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Mike Protack, Candidate for Governor on his Delacare proposal 17 April, 2008

Posted by David Anderson in Economic Policy, Election 2008, Healthcare, State.
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Everybody Is In

No One Is Out

Everyone Pays Their Fair Share

The year 2008 will be a monumental step in the history of Delaware, as together we launch a dialog for change. Ours is a message of healthcare security for all, now and in the future years. We look not into a far-off crystal ball and hypothesize the what-ifs based on a notion, but instead we look into the needs of our people and say “Let’s work together for positive change now and for the future of our state and nation.” After many discussions with people all over this nation, I have seen a common thread that affects us all yet lacks current leadership is healthcare. Healthcare is the single largest domestic issue we have as a nation that could jeopardize our entire economy because it affects our ability to work, our ability to achieve a balanced federal budget, our ability to see our children grow up happy and our ability to age gracefully. It touches the lives of all people.

Although the U.S. has the best healthcare in the world, we are still in an extremely vulnerable state with costs increasing 5-8% faster than our income, personal expenditure rates steeply climb as we experience higher insurance premiums, higher co-payments, more services limited within our insurance coverage policies, and fewer benefits covered. These are not the results of frills or extravagances. These results are the state of a critical need for all Americans that threaten our society. If left unchanged, the threats will not disappear. Our challenge is to team up as a community and bring overdue leadership to this very real issue. As your Governor, I will bring leadership in the development of a new healthcare program for all Americans that will start right here in Delaware. We call this Delacare.

The Delacare Plan will be a universal, private health care system that will be open to all citizens. Just as today, it will be funded by its citizens through taxes, employment contributions and private business taxation. Unlike other systems previously introduced for reform, this plan comprises a multi-tiered approach that encourages additional investment into all levels of education, refocuses industrial growth and creates larger markets for healthcare to be a more economically viable export product through which we shall be able to assist other nations around the world. An ambitious effort, our model affects personal health status as well as it affects local, regional, national and global efforts. It intends to put personal human capital at the top of the list of importance for our families, our communities, our nation and our world.

We seek your consideration and support as we consider implementing perhaps the most significant legislation in decades for Delawareans.

Key Points
Healthcare will become the highest priority in the nation:

· All citizens are covered from cradle to grave and each state will “build” large geographic pools, Delaware will have one pool.

· Doctors, Nurse Practioners etc will be paid ‘fee for service’ and there will be recognition of the years of training, sacrifice and stress of daily decisions that are often looked at with zero tolerance.

· Citizens may receive care anywhere – total freedom of choice.

· No more product confusion: In Network/Out of Network, POS, PPO, HMO

· A “basic” plan will be offered along with optional buy-up plans.

· Buy-up plans will be at the option of the individual consumer.

· The buy-up plans will cover benefits not covered under the basic plan.

· States may offer their own buy-up plans or minimally priced riders to the basic plan.

· Plan covers both allopathic and selected integrated medical care.

· Individuals shall receive EOBs that detail expenditures, so they will become better healthcare consumers.

· Federal allocations to healthcare shall be frozen. Private corporate and personal taxation shall contribute to the balance of the expense.

· The rate of increase to the government shall not be higher than the national rate of inflation.

· The financial goal of the plan shall be to develop a pricing structure that is cost-neutral to the current financial landscape.

· Administration of the basic plan will be a 4 year administrative contract that may be bid on by any qualified company.

· Providers are supported with streamlined administrative processes.

· Professional providers will receive educational loan forgiveness.

· Education systems will be reformed to complement the demand and quality required for a high level of quality care and support by future providers

· States will develop healthy community partnerships between providers, employers and educational institutions to promote healthy lifestyles

· Corporations will team with the government to export healthcare expertise to other nations on a fee basis to help foreign nations

· Paraprofessionals will be trained in their programs to provide healthcare both locally and overseas

· Volunteerism will be encouraged of professional and paraprofessional healthcare students rewarded by student loan redemption credits

· Youth service corps will be set up to have young people serve as health care interns and trainees to serve as local patient advocates, before they can apply for professional healthcare schools

· Costs for reckless lifestyles will be borne by the citizen choosing riskier behavior, not solely by the national plan

· Tort reform shall be imposed to limit the malpractice awards, limit attorney percentages and the plaintiff attorney will be required to have a board certified Dr in the same area as the alleged malpractice that harmed the patient. The Judge will review the report prior to filing and rule on the appropriateness. The expert’s opinion should clearly state who erred and filing will be limited to those an appropriate expert said erred.

·

Delaware will make investment into championing the nation on specific areas of healthcare including science and engineering applications and supporting educational systems. Collaborations will be made with public and private schools, colleges and universities to address current and future developments of biotechnology, culturally competent healthcare communications and corporate healthcare sites to increase access to care in rural parts of the state.

· Exporting healthcare excellence in collaboration with foreign governments, non-governmental organizations and private businesses working in international communities. Export projects will help increase the expertise and income to our own national healthcare system and will create more jobs for our citizens, in all aspects of global healthcare delivery and management.

Benefit are to citizens

To be part of this plan, you must be registered as a US citizen. All immigrants, legal aliens and visitors are excluded from the publicly funded program, so must pay for their care through the fee for service arrangement with the providers.

