Please vote up "The Sperry Plan" (an evolvable "single payer plan) question at: http://change.gov/page/content/openforquestions_20081217_private_url
THE SPERRY PLAN
PART OF THE ANSWER TO THE HEALTH CARE PROBLEM
(The below plan was presented to David Cutler as an evolutionary plan not a revolutionary plan. It should cover MEDICAID and should be open to anyone who doesn’t have insurance on a means basis the way the “single payer” plan is in Japan. It should also be an option for MEDICARE and anyone else. It is believed the bonuses for better care and service will provide a service that will be the most attractive to all as they see it work and as it brings its costs down.)
To obtain optimum health care for less we must change the way we buy health care. It is easy to do. All that is necessary is to stop letting the special interests control the market through fear mongering. We are the source of the money and we can decide how we want to give it over to the health care providers and insurance companies. As we decide we wish to change the way we buy health care, the health care providers will have to adapt the way they sell or get out of the health care business.
The Meat:The Sperry Plan has contract bonuses based on morbidity report line items and service satisfaction reports such that the bidder for a contract would see the bonus as the expected profit if a projected performance is met.
Endemic health problems for a bid area could be approached by providing increased bonuses on that morbidity report line item. An example of a morbidity line item and its related bonus might be .01% for meeting a minimum acceptable rate of live births.02% for achieving a national average rate of live births .02% for achieving a locally set goal of live births .02% for exceeding the locally set goal by 20%Etc.The above is picked out of the air. It would be expected that contract administrators would be able to set the bonus items somewhat scientifically on a goal achieving target basis which should be somewhat based on community input. Such items should bring more focus on the less costly preventive medicine methods of health maintenance and benefit us all with a longer life expectancy and lower cost health maintenance.
Others have been thinking along the lines of some of The Sperry Plan details.
Peter Diamond: Institute Professor, Massachusetts Institute of Technology wrote an op-ed for the New York Times in 1992 entitled “Fanny Medic”. His basic premise, we should buy health care based on where we live, is on the right track but the Sperry Plan had it first. Lemuel was promoting the better and more complete Sperry Plan in the Los Angeles area in 1991 as a potential ballot initiative but was unable to have or raise finances sufficient to get it off the ground.
The Sperry Plan buys health instead of sickness. Contracts for health maintenance would be issued by location with the consumer choosing his home zip code, his work zip code, his school zip code, or a neighboring zip code for the location of his health care.
The consumer would be able to choose his physician and hospital with in his selected area. Emergency care would be at the nearest available site with fixed day rate transfers between the provider of the care and the patients health maintenance contractor. (This charge would be similar to the fixed charges by military medical facilities for emergency care to those who would not otherwise be qualified for care at military facilities.) A patient who becomes dissatisfied with his contract area’s care should be able to change his area at will.
There would be no co-payments.
A physician’s assistant corps would be developed by methods similar to the training of Navy corpsman. The physician’s assistant corps could be reserve military and would be assigned to health maintenance contractors on request with the contractor picking up the costs of pay and benefits for the members of the physician’s assistant corps assigned to them.
The physician’s assistant corps is the backbone of the preventive medicine item of no co-pay. Physician’s assistant corps volunteers should be able to receive full scholarships to medical, nursing or medical technical school if they are mentally and physically qualified, including the pay and benefits of military academy cadets and if a slot is available. They would be required to continue to serve the corps as assigned for a minimum of say 2 years for each year of training as a means of payback.
The Sperry Plan has a contract bonus based on morbidity report line items and service satisfaction reports such that the bidder for a contract would see the bonus as the expected profit if a projected performance is met.
Endemic health problems for a bid area could be approached by providing increased bonuses on that morbidity report line item. An example of a morbidity line item and its related bonus might be .01% for meeting a minimum acceptable rate of live births.02% for achieving a national average rate of live births .02% for achieving a locally set goal of live births .02% for exceeding the locally set goal by 20%Etc.The above is picked out of the air. It would be expected that contract administrators would be able to set the bonus items somewhat scientifically on a goal achieving target basis which should be somewhat based on community input. Such items should bring more focus on the less costly preventive medicine methods of health maintenance and benefit us all with a longer life expectancy.
