’s computer to the insurance company computer that does not require the doctor to file a specific claim. This mitigates against fraud by both the patient and doctor but allows the physician to implicitly verify that the patient has the disease that constitutes an insurable event. When a patient sees a doctor or other health care provider, the doctor or health care provider examines the patient and prepares a computerized medical workup which will be used to determine a dollar amount to be paid directly and electronically into the patient’s extended HSA by the insurance carrier. Software that is part of this design evaluates 糸リフト 口コミ the work-up and determines if there is a new insurable event. If there is, the software determines information about which established “protocol” and “complexity level” the patient’s condition corresponds to. An electronic transfer of this information from the provider’s office computer to the insurance carrier’s computer triggers a “lump sum paym糸リフト 持続期間 ent” from the insurance carrier into the patient’s extended HSA. The lump sum payment provides the patient with enough money to be able to pay for all anticipated expenses (at fair market value) associated with treatment, e.g., doctor bills, hospital bills, pharmaceutical bills, surgery bills, and bills for any other necessary therapy. The lump sum payment made is determined by protocol and complexity level and course of tr糸リフト 名医 eatment for a given condition. This insurance payment does not require a co-payment or deductible payment from the patient because it is used exclusively for necessary, non-discretionary care not associated with moral hazard. The patient then accesses this lump sum payment in his extended HSA with a medical debit card to pay for all health care goods and services required to treat the condition. By paying the lump sum payment directly into a patient’s expanded HSA account, instead of directly to the patient as cash, several advantages are achieved that move us further to our goal of patient driven market based health care. First of all , it separates the financing entity from the provision entity. It gives more power to the demand side (that is, money follows the patient. By paying the money into the account where it can only be accessed by an electronic debit card with electronic keys, the money can only be spent by the patient for health care or other designated purpose. It also gives the patient control over his entire health care dollar not just a deductible portion used for routine care. By having full control over all of the health care dollar, the patient can use market forces to help lower 糸リフト 半永久 our very expensive hospital costs, a much more efficient method than our current managed care. According to the RAND Health studies, the patient will be much more careful in spending what he perceives to be his own money instead of the insurance money as a third party payment. The lump sum payment serves as a budget for the doctor and patient to use to pay for all necessary care associated with a particular ins糸リフト 芸能人 urable event. The physician and other providers would be paid for those services that the physician ( as the policy holder’s disease treatment manager and broker ) deems medically necessary for treating each idiosyncratic patient/disease combination. This type of payment does not interfere with the physician’s ability to diagnose and treat his patients. This plan balances the physician’s selling expensive procedures against the patient’s choice to spend money in his asset savings account, for which he may have other uses in the future. Its design provides cost sharing that will not penalize the sick and the poor while favoring the healthier and wealthier. Physicians will compete on how well they can provide the patient with quality care at the lowest price. Since the physician functions more as a broker of services rather than as a prix fixe purveyor, it is not necessary for there to be a large number of physicians engaged in a cut-throat competition. Therefore patients would not be at a disadvantage in a rural area in this paradigm. Most physicians would welcome a new system that would provide incentives to practice high quality medicine at the most reasonable price for the patient.リフト It also prevents third party rationing of care. If a price option chosen by the patient exceeds the lump sum insurance payment, there is additional money in the account derived from the annual or periodic contributions into the account that represent a premium savings from today’s more much higher priced insurance premium. The patient can use these funds which rolls over from year-to-year and is fully “portable,” to pay help pay for his selected price option. Every American will have a health plan that they can afford, own and keep. The unique element of this design is that it creates demand side incentives that balance protection of the patient from unforeseen medical care expenditures with stimulating cost conscious consumer choice. On the supply side the need for third party managed care is eliminated and, with it, all the distortions and cost inflation it has created in the healthcare market.

Managed Care-A Failed Attempt at Market Reform What Can We Learn?

The concept of managed care was based へそ形成 n a planned shift of ultimate power to individual consumers who were to have the choice and the information about cost and quality to make wise, economical selections. Armed with the tools of the marketplace and へそ形成 安い freed from the perverse incentives of third party payment and fee-for-procedure medicine, consumers and caregivers were going to reshape health care delivery and financing. But the conditions precedent failed, the stakeholders did not behave as predicted, and the result is not to anyone’s liking. Managed Care reform proved an imperfect mechanism for quality improvement. The marketplace provided only disincentives to excel in caring for the very sick. An organization that managed the care of seriously or chronically ill patients exceptionally well risked attracting more than its actuarially predicted share of coでべそ 手術費用 stly cases. This marketplace disincentive to develop skills at providing high-quality, cost-effective care in complex cases created suspicion among vulnerable patients. An opportunity to improve quality and control health care spending on the costliest cases was lost. Some comprehensive quality initiatives fell victim to a market that emphasized cost-based competition. Unlike the prepaid group practice plans on which the managed care revolution was founded, many newly created plans that resulted from the insurer takeover of the managed care industry lacked the infrastructure to initiate quality improvement programs and intervene in the quality of care delivered by their widely dispersed independent providers. In fact it maintained tへそ形成 費用 hird party payment and fee for procedure medicine. Employers did not perceive quality as a critical issue and showed little inclination to direct employees to plans with the infrastructure to manage quality of care. In the absence of purchaser demand, competition on the basis of quality failed to materialize. In the end Managed care failed to bring about effective market reform or result in a functional market. It failed for several significant reasons. Physicians were bypassed in favor of “corporate competition”. For the most part the architects failed to implement their plan themselves but rather left it to the Government to implement. They botched the job. Then when it failed the existing insurance companies took over and used managed care for their own agenda へそ形成 口コミ which has brought them huge profits but given the rest of us a broken system. What we have now is a highly inefficient and complex “Rube Goldberg “system. Managed care reform created a big noise on the staircase but very little ever came down. What can we learn from all of this? First of all we must build on the progress we have made previously but not repeat mistakes. In 1970, Ellwood stated: “It is the indispensability of the physician’s judgment that makes it unlikely that the price regulation approach can succeed. Only the physician can determine what care is necessary, and therefore, only he can eliminate unneeded expense. The physician cannot be policed to do so, but must be motivated by professional ethics, and by organizational arへそ 整形 縦長 angements which align . . . [the physician’s] economic incentives with those of the consumer.” Physicians have an unavoidable role in controlling health care spending and achieving cost-effective clinical care. Their decisions have always dictated much of health care spending, and even if consumers assume a larger role in their own health care, reliance on medical judgment is inevitable in the complex cases that account for the majority of health care spending. In addition, physicians are in the best position to assess different patient preferences and functional needs and to educate patients about the incremental gains or risks associated with additional increments of clinical intervention. They are also going to be essential to any broad-base湘南美容外科 へそ形成 d effort to collect medical outcomes data. Unfortunately Managed care left the physician out of the design; something we can not afford to do again. We must return the market place back to the doctor- patient axis. Corporate competition never worked nor was it necessary. What is necessary, is for the physician to work exclusively for the patient with the patient’s best interest at heart, to guide the patient through our technologically complex, uncertain and expensive health care system to provide the patient with the best quality care at the lowest possible price by providing the patient with information concerning how various price options will affect the quality of his care so that the pati韓国へそ形成 ent can make informed decisions. This model is more consistent with the way in which physicians have been traditionally trained and will be easier to implement than some of the new forms introduced by the managed care concept with could never be implemented. Early experience with HSA-eligible high-deductible health plans reveals low satisfaction, high out-of-pocket costs, and cost-related access problems, Collins said. A survey conducted with the Employee Benefits Research Institute found that people enrolled in HSA-eligible high-deductible health plans were much less satisfied with many aspects of their health care than adults in more comprehensive plans: Obviously HSAs in their current state of evolutionary development are inadequate. The concept of funneling insurance payments as well as tax free savings into the account allows the patient to pay directly for all health care without having to resort to post-tax out of pocket payments. There is a lot of merit with this model since it gives the patient an incentive to be a more careful and appropriate health care spender along with enough money that he perceives to be his own and for which he may have an alternative future use to be able to pay for all necessary and non-discretionary care at fair market value in a functional and competitive market.

Market Base System vs. Single Payer Contrasting Two Different Points of View

The followブチ整形 ing essay is an example of how the market economist and single payer advocate can look at the same data and problems and analyze it so differently. Below is aプチ整形 エラ link to Robert Kuttner’s February 8, 2008 New England Journal of Medicine article “Market Based Failure— A Second Opinion on U.S. Health Care Costs” http://content.nejm.org/cgi/content/full/358/6/549?query=TOC Below is Dr. Lanzalotti’s market based essay analyzing the same data showing different プチ整形 費用 causes and solutions from Mr. Kuttner’s single payer point of view. Market Failure — A New Opinion on U.S. Health Care Costs John A. Lanzalotti, M.D. U.S. health care expenditures rose 6.7% in 2006, the government recently reported. According to the Centers for Medicare and Medicaid Services, total health care expenditures exceeded $2.1 trillion, or more than $7,000 for every American man, woman, and child.1 Medicare costs jumped a record 18.7%, driven by the same inefficient financing system used in the private sectプチ整形とは or. Total health care spending, now amounting to 16% of the gross domestic product, is projected to reach 20% in just 7 years. Relentless medical inflation has been attributed to many factors. Among those mentioned, the aging population, is not deliberately reversible. Another factor often mentioned, the proliferation of new technologies, does not cause inflation, rather new technologies introduce new efficiency. An MRI is less expensive than an exploratory laparotomy and a week stay in hospital. It is the inappropriate overuse of technology that inflates the costs of health care delivery. This over utilization, as well as allサーモン注射 of the other twenty- two cost drivers, is the result of perverse incentives which derive from the design of our current financing system, third party payment, our fragmented procedure driven delivery system, and the domestic mercantile economy that exists in American health care. It is these perverse incentives which lead to poor health quality and the tendency of supply (physicians, hospitals, tests, pharmaceuticals, medical devices, and novel treatments) to generate its own demand. Tax-favored employer based insurance coverage together with high insurance premiums leads to many Americans being uninsured. Inflated premium costs is found equally in both the public sector (Medicare, Medicaid, リジュラン 韓国 Tri-care, VA medicine), and the private insurance sector. Each American household is taxed over $1,200 to pay the costs associated with defending frivolous lawsuits, jackpot jury awards, and the costs associated with defensive medicine. This crisis is threatening quality of care; i脂肪吸入 t is threatening access to care for all Americans 2 Here is a new second opinion on medical inflation. The extreme failure of the United States to contain medical costs results primarily from our unique, pervasive mercantile system that fails to change our current finance design of American health care in both the public and private sector. Do脂肪吸引 デメリット mestic mercantile systems are characterized by a government-industrial complex with government subsidies to industry as well as protectionist policies that protect profits and empower private industry. It is a zero sum game. Industry wins but the provider and consumer loses. Government benefits from lobby money from these same industries. In a mercantile 脂肪吸引 メンズ system, the consumer doesn’t count, only production and profits count. There is nothing inherently wrong with profits. It is the engine that makes the market work. It is the resulting power imbalance that causes market dysfunction. We do not have a market based system in American medicine. The dominance of both government public funded insurance ( which is a single payer) as well as for-profit insurance and pharmaceutical companies, a new wave of investor-owned specialty hospitals, and profit-maximizing behavior even by nonprofit players raise costs and distort resource allocation. Profits, billing, marketing, and the gratuitous costs of these protected bureaucracies siphon off $400 billion to $500 billion of the $2.1 trillion spent. Cost shifting due to care for the u脂肪吸引 値段 ninsured and from under-market payments by both public and private insurance results in another $200 billion dollars a year shifted to and paid by the American taxpayer. But the more serious and le脂肪吸引 値段 ss appreciated syndrome is the set of perverse incentives produced and maintained by mercantile economic dominance of the system. Markets will optimize efficiencies. Competition is the key to cost containment. But this will never happen within our current paradigm of mercantile health care finance and delivery with its third-party payers and i성형외과 ts fragmented, procedure driven delivery system. Third party payment with its perverse incentives for over-consumption and over-utilization does not lend itself to market discipline. Why not? Because it is always easier to spend someone else’s money than it is to spend your own. Market forces 신논현성형외과can not operate here. Both the current public and private insurance system’s main techniques for holding down costs are practicing third party rationing by limiting the services covered, price controls by constraining payments to providers, and shifting costs to patients. But given the system’s fragmentation and perverse incentives, much cost-effective care is squeezed out, resources are increasingly allocated to costly, inefficient and opaque administrative and regulatory procedures and central organizational overgrowth with un-necessary and in-efficient micro-management of physicians as well rather than medical need. The system wastes money on unnecessary premium care workups for all patients, and inappropriate use of expensive technology. Other inefficiencie강남성형외과s include information failures, inefficient moral hazard issues, adverse selection, distorted incentives, inflated hospital and pharmaceutical pricing and cost shifting. Many attainable efficiencies are not achieved. We also use medicines and technologies that cost a lot for little or no marginal health benefit. Administrative expenses are high, and enorm자연주의성형외과ous sums are squandered in efforts to game the system. Given the mercantile emphasis on production and the ignored consumer it is no wonder that between one fifth and one third of medical outlays do nothing to improve health. Great health improvements can be achieved through basic public health measures and a market based approach to wellness and medical care. But under our current paradigm of both public and private insurance, providers have neither the incentive nor the time to provide these services. Those who need them most are the least likely to have insurance in our current system. Studies have shown that preventive care for conditions such as diabetes, asthma, and elevated cholesterol levels, use강남뷰티성형외과 of clinically proven screenings such as annual mammograms, provision of childhood immunizations, and changes to diet and exercise can improve health and prevent larger outlays later on. Comprehensive, market based universal access, where everyone is not only covered with a more efficient health insurance system but has equal purchasing power to be able to pay fair market value for their health car원진성형외과e goods and services, is needed. Lump sum insurance payment needs to replace third party payment to correct current perverse incentives that fragment health care delivery, over-consume and over-utilize to pursue the most profitable treatments rather than those dictated by medical need. The growth rate of medical expenditures has been slowest in nations with universal health insurance systems. However they are the most expensive health care systems and use massive third party rationing. They provide no incentives for the physicians to work and there is no incentive for innovation. Because there is no competition, quality of care is low. Single payer system is a high priced way of delivering routine care but cannot compete wi아이디병원th American care for innovative, complicated treatment of life threatening disease. Many U.S. insurers claim to reward physicians for following standard clinical practices, but these incentives do not aggregate to an efficient national system of care. This occurs because like the consumer, the physician does not count in the mercantile system. After more than three decades of managed care — and the same three decades of studies by Wennberg and colleagues identifying wide variations in practice patterns — consistent practices are still far from the norm.3 Medical practice will never be consistent, nor should it be. There is much individual variation among patients. Only that patient’s physician knows w나나성형외과hat is best for that patient at any one moment in time. We don’t need to force all physicians to be automatons responding to a one size fits all single payer system. Rather we need to replace the perverse incentives of the current system with proper incentives and design the market institution to be win-win for all participants so that the physician can do what he was trained to do— treat the patient appropriately and cost efficiently. Managed care and our current single payer government system is not fixing what’s broken. Cookbook medicine doesn’t contain costs. All current cost containment strategies are failing. Under the misguided current paradigm in both private and public insuranc원더풀성형외과e, cost-containment efforts have fallen heavily on physicians, who have seen caseloads increase and net earnings stagnate or decline. A popular strategy among cost-containment consultants relies on the psychology of income targeting. The idea is that physicians have expected earnings — an income target in order to financially maintain their practice. If the insurance plan squeezes their income by reducing payments per visit, doctors compensate by increasing their caseload and spending less time with each patient. This false economy is a telling example of the myopia of Medicare, Medicaid and managed care. It may save the plan money in the short run, but as any practicing physician can testify, the strategy has multiple self-defeating effects. 링크성형외과 A doctor’s most precious commodity is time — adequate time to review a chart, take a history, truly listen to a patient. You can’t do all that in 10 minutes. Yet all current insurance , with Medicare being the worse, continue to waste the doctor’s time with more and more paperwork requirements. Doctors beset with these paperwork problems are more likely to miss cues, make mistakes, and order more tests to compensate for lack of time for hands-on assessment. The current system emphasizes specialist care even though ninety percent of the time it is not needed. Generalists, who have been reduced to minimal pay triage functionaries, are also more likely to make more referrals to specialists for procedures they could perform more cost-effectively themselves, given adequate time and compensation. And링크 the gap between generalist and specialist pay is widening.4 A second cost-containment tactic is to hike deductibles and co-payments, whose frank purpose is to dissuade people from going to the doctor, another self defeating false economy. But sometimes seeing the doctor is medically indicated, and waiting until conditions are dire costs the system far more money than it saves. Moreover, at some point during each year, more than 80 million Americans 눈성형go without coverage, which makes them even less likely to seek preventive care.5 This is yet another self defeating strategy. The current third party payment, fee for procedure system also has inflationary effects on hospitals’ revenue-maximization strategies. Large hospitals, which still have substantial bargaining power with insurers, necessarily cross-subsidize services. The emergency department may lose money, but cardiology makes a bundle. So hospitals fiercely defend their profit centers, each investing heavily in facilities for lucrative procedures that will attract physicians and patients. For the system as a whole, it would be far more cost-effective to shift눈성형 효과 high cost resources to a central location that can be used by several competing hospitals. But as in all mercantile systems, its protectionist policies distort cost-effective resource allocation Proper economic incentives in a functional market based economy are the only thing that will work. But since we don’t have a market economy but rather a mercantile system, incentives work in perverse ways. Both the privately and publicly regulated medical market is signaling pressured physicians to behave more like entrepreneurs, inspiring some to defect to “boutique medicine,” in which well-to-do patients pay a premium, physicians maintain good incomes, and both get 눈성형 비용leisurely consultation time. It’s a convenient solution, but only for the very affluent and their doctors, and it increases overall medical outlays and creates a two tiered health system. Other doctors opt out by becoming proprietors of specialty hospitals, usually day surgeries. In principle, it is cost-effective to shift many procedures to outpatient settings that are less expensive but still offer high-quality care. In a government-organized universal system, day hospitals will have a perceived parasitic relationship with community hospitals, which retain the hardest cases and give up the remunerative procedures needed to subsidize those which lose money. In a market based system resources and profits will be allocated 눈성형 후기appropriately between hospital and outpatient canters with all providers being paid in full on the day of service at fair market value ( equilibrium price). A comprehensive functional market based system is far better positioned to match resources without price controls or rationing care. It is the current U.S. mercantile system that has the most de facto rationing — high rates of un-insurance, exclusions for preexisting conditions, excessive deductibles and co-payments, and shorter hospital stays and physician visits.) A universal protocol insurance market based system suffers far less of the feast-or-famine misallocation of resources driven by our current mercantile system. It also saves huge sums that our current system wastes on administration, physician micro-management, billing, marketing, excessive executive compensation, and risk selection signing up only the healthy and wealthy leaving the sick and poor to be paid at the maximum rate by the American taxpayer.. Despite our crisis of escalating costs, dwindling insurance coverage, and deteriorating conditions of medical practice, universally used protocol health눈성형 부작용 insurance could be mediated by private insurers and reverse this trend. Because protocol insurance replaces third party payment with lump sum payment to a patient’s tax favored account from which the patient pays directly for all health care goods and services, it eliminates all of the reversible perverse incentives of the current system, and has all of the advantages of a single payer system with none of the disadvantages but rather all of the advantages of a free enterprise market system.. Under the new paradigm the legacy of our current mercantile health care system, the immense power of the insurance and pharmaceutical industries, the political fragmentation and ambivalence of the medical profession, the intimidation and corruption of politicians will disappear and in its place will be a functional win-win market based system where market power will be on a level playing field. Adam Smith wrote An Inquiry into the Nature and Causes of the Wealth of Nations 1776 as a solution to the Mercantile system. We have never given his classical economic market system a chance in health care. There have been many attempts over the twentieth century at market reform in health care. Each time they were thwarted by a powerful stakeholder, the AMA, the insurance industry, government bureacratics etc. resulting in persistence of the mercantile system and market failure. Sometimes, we Americans do the right thing only after having exhausted all other alternatives. It remains to be seen how much exhaustion the health care system will suffer before we turn to a functional market based health care system with its reformed and efficient insurance and properly designed market institution so that all market participants will be equally empowered on a level playing field. . Source Information John A. Lanzalotti, MD is Policy Director and a senior fellow at The Jeffersonian Health Policy Foundation, a Virginia–based economic, health and public policy research foundation. References Catlin A, Cowan C, Hartman M, Heffler S. National health spending in 2006: a year of change for prescription drugs. Health Aff (Millwood) 2008;27:14-29. Allen, Claude Testimony Health and Human Services, Mar 13, 2003 Wennberg JE, Gittlesohn A. Small area variations in health care delivery. Science 1973;182:1102-1108. 2007 Medical Group Compensation and Financial Survey. Alexandria, VA: American Medical Group Association, 2007. Going without health insurance: nearly one in three non-elderly Americans. Princeton, NJ: Robert Wood Johnson Foundation, March 2003.

