The general idea behind this health plan is to provide a government run health care plan that does not overly compete with private health care plans to the point that they will be put in bankruptcy courts. In fact, this plan actually permits private insurers to use the same lower government negotiated rates for procedures if they meet certain criteria and fee requirements.
1) My idea includes a Universal Government Health Plan (similar to Canada) that is controlled by our government and paid for using a progressive tax on individuals that enrolled into the plan as well as fees paid from private health insurers that wish for the right to use the same negotiated government rates for medical procedures.
2)My idea sprung from the Single Payer plan. But one of the major arguments of Single Payer was that it would UNFAIRLY compete with the private health insurance companies because of it's larger size and government financial backing that would be able to pressure hospitals to get cheaper rates. My idea was to allow the private insurer the right to use those same government rates for a medical procedure provided that the company paid for that right to use those rates using one of the enrollment fee options list below:
---A)The Private insurer could pay an annual fee to the government that would allow the company to use these rates for ALL of its own participants. (Advantage-The cost of this fee to the government is spread over all participants thought each individuals private health insurance policy premium. Lower group rates would also apply.)
---B)The Private insurer would have the option to pay the fee on an "individual" basis allowing each individual participant the option to decide if it is beneficial to pay for it's use. (Advantage-Cost of the fee is paid by the individual that uses those rates. Each individual case is different. Many that have a higher chance of medial situations will find that this option may be worth it. The private insurer itself would definitely benefit from paying less when your ill. Paying the fee IN EFFECT hooks up your private insurer with a larger insurer (the U.S. government's plan) and has it's advantages in cost savings. Others whom, reject the government being involved in a health care plan could opt out on an individual basis.)
3) Their would be no mandate to join the Universal Primary Payer Heath Care (government) plan. However, if you decide to enroll you are then taxed for it.
4) If you enroll into the government plan and pay the tax out of your check but ALSO purchase a private health insurance plan OR you are GIVEN a private health insurance plan paid for by your employer you could be entitled to a FULL or PARTIAL refund of your taxes at the end of the year IF you did not submit a claim into the government plan during that previous tax year. (Advantage-Those that only work now and then and can not depend on their employer paid health plan would have the option to use the government plan as a back-up to prevent laps of coverage during the year.)
Finally, this idea allows a Canadian style health plan to co-exist with private health insurers and not overly compete with them to the point that will result in more job losses in that industry. Just what we don't need now.
See more specifics in other following posts.
20090830
20090829
Universal Primary Payer Health Care. 09/13/09
Note-This post is about 99.9% etched in stone with concern to my thoughts and ideas.
WHAT IS UNIVERSAL PRIMARY PAYER HEALTH CARE?
-Universal Primary Payer Health Care or "UPP CARE" is a government health care plan that functions differently from other proposed health care plans.
-UPP Care closely resembles the proposed government controlled Single Payer health plans BUT it goes several big steps further by allowing those participants covered under the plan the option to have ALTERNATE INSURANCE (such as private insurance). A tax voucher is possible at the end of the year IF the individual's alternate insurance qualifies.(See post on Vouchers).
-UPP Care is intentionally designed NOT to compete with private insurers but to actually work in harmony with them. It does this by providing options for it's active participants to choose from so that their ALTERNATE INSURANCE can pay for medical procedures performed using the SAME negotiated discounted rates that the UPP Care plan uses. This is PROVIDED that the procedure or benefits are IDENTICAL to the UPP Care plan.
DEFINE-
ALTERNATE INSURANCE-
The term alternate insurance includes private insurance, group insurance, self insurance, non-profit insurance, charity medical funds and alike.
DEFINE-
IDENTICAL COVERAGE-
One way to make identical coverage easier to verify is to require ALTERNATE INSURANCE to adopt UPP Care's legal policy language so that an identical match between benefits and procedures is without question identical.
-UPP CARE would AUTOMATICALLY BY LAW become the PRIMARY PAYEE (first payee) for ONLY those medical procedures that are included in the plan and for those participants that decide to remain ACTIVE PARTICIPANTS in the plan.
DEFINE-
ACTIVE PARTICIPANT-
An active participant is one that is eligible for coverage under the UPP Care plan and does not reject being included into the plan by officially notifying the UPP Care Administrator by filing and singing an UPP CARE PARTICIPATION REJECTION form.
-Under the UPP Care plan any COVERED medical procedure or benefit that is performed on a participant of the plan would be paid by the government's UPP Care plan FIRST, UNLESS the government's UPP Care Administrator is told in writing by the participant that the individual has chosen an ALTERNATE INSURER to be the ALTERNATE PRIMARY PAYEE (Plan A or B) or the FINAL PAYEE.
DEFINE-
ALTERNATE PRIMARY PAYEE-
-An ACTIVE PARTICIPANT in the UPP Care plan can TEMPORARILY release UPP Care from the obligation of paying or controlling the individual's medical bills as PRIMARY PAYEE. This is done to allow the active participant's alternate insurance to pay the medical bills DIRECTLY with or with out the option of paying using UPP Care's discounted rates.(See Plan A & Plan B options below). This selected option is TEMPORARY and can be changed.
