What I want in health care reform

1) Medical malpractice - which I call the malpractice lottery. Put a lid on it. Cut the lawyer compensation, not the providers.

2) Consumer involvement in comparing cost and value of specific services, not just insurance policies. Until consumers are active participants in questioning the cost and necessity of medical care through incentives such as tax free medical savings accounts, this is just more gaming between the government, insurance companies and big providers like Humana.

3) Transparency in the way that medical insurance plans are funded and details on where the money goes. If charities can reveal their administrative and lobbying costs versus direct benefits, we can require the same for hospitals, pharmacies, mega corps like Kaiser and Humana and for insurance companies as well. Insurance companies should publish their claims denial rates, time to pay, and average out-of-pocket costs per year.

4) Middlemen, like unions and AARP, need to be cut out of the cash flow. No more brokers and speculators.

5) Allow drug reimportation. Stop subsidizing all the other countries. Pharm. industry has been on a free ride way too long. It's not like the drugs they sell here are safe.

6) Make insurance companies accept people, but put a 5 year waiting period in there for most expensive treatments. We do it for long term care and life insurance. That is a motivator. $500 penalty is not. Make insurance portable beyond just one employer to another. Why can't I keep the policy I have and use a new employer's and my contribution to pay for it? Why does the price change for COBRA?

7) Set up bigger risk pools.

8) Allow interstate business.

9) You pay for insurance on your car in case of a collision. You don't expect your auto insurance to pay for your maintenance and mechanical repairs. Insurance should be for the unexpected. Instead, use savings accounts paid into monthly, and what's left over at the end of the year is added to a long term reserve account that can be used for copays for hospitalization and surgery or to pay premiums for medicare supplemental insurance or Advantage. Physician visits, routine lab tests, maintenance Rx bills are paid out of the account like FSA. But you don't loose it all at the end of the year. Employers can contribute to the savings account and get the same tax benefits as they do from providing insurance. Self-employed get the same tax benefits as those working for someone else. Make all this pre-tax payroll deduction for at least 5 years. This is a hybrid high deductible policy, short term prepayment account and long term savings account.

10) Since the idea is to broaden and flatten the risk pool, quit trying to create different risk pools for behavior management. Charging more for smoking, swimming, sitting, eating, etc., is just a gimmick to reduce costs for certain people, and discriminates against people who are poor and disabled. It's just wrong to be that intrusive and manipulative in people's lives. Don't let the insurance companies even think of going there.

11) Quit trying to manage health by the percentages. Health care is a matter between one person and their provider. If I want a mammogram every year starting when I am 40, it's none of your damn business. What works for 80% of people may not work for me. Would you say that 80% of abortions are ineffective so you won't allow them? Of course not. You can't have it both ways.

12) People should have the option to increase their lifetime cap (with a waiting period), if they choose to. Just like limits with auto insurance, you should be able to pick what you want to pay for.

13) Go learn a lot from veterinary medicine.

14) Incentivize a standardized claims process. Since you have about 50% of the population under medicare and medicaid, you can define that process. Make insurance companies reimburse physicians if they require using their proprietary processes and systems. Make insurance companies pay interest when they delay payment.

15) Keep any and all information about my medical treatment and condition out of government's grubby hands. Even anonymously. You do not need to know any individual's anything except to investigate illegal activities like fraudulent billing or fake prescriptions.

16) You took people's money (took it, didn't ask for it) to pay for medicare for them when they reached 62 (or whatever). That's a promise and a commitment. Do not break that promise and take the money back to pay for someone else's insurance.  In the private sector, that would land you in jail. Be honorable. Do not expect people who are paying for private insurance or paying out of pocket to cover your shortfalls and gaps. It's "hide the weenie" and it's dishonest.

17) Insurance for people who aren't supposed to be here - not gonna happen. Send their medical bills back to the country they came from. If Mexico and Canada have "free" medical care, let them pay for their own. Take it off their aid, import tax bills, border entry fees, whatever. Don't make me pay either by subsidizing premiums or by paying more for services.

18) Maybe if you didn't tax all the pieces and parts, the overall cost would be less? Think of that? Why does taxing insurance policies make insurance less expensive? Since people just won't buy those now unaffordable policies, where do you get the idea that there will be any revenue? Duh?

19) If you can manage bank salaries, you can manage health care executive salaries, too. How is it they are making salaries in the top 1% range you are always demonizing?

20) If it is good enough for us, it's good enough for you. Play by the same rules, no congressional exemptions.