Introduction

The way we are financing and delivering healthcare in America is not working and we need transformational change. Everything we have done in the past to make incremental changes to tiled to control costs and failed to improve quality care. We have made significant errors. Can we learn from those errors?

All previous reform attempts have expanded the bureaucracy, increased regulation and price controls, and have resulted in more stringent third party rationing of the patients. Our dysfunctional market can be characterized by market and information failures, inefficient moral hazard issues, distorted incentives, inflated insurance premium, hospital and pharmaceutical pricing, and cost shifting.

In large part the dysfunctional market has been caused by protectionist government policies of the large insurance, pharmaceutical, unions and hospital corporations that have led to power imbalances that have led to more of an emphasis on maximizing profit than on an efficient, affordable product for the consumer. In spite of their wealth and power, these corporations have failed to develop solutions to the reversible inefficiencies and perverse incentives that plagues the finance and delivery of American health care. They have done nothing to alleviate the uncertainty due to asymmetric information that causes market dysfunction. In fact they lobby for laws to perpetuate these inefficiencies and bad incentives. There are costly, inefficient and opaque administrative and regulatory procedures and central organizational overgrowth, with un-necessary and in-efficient bureaucratic micro-management of physicians as well.

At over $2 trillion per year, the U.S. health-care system suffers much more from inefficiency than from lack of funds. The system wastes money on unnecessary premium care workups, and inappropriate use of expensive technology. We also use medicines and technologies that cost a lot for little or no marginal health benefit. The current paradigm also provides strong financial incentives to preserve such inefficiency.
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Some Fundamental Philosophical Issues

Is health a right for all Americans? This is a political question to which there is no answer on which we can build a consensus. Those who say that health care is a right are trying to establish justification for a single- payer, government owned and run health care system of universal care. Those who say that health care is a responsibility al seek justification for rejecting the single payer universal care government system. All of the philosophical argument on both sides of the argument really doesn’t help us reach a consensus either. We are simply divided on this subject and always will be. The argument has been going on for one hundred years now. During this time our current non-system evolved haphazardly with all of its price drivers, perverse incentives and inefficiency. And yet this question remains and prevents us from moving forward with a plan which will solve our problems. A more appropriate question would be how can we lower costs and create a more efficient and cost effective system right now in our current paradigm.Once instituted, a free market will completely change the hostile climate that now exists to innovation and job producing activity. There is no way to tell what that future holds. The best we can do is to effect economic reforms which will create a more efficient and cost effective system within the current paradigm and then shift to a free market to change the paradigm.

The fact of the matter is that all Americans do get health care now, although there are great disparities in this care. The patient’s without insurance show up in hospital emergency rooms to receive care. But there are problems with the quality, equity and price of that care. This is the most expensive venue. Hospitals cost shift all un-reimbursed care from the un-insured, those with Medicaid and Medicare, BCBS and commercial insurance that all pay under-market market value payments to doctors and hospitals, to the tax payer and everyone else who is insured. This helps drive up the premium price for insurance. There is something on which everyone can agree—– that all Americans, once they have paid for health insurance or when they do get care, should get access to appropriate and equitable medical care.

Fully one-third of the population lacks health insurance for at least part of the year. Of the 44 million who are completely uninsured, 78.8% work full or part-time. The lack of available care is especially acute for those living in rural areas and for minorities. And the quality of health care for all but the wealthiest patients has declined dramatically, with more people dying each year from avoidable medical mistakes than from car accidents.[1] Add to these problems the lack of services for Americans in rural areas, discrimination in health care provision and outcomes between whites and non-white minorities, and pharmaceutical and insurance costs that are spiraling out of control, and it is clear the U.S. health care system is in profound crisis.

How is this possible when the United States spends more per person on health care than any other industrialized country in the world?[2] The health care crisis in this country is more complex than questions of rising costs or lack of insurance, and as important as those elements may be, any successful reform of the health care system must take a broader approach to understanding the problems.

With a mercantile, government-industrial system that that has the power to value massive profits over people, it is no surprise that health care costs continue to spiral out of control for ordinary Americans even as HMOs and pharmaceutical companies accumulate record-breaking profits. Only a new approach that shifts our current paradigm of finance and delivery can address the magnitude of the current crisis.

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The Health Care System Needs to be Simplified.

The current system has become bewilderingly complex, making it more difficult than ever for individuals to access health care. With federal, state, and private funding sources, hundreds of individual insurance plans to choose from, and different referral procedures for different types of delivery systems, obtaining basic care has become a bureaucratic nightmare. Despite the vast array of putative “choices”, the U.S. health care system frequently delivers inadequate and poor quality health care, and imposes wasteful expenditures on administrative and litigation costs. Policymakers must streamline and simplify the system to make it more understandable and accessible.

The main problem is that we are paying in the most expensive and inefficient way for this inadequate and poor quality care. We need to reduce costs, remove the inefficiency, and improve the quality of all health care.

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Health Care Must be Universally Affordable and Accessible.

Health care in a changed paradigm must be accessible and affordable to all Americans, irrespective of race, gender, religion, geography, and income. The increasing costs of providing services combined with the waste and inefficiency apparent in the current system result in fewer and fewer people having access to basic health care. Policymakers must ask at the outset how well a given plan will work to cover all people in this country. How can we provide for access for all Americans and yet pay in the most efficient and least expensive way?

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The Sufficient Purchasing Power Doctrine

Good health care will always be expensive because all health care resources are limited and demand will always be high. But although health care is inherently expensive, it doesn’t make good sense to pay more for it than we need to. And yet that is exactly what we are doing with our current financing and delivery system. Because of the inefficiencies and cost shifting now, we are paying for health care in the most expensive way possible. Many others have recommended solutions to this problem. Taxing everyone and redistributing the wealth from a top down centrally controlled highly regulated bureaucracy has failed. We need a new concept. I disagree that full subsidy of health care is not the best way to help the elderly, the poor and those not insurable because of chronic illness or pre-existing conditions. However, we currently use a subsidy system. A free market will change that. Until that occurs we need to exist in the current paradigm. Economic theory suggests that it is probably better to give the money regardless of its source government or private, as a transfer payment to low income people that would have been spent on a health care program and let them decide which additional goods and services they need since the money has more utility than the program. It also eliminates the moral hazard issue because they are spending money that they perceive is theirs and not someone else. (See the RAND Health Study).

It is ultimately important that every American have sufficient purchasing power in health care so they will have means to pay a reasonable price for their non-discretionary health care. This is the least expensive and most efficient way to achieve universal access and equitable care. Currently we are subsidizing the full care of the uninsured at the highest rate, the elderly with Medicare, the poor with Medicaid and everyone else with private insurance through cost shifting, and paying for it in the most expensive and inefficient way. With sufficient purchasing power we can eliminate all cost shifting while assuring that every health care provider is paid at market value rather than under market value as in the current system and all other proposals for reform. Sufficient purchasing power is also an important part of eliminating the disparity in the delivery of health care that currently exists. With the savings from making our system more efficient, we can generate funds to be used for subsidizing the insurance premiums and not the full cost of care of the poor uninsured, and those with chronic illness making this proposal budget neutral.

Which direction should we go? Many tell us we need a government run single payer system. Others tell us we need a market based system. As we have seen there are many problems with either choice. Many of these problems derive directly from third party payment and procedure driven and reimbursed health care and market distortions caused by government policies that protect the corporations at the expense of the individual American. If we elect to reform health care through a single payer system, the lobby power of the corporations and the bureaucratic growth will lead to more price controls and rationing. One of the problems responsible for our inability to solve this problem is that we have looked exclusively to political solutions in the past to give us the answers. It is the nature of political solutions that they often violate economic principles and introduce distortions in the market. This because the political card always trumps the economic card and politicians have degenerated to the point where they use smoke and mirrors to manipulate the publics perception that there political agenda that they have substituted for an economic plan will work. This is what happened repeatedly during all of the health care market reforms during the 20th century. A large part of our future reforming of health care will be economic. Of course there will need to develop non-market political strategies to implement the economic plan and those solutions for those problems not amenable to market solutions.

Our aim is to seek to correct the many problems of our current health care finance and delivery sector that leads to inefficiency, bad incentives, market dysfunction and out of control cost growth. Rather than start with a particular political agenda or ideology, we have tried to transcend partisan politics, applying basic economic and public policy principles in a reasoned way to solve the problem.

It is a fact that a market economy is the most efficient system for producing consumer goods and services. Markets solve problems, bureaucracies do not. No one knowledgeable about economic systems will deny that. This fact can not be ignored because health care reform represents re-organizing one seventh of the U.S. economy. However we have seen how the lack of a level playing field, a proper model for competition and perverse incentives with no checks and balances can lead to corporate monopolistic power that exploits the vulnerable to make huge profits with which they lobby our government for more money and power. This will always lead to market failure. We need to avoid repeating this mistake. Medicare and Medicaid are non-profit single payer systems. They are just as dysfunctional as our private insurance for profit system is. The reason is they both suffer from the same causes. Moving to a government controlled single payer system will not only not fix the system but will also exacerbate the dysfunction.

The most important target for our reform effort is U.S. health sector inefficiency. At two trillion dollars last year, America spends twice the rich-country average, equivalent to $6,280 for every American each year. Yet our outcomes are no better than those in other countries. Improving efficiency will reduce costs making insurance more accessible and affordable to all Americans.

The competitive market is the best way to address cost and efficiency. This conclusion is based on many assumptions about the market. However, there is no one list of assumptions that has been generally agreed on by economists. [3] Furthermore, no one has yet to offer a proper model of how to introduce competition in the health care market. The fact that many economists and policy types haven’t figured out how to make the market work in health care doesn’t mean it can’t be done. However, does economic theory support the belief that competition in health services leads to superior social outcomes? There are two areas where the competitive market may not lead to superior social outcomes. Ensuring that free and open markets operate fairly and that competition is based on price and quality rather than on the selection of the healthiest patients, and making sure that disadvantaged Americans can participate in the market, that is, how will we subsidize the poor and chronically ill.

I prefer to create a new approach that maximizes the good that a free enterprise market system can do while at the same time does justice to the economically disadvantaged. In order to do this we must correct those conditions on which the assumptions are based that make a competitive market and market forces give us the best economic system for health care finance and delivery. We must also address all important issues not answered by market forces and design reform strategies with empirical answers that will not have disastrous unforeseen consequences. We are not anti-government. We are not anti private sector corporation. We do, however, oppose the power imbalance that has in large part caused market dysfunction. We admit that it is not possible to make the market work in a highly regulated third party payment procedure driven system with powerful stakeholders causing continuing market dysfunction. That is why we propose to replace this system with a lump sum payment from insurance into a reformed health account from which the patient can pay for all of his medical expenses directly, giving the patient true transparency, portability and control over all of his health care dollar. We must also redesign the market institution in order to create a level playing field with rules of engagement to maintain it.

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Market Theory and Design

Designing a new market system should be based on Adam Smith’s traditional, economic model. This model is based on his concept of self interest and the “invisible hand” theory of functional markets. Self interest doesn’t mean a selfishness that produces goods and services that don’t meet anyone’s needs, a selfishness designed to only generate and maximize profits. Rather, self interest in Adam Smith’s own words means that the individual is following his own private happiness and interest by exercising the habits of economy, industry, discretion, attention to detail, and application of thought. In other words he is doing what he likes to do and being productive at it. Smith tells us that when one follows self interest instead of being careless and inefficient it benefits others in the market as well, the end product being the generation of wealth for everyone via the invisible hand. This is the basis of the win-win doctrine of free market economy.

In and of itself profit is not a bad thing. Profit is the engine that makes the market work. The problem occurs when power imbalances develop and some market participants harm the other market participants; when the dominant participant generate profits by exploiting the other participants who are rationed and price controlled. This power imbalance leads to market dysfunction and drives health care costs up.

The current private market in health care resembles a mercantile system more than a market system. Consequently, just adding competition to the current system will not generate healthy market forces, efficiency or cost control. There are many reform steps necessary before we can have a free market operating on and generating market functional market forces. Even more important, these intermediate reform steps need to be done in the correct order or it will fail. For example, we need to reform the individual market and risk spreading strategies first before we can change the tax incentives that will shift people from the large group market to the individual insurance market.

Mercantilists view the economic system as a zero-sum game, in which any gain by one party requires a loss by another. Thus any system of policies that benefit one group would by definition harm the other, and there is no possibility of economics being used to maximize the “commonwealth”, or common good. Health care should not be a mercantile system and should never be a zero sum game. It is incumbent on us to design and establish a market institution for American Health Care that is win-win and the end result is the common good.

A distinguished economic theorist, Kenneth Arrow, is credited with establishing the field of healthcare economics. He was asked by the Ford Foundation to describe the economic properties of the medical services industry. Arrow was the first to show how behaviors in medical markets could be understood within the context of standard economic models of competition. In his seminal1963 paper[4], “Uncertainty and the Welfare Economics of Medical Care”, he concluded that health care differs from the conditions set for standard welfare economics because two types of markets were undeveloped in health care. The first type was markets for the risk inherent in the uncertainty in the incidence of disease and the efficacy in treatment. The second type was markets for information assumed to be accessible for all participants in perfectly competitive markets. Arrow described information asymmetries between the doctor and patient which made it difficult for the patient verify the quality of medical care.

The main theme of Arrow’s article was that non-market institutions either public or private, tend to arise to deal with the special features of markets in medical services or medical insurance that cannot be handled efficiently in conventional markets. Inefficiency used in this context means more than waste or sloth. It means that mutual gains that could have been achieved were not achieved. Arrow pointed out that the most important of these non-market forces are the professionalism of physicians who make the market work in the best interest of the patient in spite of the asymmetric information and uncertainty issues. Arrow believed professional norms would guarantee appropriate use of services. Arrow used an economic role for non- market institutions in an effort to deal with the limitations of markets in health care that were causing market failure.

Ever since Arrow described the utility of physician professionalism, the micro-management and regulatory burden has expanded which has systematically eliminated professionalism. However, the market failure that presumably justified the regulation has not only gotten worse but has become intractable.

The answer therefore, is not more central control and credentialing of physicians. It is not working. The answer is correcting the incentives that drive market behavior. Most of the perverse incentives derive from third party payment , procedure driven health care delivery and under market value payment to providers. (physicians and hospitals)

Why did the economists miss this? First, the health care system was much different in 1963 and second, Kenneth Arrow had no experience practicing medicine to see how market principles should be applied. Arrow tried to approximate the health care market to existing economic models. The system that we have had over the past 45 years has failed. Market based health care finance and delivery within a proper economic model is the only way it could have worked.

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The Question of Market Regulation

How is the market regulated? Does free market mean that every participant can do as he pleases and run wild being solely motivated by greed and profit maximization? How do we reconcile the idea of a free market with the concept of “market design”? At a practical level, I reconcile them by acknowledging that we need to actively design a level playing field because it won’t develop spontaneously when we are dealing with markets or industries that have historically had a significant amount of regulation, government control and powerful and wealthy stakeholder involvement with considerable lobby power such as we have in healthcare. “Therefore the movement from heavily regulated to thriving free market process is very unlikely to be spontaneous. It’s also unlikely to be a healthy transition, because embedded regulation creates embedded special interests who would like to see the regulation persist and will resist change. If the transition process is too “laissez-faire”, the embedded special interests are likely to succeed at manipulating the transition to their advantage” [5].

The laissez-faire doctrine associated with the 18th century Physiocrats and 20th Century libertarian classical economic theory was intended to eliminate government micromanagement, protectionist interference and the resulting distortions. These distortions, created by government protectionist policy, of the large corporations and their wealth acquisition through corporate welfare, subsidies, rent seeking behavior, monopolies and patents, caused our present market dysfunction.

Hayek writes in Law, Legislation, and Liberty that market processes for the mutually beneficial, voluntary exchange of goods and services always occurs within a context of law, of legal institutions, whether formal, informal or a combination of both. [6]

“Many of what we think of as the most free and most capitalist of our market institutions, such as financial exchanges, involve elaborate contracts and laws enforcing those contracts. This legal context determines the rules of engagement by which we exchange; the context, the incentives and checks and balances and the agreed upon rules form the market institution. The quality of that institution and its variation across places or across time can affect how much exchange actually occurs, and how much net benefit is created through exchange. Even in free markets, the market institution is carefully designed, although in most spontaneous markets the design process is very subtle, building upon centuries of legal precedent and experience, so it doesn’t look like it’s highly designed or deliberate. The market institution is created by trial and error to create efficiency. This process cannot be duplicated by government protectionist policy of wealthy and powerful corporations who are only concerned with preserving their wealth and power by exploiting the consumer as it is done in the mercantile systems”[7].

The problem is that in markets coming out of severe over-regulation with powerful entrenched special interests or in markets that have never existed before, the market institution has to be designed in less-than-spontaneous circumstances. That’s the hard part, because it introduces a political dimension to the design of market institutions that is not present in more spontaneous situations, because of the special interests in the status quo and special interests in the future setup, all trying to influence the design of the rules in the market institution to preserve current regulation that will perpetuate their power imbalance. [8]

In our design of the market institution we must strive to emulate the design style of the spontaneous markets rather than the superficial and ineffective regulatory efforts of the bureaucracy. My insurance reforms and incentives with checks and balances provide that design but obviate the high transaction and legal costs. The design must come from the collaborative effort of the participants in the health care market since they are knowledgeable about their business and know how to set up the incentives and checks and balances.

