Well here's your silver lining: It's almost a guarantee that you have the cleanest bed sheets in you apartment complex, as I'm sure you purchase new ones on a weekly basis. Not to mention that you probably buy a new mattress every six months or so, and that says something about your financial status. With buying a new mattress that often the odds of you suffering from sleep related back pain are extremely thin. This will reduce medical visits and insurance co-pays. If ever you can talk a girl into bed, you'll have a valid excuse not to stay and cuddle. If you still feel out of place then go to the pool more often, because we all pee in the pool from time to time. :)

By James Arvantes | AAFP News Now
7/1/2008

CMS is required by law to hold Medicare claims it receives for 14 days before issuing payment on the claims. In normal circumstances, the agency starts to process claims within a few days of receiving them, paying them by the end of the 14-day time frame, Moore said. CMS now plans to hold Medicare claims for 10 business days before processing them to give Congress more time to pass Medicare payment legislation that is expected to negate a 10.6 percent payment cut effective July 1.

"CMS will use that 14-day window they have statutorily and refrain from processing the claim," Moore said. "Instead of processing (a claim) at the front end of that 14 days, they will process it 10 days later on the hope that Congress will act within the first days of July," said Moore. "Physicians should not see a delay in payment," he added.

In late June, the House overwhelming passed an 18-month Medicare physician payment bill that would have prevented the 10.6 percent reduction scheduled for the remainder of this year, along with a 5.4 percent cut scheduled for 2009. But the Senate failed to pass the legislation, allowing the 10.6 percent cut to take effect on July 1. Congress adjourned for a weeklong July 4 recess on June 27 and will return on July 7. Senate Majority Leader Harry Reid, D-Nev., in a prepared statement, said the Senate would address the Medicare legislation shortly after returning from the July 4 break.

Many physicians, meanwhile, are upset and angry, said Moore, thinking CMS will withhold Medicare payments, a perception that he characterizes as a misunderstanding.

"CMS is simply saying that they are going to take advantage of the 14-day payment floor they already have by law," Moore said. "They still intend to pay claims in a timely manner."

Although physicians will experience a reduction in their Medicare payment levels if Congress and the Bush administration cannot agree on a Medicare payment bill by mid-July, there is an expectation that they will agree on a payment bill by then and will make the legislation retroactive to July 1.

CMS has said that physicians should submit their Medicare claims for services on or after July 1 using the pre-July 1 scheduled amount. Claims submitted after June 30 that reflect the 10.6 percent reduction will be paid based on that amount, and "will likely require providers to resubmit a revised claim," said CMS in a June 30 press release.

Submitting claims with pre-July 1 amounts "will facilitate reprocessing of the claims by CMS, if needed, and will ensure that physicians are able to collect the full pre-July 1 allowed amount, when or if the cut is retroactively negated," said Moore.

However, noted Moore, "physician practices may only collect copayments and deductibles from Medicare beneficiaries based on the reduced (Medicare) rate, even if they are charging the pre-July 1 rate to Medicare."

Physician practices wishing to avoid confusion may choose to hold their Medicare claims in-house until it becomes clear that new legislation will be enacted or until cash flow becomes a problem, said Moore. "This will reduce the need for (physicians) to reconcile two payments -- the initial claim and the reprocessed claim -- and it will simplify physician billings of beneficiary co-insurance and payment calculations for payers that are secondary to Medicare," said Moore.

I am passionate about this subject because I went through this painful ordeal with the Death of my father at the end of the nursing home merry go round…. the hospice. This is America, where profits and wealth are top heavy. The top 1/5 of the America’s population’s is filthy rich, hoarding money and status and the ability to pay for health care, when their money can’t save them. When they are old and alone and near death, nothing can't save them. The trapping of the world can’t. No one can but only a caring an loving God, who teaches us to not get caught up in the trapping of this world, but to rely on Him through every event. In this world we will have trouble, but he is with us always giving us hope and love to rise above our circumstance.

The nursing Home system is a travesty. It is intertwined with the America’s Health care system and the insurance system. Nursing homes in my opinion are there for the fortunate few who need them to receive care for a short time and then they are released. I believe there is a systematic effort to encourage a gradual decline of individuals who insurance companies target as high maintenance and money drains. Insurance companies do not wish to pay for long term care so that an extra bed will be released and not taken up by a dying elderly person.

It is sickening when we have to have discussions about everyone being insured in this country, but still everyone is not insured.  Even when they are insured; the coverage is never enough and the co-pays are astronomical.    We are the richest country in the world, yet we still cannot guarantee that everyone is insured. The sad thing is, no amount of money can save you, so instead of the medical community feeling compassionate toward the elderly, they systematically find ways to hasten their death.

This is what happened to my Father. Don’t get me wrong, He was in the worst of circumstances and he was hard pressed to come through his ordeal, but the medical community could have done more to help him to survive longer. Instead they took the low road and systematically found a way to subtly kill him. I can’ t prove this; because they are masters at this, but it is the truth.

My Father had a variety of ailments that made him a walking candidate for a nursing home. He had lousy insurance, because he negotiated his insurance alone and without all his faculties, and signed up for bogus coverage that was suspect to say the least. You see Insurance companies prey on the elderly. They find independent minded elderly people and prey upon them.

They take their homes and all their money when families pressure the nursing home to give their love ones the best care possible. After the private funds of the patient runs out, then there is absolutely no money at all. If you have money when you are elderly; my advice to you is to get rid of up it quickly before you get sick and need long tern care. If you have a house and your insurance coverage runs out. The government will take your house in order to pay your medical cost. It is a travesty when the elderly, the most deserving people in this country are treated this way.

Republicans could care less about the plights of the elderly who have no health insurance or have suspect coverage. They don’t care because of one simple reason, most have enough money to pay for the best of care no matter how long it takes. So this is not a concern to them and their families.

Perhaps this country will wake up and elect into office someone who really cares about the plight of the elderly and are actually therefor them and spearhead a drive to help them. In a word that would be Obama.

