"Rx For U S Healthcare Reform": A Proposal for a "Consumer-driven" Movement to Break the Century-Old Criminalization of Healthcare - Full Presentation

Healthcare Reform in America:
Beyond The CLOSED-FORUM in Congress

Please read our position paper at http://www.transamericanalliance.org
Copyright © 2010, Trans-American Alliance for a National Consensus
ALL RIGHTS RESERVED

The Faces of Uninsured Americans
Desperately Seeking Affordable Care

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Copyright © 2008 Michael A. Freeman
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What the “Huddled Masses” Could NOT
Get at Hospitals and Family Clinics

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NONPROFIT-based Health Insurance/Care Plans are the
BEST WAY to Reverse the Artificially High Pricing from
the Antitrust-Exempt, For-Profit Insurance Carriers
Start by Finding a LOW-COST Community Health Provider at…

Go to www.communityplans.net to find local carriers!
• AANHC represents over 30 nonprofit state/community health
plans. Visit www.nonprofithealthcare.org for a list of plans
and hyperlinks to their websites.
• 83% of nonprofit-based health plans, according to a J.D.
Powers survey1, had above-average customer satisfaction
scores — compared to a 47% satisfaction score for For-
Profit/Big Health Insurance plans.
J.D. Powers survey
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NONPROFIT-based Health Insurance/Care Plans are the
BEST WAY to Reverse the Artificially High Pricing from
the Antitrust-Exempt, For-Profit Insurance Carriers

• ACHP represents over 16 nonprofit state/community health
plans. Visit www.achp.org for a list of plans and hyperlinks to
their websites.
• 11 of 16 ACHP member community nonprofit plans ranked in
the Top-10 in each of the Commercial, Medicare and Medicaid
categories of healthcare, as measured by NCQA in 2006.*
* National Committee of Quality Assurance, in association of the U.S. News & World Report

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Low-Income Families Who Qualify for Medicaid
Coverage Can Also Find Higher Quality Coverage in
Nonprofit Community Health Plan Organizations

The Association for Community Affiliated Plans offer:
• ACAP represents 45 not-for-profit health plans in 24 states
• Six member community health organizations were voted
“America’s Best Health Insurance Plans” in an annual
ranking report completed by U.S. News & World Report and
the National Committee for Quality Assurance (NCQA)

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TANC is Now Offering a NATIONAL DATABASE
of Nonprofit Insurance Organizations

Trans-American Alliance for a National Consensus (TANC)
http://www.transamericanalliance.org

Featuring an online database/directory of over 130
Nonprofit Health Insurance Organizations to locate and
hyperlink to in your state for LOWER-COST and
BROADER COVERAGE health plans.

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“Social HMOs” are the Best-Kept Secrets as LOW-
COST Nonprofit Health Insurance for Seniors and
Exemplary Models for the Entire U.S. Population

“Medicare Advantage Prescription Drug” (MA-PD) Social HMOs:

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Congress Created & Fostered Nonprofit-
based “Social HMOs” a Quarter-Century Ago!
The creation of Social Managed Care Plans (aka “Social HMOs”) was
enacted by Congress under the Federal Deficit Reduction Act of 1984.
Although a tiny niche of the Senior health insurance system, the
handful of “Social HMOs” have been operating as a sub-classification
of the Medicare Advantage Prescription Drug (MA-PD) program —
helping to relieve Medicare of the logistical and financial costs of
managed senior care.
Among the “Social HMO” roster, leading the nonprofits is SCAN Health
Plan of Southern and Northern California, Elderplan of the 5 boroughs
of New York City and Kaiser Permanente of the Northwest (Oregon
and Washington state).

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Select SCAN Coverage Areas &
Monthly Rates/Co-Pays for Seniors
Benefits Overview
“Classic” Plan Benefits/Services In-Network “Options” Plan

$0 Per Month * Monthly Plan Premium $0 Per Month *

$5 Co-Pay Per PCP Doctor Office Visits $0 Co-Pay Per PCP
$10 Per Specialist $0 Per Specialist
$50 Co-Pay: Days 1-8
In-Patient Hospital Care $0 Co-Pay: All Days
$0 Co-Pay: Days 9-90
$0 Co-Pay Diagnostic Tests, X- $0 Co-Pay
Rays & Lab Services
$0-$5 Co-Pay on Generics Contracted Pharmacy $0-$10 Co-Pay on Generics
$28 Co-Pay Brand Drugs Prescriptions: 1-31 days $30 Co-Pay Brand Drugs
* SCAN Health Plan has a contract with Medicare to bill for the “standard” base-rate premium deduction ($96.40 per month in 2009) automatically
deducted from the individual’s Medicaid/Medicare account; additional monthly charges might be incurred, including for “Special Needs Patients.”