We must establish and maintain a level playing field in applying market principles to health care. Insurance companies need to compete on the basis of price and not on avoiding necessary care. They need to provide transparency to their potential customer in the form of value per premium dollar information. Our goal is to generate profit as a function of providing efficient, appropriate goods and services. This will give us a functional market that is win-win for all market participants.

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The Role of Government

Government has significant roles to play in market based Health care. Interfering with a participant’s business is not one of them. That will only cause market distortions that will lead to market failure.

More appropriate roles are:

o Subsidizing the premiums of the poor, the disabled, high risk individuals and those with chronic illness.

o Subsidizing a product or procedure that constitutes a public good, that has been determined to provide a substantial gain to society, that are either under-produced or not produced because a firm cannot recover its cost.

o Government contributions where positive and negative externalities exist. Examples would be immunizations or cigarette smoking.

o Oversight of market functioning to make sure every participant is playing by the rules of engagement.

Other market deficiencies that currently exist can be corrected by either new tactics, strategies or creating different incentives. Our ability to achieve this is strictly a function of the way we design the market to perform. Unfortunately, no one currently in American health care is following his self interest in the way Adam Smith recommended. We have been victimized by our domestic mercantile system which is destroying medical care in this country.

We must resist the temptation to resort to bureaucratically, micro-managed, regulation. Rather, our job should be to create incentives with checks and balances to get individuals to behave the way they were properly trained to behave( using Smith’s definition of self interest). By so doing they will be able to provide a needed service that will turn out to be in the best interest of the consumer and lead to a functional market. These incentives with checks and balances are the correct way to deal with abuse of market power where a single buyer or seller can exert significant influence over prices or output. Abuse of market power can also be reduced by stricter use of our antitrust regulations to stop the monopolistic market power that currently exists. Many times what appears to be a benevolent policy gesture may backfire and lead to market dysfunction because although it is well meaning, it is misguided. This happened with third party payment and procedure driven medicine. Political agendas often create economic distortions when they violate basic economic principle. Unfortunately, a lot of our misguided public policy in health care finance and delivery has done this.

Creating a centrally controlled command economy as a single payer system or expanding current government programs is not the answer. A single payer system is even more inefficient compared with our current dysfunctional system. However, we can design the same efficiencies in a market system which also gives us the added advantage of market competition, and the market’s ability to solve problems which doesn’t exist in the bureaucratic single payer system. Single payer system programs are characterized by costly, inefficient and opaque administrative and regulatory procedures with central organizational overgrowth, and with un-necessary, expensive and in-efficient micro-management of physicians as well. These health reform plans will fail if we don’t address our current market failures and redesign health care financing, incentives and checks and balances. The single payer system in current government run health insurance (Medicare and Medicaid) suffers from the same out of control cost growth that we have in commercial insurance. Imposing the so called play or pay schemes with either individual or employer mandates forcing people to purchase insurance in this perverse, expensive and distorted market is also wrong and will never work.

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New Mandates to Purchase Insurance?

In his 1992 book, Responsible National Health Insurance , health economist Mark Pauly stated that a mandate to purchase health insurance would be necessary to achieve universal access to insurance.[9] I disagree. A new mandate to purchase health insurance, for either the individual or the employer, will cause a significant increase in taxes and costs that would not be politically viable, just as it has not been throughout the twentieth century. Furthermore, we must not force people to buy a highly overpriced and deficient product that currently exists in American health insurance.

Employer mandates to purchase health insurance will just burden the business sector more than employer based health insurance does already. Many businesses will either go out of business or go to other countries such as Ireland that are more favorable to business with resulting loss of jobs here in the U.S.

Individual mandates will require increasing subsidies to all Americans as the unchecked inefficiency of poor design and perverse incentives associated with our current insurance design drives up costs. Mandating people to purchase un-reformed health insurance with its current inflated premium prices is perverse and unworkable.

I believe that we can achieve universal insurance access in a market based system without new mandates. I propose that we use a current mandate for Worker’s Comp insurance instead that also has other advantages in providing a source of funding for the working poor and will ensure universal insurance access to necessary care for all employees.

Many current problems associated with Worker’s Comp insurance can be solved by using the Worker’s comp premium as a defined contribution into all employee’s reformed health asset savings account. Once the employee accepts the funding they are obligated under current law to purchase a Worker’s comp policy or a 24 hour policy. A 24 hour health insurance policy covers all illness and injuries irrespective of whether they occur on the job or after work. The reformed health insurance in our plan is designed to be a portable 24 hour policy. Of course this proposal assumes that all Worker’s Comp laws will stay the same. This use of a 24 hour policy will also provide incentives for the employee to return to work as soon as possible and reduce or eliminate the money wasted on sorting out Worker’s Comp claims from employer based claims. This proposal suggests that with the strong positive incentives and affordable premium prices of this plan, no mandates will be necessary to achieve universal access for all Americans.

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Controlling Insurance Costs Under Universal Access

Forcing insurance companies to provide insurance to the uninsurable through guaranteed issue and resorting to community rating will also drive up costs significantly. Failure to provide for true portability will also drive up costs. It will also contribute to higher premiums and overburden high risk pools making them less effective. Ironically, none of this is necessary. Portability means that people won’t lose their insurance whenever they change jobs. As people age their insurability risk increases. If they own their insurance policy throughout their lifetime with true portability they won’t have to lose their insurability.

The answer lies in redesigning not only our approach to health insurance but how we finance it and how we design the incentives with checks and balances to create an effective and efficient delivery system in a functional market.

Many Americans are uninsured simply because they can’t afford to purchase our very expensive health care insurance. When they become ill and finally end up in our hospital’s emergency rooms, the most expensive venue, they are farther along in their disease process requiring more care than if they sought care sooner. The hospital then charges the uninsured the most expensive price….pay master list price ……which of course they cannot pay. These unpaid hospital costs are shifted to everyone who is insured in the form of increased insurance premiums to the tune of 130 billion dollars a year, or roughly $900 per family, higher than it has to be just to pay for the cost of care for the uninsured. This amounts to a “hidden tax”. In addition, the unpaid costs of the un-insured are also cost shifted to the American taxpayer directly. In 2007 we paid 30 billion dollars in taxes to pay for this unpaid for care in the emergency rooms. This is in addition to lost revenues from under market payments from Medicare and Medicaid that is also cost shifted to the taxpayer at $160 billion a year and also used to increase private insurance premiums. But we also pay in increasing deductibles and co-pays and bankruptcy costs and cost-shifting to the American taxpayer and on and on and on. We are paying for this care in the most expensive and least efficient way not the least expensive way and most efficient way.

By creating access to insurance for every American through premium subsidy and improving the way we spread and mange risk we can save about half of the money that we now spend for health care but for which we receive little to no utility.

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The Doctor-Patient Relationship

Making the Market work

Critics of market based plans in health care point out that when patients are very sick or injured, they are in no condition to haggle price or shop around for a doctor to treat them. However, that is not how the market works in health care. The purpose of designing incentives with checks and balances is to create a professional atmosphere consistent with the way doctors have already been trained to function in order to provide the patient with the best quality care at the least cost. We must align the doctor’s financial incentives with those of the patient. Most physicians truly desire to and take pride in their ability to use their knowledge and skill to guide the patient through a complicated, oftentimes uncertain and inherently expensive health care system appropriately and cost effectively. Unfortunately, our current third party payment, procedure driven system with its over regulation and micro-management thwarts this desire and provides perverse incentives that degrade the physician’s professional relationship with his patient.

Medical treatment involves countless variables and options that must be taken into account, weighed, and summed up by the doctor’s mind and subconscious. Your life depends on the private, inner core of the doctor’s function: it depends on the complicated input that that he deals with, and how he processes that information in terms of the individual needs of each patient.

Just what does the physician have to deal with in our current system? It is more than just the objective medical facts. Today physician must also consider the : ‘The diagnostic related group administrator [in effect, the hospital or HMO man trying to control costs] will object if I operate, but the malpractice attorney will see it as an extraordinary opportunity if I don’t. My professional rival, who heads the local PRO [Peer Review Organization], favors a CAT scan in these cases, and I can’t afford to antagonize him, but the government who controls the certificate of need disagrees and they won’t authorize a CAT scanner for our hospital. The FDA prohibits the drug I should be prescribing, even though it is widely used in Europe, and the IRS might not allow the patient a tax deduction for it. I can’t get a specialist’s advice because the latest Medicare rules prohibit a consultation with this diagnosis, and maybe I shouldn’t even take this patient, he’s very sick. Some doctors are manipulating their roster of patients, they accept only the healthiest ones, so their average costs are coming in lower than mine, and that makes me look bad when I am reviewed for my staff privileges. If I accept an uninsured patient , he won’t be able to afford the proper diagnostic tests and that increases my risk of being sued for missing a diagnosis. Perhaps I shouldn’t accept these patients.

Would you like your case to be treated in this manner by a doctor who takes into account your objective medical needs and the contradictory, incoherent demands of some ninety different state and Federal government agencies? Could you, trust this doctor to have your best interest at heart?

If you were a doctor could you comply with all of this conflict? Could you plan or work around or deal with such arcane and opaque regulation? How could you possibly avoid it? These government agencies are real and are rapidly gaining total power over the doctor, his profession and his future viability in medicine. They have already systematically destroyed professionalism with growing regulation and bureaucratic control.

In this kind of frightening and dreadful world, for the wretched doctor, resistance and survival is futile; no one will be able to decide by any rational means what to do in any particular case. All a doctor can do is try to survive the best he can. A doctor either obeys the most powerful authority—or he tries to sneak by unnoticed, illegally trying to practice some good health care occasionally or, as so many are doing now, he simply gives up and quits the profession.”

Every physician has perverse incentives thrust on him to provide procedure driven, fragmented care to his patients involving as much expensive, high tech diagnostic and therapeutic procedures as possible. He is forced to see too many patients every day just to bring in enough money to break even with expenses. He has to hire at least one half dozen office staff to shuffle the increasing paperwork in filing and re-filing claims with the insurance plans. This is not why most doctors chose medicine as a profession. It steals too much time from patient care. The bureaucrats have taken over and are out of control. This has to stop.

In the American Health Care Plan, each physician will be competing on the basis of how skilled and knowledgeable he is, so that with time each practicing physician will improve. In our market design we introduce competition by having the doctor manage the patient’s care given the budget represented by the lump sum insurance payment by giving the patient different options. It will not be necessary for the patient to haggle over price, once he has selected the doctor of his choice and with whom he feels is working in his best interest. The physician will provide the patient/guardian with several price options within the context of appropriate care with enough information so that the patient/guardian can make an informed choice to achieve the value and quality of care that is appropriate to their problem. Only the doctor knows if the marginal price difference of an option is justified by the marginal difference in quality or value. These price options represent a “total care package” which represents all the care the patient needs for that particular insurable event. This includes physician, nursing care; hospital care; pharmaceuticals; any surgery and post surgical care; and any rehabilitation. This design provides price transparency to the patient. In this plan the insurance payment is transferred into the patient’s reformed asset medical savings account. The patient then pays directly for all aspects of his care from his health care asset savings account via an electronic debit card usable only for health care.

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Conclusion

This plan balances the physician’s selling expensive procedures against the patient’s choice to spend money in his asset/health savings account that exceeds the insurance lump sum payment, for which he may have other use in the future. The unique element of this design is that it creates demand side incentives that balance protection of the patient from unforeseen medical care expenditures with stimulating cost conscious consumer choice. On the supply side the need for third party managed and regulated care is eliminated and, with it, all the distortions and cost inflation it has created in the current healthcare market.

[1] INSTITUTE OF MEDICINE, NATIONAL ACADEMIES PRESS, TO ERR IS HUMAN: BUILDING A SAFER HEALTH SYSTEM 26

(2000b).

[2] Organization for Economic Co-operation and Development, OECD Health Data 2004, Table 9: Total expenditure on health, Per capita U.S (June 2004). The United States spends an average of $5267 per person per year. This is 50% more than the next highest spender, Switzerland, which spends $3445 per person on health care. Switzerland also has higher life expectancies and lower infant mortality rates than the U.S., which are two key factors in evaluating the success of a country’s health care system.

[3] Rice, Thomas. 2003. The Economics of Health Reconsidered, 2nd ed .Health Administration Press, Chicago, Illinois Academy Health , Washington, D.C.

[4] Arrow,K.1963. “Uncertainty and the Welfare Economics of Medical Care”, The American Economic Review, 53(3):941-73

[5] Kiesling, Lynne.2007. Reconciling Hayekian/Organic approach with designing markets. http://www.knowledgeproblem.com/archives/002073.html#comments

[6] Kiesling, Lynne.2007. Reconciling Hayekian/Organic approach with designing markets. http://www.knowledgeproblem.com/archives/002073.html#comments

[7] Ibid.

[8] Ibid

[9] Pauly, M.1992. Responsible National Health Insurance AEI Press

It is an alternative model for health insurance that avoids third party payment, procedure driven medicine a쌍꺼풀 수술nd promotes patient driven health care. It is a contingent claims contract that pays off in a lump sum rather than a separate fee for each procedure performed by a provider. It makes insurance merely a financing mechanism that provides the patient with a sufficient amount of money when they have become ill and developed a disease which is a covered event. The protocols offer a coherent explanation of the relationship between price, cost and economic value. Advocates for the free market usually argue for consumer choice and free-market competition in health care, without adequately distinguishing between the usefulness of competition in the insurance market and in the health care market. Empirical evidence indicates that a free market for third party procedure driven insurance cannot achieve social equity and that serious market failures allow insurers to practice risk selec쌍꺼풀 효과tion, leaving the most vulnerable people uninsured. Adverse selection among insurance buyers impairs the functions of the insurance market and deters the pooling of health risks widely. Also, the current insurance market’s high transaction costs yield highly inefficient results. In addition high deductible, third party payment procedure driven insurance drives up health care costs. On the other hand, evidence indicates that reliance on market competition for the provision of health care may hold potential for more-efficient and higher-quality care. Our goal is to design a financing method which will produce efficient, equitable, and effective health care. The financing method chosen is of critical importance because it determines the risk-pooling arrangement and the distribution of the cost burden. It also will decide resource allocation and will choose a payment amount to provide incentives to providers. It should also facilitate a new system where millions of individual patients will pay providers directly. Protocol health insurance utilizes a separate protocol for each insurable 쌍꺼풀 비용event. The idea is to determine what broadly accepted standards are held by the medical community of what constitutes good health care practice and what defines episodes of that care and the relative value of those episodes. This is not as complicated or difficult to accomplish as is commonly believed. Approximately 90 percent of health care spending is for sicker patients spending $1,000 per year or more. And, about 80 percent of health care spending is traced to patients with largely predictable health care needs and expenses: the chronically ill. We now have an enormous amount of experience data representing the treatment and outcomes of many patients over the past 5 years. Protocols are created based on this data and developed by physicians from each specialty area that can determine the relative value of all of the necessary procedures necessary when a patient exhibits a disease that represents an insurable event. This results in a severity rated list of complexity levels within each protocol for each insurable event. These protocols are reduced to computer software. The amount 쌍꺼풀 매몰법of the lump sum payment for each insurable event is a function of or determined by the complexity level and protocol. Each established protocol (a diagnosis or condition representing the primary morbidity) in the software is comprise눈매교정 비용d of several complexity levels. Each complexity level represents increasing morbidity associated with the insurable event and the presence or absence of any co-morbidity associated w눈매교정 효과ith that particular protocol. Each complexity level is associated with a relative value scale number, which represents the relative value of each level of necessary care. The number of complexity levels may vary and depends on the particular diagnosis). In other words, the sicker the 쌍꺼풀 절개법patient, the more money the patient will need to pay his medical bills. Because health care is primarily a local market phenomenon, the relative value scale number is then multiplied by a factor λ that floats with known local market-related components to determine the actual dollar amount to be transferred as a lump sum payment into the patient’s expanded HSA. The payment from the insurance to the patient’s expanded HSA does not 눈매교정dictate what price the provider or doctor charges the patient. The physician is free to charge the patient market price. We just need to get the insurance payment in the neighbor쌍꺼풀 절개hood of fair market value. Using experience data and having physicians determine relative value is the best and most rational way to do this to initiat쌍꺼풀 후기e the system. Once the market has determined fair market value, insurance payments can be adjusted to make sure that the patient has enough money from insurance to pay his bills. The utility of Protocol Health Insurance is that it eliminates the high transaction costs of current health insurance. It also obviates risk selection and allows for high risk pools so that all Americans including the most vulnerable will not be excluded. Under such a model, all insurers in a state or region (across state쌍수 절개 lines) would cede their cata­strophic claims to the pool, and the cost of the pool would then be funded out of a per-co세미아웃 연예인vered-life assessment on all insurers, as well as public and private subsidies and re-insurance and other creative risk spreading arrangements such as underwriting and re-insurance syndicates. In that way, the burden o눈매교정 후기f high-cost cases would be broadly spread evenly among all carriers and insurers, who would have strong economic incentives to manage these cases, and not simply dump them on the taxpayer as part of a cherr눈매교정 부작용y picking scheme. Because Protocol쌍꺼풀 부작용 Health Insurance can be used by all insurance companies as well as self insured entities, it levels the playing field, providing for competition in the insurance market, as well as allowing the insured to be individually underwritten but allowing patients to transfer insurance carriers within their risk category. The protocols also provide the patient with a value per premium dollar ratio that will allow patients transparency in selecting which insurance carrier will give them the most value per premium dollar. Protocol Health Insurance is a technically efficient health care system that will only deliver care that improves health status and in a way that minimizes the use of society’s resources. Unnecessary care and inefficie세미아웃nt modes of delivery would be minimized or eliminated, and health care cost growth would be consistent with improved quality and effective세미아웃 쌍꺼풀ness of care.