]]> http://healthcarebpo.wordpress.com/?p=72 Sat, 14 Jun 2008 11:59:19 +0000 Karna http://healthcarebpo.wordpress.com/?p=72 Number of underinsured up 60% last year vs. 2003, study finds

By KRISTEN GERENCHER
June 13, 2008 3:38 p.m
Source: wsj.com - The Wall Street Journal

SAN FRANCISCO (MarketWatch) -- People without health insurance risk potential financial disaster if they should need expensive medical care, but a growing number of underinsured Americans also find themselves on shaky financial ground.

Despite the U.S. economy's growth in the last five years, the number of people with health insurance who face high out-of-pocket medical expenses relative to their incomes has risen sharply since 2003, according to a new study.

More than 25 million working-age Americans were underinsured last year, up 60% from the 16 million who had inadequate coverage in 2003, according to a report from the Commonwealth Fund, a private foundation in New York. The rate of underinsurance nearly tripled among middle- and higher-income families, those with at least $40,000 in family income.

"Lack of insurance is only one part of the problem, as even the insured have serious gaps in coverage," said Karen Davis, president of the Commonwealth Fund. "Insurance coverage is the ticket into the health-care system, but for too many, that ticket doesn't buy financial security or genuine access to care."

The upward trend in the underinsured rate reflects how much rising health-care costs have outpaced wage gains. Premiums for family coverage have jumped 78% since 2001, while wages have risen 19% and general inflation has gone up 17% in that time, according to the Kaiser Family Foundation.

Researchers considered people who had coverage all year long underinsured if they had out-of-pocket medical, prescription, dental and vision expenses that amounted to 10% or more of their total household income, or 5% if they were low income. People who had deductibles equal to or greater than 5% of their income also qualified as underinsured because of their potential financial exposure.

During 2007, 42% of adults, or 75 million people, were either uninsured or underinsured, up from one-third in 2003, according to the study of 2,616 people ages 19 to 64. It was published online Tuesday in the journal Health Affairs.

Similar patterns to uninsured

Employers burdened by rapidly rising health-care costs have been shifting more of those costs to workers or limiting benefits, the study found. The underinsured were more likely to have individual or small-group coverage, and those with employer-based health insurance were more likely to work in low-wage jobs or at small firms than their adequately insured counterparts. What's more, the underinsured were more likely to report paying high deductibles and many paid high annual premiums.

The underinsured often resembled the uninsured more so than the insured in their health-care choices and experiences. More than half of the underinsured -- 53% -- and 68% of the uninsured avoided needed care because of cost, compared with 31% of the adequately insured who went without, the study found. That includes not seeing a doctor when sick, not filling prescriptions and not getting recommended diagnostic tests or treatments.

About 45% of the underinsured reported difficulty paying medical bills, being contacted by collection agencies or changing their way of life to keep up on health-care payments, just shy of the 51% of uninsured who said the same.

In the U.S., even people with health insurance can rack up medical debt or face bankruptcy, said Cathy Schoen, senior vice president of the Commonwealth Fund. "As a nation we are losing ground. We need to move in new directions."

Leon Rousso, a certified financial planner in Ventura, Calif., who sells health insurance as part of his business, said he tries to place moderate-income people in health plans that have a sensible annual out-of-pocket maximum and reasonable coverage for their biggest potential out-of-pocket costs. Sometimes that means moving them to a higher deductible plan in exchange for lower premiums.

Of course, many people have to take whatever their employer offers them, he said.

Insured people "don't really have a lot of clout," Rousso said. "Middle to lower middle class, that's really where the vulnerable spot is. You see a lot of people who don't have a lot of money."

Those who shop for their own plan are wise to look for coverage of big-ticket items. Rousso advised focusing on financial protection for hospitalization charges and prescription drugs.

"Those are the biggest places to lose your fortune," he said. "It's all about protecting your assets."

Many of the underinsured are in scaled-down, more affordable health plans, said Nancy Davenport-Ennis, chief executive of the nonprofit Patient Advocate Foundation in Newport News, Va. The group tries to help people with chronic, debilitating and life-threatening conditions get the care they need, with 78% of its annual cases involving cancer patients.

"We actually found that an underinsured consumer has a tougher time getting to resources than a completely uninsured consumer," she said.

The underinsured are often in plans that have limits such as dollar caps on diagnoses and specific services and restrictions on the number and kind of drugs covered, which can undercut the kind of aggressive care many cancer patients count on, Davenport-Ennis said.

"In affordable plans, it's almost standard to see a cap on the number of radiation visits you can have a year - somewhere between 12 and 15 -- while most cancer therapies that have radiation as part of the treatment protocol historically require six consecutive weeks of daily treatments," she said. "If you're capped at 12, you're going to be a private-pay person for the next 18."

The Patient Advocate Foundation offers free case management for health-insurance issues of the seriously ill. Its hotline is 1-800-532-5274.

Controversy over cost controls

The U.S. spends enough on health care -- 16% of its gross domestic product -- to extend adequate health insurance to all, said Alan Sager, a health policy and management professor at Boston University's School of Public Health.

"It's something everyone wants and deserves, and crafting durably affordable health care is essential to rebuilding the economy," he said.

"If we continue to accelerate toward the cliff, we'll be spending more money on care but will have more uninsured and underinsured people, which means hospitals and doctors will work harder to overserve those of us who still have good insurance."

In Massachusetts, a statewide reform law passed in 2006 that aimed to cover all residents "took an important step" but introduced new tensions, he said, especially around politically palatable cost-control methods. Many of the ones currently in vogue in national politics as well won't do the trick, Sager said.

"The ideas that are under widespread political discussion -- electronic medical records, prevention, chronic-care case management or deinsuring patients so they will be more motivated to shop by price and quality -- none of these things will work to contain costs," Sager said. "They're all being pushed because they offer the shallow political promise of containing costs without actually disrupting business as usual in health care. Business as usual in health care means regular, large infusions of more money every year."

Still, Sager said he's optimistic that the next five years will bring major improvements in the nation's health-care system.

