First thing we have to do is toss out all federal poverty guidelines. They're worthless. AK and HI get regionally adjusted thresholds. The rest of us in the lower 48 get one level. Excuse me, but a family in the NY Metro area is impoverished at a higher income level than one in Lincoln, NE. Throw in the $.65 we in Jersey get back on our fed tax dollars so the folks in MS can get $2.00 for every one and tell us how our property taxes are too high and the disparities become more evident. 

Using these guidelines to means test any aid is pointless. We all need healthcare, each of us and our families, to varying degrees. Whatever it costs, we need to pay for it. So, lets put the actual costs, cleansed of profit, on the table and figure out a fair markup for all services.

Cutting insurance companies out of the mix and shifting all of our public and private premiums to a single pool for direct disbursement will conservatively yield a 20% savings. Next, put an end to hospital and pharmaceutical advertising and marketing. Reduce them to the functionaries that they should be. Tell pharma that the value of all research funding derived from tax deductible charities, public universities, outside firms, and government agencies needs to come off the pricing. Let them pay a non-recoverable license fee for every drug they want to market.

These are my opinions and may be bad ideas but Congress should be about recovering costs from the suppliers, not the people. I'll bet we could publicly fund a universal care with money we're already paying out and reduce healthcare costs by at least 30% to 40% before tackling medical practice, defensive medicine, overuse of specialists, overmedication, dental costs, and poor allocation of resources.

I advise on several health insurance boards such as [NOTE -- comment originally included a number of links to sites offering quotes on health insurance.  To avoid appearances of spam, these have been removed.  No other sentence in this comment was altered.]  I often quote the Switzerland health care system as an example of tough questions that we as a nation will have to answer someday, if we go down the path of nationalized government health care plan.  We’ll have to at some point draw the line in the sand and refuse further care for patients receiving critical illness treatments, intensive care unit, trauma care, acute management services, disease management, neonatal intensive-care unit for newborns and  seniors in extended care treatment nearing hospice stage .  Did you know that premature babies are not resuscitated upon birth if they cannot draw breath in Switzerland? Did you also know that holds true with “senior care” experiencing system failure or multiple organ failures requiring support? Another example, they don't extend the life of a senior via medical equipment such as intubation or respiration for multiple organ failures.  Not to be morbid….they are unplugged and allowed to pass.  Anyone in the business of paying claims knows that the single most expensive bill in what carriers call “shock loss” is within NICU for newborns and seniors in acute / intensive care / hospital in the last three months of life.

The Swiss apparently made decisions made based upon cost vs. quality outcome. Are we as a nation prepared to make that type of decision or to define when to incubate, resuscitate a newborn or a senior?  Are we ready to define the conditions and rules of medical procedures with organ failure?  With a litigious society I think not.  This is why we need TORT REFORM.  Without TORT REFORM medical provider costs will never drop. Liability costs with medical providers are nearly half of operating expenses.  Humana health plans state that their costs of medical liability and defensive medicine accounts for nearly 10 cents out of every premium dollar collected.  Compare that to Humana’s reported pharmaceutical claims of 15 cents out of every premium dollar collected.  Or better yet, 21 cents out of every premium dollar collected is paid back to physicians for physician treatments.  The cost of litigation is only obvious with Humana health plans. I sit on the board with several other health insurance carriers. Their books all show similar costs.  They basically insure a shrinking populace that is mostly made up of people that only buy insurance because they need it. So is mandatory participation such a bad idea?

I don't think we are hearing about TORT REFORM because most of the house and senate on the federal level are lawyers and have practicing law firm interest’s. In the healthcare system there is no total innocence. We hear about insurance executives with bonuses, doctors overbilling, hospitals overbilling because the street gang thug got dropped at their ER door with no insurance.  The lawyers are there to stir the pot and promise lavish fortune at the end of the PERCEIVED misery chain.  Am I saying we don’t need them? No, but I am saying there is clear and documented abuse of the legal system that awards outlandish claims in the millions for a questionable mistake.  Are ambulance chasers not sociably recognized as being the most abusive?  What about those that educate their clients on defraud and then use the legal system to pirate insurers?

I sure wouldn’t want to be on the receiving end of these serious decisions that we will have to make. My senator claims that the government would be held blameless but what about the medical provider that has to make the call?  What about the insurance payer that has to deny continued care for an infant that will not survive?  Without serious TORT REFORM we aren’t going to get costs down or have good people make headway.