By Jason Roberson
The Dallas Morning News
January 2, 2008

DALLAS – Mortgage lenders aren’t the only ones showing more interest in your credit score these days — the health industry is creating its own score to judge your ability to pay.

The new medFICO score, being designed with the help of credit industry giant Fair Isaac Corp., could debut as early as this summer in some hospitals.

Healthcare Analytics, a Waltham, Mass., health technology firm, is developing the score. It is backed by funding from Fair Isaac, of Minneapolis; Dallas-based Tenet Healthcare Corp.; and venture capital firm North Bridge Venture Partners, also based in Waltham. Each kicked in $10 million for the project he score is already raising questions from consumer advocacy groups that fear it will be checked before patients are treated. People with low medical credit scores could receive lower-quality care than those with a healthy medFICO, they argue.

“How much assurance do I have that they’re not going to look at this medFICO first, before they decide whether to treat or not?” asked Linda Foley, founder of the Identity Theft Resource Center in San Diego.

That will not happen, said Stephen Farber, chairman and chief executive of Healthcare Analytics. Hospitals will check the score, which will be based on the patient’s medical bill payment history, only after the patient is discharged, he said.

“We only come into play once the patient has been treated and discharged, and the bill already exists,” said Farber, who has visited hospital executives nationwide over the last six months to sell the concept. “We just help figure out what sort of relief a hospital should grant the patient.”

Hospitals and other caregivers already can tap into regular credit scores — even without the patient’s permission — but those are not necessarily a good indication of whether a patient will pay a medical bill, Farber said. Such credit scores are based on voluntary purchases, such as a car. Health-care debt is largely involuntary.

Under the Fair Credit Reporting Act, hospitals and doctors are allowed to report health-care debts to credit reporting agencies, but they cannot indicate what they were for.

“They have to do it in a way that there will be no way a person looking at the information would be able to guess what they were treated for,” said Frank Dorman, spokesman for the U.S. Fair Trade Commission.

Conditions concealed

By custom, hospitals generally do not report delinquent accounts, but they do turn them over to collection agencies, said Norm Magnuson, vice president of public affairs for the Consumer Data Industry Association, a Washington trade group for companies that provide credit reports.

In such cases, only the medical provider’s name and the amount owed would be listed. But even that cannot be included if the name gives away too much information, as in the Betty Ford Clinic, widely known as an alcohol and drug rehabilitation facility.

The proposed medFICO score would be legal as long as it only includes billing data. And unlike a standard report, which only lists late medical bills, the medFICO score would reflect a history of on-time payments.

To develop its scoring system, Healthcare Analytics is collecting patient billing data from hospital systems with a combined $100 billion in annual net revenue.

Tenet executives say the scoring system could help them decide whether a given patient can pay his or her bill or if they should just write it off as uncollectible, or a “bad debt” in industry lingo.

Without a way to gauge the likelihood that patients will pay their bills, hospitals cannot comfortably invest in new projects or accurately balance expenses against revenue.

Tenet, the nation’s third-largest hospital system, with 63 hospitals and medical centers, had $433 million in bad debt through this year’s third quarter. Seventy-five percent of that bad debt was from uninsured patients and 25 percent from those with deductibles they couldn’t, or wouldn’t, pay, said Steve Mooney, Tenet’s senior vice president of patient financial services.

To figure out how to collect from patients, Tenet now divides them into categories based on whether they are married or single, whether they came through the emergency room or had a scheduled procedure, and whether their regular credit score is high or low.

“But the problem with the credit score is that not everybody has one,” Mooney said. “We have about 40 percent of our self-pay patients who we do not get a credit score on.

Incorrect scoring alleged

Meanwhile, consumer advocates argue that given the problems arising from the Fair Isaac credit score — such as identity theft and inaccurate scoring data — it should not become the basis for a medical version.

In an analysis of more than 500,000 individuals’ credit scores, the Consumer Federation of America says it found that 29 percent were 50 points lower than they should have been.

“What if there’s a mis-scoring — whether it’s due to some clerical error or due to an identity theft issue, where you have two William S. Joneses who have similar numbers?” asked Foley. “This is the same problem we’ve seen in the credit industry.”

Foley said a recent personal experience heightened her sensitivity to the possible dangers.

The day before she was interviewed, she said she spent more than six hours in an emergency room with her husband, who was believed to be suffering a heart attack.

“We have an HMO, but what if we didn’t have health coverage?” Foley asked. “If he had a low score, would he have gotten the same type of care that he got last night?”