DEFINE
-Plan A)
This plan option DOES allow the alternate insurer to pay the medical bills using UPP Care's negotiated discounted rates. However, there is a fee charged to the ACTIVE PARTICIPANT'S account for the permitted use of the UPP Care's rates by the ALTERNATE INSURER. This charged fee will reduce a tax voucher to some degree at the end of the year if the individual's alternate insurance qualifies.(See post on Vouchers).
DEFINE
-Plan B)
This plan option DOES NOT allow the alternate insurance to pay the medical bills using UPP Care's negotiated discounted rates. This could allow for a full tax voucher at the end of the year if the individual's alternate insurance qualifies.(See post on Vouchers).
DEFINE-
FINAL PAYEE-
This option would require UPP Care to pay FIRST but then the ALTERNATE INSURER would simply be sent a copy of the bills to permit reimbursement to UPP Care. If full reimbursement of costs are made to UPP Care by the end of the year then a higher tax voucher could be possible if the individual's alternate insurance qualified.(See post on Vouchers).
-If no ALTERNATE PRIMARY PAYEE or FINAL PAYEE is selected then the government option remains the PRIMARY PAYEE (first payee) and also the FINAL PAYEE as well.
-One advantage of the ALTERNATIVE PRIMARY PAYEE option is that it permits an active participant with alternate insurance to re-route the payment of a claim to the alternate insurer. By re-routing the claim to an alternate insurer the active participant reduces or eliminates claim costs charged to the UPP Care plan and could possibly receive a higher tax voucher if his alternate insurance qualifies at the end of the year.(See post on Vouchers).
-Another advantage of ALTERNATIVE PRIMARY PAYEE option is that an individual that is an ACTIVE PARTICIPANT in the UPP Care plan can use the plan as a BACK-UP plan should his alternate insurance be lost during the same time period or for some reason not pay the medical bill. This could be done with little if any cost to the individual if the individual's alternate insurance qualifies for a full tax voucher at the end of the year. The size of the tax voucher would depend on the outcome of who pays the medical bills in the end.(See post on Vouchers).
-MINIMUM REQUIREMENTS TO PAY USING UPP CARE"S NEGOTIATED DISCOUNTED RATES-
For a alternate insurer to be able to pay the subscribers medical bills using the governments discounted rates, one of the following requirements must be meet and maintained:
A) INDIVIDUAL PARTICIPATION OPTION-
In this option, the individual must remain an ACTIVE PARTICIPANT in the government's UPP Care plan and pay taxes into the plan to permit his chosen alternate insurer the option of reimbursing the medical bills using UPP Care's negotiated reduce rates. When an individual's alternate insurance uses UPP Care's discounted rates their is a charge to the individual's account for the use them. This will then reduce any possible tax voucher to the active participant at the end of the year should he apply and qualify for one.(See post on Vouchers).
B) PRIVATE INSURER GROUP PARTICIPATION OPTION-
This option could be available to private insurers permitting them to use UPP Care's negotiated discounted rates for identical benefits for an annual fee to UPP Care. This would permit a private insurer to pay any identically covered medical procedures or benefits using UPP Care's negotiated discounted rates even if the individual that received the treatment WAS NOT an ACTIVE PARTICIPANT in the government's UPP Care plan. This permits those that may be in-eligible to receive UPP Care the benefit of paying medical bills at UPP Care's discounted rates indirectly.
Ba OPTION.)
If the private insurer's treated individual subscriber IS NOT a participant of the UPP Care plan but the private insurer has paid a fee to UPP Care for the use of the negotiated discounted rates then the private insurer would be permitted and responsible to DIRECTLY pay the individual's medical bills using the government's negotiated discounted rates. Their would be no reason for the UPP Care plan to be involved with the payment process beyond providing necessary information and proof to the parties involved that the private insurer is permitted to pay using the UPP Care's negotiated rates. By law, payments paid at UPP Care's negotiated discounted rates would have to be accepted under this option.
Bb OPTION.)
If however, the private insurer's treated individual subscriber IS also an ACTIVE PARTICIPANT in the government UPP Care program then should it be necessary, the government could still be requested to pay the medical bills in the end the same way as if the individual selected an ALTERNATE INSURANCE option as previously mentioned.
-WHAT UPP CARE IS NOT.
-UPP Care is not a co-op. The government has full control over the plan and the negotiation of the rates and benefits.
WHAT IS THE MAIN MOTIVATION TO EXPANSION OF UPP CARE COVERAGE?-
Private insurers and self insurers will only benefit from discounted rates where their coverage is identical to the government's coverage. The more medical procedures covered by the government's plan the more private insurers and self insures will also benefit from the discounted rates in identical areas. If you scratch my back, I'll scratch yours!
