Health Care

Multiple single-payer HC systems are possible without politicians or insurers!

Face facts:


Neither politicians nor commercial insurance companies are indispensable in order for the public to enjoy a better quality of health care at lower costs, via locally-controlled single-payer systems!

Why possible? In addition to 20% admitted company profit, insurers pay sales commissions for people and offices; advertising/PR; 19% for "leech" consultants (CEO of an HMO); perks for executives and placers of large policies; and salaries for lawyers who try to limit or break expensive policies. Local savings can approach a 40% (yes, forty) cost savings for premiums (vs national averages), depending on the specifics within local cohorts.

If expensive policies are cancelled or persons are refused coverage or specifics ervices (pre- existing conditions, age, accidents, severe illness, etc) claims-risks are lowered and profits are raised. End-of-life choices? Are TV-program heroics needed to salve family guilt or feed fears of religion-threatened retribution to come? Prolonging death is not prolonging a liveable life!


Healthy young people must understand that a refusal to pay for insurance is their personal decision that their families, friends, and even strangers must pay for their care in case of accident. Emergency care only? Long-term care to be paid by themselves? That prospect is the purpose of insurance. The voluntarily-uninsured should expect no relief from bankruptcy--their chosen irresponsibility is not the public's choice or problem.

Insurance companies are paid for paperwork--only! They can impede--but not deliver--health care . . . yet they can control the delivery and quality level. Insurer methods and policies are at root of our non-system health care mess. Insurance is simple arithmetic averaging--until skewed by the profit motive and a corporate-hierarchy's money-first 'values.'


Those faulty motives and methods provided the framework for early self-insured groups under Obamacare; nearly all have failed already because the previously-uninsured folks claim more and immediately. Blame the faulty insurer 'equal body count' methods, not the 'cohort' concept!

Underlying the faults attributed to insurer policies is the operating insurers' assumption (for any given level of care) that any 'body' is equal to any other 'body.' Not so. Each given cohort and its own members' ages and medical history will determine the appropriate risk assessment and resulting premium to be paid by each. That fact was demonstrated when never-insured persons claimed in the first days of Obamacare and were (and might remain) sicker than the norm.


The never-insured or otherwise uninsurable persons are one cohort that will probably be sicker throughout their lives. That non-insured cohort will disappear only at death; all future births can begin with insurance. It's a bit-the-bullet problem that must be addressed before we can create a national program. Current plans for choice of covered-cohorts seems to be disgustingly political.

Yet, some politicians hope arbitrarily to eliminate millions of expensive cohorts, as determined by their commercial insurer-contributors. Who in our democracy should decide which folks are worth insuring and which are easily ignored and possibly condemned to life-long pain and suffering? Or make that decision in favor of tax cuts for the rich?


Quaint notion: "You are your brother's keeper." But, with a separation of church and state, surely that notion is not applicable to tax codes . . . . Will we hear from the religions? They could sponsor congregational cohorts for health care coverage.

A one-size-fits-all premium is possible only with a 100% 'universe.' That's possible locally via each cohort; but nationally, only with a single-payer system. Enter politicians. If tax policy is considered to be more important than human health, then the rental politicians in congress will block responsible politicians from opting for a national single-payer system. After all, political contributions are at risk for all reformers! Doesn't the Congress owe their biggest contributors?

However, multiple single-payer systems can be created via Local Wellness Co-ops of 3,000- minimum premiums-payers (statistically, it compares to the national average). Again, your particular cohort will determine local costs and premiums. Expect different cohort costs and premiums for identical care in the same area. Families and communities will provide for all. Insurers can compete with the local Co-ops if they choose to adopt more business-like profit margins and more-humane methods and policies.


If you help to create your own Local Wellness Co-op, it will become your local single-payer. It will deal with local physicians and hospitals in business-to-business negotiations for Co-op-chosen health care levels and specific elective surgeries or special services and end-of-life care. Individual electives might be offered or not by individual Co-ops. Your group will decide.


For end-of-life: TV-heroics or palliative care? Everybody can't have the most expensive version everything-unless you're willing to pay up-front! If all limitations are stated up-front, there's no need for legal battles. Those who choose to pay for exceptional prolonged care can do so. Physicians' panels can guide the decisions of distraught families.