Mooney, of Tenet Healthcare, said the hospital business has changed over the past 30 years to take on characteristics of the retail industry. With patients expected to pay a larger share and do more comparison shopping, they soon will be able to purchase health care much like an automobile, he said.

Pamela Dixon, executive director of the World Privacy Forum, a consumer advocacy group, isn’t impressed. “I don’t like it; I don’t like it at all. These are people’s lives we’re talking about. This isn’t some car.”

Letters to the Editor
Boston Globe
February 10, 2008

JONATHAN GRUBER suggests that a single-payer system “would cost many multiples” of the current effort to expand health insurance coverage in Massachusetts through an individual mandate (letters, Feb 1) (http://www.boston.com/bostonglobe/editorial_opinion/letters/articles/2008/02/01/recognizing_progress_in_massachusetts_health_reform) Yet at least 18 studies conducted since 1991, including two that examined single-payer plans for Massachusetts in 1998, have found that a single-payer plan could provide comprehensive coverage for everyone while costing less than is now being spent. Savings in insurance overhead and hospital and physician office billing costs would more than offset the cost of providing access to care for those who now don’t have it. Massachusetts should reconsider this cost-effective alternative to the increasingly costly approach now being attempted.

LEONARD RODBERG
New York

The writer is a research director with Physicians for a National Health Program

By Adam Doster
In These Times
February 11, 2008

Dr. Nancy Nielsen’s résumé is exhaustive. Currently a clinical professor of medicine and senior associate dean for medical education at the University of Buffalo School of Medicine and Biomedical Sciences, Nielsen has worked for the New York State Department of Health and has held various leadership positions in the American Medical Association (AMA). So it’s not surprising that the AMA voted her president-elect last June, only the second woman to hold the post. Yet other jobs on Nielsen’s résumé have alarmed some progressive healthcare advocates.

From October 2004 to July 2007, Nielsen served as chief medical officer of Independent Health Association, a Buffalo-based HMO. Although AMA spokesperson Brenda Crane notes that Nielsen ended her affiliation with Independent Health upon receiving her promotion at the AMA, her tenure raises flags for Geri Jenkins, president of the California Nurses Association, a healthcare union.

“I think you have a conflict when you have someone in that position who’s worked for an insurance company and is also a physician who’s going to run the AMA,” Jenkins says.

Since 1996, Nielsen has also sat on the board of the Medical Liability Mutual Insurance Company, one of the country’s largest medical liability carriers. While some Republicans have embraced medical malpractice reform as a virtual cure-all for America’s healthcare crisis, critics contend that putting caps on non-economic damages provides unjustified protections for hospitals, HMOs and insurance companies, another potential conflict of interest.

In a vacuum, Nielsen’s professional relationships might be considered inconsequential. But the AMA has a long history of thwarting progressive healthcare reform, which amplifies the importance of her connection to the insurance industry.

As early as the 1930s, then-AMA President Dr. Morris Fishbein wrote that a national healthcare program would cause “a weakening of national caliber,” and signal “a definite step toward either communism or totalitarianism.” When, in 1948, President Harry Truman called for the creation of a government-run national health insurance fund, the AMA characterized the bill as “socialized medicine” and campaigned against it.

Next came the 1961 battle over Medicare that pitted the Kennedy administration against a recently hired General Electric public-relations flak named Ronald Reagan. The future president recorded an LP titled “Ronald Reagan Speaks Out Against Socialized Medicine” that the AMA distributed to housewives across the country. “Operation Coffee Cup” architects suggested that women organize small gatherings, brew some java and listen to the dangers that a national healthcare system would invariably pose.

During the Clinton years, the AMA was active in the coalition that beat back “Hillarycare”–the Democrats’ last attempt at major healthcare reform.

In August, the AMA launched a $15 million advertising campaign that focused on the problems of the uninsured, hoping to persuade voters to cast their ballots in 2008 with the issue in mind. But this project has frustrated reformers, who contend that the organization’s approach to achieving universal care–providing tax breaks and vouchers for those lacking coverage so they can purchase affordable plans–is too timid.

“At best … the AMA is advocating a completely unproven method of achieving their ends and ignoring things that we know will work,” says Dr. Stephanie Woolhandler, co-founder of Physicians for a National Health Program.

Given these realities, many doctors are turning their backs on the AMA. The medical news service MedPage Today estimated that the AMA represented only 15 percent of practicing U.S. physicians in 2005, down from 70 percent during the 1961 Medicare fight.