"We all know we're medically vulnerable because none of us is going to live forever, but as more of us realize that we're also financially vulnerable, we'll demand change and [solutions] that work financially, medically, ethically and politically."

Write to Kristen Gerencher at kgerencher@dowjones.com

State officials, hospitals and doctors are locked in a dispute over whether some patients can be charged if they are taken to an emergency room outside of their health care network. For some, that bill can be a couple of hundred dollars, but for others it can reach into the thousands.

The ban proposed by the California Department of Managed Health Care would affect members of HMOs, such as Kaiser Permanente, not members of other kinds of insurance plans. The department only regulates HMOs. Administrators and hospital-based doctors say the state should be targeting insurance companies.

Statewide, thousands of people get pressed for payment by doctors and hospitals, typically after they are taken to an emergency room outside their insurance plan. Doctors and hospitals that think health care plans and insurance companies have shortchanged them on payment for treatment then try to make up the difference by going after patients who already paid their share. It's called balance billing.

Karla and William Gledhill, of Chino Hills, understand the practice well.

The couple got hit with a $53,000 bill from Arrowhead Regional Medical Center in Colton after their insurance company, Anthem Blue Cross, paid about $25,000. Their 16-year-old son, Ryan, was flown to the hospital after a serious dirt bike crash in Lucerne Valley.

Karla Gledhill said she racked up late-payment fees and bill-collection threats as she repeatedly wrote letters and made telephone calls to the hospital and insurance company. Last week, the insurance company agreed to pay the bill.

Gledhill said she thought she would have to hire an attorney, which sometimes is a patient's only recourse, hospital officials say.

The hospital and insurance company said privacy laws prevented them from commenting on the family's claim.

"You don't know anything about balance billing until you're stuck in the middle, trying to hammer out what's right," Gledhill said.

Balance Billing

More than 1.75 million insured Californians who visited emergency rooms in the past two years were asked to pay more, even after their co-payments and deductibles, according to the California Association of Health Plans. The professional organization represents 40 health care plans that cover an estimated 21 million Californians.

The average balance bill was $300, which added up to about $528 million that patients spent in addition to their co-payments and deductibles, the association said. More than half of the patients who were balance billed paid.

"The practice needs to be banned, period," said association spokeswoman Nicole Kasabian Evans. "The patient shouldn't be placed in the middle. That's what the insurance companies and health care providers are doing."

In July 2006, Gov. Schwarzenegger ordered an end to balance billing after he realized many residents were being charged for medical expenses they didn't owe, said Cindy Ehnes, director of the state Managed Health Care Department. But the department couldn't come up with a suitable solution to HMOs and providers, she said. So, the department decided to merely ban the practice.

"We have tried many other approaches to solve this problem," Ehnes said. "We have decided to go back to our first job, which is to protect consumers."

Ehnes said she had hoped lawmakers would have passed legislation regulating balance billing. At least seven states have balance billing laws, including Colorado and Florida. Meanwhile, state Sens. Don Perata, D-Oakland, and Leland Yee, D-San Francisco, have introduced balance billing legislation.

HMO Vs. Hospital

The ban comes as Kaiser, the state's largest HMO, got a temporary restraining order earlier this month from Los Angeles County Superior Court against Prime Healthcare Services Inc., of Victorville, to stop it from collecting money from thousands of Kaiser patients or reporting them to credit agencies. A hearing is set for Thursday.

"This has been an ongoing dispute for a year or year and a half," said Dr. Ben Chu, president of Kaiser's Southern California region. "... They threatened to trash their credit ratings if they didn't pay."

Earlier this year, Prime Healthcare sued Kaiser, claiming that Kaiser owes $25 million for its patients who were treated at eight of Prime Healthcare's hospitals, including Desert Valley Hospital in Victorville, Chino Valley Medical Center and Montclair Medical Center.

Prime Healthcare attorney Michael Sarrao couldn't be reached for comment.

Prime Healthcare has accused Kaiser of delaying payments by repeatedly demanding patient medical records, claiming that care provided was unnecessary and requiring transfer of members to Kaiser hospitals.

Chu disputed the claims.

"It's not about delaying payment," he said. "It's about substantiating claims."

Calculating Health Cost

Dr. Richard Frankenstein, president of the California Medical Association, said the organization, which represents 35,000 doctors, will fight the state Managed Health Care Department's ban.

"They ought to be regulating the insurance companies, not the doctors, which it does not have the authority to do," he said. "We see this as a $500 million transfer from patients to insurance companies, and the insurance companies aren't paying the bill."

On average, Frankenstein said, insurance companies pay all but about $30 of a doctor's bill.

"If that doctor sees 50 to 60 patients, that $30 does add up," he said.

Some specialists may not work on-call emergencies if insurance companies refuse to pay and they can't bill patients, Frankenstein said.

Frank Arambula, Arrowhead Regional Medical Center's chief financial officer, said the hospital compares its costs to those of other facilities, which are reported to the California Office of Statewide Health Planning and Development. The data are posted on the agency's Web site.

"We set our rates based on market-driven prices," he said. "We think it's a fair assignment and the payer is going to pay those charges."

Conversely, insurance companies rarely show patients and health care providers how they determine what to pay for service, Arambula said.

In a written statement, Anthem Blue Cross spokeswoman Peggy Hinz said the company reimburses out-of-network hospitals for what it considers reasonable and customary costs. It is changing its reimbursement policy to protect members who require emergency care, she wrote.

"It was not the intent of our reimbursement policy to increase out of pocket expenses for our members, who do not have a choice in selecting the place where health care services are performed, such as in the case of an emergency," Hinz wrote.

Anthem Blue Cross bases its reimbursement rates on factors including submitted charges for payment, comparisons of charges for services offered at other hospitals, and service costs that are reported to the state, Hinz wrote.

Fighting the Bill

The Gledhills didn't care whether Arrowhead Regional Medical Center was in their Anthem Blue Cross preferred provider organization network. Their son needed surgery on his pancreas.