More to come.
-to be continued.
WHAT IS UNIVERSAL PRIMARY PAYER HEALTH CARE?
-Universal Primary Payer Health Care or "UPP CARE" is a government health care plan that functions differently from other proposed health care plans.
-UPP Care closely resembles the proposed government controlled Single Payer health plans BUT it goes several big steps further by allowing those participants covered under the plan the option to have ALTERNATE INSURANCE (such as private insurance). A tax voucher is possible at the end of the year IF the individual's alternate insurance qualifies.(See post on Vouchers).
-UPP Care is intentionally designed NOT to compete with private insurers but to actually work in harmony with them. It does this by providing options for it's active participants to choose from so that their ALTERNATE INSURANCE can pay for medical procedures performed using the SAME negotiated discounted rates that the UPP Care plan uses. This is PROVIDED that the procedure or benefits are IDENTICAL to the UPP Care plan.
DEFINE-
ALTERNATE INSURANCE-
The term alternate insurance includes private insurance, group insurance, self insurance, non-profit insurance, charity medical funds and alike.
DEFINE-
IDENTICAL COVERAGE-
One way to make identical coverage easier to verify is to require ALTERNATE INSURANCE to adopt UPP Care's legal policy language so that an identical match between benefits and procedures is without question identical.
-UPP CARE would AUTOMATICALLY BY LAW become the PRIMARY PAYEE (first payee) for ONLY those medical procedures that are included in the plan and for those participants that decide to remain ACTIVE PARTICIPANTS in the plan.
DEFINE-
ACTIVE PARTICIPANT-
An active participant is one that is eligible for coverage under the UPP Care plan and does not reject being included into the plan by officially notifying the UPP Care Administrator by filing and singing an UPP CARE PARTICIPATION REJECTION form.
-Under the UPP Care plan any COVERED medical procedure or benefit that is performed on a participant of the plan would be paid by the government's UPP Care plan FIRST, UNLESS the government's UPP Care Administrator is told in writing by the participant that the individual has chosen an ALTERNATE INSURER to be the ALTERNATE PRIMARY PAYEE (Plan A or B) or the FINAL PAYEE.
DEFINE-
ALTERNATE PRIMARY PAYEE-
-An ACTIVE PARTICIPANT in the UPP Care plan can TEMPORARILY release UPP Care from the obligation of paying or controlling the individual's medical bills as PRIMARY PAYEE. This is done to allow the active participant's alternate insurance to pay the medical bills DIRECTLY with or with out the option of paying using UPP Care's discounted rates.(See Plan A & Plan B options below). This selected option is TEMPORARY and can be changed.
DEFINE
-Plan A)
This plan option DOES allow the alternate insurer to pay the medical bills using UPP Care's negotiated discounted rates. However, there is a fee charged to the ACTIVE PARTICIPANT'S account for the permitted use of the UPP Care's rates by the ALTERNATE INSURER. This charged fee will reduce a tax voucher to some degree at the end of the year if the individual's alternate insurance qualifies.(See post on Vouchers).
DEFINE
-Plan B)
This plan option DOES NOT allow the alternate insurance to pay the medical bills using UPP Care's negotiated discounted rates. This could allow for a full tax voucher at the end of the year if the individual's alternate insurance qualifies.(See post on Vouchers).
DEFINE-
FINAL PAYEE-
This option would require UPP Care to pay FIRST but then the ALTERNATE INSURER would simply be sent a copy of the bills to permit reimbursement to UPP Care. If full reimbursement of costs are made to UPP Care by the end of the year then a higher tax voucher could be possible if the individual's alternate insurance qualified.(See post on Vouchers).
-If no ALTERNATE PRIMARY PAYEE or FINAL PAYEE is selected then the government option remains the PRIMARY PAYEE (first payee) and also the FINAL PAYEE as well.
-One advantage of the ALTERNATIVE PRIMARY PAYEE option is that it permits an active participant with alternate insurance to re-route the payment of a claim to the alternate insurer. By re-routing the claim to an alternate insurer the active participant reduces or eliminates claim costs charged to the UPP Care plan and could possibly receive a higher tax voucher if his alternate insurance qualifies at the end of the year.(See post on Vouchers).
-Another advantage of ALTERNATIVE PRIMARY PAYEE option is that an individual that is an ACTIVE PARTICIPANT in the UPP Care plan can use the plan as a BACK-UP plan should his alternate insurance be lost during the same time period or for some reason not pay the medical bill. This could be done with little if any cost to the individual if the individual's alternate insurance qualifies for a full tax voucher at the end of the year. The size of the tax voucher would depend on the outcome of who pays the medical bills in the end.(See post on Vouchers).