“A lot of younger doctors,” says Jenkins, “have gone into other groups and organizations because they haven’t always been happy with how the AMA is run and what they do.”

States like Minnesota and Massachusetts show majority support among physicians for a single-payer system, and the American College of Physicians–America’s second-largest physician group–endorsed such a proposal in December.

That’s made no difference to the AMA.

“The AMA has stuck with this position of vehemently opposing national health insurance,” says Woolhandler, “despite a major shift in the physician community in terms of opinion.”

With Nielsen at the helm, the AMA’s intransigence seems likely to continue.

By John Warner
Op-Ed
West Virginia Gazette
February 8, 2008

I HAVE written very critically of the American Medical Association, nor am I finished with my criticism. But I will report to you that there is light at the end of the tunnel. Not all physicians are enamored with the senior medical association. Today there is a younger organization, the Physicians for a National Health Program, comprising 14,000 physicians who support a plan for universal health care in America. It’s about time.

I HAVE written very critically of the American Medical Association, nor am I finished with my criticism. But I will report to you that there is light at the end of the tunnel. Not all physicians are enamored with the senior medical association. Today there is a younger organization, the Physicians for a National Health Program, comprising 14,000 physicians who support a plan for universal health care in America. It’s about time.

Let’s start with this. It is estimated that about 47 million Americans lack health insurance. That means they cannot cover trips to the doctor, prescriptions, dental or eye appointments. That means when they get sick, they just suck it up. Forty-seven million. Friends, that number is equal to 26 states the size of West Virginia. There is no explanation other than the severe opposition to universal health insurance provided by the American Medical Association and its Republican friends in Congress. That is a national shame.

The AMA has never campaigned for good health, although it has pretended to do so. Its stated interest throughout most of the 20th century has been such political ideals as “free enterprise” and “voluntary medicine.” The result has been a national disgrace.

The AMA has never attempted to look at medicine from the point of view of the consumer, those of us who need a doctor’s care. It has always seen medicine as a business and has argued only for good business, never good health care. What it did in the past is precisely what it is doing again in the current campaign for a new health system. The leopard does not change his spots. The result has been that we rank at the very bottom of the industrialized world in life expectancy and infant mortality.

The association has labeled all attempts at universal health care as “socialistic” and “compulsory.” Early in the Clinton administration, the president assigned his wife to redesign America’s health care. So opposed was the AMA to the plans Hillary was making that it plastered her work with bold-faced lies, telling us that under the Clinton plan we could no longer choose our own physicians, that those decisions would be made by bureaucrats in Washington, and that the AMA supported “voluntary” health care, not the “compulsory” system recommended by Bill and Hillary. That was a lie. Remember those television ads sponsored by the AMA, an attractive couple worried that they could no longer choose their own doctor? That was a lie.

In order to block health-care plans in the 1960s (Medicare and Medicaid) – and the work begun by Harry Truman before that – the AMA set up local committees of physicians to meet with their members of Congress and advise them against government-aided health care. They worked to defeat members of Congress who disagreed with them. They provided literature to be distributed in physicians’ offices warning patients against socialized medicine. They joined efforts with Readers’ Digest to flood physicians’ offices with propaganda. They provided leaflets to doctors’ wives, leaflets they could slip into every letter they mailed. Physicians put pressure on nurses in their offices to support AMA claims, while several nurses’ organizations actually supported government-supported insurance.

Here is one leaflet: “An important message from your doctor.” It claims that the Kennedy-Johnson plan would be “socialized medicine,” placing the government at your bedside, providing bureaucrats with confidential information about your health. It claims that “socialized medicine,” as practiced in European countries, was “a system which has resulted in the deterioration of medical care wherever it has been tried.”

“Working together,” the AMA argued in this doctors’ office literature, “we can preserve the high quality of health care now available in this country. Let’s keep politics out of medicine.”

What a frightful lie. American medical care is not better than our European friends’ care. Ask those 47 million Americans who live on the edge of disaster, who lack health coverage, for whom a health crisis means economic ruin.

Today, realizing that the health-care die is being cast and recognizing that the next Congress, a Democratic Congress, will pass new health-care legislation, the AMA has proposed what it calls the “Voice of the Uninsured.”

In August 2007, just last summer, AMA president-elect Nancy Nielson announced the new AMA health-care plan. “Under the AMA plan, the vast majority of Americans would have the means to purchase health-care coverage,” she said. “It would give individuals choices, so they can select the appropriate coverage for them and their families, and would promote market reform in the insurance industry.” Friends, that is a lie.