"Worst case, we thought we would owe $6,000," said Karla Gledhill, whose husband owns a small Anaheim business.

Anthem Blue Cross first determined the Gledhills owed the hospital $53,273.17 after it paid $25,121.28, according to a claim recap. It paid another $12,606.15 after Karla Gledhill complained to the California Department of Insurance.

The Gledhills still faced a $40,667.12 bill and no explanation of how Anthem Blue Cross determined what it would pay.

"How could I fight a fair fight if I didn't have all the information?" Karla Gledhill asked. "I didn't think Arrowhead's charges were exorbitant for the care my son received."

On May 21, Anthem agreed to pay the rest of Ryan Gledhill's hospital bill after the company "made a one time administrative decision to remit payment," according to the letter the Gledhills received.

The letter did not include further explanation, and Hinz said privacy laws prevented her from offering one.

Reach Lora Hines at 951-368-9444 or lhines@PE.com

Gotcha #5 - "My local hospital was in the network when I first enrolled so I'm sure it's still on the PPO list"

Don't bother going back and digging up your PPO (Preferred Provider Organization) directory.  That list was actually outdated the day it was printed!  Being out-of-network is similar to handing the hospital administrator your checkbook and allowing him to bill you whatever he wants.  We have seen 80% or more of the original charges be discounted because the facility was in the PPO network.  There are constant fluctuations with physicians and hospitals moving in and out of PPO networks.  Today the only way to get real-time PPO participation is to look up the network online.  Most insurance cards will show the provider network name or website.  When I travel out of town, I print a PPO network for the city I am traveling just to be safe. 

Gotcha #4 - "I've had the same insurance company for my auto, home, and life.  They have always paid well so their health insurance should be fine also."

We all know the jack-of-all-trades story line.  Just because their auto insurance paid for your fender bender doesn't mean their health insurance will cover a $940 per week prescription drug to fight cancer.  You should search for an independent health insurance agent that represents many different insurance companies and is familiar with the pre-existing condition limitations and underwriting criteria.  It is difficult for an insurance agent that offers many different lines of insurance to remain up-to-date with the changing health insurance landscape.

Gotcha #3 - "A guy I work with recommended this company.  He's had them for years."

Ask your friend if he has had any claims, and if so, how big were they.  There are many inferior health insurance plans being renewed year after year simply because the insured has never had any real large claim experience.  If they are limited benefit plans they have internal limitations that can have severe consequences.  Some common health insurance policy limitations are annual maximums for prescription drugs or outpatient treatment (some "saver" plans exclude these altogether!) and daily maximums for chemotherapy, hospital room charges & intensive care.  I recommend comprehensive major medical plans that include inpatient, outpatient, physician visits, and outpatient prescription drug coverage.  These should all count together towards a large lifetime maximum of at least $2 million (I personally own a $5 million plan).

Gotcha #2 - "My employer group plan has got to be better and less expensive than an individual health insurance policy."

Not so fast!  That depends on how much your employer contributes.  Since group health insurance plans require the employer to pay at least half of the employee's health insurance cost, it is very rare for an employee to be able to purchase an individual plan on their own for less.  The additional family members are a different story.  Most employers pay little or none of the additional family monthly premium.  We often see healthy families paying $500 to $900 per month to get a spouse and/or children covered on the group plan.  With HSA qualified plans (Wow!  This is the first time I mentioned Health Savings Accounts this whole post!), we can sometimes cut this cost in half leaving the other half to deposit in the HSA.  This premium savings can be enough to fully fund the family out-of-pocket maximum within 12 to 24 months! 

Gotcha #1 - "The plan with the lowest deductible and lowest co-pays is the best plan!"

If your family had to choose between 2 plans from the same insurance company using the same PPO network, the first plan has a $0 deductible 80/20 co-insurance plan with co-pays for physician visits and prescription drugs at monthly cost of $900, the second plan is an HSA qualified plan with a family calendar year deductible of $5000 and 100% co-insurance that includes all physician visits, prescription drugs, inpatient and outpatient hospital charges at a monthly cost of $450 per month, which would you choose? 

Let's do the math:  $900 - $450 = $450 per month premium savings x 12 months = $5400 in premium savings to offset a true "out-of-pocket maximum" of $5000 for the HSA qualified plan.  Tough decision here... With the $900 per month plan, you still have to come up with additional money out of your pocket to pay the co-pays and co-insurance.  With the HSA plan, you would have the entire deductible available in your HSA within the first year.   You should still allocate $900 per month for your health care, but give $450 per month to the insurance company and put the other $450 into your HSA account.   You get a tax deduction for every dollar you deposit.  It pays you interest tax free.  Withdrawals can be made at any time tax free for eligible medical expenses.  There is no other savings vehicle that is tax free at both ends.

The beauty of an HSA is that if you don't spend your HSA dollars, YOU KEEP IT!  Unspent balances roll over year to year (not like an FSA or section 125 which are use-it-or-lose-it). 

Just how much money could you be saving with an HSA qualified plan?  Now you can find out!  We utilize unique technology that allows real-time highly competitive HSA qualified health insurance quoting and enrolling online.
  
The ultimate "Gotcha" is paying too much for health insurance.

Do the math...

Get an HSA!

Apparently American health insurance companies, in their infinite wisdom and compassion, have started adjusting their co-payment system (whereby the insured person pays for part of the cost of their prescription drugs) from flat fees – say $20 or $50 a prescription to percentages. Like, 25% or 30%, or more. Not, of course, for cheap, bog standard antibiotics (there’s no money to be made there, they’re in the public domain) but for exorbitantly expensive new drugs “used to treat diseases that may be fairly common, including multiple sclerosis, rheumatoid arthritis, hemophilia [sic], hepatitis C and some cancers.” Diseases, in other words, that are chronic, devastating and require indefinite treatment.

Usually with drugs which, as the IHT blandly reports for which“[there are] no cheaper equivalents… so patients are forced to pay the price or do without.” Think about that for a minute. This isn’t your usual, boring petty larceny on the part of the insurance companies. This is blackmail on a ferociously ambitious scale. It’s conspiracy to commit grievous bodily harm. It’s attempted manslaughter (if you, the jury, are feeling generous).