-MINIMUM REQUIREMENTS TO PAY USING UPP CARE"S NEGOTIATED DISCOUNTED RATES-
For a alternate insurer to be able to pay the subscribers medical bills using the governments discounted rates, one of the following requirements must be meet and maintained:
A) INDIVIDUAL PARTICIPATION OPTION-
In this option, the individual must remain an ACTIVE PARTICIPANT in the government's UPP Care plan and pay taxes into the plan to permit his chosen alternate insurer the option of reimbursing the medical bills using UPP Care's negotiated reduce rates. When an individual's alternate insurance uses UPP Care's discounted rates their is a charge to the individual's account for the use them. This will then reduce any possible tax voucher to the active participant at the end of the year should he apply and qualify for one.(See post on Vouchers).
B) PRIVATE INSURER GROUP PARTICIPATION OPTION-
This option could be available to private insurers permitting them to use UPP Care's negotiated discounted rates for identical benefits for an annual fee to UPP Care. This would permit a private insurer to pay any identically covered medical procedures or benefits using UPP Care's negotiated discounted rates even if the individual that received the treatment WAS NOT an ACTIVE PARTICIPANT in the government's UPP Care plan. This permits those that may be in-eligible to receive UPP Care the benefit of paying medical bills at UPP Care's discounted rates indirectly.
Ba OPTION.)
If the private insurer's treated individual subscriber IS NOT a participant of the UPP Care plan but the private insurer has paid a fee to UPP Care for the use of the negotiated discounted rates then the private insurer would be permitted and responsible to DIRECTLY pay the individual's medical bills using the government's negotiated discounted rates. Their would be no reason for the UPP Care plan to be involved with the payment process beyond providing necessary information and proof to the parties involved that the private insurer is permitted to pay using the UPP Care's negotiated rates. By law, payments paid at UPP Care's negotiated discounted rates would have to be accepted under this option.
Bb OPTION.)
If however, the private insurer's treated individual subscriber IS also an ACTIVE PARTICIPANT in the government UPP Care program then should it be necessary, the government could still be requested to pay the medical bills in the end the same way as if the individual selected an ALTERNATE INSURANCE option as previously mentioned.
-WHAT UPP CARE IS NOT.
-UPP Care is not a co-op. The government has full control over the plan and the negotiation of the rates and benefits.
WHAT IS THE MAIN MOTIVATION TO EXPANSION OF UPP CARE COVERAGE?-
Private insurers and self insurers will only benefit from discounted rates where their coverage is identical to the government's coverage. The more medical procedures covered by the government's plan the more private insurers and self insures will also benefit from the discounted rates in identical areas. If you scratch my back, I'll scratch yours!
More to come.
-to be continued.
20090828
Tax Vouchers. 09/08/09
Note-This post is currently under major construction and is 40% etched in stone as to my ideas and thoughts.
QUALIFYING FOR A TAX VOUCHER.
-A TAX VOUCHER could be requested after a tax year is ended but probably prior to the regular federal tax deadline of April 15.
DEFINE-
TAX VOUCHER-
-This is a reimbursement of some or all of the taxes you paid into the UPP Care during a tax year.
-MINIMUM REQUIREMENTS FOR A TAX VOUCHER TO BE REVIEWED.
-#1)In order to request a tax voucher from UPP Care you must have been an ACTIVE PARTICIPANT and paid taxes into the UPP Care health plan during part or all of the prior tax year.
AND
-#2)In addition to #1 you must also have a QUALIFYING ALTERNATE INSURANCE PLAN that included the same identical coverage that the UPP Care plan offers during the same time period.
OR AND
#3)You in addition to #1 you believe you can qualify for a partial tax voucher for meeting the special requirements to UPP CARE'S PARTICIPANT COST REDUCTION INCENTIVE PROGRAM.
-DEFINE
QUALIFYING ALTERNATE INSURANCE
-Their is no question that a qualifying alternate insurance should include a private insurance plan that has the same identical coverage as UPP Care and was paid 100% IN FULL by the active participant. This is clearly a alternate insurance chosen by the active participant and clearly shows he insured himself properly and suffered the expense of this personal choice.
-From this point on however, it because questionable weather or not those that are not paying in full should get the same tax voucher or be considered a qualifying alternate insurer.
-Further from this point on it is also becomes questionable and highly debatable on weather to include self proclaimed self insurers as a legitimate qualifying alternate insurance.
IS A TAX VOUCHER IN ORDER?
-This is where things become to difficult for someone like myself to complete this information without further input.
-EXAMPLE A) Lets look at one case in the extreme as one example. If someone has paid 100% out of their own pocket for a private insurance plan that has the same identical coverage as UPP Care and it was listed as an ALTERNATE PRIMARY PAYEE-PLAN B option but had no claims paid by UPP Care nor did the private insurer use the UPP Care rates because PLAN B was chosen then this situation should without question should result in the MAXIMUM POSSIBLE TAX VOUCHER. However, a completely FULL TAX VOUCHER should really never be possible with an ACTIVE participant.