THE AMERICAN HEALTH CARE PLAN Protocol Insurance

Health Care costs and prices are increasing. This inflation is a function of insurance design and the current method of filing claims by providers, third party payment and third party regulation. Currently, the methods to finance health care are complex, inefficient, and poorly designed. In particular, there are a lack of proper incentives, many perverse incentives, increasing micromanagement, overhead and administration costs of medical care delivery, all resulting in a dysfunctional market characterized by eccentric power distribution, over-utilization, high costs, high prices, and low quality of insurance and health care delivery. As system specifications and the need to micromanage the finance and delivery of healthcare to control rising costs, the task of reforming the system has become more highly complex, further driving up costs. This increased complexity has resulted in a need to shift the paradigm of the design of health care insurance, of the finance and delivery of health care and the design of the health care market place; and created a need for a computer based system to obviate the inefficiencies of the current system and handle complicated data that is necessary to determine the proper insurance payment for any given patient with their individual needs. The purpose of this plan is to redesign health insurance to eliminate many of the perverse incentives and inefficiencies of the current health insurance product. This plan eliminates twenty-two of the twenty-three cost drivers – those problems associated with current health insurance design that are responsible for driving up the costs of health care in this country. These medical costs consequently drive up the costs of all of our goods and services manufactured or produced by American business. The plan also proposes a new design with checks and balances in a level playing field for the health care market place which will create competition and quality care at lower costs. The health care finance system according to this plan features an expanded health care savings and asset account that may be funded in a variety of ways giving all Americans equal purchasing power. An insurance carrier is paid a premium out of the account. When a patient sees a health care provider, the health care provider generates an electronic medical work-up. The work-up is analyzed by software, which determines an appropriate protocol and complexity level associated with the patient’s condition. The protocol and complexity level are then transmitted to the insurance carrier, and the insurance carrier makes a global or lump sum payment directly into the patient’s health care asset account based on the physician work-up determined protocol and complexity level. The patient accesses those funds using an electronic debit card, to pay the health care provider directly. This allows for immediate direct payment by the patient on the day of service at fair market value at prices set by the provider and not some third party. This eliminates cost shifting and the cost of billing and collections as well as the cost to file and follow-up on insurance claims This plan will allow the doctor freedom to practice medicine, i.e., to diagnose and treat the patient within the context of appropriate care as defined by the physician and professional standards and not some third party to offer the best quality care at the lowest cost to his patient, to be able to offer the patient various value options at different prices and not be restricted and constrained by the overweening top-down bureaucratic control necessary with today’s insurance design. The protocols also allow the insurance payment to be closely and accurately matched to any patient’s particular medical needs and eliminate the need for third-party micro-management and rationing of health care to the patient. The use of computer software allows the physician to simply work up his patient and by so doing automatically match the complicated data defining the patient’s problem with an appropriate protocol complexity level that accurately matches the patient’s condition. This plan should result in a 50% overall savings( 800 billion dollars in today’s market) and reduce administrative costs to less than 2% while providing 24 hour coverage that is accessible, portable, affordable and renewable to all Americans.
The problem is that many Amer트임수술 효과icans can’t afford deductibles and co-payments and they either go without medical care or food or the doctor doesn’t get paid. The reason for co-pays and deductibles derives from the fact that our conventional health insurance has a lot of inefficient moral hazard inherent in its design. It lowers the price of health care without lowering the cost of health care. The fact that our conventional high deductible insurance is third party payment and procedure driven merely magnifies the inefficient moral hazard. It makes more sense to redesign the financing mechanism of health insurance to eliminate the moral hazard and other cost drivers than to compound the folly of our flawed conventional insurance design with more bad policy. 트임수술 비용 By using Protocol Health Insurance for all non-discretionary, necessary, and emergent care and care that is not associated with inefficient moral hazard and all medical visits, pharmaceuticals, imaging procedures, hospital stays, surgery associated with the covered event we can eliminate much of the moral hazard. In addition by designing patient induced market incentives for the doctor to recommend appropriate use of medical technology we can further eliminate moral hazard without having to use deductibles and co-payments. This new design will lower the price of health insurance premi트임성형 효과ums. The premium difference from today’s more expensive health plans can be kept in an extended HSA as a tax free self insurance for all discretionary care, initial medical care before a diagnosis is made and any care that is associated with moral hazard. This premium difference can be used to fund disability and long term care insurance for all Americans at very low premiums as well. Not every patient or patient visit to the doctor requires the full court press of premier care. Most visits to the doctor result in a diagnosis of a condition that is self limited or does not require an expensive diagn트임성형 비용ostic work up. However, some visits do require an extensive work up and result in a diagnosis that requires an expensive treatment course. We need a financing system that allows the doctor and patient to cover both contingencies in an efficient manner. We can do this by bifurcating the payment system. In this way the patient only cost shares for care that is discretionary or not associated with an insurable event. That means that when a patient is ill, and can not work, he can pay for his non-discretionary care and do it in an efficient manner with funds derived from health insurance. High deductible insurance offers lower premiums only through the su앞트임bstantial deductible. High deductible insurance does nothing to address out of control cost increases and high hospital costs. It does not address any of the cost drivers associated with third party payment and our procedure driven delivery system. Protocol insurance offers a lower premium through several factors. They are: a more efficient design which eliminates inefficient moral hazard from insurance, elimination of cost shifting, inappropriate use of high tech procedures, elimination of all discretionary spending from insurance, and elimination of all cost drivers associated with third party procedure driven medicine. In addition protocol insurance has much lower administration costs and eliminates premium elevation due to all stat앞트임 효과e mandates. There are no high premiums due to guaranteed issue or community rating with protocol insurance. The bottom line is that protocol insurance delivers a low premium because of its design and not because of a political mandate in the face of unresolved cost drivers. Protocol insurance gives the patient full control over all of his health care dollar and not just the smaller deductible portion. This means that market forces are used to control high hospital costs, something not possible with high deductible third party payment. The introduction of Protocol Health Insurance does not preclude the market from producing many new designs for health insurance. I can envision a variety of risk sharing plans and variations to fit the needs of many different people just as we now have many varieties of plans all using third party payment that are procedure driven, The point is that only protocol health insurance shifts the paradigm from third party payment procedure driven medicine to make the insurance low premium, efficient and di앞트임 비용rect payment by the patient that requires no deductible or co-pays.