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Select Elderplan Coverage Areas &
Monthly Rates/Co-Pays for Seniors
Benefits Overview
“Elderplan Classic I” Plan Benefits/Services In-Network “Elderplan Classic II” Plan


$5 Co-Pay Per PCP Doctor Office Visits $0 Co-Pay Per PCP
$20 Per Specialist $0 Per Specialist
$100 Co-Pay: Days 1-7 In-Patient Hospital Care $100 Co-Pay: Days 1-7
$0 Co-Pay: Days 8-90 $0 Co-Pay: Days 8-90

$80 Co-Pay Radiology Rays & Lab Services $80 Co-Pay Radiology
$0 Co-Pay on Generics Contracted Pharmacy $0 Co-Pay on Generics
$25 Co-Pay Brand Drugs Prescriptions: 1-31 days $25 Co-Pay Brand Drugs
* Elderplan has a contract with Medicare to bill for the “standard” base-rate premium deduction ($96.40 per month in 2009) automatically deducted from
the individual’s Medicaid/Medicare account; additional monthly charges might be incurred, including for “Special Needs Patients.”

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Select Kaiser Permanente of the Northwest
(Oregon and Washington state) Coverage
Areas & Monthly Rates/Co-Pays for Seniors
Benefits Overview
“Senior Advantage Basic” Plan Benefits/Services In-Network “Senior Advantage” Plan


$30 Co-Pay Doctor Office Visits $20 Co-Pay

$250 Co-Pay: Days 1-4 In-Patient Hospital Care $200 Co-Pay: Days 1-4
$0 Co-Pay: All Other Days $0 Co-Pay: All Other Days

Rays & Lab Services
$10 Co-Pay on Generics Contracted Pharmacy $10 Co-Pay on Generics
100% Co-Pay Brand Drugs Prescriptions: 1-31 days 100% Co-Pay Brand Drugs
* Kaiser Permanente has a contract with Medicare to bill for the “standard” base-rate premium deduction ($96.40 per month in 2009) automatically
deducted from the individual’s Medicaid/Medicare account; in addition to charging additional monthly charges, including for “Special Needs Patients.”

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How SCAN Makes “Dollars and
Sense” as a Nonprofit “Social HMO”
SCAN has a contract to bill the Medicare Advantage
Prescription Drug (MA-PD) program and is reimbursed at
the $96.40 per-month/per-individual “Medicare-minimum”
base rate (normally deducted from “standard” premiums).

With SCAN serving over 110,000 Senior Citizens in Southern
California (and recently expanding into Northern California
and the Phoenix, Arizona region), Wikipedia.org estimates
SCAN earns $1.3 billion in reimbursements translating to
roughly $98.48 per-month/per-person rate — or $1,181 per-
person for a year.

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Escalating Single Individual & Family
Health Insurance Coverage Costs

Source: Kaiser Family Foundation/HRET Survey of Employer-Sponsored Health Benefits, 1999-2009

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Spiraling Worker and Employer
Insurance Contribution Costs

Source: Kaiser Family Foundation/HRET Survey of Employee-Sponsored Health Benefits, 1999-2009

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What Would NONPROFIT Health Insurance Savings
Translate to for Individuals & Employers?

Today, an overall $9,000 annual average for
Health Insurance coverage (from “individual” and
“family” premiums) to insure 160 million Americans
translates to roughly $1.4 trillion in health
insurance expenditures annually.
The $3,000 or so per-year overall premium
average with nonprofit “Social HMOs” health
insurance would conversely translate to a $480
billion annual national expenditure.
Nonprofit-only insurance would SHAVE two-thirds
off today’s $1.4 trillion in national Private/For-Profit
insurance expenditures.
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Like Consumers & Employers, the U.S.
Government is Getting HOSED, Too!