They’re not just randomly jacking up the prices for everyone. The insurance companies, surely in collusion with the pharmaceutical companies, are methodically working out what drugs people literally cannot live without and which – because the pharmaceutical companies have cowed the government into ridiculously favourable intellectual property laws – there is no alterative supply for, and unapologetically telling them: your money or your life.

It would be more honest, and probably kinder, if they went round a cancer patient’s house and held a gun to their head. At least then if they couldn’t afford to pay out the end would be quick and painless.

The insurance companies are trying to use the paper-thin justification that by making the sickest people pay the most they are “holding down premiums” for people who aren’t sick – in itself, a breathtaking display of doublethink. People who aren’t sick aren’t going to be paying for prescription drugs anyway, so whether they pay a fixed fee out of zero dollars or 30% out of zero dollars it makes no odds.

Effectively, this new system benefits no-one (except the insurance companies) and flattens already struggling, vulnerable people with the financial equivalent of a cartoon anvil. Only there’s nothing funny about this. There’s nothing funny about having to choose between paying your rent or taking the drugs that will stop you bleeding to death from a bad cut, or having your muscles waste away.

The best bit? Private health insurance companies can “legally change their coverage to one in which some drugs are Tier 4 [the new, percentage co-payment] with no advance notice.” If Kafka were writing today he’d be a reporter, not a novelist.

Posted: 4/9/08

If you have health insurance you ought to know what "balance billing" is. Balance billing and the ongoing attempts to outlaw it directly determine how much you pay for medical services.

Typically, if you have medical insurance (say, Kaiser Permanente), your provider will pay any medical fees above your standard co-payment. If Kaiser, however, only pays a standard allotment of $500 for a service a physician would normally charge $750 for (say, an emergency cardiac bypass), the doctor or hospital might send the patient a bill for the missing $250.

What this means for the average consumer is that not only do they have to pay their co-payment, they may receive a second bill for the remaining amount the insurance chose not to pay. Governor Arnold Schwarzenegger supports a bill that would outlaw balance billing.

The less money you have to pay the better, right?

Wrong. The legislation is blatantly unjust; worse, it undermines the foundation of free enterprise that our economy is built upon.

Think about it - when you sign up with an HMO like Kaiser, you agree to pay a standard fee monthly in exchange for a guarantee of financial aid if you need serious medical care.

In return, Kaiser receives monthly income and negotiates flat rates for services with a pool of physicians; those physicians give up the right to charge their own price in exchange for guaranteed business from Kaiser customers.

But if you, as a Kaiser customer, are brought to the ER for emergency surgery, there are no guarantees that the surgeon working is a Kaiser-approved doctor. If that surgeon saves your life, should he or she be forced to accept whatever percentage of the standard rate Kaiser chooses to pay him or her for the service? He does not receive the benefits of being a member of the Kaiser family; why should he be forced to abide by their restrictions?

Essentially, passing this bill destroys the basis of our capitalist economy in favor of a more socialist system in which the government regulates our freedom to spend and charge what we think is fair. By eliminating the practice of balance billing, Schwarzenegger forces all doctors to accept whatever healthcare providers think is fair payment.

Even worse, it makes the entire system of licensed physicians meaningless. A doctor who agrees to accept Kaiser's rates does so in exchange for receiving more business from the company. In essence, what he loses in individual sales he more than makes up for in volume.

If all physicians are limited to collecting only what Kaiser chooses to pay, why bother contracting with doctors in the first place?

Kaiser can pay a doctor whatever they believe they can get away with, and the physician has no choice but to take what he is given.

By removing a practitioner's ability to charge what he thinks is adequate for his services the government is sullying the principles on which this country was founded.

Though this legislation seems to benefit the consumer, in the end only the corporation wins.

My purpose, of course, was to ascertain why he decided to switch parties, and whether he truly holds Libertarian views as opposed to only conveniently holding libertarian views in order to get the LP nomination. I quickly discovered that his most basic belief, which he has provably held for over 30 years, is thoroughly libertarian: the right of the American people to bypass and even overturn Congress and the President, when those elected officials act in contradiction to the will of the people.

Senator Gravel believes that "the American people are not empowered to do anything, and this is wrong." He therefore believes Americans should have the ability to directly make laws through federal ballot initiatives. At present, many states allow citizens to present laws directly through initiatives which, if supported widely enough, will be placed on the ballot to potentially become law; an example of this is Proposition 215, which legalized medical marijuana in California. Senator Gravel believes citizens should be able to do the same thing on the federal level, under his National Initiative For Democracy.

The government is a tool, the people can use it. But if the people have the direct power to use it, then you're going to see the government as a real tool, not the tool you have when the special interests determine how the tool of government is handled, by the lobbyists, who pay for the campaigns, who manipulate you to vote for them. That's the process that has to change.

When he says that the government has the duty to release information to the public, so they can make sound decisions, he is not blowing smoke, nor is he promoting something he hasn't already done himself. During the Vietnam War, Senator Gravel released the Pentagon Papers, reading thousands of pages into the Congressional Record, so that Americans would finally know the truth behind that war; and his defiance, by informing Americans of information which was previously viewed as classified, was a pivotal moment in American history.

Under his National Initiative For Democracy we, as citizens, could end the war, end the federal income tax, or pass a federal law allowing Americans to carry guns openly; we could make any law we want, as long as there is sufficient citizen support for it. Senator Gravel says that "the real power in this country does not lie with the leadership, with Congress or with the President; it lies with you, the American citizen". This program would in fact become an important part of the checks and balances system, which Senator Gravel believes should have been in force from the beginning, so citizens could more easily keep Congress and the President in check.

Of course, when he was running for President in the Democratic Party, the Democrats weren't very happy with that idea. I asked the Senator whether they oppose it because it threatens their power, or if they oppose it because they believe the average American is unable to make sound legislative decisions. He immediately replied, "Both." He went on to explain that "the average person in Congress believes they are more intelligent than the average American, and there are a few in Congress who are very intelligent; but at the same time the average American is smarter than the average Congressman, and perfectly capable of making sound decisions."

His suspicion of the leading presidential candidates was made clear when he said, "Don't trust anyone who says they have all the answers. Nobody has all the answers; I don't have all the answers. But the American public knows what is best for them, and I trust them to make those decisions."

Talking war with Senator Gravel, for someone my age who lived during Vietnam, is like getting into a time machine, and going back to the last destructive war this country faced, when he forced a filibuster to end the draft, and thus end the Vietnam war. Senator Gravel was a maverick, and he defied Congress again and again.

As you may recall, even before we sent troops to Iraq, he warned the American public that there were no WMDs in Iraq. I asked him why, in his opinion, President Bush lied about the presence of WMDs. "Oil. He wanted to get control of the oil, and it's all just more American imperialism and the military-industrial complex." He went a step further, and agreed that Bush and Cheney should not only be impeached, but that they should face trial for war crimes. "Americans must stop thinking we're above the law," he stated. He believes that the United States should stop getting involved in foreign conflicts altogether, and "stop being the world's policeman".

Senator Gravel is completely against the War on Drugs, which he categorizes as a failure. "We spend 50 to 85 billion dollars a year on a drug war that does no good to anybody other than criminalizing people who shouldn't be criminals. We have 2.3 million people in jail right now, and half of them shouldn't even be in jail .... if you want marijuana, why not go to a package store? A fifth of gin will do more damage to you, to your health, than will a pack of marijuana. As for the rest of the drugs, why not legalize them and regulate them? We put addicts in jail when they aren't criminals, but there they learn to be better criminals, to steal and commit crime to feed their habit. It's a public health problem, and we need to solve it as a public health problem, and save all this money we're spending to keep people in jail for drugs, $30,000 a year for each of them."

He is therefore in support of decriminalizing and regulating all drugs. "If you need to get some coke, go to a doctor and get a prescription. If you're an addict, you'll have to register so we can help you. But the way we do it now, we catch you with drugs, we throw you in jail, and you don't get any help."

With regard to whether legalizing all drugs would increase addiction, he states, "That's what they told us about alcohol, during Prohibition. Alcohol is more addictive than marijuana. Should you go to jail for having marijuana, when you don't go to jail for having whiskey and alcohol? It's a stupid policy, it's gutless, and it's damaging our inner cities. Seventy percent of the people in jail are African-Americans, and most of it is for drugs. It's gutless on the part of our leaders to not solve this, to not treat it as a public health problem rather than a criminal problem ..... For those who say we have a drug problem, yeah, we have a problem, and it's with stupidity at the highest levels of our government."

As for those in prison for drug offenses, he would educate nonviolent drug offenders - whether it's a college degree or technical training - then grant them a full pardon so they can not only be released from prison, but also have the tools they need to immediately become fully productive members of society.

He is for Second Amendment rights, saying "I have a weapon, and I'll fight to keep it." Insofar as how openly Americans should be able to carry weapons, he referred me back to the federal ballot initiative, saying that the American people should decide that issue.

When I asked him about reducing the size of government as well as its spending, he agreed that it has gotten completely out of hand, and that severe cutbacks should be made. The first steps would be dismantling the IRS (which would no longer be needed with his national sales tax program), and the "War On Drugs" arm of the DEA (since all drugs would be legalized). He also believes that "if we empower the people to make laws, they will shrink the government."

I could actually hear the thrill in his voice when one question pointed out that libertarians are, by and large, for open borders. He believes that we have so many illegal immigrants here because our own laws caused them to not have work available in their own country; he states that 1.3 million farming jobs were lost in Mexico when NAFTA was passed. For that reason, he believes repealing NAFTA would cure most of the illegal immigration, as more jobs are created in their home countries. As for those who are already here and don't want to leave, he wants to simply "put them on the path to citizenship." He believes that we should create completely open borders, similar to what is in place in Europe, whereby citizens could cross into or from Canada or Mexico, with no questions asked.

It is undeniable that the federal government is deeply in debt, and must raise revenue. Senator Gravel, however, is opposed to the income tax, since it over-taxes the poor and middle-class, and grossly undertaxes the wealthy. He therefore proposes dismantling the IRS altogether. He would replace the income tax with a 23% sales tax, and give a rebate each month to every American family to pay for necessities. Senator Gravel believes that this would allow the poor and middle class, who spend mostly on necessities such as food and housing, to have far more disposable income. He believes this program will create the same amount of federal revenue, but in a manner which is far more fair to the poor and working class.

"I don't know whether it's a step to end taxation, but at this point it is a good way to fund needed revenue. Right now we tax income and investments, and investment income is taxed at a lower rate than income. We don't tax the wealthy, and that's what's wrong with our system." He again reiterated that the American people could make the final decision regarding whether federal taxation should eventually end, through his ballot initiative program.

Senator Gravel believes that Social Security funds should be left alone, rather than used by the government for other purposes as is now the norm. At this point, most Americans have already paid into Social Security. He wants everyone's Social Security funds invested in the free market, and he wants everyone to get an accounting of their money and interest earned, just as if they had invested it with a bank; and if they die before spending what they have invested and earned, he believes that the surplus in their Social Security account should go to their heirs.

As for private investments, he believes his sales tax program with refunds for necessities will give the average American the additional funds needed to save in an IRA or other investment vehicle, as additional retirement savings to supplement what they have already put into Social Security.

He is aware that many libertarians are against Universal Health Care, but believes his plan will meet libertarian standards. He came up with the idea of a Healthcare Security System 30 years ago. Senator Gravel pointed out that he knows the healthcare system "up front and personal". One year, he ended up with over $150,000 in healthcare costs, and went bankrupt as a result.

He believes the Democratic health care plan, wherein businesses are forced to provide health insurance for their employees, is "the wrong way to go, because it is not the responsibility of businesses to provide healthcare; their job is to be competitive in the global marketplace." So instead, he wants to enact a Universal Single Payor Voucher plan, similar to the plan which the Veterans Administration has in place. Every American would be given a health care voucher. The vouchers would have a very modest co-pay, and a very modest deductible. Americans would have their choice of hospitals, their choice of doctors, and a choice of five or six plans. There would be no exclusions for preexisting conditions.

He doesn't think we need to raise taxes in order to provide health care for all Americans; we just need to make our healthcare system considerably more efficient than it is at present. He believes that if we computerize healthcare records, it will streamline the system, because he says 30% of healthcare cost is in paperwork. He intends to provide every American with basic healthcare services, and if they want more or different coverage, they can choose to buy additional or supplemental plans in the free market.

He is aware of Ron Paul's belief that the Federal Reserve is responsible for the inflationary effects which are harmful to poor and middle-class Americans. Senator Gravel wants to reexamine the Federal Reserve, and study the gold standard with an eye toward a global monetary system, which will better protect the value of our money in a global marketplace.

Senator Gravel was pivotal in shepherding the Alaska Pipeline though Congress, but at this point he would oppose any effort to drill for oil in the Alaskan Wildlife Preserve. He states that instead, he wants us to end our dependence upon oil within five years. His goal would be to replace oil with alternative energy sources.

I asked Senator Gravel if there was any one moment - a light bulb moment, if you will - in which he realized that he was a libertarian. He stated, "Not really. It's an awareness that goes back 30, 40 years, that the best way to to change things was from inside, within the power structure. Now, it's time for a change. I am joining the Libertarian Party to become its presidential nominee. I can take the Libertarian Party to a level they've never been before. I am against war, I am against taxing income, I am against the war on drugs. I am for smaller government, open borders, and the ability of the American people to self-govern. I am a libertarian. I scored seven out of seven on Reason's "Seven Ways To Win Votes" - I am for internet gambling, for medical marijuana (but I go much further than that, by decriminalizing all drugs) .... so I'm more libertarian than Ron Paul, because he scored lower. And I will work very hard as the Libertarian Party's candidate, I will get the libertarians the national playing field they need to grow. And not just libertarians, either. I will raise the playing field for all third parties."

All in all, Senator Gravel impressed me as sincere, intelligent, and passionate about libertarian issues. I did not at all get the impression that he is a pseudo-libertarian; I think he's the real deal, because his actions even decades ago indicated that he is a libertarian. He left the Democratic Party because he realized that they are not receptive to his ballot initiative plan, and are not in agreement with his healthcare plan, his opposition to the War on Drugs, and many other issues. He has the presence, he has the speaking ability and dynamic personality, and he has the name recognition and contacts to place us on a more even playing field.

The Democrats' loss may very well be our gain.

Senator Gravel suggested that those interested in more information about his views read his book "Citizen Power: A Mandate For Change", which can be ordered online here. It is also available on Amazon.com, but their new book price is actually several dollars higher than the price on his website. Amazon's description of the book is as follows.

As author of Citizen Power in 1971, Senator Mike Gravel determined that much of what he wrote then is apropos in America today; hence, the release of Citizen Power: A Mandate for Change that reflects the accuracy of his evaluation of problems then, his current position on a number of issues facing America now, and the process that Americans can undertake to become empowered as lawmakers in partnership with their elected officials. Most chapters of Citizen Power: A Mandate for Change present material from the original book, as well as new information and revised positions. The exceptions are Chapter 2: The National Initiative, and Chapter 7: The War on Drugs. All other chapters cover similar topics in both books, but with the senator's fresh insights for today's world. Each chapter ends with how the National Initiative, once enacted, could help solve the problems presented in that chapter. The Table of Contents is as follows: Chapter 1 - Now It's the Citizen's Turn Chapter 2 - The National Initiative Chapter 3 - America's Failure in Education Chapter 4 - Tax Reform - The Fair Tax Chapter 5 - The Health Security System Chapter 6 - National Environmental & Energy Policy Chapter 7 - The War on Drugs Chapter 8 - Crime & Punishment Chapter 9 - The Shroud of Secrecy Chapter 10 - American Imperialism Chapter 11 - Global Governance Chapter 12 - Who Stole the American Dream?

All three customer reviews give the book five stars. There is a "look inside the book" feature, and based on that material and given that it was originally written in 1971, then updated recently, I don't think there is any real question whether Senator Gravel is a libertarian. Based upon his statements in that book, it appears that he was a libertarian even before there was a Libertarian Party.

Here are the reviews:

It's all about lawmaking!,

February 25, 2008

By	Goodrich (Dearborn, MI USA) - See all my reviews

Those who still want Mike Gravel's original Citizen Power, but can't afford to pay over $200 for the few rare copies that are available, will be pleased with the new Citizen Power: A Mandate for Change. In some chapters, Senator Gravel has incorporated substantial excerpts from his original book and then updated his thoughts on each issue, often admitting that his position on a certain issue in the 1970s was naive and that he now views that issue with a mature mind. This is a refreshingly candid look at a presidential candidate's positions on key issues facing the American people today. Most importantly, however, is Chapter 2 and supplemental appendices about the National Initiative, which Senator Gravel and some of the nation's top constitutional scholars crafted to empower citizens as lawmakers; after all, lawmaking is the cornerstone of democracy. All subsequent chapters address how the National Initiative for Democracy (NI4D)would work to alleviate problems, such as healthcare and education.

