Canada is not the answer.  Britain is not the answer.  France is not the answer.  Switzerland is not the answer.  Cuba is not the answer.  Michael Moore’s film SICKO was in my opinion a great movie,but it by no means provided the answer. What we need to accept and aggressively promote is the fact that America is the answer.  America must commit to providing the best to all its citizens.  It must look critically at what has been provided around theworld, take what it can, innovate what it must, and deploy what will be most effective. 

Please, my friends, Americans and others around the world,let’s clarify the situation from my perspective, the perspective of an aspiring critical thinker who claims the title of Critical Thinker because I believe in the best of a thing, and thinking a thing best into existence, and working hard to achieve it increases the probability that such a thing can come to pass, such is the nature of Critical Success. And what is Critical Success? It is the planned achievement of something urgent and essential utilizing careful planning and judgment for the express purpose of attaining personal prosperity. 

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Our nation as a whole should be rallied around the national tragedy that is health care.  I firmly believe that far too many of us do not have the proper perspective on this issue.  You have GOP rank-and-file inciting, and talking about Death Panels, winnowing the intelligent from their ranks and focusing more on hyperbole and the attainment of personal and party power in the mid-term elections. 

There are GOP constituents who are understandably upset about government expenditures, yet they are not critically considering the size and weight of the debt we have incurred in the past, or the need of the additional debt we’ve incurred since the transition from the previous administration.  They think they are considering it critically, but they are not.  How can this be true?  

Their leaders, such as Congressman Cantor, make statements lauding the President for supporting Afghanistan, and call for an immediate troop surge, and state nothing regarding the cost of said surge.  They play power politics as we continue to spend billions in Iraq.  We must concede that these military actions are necessary in order to ensure global stability(after a fashion), but they do nothing to eliminate the debt.  

The GOP is not attempting to discuss how these proposals will require funding, just as their Medicare Part D drug plan required funding,generating a debt that was kicked down to the next generation.  Where were the TEA citizens then?  Where are the TEA citizens today on the GOP’s own health care reform costs? They have put forth proposals, and those proposals will require additional funding.  Where are theTEA citizens on the outrageous costs of the global expansion of military initiatives?  The GOP leadership is silent on the costs, as they happily support and pursue additional expenditures.  Secretary Gates, a die-hard Republican, seeks to balance military need with costs.  He is a critical thinker, and an aspiring fiscal conservative, a man after my own heart.  But he appears to be a man without a party, as if the party was on a boat, they stopped, he stepped off, and the party boat went on without him. Incidentally, if you ask some folks they’ll tell you the boat is sinking.  Every time Michael Steele speaks … well.

The GOP constituent doesn’t appear to begin to think critically about this situation.  I’m not making an insult. I’m simply making an observation that seems to  be increasingly clear with each passing day.  They are more apt to go to a rally with a sign saying get me my gun, or from my cold dead hands.  Or, they’ll actually go to a rally carrying an unloaded gun.  They’ll talk about veterans, supporting the military, dress up in fatigues, and proceed to aggressively dress-down everyone they encounter who they perceive to be a liberal. 

THEY AREN’T THINKING!!!! 

I say this because it’s clearly evident.  I believe in the right to bear arms.  I fire guns.  I’m pretty good at it.  It might surprise you to know I will be the first to say from my cold dead hands.  However, I don’t equate this with any of the previous critical national issues.  I know and understand that the prosecution of war costs money, a ton of money.  Supporting our veterans costs money, a ton of money.  Remember when our military was fighting in Iraq with substandard body armor, and put HUMVEES in the field that lacked armor plating, allowing insurgent SHOCK and AWE to come right up through the bottom of a jeep, blasting our proud soldiers all to hell and back?  I know we Americans have short memories, but I’m fairly certain most of you remember.  Do you remember why?  Do you remember it being a matter of costs? 

Do you remember?

Understand, we should not compromise on the costs for our soldiers.  In fact, for all our people we should not compromise on any of it.  We need to spend the money.  However, if we’re going to spend the money, and satisfy our national requirements, we must think and consider critically the actions we take, and put forth initiatives UNLIKE Medicare Part D, or a war to end the regime of a man who did not possess Weapons of Mass Destruction, or an initiative to add a definition of marriage to our Constitution (a cost prohibitive national referendum to fight the future and common sense), or even the creation of nuclear bunker buster bombs (didn’t know that about the previous administration did you?), a ridiculous waste of funds to create a weapon that is a slap in the face to our international allies and a complete disruption to the peaceful direction of worldwide progress through nuclear non-proliferation, all to blast dirty-faced men with guns deep in holes all to hell and back. 

If we’re going to spend money on national initiatives, and it is clear to the critical thinking that we must, then we must spend it on programs that will benefit all Americans. The money must be spent in a manner that will generate efficiencies that contribute to aggressive cost savings in coming years, essentially requiring our expenditures to generate savings that chase down our debts.  We’re Americans, we’re innovators, we can do this.  We will do this.  And we will do it all the more speedier and without acrimony if we attempt to do it together. 

The issue of health care is a national tragedy and it requires a national focus.  It is an emergency that rivals 9/11, or anything we’ve faced in a generation.   It is a situation that will of itself result in the catastrophic disillusion of our nation, if the status quo remains, and we push the issue down the road.  If GOP constituents are concerned about the debt to their posterity as much as we critical thinkers are, then they should open their eyes now, and readily acknowledge this national catastrophe waiting to explode to nation-ending proportions.  This issue alone is the debt that will break the backs of their children, and our own.  We must face this, and end it together.