The American Health Care Plan ECONOMIC AND LEGISLATIVE POLICY SUMMARY

The way we finance and deliver healthcare in America is not working 뒤트임 효과and we need transformational change. The U.S. health care system needs comprehensive, patient centered market reform. After a century of innovation, the technology of our health care is the envy of the world. Yet the system is in deep trouble. Costs are out of control and rising rapidly, the number of uninsured is at an all-time high, and public satisfaction is sinking because many simply cannot afford the highly inflated price of American health care. Last year for a family of four, annual health care costs rose to $13,382.00. All attempts at reform and lowering costs have failed to date. The reason is that we have maintained a third party payment, procedure driven system. Any new attempt to reform the system must replace third party payment procedure driven medicine if it is to succeed.뒤트임 비용 The American Health Care Plan is a comprehensive market based plan. This innovative plan not only eliminates third party payment but uses design changes that will make all of the goals of free market, patient driven health care using an insurance that is affordable, renewable, portable and accessible to all Americans possible. There are no mandates with this plan. Our goal is to move from today’s dysfunctional zero sum game market to a win-win functional market. This proposal inv밑트임 효과olves an alternative to third party, procedure driven medicine as a means to get to a functional market. Once we have a functional market, the market will develop additional insurance designs. A good place to start a market based plan is in the private sector market. This can be done immediately without the need for any new legislation under the self insurance provision of the ERISA law. . However before this plan can be instituted in the public sector and address the problems of the working poor uninsured we will need some new legislation to correct the problems with our current system. Strategy for New Legislation: The first st뒤트임ep to solving these problems must include reforming several very poorly designed current policies. I suggest three areas for immediate attention: the tax treatment of health expenses, the design of health insurance, and the creation of proper incentives and checks and balances in the health care market. Tax reform. A simple change to the tax law would cut unproductive health spending, reduce the number of uninsured, and promote greater tax fairness. Make all health care expenses—employee contributions to employer-provided insurance, individu밑트임ally purchased insurance, and out-of-pocket spending— tax free. This would be available to all Americans as either a deduction above the line or equivalent refundable tax credits for a total of $15,000.00/year for each American family as suggested by President Bush.. The most important effect of this tax treatment would be to reduce unproductive health spending. Under current law, medical care purchased through an employer’s insurance plan is tax free, whereas direct medical care as well as deductibles and co-payments paid by patients must be made with after-tax income. Many Americans can not afford this. This tax preference has given patients perverse incentives which in turn leads to cost-unconsciousness. over-utilizati트임수술 후기on of high tech procedures and wasteful medical practices. Using tax free money for all health care expenses has two other important benefits. First, by making health care more affordable for uninsured persons, it will reduce the number of people who are uninsured. This will eliminate a major source of cost shifting, a major cost driver. The un-insured are charged pay master list price, the highest rate for care, 5-7 times what the insured pay, for care they receive in our hospital emergency rooms the most expensive venue. Since they cannot afford this care it is cost shifted raising the premiums of health insurance and adding an additional burden to the American taxpayer. Last year the American taxpaye트임수술 부작용r paid 30 billion dollars for this cost shifted care. Second, it will make the tax system fairer and more progressive. It will give all Americans equal purchasing power in health care regardless of their socio-economic level. This is the least expensive and the most efficient way to eliminate cost shifting due to the uninsured. Current tax law penalizes workers whose employer does not offer them health insurance, making them buy insurance with after-tax dollars. For many this is not affordable or sustainable. Moreover, percentage tax reductions from deductibility for low-income households are much larger than the same reductions for high-income households, despite the fact that a one-dollar deduction benefits a high-income taxpayer more than a low-income one because low-income taxpayers are more likely to have high levels of out-of-pocket spending. Health Insurance design reform. Under current law, funds from an HSA cannot be used to purchase insurance. Under our proposal, funds from an HSA could be used for any qualified health care expense including 트임성형 후기the purchase of health insurance, long term care insurance and disability insurance. We are also concerned that the high-deductible requirement under current law might serve as a barrier to the widespread use of HSAs. We propose that the law be changed so that every American can purchase Protocol Health Insurance that has no deductible or co-payments as well as any other insurance product. The purpose of these proposed changes is to make the HSA law less prescriptive and thereby encourage greater use of HSAs by all Americans and provide for true portability and affordability and a mechanism that allows Americans to pay their premium expenses whether they are employed or not. The perverse incentives associated with third party payment and our procedure driven system are responsible for our dysfunctional health care sector and almost all of the cost drivers and lead to the compromised quality of U.S. Health Care. We have designed a series of electronic communication and insurance protocols that will correct this. These protocols will make it possible for all Americans to have affordable, accessible, and po트임성형 부작용rtable health care and insurance in a functional market. These protocols were developed in conjunction with Milliman U.S.A. data and obviate physician micro-management, claim form filing and processing, and third party payment by the insurance plan. These insurance protocols which can be used universally by all insurance plans allow patients to be paid in a lump sum based on the severity of their insurable event. Their premium is a fraction of the price of today’s inflated health plans because of their efficient design. Patients will be able to pay for all health care services directly requiring transparency in pricing; and together with an expanded Health Savings Account will give all Americans equal purchasing power in the market place so every American can have health, disability, and long term care insurance and be able to pay for all of their care at fair market value on the day of service. These protocols solve three very important problems in insurance design. First, they obviate the need to use very expensive legal contracts that have precluded the use of lump sum payment in health care insurance in the past. Second, they also solve the problem of very high administrative expense usually associated with the individual insurance market. These protocols can reduce administrative costs to less than 2% in the individual market. Third, These protocols allow us to bifurcate the source of the payment for all health care expenses making financing extremely efficient and the insurance actuarially sound. All non-discretionary costs are paid from funds derived from insurance. All discretionary costs and inefficient moral hazard expenses are paid from money saved in the account from the premium difference from today’s much more expensive health plans. Another advantage of these protocols are that they obviate the two types of state regulation—“mandated benefits” laws and “any-willing-provider” laws—that currently drive up the cost of health care and increase the number of uninsured in our third party procedure driven system. The Congressional Budget Office estimates that mandated benefits laws—which require that health plans cover particular types of persons, services, or providers (e.g., alcoholism treatment or chiropractic services)—increase health insurance costs by 5 percent, and possibly as much as 15 percent, beyond what they would be if consumers were free to choose the benefits package they most preferred. New research finds that “any-willing-provider” laws (which require that health plans reimburse for care provided by any doctor, hospital, or pharmacist who is willing to accept the plan’s terms and conditions) increase health care costs by 1 to 2 percent, by weakening the cost-containment effects of current managed-care plans. For this 1 to 2% cost containment, managed care has put a lot of experienced and well trained doctors out of work, a terrible waste of scarce and expensive resources. These protocols also obviate the need for managed care. Managed care has failed to control costs and has disrupted the practice of medicine. The protocols will give patients choice of physician, hospital and treatment plan option provided by the physician. Savings will far exceed anything claimed by managed care. These protocols will level the playing field and allow insurance companies to offer their plans on a nationwide basis, free from costly state benefit mandates and excessive regulations. Government regulations should be confined to enforcing the rules of engagement to ensure a functional market place. The benefits of nationwide insurance are considerable. Health insurance will become more portable because people could switch jobs across state lines without their insurance being canceled. All people, but especially the uninsured, would have access to lower-cost insurance options. Applying market principles to health care. We have also designed a series of incentives and checks and balances that are win-win for all market participants that will give us a functional, free market on a level playing field that will generate wealth rather than spend our wealth inefficiently. Dr. Lanzalotti has also re-defined the doctor- patient relationship through incentives to a new professional model that is more consistent with the way physicians were trained to function. This is important because managed care moved the focus of the market to the corporate level. Dr. Lanzalotti has returned the focus of the health care market to the patient/physician axis. This will allow doctors to elect to practice in solo practice once again. The market should allow all choices. If there is a level playing field, there will be no power imbalances that force doctors into practice patterns they choose not to be in. These new incentives and checks and balances will eliminate the hostile and nightmarish, Hobbesian economic climate that characterizes our current health care market, making our health care system fragmented, inefficient and expensive. Rather than our present free-for-all health care sector with physicians and hospitals competing with each other to survive in a hostile economic climate where they struggle for scarce health care dollars while insurance carriers constantly seek to reduce payments to providers and their financial obligations to sick patients, these new incentives and rules of engagement will create a new marketplace. A marketplace characterized by creativity and cooperative competition that will allow all market participants to re-group to focus on and support the patient during his time of need. In our vision, the doctor not only diagnoses and treats the patient but is working for the patient directly and exclusively. The physician needs to provide the patient with enough information and price options so that the patient can make informed decisions for his care. The physician, with the best interest of his patient at heart, will be able guide the patient through our increasingly complex and expensive health care system so that the patient can get quality care at the lowest price. Only comprehensive market change of our broken system can provide universal, portable access. Only a new paradigm in health insurance, one that replaces third party payment and our procedure and money driven system of finance and delivery, with the protocol insurance design will reduce inefficiency, control costs and secure and stabilize health care for all Americans long into the future.
Although the current U.S. health care sector has m하안검ade remarkable advancements in high tech medicine and surgery, it is costly and wasteful, and it leaves many people without appropriate care and the means t상안검수술o pay for it. Consequently, the American taxpayer is paying for it in the most expensive way. The challenge for public policy is to enable consumers and taxpayers to obtain good value for their health care dollars. Achieving this objective stands the greatest chance of success if health care markets function well. To make markets work, we recommend changes in five areas of public policy: tax reform, insurance reform, improved provision of information, enhanced competition, and malpractice reform. Our policy reforms will improve the productivity of the health care system, make insurance more affordable, reduce rates of those who are not insured, and increase tax fa하안검수술irness. The power of markets is to allocate resources efficiently—power evident in every other sector of the economy—and it is part of the solution in health care. Unfortunately, several U.S. public policies prevent markets for health services from accomplishing this objective. In two areas—tax policy and health insurance regulation—government policy has actively hindered the operation of markets. In three other areas—the provision of health care information, the enforcement of antitrust laws, and medical malpractice rules—government policy has failed to adequately promote the proper functioning of markets. Correcting this public policy it is a necessary first step in health care reform at the legislative 상안검 효과level. Current tax policy allows people to deduct the costs of employer-sponsored health insurance but generally requires out-of-pocket medical spending to come from after-tax income. This tax bias creates an incentive for employers to offer, and workers to choose, health plans that allow workers to purchase as much medical care through insurance as they can. In practice, this has been achieved through third party payment, procedure driven insurance that covers a broad array of health services with minimal deductibles and low co-payments, instead of lump sum catastrophic coverage. The tax preference for employer health insurance is substantial. For the typical U.S. worker, the combination of federal income and payroll tax rates raises the total marginal tax rate on wage income to approximately 30 percent and thereby reduces the effective cost of purchasing medical care through insurance, rather than out of pocket, by 30 percent. In states with high state and local income taxes, and for people with high family incomes, the eff하안검 효과ective cost reduction is even larger. The tax preference has had a powerful impact on the way medical care is purchased in the United States; approximately 85 percent is purchased through insurance. According to unpublished data for 2003 from Anthem, a large health insurer, the average annual deductible of health insurance policies purchased by individuals ($1,250) is four times greater than that of policies purchased by large firms ($250). Although many factors could affect the magnitude of this difference, the tax preference for employer-sponsored insurance is clearly important. Low-deductible, low-co-payment third party payment procedure driven insurance has led to today’s U.S. health care market in which a lack of cost-consciousness and an abundance of wasteful medical practices are the norm. According to the RAND Health Insurance Experiment, an increase in a health plan’s annual deductibles from $200 to $500 reduces the total amount a person spends on health care t안검하수hrough both insurance and out-of-pocket payments by nearly 5 percent. More recent estimates of the effect of deductibles and co-payments on health spending are even larger. The fact that these changes occur without any appreciable impact on most people’s measurable health outcomes implies that the extra care attributable to over-insurance that does not provide good value for money. We propose three changes in the tax code to correct this bias. Full deductibility. All Americans should be entitled to deduct health insurance payments and health care expenses as long as they purchase insurance and maintain an extended tax free health savings account. In all cases, the deduction is “above the line”—available even to taxpayers not itemizing income tax deductions, or for those below 150% of poverty, equivalent tax credits. This levels the playing field among those who are buying health care directly, buying insurance on their own, and buying insurance through their employer. Allowing out-of눈썹거상-pocket health care spending to be tax-deductible would raise the price of purchasing health care through insurance relative to out-of-pocket in our current system. This would induce people to shift to health plans with higher deductibles and coinsurance rates, which, in turn, would lower health care spending. The problem is that many Americans can’t afford deductibles and co-payments and they either go without medical care or food or the doctor doesn’t get paid. The reason for co-pays and deductibles derives from the fact that our conventional health insurance has a lot of inefficient moral hazard inherent in its design. It lowers the price of health care without lowering the cost of health care. The fact that our conventional insurance is third party payment and procedure driven merely magnifies the inefficient moral hazard. It makes more sense to redesign the financing mechanism of health insurance to eliminate the moral hazard than to compound the folly of our flawed conventional insurance design with more bad policy. By using Protocol Health Insurance for a눈썹거상 효과ll non-discretionary, necessary, and emergent care and care that is not associated with inefficient moral hazard and all medical visits, pharmaceuticals, imaging procedures, hospital stays, surgery associated with the covered event we can eliminate much of the moral hazard. In addition by designing patient induced market incentives for the doctor to recommend appropriate use of medical technology we can further eliminate moral hazard without having to use deductibles and co-payments. This new design will lower the price of health insurance. The premium difference from today’s more expensive health plans can be kept in an extended HSA as a tax free self insurance for all discretionary care, initial medical care before a diagnosis is made and any care that is associated with moral hazard. By bifurcating the payment system in this way the patient only cost shares for care that is discretionary. That means that when a patient is ill, and can not work, he can pay for his non-discretionary care and do it in an efficient manner. Full deductibility will reduce wasteful private health spending. This result is important for two reasons. First, it implies that full deductibility is an effective policy to address rising health care cost growth and the uninsured. Second, it has important implications for the policy’s impact on the federal budget. The tax-free resources not being used for health care consumption in the extended HSA would be channeled to other, taxable, economic activities as investments. The resulting increase in tax revenues would offset a sizable amount of the revenue loss from making all HSA health care expenditures tax-free. Full deductibility would have several additional beneficial effects. Because the tax change would allow the deductibility of out-of-pocket health care expenses only with the purchase of insurance, the proposed policy also would create a powerful tax incentive to purchase insurance. Under current law, a typical uninsured person receives no tax benefit from purchasing insurance. Under our proposal, a person who purchased a health plan with a $2,000 premium and also paid $1,000 out of HSA would not pay taxes on both the premium and out-of-HSA costs. For a person in the 15 percent tax bracket, the tax break would be worth $450—23 percent of the cost of insurance. Although deductibility would mitigate the bias against individual insurance (because both employer-sponsored and individual insurance could be acquired with pretax dollars), it still would retain major incentives for the purchase of insurance and for the purchase of employer-sponsored insurance. Because the tax change would allow the deduction of the cost of individual insurance from the income tax base but not from the payroll tax base, the proposed policy would retain a tax incentive for the purchase of employer-sponsored insurance. Spending on insurance purchased through an employer would, as under current law, still be excludable from both the income and the payroll tax bases. For this reason, deductibility would be unlikely to increase the number of uninsured people by inducing employers to stop offering insurance to their employees. Finally, the tax change would increase the fairness of the federal income tax system. Under current law, people whose employer declines to offer insurance are penalized because they must purchase insurance with after-tax income. Tax deductibility would replace a myriad of special health care tax deductions—such as Section 125 flexible spending accounts and Section 105 health reimbursement arrangements—with a single deduction equally applicable to all. Deductibility would make the tax system more progressive. Although marginal tax rates are higher for higher-income people, the fact that lower-income people have higher (currently taxable) out-of-pocket spending more than compensates for this effect. Using data from the 2002 Medical Expenditure Panel Survey (MEPS), we found that the tax reductions for low-income households are three to five times as large, on a percentage basis, as those for high-income households. For example, households earning less than $20,000 per year can expect a 5.7 percent reduction in their average tax rate, whereas households earning $20,000–$30,000 per year can expect an 8.3 percent reduction. This reduction would come about because our policy would allow health expenses to be deducted “above the line.” By comparison, households earning $70,000–$100,000 per year can expect only a 1.8 percent reduction in their average tax rate, and households earning more than $100,000, a 1 percent reduction. Universal health savings accounts. The tax code could also be changed to make it easier for individuals and families to save for expenses not covered by protocol insurance. We propose making all individuals eligible for HSAs conditional on the purchase of insurance that covers at least catastrophic expenditures. As with current HSAs, balances may be spent on the health care of a relative, and balances not spent on health care could be carried forward tax-free. Funds withdrawn for non–health care purposes would be subject to income tax. Recipients of health care tax credits (described below) could deposit funds in an HSA if they wished. To expand the availability of HSAs, we propose three major changes. First, under current law, an employer-sponsored family health insurance plan must have a deductible of at least $2,000 to qualify its purchaser for the HSA ($1,000 for an individual plan). We should eliminate the deductible requirement. Second, the amount a household can deposit in an HSA is now limited to the amount of the health insurance plan deductible, up to $5,150 ($2,600 for an individual plan). We propose setting a $15,000.00 limit ($7500.00for individuals) on the amount that can be deposited in an HSA, annually. Third, under current law, funds from an HSA cannot be used to purchase insurance. Under our proposal, funds from an HSA could be used for any qualified health care expense, protocol health insurance, long term care insurance, and disability insurance. The purpose of these proposed changes is to make the HSA law less prescriptive and thereby encourage greater use of HSAs. We are concerned that the high-deductible requirement under current law might serve as a barrier to the widespread use of HSAs. Under our proposal, people would be free to purchase insurance on their own rather than through an employer, all without tax penalty. Consistent with our policy of full deductibility, we believe that public policy should, whenever possible, allow individual preferences rather than government mandates to determine people’s health insurance arrangements. Tax credits for low-income people. A third policy we propose is designed to improve the health care “safety net” for very-low-income households. Although our proposal to make out-of-HSA medical expenses tax-free offers important benefits for many low- and middle-income working families, it does not help families that pay few or no income taxes. To address this inequity, we should offer low-income households financial assistance to purchase health services. Eligible expenses would include payments for insurance and out-of-HSA expenses. Thus, the refundable credit would be available to buy insurance through an employer or on one’s own, or to pay for out-of-HSA expenses (conditional on having insurance). It is less expensive to subsidize the poor to be able to purchase an efficient, low price insurance product such as Protocol Health Insurance, than to continue to pay for their most expensive care in the most expensive venue through cost shifting. These families would receive tax credits on a means tested sliding scale so that every American could put $15,000.00 into their extended HSA . Regulation of markets for health insurance The second area in need of policy reform is the regulation of markets for health insurance. Under the McCarran-Ferguson Act of 1944, states have had primary responsibility for regulating health insurance markets since the 1940s. Each state specifies the rules by which its insurance market operates, including the financial requirements insurers must meet to sell policies in the state, the services that a health insurance plan must cover, the prices that insurers can charge, the individuals or groups that must be offered coverage, and the method by which insurance companies must conduct their business operations. As with the tax preference, the unintended consequences of inefficient insurance regulation drive up costs and increases the number of Americans who are uninsured. We propose two major changes to insurance regulation: the creation of a federal market for health insurance; and provision of a subsidy for the insurance costs of the low-income, chronically ill. Create a federal insurance market. One particular form of state insurance regulation—benefit mandates—has expanded dramatically over the past forty years. In 1965 there were fewer than a dozen such mandates throughout the fifty states and the District of Columbia; by 2003 the number had risen to more than 1,800. Benefit mandates now require coverage of off-label drug use (thirty-seven states), acupuncture (eleven states), and chiropractic (forty-seven states). According to the Congressional Budget Office (CBO), states’ benefit mandates have raised the cost of a typical insurance plan 5–15 percent. According to one study, about one-quarter of those who lack coverage are uninsured because of the cost of state mandates alone. Oddly enough all state mandates relate to third party payment insurance only. If we change the financing paradigm to Protocol Health Insurance, all of the state mandates will no longer apply and be obsolete. We propose that insurance companies that meet certain federal standards be permitted to offer plans nationwide, free from costly state mandates, rules, and regulations. With this change, insurance would become available to individuals and small groups on the same terms and conditions as those now available to employees of many large corporations, which, by self-insuring, are exempt from state insurance regulations and instead operate under the federal insurance law provisions of the Employee Retirement and Income Security Act (ERISA). Given that approximately half of the privately insured U.S. population is already covered by plans that operate under federal regulations, this reform would not lead to radical or unpredictable changes in consumer protection. Federally certified health insurance products would be required to meet all federal regulations that now govern the provision of health insurance for large employers; there would be no rollback of existing protections. Insurance companies that now offer federally certified products would be required to meet financial structure and solvency requirements. In addition, states could continue to supervise day-to-day market conduct, such as consumer complaints. Finally, insurance companies that now offer federally certified products would no longer be exempt from antitrust liability under the McCarran-Ferguson Act, which would expand the federal government’s ability to police anticompetitive behavior. This change would bring several benefits. Most importantly, it would foster a more competitive, efficient non-group health insurance market that would enable people to obtain a greater variety of lower-cost health insurance alternatives such as protocol health insurance. The lower cost would induce more people to buy insurance and thereby increase the size of risk pools—which would further strengthen markets for insurance. In addition, a federal market would increase the portability of health insurance by making it easier for people to keep their insurance when they move across state lines. Solving the Worker’s Comp Problem and Avoiding any new Individual or Employer Mandates to Purchase Insurance Protocol health insurance is a twenty-four hour health insurance. That means that it covers on the job as well as non job related illness and injury. Employers can make a defined contribution into an employee’s HSA of the premium he currently pays for Worker’s Comp. This then obligates the employee to purchase a Worker’s Comp policy. By purchasing a protocol health insurance policy the employee not only satisfies the existing mandate but gets twenty-four hour health insurance coverage. This has many other beneficial effects on making health insurance more efficient. Millions of dollars will be saved from trying to sort out which cases is Workers Comp and which are not. Protocol insurance will serve as an incentive to keep workers on the job instead of staying home because of “back pain” NOS since it is not a covered event and they have to not only spend their own money but lose income while they are at home. Subsidize insurance for the chronically ill. Providing affordable health insurance for chronically ill people who have predictably high medical expenses year after year and who lack sufficient resources to finance them is one of health policy’s most vexing problems. Competitive markets for insurance, which provide good protection for unforeseen major medical expenses, do not work well for persistently high-cost patients. States have responded to this problem in two ways, both of which have been unsatisfactory. High-risk pools, in theory, allow those who have been denied coverage or charged a high premium because of their health status to obtain subsidized insurance through the high-risk pool. According to a recent study, although twenty-eight states operated high-risk pools in 1999, they covered a total of only 105,000 people. This study concluded that the small size of pool enrollment was the result of several factors, including high costs; limited benefits; limited outreach to prospective members; and, in some cases, explicitly capped enrollment. State-mandated premium risk bands and underwriting restrictions seek to extend coverage by limiting the range of premiums and the characteristics on which they can be based. However, a study of regulation of the small-group market found that such stringent regulations decreased the rate of coverage among workers and increased premiums for small employers. Further, most of the increase was passed on to workers through higher employee contributions—ironically worsening the problem of the uninsured. We propose a subsidy to help people with predictably, persistently high health costs to purchase insurance in the new nationwide market through a properly designed high risk pool. A public-private partnership between the federal government and insurance companies would administer the subsidy. This subsidy would preserve coverage for the chronically ill at a lower cost than, and without the unintended consequences and market distortions created by, its alternatives. One alternative, for example, seeks to socialize the costs of all high-cost patients. Such socialization helps the chronically ill but also subsidizes the catastrophically ill—those with unexpectedly high costs that will not persist, such as costs for people injured in auto accidents. Private insurance markets, however, work well at financing the care of the catastrophically ill; adverse selection arises only when a patient’s (high) expenditures are predictable in advance. We also propose reforms in three additional areas: better provision of information to providers and consumers; an explicit public goal to control anticompetitive behavior by doctors, hospitals, and insurers; and reforms to the medical malpractice system to reduce wasteful treatment and medical errors.
We are told that for the risk pool to work efficiently all Americans have코성형 효과 to be insured. The price of current insurance premiums is prohibitive and many can’t afford them. An individual mandate would be a new tax on every American. The play or pay option forcing employers to either provide health insurance or pay a new tax as a penalty is just as unacceptable as the individual mandate. The truth is we really don’t need new mandates to insure every American. Currently, all persons over 65 and all disabled persons under 65 are insured through Medicare. Among the under 65 group employed individuals a코성형 비용re either in the uninsured working poor making about 8 million persons, working covered with employer based insurance, working for a small company that either insures their employees or does not insure their employees. There are people that are self –employed that are uninsured. They are working against a federal government gradient by not being given the same tax advantages that those who own large companies. There are about 18 million people that are not poor and uninsured because they either have a chronic medical condition which make them uninsurable or would pay a disproportionate amount of insurance premium for some reason. There are 8.4 million 1코성형 후기8-25 year old persons who are uninsured because community rating increases their health insurance premium too high. Then there are about 9.4 million persons who are in between jobs and temporarily uninsured. Those who are non-working poor are covered by Medicaid. About 3.5 million of the non-working poor are eligible for government health programs but have not signed up. That leaves about 13 million illegal aliens who are uninsured but receiving free health care on The American taxpayers nickel. There are about 125 million workers who are covered by Worker’s Compensation health insurance iเสริมนม เกาหลี f the injury or illness occurs on the job but not after work when they are home. These 125 million persons include the working poor who are otherwise uninsured. There are several tactical options available make sure every American is insured that does not require either a new personal or employer mandate. The ultimate goal of all of these options are to design the lowest iทำนม เกาหลี nsurance premium possible making it more affordable for all Americans without forci코성형 부작용ng the insurance carrier to lower the premiums through a government edict which would just drive up health care costs. We need to employ a strategy that creates incentives that make having insurance a desirable and affordable options for all Americans rather than forcing them through government edict and incurring government punishment if they don’t purchase insurance. We can create industry standard risk categories so that the young and healthy don’t have to pay a disproportionate premium but rather a lเสริมหน้าอก เกาหลี ow premium appropriate to their low risk status. We need to create equitable tax laws by giving the self-employed the same tax advantages that employers of large groups enjoy. We also need to preserve the employer tax deductibility for health care to create an incentive for the employer to make a defined contribution into the private tax free account of the employee. Having a tax free account has ราคาเสริมหน้าอกเกาหลี many advantages but would provide a savings fund to pay insurance premiums when they are in between jobs. They also provide a fund to finance discretionary care that is price sensitive, used to pay for routine low cost care, or care associated with treatments that are low value. That is care that is associated with treatments that are controversial but chosen by the individual precluding any rationing by the government or insurance carrier.เสริมนม โรงพยาบาลนานะ A way to avoid a federal mandate and use a current state incentive would be to allow the employer to make a defined contribution of the Worker’s Compensation insurance premium into the account of his employees thus transferring the legal obligation on to the employee to buy a Worker’ยกกระชับหน้า เกาหลี s Compensation Plan. If they purchased a twenty four hour Plan such as The American Health Care Plan they would get Worker’s Comp insurance as well as coverage when they were not working and make it completely portable. This would make sure that the 125 million workers under this program both those who are currently working poor uninsured and those with employer based insurance, would be coดึงหน้า เกาหลี vered by health insurance 24 hours a day. The added advantage to this tactic is that we would eliminate the bad incentives that currently exist in the Worker’s Compensation program such as all of the time and money lost by people with back pain not otherwise specified. Under Protocol insurance this condition is not an insurable event because it is price sensitive. It will take political policy to ultimately detร้อยไหมหน้า เกาหลี ermine how we will deal with the elderly, the poor and the uninsured and uninsurable. However, the AHCP does not dictate political policy. I don’t agree that top down government subsidy is the best way to cover these costs. There is no way to predict what new and innovative ideas will arise in a free market and the new atmosphere that it will bring which is conducive to innovation. Also many of the current poor prดูดไขมัน เกาหลี obably won’t be poor in a free market which will also provide the atmosphere for new jobs in the private sector to arise. The free market needs to be instituted first to create a conducive environment to new, creative strategies to deal with this perplexing problem. Whatever strategy we ultimately choose, we should choose one which will not have unintended consequences and the strategy shouldดูดไขมันขา เกาหลี be optimally efficient and cost effective. Until we have established a free market, we need to implement the economic reforms in finance and delivery to achieve efficiency and cost effectiveness. Under the current system ,we will probably have to partially subsidize the health insurance premiums of the 3.5 million nonworking poor and those with pre-existing or chronic illness if we don’t want to drive costs and premiums up with insurance mดูดไขมันหน้าท้อง เกาหลี andates to provide care for these people in a community rating and guaranteed issue scheme. This subsidy should not be top down government run since any government design costs too much and causes market failure. The partial subsidy would be for the amount of the premium above the mean charged to those of the same age without those conditions. Although this partial subsidy would cost money, it would cost much less than to pay for ดูดไขมันเกาหลีที่ไหนดี the cost of care of this people at pay master list price the highest tier of price in the Emergency room of a hospital as we do now. This subsidy would also create sufficient funds for all Americans to pay fair market price for health care and create equity in health care delivery, two very important features we should have in health care reform. We need to create an incentive for the non-workiดูดไขมันเหนียง เกาหลี ng poor who receive Medicaid, which was designed to be a temporary safety net only, to avoid using the emergency room at their local hospital the most expensive venue, as a clinic to receive routine health care. An incentive can be created with refundable tax credits. Since the non-working poor don’t pay taxes, refundable tax credits turn into cash. The Medicaid patient will pay in a combination of money + tax credit to equal fair market value price. Byดูดไขมันต้นขา เกาหลี being a careful steward of the public dollar any tax credits left over at the end of the year converts into cash which stays in the patients account and creates a starter fund for when they move up to become a member of the working poor. Finally the problem of the illegal alien. The problem most Americans detest is that the alien makes American money and sends it back to Central America and then our government gives them free health care at the American taxpayers expense. There is another problem. American citizens only have 1.6 children per couple. This has not produced enough younger persons to support the social security and Medicare programs. Currently there are 48 million persons using Medicare. When the post war baby boomers reach retirement age in two years, there will be an additional 89 million persons who will not be working and will start to depend on Medicare and Social Security. Medicare is 50 trillion dollars in the deficit and will not survive. The influx of aliens can solve this problem, if it is handled properly. In the American Health Care Plan, each of these aliens will have to invest their money in the asset savings account in American T bills not send it back to their country, In addition they will have to purchase insurance here in America, according to the tactics described above, just like any other American. In other words we can have the illegal alien assist us with our problems rather than add to them since they like our country so much.
1) MAJOR COST SAVINGS TO INSURANCE COMPANIES 가슴성형 비용 a. Significant expansion of markets due to ALL Americans purchasing: i. Health insurance ii. Long-term Care Insurance iii. Disability Insurance b. Separation 가슴성형 효과of Financing from the Delivery of health care at the Provider Level will eliminate the perverse incentives associated with the current third party payer procedure-driven system c. This plan eliminates the multiplicity of health plan claim requirements and the bureaucracy necessary to pay those claims giving us a “single payment” insurance plan가슴성형 후기 d. This design reduces costs and prices by eliminating twenty-two of the twenty-three cost drivers responsible for inflating insurance premium prices e. Insurance company will only be responsible for non-discretionary spending associated with the insurable event. This will be completed by a single “Lump Sum Transaction f. Insurance company will make a “Single Lump-Sum Payment” to the patient to allow for payment of non-discretionary care associated with the insurable event. This will eliminate multiple insurance payments for multiple procedures currently at the discretion of the patient 가슴성형 부작용 g. Eliminates all the perverse incentives associated with the current third party payment procedure driven health care, which results in patient over consumption and provider over-utilization. h. Eliminates the perverse incentive for physicians to inappropriately utilize expensive, high-tech procedures. i. Protocol utilization will eliminate the perverse incentive of physician to defensively order unnecessary testing for protection from potential litigation. j. Abolish State Mandated Insurance Benefits by obviating problems derived from third party payments that MIB are designed to eliminate. k. Protocol Paradigm will Reduce Administrative Costs i. Reduced staffing currently associated with provider micromanagement. ii. Eliminate complicated & expensive legal contracts that were formally associated with lump sum payment and writing policies in the individual market. iii. Design High Risk Pools for patients with pre-existing and/or chronic conditions. This will be accomplished via public and private subsidy which will establish a more equitably system allowing insurance companies to more effectively spread and manage risk. iv. Improvement of profit margin will occur due to significant reduction in overhead, rather than by third party rationing to patients and price controlled under-market-value payments to providers. v. Elimination of “Moral Hazard” Issues vi. Elimination of “Adverse Selection” Issues vii. Appropriate Lump-Sum Payment will allow the patient to pay for all non-descretionary care only. This will eliminate insurance payments now being made for procedures associated with discretionary care. viii. Elimination of Insurance payments for 90% of Family Doctor visits because these encounters are for conditions that usually self-limiting and rarely require procedural care. ix. Elimination of cost associated with both eligibility and denial of claims (both in paper work and time). x. Plan is a 24 hour product and thus will eliminate the expense of determining eligibility between Employer Based Insurance and Workman’s Compensation Insurance. xi. Discourages filing of fraudulent claims xii. Discourages filing of claims for non-insurable events such as “back pain” not otherwise specified. xiii. Eliminate the need for “Guaranteed Issue” as the only strategy to achieve universal access. xiv. Eliminates the use of “Community Rating” with its self defeating aspects as the way to manage risk xv. Introduces innovative risk sharing and spreading tactics viii. Elimination of Insurance payments for 90% of Family Doctor visits because these encounters are for conditions that usually self-limiting and rarely require procedural care. ix. Elimination of cost associated with both eligibility and denial of claims (both in paper work and time). x. Plan is a 24 hour product and thus will eliminate the expense of determining eligibility between Employer Based Insurance and Workman’s Compensation Insurance. xi. Discourages filing of fraudulent claims xii. Discourages filing of claims for non-insurable events such as “back pain” not otherwise specified. xiii. Eliminate the need for “Guaranteed Issue” as the only strategy to achieve universal access. xiv. Eliminates the use of “Community Rating” with its self defeating aspects as the way to manage risk xv. Introduces innovative risk sharing and spreading tactics
Transforms American health care fro배꼽성형 효과m procedure driven to patient driven Eliminates third party payment Introduces direct patient payment for all health care goods and services Gives every American equal purchasing power in health care regardless of socio-economic level Patient receives a lump sum payment from insurance with enough money to pay for all aspects of care resulting from that insurable event at fair market value. Introduces price, value and quality transparency Creates incentives for appropriate consumption of health care Creates incentives for appropriate venue for배꼽성형 비용 health care Gives all American choice of doctor, hospital, and treatment Eliminates all third party rationing Allows all Americans who are working to build wealth tax free through out their lifetime in their expanded health care savings account Provides for tax deferred retirement income at retirement Provides for tax free transfer of any unused funds from exp-HSA to heirs and assigns at death Empowers the patient in the health care market place Government enforces the rules of engagement in the market institution to protect patient rights and prevent power imbalan배꼽성형 재수술ces in health care market Protects patients by providing disincentives for fraud Eliminates all out of pocket payment in post tax dollars Eliminates all deductible and co-payments for all non-discretionary care Creates incentives and provides market power for the patient to demand cost effective health management (highest quality care for the lowest price within the context of appropriate treatment) creates demand side incentives that balance protection of the patient from unforeseen medical care expenditures with stimulating cost conscious consumer choice It would lead to incentives for patients to maintain a healthy lifestyle and use preventative care because it would lower their risk category and premium price. Today’s health배꼽성형 방법 plan is transformed into bifurcated coverage ( self insurance + insurance payment) that is owned by the patient in a tax free account that is personal , portable and affordable for all Americans There is protocol insurance which covers all necessary health care needs when expensive insurable events occur and funded by the premium difference from today’s more expensive health plan, There is a “self insurance” which remains in the asset account after the insurance premium is paid that is used by the patient to cover initial diagnostic visits to the doctor, discretionary care and routine healthcare The pretax asset savings account, which pays for all discretionary and routine medical care as well as premiums for the portable protocol insurance, is funded by defined contributions from employers, Medicaid and Medicare, individual contributions, and refundable tax credits or vouchers (in the case of lower income individuals). All protocol insurance payments are paid into this account instead of to the providers. All health care goods and 배꼽성형 후기services are paid by the patient directly from this account This plan balances the physician’s selling of expensive procedures against the patient’s choice to spend money in his asset savings account, for which he may have other use in the future Allows all American to have access to affordable disability and long term care insurance to be paid out of money currently being used to pay the high insurance plan premiums Creates a functional, competitive market that offers reasonable and fair prices for insurance premiums and hospital care Provides all Americans with affordable, portable , renewable health care insurance and access to affordable, quality health care Patient selects w케이스성형외과 hich providers are keyed to their electronic debit card that accesses their HSA account