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For-Profit/Big Health Insurance’s Looting
of Medicare, Seniors & All Taxpayers!

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A Result of the “Antitrust-Exempt Status”: Half of the
States are Monopolized by 1 or 2 BIG Health Insurers

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U.S. Healthcare Spending vs. Six Other
“Developed” Nations

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U.S. Health Spending is DOUBLE and QUADRUPLE
Versus Upper- to Lower-Income Nations

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Fat Profits for “Big 6” of Health
Insurance, Even in a Down Economy

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Your Premiums Pay for These
Bloated CEO Salaries & Perks

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Big Health Insurance’s “Maximizing Profits & Minimizing
Risks” Business Model = Many Unnecessary DEATHS!

A recent Harvard Medical Study (Sept.
2009) cited 44,800 Americans unnecessarily
DIE due to inadequate or no health
insurance coverage.
In 1997, a New England Journal of Medicine
had estimated 100,000 needless American
deaths for citizens lacking quality insurance
coverage and none at all.

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“Bonuses” for Rescissions/Cancellations
of Health Insurance Policies, Yes!

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Maintaining Profits, Minimizing Risks, Inflating Prices, and
Shifting Co-Pay/Deductibles, and meeting Wall Street
Earnings/Profit Estimates – An Exploitive, Criminal Marriage

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“DENIALS” on Medical Claims: Meet Sarah Palin’s
True “Death Panels” — Big Health Insurance!

PBS’s Bill Moyers’ interview with
former CIGNA executive Wendell
Potter, a whistleblower who speaks
in detail of Big Insurance industry
Nataline Sarkisyan
practices, offered the most riveting
and shocking behind the scenes
details about CIGNA’s foot-dragging
and long-standing DENIALS on
medical claims, including the
circumstances involved with the
death of Nataline Sarkisyan.

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Even Cuts in Federal/State Medicaid
Agencies Can Lead to Policy Rescissions

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Melanie Shouse, A Healthcare Reform Advocate,
Died Denied Chemotherapy Claims by Anthem

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Of the 50 million-plus Americans* without Health
Insurance, High-Population States Hit Hardest

* Estimates of remaining uncovered Americans, based on U.S. Census Bureau data (Sept. 16, 2009), stood at 46.3 million uninsured
Americans. However, with an estimated 14,000 Americans losing coverage every day, the ongoing, most up-to-date calculations from the
Center for American Progress is that the total of uninsured Americans is around 51.5 million people as of January 9, 2010.

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Up to 70 Countries with Forms of “Universal
Healthcare” — not in the U.S. though!

Single-Payer Universal Healthcare Systems
Other, Various Forms of Universal Healthcare Systems
No Forms of Universal Healthcare or No Data Available

Universal Healthcare world map courtesy of Wikipedia.org (through December 2009)

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America’s CENTURY-LONG Struggle for a
National “Universal Healthcare” System

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Today’s Congress: A Byzantine, Arcane
Closed-Door Legislative Process On HCR

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The “Worst” Congress that Big Healthcare
and Insurance Contributions Can Buy
TOTAL HEALTH LOBBY CONTRIBUTIONS (1989-2010)

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A Befuddling Array of Congressional Healthcare
Reform Bill Proposals — All Leaving BIG HEALTH
INSURANCE’s Monopoly Intact!
“Patient Protection and Affordable Care Act” (S. 3590)
“Affordable Health Care Act” (H.R. 3962, Rep. John Dingell, D-Mich.)
“America’s Healthy Future Act” (S. 1796, Sen. Max Baucus, D-Montana)
“America’s Affordable Health Choices Act of 2009” (H.R. 3200)
“Healthy Americans Act” (S. 391, Sens. Ron Wyden, D-Oregon, Robert
Bennett, R-Utah)

“The Medicare for All Act” (H.R. 676, “Single-Payer Bill,” Rep. John
Conyers, D-Ohio)
“Access to Insurance for all Americans Act” (H.R. 3438, Rep. Darrell Issa,
R-Calif.)

“Patients’ Choice Act” (H.R. 2520, Rep. Paul Ryan, R-Wisc.)