Why? Even though their was no actual expense to UPP Care nor was UPP Care chosen to be on ACTIVE STANDBY PLAN to cover the individual in the event of a medical situation. UPP Care was still chosen to be an INACTIVE STANDBY BACK UP PLAN just by actively continuing participation in the plan. So, a FULL VOUCHER really should never be possible unless an individual rejected the plan and was still kept mistakenly at an ACTIVE PARTICIPANT status and forced to pay taxes into the plan.
DEFINE-
SELF INSURED OR SELF INSURANCE
-Individuals that claim they will pay medical expenses out of their own pocket and have no actual policy or legitimate insurance coverage. Could include those that are wealthy or not and intend to pay on their own when necessary.
EXAMPLE B)Another more difficult example is what if an ACTIVE PARTICIPANT says he has what he calls SELF INSURANCE (no policy, intending to pay out of pocket) and lists it as an ALTERNATE PRIMARY PAYEE-PLAN B. Basically someone can say they have self insurance (no premium, no proof of insurance) but they may or may not actually have the funds for it and if no claims are made or paid by his so-called self insurance plan or the UPP Care plan he could attempt keeping the UPP Care plan as a INACTIVE STANDBY BACK UP PLAN knowing he could change this at any time since the status is temporary. Provided he lucks out and was healthy and no claims where made he could then file for a tax voucher. Should he receive the same tax voucher in the EXAMPLE A ?? In effect, this individual has fooled the UPP Care plan into giving a tax voucher when their really was no expense to the individual and the individual had every intention of switching the ALTERNATE PRIMARY PAYEE back to UPP Care when he becomes sick or injured.
First, this person is using the UPP Care plan to his advantage and even though he has placed UPP Care as the INACTIVE STANDBY BACKUP PLAN he may fully know that he has no other real alternate insurance and in a way the UPP Care plan is in reality his ACTIVE STANDBY BACKUP PLAN because he has no money. Provided he has no claims he never needs to change that status and could qualify for a tax voucher. How do we deal with this situation?
-To begin with, my guess is that we must require a special minimum balance maintained account that is monitored by the banks and reported to the government at the end of the tax year. It very well might require a minimum of many millions of dollars to qualify under this self insured definition or at least to the limits of the UPP Care plan if any?
-Beyond that I do believe there is a need to reduce such a tax voucher for those that claim they are self insured and still ACTIVELY PARTICIPATE in the UPP Care plan. Perhaps the definition of ALTERNATE INSURANCE should be limited to private insurance or group insurance that contains a written policy? Besides, if you have the money to be self insured why even be in this plan?
DEFINE-
UPP CARE'S COST REDUCTION INCENTIVE PROGRAM
-This incentive pROGRAM provides a list of tests that are expected to be authorized for certain conditions. If you can refrain from excessive testing beyond these tests listed you can qualify for a small incentive partial tax voucher for helping in cost reductions. This is completely up to the patient to decide on where to refuse a test or not.
QUALIFYING FOR A TAX VOUCHER.
-A TAX VOUCHER could be requested after a tax year is ended but probably prior to the regular federal tax deadline of April 15.
DEFINE-
TAX VOUCHER-
-This is a reimbursement of some or all of the taxes you paid into the UPP Care during a tax year.
-MINIMUM REQUIREMENTS FOR A TAX VOUCHER TO BE REVIEWED.
-#1)In order to request a tax voucher from UPP Care you must have been an ACTIVE PARTICIPANT and paid taxes into the UPP Care health plan during part or all of the prior tax year.
AND
-#2)In addition to #1 you must also have a QUALIFYING ALTERNATE INSURANCE PLAN that included the same identical coverage that the UPP Care plan offers during the same time period.
OR AND
#3)You in addition to #1 you believe you can qualify for a partial tax voucher for meeting the special requirements to UPP CARE'S PARTICIPANT COST REDUCTION INCENTIVE PROGRAM.
-DEFINE
QUALIFYING ALTERNATE INSURANCE
-Their is no question that a qualifying alternate insurance should include a private insurance plan that has the same identical coverage as UPP Care and was paid 100% IN FULL by the active participant. This is clearly a alternate insurance chosen by the active participant and clearly shows he insured himself properly and suffered the expense of this personal choice.
-From this point on however, it because questionable weather or not those that are not paying in full should get the same tax voucher or be considered a qualifying alternate insurer.
-Further from this point on it is also becomes questionable and highly debatable on weather to include self proclaimed self insurers as a legitimate qualifying alternate insurance.
IS A TAX VOUCHER IN ORDER?
-This is where things become to difficult for someone like myself to complete this information without further input.
-EXAMPLE A) Lets look at one case in the extreme as one example. If someone has paid 100% out of their own pocket for a private insurance plan that has the same identical coverage as UPP Care and it was listed as an ALTERNATE PRIMARY PAYEE-PLAN B option but had no claims paid by UPP Care nor did the private insurer use the UPP Care rates because PLAN B was chosen then this situation should without question should result in the MAXIMUM POSSIBLE TAX VOUCHER. However, a completely FULL TAX VOUCHER should really never be possible with an ACTIVE participant.