A percentage of the bonuses would be required to be shared with all employees on a pro-rata basis to help improve “bed side manner”.
No type of current medical provider would be blocked out of being a contractor or subcontractor. If an insurance company using fee based medicine could achieve profitable results and meet the morbidity and consumer satisfaction standards they could bid on a contract. The patient however, must be exempt from filling out claim forms other than signing a certification that the care was received. It is unlikely that an insurance company could obtain a competive basis bid contract because of their added costs of claim administration and a requirement that they pay all claims.
Anyone who is satisfied with their present medical plan would be able to continue it. Employers who provide health insurance presently would be required to maintain what they have as long as the employer cost isn’t raised and be required to add The Sperry National plan as an option.
Everyone would be required to pay Sperry Plan premiums according to their means, and other available coverage; a minimum premium for National Catastrophic incident coverage and would be transferred to The Sperry Plan on exhaustion of all other insurance benefits. In this manner The Sperry Plan would replace much of MEDICAID. Everyone would be required to be insured or post an adequate bond to assure their ability to pay for their health care out of pocket. In the event they choose to “roll the dice” and not pay for health insurance other than the means tested catastrophic fee collected with the Income Tax (MEDICAID now hidden in your tax bill), they would have to catch up all unpaid premiums from the point of their last coverage until they need insurance covered care. (Similar to what MEDICARE does now for those who elect not to have other than hospital coverage except not as onerous.)
The Sperry Plan would take all pre-existing conditions without an additional charge. Any state desiring to add their welfare recipients or other destitute residents to The Sperry Plan could do so by doing the means testing and could elect to pay the premium for such individuals.Premium collection and issuance of insured cards would be administered by the IRS while the contract auditing and oversight would be by the National Public Health Department. Local area contracts would be administered by contract administrators selected by state publically elected officials and approved by the Surgeon General of the U.S.
Prescription Drugs need to be free. We don’t want anyone to die because they can’t afford or think they have more important choices than their medication. To keep the cost down, military style pharmacies should be at all clinics. How the commercial pharmacies will be compensated for loss of business is a question? Perhaps they could bid as a subcontract for providing pharmaceutical services.
THE SPERRY PLAN is not written in stone. Let's discuss it and revise it to the point that most voters will accept it. It can be revised or repealed even after it is enacted. But let's get off the fence and do it. Just do it.
For editable copies of this blog email me at: lembray@hotmail.com
Plenty of space has been left to insert flags in the pdf file, or if you choose you can recommend changes in the word document and send which ever you use back to me. We’ll discuss the changes and up dates on the various forums for this purpose. Ultimately, I may send 2 or 3 versions to David Cutler and the institute writing the details. (I’m still hoping to be selected to be on the institute.)
My way to get an OP ED in a paper is to call the editor and see what he is looking for. That is asking them a question like this:
"I have several OP EDs from various writers I am promoting. This is a list of subjects. Would you like to see any of them?"
I want to start a personal relationship with them so that when I call and say I have something they might be interested in they will say send it and they will take a good look at it because I sent it.
I need the profiles of the writers (no matter what they are) so that I can identify them on the heading. I want the name they write under and a short statement like, “graduate of… with...” “Writes for…” or anything else they want there. Could be “rabid Obama supporter” “Citizen concerned about…” etc.
Send me an email: lembray@hotmail.com
Lem Bray
Yesterday the Canadian administration was accused in the Canadian Parliament of meddling.
Line for an email and online posts, not for an add.
"You don't suppose the Canadian administration's "bias" for NAFTA would induce the Canadian administration to try to shoot down the candidate who might change it to be less favorable to Canada do you?"
Another solution not mentioned below is that we, the other states could raise the money to hold the new primary in MI and FL.
It would show the voters that we want them in but we don't want the "big states" to destroy the opportunity for candidates who are not "pre anointed" by political bosses like the Russian Presidential Candidate, to get into the race.
It is clear we don't want to through these states to the GOP because we didn't stick up for the voters and seat their delegation.
“It's easy to understand why the state party people responsible for the move to January are digging in their heels. They feel defensive about it. For one thing, both states blew it. If they had stayed within the approved calendar, each would have voted at a critical stage in what has become the closest Democratic battle for the nomination since 1984. ”
What are the Democrats going to do about Florida and Michigan? The answer to that question could determine the party's nominee for president in August, and it could affect the fate of that nominee in November.
As it stands officially, no delegates from either state will be welcome when the party gathers in Denver in August. That is because both defied the national party and held their primaries before the first party-sanctioned date in February. They did this in frustration over the favored role granted to four smaller states that held their events in January (Iowa, New Hampshire, Nevada and South Carolina).
The confrontration between national and state parties erupted last year and has festered through a winter of malign neglect and unlucky circumstance. But two things are pretty clear now: First, the full delegations from the two states must be seated in Denver. Second, their votes for president cannot be apportioned according to the primaries they held in January.
Obviously, some may disagree with the first of these points. They may argue for the "death penalty" for both states because they defied the national party and scheduled their votes outside the calendar window as determined by the proper party authorities.
But this would be ugly and alienating within the party and make a nasty spectacle on TV for all the world to see. It would also all but doom the national ticket in both states; and while Florida may be a reach for Democrats this year, Michigan is essential to any Democratic victory scenario.
Looking at the other side, there will be those, including the senior Democratic senators from Michigan and Florida, who insist the states have done nothing to deserve punishment and ought to have their seats and be allowed to allocate their votes according to the January primaries.
Such protestations of innocence are disingenuous, to put it politely, given the two states' willful rule-breaking in their bid for greater power in the nominating process. To be sure, either Michigan or Florida would be more representative of the big states and the diversity of the Democratic party than Iowa or New Hampshire. But it's equally obvious that every other Top Ten state could say the same, and virtually all of them wanted to move up into January too. The difference was that Florida and Michigan actually did it, thumbing their noses at the rest of the country in the process.
But it's easy to understand why the state party people responsible for the January move are digging in their heels. They feel defensive about it. For one thing, both states blew it. If they had stayed within the approved calendar, each would have voted at a critical stage in what has become the closest Democratic battle for the nomination since 1984.
Beyond that, the party sanctions kept the candidates from campaigning in either state, and in Michigan all the major contenders except Hillary Clinton removed their names from the ballot. Local broadcasters and other businesses lost out on a bonanza when the campaigns in both states were cancelled.
So at this point, those responsible need to come away with something of value or risk taking the blame.
The national figures in this fiasco are also in desperate straits. If they can't reconcile the competing interests they may bruise the party's nominee and degrade its chances in November. That would always be stupid, but this year it's insane. The country has not been this ready to put the GOP out of the White House since at least 1992, when Bill Clinton won -- or 1976, when Jimmy Carter did.
Fortunately, there is a reasonable zone of compromise to be found, provided both sides of this confrontation are ready to climb down from their respective high horses.
First, the states must be assured they will not be barred. Second, their superdelegates must be told they will be seated as well, under the usual rules preserving their independence. Third, the bulk of the delegations, the pledged delegates must be apportioned according to a system acceptable to the rule-making body the states defied.
The states could hold new primaries or caucuses, although this is unlikely because it would either require Republican cooperation or cost the state parties money they don't have. It would also alienate people who don't want to have to vote a second time.
But there are still other possibilities for compromise.
One would seat the full delegations but split their votes equally between the remaining candidates. Another would apportion the delegates according to the delegate split of the other 48 states. Yet another would give Hillary Clinton whatever share she won in the two states but give all the remaining delegates to Barack Obama. That way, no one is "disenfranchised."
In any event, what is most necessary is that these two states not be allowed to both seat their delegates AND determine the party's nominee. That would not only rescind the punishment for their brazen defiance of the rules but richly reward them for it.
Notice the lead in super delegates held by Senator Clinton are the DNC largely appointed (I think) by President Clinton. The more the delegate lead in pledged delegates is built up the more "political capital" will be built up by Senator Obama and that political capital will certainly be invested in superdelegates.
Superdelegates by Position (w/o Michigan and Florida) CandidateClintonObamaGov.1011Sen.1215Rep.7269DPL104DNC13692Add-Ons01Total240192Last Updated: 3/1/2008
source: http://demconwatch.blogspot.com/2008/01/superdelegate-list.html
It should be clear to anyone of reason that to continue to enjoy a high standard of living, the United States needs to export something besides U. S. Treasurery Bills.
Don't expect simple (flat tax) (lower tax) solutions to complex problems. If managing the ecconomy were so easy a simpleton could do it we wouldn't be in the pickle were in today.
The very first "Change" most voters want is a "change" in the tone of the campaign. The old police escort shafting of candidates is out. Rove's full range of negative tactics will lose far more than they will gain in this election season.
DON'T LET THE HEAT SUCH YOU IN. If we can't win nicely, we won't win this time. The HRC campaign is living proof.
Constance B from Athens, OH In response to your request RE: my below post: mye email address is: lembray@hotmail.com I would have contacted you directly but you don't have a public profile.
I'm in Japan away from my files so I need someone who can access NIH for a copy of the KASTL REPORT on p. falciparum malaria and find a copy of the Congressional Hearing Report where it was presented during the Clinton administration to curtail "entitlements".
During the Clinton administration attempts were made to compensate veteran with cerebral malaria, aka psychotic malaria, aka p. falciparum malaria. These veterans are being treated for various "non compensable conditions" conditions and for behavioral problems instead of an "organic" problem which would change to focus of treatment to "adjusting to" instead of "overcoming".
The problem is the KASTL REPORT which was presented at a congressional hearing during the Clinton administration to deny these vets compensation. It is a research done in Vietnam in 1966 that was "peer reviewed" by researchers who were just as bad as the KASTL GROUP.
1. The control group was also diagnosed with p. falciparum malaria not an equal group of non infected persons. And the induction test scores were not used to pick "equals" or to determin outcome.
2. The findings that, after casting out equals, compared a group of 10th grade drop outs with high school graduates and decided that because the 10th grade drop outs had only a little over 1 pt higher IQ than the high school graduates, the high school graduates did not suffer any brain damage from the disease?
There are additional fallacies with the paper that can be deduced without seeing the back up data just on the face of it.
I bring this up because of Senator Clinton's repeated statements about helping vets when in fact the Clinton administration continued the Regan/Bush policy of curtailing "entitlements" through curtailing veteran compensation through every means possible.
Please understand, I have NEVER, NEVER, NEVER had p. falciparum malaria or any other species of malaria. I have a focal brain injury and noticed a lot of vets, who had malaria, in the mental health facilities over the years with the same symptoms I have but were being mistreated as having an "adjustment disorder" the way I was before I was finally diagnosed in 1985.
During the Clinton administration attempts were made to compensate veterans with cerebral malaria, aka psychotic malaria, aka p. falciparum.falciparum malaria. These veterans are being treated for various "non compensable conditions" conditions and for behavioral problems instead of an "organic" problem which would change to focus of treatment to "adjusting to" instead of "overcoming".
2. The findings, after one casts out equals, compared a group of 10th grade drop outs with high school graduates and decided that because the 10th grade drop outs had only a little over 1 pt higher IQ than the high school graduates, the high school graduates did not suffer any brain damage from the disease.
It is possible that Senator Obama will only need to double his "super delegate". (156 out of 406 unpledged, as of 02/13/2008.) (note various sites have different counts -- I'm using CNN)
3253 total pledged delegates. -1158 pledged to Obama -1016 pledged to Clinton
leaves 1079 unpledged delegates
Senator Obama needs 2025 to be nominated. Has 1158 pledged 161 Super +151 additional Super
leaves 555 to get out of 1079 or 51.28% of the pledgeable delegates.
(some of the pledgeable delegates (157) are still to be allocated from previous elections)
This is more than doable. But the more delegates gotten the harder it will be to steal the nomination.
Obviously you are not an economics major.
If you were you would know we are in the Great American Partnership. And that David R. Kamerschen, Ph.D., Professor of Economics, University of Georgia's economic analysis makes little sense.
Are you a "Flat taxer"? Did you know that Japan burst their bubble economy with a 2% raise in the consumption tax? What taxing the poor does is limit their spending. If you have to spend all you get just to keep food on the table for your kids a 2% raise in the consumption tax means you have 2% less food on the table--actually even less than that because you had a 2% increase in other costs that you cannot get less of--like rent etc.