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Two Remaining Senate & House Proposals to
be Reconciled for Congressional Passage?
Affordable Health Care for Patient Protection and
America Act (H.R. 3962): Affordable Care Act (S. 3590):
5.4% surtax on incomes over $500,000 Increases Medicare payroll tax from
for individuals and $1 million for 1.45% to 2.35% on incomes over $200,000
families. for individuals and $250,000 for families.
Public Option coverage for low-income No public option. But, Medicaid
Americans. Medicaid expanded to 150% expanded to 133% of the Federal Poverty
of the Federal Poverty Level. Level.
Single National health insurance Instead, Feds mandate newly-created
exchange with both private and Public State Insurance Exchanges to include at
Option plans; States can run their own least two “national” health plans — one
exchanges under federal guidelines. of those being a private NONPROFIT
plan.
CBO Cost Estimate: $1.050 trillion over
10 years. CBO Estimate: $871 billion over 10 years.
Proposes covering 29 to 30 million Proposes providing “loan assistance” on
Americans, but could leave over 20 health insurance policies to 31 million
million uninsured. * Americans, but no actual “Public-Option”
aid.
* Estimates of remaining uncovered Americans, based on U.S. Census Bureau data (Sept. 16, 2009), stood at 46.3 million uninsured
Americans. However, with an estimated 14,000 Americans losing coverage every day, the ongoing, most up-to-date calculations from the
Center for American Progress is that the total of uninsured Americans is around 51.5 million people as of January 9, 2010.
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Arrests of Single-Payer/Universal Healthcare
Advocates During DC’s CLOSED-FORUM Hearings

Advocates of a “Single Payer” and “Universal
Healthcare” had to make their feelings known
quickly as Sen. Max Baucus (D-MT), chairman of
Senate Finance Subcommittee holding hearings on
Healthcare Reform, had security officers quickly
escort them out due to the CLOSED-DOOR nature
of the HCR debate.
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PRIORITY: Repeal of the ANTITRUST-EXEMPT
Status for Monopolistic, Big Health Insurance
Support Congressional passage of Sen. Patrick Leahy’s (D-Vt.)
proposed bill, “The Health Insurance Industry Antitrust Enforcement
Act,” for the immediate repeal of The McCarran-Ferguson Act – a 65-
year-old “antitrust exemption” bestowed upon the Health Insurance
industry.

Central to Leahy’s bill is stripping Health Insurance and Medical
Malpractice Insurance companies of their monopoly powers
condoning “flagrant antitrust violations, including price-fixing, bid
rigging, and market allocations.”

Potentially shift or amend regulatory oversight of Health
Insurance/Medical Malpractice Insurance from state insurance
commissions to federal oversight – making sure our “elected”
representatives and the federal courts live up to their Constitutional
law obligations.

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PRIORITY: A “Consumer-Driven” Movement
Towards NONPROFIT Health Insurance
Introduction and launch of “Americans Uniting for an Independent
Nonprofit Health Insurance Exchange” as an entirely autonomous,
consumer-run, national nonprofit insurance authority.

With an online database and participation of over 150 nonprofit-based
“Health Insurance Organizations” (HIOs) across the United States, the
newly-formed Americans Uniting for Nonprofit Health Insurance
(AUNHI) association will look to be a “clearinghouse/exchange” for
LOWER-COST health insurance available to both consumers and
businesses of all sizes.

Short of the federal government agreeing to enforce Constitutional laws,
AUNHI will look to represent consumers in setting “Uniform Billing/Claims”
practices and a standardized/industry-wide “Personal Electronic Medical
Record-Keeping” system with participating Health Insurance and
Healthcare Providers.