Why? Even though their was no actual expense to UPP Care nor was UPP Care chosen to be on ACTIVE STANDBY PLAN to cover the individual in the event of a medical situation. UPP Care was still chosen to be an INACTIVE STANDBY BACK UP PLAN just by actively continuing participation in the plan. So, a FULL VOUCHER really should never be possible unless an individual rejected the plan and was still kept mistakenly at an ACTIVE PARTICIPANT status and forced to pay taxes into the plan.
DEFINE-
SELF INSURED OR SELF INSURANCE
-Individuals that claim they will pay medical expenses out of their own pocket and have no actual policy or legitimate insurance coverage. Could include those that are wealthy or not and intend to pay on their own when necessary.
EXAMPLE B)Another more difficult example is what if an ACTIVE PARTICIPANT says he has what he calls SELF INSURANCE (no policy, intending to pay out of pocket) and lists it as an ALTERNATE PRIMARY PAYEE-PLAN B. Basically someone can say they have self insurance (no premium, no proof of insurance) but they may or may not actually have the funds for it and if no claims are made or paid by his so-called self insurance plan or the UPP Care plan he could attempt keeping the UPP Care plan as a INACTIVE STANDBY BACK UP PLAN knowing he could change this at any time since the status is temporary. Provided he lucks out and was healthy and no claims where made he could then file for a tax voucher. Should he receive the same tax voucher in the EXAMPLE A ?? In effect, this individual has fooled the UPP Care plan into giving a tax voucher when their really was no expense to the individual and the individual had every intention of switching the ALTERNATE PRIMARY PAYEE back to UPP Care when he becomes sick or injured.
First, this person is using the UPP Care plan to his advantage and even though he has placed UPP Care as the INACTIVE STANDBY BACKUP PLAN he may fully know that he has no other real alternate insurance and in a way the UPP Care plan is in reality his ACTIVE STANDBY BACKUP PLAN because he has no money. Provided he has no claims he never needs to change that status and could qualify for a tax voucher. How do we deal with this situation?
-To begin with, my guess is that we must require a special minimum balance maintained account that is monitored by the banks and reported to the government at the end of the tax year. It very well might require a minimum of many millions of dollars to qualify under this self insured definition or at least to the limits of the UPP Care plan if any?
-Beyond that I do believe there is a need to reduce such a tax voucher for those that claim they are self insured and still ACTIVELY PARTICIPATE in the UPP Care plan. Perhaps the definition of ALTERNATE INSURANCE should be limited to private insurance or group insurance that contains a written policy? Besides, if you have the money to be self insured why even be in this plan?
DEFINE-
UPP CARE'S COST REDUCTION INCENTIVE PROGRAM
-This incentive pROGRAM provides a list of tests that are expected to be authorized for certain conditions. If you can refrain from excessive testing beyond these tests listed you can qualify for a small incentive partial tax voucher for helping in cost reductions. This is completely up to the patient to decide on where to refuse a test or not.
20090821
How do we pay for UPP Care? 08/30/09
Note- This post is currently under custruction and is 10% etched in stone.
UNIVERSAL PRIMARY PAYER HEALTH CARE RISK TAX.
-This is an area I will admit I am still in the research stage.
-I do see their should be a special Health Risk tax that is placed on items that are known to cause higher health costs and claims. It seems only fair that those whom will live dangerously should also be a larger payer into the the very system that will be called upon to repair that individual.
-This Health Risk tax would be on items such as motorcycles, compact cars or other items that are known in their historical record to be large contributors of high claims. No one is purposing a high Health tax on a family car that is necessary. This tax would be moderate to low as many people do operate these items responsibly.
- For those items that are unnecessary and high performance a moderate health risk tax would be placed on them.
-For items that are without question known to cause high cost health claims such as greasy foods and possibly sugar I believe a much higher tax should be placed on these items. Over all their should be an agreed limit to the maximum tax permitted under this government plan.
-Other sources must be used as well.
-Save receipts for those that desire a voucher at the end of the year if they have a private insurance plan.
-I DO SEE THAT IT IS POSSIBLE TO USE A MONTHLY PAID PREMIUM TO A NON-PROFIT GOVERNMENT PLAN THAT SOMEHOW KEEPS THE FUNDS IN THE PROGRAM AND OUT OF CONGRESSES GRASP. MAYBE?
-more to come as I learn more.
UNIVERSAL PRIMARY PAYER HEALTH CARE RISK TAX.
-This is an area I will admit I am still in the research stage.
-I do see their should be a special Health Risk tax that is placed on items that are known to cause higher health costs and claims. It seems only fair that those whom will live dangerously should also be a larger payer into the the very system that will be called upon to repair that individual.