Obviously, each Co-op will need a small office with staff plus actuarial service from a hired consultant (NOT a profit-driven, independent, one-stop enterprise). Office expense is legitimate in any system. Admitting new members from time to time? Apart from babies, if you change the make-up of your cohort significantly, be sure to recalculate risks, immediately. That might affect the cost of premiums for your member families, friends, and neighbors. Inflation will plague you're here, just as in all economic matters. Cohort really matters! Human values vs dollars- just like in the Congress.

Where will the savings come from? From not imitating insurers' 20% profit margin and abundant excess spending that's not related to health care. Accumulate some 'saved' percentage for emergencies, rather than slightly-lower premiums. Excess profit initiates the insurers' problem. Non-health, wasted spending is not needed locally. In addition, disasters do happen-and insurance companies therefore re-insure themselves via third-party insurers. A prime re-insurer is Lloyd's of London.


Additionally, the insurance companies squeeze local physicians and hospitals with flat-rates. Squeezes can result in a) insurer- refused care that's ordered by physicians; and/or b) culpable injuries (caused through dictated- reimbursement limits or mechanical or human fault). Human fault will probably never be eliminated, but should it be caused by money-first considerations.


Some insurer policies tacitly invite medical entities to hide culpable injuries if not immediately apparent. Hidden injuries create late discovery and often long-term pain and/or expense for patients. The first major study of cases (not literature) was completed over three decades ago, in California. Its uncomfortable findings are challenged by industry opinions but seem never to be disproved with facts or additional studies.

Late discovery of hidden injury creates the 'long tail' of insurance claims that insurers loudly denounce--but are in fact causing! Insurers claim that nuisance claims are the majority of legal court cases. But court cases! Admitted injuries are settled out of court, with sealed documents- you never hear of them. The really tough--but legitimate--cases produce far fewer court records.


That statistical discrepancy provides red-herring reference material when counting proportion of known injuries (estimated at about 4% of all patients) to blame nuisance court claims. Why are lawyers not penalized for bringing groundless cases? Oh-lawyers write the laws? Why not tell the truth to the public?


The Patient's Bill of Rights was an outfall from the hippy revolt of the 1960s; Holderby took the practical application of demanded Rights from the streets into the hospitals and to their professional staffs. See 'Targeted Writing'; 'Essays'; and 'Health Care' and its base buttons for two published articles plus a how-to for an employer's generic version of Local Wellness Co-ops. Don't forget to apply the caveats above.


Other sponsoring groups (communities, organizations, religions, clubs, etc) can extrapolate easily. Sponsoring groups needn't pay-just organize and launch a local office to establish local care levels and premiums and then collect premiums that pay the bills. Barring catastrophe, it's arithmetic, pure and simple. Don't muck it up with 'industry' policies and methods! Key:


'Spreading the risk' is the industry's self-protective mantra: 'Spreading the risk' also spreads the claims potential. The 3,000-minimum number allows early comparison to national claims statistics by age/condition categories when setting local premiums according to your local cohort make-up and service-level choices. No significant savings? You needn't proceed.


Ultimate mutual benefit: Compared to traditional insurers' set payments, your local health care medical and related professionals and facilities should be able to charge somewhat higher fees for their enhanced services in conference with the local Co-op offices . . . at premiums costs that are nevertheless lower for the covered Co-op members. Win/win! Will the AMA and AHA side with their patients or with the insurance companies?


Full disclosure: Richard Cavalier has absolutely no financial interest or profit motive in any Local Wellness Co-op. He works in memoriam Rev Robert A.P. Holderby, PhD, the probable source of the nation's Crisis-Intervention/Patient-Advocacy service . . .in the 1960s. The health care industry's Official Version gives credit for what are currently known as the ombudsmans programs (Scandinavian) to an unnamed nurse in an unnamed New York hospital at an unnamed date. At that low-level of importance did the health care industry then consider patients' interests.


When politicians and insurers have seen enough of a shift to Local Wellness Co-ops, maybe then the two might agree on a system that's fair to patients-at a cost that's far lower and comparable to established national programs in other countries.

Why not implement a national single-payer system now? (Added 7/17)

"MODERN HOSPITAL" "Tribune" SUNDAY Wellness Co-ops

Entire contents of the Website Copyright 2010, 2006, Richard Cavalier
Site design by: