Regarding Health Care Reform – July 5, 2010

Regarding Health Care Reform – July 5, 2010


Thanks for "chiming" in, Diane.

Health care should not be viewed as outside the realm of environmental/public health.

Health care reform should not be viewed as outside the realm of comprehensive ecological economic reform.

But, addressing the particular issue, allow me to offer the following for your consideration, communications, and eduaction.

Having worked for about 15 years in the "Managed Care" and Cost Containment Branches of Health Insurers and other Finance Providers, I have had many valuable lessons on how not to do it.

I agree with PNHP and others about the inefficiencies and redundancies of the past and remaining current health finance firms. A single payer is a good suggestion, but the ways and means by which money is garnered into the system (also the allocation policy and methods, which I will address in a moment) is problematic.

Current understanding presupposes a system of taxation, which is quite unpopular with many and even odious to some if not many if not most. For a payment system this is the major issue. There are also infrastructure problems related to existing finance systems. In other words, people have money allocated to physical capital, and there is a large amount of human resources who have dedicated much of their precious time to building the status quo. Everyone gets up and does something similar or very similar to what they did the day before. Radical change is problematic but not insurmountable.

My transition idea or plan, if you will, is a double payer system with Medicare and Medicaid on the "Public Side" and a Union of "Private" Financiers on the "Quasi-Public" Side. Reform would be expected on both sides, and maybe eventually evolving to a single payer?

Where I differ greatly from PNHP and other advocates of Single Payer, is there total abdication of their responsibility related to the huge role that the irresponsible system of health care providers and the medical industrial complex has caused in the dissolution and breakdown of an affordable workable system of health care. The answer here is again Union. Unions of Institutional and Professional providers.

Working with the above defined workers and phasing down and eventually out Capitalists, we would work to establish HMO in every region/locality and budget resources based on a medical policy set by Physicians and others who are well acquainted and versed in the abuses of the Provider Communities and are excellent, knowledgeable, experienced at their trade. Shannon Brownlee and Nortin Hadler are two eminent such Physicians who come to mind and have written excellent books. Physicians with such qualities should be the Primary Decision Makers, especially on the professional side, but also with respect to the use and allocation of Institutional Resources.

But to reiterate, working toward such an ideal needs to be done within the purview of environmental/public health policies, programs which are part of a comprehensive ecological economic reform plan.


In Peace, Friendship, Community, Cooperation, and Solidarity

Health Care Reform: 12-9-09 to AFL-CIO Blog

Incremental Change was not good enough almost 20 year ago when I wrote to the US House of Lords, Kennedy and Kassebaum, and was told by Mick Moran that my five basic pillars, er, principles were "too radical" and ny Dean Rosen, who would later go to work for a British Pharmaceutical Company, that the Senator said, "We have to do things incrementally".

Here it is twenty years later, and I have gone far beyond just stating the basic principles.

Yet, all we get is BS out of DC. Of course, DC cannot do it by themselves. I believe that is the first thing we must recognize.

I have been trying to get my health plan clear and communicated to everyone, but that is a very difficult charge (even worse than Anthony Mason ;-) ) given a limited stage and the frustration of non-response to my efforts.

Oui? Si?
See? We? d
Kelp!
I need somebuddy
Kelp!
Everybuddy!
- with the greatest respect to John Lennon


In Peace, Friendship, Community, Cooperation. and Solidarity,

Mike Morin
Peoples Equity Union
Eugene, OR
(541)343-3808

ProvidersUnion: Posted to “Michael Moore”

I ain't fakin'.

Now, here's the "prescription". All the Physicians and Allied Health Workers and the Owners and Workers of Hospitals and Insurance Companies join that Union and face the FACT that their revenue levels be reduced by, let's say 30 to 40% in the next ten years and staffing levels cut to a similar, yet somewhat less, amount.

There will be unemployment compensation for all workers and eventually for the uninitiated a lesser guaranteed income. All efforts by the Union working within and with other sectors would be to try and guarantee placement and/or re-training.

For example, there needs to be an increased presence in the field of wellness education and wellness policy and program implementation. I am not "talking" about the early screening shams, I am writing about environmental/public health issues. There will also be need for the ethical practice of sorting out what is really medically necessary and beneficial relative to the terrible fraud and abuse practiced by the medical profession and rammed down our every orifice by the medical industrial complex.

Enough for now.


In Peace, Friendship, Community, Cooperation, and Solidarity,

Mike Morin
Peoples' Equity Union
Eugene, OR

Another Futile/Unheeded Post?

Hear ye! Hear me!

Single Payer with very tight budget controlled HMOs with emphasis on wellness (i.e. environmental/public health).

Dealing with pollution at the source (definitely with concern directly related tobacco, alcohol, and sources and causes of obesity (e.g. sugar waters, consumption of meat without rigorous exercise, etc.).

Please, let us get our eduaction together. Work with me on developing the izquierdo correcto policies, programs, and projects related to promoting the "general welfare" both within and beyond the borders of our fifty plus ONE (and that's reality) ways and means and the necessary libertarian voluntary evolution of the "private sector" to a quasi-public ONE.


In Peace, Friendship, Community, Cooperation, and Solidarity

Mike Morin
Eugene, OR
Peoples' Equity Union
Industrious Workers of the World
International Workers of the World
United Socialist Workers (USW)

Comment on Michael Moore’s Website Regarding Health Care Reform

Then there's Hospital Corporation of America (HCA), Columbia Health Systems, Humana, and many, many more. Then there is General Electric, Siemens, and many, many more, Pharmaceutical Companies. Doctors whose revenue motivation is to cut and poison.

Then there was the famous US Government Hill-Burton Act. Perhaps some can defend this, but like most government public works (e.g. National Highway Act, subsequent amendments including O'Bomber's recent "Stimulus") my opinion is that they went way too far in their supply side corruption.

I favor a single payer, but I also favor a single provider, with drastic immediate cuts in medical spending on the order of 30 to 40% in the next 3 to 5 years and 60 to 70% within the next 10 to 20 years.

With respect to budgeting, a medical policy board and regional and local administrators made up of ETHICAL (that may be hard to find) health care professionals who are acutely aware of the fraud and abuse in the medical care system. Shannon Brownlee and Nortin Hadler come immediately to mind.

Concerning the Provider Situation, that's where the Budgeting Committee will have to get tough. All for-profits need to be converted to non-profits, but that will not be nearly good enough. Unemployment Compensation and/or Social Security should be offered to all displaced workers and much effort put into the function of job retraining.

It's gone way too far, has been going way too far for far too long, and it's time we stopped the massive complicity to corruption and decadence.


In Peace, Friendship, Community, Cooperation, and Solidarity,

Mike Morin
Eugene, OR, USA

Health Care Reform in the USA

All People's Health Care should be covered, as in other countries.

I think that a Single Payer is the vehicle that we should employ, with HUGE CAVEATS.

I worked in the Health Care Finance field for 15 years, mostly as a Utilization and Cost Analyst for "Managed Care" companies. While Physicians for a National Health Plan (PNHP) makes good and valid arguments for a single payer system, they neglect to address the massive fraud and abuse on the Provider side of the health care "INDUSTRY". The massive greed of physicians and the over-supply manifestations of the "medical industrial complex" have caused the USA to have, by far, the highest cost medical system in the world, with poor results due to a preponderance of bureaucracy and the revenue driven bias towards maximum intervention leading to "damaged care" and waste.

We need a single payer with VERY TIGHT budget controls (huge rollbacks on medical spending). We could evolve to a single payer by mandating a public option in all places where insurance coverage is offered and expanding Medicare to everyone else.

But fee for service medicine has got to go. Regional HMOs need to be established with budgets being phased down by 35 to 40% in the next 10 to 20 years. Medical policy boards to oversee the formulation and implementation of such budgets, as caring physicians who understand the cost and abuse issues need to be put in charge of resource allocation policies and administration.

Hospitals and Hospital Corporations need to consolidate their resources into a unified organization so that rational resource allocation and the necessary winnowing out of over-competitive redundancies can be carried out.

Then there are the issues of environmental and public health, the subject of another HUGE discussion.


Mike Morin
Eugene, OR, USA
wiserunion@earthlink.net
(541) 343-3808

Health Care Reform

No Mouse,

The biggest obstacle to having universal health care is the decades long and continued abuse by the medical industrial complex (very much including the pharmaceutical industry), and "health care" providers, both professional and institutional.

The only way to achieve health reform in the USA and worldwide is to a implement a single payer (combining private and public payers into one payment system with locally and regionally administered HMOs with Providers forming a non-profit Union contracting to scale back costs on the order of at least 35 to 40%.

A Medical Policy Board needs to be established with non-economically interested Doctors, who also understsnd the issues of abuse and fraud and over-competition (e.g. Nortin Hadler, Shannon Brownlee) and resources budgeted to communities under the aegis of a regional plan, which strongly emphasizes an environmental/public health/wellness plan.


Mike Morin

Role of Providers in Health Care Reform

In my mind, based on personal and familiar experience, the jury is still out on the motivation of physicians. I've seen the work of some good ones, but I've seen the disasters caused by probably more of them who were driven by the need to maximize revenues through all aspects of the "medical-industrial complex" ( a term that I coined many years ago).

It is probably quite true that over-treatment also comes from the need to practice "defensive medicine". Again, I concur that computerizing and standardizing, and making universal access to medical records would not only create efficiency in resource use, if the hospital and clinic administrators truely want this (and remember physicians invest in health care facilities), but could also be helpful to physicians in determining "best practices" and could be most useful in medical research. Sometimes, I wonder though, if medical research has not become a self-perpetuating "industry", with largely diminishing returns.

Most hospitals are not-for-profit, but there has been the insidious entry of for-profit corporations onto the scene in the last twenty to thirty years. Certainly, there is no room for profit in any aspect of health care. (I leave room for not-for-profit organizations). Also, the need of non-profits to compete with regards to the latest technologies and the updating of physical amenities has been a huge driver in the escalation of health care costs. There are far too many hospitals and they are far too redundantly equipped with a lot of what could be considered unnecessary technologies. Only by pooling the equity and assets of hospitals, clinics, etc. can we correct this situation and ratchet down the costs of health care. This is the beauty of an equity union and the private sector participation is necessary from not only a payers' perspective (i.e. "double payer" system), but especially with respect to reining in the costs associated with over-utilization, be it from provider abuse and/or defensive medicine.

I paid dues to the Physicians for a National Health Plan (PNHP) for a couple of years. They make some excellent points about the inefficiencies and ineffectiveness of the current health insurance industry. I agree that great savings could accrue from reforming said businesses (again, a combination of for-profits and non-profits). However, PNHP has yet to acknowledge and speak to the abuses on the Provider side of the equation, except to criticize the pharmaceutical industry.

Let's see more talk and writings from the Provider Community concerning their role in the continuing tragedy and impending disaster of the health care system in the USA.

Then there is all the issues of environmental, and thus public health, a subject of another, very large, discussion.

I'm a Work kin for peace and cooperation.


With much love and care,

Mike Morin

A Note on Health Care Reform

I agree that effectiveness and efficiency in medical records would be one of the goals of health care reform. It has nothing to do with single payer, correct me if I am wrong, it is a provider issue. If we had a United Healthcare Provider Community (ideally worldwide), we would be all that much closer to realizing true health care reform (a more perfect union, if you will). However, the provider community MUST come to grips with over-treatment, over-utilization, and the resulting costs that are contributing to our collective and individual bankruptcies, and reduced quality of lives that result from such.

The provider community and their associated administrators need to start thinking about how they can transition to a more workable health care system. That's the beauty of an Equity Union and my Plan where Equity can be put into trust and assets and employees methodically transitioned into to useful alternative roles.

A “Double Payer” Economy and Health Care System

A single payer health care system paid for by tax revenues?

Single payer should be double payer with the “private” financial sector uniting into an Equity Union to cooperate with governments to fund all sectors of the (ecological) economy.

Who the hell pays taxes anyway?

People on payroll and their employers, that's probably about all. Those people, to a great extent should be relieved of that unfair burden.

Large companies use creative accounting schemes and there are just too many businesses, diversified corporations with diversified investment portfolios, equity investors, stock traders, medium and small contractors and businesses, etc. for the IRS to keep up with it all.

I don't think that much of the taxes that the government(s) would expect are actually being collected.

Why not pay, a well-managed capitated health care system directly out of the treasury and funds allocated by the Equity Union, supplemented by voluntary contributions from the wealthy and relatively wealthy?

An Equity Union (the pooling of ownership assets worldwide) could promote the active participation in a health fund. The Equity Union and the Treasur(ies) could make allocations on behalf of individuals in communities. The sum of payments to the community funds would be the budgeted amounts from which the capitated Regional HMOs would make their delivery decisions, consistent with a larger plan and well deliberated medical policies, which include a long-term plan for eliminating the plethora of unnecessary care, as well as taking all profits out of the delivery systems.

The equity fund and the treasury could allocate funds based on need, or the treasury could allocate to those in poor communities with little to no or negative equity (based on property values, and the amount of equity personally held in all property (real, capital, and personal)). People in wealthy communities, over their head in debt should be encouraged to move to poorer communities with some, if not all debt, forgiven.

In the new economy, there would be no debt and all would make equity payments instead of rent and mortgage interest payments.

Debt forgiveness should be part of the transition plan as should the writing down of real property values and the value of capital assets.

A double payer health care program would be part of a larger effort to invest in human and community improvement in poor areas and the transition of wealthy neighborhoods from standard of living wealth zones, to quality of life wealth zones (in all communities).

Don't tell me that it is too complicated. Have you ever seen the internal workings of Accounting, Information, Finance, and Marketing systems within large capitalist conglomerates, banks, governments, insurance companies, etc.? Like reducing the redundancy in health payment systems, a Peoples' Equity Union would save great amounts of money by eliminating profits (certain sectors such as health would be non-profit and sectors such as community improvement would be not-for profit), eliminating Marketing costs (save logistics), and greatly reducing redundancy in administrative costs in all sectors of the economy. It would actually be a simplified system with the ability to cooperate with social/environmental equity and sustainability goals. An Equity Union as a quasi-public organization (a NGO) would greatly reduce the need for big government(s).

Coordinated with an explicit Ecological Economic Plan, such Financial Systems Reform would go a long way towards the hope of realizing a peaceful, equitable, and sustainable world.

Workers' Compensation and Social Security programs need to be maintained.

The environment is the entire world and each individual’s relationship to their world. The environment is not an issue. It is THE issue.

Health Reform - Posted to New York Times Blog

(For those of you visiting from the the New York Times blog, there are other posts related to health care reform below).

As a veteran of the health insurance "cost containment" and “managed care” movements and a student of the health care "industry", I have seen from the inside the inefficiencies of the health payment system and the ineffective and bloated bureaucracies of Managed Care (on both the payer and provider sides of the equation)..

A single payer system (a world single payer would be the ideal), with regional administration units, would reduce health care costs by eliminating profit from the system, greatly reduce costs by eliminating marketing costs and by the streamlining of huge redundancies in administration systems. A single payer system would also allow for a capitated non-profit delivery system where Physicians could triage care unencumbered. But this is only a third of the picture.

A second third of the problem is the rampant abuse (perhaps much or some of it is well intentioned) and fraud associated with the profit driven medical industrial complex and the associated revenue and job security needs of the provider community.

Instituting a non-profit HMO system with careful medical protocols, could allow us to slowly, orderly, and healthily bring the leviathan costs associated with medical care delivery way down.

The third piece, and it is a huge one, is environmental and public health.

Thank you.

Universal Health Care and Health Care Reform

The following essay was written in response to an inquiry asking for help to form a single payer health care finance system in the State of Colorado:

I think it is a mistake to do single payer on the state level. All you will be doing is rearranging the redundancy of claims (if any - I would propose that there not be), information systems (including medical records), actuarial, underwriting, accounting, and medical management (the last which I strongly believe should be done by experienced Primary Care Physicians who are of course of the highest quality in general medical expertise and very cognizant of the cost and over-treatment problems and issues). Besides, states are arbitrary boundaries and metropolitan areas and bioregions would be more effective and efficient planning regions.

Single payer(s) would eliminate profits, marketing costs, and if structured correctly could bring fairness, effectiveness, and efficiency to the health care delivery realm.

The ideal would a world single payer system, with unity in policy, management, payment methods, and health (care) equity, but health care services (at least in the longer run) should be viewed as a last resort relative to environmental/public health matters.

Of course administration on the world-wide or national level (in the case of the USA) would be unwieldy, so regional planning/administrative units would need to be set up. But policy should be global, and if not feasible, national, so that a coordinated, effective, equitable system could be planned and implemented. States could be regional planning/administrative units, I suppose, but maybe EPA regions or some variation thereof would be a better place to start. Certainly that would be an issue of discussion whether the plan be national or global.

Remember, there is going to be a lot of friction involved with such a radical change and there will be continued resistance from the status quo because of that. The fate of workers involved in the payment and delivery systems needs to be of paramount concern and the holdings of Capital and the interests of the medical/pharmaceutical industrial/distribution complex can not be ignored. Another reason that we need an Equity Union.

Please feel free to distribute this communication as widely as possible.



Workin' for peace and cooperation,

Mike Morin