Eligibility

All citizens of all ages are enrolled into the program, regardless of income level.

Focus on health care
The Delacare plan maintains focus on providing required care to people and preventive care before more serious care is required while re-establishing the Doctor-Patient relationship. The plan covers preventive primary and medically necessary care, including maintenance care for most chronic medical conditions. Primary care shall be provided to holistically benefit citizens, so the plan covers dental, vision, chiropractic and podiatric care in addition to medical care. In addition to regular allopathic care provided by licensed medical and dental practitioners, the plan also pays a portion of the care for limited naturopathic and integrated alternative medical practitioners when care is used in conjunction with allopathic care paths.

Coverage is not exclusive to the cause of the medical event, so it does not discriminate between health, workers compensation or liability insurance cases. Citizens are covered 24 hours a day, 7 days a week by the same program.

The goal of the Delacare healthcare initiative is to promote and maintain a healthy population. As part of that goal, physicians will evaluate patient care independently and encourage each patient to adopt a treatment plan for their personal medical status. Citizens would not be required to adopt the physician’s specific plan, but healthcare options and education will be greatly encouraged as citizens adopt healthy lifestyles throughout their lives. Injurious or reckless lifestyle choices and non-compliance with generally accepted medical advice will require additional costs to be borne by the individual citizen’s coverage program.

Benefit management

· Delacare maintains a common, basic benefit plan for Universal Coverage.

· The buy-up plans will cover benefits not covered under the basic plan.

· Insurance companies may offer their own buy-up plans or minimally priced riders to the basic plan.

· Citizens have the ability to receive care anywhere, up to a certain limit

· Health benefits are managed by a state-appointed health plan as the benefits administrator

· Benefits administrator will serve a 4 year contract term

· Any viable organization may bid for the statewide administration including Doctor’s groups.

· EOB (explanation of benefits) will provide healthcare educational material and the cost of care

· Health and pre-procedural education will be provided prior to any surgery, invasive care, extensive therapy, etc.

· Follow-up care is mandatory to ensure patient comfort level and compliance to self care management

· Individual health risk assessments would have to be employed to impose penalties on those who voluntarily engage in high risk, un-healthy lifestyles. This could be in the form of a stipend of roughly 15%. Doctors will not be the health police but will provide basic information to the administrator.

· Only approved medical technology may be performed under the basic plan

· Claim administration shall be streamlined by electronic information transactions

· Current HIPAA laws shall be maintained for privacy and security of the transaction of personal health information

Financing

· The rate of increase to the government shall not be higher than the national rate of inflation.

· Personal or corporate taxation shall not exceed the current personal or corporate expenditures. In fact, the financial goal of the plan shall be to develop a pricing structure that is cost-neutral to the current financial landscape.

· Financial efficiencies will be created to better manage the costs of the program

· Medicaid allocations would fund the program

· Employer contributions will be in the form of a tax not to exceed present contributions

· Employee contributions will be in the form of a tax not to exceed present contributions

· With individuals witnessing the expenditures noted on EOBs, they will become better consumers of the program’s expenditures

· The federal system would maintain a catastrophic reinsurance fund to assist states that experiences excessive claim losses

· State-appointed selection committee will determine the financing of the program, covered services and will select the administrator

Tax benefits and Funding
· Tax benefits would not be realized by those purchasing buy-up plans, since that is a luxury

· Employees will receive tax breaks for their contribution

· Employers will receive tax breaks for their contributions

· Tax breaks given for citizens who receive high grades on their healthy, wellness profiles

· Tort reform shall be imposed to limit the malpractice awards and limit attorney percentages.

Grievance Boards
· Arbitration courts will be set up to handle specific grievance hearings and ways to correct and rectify medical misconduct and other problems caused by negligence.

· Patient care advocacy officers will help people receive needed care in complicated medical circumstances

· A reporting system will be set up to encourage non-judgmental incident reporting that shall be free from determining medical liability

· Malpractice companies nationwide must not be able to account shift set asides for “possible” claims artificially and dramatically increase “costs”

Risk pools

· Plan rating coverage is based on residence of the individual, assuming a majority of the care will be gained within that risk region, by a local provider

· Extra-territorial mandates would cover medically necessary care with claim payment decisions and catastrophic amounts reimbursed by the home region

· Regions would each have a fee schedule that is accepted by all other regions, with a reinsurance pool for keeping a region financially whole

· Statewide underwriting curve calculations shall be governed by a centralized administrative agency. This will ensure that financial risk reporting and allocations are clearly understood, managed and funded.

Providers

· Providers will serve the public and private systems

· Providers may develop satellite locations to serve areas with low access

· Providers would all employ electronic transmission of records

· They would all receive a 1-time dollar for dollar tax credit to implement an electronic claim processing system including a ‘look back’ provision for previous expenditures.

· All electronic systems would have to be approved and EDI and HIPAA compliant

· Providers shall include current licensure of professional and facility requirements covered under existing state laws

· All providers will have a simplified identification code for licensure, CE, reimbursement, DEA, UM profiles and QA compliance

· Recertification requirements will include cultural competence training

· Training, licensure and specific scope of services shall be developed for naturopathic and certain integrative health practitioners to provide care under the basic plan

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