Tag Archives: Community Clinics

Healthcare Bill Passed by the Senate Finance Committee

Senators Snowe and Baucus shake on the Americans Healthy Futures Bill

Senators Snowe and Baucus shake on the Americans Healthy Futures Bill

Today the last of the five healthcare reform bills in the US Congress was passed from committee to the floor of one of the two chambers. The Senate will have two bills endorsed by committees to consider and there will be three committee endorsed bills in the House of Representatives. Of course each of these bills will have a certain amount of powerful institutional endorsement and each will have been written so that there is something to be negotiated away. I have used this blog to promote my own ideas of a healthcare reform plan.

So, for no particular reason, instead of going over these five bills I am reprinting my plan in today’s blog post. If you like it talk to someone about it send a copy to the Congress, print it out and mail it to a friend in a relevant industry.  We could still see a plan like this plan become the law of the land.

A Dozen Policy Points on Healthcare:

1.Medicare and S-CHIP programs should be mostly preserved.  Medicaid should be reformed but not abolished.

2.  Americans should each be allowed to join three  or fewer family associations and pay in one percent of their taxable income tax with the amount of the family association deductible from the amount of each Americans tax liability. Donations to each and all of these funds should be able entitled to FDIC protection in a special class of funds and authorized to buy health insurance, get loans and make investments in a structure of options designed by the government to address the Healthcare situation. One investment which would qualify for some Federal support would be a Community Clinic.

My nieces and nephews at my  maternal grandparents home

My nieces and nephews at my maternal grandparents home

3. A National Wellness Agency should be established. One mil of all FICA revenues and  small fee of say $1.00  collected from everyone entering the United States would be devoted exclusively to this NWA. The NWA would have various chartering regimes for Community Clinics being especially generous to those already existing in getting Agency approval.

4. The NWA would have a subagency devoted to collecting, inspecting and dating unused medicines from institutions and deceased persons and would distribute them to Community Clinics.

5. Every physician who received federal financial aid would be required to spend one day for every thousand dollars of Federal loans and five days for every thousand dollars of Federal grants working for an approved Community Clinic after basic medical school graduation and before any extended residency or specialty training. The National Wellness Agency would oversee this program. 

6.  The National Wellness Agency would receive a dedicated tax of one mil of every health and life insurance premium collected in the United States. This money would largely (but not exclusively) pay for a  coordination program linking Community Clinics to  school nurses, fitness centers, foodbanks,  shelters, eldercare and daycare facilitites as well as other community institutions.

7. The Community Clinics would have hours reserved for only those invested in the clinic or owning cheap Community Clinic Insurance which would be available to all including fugitive felons and illegal aliens on confidential basis. The Community Clinics would also charge a visit fee of five dollars and a file fee of twenty dollars per year to any one able to pay and not insured. Half of one percent of the revenues of each clinic would be paid to the National Wellness Agency. Insurance would be about ten dollars per household per month and would cover clinic fees if current. 

8. The National Wellness Agency would also receive a small dedicated of perhaps one percent on all imported alcohol, tobacco, firearms and high performance recreational vehicles.   These funds would be largely dedicated to the Volunteer Support Program.  Meals and seminars would be provided where possible for Health and Medical Professionals volunteering at  Community Clinics. The Clinics would keep track of hours and the volunteers would receive a check at the end of each year for the federal minimum wage or one fifth of their normal hourly rate of pay — whichever was less.

9. The National Wellness Agency would offer a  lottery for tests, specialists and referrals for all those holding  Community Clinic Insurance.    The NWA would also interface with research institutions, charity hospitals and other players. These agencies would also be required to dedicate at least one percent of the value of Federal funds received to the network of deserving cases.

10. The National Wellness Agency would train community workers in churches, clubs and sports leagues and sponsor nutrition, hygiene and other programs. This  activity would be paid for in large part by a one mil tax on the wholesale  and a one percent tax on the retail of all  prescribed pharmaceuticals. These community workers would be trained to transport persons needing care to the Community Clinics. Clinics would work with other nonprofit organizations of all types to create medical transport with donated vehicles and other assets.

11.  Emergency Rooms and Ambulances would be required to give some triage preference to those coming from Community Clinics over those coming from the open street.

12. Corporations which sponsored a Community Clinic would receive a Wellness Program Support Package from the NWA tied to their level of support.

That is about half the operative language which I have devoted to this program. The other half of the language is just coming up below (to use an odd turn of phrase). The rest is about risk, torts, conflict and problems not with health but with the system itself.

So while I presumed to use a dozen principles to change everything in terms of laying out the new scheme I will allow myself twelve principles just for dealing with legal conflicts which arise. I propose a DOZEN LEGAL PRINCIPLES FOR THE NEW REGIME:

1. All malpractice policies and automobile liability policies and any other policies which insure against tort liability must cover any activity generally or usually  covered when it is performed by a Community Clinic or the National Wellness Agency or in collaboration with them.

2. All users of the Community Clinics will sign a liability waiver when using the program and will be limited to the maximum level of benefits on a set program of awards and benefits unless a plaintiff can show intentional tort or criminal malfeasance.

3. Workers Compensation Programs which assist in administering this liability program will qualify for discounts and special services as investors in the clinic system.

4. The National Wellness Agency shall have standing to defend any claim against a licensed Community Clinic

5. All law students receiving federal grants and loans will be required to contribute one day for every thousand dollars in loans and five days for every thousand dollars in grants after the end of their second year and before beginning a regular practice to the National Wellness Agency.  These students will assist in malpractice defense. They shall also assist the NWA in suing those who create a narrowly defined new federal Threat to Public Health. A sizable portion of the funds collected in each of these cases shall go into two dedicated funds. One shall be used to compensate those injured and the other to assist in all aspects of liability management including defense of malpractice.

6. All liability insurers for companies where the NWA maintains a wellness support program must contribute half of one percent of all premiums collected to the total liability management fund of the National Wellness Agency.

7. The National Wellness Agency shall assist in the development of safety standards and seminars for all Community Clinics.

8.  Emergency Rooms and Ambulances shall have National Wellness Agency liaison subagency that interacts them in providing quick emergency support to clinics and using clinics to better mange crises.

9. The NWA will have as part of its mission to increase the effectiveness of its partners in providing safe low level health  services as school nurses, fitness trainers and others who enhance health outside of sickcare.

10. The US military will have protocols for crisis management support with the NWA and clinics so that hospitals and other providers will not be as quickly overwhelmed by crises which arise in cities and regions. This will be secondary to their purely military missions but still mandated.

11. Hospitals shall be required to acknowledge and not undermine the work of those providing a less defensive standard of care in the Community Clinics than is to be the standard in hospitals and other institutions.

12.   All medical records of community clinics are to be capable of transmission to all other clinics through the NWA to minimize errors and risk.

San Francisco Mayor Newsom in an unrelated appearance with Former Pres. Clinton

San Francisco Mayor Newsom in an unrelated appearance with Former Pres. Clinton

 Recently on television news, I think it was on CBS Sunday Morning, I saw a special report on Mayor Newsome and the City of San Francisco and their program called Healthy San Francisco. I really felt when I watched the show that this program would be a tremendous assistance to them in trying to make their system work. It would be a real boost if it could be made to interface well with what is good in their system.They would give this national structure the right shape and flavor for San Francisco. I am sure that the members of the Senate Finance Committee also feel that their bill would assist  the best programs and initiatives in states and communities but I am skeptical about the likelihood that this will happen.

The American Impasse on Healthcare

It may well happen that the Baucus bill will pass. I am quite ready to believe that something big can happen that will create a metamorphosis of much of the status quo. But America is a very complicated place in lots of good ways. Despite all this nation’s problems there are many ways in which we excel. I also believe that we have ways of reaching for new goals that are far better than our current situation will reflect. I  lived in China and I liked it. There is a lot more diversity, federalism and tolerance in their system than a lot of people think. There is also a lot of coldblooded killing, fear and suffering in the lives of the Chinese that seldom get reported. I was not there all that long but I left behind people I really cared about and China has many problems that make me worry about those people. However, America is not like China in a whole lot of ways. All countries benefit from a certain federal impulse but not all depend upon it in the same way. For America to survive and prosper it must be pretty darn federalized,

On the surface that may seem to be an agument against establishing another agency at the national level. But the NWA would be chartered to do most of its work through a web of Community Clinics (although it would do some other things as well) and those clinics would be chartered to fit in with the laws oand cultures of States, territories, the Commonwealth of Puerto Rico and the District of Columbia. If possible it should be able to work in some good agreement with Indian Nations as well. The National Wellness Agency would help us to answer thousands of questions in different ways that reflect community standards. It would not force countless groups of people to give up huge areas of freedom and autonomy to achieve a solution everyone would have to admit is a lowest common denominator at best. We must find an American solution and I believe that my proposed solution is one in keeping with our national character.

Healthcare and The Death of Government

I am ready to accept that my point of view is very much at variance with that of almost the entire political system in the United States and much of the world. However, when I look at the several hundred pages of something Baukus will call his bill and remember that Member of Congress who held a sign reading “What Bill” as Obama addressed the nation with his plan these things make me think. My proposal for a true independent national agency supporting a web of licensed but autonomous community clinics would only require fity pages of actual legislative memoranda and most of the regulation would be in agency which should be a cabinet level position with Senate confirmation.  This would be a more constitutional approach than the proliferation unconfirmed “czars”.

Whoever you may be if you read this I am grateful. However, you are not part of a vast readership even by the most generous estimate.  The National Wellness Agency with largely independent funds would also not create entitlements. The clinic insurance would buy only a right to whatever was available at a nominal fee. The NWA would commit to supporting the clinics with whatever it did in fact have in the bank. However, because the funding should not be part of the regular budget but fixed into various transactions at low costs the NWA would always have something.

President Obama’s election was one of many disappointments to me but his policy in this case is going to be part of the continuing death of government. What was the United States government is becoming something at once too expensive and intrusive on the one hand and too weak and ineffective on the other. It still does many things well. But real political science is a bit like medicine. The sickened parts of the body politic get more attention than the healthy parts proportionately.

Overall, I am feeling personaly sad and worried about a variety of things today but healthcare debate is really adding to my glum frame of mind. Not all political debates do — many leave me feeling unaffected.

Some thoughts on healthcare….

Today I am coming back from a vacation and after canoeing, swimming, being with family and other things I am feeling a lot more healthy than I have been lately. That has me thinking about healthcare. I think that a lot of other people are probably thinking about the same topic these days.  

This Post which is a bit parable and a bit bad joke was posted  by me on Facebook on my 44th birthday on June 15, 2008.  It is meant to suggest that we take a hard look at healthcare as many are doing. It is not meant suggest any solutions in and of itself. 

It is my conclusion tthat 44 year old today enjoy many of the benefits and opportunities that 42 year old people enjoyed in my parents generation. A booming set of industries in abortion, stolen organs, cut drugs, insurance fraud, nursing home abuse and the pinching of legitimate first response and family care medical people forbodes dire things for some. But after years of careful study I feel that I have proven that because of medicine as it is, a 44 year old oday can live almost the same quality of life which a 42 year old enjoyed when my parents were that age.  As a 44 year old how can I be anything but grateful.

In our hotter world as the idealist rural practitioner finishes his seven hours of paperwork to prepare for half an hour of patient contact, he feels unhappy. Two of last week’s patients  who are admitted to the hospital received a mixture of laxatives and amphetamines when he prescribed antibiotics and the bank is foreclosing on his house. But he is being selfish. The evidence is all around him. His patients are all living people, could they be if modern medicine were not great?

As I wait to see him he is distracted by the news that the blood components he prescribed last week came from people murdered for body parts in a foreign country. However his professional limited partnership group assures him that this only happened because the regular suppy of blood components was contaminated by addicts to a new ilegal recreational drug which in turn was cut with five different poisons coming from the shadows of a new gang — possibly linked to Al Quaeda.  He tries to report his concerns to a government public health line for physicians. After five attempts he hears the voicemail explaining that health is not really public and he should seek a free market solution to his problem.  However he can call back on Tuesdays between 11:00 and 11:09 a.m.  He comes out and looks at my file and talks to the Assistant Sub Vice Advisory Practical Nurse. This country doctor and I are old friends so he actually waves his stethothoscope in my direction. I leave the pink slip to my car with his receptionist and walk to the drug store, hoping the robbery will go well and they won’t notice the name on the prescription and be able to arrest me later. I thank goodness for the advances in medical science and our increased quality of life.

The End

I have suggested a few policy points on Politico’s “Speak to Power”.  These ideas are not being considered seriously so far as I know.  However, I still believe in them and while I am sure this summary will differ from the other summary submitted to Congress it has many of the same ideals and ideas.

So…

A Dozen Policy Points on Healthcare:

1.Medicare and S-CHIP programs should be mostly preserved.  Medicaid should be reformed but not abolished.

2.  Americans should each be allowed to join three  or fewer family associations and pay in one percent of their taxable income tax dedudtibly to each and these should be able to buy health insurance, get loans and make investments in a structure designed by the government to address the Healthcare situation. One investment which would qualify for some Federal support would be a Community Clinic.

3. A National Wellness Agency should be established. One mil of all FICA revenues and  small fee of say $1.00  collected from everyone entering the United States would be devoted exclusively to this NWA. The NWA would have various chartering regimes for Community Clinics being especially generous to those already existing in getting Agency approval.

4. The NWA would have a subagency devoted to collecting, inspecting and dating unused medicines from institutions and deceased persons and would distribute them to Community Clinics.

5. Every physician who received federal financial aid would be required to spend one day for every thousand dollars of Federal loans and five days for every thousand dollars of Federal grants working for an approved Community Clinic after basic medical school graduation and before any extended residency or specialty training. The National Wellness Agency would oversee this program. 

6.  The National Wellness Agency would receive a dedicated tax of one mil of every health and life insurance premium collected in the United States. This money would largely (but not exclusively) pay for a  coordination program linking Community Clinics to  school nurses, fitness centers, foodbanks,  shelters, eldercare and daycare facilitites as well as other community institutions.

7. The Community Clinics would have hours reserved for only those invested in the clinic or owning cheap Community Clinic Insurance which would be available to all including fugitive felons and ilegal aliens on confidential basis. The Community Clinics would also charge a visit fee of five dollars and a file fee of twenty dollars per year to any one able to pay and not insured. Half of one percent of the revenues of each clinic would be paid to the National Wellness Agency. Insurance would be about ten dollars per household per month and would cover clinic fees if current. 

8. The National Wellness Agency would also receive a small dedicated of perhaps one percent on all imported alcohol, tobacco, firearms and high performance recreational vehicles.   These funds would be largely dedicated to the Volunteer Support Program.  Meals and seminars would be provided where possible for Health and Medical Professionals volunteering at  Community Clinics. The Clinics would keep track of hours and the volunteers would receive a check at the end of each year for the federal minimum wage or one fifth of their normal hourly rate of pay — whichever was less.

9. The National Wellness Agency would offer a  lottery for tests, specialists and referals for all those holding  Community Clinic insurance.    The NWA would also interface with research instituions, charity hospitals and other players. These agencies would also be required to dedicate at least one percent of the value of Federal funds received to the network of deserving cases.

10. The National Wellness Agency would train community workers in churches, clubs and sports leagues and sponsor nutrition, hygiene and other programs. This  activity would be paid for in large part by a one mil tax on the wholesale  and a one percent tax on the reatil of all  prescribed pharmaceuticals. These community workers would be trained to transport persons needing care to the Community Clinics. Clinics would work with other nonprofit organizations of all types to create medical transport with donated vehicles and other assets.

11.  Emergency Rooms and Ambulances would be required to give some triage preference to those coming from Community Clinics over those coming from the open street.

12. Corporations which sponsored a Community Clinic would receive a Wellness Program Support Package from the NWA tied to their level of support.