-This Health Risk tax would be on items such as motorcycles, compact cars or other items that are known in their historical record to be large contributors of high claims. No one is purposing a high Health tax on a family car that is necessary. This tax would be moderate to low as many people do operate these items responsibly.
- For those items that are unnecessary and high performance a moderate health risk tax would be placed on them.
-For items that are without question known to cause high cost health claims such as greasy foods and possibly sugar I believe a much higher tax should be placed on these items. Over all their should be an agreed limit to the maximum tax permitted under this government plan.
-Other sources must be used as well.
-Save receipts for those that desire a voucher at the end of the year if they have a private insurance plan.
-I DO SEE THAT IT IS POSSIBLE TO USE A MONTHLY PAID PREMIUM TO A NON-PROFIT GOVERNMENT PLAN THAT SOMEHOW KEEPS THE FUNDS IN THE PROGRAM AND OUT OF CONGRESSES GRASP. MAYBE?
-more to come as I learn more.
20090820
Hypothetical medical situations. 09/08/09
Note-This post is under major construction and is 20% etched in stone.
HYPOTHETICAL SITUATION #1.
-Lets say that their is a man named Dennis who has just received a letter from the government in 2009 telling him he will automatically be included into the government's new UPP Care health plan starting Jan 2010. He is told that he has the right to reject this plan if he desires.
Dennis has his own private insurance he's been happy with called Guysinger Health Insurance. The Guysinger plan later in 2009 announces that it's plan will include the same identical coverage as UPP Care by adopting the UPP Care's legal policy language so that their is no question that it is identical to UPP Care.
Dennis is fine with that but is realizing that if he gets sick he may not afford his private plan premiums as his income is likely to be effected by his illness and time missed at work.
So, Dennis decided to continue as an ACTIVE PARTICIPANT in UPP Care but decide to inform the government that he will continue to pay on his own for his Gusinger health plan and lists it as the ALTERNATE PRIMARY PAYEE-PLAN B. The PLAN B means Guysinger will not be able to use the UPP Care reduced rates through Dennis's account because of his account status.
During the year of 2010 Dennis is an ACTIVE PARTICIPANT in the UPP Care plan and also continues to pay the premium in full out of his pocket for the Gusinger health plan.
During that year he only has a few claims for physicals & check-ups and they are paid DIRECTLY out of his Guysinger plan. Their is no claims paid buy the UPP Care plan and their reduced rates where not used through Dennis's account.
In Jan of 2011 Dennis can file for a TAX VOUCHER request for almost all of the taxes he paid into the UPP Care plan. This would include any tax that is taken out of his check or taxes he has receipts showing he paid a HEALTH RISK TAX.
Dennis's insurance would certainly qualify as an ALTERNATE INSURANCE and Dennis should get almost all of his taxes back because he had paid for and maintained a private insurance of his choice.
However, Dennis won't get back ALL of his taxes because he remained and ACTIVE PARTICIPANT in the UPP Care plan which allowed him the POSSIBILITY to change his ALTERNATE PAYEE status at anytime to have the UPP Care program pay for a medical bill should Guysinger not pay or be cancelled. In effect UPP Care was the back-up plan if Dennis could not keep paying his private plan.
If Dennis rejected the UPP Care plan it would put Dennis in a possible situation where he may have to cancelled his plan due to lack of money while he was sick in bed and then be uninsured. But Dennis was able to afford both paying taxes on UPP Care and continue his Guysinger plan. Not all will be able to do as Dennis did, however, it remains an option.
One advantage to UPP Care is that as Dennis's income falls he may qualify for assistance to help pay for UPP Care. But this could effect a final tax voucher distribution if qualified.
HYPOTHETICAL SITUATION #1.
-Lets say that their is a man named Dennis who has just received a letter from the government in 2009 telling him he will automatically be included into the government's new UPP Care health plan starting Jan 2010. He is told that he has the right to reject this plan if he desires.
Dennis has his own private insurance he's been happy with called Guysinger Health Insurance. The Guysinger plan later in 2009 announces that it's plan will include the same identical coverage as UPP Care by adopting the UPP Care's legal policy language so that their is no question that it is identical to UPP Care.
Dennis is fine with that but is realizing that if he gets sick he may not afford his private plan premiums as his income is likely to be effected by his illness and time missed at work.
So, Dennis decided to continue as an ACTIVE PARTICIPANT in UPP Care but decide to inform the government that he will continue to pay on his own for his Gusinger health plan and lists it as the ALTERNATE PRIMARY PAYEE-PLAN B. The PLAN B means Guysinger will not be able to use the UPP Care reduced rates through Dennis's account because of his account status.
During the year of 2010 Dennis is an ACTIVE PARTICIPANT in the UPP Care plan and also continues to pay the premium in full out of his pocket for the Gusinger health plan.
During that year he only has a few claims for physicals & check-ups and they are paid DIRECTLY out of his Guysinger plan. Their is no claims paid buy the UPP Care plan and their reduced rates where not used through Dennis's account.