Did you know that it was necessary for President Bush had to put some "spending money" in the pockets of those poor to get a little boost to the economy? When you shift the tax from the poor to the rich you reduce spending and consumption and thus your economy.
Everyone benefitted when AMERICORP was created and a bunch of welfare recipients were moved to workfare rolls with an increase of from $200 to $400 in thier spending capacity. You know what? They have to spend all they get just to keep from being homeless and hungary. What a boon to the economy that was.
It is simply this, it doesn't matter how much money is available to make your professors beer, if there is no money in the pockets of the consumers there will be no beer purchases. But if there is money in the pocket of a beer consumer--the beer maker will find the capital to make all the beer that can be consumed.
To quote the professor, "For those who understand, no explanation is needed.For those who do not understand, no explanation is possible."
I'm really suprised your professor has such a short understanding of macro economics!
On the issue Leo contacted me about: my worry that some Senator Obama Speech items would be something that could be traced back to health care proposals that we have authored and handed out in LA and DC which are now called THE SPERRY PLAN. (an abbreviated version with some arguments here: http://my.barackobama.com/page/community/post/lembray/CGjSd ) The primary point of our proposals have been the reduction of health care costs through the use of market forces. Presently market forces work against cost reduction and to a degree all of the consumer interests particularly in "fee based" medicine. "Buying health instead of disease" has been around as long as socialized medicine and HMO's. The problem with "buying health instead of disease" is the model. The provider can reduce his costs by reducing care. Long lines, waits etc are either market and competitively pressured into existence or pressured into existence by the competition for funding. The plan model we envision has the following features: 1. Bid base price contracts for health care for optimum size areas to maximize competition and cost reduction. Contracts would be designed to elicit bids expecting to receive 25% over base price to be profitable and a possibility of earning up to a cap %, probably a 50% bonus. 2. Bonuses for several levels of achievement on each line item on morbidity reports set up by the contracting agency. (State level or City level depending on population density) 3. Bonuses for service items. Wait time, satisfaction etc. 4. "Insurance cards" machine readable (like the present VA card) for monitoring for bonuses and for accessing online personal medical records. Could be used to control "prescription abuse". 5. A military style "medic corps" which could be assigned to providers on a need basis and partially funded by providers through pay and benefits reimbursement by providers based on use. 6. Limited compensation to consumers for untoward outcomes. Perhaps something like the present VA compensation for such items. 7. It would be optional for anyone to join except mandatory for MEDICAID. 8. To encourage joining it would have no co - payments, premiums based on "taxable income" and total assets, full catastrophic coverage. 9. There would be an optional "catastrophic coverage" available to those wishing to maintain other plans.Persons who opt out of catastrophic coverage would be subject to MEDICAID limitations to join after a catastrophic event. 10. There would be no mandated cost controls other than medical liability. The bonus system would be expected to eliminate the need for punitive liability awards. 11. All current medical industry participants would be eligible to participate. Fee based insurance companies would probably not be able to compete financially with HMO style operations but they wouldn't be locked out from bidding. I'm a little foggy today but I think I have covered most items. There are some additional features regarding bid areas to maximize competition. Most of my files are in storage in CA and I am in Japan. In any case it is better to get this off than take too much time to make it shorter and more complete. Some of these points are all ready in Senator Obama's plan and the others could easily fit into the details of the plan.
LEM
LEMUEL C. BRAY
I wish I could have gotten this out sooner. I would like to take part as much as I can from Japan in your "independent institute to determine what works in healthcare" Any one who wishes to discus health care with me can reach me at lembray@hotmail.com
McCain is saying -- the surge is working -- the political situation is resolving
The surges work's proof in pudding is when the surge is over. Did the insurgents just wait it out and regroup. They know it is a way to weedle down the U.S. 's ability to prosecute the war.
The political situation had no movement until a deadline began to appear--6 mo to 1 year after January 20, 2009.
Who knew where they would be now?
1970 < Bill and Hillary > Click and drag between < >
60s+for Obama group doesn't have a lot of posts, and is open. So until someone who has enough time to monitor it sets up a one liner group lets post there.
Please limit your posts to self explanatory one line comments for possible inclusion in speeches.
The first one is:
Would you rather have a canidate who had been vetted with a lot of negatives or one who had not been vetted because he had so few negatives to vet.