I said above that there is light at the end of the tunnel. The younger organization, Physicians for a National Health Program, denounced the claims made by Ms. Nielson, saying: “What the AMA isn’t saying is that its plan would steer about 47 million people into the health insurance industry’s most expensive form of coverage. And it would probably leave taxpayers holding the bag.”

“It’s a flawed plan because it’s the most expensive way that we could extend health coverage to everyone,” reports a representative for the Physicians for a National Health Program. Thank heavens for the PNHP. They are on our side.

Warner, professor emeritus at West Virginia Wesleyan College, is a Gazette contributing columnist. This is the last of three essays on medical care.

Howard A. Green, MD, FACP, FAAD, FACMS
Palm Beach County Medical Society

You’ll listen to me because I’m your doctor. I only have your health interests in mind.. I have written this article without ‘prior authorization’ from any insurance companies.

There are some intuitively obvious services that the government runs more productively and efficiently than private for-profit enterprises. For example, our armed forces and GI’s conquer and hold and protect territory more effectively and at a fraction of cost of private militias such as Blackwater USA and the Crescent Security Corporations. In addition, the government rules and regulations which our governments’ military adhere to insure an ethical cohesive fighting force compared to the unregulated for-profit corporate armies. Our GI soldiers assigned to kitchen duty prepare and cook meals at a fraction of the cost of identically prepared meals from the private for-profit logistics divisions of the Halliburton or Kellog Brown and Root Corporations. Government regulated public education in America such as the undergraduate and college systems of the City of New York and other large metropolises have for over a century produced more CEO’s, doctors, lawyers, accountants, engineers, chemists, poets, philosophers and military officers than any private school system, and at a fraction of the cost compared to all the private schools in the country combined. Take away the government grants, government tax breaks, and government sponsored free overseas labor from Americas top private Colleges and their classrooms and graduate programs would most likely shut down, no matter how large their private endowments. The government run and regulated public school systems of Israel, India and China are churning out competent engineers, scientists and entrepreneurs at a quality and rate much greater than that of any collection of private schools in any country in the world. These non-American people, highly educated by their government run school systems, have formed a new collective worldwide labor arbitrage system which is fueling the productivity of intercontinental private business. The Marshall Plan, Interstate Highways, Space Program, Peace Corps, and the GI Bill all demonstrate successful government run bureaucracies of their time.

In a similar fashion, our mammoth government-run health insurance company (Medicare) operates at a fraction of the cost of private insurance corporations such as Aetna, Cigna, United, Blue Shield Blue Cross, Kaiser Permanente and Humana. Medicare, the government health insurance for the elderly uses only 1-2% of your dollar to achieve rates of morbidity (sickness) and mortality (death) among their patients which are identical to those of the private health insurance corporations. However, private insurance corporate bureaucracies inefficiently siphon $350 billion per year, or 20-25% of your hard earned dollars away from doctors, hospitals and patient care into the pockets of their executives, administrative employees, shareholders and politicians. The recent stock option fraud perpetrated by the CEO of United Health Care demonstrates the negligent disdain the private insurance corporations have for physicians, hospitals, health care workers and patients. Since their founding 40 years ago, private health maintenance insurance corporations have failed to deliver what their business plans always promise; lower rates of morbidity and mortality associated with low costs to the patients. These insurance companies are financially profitable for their shareholders and executives, but medically bankrupt for their patients. Without their own massive government subsidies, government protection from malpractice lawsuits, and a government ban on collective bargaining by physicians the private health insurance corporate bureaucracies of Aetna, Cigna, United and Humana, and hundreds of other smaller health insurance companies of the health insurance industry would undoubted fail to exist. Most elderly people who call themselves Republicans, and conservative physicians in this Country have recognized the efficacy of our government regulated Medicare health insurance corporation and have enrolled themselves and utilized this Government run health insurance company for their own medical needs (despite the shrill cries of socialized medicine from their leaders). 40 years ago we heard these same shrill cries from organized medicine and Republicans concerning the establishment of Medicare. After accepting hundreds of billions of dollars in Medicare Insurance payments over the ensuing 4 decades, one can only wonder why conservative physicians still rally like Quixote against this government run insurance product.

The following 9 steps will simply suggest how, without the inefficiencies and burden to productivity of private insurance corporations, we can deliver efficient and effective comprehensive health care with great savings and no sacrifice of jobs. In fact, we may be able to decrease morbidity and mortality in this Country with one coordinated system which cares for all Americans, and concurrently analyzes optimal diagnoses and treatment modalities through its integrated computerized billing system. The savings incurred insuring all Americans through the more efficient Medicare system will benefit all citizens of our Country.