Eliminates third party payment, management, interference and control
Eliminates claim form submission
Introduces direct 엑소좀 효과patient at full fair market value on the day of service by every patient seen
Eliminates third party price controls. Allows the physician to define fair market price and be paid at the price.
Eliminates third party paperwork requirements
Eliminates all eligibility and denial of claims hassles
Eliminates the need for non-medical staff to churn paperwork
Reduces 엑소좀 비용administrative costs
Reduces overhead
Transforms the doctor patient relationship to a professional model
Provides incentives for the physician to provide a cost -effectiveness analysis to the patient in his selection of diagnostics and treatment modalities
Provides the physician with information technology at the point of service to aid in determining marginal benefit for marginal cost.
Provides incentives to the physician to constantly improve his knowledge base, his skills and effectiveness with time through market competition ( Competition gives incentives for self improvement )
Provides software that automatically communicates the patient’s complexi엑소좀 후기ty level for their insurable event to the insurance company that results in a lump sum payment to the patient’s tax favored savings account( can only be accessed with an electronic debit card keyed the health care providers selected at patient discretion only
Returns the physician main function to doing a thorough history and physical exam and then providing the patient with enough information so that the patient can make an informed choice between different cost options within the context of appropriate care
Eliminates being leveraged by hospitals
Gives physician personal choice of practice (solo, group, employee, corporate) without prejudice
Eliminates the need to garnish wages from patient that you have a judgment against
Allows the physician to see a reasonable number of patients each day and earn enough money to maintain the practice and a personal lifestyle that is commensurate with the physician’s education, skill, and responsibility
Eliminates all of the perverse incentives associated with the current paradigm that distorts the physician’s practice efforts.
Eliminates liability risk
Allows the physician to set fair market pricing autonomously in response to the true equilibrium point of the supply demand curve; Eliminates all billing and collection problems


Eliminates rising costs that currently occur in Medicaid, Medicare, Tri-care, and Veteran’s Care
Allows for the more efficient use of mon슈링크 비용ey currently being used for government funded health care
Significantly reduces administrative activity, paperwork and costs
Eliminates need for physician micro-management
Eliminates the need for eligibility and denial of claim forms
Eliminates the need for the government to be involved in the insurance business
Allows all Americans to have equal purchasing power in health care regardless of socio-economic level
Eliminates disparity of care
Creates a single tier of quality, affordable health care for all Americans
Creates a role for the government to enforce the rules of engagement of the market institution
Confines government intervention to correcting market failures
Proscribes protectionist policies and corporate subsidies that protect profits at the expense of the patient (third party rationing) and the physician (price controls) as well as all other policies that add distortions to the private health care market
Eliminates the need for many middle class elderly from having to use Medicaid for long term care슈링크 효과시기
Provides incentives for all working Americans to save for health care costs for themselves and their families
Eliminates the cost shifting to the American taxpayer for unpaid for care for the currently uninsured (including illegal aliens), for the under market payments for those on Medicare, Medicaid, and now private insurance who have negotiated under market payment to hospitals
Improves our foreign trade on a macroeconomic level
Helps to deal 슈링크 후기constructively with the national debt
Will create an economic renaissance in America

Eliminates the need for multiple pricing for the same procedure Eliminates the need to negotiate under market pricing with insurance payers Eliminates third party payment Introduces direct patient payment at fair market value in full on韓国整形 the day of service by every American patient Allows the hospital to set fair market pricing autonomously in response to the true equilibrium point of the supply demand curve Eliminates all billing and collection problems Eliminates cut throat competition Hospitals will compete on the basis of how efficiently they can provide appropre care to the patient. Allows the hospital to focus on the needs of the patient and providing quality care rather than seing the patient as mere substrate who is only tolerated as long as the money keeps coming Provides incentives to eliminate “syste failure” that results in patient injury Reduces liability

What is ERISA?

The Employee Retirement Income Security Act of 1974 (ERISA) is a federal law which is primarily concerned with pension plans. However, it also sets minimum standards for many employee benefits, including employer provided health coverage.

ERISA governs approximately 2.5 million health benefit plans sponsored by private employers nationwide. It does not apply to government and church employee plans. Approximately, 134 million Americans are covered by ERISA regulated medical, surgical, hospital and other health care benefits.

What is the difference between a health insurance plan and an employer-funded health benefit plan (ERISA)?

Employee benefit plans can be either fully insured, or self-funded. (Self-funded plans may also be called self-insured or non-insured). Under a fully-insured employee benefi plan, the employer purchases commercial health coverage from an insurance company, and the insurance company assumes the risk for payment of claims. The insurance company is regulated under state law and is subject to rules about mandated benefits, network adequacy, prompt payment of claims, etc. Other employers create “self-funded” hea
th plans for their employees. In these self-funded plans, the employer keeps the risk to pay the bills and usually hires a plan administrator to process the claims. When an employer self-funds the plan, it is generally not subject to state laws and regulations — so state mandated b
enefits, state prompt payment rules or standards of network adequacy don’t apply. Sometimes insurance companies act as an administrator to process claims for an employer self-funded plan. In these circumstances and wearing the plan administrator “hat”, the health plan is not subject to state laws and regulations.

Employer self-funded ERISA plans are not subject to state insurance laws or jurisdiction. These plans are subject to federal law. What is ERISA? What is the difference between a health insurance plan and an employer-funded health benefit plan (ERISA)? What steps can I take if I am covered under an ERISA plan and my claim is denied? Who has regulatory authority for ERISA plans? What are required procedures for Employee Welfare Benefit Plans (Self-funded Plans)? What is the “summary plan description” and how does it work? Do states have the authority to regulate Employer-sponsored Self-funded Health Benefit Plans? How many people in Colorado are insured under an employer-sponsored or self-funded health benefit plan (ERISA plan)? Who can provide more information on Employer-Funded Health Benefit Plans? Colorado Division of Insurance June,
2009

If I am covered under an ERISA plan and my claim is denied, what steps can I take to resolve my claim?

If you are covered under an ERISA plan and your claim for benefits has been denied, take the following steps:

Review the summary
plan description provided by your employer or plan administrator. The summary plan description gives you a detailed summary of your plan – what benefits is provides, what limits there may be, how the plan works, etc. The summary plan description also must spell out your appeal rights and the process to follow if a claim is denied.
Make sure you or your provider has followed th
e claim submission requirements. The plan must provide a written specific explanation if a claim is denied. The plan must also outline the procedures to appeal the denial, including the required deadlines.
Contact your employers’ human resources department about the appeal. Make notes and keep copies of all communications concerning your claim, including the date, time, and who you may have spoken with.
Follow the requirements f
or the appeal and provide all required information – your provider or your employer’s human resources staff may be able to assist you with this. Generally, you must file the appeal within 60 days, and then it should be decided within another 60 days (or an extension will be requested, but the decision must be made and communicated within 120 days from the filing of the appeal).
If the plan does not follow the appeals process, contact the U.S. Department Labor Employee Benefits Security Administration (EBSA).
If you cannot get relief in any other manner, you may want to consider hiring a lawyer
Who has regulatory authority for ERISA plans?

Self-funded plans fall under the regulatory authority of the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA). ERISA protects the benefits of employees and retired employees in private-sector pension and welfare benefit plans. ERISA sets minimum standards these plans must meet, but the Department of Labor’s EBSA does not interpret plan documents or determine if individuals are entitled to benefits. States are not permitted to regulate most self-funded plans under terms of the Employee Retirement Income Security Act (ERISA). These plans are regulated by the U.S. Department of Labor.

In most cases, this means: – state insurance departments have no authority to investigate complaints that involve self-funded ERISA plans; – certain other group health plans provided by governments, churches, some school districts and out-of-state employers also are exempt from most Colorado state regulations and laws; and – state laws requiring specific benefits in health care plans (mandated health benefits) do not apply to valid self-funded ERISA plans. Federally mandated health benefits do apply.

What are required procedures for Employee Welfare Benefit Plans (Self-funded Plans)?

ERISA (Federal Law) requires that self-funded plans set up reasonable procedures for participants. These procedures, which should be outlined in the Summary Plan Description, include:

Colorado Division of Insurance June, 2009

How to file claims for benefits and a timeline (usually 90 days) for the initial response to claims to be made;

How to submit a denied claim for a full and fair review.

A list of specific additional information which may be required in order to appeal if a denial is made. The participant has at least 60 days in which to appeal the denied claim.

Once the final decision is made, the participant must be told the reason and the plan rules upon which the decision was based. However, ultimate authority rests with the employer, not with the plan administrator.

If a claim for benefits is denied, the participant must be notified in writing (generally within 90 days after the claim is filed) of the reason(s) for the denial and the specific provisions on which the denial is based. The decision, on review, must be furnished to the claimant and include reasons for the decision, and references to benefit plan documents that support a denial.

What is the “summary plan description” and how does it work?

Under ERISA, workers and their families are entitled to receive a summary plan description (SPD). The SPD is the document that gives information about the plan, what benefits are available under the plan, the rights of participant and beneficiaries under the plan, and how the plan works.

Among other information, the SPD of health plans must describe:

Cost-sharing provisions, including premiums, deductibles, coinsurance and co-payments for which the participant will be responsible
Annual or lifetime caps or other limits on benefits under the plan
The extent to which preventive services are covered under the plan
Whether existing and new drugs are covered under the plan
Whether coverage is provided for medical tests, devices and procedures
Provisions on the use of network providers, the composition of provider networks and whether coverage is provided for out-of-network services
Conditions on primary care providers or specialty care providers
Conditions or limits applicable to obtaining emergency medical care
Provisions requiring a pre-authorization or review as a condition to obtaining a benefit or service under the plan.
The Summary Plan Description must explain how benefits are obtained and the process for appealing denied benefits. ERISA requires written disclosure of any material reduction in covered services or benefits to participants and families generally within 60 days of the adoption of the change. Changes that do not result in a reduction in covered services must be disclosed not later than 210 days after the end of the plan year the change was adopted.

ERISA regulation describes the consumer’s right to get an answer regarding a health benefit claim. The regulation protects the consumer – providing for a timely response by describing the time frames for a decision, providing for a fair process by describing the standards for a decision, and providing for disclosure by describing the notice that a participant is entitled to receive from the plan.

A participant in an Employer-sponsored Self-funded Health Benefit Plan can dispute a denied claim through the company’s written procedures. If not satisfied with the outcome of the claim review, ask the plan administrator for an interpretation of the plan documents and benefits.

If a participant believes ERISA requirements or individual rights were violated under the self-funded plan, the participant may seek professional legal advice for further review.

Colorado Division of Insurance June, 2009

Do states have the authority to regulate Employer-sponsored Self-funded Health Benefit Plans?

The Colorado Division of Insurance does not have the authority to regulate other private, employer-sponsored plans that are self-funded since they are not insurance. ERISA plans are regulated at the Federal level through the U.S. Department of Labor.

States have the authority to regulate the following types of health insurance:

individually purchased insurance,
employer-based plans that are fully insured, and
Multiple Employee Welfare Arrangement (MEWAs) that are either fully-insured or self-funded.
How many people in Colorado are insured under an employer-sponsored or self-funded health benefit plan (ERISA plan)?

Since it is not a requirement to report whether or not you are insured, it is always an “educated guess” about how many people are insured. The best information available indicates that about 30 percent of all Coloradans have health benefits through an “ERISA” plan, as opposed to insurance through a health insurance company or health maintenance organization. This estimate includes all Coloradans, including those who are not insured.

Of Coloradans who have health benefits through an employer, about half are covered by ERISA plans, and the remainder by traditional health insurance (whether an employer pays part of the premium or whether an individual obtains private insurance.)

Who can provide more information on Employer-Funded Health Benefit Plans?

For more information on ERISA, call the U.S. Department of Labor at 866-4-USA-DOL.

Details on ERISA plans can be found on the Department of Labor website at: http://www.dol.gov/dol/topic/health-plans/erisa.htm