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Two Scenarios: A Consumer/Business-Only Movement or
Consumer/Federal Government Movement
Scenario 1 — A Consumer/Business-Only Scenario 2 — A Consumer/Business and Federal
Movement for Nonprofit Health Insurance Government Union for Nonprofit Health
Organizations: Insurance:
Consumers opt for Nonprofit-based Health Consumers & businesses would be able to
Insurance by searching through an “Americans search through a federally-endorsed “Nonprofit
Uniting for an Independent Health Insurance Health Insurance Exchange
Exchange” database system. The federal government could levy a new
Locate and secure community-based nonprofit corporate surtax on “Unhealthy/Addictive
Health Insurance Organization coverage in Consumable Products” (i.e. tobacco products,
urban or rural centers around the country. fastfood chains, etc.), raising between $25-$50
billion annually to offer “Public Option”-like
Consumers and businesses would be able to subsidization of low-income Americans who
negotiate greatly discounted, “Medicare- can’t afford regular coverage.
minimum” base-rate premiums with individual
nonprofit carriers. Potentially, a 1-2% “general” surtax on all other
corporations could raise between $140 billion to
A 10-20% add-on monthly premium charge $280 billion in new tax revenues, which could be
could help to subsidize an aid program for low- utilized for the “startup” cost to create other
income, uninsured Americans to obtain new nonprofit Health Insurance Organizations
temporary, 1 year transitional term health and partially subsidize a Public Option subsidy
insurance coverage – placed under renewal plan as well.
review on a year-to-year basis.
A federal bond-issue program, under a
A set of “standardized” by-laws to be bannered “Federal Nonprofit Insurance
established between the Consumer Union and Conversion Corporation,” could also be formed
Nonprofit HIOs to establish a “Uniform Billing & temporarily to finance the “Buyback of
Claims Processing System” and potentially a outstanding public shares in the established
“Personal Electronics Medical Records” system Private/For-Profit Insurance Corporation –
with participating nonprofit HIOs and other effectively providing an avenue for Big Health
healthcare/medical providers. Insurance companies to de-list from stock
exchanges and become nonprofit orgs instead.

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Imagine the Creation of THOUSANDS of New
Nonprofit Health Insurance Administrator Jobs!
Multiplying the number of new nonprofit, “ethics-based”
Health Insurance Organizations will have many
tangible/intangible benefits for the U.S. economy.

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Leaders from All Religious Faiths Back
“Accessible” Universal Healthcare
"To be without health insurance in this country
means to be without access to medical care. But
health is not a luxury, nor should it be the
sole possession of a privileged few. We are all
created b'tzelem elohim — in the image of God —
and this makes each human life as precious as
the next. By 'pricing out' a portion of this
country's population from health care coverage,
we mock the image of God and destroy the
vessels of God's work.“ — Rabbi Alexander
Schindler, Past President, Union of American Hebrew
Congregations (1992)

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"Every person has the right to adequate health care.
This right flows from the sanctity of human life
and the dignity that belongs to all persons, who
are made in the image of God... Our call for
health care reform is rooted in the biblical call
to heal the sick and to serve 'the least of
these,' the priorities of justice and the
principle of the common good. The existing
patterns of health care in the United States do
no meet the minimal standard of social justice
and the common good." — Resolution on Health Care
Reform, U.S. Catholic Bishops, 1993.

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“The health of a society is truly measured by
the quality of its concern and care for the
health of its members... The right of every
individual to adequate health care flows from
the sanctity of human life and that dignity
belongs to all human beings... We believe
that health is a fundamental human right
which has as its prerequisites social justice
and equality and that it should be equally
available and accessible to all.” — Imam
Sa'dullah Khan, The Islamic Center of
Southern California

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“Of all forms of inequality, injustice in healthcare
is the most shocking and inhumane.” — Rev. Dr.
Martin Luther King, Jr. (1966)

"One of the central public policy questions for U.S.
citizens today is whether the richest nation on
earth will continue to allow millions of poor people
to exist without health insurance. To do so violates
biblical justice. How can any Christian read what
the Bible says about the poor and what Jesus says
about the sick without hearing a divine call to
demand that every person in this nation, starting
with the poor, have access to health insurance?" —
from "Just Generosity" by Ronald Sider, founder of
Evangelicals for Social Action

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Healthcare Reform in America:
A “Consumer-Driven” NONPROFIT Movement to Break
the Century-Old Criminalization of Healthcare

Please read our position paper at http://www.transamericanalliance.org
Copyright © 2010, Trans-American Alliance for a National Consensus
ALL RIGHTS RESERVED

"Rx For U S Healthcare Reform": A Proposal for a "Consumer-driven" Movement to Break the Century-Old Criminalization of Healthcare - Full Presentation

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"Rx For U S Healthcare Reform": A Proposal for a "Consumer-driven" Movement to Break the Century-Old Criminalization of Healthcare - Full Presentation