9 Steps to Comprehensive Quality Health Care in America

1) Shut down the private health insurance corporations.

2) Enroll all Americans (including Veterans) and the 40 million uninsured citizens into the Medicare Health Insurance Corporation. Since the current functioning Medicare Insurance Company is already accepted by almost all physicians, Hospitals and clinics in the Country, hardly any infrastructure investments on the health care delivery end will be necessary. Have all private businesses pay a Medicare premium for their employees instead of private health insurance premiums. Let employees as well as businesses contribute a fixed premium amount based on their age up until 65 for their Medicare services and drugs. Freeze current premiums for all Americans over 65 and adjust in the future according to the cost of living index. These premiums paid by businesses to Medicare for their employees should be less than that paid to current private insurance companies because of the lower overhead costs of the Medicare Corporation.

3) Hire the now unemployed former private health insurance corporate bureaucrats to actually deliver and not inhibit health care by working in hospitals, doctors’ offices, clinics and nursing homes around our Country. Demographically, the percentage of elderly Americans is rapidly increasing. With every American now insured through Universal Medicare Insurance, real health care workers will be in desperate need. For the first time in the brief but bloody history of managed care, these former private insurance corporation employees will actually touch and improve care for patients by working in physical therapy, nursing, home health care and other ancillary patient care capacities.

4) Obtain by eminent domain (for the public good) the best of the intellectual property protected computer codes which the closed private insurance businesses previously used to monitor patient care and doctors utilization and performance. Private health insurance companies have used these computer programs exclusively for the purpose of strong-arming their contracted health care providers into doing less for their patients and increasing the premium costs for sicker patients in order to achieve higher corporate profits. Medicare on the other hand can use these same computer programs for the common good; to monitor, collect data and eventually improve the efficacy of diagnoses and the treatment of diseases and medical outcomes every time a doctor submits a bill. For example, wouldn’t it be nice to know as a medical consumer (patient) which oncology groups in Boston, New York or Houston have the highest cure rates for stage III breast cancer or Stage II prostate cancer? All those numbers currently exist in cancer registries nation wide and just need to be collected and honestly disseminated. Currently, instead of solid medical data which delineates morbidity and mortality and performance, the medical consumer when choosing an oncologist must rely on word of mouth, physician referrals or advertisements in the local papers which show photographs of smiling doctors in white coats who claim to be the ‘best’ doctors in town. In addition to garnering invaluable instantaneous epidemiologic data on diagnoses and treatment of diseases based on severity and other variables, a strong Medicare based utilization review computer code would also allow Medicare to monitor doctors and hospitals who abuse a fee-for-service billing system. Any physician, institution or service found to abuse the Medicare fee for service billing system after proper review and appeal should be dealt with severely through stiff penalties and loss of their Universal Medicare provider contract.

5) Freeze Medicare physician, hospital and ancillary services reimbursements at current 2007-2008 levels. Adjust reimbursements for future services yearly by Cost of Living increases, or in the event of a deflationary economy a decreases in doctor and hospital payments. Ask any physician and they’ll tell you they would accept current reimbursement rates with COLA over the current mysterious illogical fee adjustment system of Medicare, or the physician population density reimbursement formula used by most private insurance corporations. Two tiered medical systems separating the “haves and have not’s” of society have and will always exist. Therefore, we must allow physicians to practice medicine without enrolling in or accepting the Universal Medicare reimbursement. With private medical insurance no longer available, and no performance based evidence for improved morbidity and mortality among their private for-pay patients, these extraordinarily expensive private ‘VIP’ practices will be limited.