The Role of ERISA Preemption in Health Reform: Opportunities an지방이식 효과d Limits EXECUTIVE SUMMARY INTRODUCTION: The Employee Retirement Income Security Acจัดเรียงไขมันใต้ตา t (ERISA) is a federal law regulating the administration of private employer-sponsored benefits including health benefits (i.e., health insurance offered by an employer). In general, since the federal government has exercised its authority to preempt state regulation of the administration of private employer-sponsored health plans, states are blocked from enforcing laws interfering with ERISA. As many states pursue health care reform experiments, ERISA preemption becomes relevant as a potential limit on the scope and type of reforms states are able to enact. The dominant trend in ERISA litigation has been to preempt state legislat지방이식 비용ion and litigation interfering with the administration of private employer sponsored health plans, making large-scale state health care reform initiatives difficult. The purpose of this paper is to examine the trajectory of judicial interpretation of ERISA and to discuss what opportunities exist to facilitate health care initiatives given the constraints of ERISA preemption. RELEVANT LAW – ERISA PRIMER: ERISA’s Preemption Provisions ERISA’s preemption clause preempts all state laws that relate to an employee benefit plan. ERISA contains an exception to this preemption rule, referred to as the “savi지방이식 후기ngs clause,” that allows state laws to regulate the business of insurance. Finally, ERISA (through the “deemer clause”) prevents states from characterizing a self-insured plan as the business of insurance. ERISA’s Remedial Scheme Plan participants may bring a civil action under ERISA against a plan administrator who fails to comply with a request for information about the plan, to recover claimed benefits, to enforce rights under terms of the plan, or to clarify rights for future benefits. A plan participant can only recover the amount of the benefits denied. ERISA imposes a fiduciary duty on those who make discretionary decisions on behalf of the employee benefit plan. However, courts tend to be very deferential to fiduciaries. LITIGATION TRENDS: ERISA litigation takes two general forms: the first involves challenges to state regulation of health plans and insurers, and the second involves challenges to state tort lawsuits for delay or denial of health care. Though the former is more directly relevant to health care reform initiatives, courts have used the same analyses in both litigation areas. While smaller-scale state reforms may survive ERISA preemption, it is an open question as to how the Supreme Court might rule on whether ERISA preempts state pay or play laws. Challenges to State Regulation of Health Plans and Insurers State Pay or Play Laws The Fourth Circuit held that Maryland’s Wal-Mart Law was preempted because it affected only one company in the state and the law effectively forced Wal-Mart to restructure its health benefit plan to increase coverage. The Ninth Circuit held that a similar pay or play law enacted in San Francisco was not preempted by ERISA because it applied to multiple types of employers. In addition, and in part because the law applied to employers with and without ERISA plans, employers had an actual choice to either pay into county funds or offer health benefits, unlike the Maryland law. It is still an open question as to whether or not the pay or play provisions of the Massachusetts Health Care Reform Act of 2006 will be preempted. Individual Mandates Individual mandates have not yet been litigated under ERISA, but Courts are unlikely to find that individual mandates bind administrators and dictate plan choices. Smaller-scale State Health Care Regulation State laws of general applicability, such as a state law imposing hospital bill surcharges on commercial insurers, are not preempted because their effect on employee benefit plans is indirect and insubstantial. State laws that are directed at insurance and that substantially affect the pooling of risk between an insurer and insured are saved, thus not preempted. Such laws include any willing provider laws that prevent a health plan from excluding any health care provider who is willing and able to meet the terms and conditions of plan participation. Challenges to State Tort Lawsuits State laws that offer a remedy that supplants ERISA’s exclusive remedial structure, such as a breach of contract action against a managed care organization for denial of coverage or a law imposing a duty on a managed care organization to exercise ordinary care in handling coverage decisions, have generally been found to be preempted. POTENTIAL SOLUTIONS: The Supreme Court has repeatedly stated that if ERISA preemption is to change, it is Congress’ responsibility, not the Court’s, to do so. There are several ways that the federal government can act: Congressional Action Enact ERISA waivers to permit state health reform experiments. Amend ERISA to explicitly allow state-based tort litigation against managed care organizations. Regulatory Action through Executive Authority The Department of Labor (DOL) could define plan and benefit in ways that expand the relief available under ERISA’s remedial scheme in regulations. DOL could publish guidance on valid state options under ERISA. DOL could amend regulations on the fiduciary duty obligations to require plan administrators to justify a benefit denial decision with evidence-based medicine. CONCLUSION: ERISA opinions are largely impenetrable, often leading to convoluted legal doctrine. Nobody can easily predict what will be preempted. Yet, there is a certain consistency that emerges over time – the return to preemption as the default option. Given this trend, states must tread carefully in crafting health care reform initiatives that address the crisis of the uninsured without impermissibly burdening private employers’ provision of employee benefit plans.
ERISA does not require that an employer prov지방흡입 효과ide health insurance to its employees or retirees, but it regulates the operation of a health benefit plan if an employer chooses to establish one. There have been several significant amendments to ERISA concerning health benefit plans: The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) provides some employees and beneficiaries with the right to continue their coverage under an employer-sponsored group health benefit plan for a limited time the occurrence of certain events that would otherwise cause termination of such coverage, such as the loss of employment. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) prohibits a health benefit plan from refusing to cover an employee’s pre-existing medical conditions in some circumstances. It also bars health benefit plans from certain types of discrimination on t지방흡입 비용he basis of health status, genetic information, or disability. Other relevant amendments to ERISA include the Newborns’ and Mothers’ Health Protection Act, the Mental Health Parity Act, and the Women’s Health and Cancer Rights Act. During the 1990s and 2000s, many employers who promised lifetime health coverage to their retirees limited or eliminated those benefits.[1][2] ERISA does not provide for vesting of health care benefits in the way that employees become vested in their accrued pension benefits. Employees and retirees who were promised lifetime health coverage may be able to enforce those promises by suing the employer for breach of contract, or by challengin지방흡입 후기g the right of the health benefit plan to change its plan documents in order to eliminate those promised benefits.
ERISA does not require that an employer prov눈재수술 효과ide health insurance to its employees or retirees, but it regulates the operation of a health benefit plan if an employer chooses to establish one. There have been several significant amendments to ERISA concerning health benefit plans: The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) provides some employees and beneficiaries with the right to continue their coverage under an employer-sponsored group health benefit plan for a limited time the occurrence of certain events that would otherwise cause termination of such coverage, such as the loss of employment. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) prohibits a health benefit plan from refusing to cover an employee’s pre-existing medical conditions in some circumstances. It also bars health benefit plans from certain types of discrimination on t눈재수술 비용he basis of health status, genetic information, or disability. Other relevant amendments to ERISA include the Newborns’ and Mothers’ Health Protection Act, the Mental Health Parity Act, and the Women’s Health and Cancer Rights Act. During the 1990s and 2000s, many employers who promised lifetime health coverage to their retirees limited or eliminated those benefits.[1][2] ERISA does not provide for vesting of health care benefits in the way that employees become vested in their accrued pension benefits. Employees and retirees who were promised lifetime health coverage may be able to enforce those promises by suing the employer for breach of contract, or by challengin눈재수술 후기g the right of the health benefit plan to change its plan documents in order to eliminate those promised benefits.눈재수술 부작용
1. INTRODUCTION This is an introduction to the Employee Retirement Income Security Act of 1974 (“ERISA”), the리팅성형외과 law affecting employee benefits plans. 29 USC CHAPTER 18 (ERISA). Health care professionals and employees should have a basic understanding of ERISA fundamentals to understand and hopefully avoid, claims of negligent or wrongful administration of employee benefits. It will discuss the interrelationship between ERISA and various state laws relating to claims over employee benefits. It will cover the basic claims employees may make under ERISA and defenses to tho리프팅 효과se claims, with an emphasis on claims avoidance and documentation. ERISA is a complex statute and this section is intended to provide a brief overview of the law, rather than a complete reference. 2. DEFINITION OF AN EMPLOYEE BENEFIT PLAN Under ERISA, employee benefits plans include: 1) employee pension benefits plans, and; 2) employee welfare benefits plans. ERISA covers every employee benefit plan unless there is a specific exemption. a. Pension Benefit Plans–An employee pension benefit plan includes any plan, fund, or program established by an employer, union, or both that provides, by its express terms or as the result 리프팅 비용of surrounding circumstances, for a retirement income for employees or deferral of income for use after termination of employment. 29 USC Sec. 1002(2)(a). b. Welfare Benefit Plans–An employee welfare plan is any plan fund or program established by an employer, union, or both that provides a wide variety of benefits including medical, sickness, accident, unemployment, vacation, disability, day care, scholarships, training programs and prepaid legal services. 29 USC Sec. 1002(1). c. Plans that Are Excluded from ERISA–Although the definitions of pension and welfare benefit plans are broad and somewhat confusing, the general rule i민트실리프팅s that any program for the delivery of employee benefits other than wages is presumed to subject to the laws governing ERISA unless a specific exception can be found.. Benefit plans that are specifically excluded by ERISA include government plans, church plans, and plans designed to comply with state laws relating to worker’s compensation, unemployment or disability insurance. 29 USC Sec. 1003; 29 USC Sec. 1101(a). In addition, certain unfunded excess benefits plans, benefits for sick leave, and vacation pay practices are excluded from ERISA. 29 USC Sec. 1003(b); 29 USC Sec. 1002(36). In the event that an employee benefit plan is found to be excluded from ERISA, state laws will control disposition of any employee claims. 3. EMPLOYEE CLAIMS UNDER ERISA Most ERISA litigation involves benefit claims or claims of breach of fiduciary duties, though litigation has arisen challenging voluntary plan terminations of over-funded plans, terminations of under-funded plans, taxing, funding, contribution and withdrawal of plan assets리프팅 후기 . Claims relating to employee benefits that are not excluded from ERISA are often improperly brought in state courts and are therefore subject to federal preemption and removal. ERISA grants exclusive jurisdiction over claims to the federal courts, with the exception of actions to enforce the terms of the plan itself, for which state courts have concurrent jurisdiction. 29 USC Sec. 1132(e)(1); 29 USC Sec. 1132(f). Potential defendants to an ERISA action include employers, fiduciaries, trustees, administrators and the plan itself. A person is a fiduciary if he or she holds discretionary authority over the management or administration of a plan. 29 USC Sec. 1002(21)(A). A liberal approach to finding plan fiduciaries has been taken by the U.S. Supreme Court. In this regard, it is important to recognize that a benefits professional may be considered a fiduciary whether or not the plan is administered by some third party. a. Statute of Limitations–Because ERISA claims may be brought a substantial number of years after an alleged breach occurs, record keeping relating to plan management, administration and benefit denials is critical. The statute of limitations for breach of fiduciary duty claims is six years from the date of the last action which constituted a breach or six years from the latest date the fiduciary could have cured a breach of omission. If the claimant had actual knowledge of the breach, the statute of limitations runs three years from the date of the claimant had actual knowledge. In the case of fraud or concealment, the statute of limitations runs six years from the date the breach was discovered. For claims other than breach of fiduciary duty, the applicable statute of limitations depends on the most analogous state statute of limitations and, for benefits claims, begins running on the date benefits were denied. b. Remedies–ERISA provides specific remedies for plan participants and beneficiaries. Actions may be brought by: 1) participants or beneficiaries to recover benefits under the plan; 2) the Secretary of Labor or a plan participant, beneficiary or fiduciary for relief under Sections 409 or 105(C) of ERISA; 3) the Secretary of Labor or a participant, beneficiary or fiduciary to enjoin actions in violation of ERISA or the terms of the plan; or 4) the Secretary of Labor to collect civil penalties under ERISA. Successful ERISA plaintiffs may be entitled to benefits improperly denied, along with pre-judgment interest and any consequential damages. Punitive damages and damages for mental anguish are not available under ERISA, though substantial statutory attorneys fees and costs are allowed in breach of fiduciary duty actions. As noted above, the Secretary of Labor can collect civil penalties under ERISA. 29 USC Sec. 1132(g)(1). c. ERISA Preemption–Though perhaps an unintended feature of a law ostensibly designed to protect employee benefits, ERISA preempts any state law that relates to an employee benefit plan. State laws include “all laws, decisions, rules, regulations, or other State action having the effect of law.” 29 USC Sec. 1144. ERISA’s preemption clause has been broadly construed by the Supreme Court, which has found that a state law is preempted if it has a connection with or reference to an employee benefit plan. In addition to precluding state-mandated pension, health and other benefits, ERISA may even bar state law claims for which the statute itself provides no remedy. Thus state law claims for wrongful discharge, fraud and misrepresentation, breach of contract, promissory estoppel, negligence, conspiracy and certain claims under state insurance laws may be barred if they relate to an employee benefits plan. Were it not for ERISA preemption, many of these state law claims would allow for the potential imposition of punitive damages and recovery of damages for emotional distress. ERISA preemption applies only to benefits provided through an ERISA-covered employee benefits plan. Because an individual contract of employment may not be covered by ERISA, breach of such a contract may be subject to state law claims. 4. CONCLUSION ERISA is a very complex statutory scheme. Those who wish to learn more about their plans should consult the statute directly and visit with a benefits professional or an attorney.
1. INTRODUCTION Thisยกคิ้ว เกาหลี is an introduction to the Employee Retirement Income Security Act of 1974 (“ERISA”), the law affecting employee benefits plans. 29 USC CHAPTER 18 (ERISA). Health care prof입술필러 효과essionals and employees should have a basic understanding of ERISA fundamentals to understand and hopefully avoid, claims of negligent or wrongful administration of employee benefits. It will discuss the interrelationship between ERISA and various state laws relating to claims over employee benefits. It will cover theถุงใต้ตา เกาหลี basic claims employees may make under ERISA and defenses to those claims, with an emphasis on claims avoidance and documentation. ERISA is a complex statute and this section is intended to provide a brief overview of the law, rather thanเสริมจมูก เกาหลี a complete reference. 2. DEFINITION OF AN EMPLOYEE BENEFIT PLAN Under ERISA, employee benefits plans include: 1) employee pension benefits plans, and; 2) employee welfare benefits plans. ERIแก้จมูก เกาหลี SA covers every employee benefit plan unless there is a specific exemption. a. Pension Benefit Plans–An employee pension benefit plan includes any plan, fund, or program established by an employer, unioทำจมูกเกาหลีที่ไหนดี n, or both that provides, by its express terms or as the result of surrounding circumstances, for a retirement income for employees o입술필러 비용r deferral of income for use after termination of employment. 29 USC Sec. 1002(2)(a). b. Welfare Benefit Plans–An employee welfare plan is any plan fund or program established by an employer, union, or both that provides a wide variety of benefits including medical, sickness, accident, unemployment, vacation, disability, day care, scholarships, training programs and prepaid legal servicesแก้จมูกเกาหลีที่ไหนดี . 29 USC Sec. 1002(1). c. Plans that Are Excluded from ERISA–Although the definitions of pension and welfare benefit plans are broad and somewhat confusing, the general rule is that any program for the delivery of employee benefits other than wages is presumed to subject to the laws governin어린공주g ERISA unless a specific exception can be found.. Benefit plans that are specifically excluded by ERISA include government plans, church plans, and plans designed to comply with state laws relating to worker’s compensation, unemployment or disability insurance. 29 USC Sec. 1003; 29 USC Sec. 1101(a). In addition, certain unfunded excess benefits plans, benefits for sick leave, and vacation pay practices are excluded from ERISA. 29 USC Sec. 1003(b); 29 USC Sec. 1002(36). In the event that an employee benefit plan is found to be excluded from ERISA, state laws will control disposition of any employee claims. 3. EMPLOYEE CLเสริมจมูกที่ไหนดี AIMS UNDER ERISA Most ERISA litigation involves benefit claims or claims of breach of fiduciary duties, though litigation has arisen challenging voluntary plan terminations of over-funded plans, terminations of under-funded plans, taxing, funding, contribution and withdrawal of plan assets. Claims relating to employee benefits that are not excluded from ERISA are often improperly broug어린공주성형외과ht in state courts and are therefore subject to federal preemption and removal. ERISA grants exclusive jurisdiction over claims to the federal courts, with the exception of actions to enforce tราคาเสริมจมูกเกาหลี he terms of the plan itself, for which state courts have concurrent jurisdiction. 29 USC Sec. 1132(e)(1); 29 USC Sec. 1132(f). Potential defendants to an ERISA action include employers, fiduciaries, trustees, administrators and the plan itself. A person is a fiduciary if he or she holds discretionary authority over the management or administration ราคาตัดปีกจมูกเกาหลี of a plan. 29 USC Sec. 1002(21)(A). A liberal approach to finding plan fiduciaries has been taken by the U.S. Supreme Court. In this regard, it is important to recognize that a benefits professional may be considered a fiduciary whether or not the plan is administered by some third party. a. Statute of Limitations–Because ERISA claims may be brought a substantial number of years after an alleged breach occurs, record keeping relating to plan management, administration and benefit denials is critical. The statute of limitatio입술필러 후기 ns for breach of fiduciary duty claims is six years from the date of the last action which constituted a breach or six years from the latest date the fiduciary could have cured a breach of omission. If the claimant had actual knowledge of the breach, the statute of limitations runs three years from the date of the claimant had actual knowledge. In the case of fraud or concealment, the statute of limitations runs six years from the date the breach was discovered. For claims other than breach of fiduciary duty, the applicable statute of limitations depends on the most analogous state statute of limitations and, for benefits claims, begins running on the date benefits were deniตัดปีกจมูกเกาหลี ed. b. Remedies–ERISA provides specific remedies for plan participants and beneficiaries. Actions may be brought by: 1) participants or beneficiaries to recover benefits unจมูกสไตล์เกาหลี der the plan; 2) the Secretary of Labor or a plan participant, beneficiary or fiduciary for relief under Sections 409 or 105(C) of ERISA; 3) the Secretary of Labor or a participant, beneficiary or fiduciary to enjoin actions in violation of ERISA or the terms of the plan; or 4) the Secretary of Labor to เสริมจมูกแบบ Open collect civil penalties under ERISA. Successful ERISA plaintiffs may be entitled to benefits improperly denied, along with pre-judgment interest and any consequential damages. Punitive damages and damages for mental anguish are not available under ERISA, though substantial statutory attorneys fees and costs are allowed in breach of fiduciary duty actions. As nคลีนิกเสริมจมูก เกาหลี oted above, the Secretary of Labor can collect civil penalties under ERISA. 29 USC Sec. 1132(g)(1). c. ERISA Preemption–Though perhaps an unintended feature of a law ostensibly designed to protect employee benefits, ERISA preempts any state law that relates to an employee benefit plan. State laws include “all laws, decisions, rules, regulations, or other State action having the effect of law.” 29 USC Seจมูกเกาหลีธรรมชาติ c. 1144. ERISA’s preemption clause has been broadly construed by the Supreme Court, which has found that a state law is preempted if it has a connection with or reference to an employee benefit plan. In addition to precluding state-mandated pension, health and other benefits, ERISA may even bar state law claims for which the statute itself provides no remedy. Thus state law claims for wrongful รีวิวเสริมจมูกเกาหลี discharge, fraud and misrepresentation, breach of contract, promissory estoppel, negligence, conspiracy and certain claims under state insurance laws may be barred if they relate to an employee benefits plan. Were it not for ERISA preemption, many of these state law claims would allow for the potential imposition of punitive damages and recovery of damages for emotional distress. ERISA preemption applies only to benefits provided through an ERISA-covered employee benefits plan. Because an individual contract of employment may not be covered by ERISA, breach of such a contract may be subject to state law claims. 4. CONCLUSION ERISA is a very complex statutory scheme. Those who wish to learn more about their plans should consult the statute directly and visit with a benefits professional or an attorney.