From ending the war on drugs to restructuring the UN,

March 8, 2008

By	Vidvuds Beldavs "Vid" - See all my reviews

Senator Gravel has produced an engaging book! He presents complex and difficult issues facing the US and the world in understandable prose and proposes solutions that call for transformational change. In response to a legislative process controlled by corporations and special interests Gravel proposes the National Initiative on Democracy that would empower the people to legislate through direct democracy in national referendums on issues. In response to ineffective global governance Gravel calls for a restructuring of the UN including an end to veto powers for the permanent members of the Security Council. I was delighted to see his position on American exceptionalism. Granted that we are #1 in the world in the numbers of people in our prisons, on many key measures such as education, healthcare we are far from being the best in the world. I was most pleased by the optimism of Mike Gravel's vision for the future of America in the world. He sees solutions to problems such as global warming, energy, and national security through greater cooperation with other countries. The beginning of his space policy statement on page 59 is particularly encouraging: "SPACE REPRESENTS A LIMITLESS FRONTIER for humankind. Laws modeled on the Law of the Sea need to be agreed upon to make energy, natural resources, and knowledge available in a manner that fosters greater cooperation, rather than greater competition, among all nations. In keeping with this spirit, space must not be militarized."

Gravel's Populist Manifesto,

March 19, 2008

By	D. Douglas (California) - See all my reviews

An eloquent and lucid political manifesto by an increasingly refreshing, honest and prudent politician.
Citizen Power showcases a myriad of power-to-the-people proposals, and sways from your politics as usual demagoguery, while Gravel's prose is filled with solemnity and earnestness, contrary to his political opponents.
The book's motif is the National Initiative for Democracy, a populist program that will enable ordinary citizens to become legislatures, moreover eliminating large bureaucracies and big government lapdogs.
An emphasis is brought upon the military-industrial complex and its draconian, unproductive results. Suggesting the ultimate disintegration of the latter, if not grave consequences will ensue
Gravel's proposals on education is most interesting, and offer an ingenious subsidiary, if utilized in orthodoxy, to our failing educational system.
The War on Drugs chapter was dismaying at least, and produced a sharp contempt for the activities our government continues to perpetuate.

I have probably forgotten important topics of this book, and my review is ultimately asymmetrical and lackluster. I can only recommend this fine book, so you can make your own judgments and discoveries.

Senator Gravel was kind enough to state that, if any of our readers have additional questions, I can phone him again to get those answers. Therefore, if you have any questions which aren't answered here, post them and in about a week I will give him another call to get your answers for you.

Photo Courtesy Oates for News

Imagine you've just had a heart attack. Luckily, you're at the doctor's office, so he calls 911 and an ambulance arrives. As you are being wheeled to the red and white vehicle, a receptionist refuses to allow the gurney to go any further...until she receives the $5 co-payment for your doctor's office visit. It sounds like a wacky health insurance commercial, but unfortunately, this is just what happened to a 76 year-old Staten Island woman (full story).

Barbara Antonelli, fished through her purse for a 5-spot, with breathing tubes flopping out of her nose. Finally, the unnamed receptionist was paid and Antonelli was whisked away to the hospital for emergency medical treatment. I'm sure she rested much easier in the E.R. knowing that she didn't neglect her doctor's office bill.

According to office policy, Antonelli was supposed to have paid the co-pay before she saw the doctor. Somehow, that didn't happen. And you know how these elderly people fake heart attacks to get out of forking over $5 to see a doctor! Naturally, the appropriate thing to do in this situation was chase down the poor ol' lady and demand the five dollars. Heck, they probably gave her a Bayer aspirin--she wasn't in immediate danger of dying, right?

Naturally, doctors at the office are calling the incident inappropriate and said the receptionist will be disciplined. Meanwhile, Barbara Antonelli is recovering nicely, and probably looking for a new doctor's office. She may even be willing to go to one with a $10 co-pay.

When I read stories like this, I just shake my head. I mean, really, how could Antonelli be so irresponsible as to not pay her co-pay on the way in to see the doctor? Who cares if she was having a heart-attack? It would be such a bother to send a bill to her house, or I don't know, get her to pay on her next visit. Or maybe even forget about the five bucks altogether. If I was the receptionist, I probably would've just pulled it out of my own purse.

But to stop a gurney headed to the E.R. for money?

To endanger a woman's life for $5?

Unbelievable.

Let me say a couple things about government and insurance. Government does play a role in health-care. The enforcement of guidelines to protect the rights of patients and overseeing practices that might endanger the well being of patients. These are the basic areas the government should be involved with. One area government has no place in is the business element of health-care. Every thing the government does loses money. All government programs fall short of projected funds. The government has ran a deficit all of my life. The Simple Truth remains; the government does not produce a product therefore they can not obtain a profit.

Now for the insurance companies. The medical entities must make money to continue operations. When you add a huge insurance company to that picture who do you think is going to demand the most profit? The doctors office might see numbers in the low millions each year while the insurance companies see multiple billions. Not to mention the number of employees the doctor must hire to properly deal with insurance claims. Should we even talk about the time offices waste trying to collect from those insurance companies we look to for rescue.

Quick illustration: My daughter asks for a candy bar. I tell her go to the clerk and pay 25 of the 75 cents owed. When the clerk asks for the rest tell her I will pay it later. All the people in the community catch on and start doing this. Oh, I forgot to mention they are all paying me $15 a month to take care of their candy-care. 25 cents is only a co-pay. The store has now opened a office for the purpose of collecting from me and others such as the those who cover gas-care and milk-care. Because the new administrative office of the mom and pop store has five new employees, each making $25,000 a year, they can't sell candy, gas or milk for the same price. What the clerk once collected at no cost at the counter is now a $125,000 a year job. Not to mention the fact when they call me for payment I am going to sit on the money for thirty days at the least. Money is going to be spent for long distant phone calls, document transportation, paper, pens, computers, fax machines and the list goes on and on.

The price of the candy bar is now $2.50 rather than 25 cents. This is the only way the store can insure they get some of their money to keep the lights on and pay the collections department. The gas is $4.50 per gallon, not $2.65.

Wouldn't it be easier to pay the cashier for the candy and be done!

How does this apply to modern medicine? If a doctor opened a practice on a cash only basis I would certainly go there. He/she could charge a reasonable fee, perform a service and get paid the fee the day of service. If you would like to see this happen let us know. Fill in the comment box. If you don't think this will work let us know. I want to get your opinion. You don't need to worry about attack responses if you disagree. Your freedom of speech is welcome here!