6) Allow Medicare, much like the current Veterans Administration System and every private health insurance company and government health care system around the world, to bid on medications from pharmaceutical corporations for its Medicare drug formulary. Every physician recognizes that we don’t need a choice of a dozen redundant drugs in each pharmaceutical category. For example, we need only 2-3 statins for cholesterol, a handful of antibiotics for infections, 2 beta blockers for hypertension, and a few pain killers. Once the Government bids on pharmaceuticals for the Medicare Corporation formulary, macro economics will force prices to massively decrease to levels identical to that which all the other people of the world outside of America are paying for the same medicines. Since it has not effectively decreased morbidity or mortality in this Country, and only wastes money, we should also prohibit pharmaceutical companies and their workers from contributing to political campaigns or buying commercials on the public airways. We need to also prohibit the current practice whereby your local pharmacy and pharmacist sells your private medical diagnoses and your doctors private prescribing drug information to pharmaceutical companies so the pharmaceutical companies in-turn can directly pressure-market physicians. Prohibit pharmaceutical companies from contributing to organized medicine societies, colleges or associations because the doctors can’t rely on soft bribes or free lunches to prescribe what’s best for their patients. Prevent pharmaceutical representatives from visiting doctors’ offices or hospital pharmacies directly. Allow delivery of Medicare formulary approved sample medications for patients to physicians’ offices via post office mail only. Allow pharmaceutical companies to market products to physicians only via peer reviewed publications delivered by email or snail mail.

7) With the savings incurred from closing the private insurance corporations and paying less for drugs, have the American government fully fund the National Institutes of Health (NIH) and the National Cancer Institute (NCI) and Small Business Innovative Research (SBIR) programs. Emphasis should be placed on basic bench research carried out at not-for-profit American Institutions which employ or utilize a majority of American Citizens in their laboratories and clinics. Too often American Universities rely on free overseas labor to conduct bench research. Clinical trials should emphasize new drugs and devices which have promise to significantly decrease morbidity and mortality for any disease, including orphan diseases. Since a large percentage of private funding for drug and device studies will originate in the expanding financial liquidity and innovations and patients of the emerging developing world, we should allow the FDA to utilize research data obtained by reproduced laboratory and clinical studies performed overseas as well as in this Country.

Corruption of honest academics should be curtailed. Force all investigators to release reproduced publicly funded scientific data for all scientists to review on the internet via the Freedom of Information act (The Senator Shelby Amendment). Prohibit rights of first refusal on scientific data for private companies performing research in non-for profit institutions which receive public funding. Any rights to profits obtained from intellectual property and patents invented with combined funding from government and private sources should be split fairly among the contributing government institutions and any other private corporations funding the research, as well as with the individual inventor. Prevent organized medicine societies, associations or colleges from contributing to political campaigns since campaign donations have no relevance for physician performance or patient morbidity or mortality.

8) Offer physicians the same legal protection from malpractice lawsuits which have been established for commercial health insurance corporations during the last 3 decades.

9) The quality of current medical records software lags two decades behind business software. Therefore, we need to fund and challenge America’s best software corporations to finally develop standardized electronic medical records software for use in doctors’ offices and hospitals in order to increase the efficiency and productivity of physician charting, billing and prescribing. We should use the integrated medical records system to instantaneously and confidentially gather important epidemiologic data on physicians’ performance, patient diseases, and treatments. With new potent viruses and unsophisticated biomedical and nuclear warfare on the horizon, this system will be absolutely necessary for rapid National Security responses. Protect patient confidentiality at all costs to prevent the commercialization and abuse of patient data like that which the pharmacies trade today.

Lastly, some argue that Universal Government run health care in America will result in delays in diagnosis and treatment similar to those experienced in Britain and Canada. One can not simply compare the massive extremely functional Medicare insurance corporation based infrastructure which seamlessly delivers health care to tens of millions of people yearly in the USA to the government run westernized health care systems of Canada and Britain, France, Switzerland, Netherlands, Scandinavia, and Israel. America, for the last 40 years, thanks to the government run health insurance corporation-Medicare, has built an incredibly dense and fluid public insurance system involving almost all doctors’ offices, hospitals, clinics and ancillary services. The Medicare system dwarfs in breadth and actual practitioners and efficacy the lesser insurance systems established in all other countries. The billing and reimbursement bureaucracy for health care providers contracted with Medicare Insurance is already relatively streamlined and efficiently centralized in America thanks to 40 years of physician, hospitals and government cooperation.

We all know that the medically bankrupt private health insurance corporations and medical malpractice lawsuit threats have caused many disheartened physicians to quit practicing or downsize their practices in America. A continuation and technological upgrading of our most fair Universal Medicare based health insurance Corporation based on the concepts outlined above would undoubtedly motivate those disenfranchised physicians to return to the profession and bright younger physicians to invigorate the field. If patients, physicians and the Medicare Corporation continue to work together, without the deleterious interference of private for-profit health insurance corporations, malpractice threats and overt pharmaceutical marketing, the future for American health care will be healthy indeed.. A continuation of the status-quo mixture of a government subsidized private health maintenance insurance industry operating parallel to and within Medicare is wasteful, and will continue to provide no potential future health improvements for America.