Table 1 – Health Care Cost Driver Comparison Title Moral hazard (reversible) Brief Description코재수술 효과 Individuals use services the cost of which is greater than their benefit. How Driver is Currently Used Currently, insurance is designed to cover discreทำตา 2 ชั้น เกาหลี tionary and price-sensitive events. This is an inefficient incentive stemming from the government in the form of Medicare and Medicaid and private sector코재수술 비용 insurance carriers in their design of insurance financing. Patients do not have a financial incentive to remain healthy, ทำตาสองชั้น เกาหลี thereby increasing risk. Currently, insurance may require some combination of eligibility requirements, co-payments and deductibles or other provโรงพยาบาลศัลยกรรมลิงค์ isions to try and offset this moral hazard. Laws may limit the ability to do so. Deficiencies, inaccuracies and Problems with This Driver People develop manyโรงพยาบาลศัลยกรรมเกาหลี habits and lifestyles that are not healthy. They then develop many diseases that are caused by these habits which are then paid for by insurance, driving up the cost of treatment. Many Americans canno 코재수술 후기t afford deductibles and co-payments especially for non-discretionary and price insensitive events. Advantages of Eliminating this Driver with the AHCP Patients do not have to pay expensive deductibles and co-payments especially for non-discretionary and price insensitive events. The need for eligibility requirements and all othหมอเกาหลี er provisions are eliminated. Moral hazard is eliminated so there iแก้หนังตาตก เกาหลี s no need to offset it. By separating non-discretionary and price insensitive events from discretionary and price sensitive events, insurance can then lower risk and create a properศัลยกรรมเกาหลี incentive for patients to remain health, changing to more healthy lifestyles and dropping unhealthy habits. By eliminatin코재수술 부작용g insurance for discretionary and price sensitive events, the premium for insurance drops considerably. The difference in premium payment from today’sจมูกทรงเกาหลี much more expensive payment can be kept in an asset savings account (reformed HSA) and used for events which are not insurable, discretionary or price sensitive.แก้หนังตาอ่อนแรง เกาหลี Table 2 – Health Care Cost Driver Comparison Under market physician and hospital reiทรงจมูกเกาหลี mbursement (reversible) Title Under-market physician and hospital re-imbursement (reversible) Brief Description Under-market physician and hospital เอเจนซี่ศัลยกรรมเกาหลี re-imbursement increases inefficiency by providing incentives for physician-induced demand for expensive, high-tech procedures. How Driver is Currently Used Government and insurance reduce reimbursement to under market payments in an attempt to conโรงพยาบาลมาสเตอร์พีซ trol costs. This is a type of price control. Physicians have to maintain a certain income to pay for ofทำตาสองชั้นเกาหลี ที่ไหนดี? fice overhead, malpractice insurance and to derive an income that is commensurate with their degree of professional responsibility. There is thus an incentive fSLC or the physician to inappropriately use expensive high tech diagnostic and treatment options to maintain this level of income. More patients also have to be seen in a given time period, reducing the time spent with each patient. More expensive and inclusive optคลินิกศัลยกรรม ions are selected to accommodate this reduced time. Deficiencies, inaccuracies and Problems with This Driver Price controls are ineffective at maintaining low costs. More expensive, high-tech options cost more money and drive costs up. Leคลินิกเสริมจมูก ss time spent with the patient lowers quality of care. Advantages of Eliminating this Driver with the AHCP The patient will receive enough money for non-discretionary, price insensitive events to pay for all appropriate expenses arising from the insurable event atกังนัมคลินิก full, fair market value. More doctors will be able to provide optimal visit time to each patient. Full fair market payment will eliminate the necessity of inappropriately using more expensive options when less expensive options suffice. โบกี้ไลอ้อน ศัลยกรรม The need for price controls can then be eliminated. Table 3 – Health Care Cost Driver Comparison Consumer demand for expensive high tech procedures (reversible) Title Consumerโบกี้ไลอ้อน ก่อนศัลยกรรม demand for expensive high tech procedures (reversible) Brief Description Consumers demand easier and broader acceหางตาตก เกาหลี ss to care and for greater service intensity. How Driver is Currently Used Because of third party payment directly to providers, the patients have no iบาโนบากิ dea of the cost of various options. To the patient, one option is as good as the next regardless of cost. Therefore patients want the “best” option. Deficiencies, inaccuracies and Problems with This Driver โรงพยาบาลศัลยกรรมนานะ This driver results in over-consumption of needlessly expensive options by patients. This drives costs up. Advantages of Eliminating this Driver with the AHCP Results in the reduction of the inappropriate overconsumption of expensive options by patients. Patient demand โรงพยาบาลดีเอ takes cost into account, allowing for more appropriate and optimal diagnostic and treatment options, lowering costs. The patient pays for medical care and knows the actual costs. The patient perceives the HSA assets as his “money” and not someone else’s. Therefore, the patient spends the money more efficiently. Table 4—Health Care Cost Driver Comparison Growing anโรงพยาบาลศัลยกรรมไอดี d aging population (not reversible) Title Growing and aging population (not reversible) Brief Description More people consuming health care drives up the cost. Advantages of Eliminating this Driver with the AHCP This driver cannot be reversed. Table 5—Health Care Cost Driver Comparison Patient overconsumption (reversible) Title Patient overcเปิดหัวตา nsumption (reversible) Brief Description Third party payment provides incentives to patients to over-consume medicทำตาสองชั้น al services and make inappropriate visits to the doctor. How Driver is Currently Used Because of third party payment directly to providers, the patient has no idea of the cost of various options. Patients make more visits to the doctor than is optimal because theyทำตา 2 ชั้น are insured and not paying directly for their care. Since the insurance (“someone else” in the mind of the patient) is paying for their care, patients have no reason to question the appropriateness of their visits or limit the costs thereof. Deficiencies, inaccuracies and Problems with This Driver This increaหนังตาตก ses demand for limited resources, thereby driving up costs. More consumption than is optimal costs more money. Advantages of Eliminating this Driver with the AHCP Optimal use of medical services based on a more conscious interaction between patient and cost has the impact of loตาตก wering costs themselves. The patient pays for medical care for which he knows the costs and directly paying for care with money that he perceives is his, making him more sensitive to the cost of those services. Therefore, the patient spends the money more efficiently, removing unnecessary กล้ามเนื้อหนังตาอ่อนแรง spending and resource consumption. Table 6—Health Care Cost Driver Comparison Physician over-utilization (reversible) Title Physician over-utilization (reversible)ทำตา 2 ชั้นที่ไหนดี Brief Description Third party payment provides incentives to physicians to over-utilize the most expensive procedures and options. How Driver is Currently Used Because of third party payment directly to providers the patients have no idea of the cost of หางตาตก various options. Patients make more visits to the doctor than is optimal because they are insured and not paying directly for their care. Since the insurance and not they themselves who are paying for their care, patients have no reason to question the appropriateness of their visits and the options chosen by their doctor. There is an incentive for the physician to inappropriately use expensive diagnostic and treatment options to maintain income. More expensive and inclusive options are selected. Deficiencies, inaccuracies and Problems with This Driver This increases demand and, when the resources are limited, drives costs up. Inappropriatยกคิ้ว e use of expensive options costs more money. These high-tech options themselves cost more money and drive costs up. Advantages of Eliminating this Driver with the AHCP The physician has a proper incentive to provide the patient with high quality care at the lowest price because he is under the rถุงใต้ตา estraints of a budget. The more efficiently and cost-effectively he selects care for the patient, the more money the physician can make for himself. Patient-induced demand for inappropriately expensive options arเสริมจมูก e eliminated, thus lowering costs. By offering the patient options within the context of appropriate care based on their price and value, competition between options is added aแก้จมูก t the doctor/patient level, thus driving costs down. Table 7—Health Care Cost Driver Comparison Procedure-driven medicine (reversible) Title Procedure-ทำจมูก driven medicine (reversible) Brief Description Fee-for-procedure medicine ( procedure driven medicine ) and the costly infrastructure necessary to file claims and receive paทำจมูกที่ไหนดี yment How Driver is Currently Used The provider currently is paid by submitting a claim to the insurance company listing the diagnosis and procedure code with modifier code. This has led to physicians trแก้จมูกที่ไหนดี eating disease episodically with a series of unrelated procedures which may or may not be optimal for that particular patient, often by different physicians who unaware of what the other physicians are doing. A large office staff is necessary to file claims and follow up with the insurance carriers when claims aren’t paเสริมจมูกที่ไหนดี id in a timely manner. Deficiencies, inaccuracies and Problems with This Driver By designing fee-for-procedure health delivery, insurance, both public and private in the current paradigm, has created incentives in the delivery of health care that fragment that care instead of treating the patient most efficiently in a coordinatedทำจมูก ราคา fashion. This inefficiency is not cost effective, and the cost of treating the patient rises. The large office staff necessary costs money and overhead costs are high. Advantages of Eliminating this Driver with the AHCP By eliminating procedure-driven care, heaตัดปีกจมูก ราคา lth care delivery is more efficient, thus lowering health care costs. By using the protocols in the AHCP, the patient receives a budget that is appropriate to treat the patient’s episode of care. A large office staff used exclusively for claim submission and retrieval can be eliminated,ตัดปีกจมูก lowering costs for the physician and thus for his patients. Table 8—Health Care Cost Driver Comparison Opaque administrative mechanisms of managed care (reversible) Title Opaque adทรงจมูกเกาหลี ministrative mechanisms of managed care (reversible) Brief Description Managed competition involves problems of information, coordination, and incentives in the supply of clinical services. How Driver is Currently Used This provides limited consumer choice and provider coordination. There is limited consumer cost sharing. Physician group practices work best in this system, and solo practitioners are discouraged with an emphasis on large physician and hospital organizations. There is physician credentialing by the carrier. It primarily uses price controls and rationing to control costs. Competition is based on cost alone. Deficiencies, inaccuracies and Problems with This Driver Large bureaucracies require money which is taken from patient care. This is inefficient and not cost-effective. Competition based on price alone results in poor choices and money wasted. Physician credentialing eliminates competent physicians from the available work force. This increases the work load and inefficiency of those physicians selected. This increase the possibility for error and needless repetition. This drives up the costs of care. Tight provider networks and increased consumer sharing drive up costs and threaten efficiency and delivery equity. Managed care has poor incentives to control costs. Advantages of Eliminating this Driver with the AHCP Largeเสริมจมูกแบบโอเพ่น bureaucracies are replaced with software using protocols and an automated process. The AHCP offers a more transparent, flexible and personal system with no redundancy. This lowers costs and provides the proper incentives to both provider and patient. The AHCP introduces compคลีนิกเสริมจมูก etition at the physician/patient level and provides optimum incentives to lower costs. Table 9—Health Care Cost Driver Comparison Micromanagement of physicians (reversible) Title Micromanagement of physicians (reversible) Brief Description The tendency for both private and federal insurance to micromanage providers is not cost effective and drives up costs in long run. How Driver is Currently Used Large bureaucracies are necessary to micromanage individual providers according to the needs of the insurance rather than those of the patient or physician. Only a two-tiered utilization management system is permitted. Deficiencies, inaccuracies and Problems with This Driver Large bureaucracies cost money that can be better used for patient care. The use of a mandatory two-tiered system leads to an inferior and more costly situation. Advantages of Eliminating this Driver with the AHCP No bureaucracy is necessary. All costs associated with physician managทรงจมูกธรรมชาติ ment can be eliminated. The automated protocols are designed to provide each patient with the appropriate funds required by the insurable event in the most efficient and cost-effective way. Table 10—Health Care Cost Driver Comparisoรีวิวเสริมจมูก n Regulatory overgrowth (reversible) Title Regulatory overgrowth (reversible) Brief Description Administrative costs and central orทำนม ganizational overgrowth as exhibited by federal government legislation/regulations. Not just administrative cost, Morbidiเสริมหน้าอก ty claims are impacted even worse. This is interrelated to many other cost drivers such as moral hazard (tax code with premium exclusion in 1954 started over-insurance which resulted in Medicare and Medicaid, whiทำหน้าอก ch led to present price controls). How Driver is Currently Used Annually, $600 billion are spent on administration. Layers of opaque regulation are used by the government to regulate the current market. With the current insurance design, adminทำนม ราคา istrative costs are now very high, though they were initially low. Deficiencies, inaccuracies and Problems with This Driver The regulation is ineffective and expensive. Administration costs of third party payment are high because ยกกระชับหน้า of the incentives inherent in the design and the abuses that have occurred over the past forty yearsศัลยกรรมตกแต่งสะดือ . Third party payment could not contain costs as our medical knowledge/technology has exploded over the past 50 years. Advantages ofตกแต่งสะดือ ที่ไหนดี Eliminating this Driver with the AHCP The protocols of the AHCP reduce administrative costs to less than 2%. Table 11—Health Care Cost Driver Comparison Cost shifting (reversible) Title Cost shifting (reversible) Brief Description Cost shifting amonใคร เคย ศัลยกรรมสะดือ บ้าง g payers; also from government payers to private sector purchasers. How Driver is Currently Used All insurances pay under market value payments. Hospitals shift their losses to people with insurance in the form of increased premiums, and to the taxpayer in the form of increased payroll and income tax. Deficiencies, inaccuracies and Problems with แก้ไข สะดือจุ่น pantip This Driver Cost shifting subsidizes the elderly, the uninsured, the poor, and those who are underinsured in the most expensive, least cost-effective and least efficient way, inflating the overall cost of health care. Advantages of Eliminating this Driver with the AHCP Since all patients using the AHCP (or HAS) ผ่าตัดสะดือจุ่น ราคา pay full, fair market value for their care, there is no cost shifting, therefore cutting cost inflation. Table 12—Health Care Cost Driver Comparison Longer, deeper insurance underwriting cycle (reversible) ศัลยกรรมสะดือ ยันฮี Title Longer, deeper insurance underwriting cycle (reversible) Brief Description A longer and deeper insurance underwriting cycle; insurance entities raise premiums in order to restore their profitability: insurer premium “catch-up.” How Driver is Currently Used The tendency to swing between profitable and unprofitable periods over time is known as an insurance underwriting cycle. These cycles are unpredictable. This is because there is not enough data with a base of simสะดือ รูปร่าง ilar risks to accurately predict future risks and thereby minimize the effects of the cycle. The losses that result from this lack of data and risk minimization often force insurers to raise prices, thereby increasing costs. Deficiencies, inaccuracies and Problems with Thรีวิว ผ่าตัด สะดือ is Driver The boom/bust cycle causes premium rates to inflate. Advantages of Eliminating this Driver with the AHCP The AHCP produces enough data with a stable base of similar risks to accurately predict claims, thereby lowering costs. Table 13—Healสะดือสวยๆ th Care Cost Driver Comparison Inflated drug costs (reversible) Title Inflated drug costs (reversible) Brief Description Escalating prescription drug costs and over-use. How Driver is Currently Used ผ่าตัดสะดือ The government/industrial complex currently gives monopoly power to the drug industry, allowing the industry to raise profits through market manipulation. Deficiencies, inaccuracies and Problems with This Driver This behavior drives up the cost of drugs. This cost is then shifted to American citizens to make up for the shortfall due to foreign price controls. Advantages of Eliminating this Driver with the AHCP AHCP institutes a free market that keeps any one provider or factor from having exorbitant power over the health care market, thereby lowering costs. Table 14—Health Care Cost Driver Comparison Provider negotiations (reversible) Title Provider negotiations (reversible) Brief Description성형외과 진료시간 Provider negotiations with health plans for higher reimbursement. How Driver is Currently Used Hospitals and physicians are suing insurance carriers for higher reimbursement. Deficiencies, inaccuracies and Problems with This Driver This activity drives up costs to offset losses elsewhere, plus the cost of the ensuing legal fees. Advantages of Eliminating this Driver with the AHCP All providers are paid at fair market value and do have an incentive to sue. 가슴보형물 종류 Table 15—Health Health Care Cost Driver Comparison Over supply of hospital beds, high-tech equipment, and specialists (reversible) Title Over supply of hospital beds, high-tech equipment and specialists (reversible) Brief Description The oversupply of hospital beds, expensive equipment and specialists. How Driver is Currently Used There is no free market to regulate these goods and services, so hospitals pay for many more of these expensive commodities than is necessary. Deficiencies, inaccuracies and Problems with This Driver코성형 보형물 종류 This causes gross inefficiencies and cost-ineffective management. Advantages of Eliminating this Driver with the AHCP Goods and services are allocated in an efficient and cost-effective way, cutting out excess while still meeting patient and physician needs. Table 16—Health Care Cost Driver Comparison Volume of medical services (reversible) Title Volume of medical services (reversible) Brief Description The volume of medical services provided for inpatient care. How Driศัลยกรรมสะดือ ver is Currently Used There is no free market to regulate these goods and services. Deficiencies, inaccuracies and Problems with This Driver This causes gross inefficiencies and the least cost effecti코 보형물 종류 ve management because the volume is needlessly high. Advantages of Eliminating this Driver with the AHCP Goods and services are allocated in an efficient and cost effective way through cutting out unnecessary medical services. Table 17—Health Care Cost Driver Comparison Defensive medicine (reversible) Title Defensive medicine (reversible) Brief Description Defensive medicine as used by physicians to protect against malpractice suiไฮฟู่ ts. How Driver is Currently Used Physicians deviate from the most efficient and cost-effective practices of medicine to doing more procedures in order to avoid the threat of lawsuit. Deficiencies, ฟิลเลอร์ เกาหลี inaccuracies and Problems with This Driver This unnecessarily drives up the cost of health care Advantages of Eliminating this Driver with the AHCP The AHCP has incentives for both the patient and physician to diราคาโบท็อกเกาหลี scuss their options, and the choice for care is made cooperatively, decreasing physician liability. Table 18—Health Care Cost Driver Comparison End of life care (reversible) Title End of life care (reversible) Brief รีจูรัน Description Excessive and inappropriate treatment at the end of life. How Driver is Currently Used Third party payment by Medicare pays for all care no matter how inappropriate. รีจูรัน ฮีลเลอร์ Deficiencies, inaccuracies and Problems with This Driver This is inefficient and not cost effective and drives costs up, also using up medical resources. Advantages of Eliminating this Driver witultra former h the AHCP In the AHCP patients, cannot be rationed excess care by the government or insurance carriers. Only non-discretionary and price insensitive events are insurable events, so patients are financially responsible for any excess care they desire. Table 19—Heaultra former lll th Care Cost Driver Comparison Medical price inflation (reversible) Title Medical price inflation (reversible) Brief Description The medical hifu price inflation which results from a dysfunctional market and economy. How Driver is Currently Used Price insensitivity on behalf of consumers, lดูดไขมัน ck of competition, and technological complexity controls the cost of medical services. Deficiencies, inaccuracies and Problems withเติมไขมันหน้า This Driver This is inefficient and not cost effective and drives costs up Advantages of Eliminating this Driver with the AHCP In the AHCP thฉีดไขมันหน้า re is a competitive free market where innovations are used only if they are efficient and cost effective, and consumers make more informed, efficient choices. Table 20—Health Cดูดไขมันหน้าท้อง are Cost Driver Comparison Poor-quality care (reversible) Title Poor-quality care (reversible) Brief Description Poor-quality care including errors, overuse, misuse and under-use of health care services, ดูดไขมันต้นขา including avoiding sick patients, lowering staff-to-patient ratios, and the denial of care by some insurers and health plans. How Driver is Currently Used The use of third party payment, under market payment, price contrดูดไขมันเหนียง ols and rationing lead to poor incentives. Deficiencies, inaccuracies and Problems with This Driver Poor incentives translate into poor quality care. Advantages of Eliminating this Driver with the AHCP In the AHCP there is a competitive free market where negative incentives are eliminated by fดูดไขมันหน้าท้อง ราคา ull, fair market payment. Table 21—Health Care Cost Driver Comparison State insurance mandates (reversible) Title State insurance mandates (reversible) Brief Description State insurance mandates that guarantee beneดูดไขมันต้นแขน fits. How Driver is Currently Used State mandates are all related to third party payment, Deficiencies, inaccuracies and Problems with This Driver This increases costs to insurance companies and raises patient premiums. Advantages of Eliดูดไขมันที่ไหนดี minating this Driver with the AHCP The AHCP eliminates third party payment and there is no necessity for state mandates. Table 22—Health Care Cost Driver Comparison Solvency requirements (reversible) Title Solvency requirements (reversible) Brief Description State solvency requirements oversee and require health plans’ financial solvency. How Driver is Currently Used Although these State solvencies were meant to benefit consumers, they result in costs that are borne by insurers and are ultimately passed on to those consumers. Deficiencies, inaccuracies and Problems with This Driver This increases costs to insurance companies and raises patient premiums. Advantages of Eliminating this Driver with the AHCP The AHCP creates a risk stabilized market for insurance which lessens the risk of insolvency. Table 23—Health Care Cost Driver Comparison Fraud and abuse (reversible) Title Fraud and abuse (reversible) Brief Description Use of the rules and loopholes of our current finance system that uses a claim form to benefit unilaterally to increase payment beyond appropriate levels. How Driver is Currently Used Physicians notify the insurance payer and validate the fact that an insurable event has occurred in a given patient using the rules and loopholes of our current finance system that uses a claim form to benefit unilaterally to increase payment beyond appropriate levels. Deficiencies, inaccuracies and Problems with This Driver This increases costs to insurance companies and raises patient premiums. Advantages of Eliminating this Driver with the AHCP Allows physician verification that a particular insurable event has occurred without the physician being able to use the rules and loopholes of our current finance 韓國整形 林克整形醫院 林克整形外科診所 韓國美容 韓國整形診所 韓國有名整形外科 首爾醫美診所 韓國醫美 推薦韓國醫美診所 system to benefit unilaterally to increase payment beyond appropriate levels, thus preventing fraud.

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