In Jan of 2011 Dennis can file for a TAX VOUCHER request for almost all of the taxes he paid into the UPP Care plan. This would include any tax that is taken out of his check or taxes he has receipts showing he paid a HEALTH RISK TAX.
Dennis's insurance would certainly qualify as an ALTERNATE INSURANCE and Dennis should get almost all of his taxes back because he had paid for and maintained a private insurance of his choice.
However, Dennis won't get back ALL of his taxes because he remained and ACTIVE PARTICIPANT in the UPP Care plan which allowed him the POSSIBILITY to change his ALTERNATE PAYEE status at anytime to have the UPP Care program pay for a medical bill should Guysinger not pay or be cancelled. In effect UPP Care was the back-up plan if Dennis could not keep paying his private plan.
If Dennis rejected the UPP Care plan it would put Dennis in a possible situation where he may have to cancelled his plan due to lack of money while he was sick in bed and then be uninsured. But Dennis was able to afford both paying taxes on UPP Care and continue his Guysinger plan. Not all will be able to do as Dennis did, however, it remains an option.
One advantage to UPP Care is that as Dennis's income falls he may qualify for assistance to help pay for UPP Care. But this could effect a final tax voucher distribution if qualified.
20090819
UPP Care-Plan B. Mandating Participation. 10/25/09
Note-This post is currently under major construction and less than 5% etched in stone.
MANDATING UPP CARE?
IF UPP CARE OR ANY OTHER GOVERNMENT OPTION IS MANDATED, WHICH IN EFFECT REQUIRES ALL THOSE THAT ARE ELIGIBLE TO PARTICIPATE MUST PARTICIPATE, THEN YOU WOULD FIRST PAY UPP CARE THROUGH YOUR TAXES OR A PREMIUM. AN OPTION COULD BE MADE AVAILABLE FOR YOU TO SELECT A QUALIFYING ALTERNATIVE INSURANCE. IF YOU DECIDE TO SELECT AN ALTERNATIVE INSURANCE YOUR TAXES THAT WHERE DEDUCTED AND SENT INTO UPP CARE WOULD BE CREDITED OR FORWARDED TO THE ALTERNATIVE INSURER DIRECTLY. THEIR WOULD BE NO EXTRA COST OR BURDEN DURING THE YEAR AND NO NEED TO WAIT FOR A TAX VOUCHER. IT WOULD GO DIRECTLY TO THE INSURER OF YOUR CHOICE IF IT QUALIFIES. IF YOU LATER ABANDON THE ALTERNATE INSURANCE THE TAXES WILL CONTINUE TO BE DEDUCTED BUT USED TOWARDS THE UPP CARE PLAN.
-After listening to President Obama's speech on health care on 09/09 I decided to rework the original definition of UPP Care I explained in the above posts so that it reflects how UPP Care would work if it was mandated that all those that are eligible must participate in this government UPP Health Care plan. Although I DO NOT personally prefer a mandate to require participation in any health plan I have included these thoughts and ideas to show just how mandating participation in a government plan would work or not.
MANDATING UPP CARE?
IF UPP CARE OR ANY OTHER GOVERNMENT OPTION IS MANDATED, WHICH IN EFFECT REQUIRES ALL THOSE THAT ARE ELIGIBLE TO PARTICIPATE MUST PARTICIPATE, THEN YOU WOULD FIRST PAY UPP CARE THROUGH YOUR TAXES OR A PREMIUM. AN OPTION COULD BE MADE AVAILABLE FOR YOU TO SELECT A QUALIFYING ALTERNATIVE INSURANCE. IF YOU DECIDE TO SELECT AN ALTERNATIVE INSURANCE YOUR TAXES THAT WHERE DEDUCTED AND SENT INTO UPP CARE WOULD BE CREDITED OR FORWARDED TO THE ALTERNATIVE INSURER DIRECTLY. THEIR WOULD BE NO EXTRA COST OR BURDEN DURING THE YEAR AND NO NEED TO WAIT FOR A TAX VOUCHER. IT WOULD GO DIRECTLY TO THE INSURER OF YOUR CHOICE IF IT QUALIFIES. IF YOU LATER ABANDON THE ALTERNATE INSURANCE THE TAXES WILL CONTINUE TO BE DEDUCTED BUT USED TOWARDS THE UPP CARE PLAN.
Personally, I am not a fan of mandating health insurance of any kind weather it is private or government controlled. Part of my grievance with mandating a government plan is that if you provide an option that allows the forced participant the choice to switch to an alternative insurance in place of the UPP Care or other government plans you are in effect mandating private health insurance. In order to get out of the mandated government plan you would have little choice but to go with private insurance or stay with the government plan.
But with that said, we must ask ourselves if we are to mandate people to be responsible for their health should we then mandate that they also lock their doors at night, buy a gun to defend their families and force them to purchase birth control as well?
We need an "incentive based" mandate not the treat of a fine or tax if one does not participate.
More to come.
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