Something to critically consider in terms of health care reform, I personally think Americans don’t mind at all price shopping on medical services that are not life threatening.  We do it already for some services, going to a local clinic for blood tests and CRT scans.  We can do this within the confines of a new wellness initiative.  Annual checkups, scans, and other services can and should be open to competition, pushing the cost down up the line, based on a combination of the profit motive, and a sincere desire to provide the patient the very best service available. 

However, in terms of trauma and life-threatening diseases,the national mandate should not require the American citizen to go through the emotional, critical, anti-sympathetic activity of price shopping for a possible cancer cure.  The national mandate should follow the lines of what we do for a downed soldier in the field.  Every American demands that we provide our soldiers the very, very best, that they need not worry about that lifesaving operation in the trauma unit, removal of that bullet, saving that arm or leg.  We should regard every single last American the same way.  When it comes to that which threatens our very lives, in America there is no option, because the choice has been made for you, we will move both Heaven and Earth to give the very best money and science can provide, because that is the American way, that is the American ideal. 

As for the money? If you do it … it will come. American medicine is advanced medicine.  It is innovative and ground breaking.  We can make it even more innovative with stem cells, and other advanced lines of research, while at the same time providing a cost and service model un-paralleled anywhere in the world.  Yes, they will come from all over the world, even more than they do now; and yes, for those of you strongly money-minded, they will pay.

Let me state that I started writing this before the President’s speech on Wednesday.  I wrote a basis, some notes, pertinent details that I wanted to be sure to highlight in the finished article. Then, I waited.  I wanted to listen to his speech before finishing the article.  I had made a supposition about the President’s actions, and wanted to see if the supposition held. It did.  The tenor of the speech, the words said rang true. However, I knew it would not make all happy.  Of course, Joe Wilson let the entire world know how he felt by calling the President a liar on International television, a disgusting, unwarranted, and unprecedented act, in extremely poor taste.  Very bad form Congressman Wilson, very bad form. 

Some progressives are still complaining about how the President waited too long to make this speech, that the summer was wasted, and that even though we know the President’s modus operandi, it has become wearying and he should have entered the field much earlier.  They have a perspective, a singular one, which I do not hold.  The summer gave us time to toss about the most heated ideas. The summer gave us time to elevate the game of the detractors.  Perhaps, if one considers it critically, this was a necessary piece, an integral piece in this political interactive.   Many have shown their hands.  Many have placed their cards on the table. 

They have … exposed themselves. 

We know a great deal more than we did entering the summer.  An argument can be made that we might have known as much about the myriad sides of the debate earlier, if the President had pushed his political will onto the process.   Or, perhaps the moves were appropriately calculated, in the mode of a serious critical thinker

With Fall before us and the President engaged, I have given it some thought and laid out what I personally believe would be a good basis for an effective Health Care Reform Bill. The aspiring critical thinker took a shot at it.  Please take a moment to consider what I’ve written.  Think about it, toss it around in your mental ring, look at it, weigh it, beat it, pick it up, see if it’s tough enough, if it has what it takes, and then, only after truly considering it, please render you opinion.  Comment on what I’ve laid out.  As a citizen of these United States of America I, D.S.Brown, the aspiring critical thinker demand that we include the following policy initiatives in the ObamaCare Health Care Reform Bill of 2009, which will include the Kennedy Public Medicare Plan:

Demand 1:

Establish health care as an accepted right for every American citizen.  On the day you are born, you are covered either by your parent’s private insurance, or the Kennedy Medicare Program.  As a child, once you reach majority (age 18), you may choose.  You can either be dropped by your parents, or retained by your parents. Or, you can either drop Medicare, or retain Medicare.   Or, you can purchase your own private insurance.

Demand 2:

Elimination of the de-facto Private Insurance monopoly.  Establishment of the American Health Care Exchange, where individuals and groups may shop for health insurance that conforms to the Federal standard.

Participation in the Health Care Exchange is not a requirement.  However, be you individual, company, or insurance company, you have the right to exercise your freedom and not participate in the Exchange.  Not participating in the Exchange comes with risks, just like any capitalist enterprise. However, in taking on this risks as a company or individual, one must remember that in being the best of that which is human in us, we must never allow politics or profit to come before human lives.  This factor is not and can never be negotiable.

Demand 3:

Creation of 12 Basic Base health care plans that can support all Americans.

Private industry, as taxpayers, must be a part of the Exchange in terms of policy, and participate on the panel that establishes and maintains the base standards.  This sets the ground rules for competition between public, private and private.  It levels the field and provides Americans with a simple basis by which to compare and shop.  Incidentally, it will also create new opportunities for innovative companies to alleviate the burden of seeking out the best policy, similar to what you see in car insurance, life insurance, and home mortgages.   

Apply overall insurance policy reform that patterns insurance expenditures on services based on comparative effectiveness research.  Allow policy options that permit increased expenditures based on varying factors and/or patient payment.  If the patient wants it,and is willing to pay for it, then give it to them.  Services along these lines will be competitive between insurance companies, clinics, and other medical facilities.

New businesses will crop up around this model whose sole purpose and revenue generation will be in guiding American’s to the best health care options.

Demand 4:

Health care need not and should not be mandatory after the age of majority (age 18).  We can get the numbers necessary to induce competition, and generate cost savings just by opening the doors of Kennedy Medicare. I guarantee just providing the option will create a flood of new customers, without making it mandatory. However, just like American citizenship, you can choose to relinquish it.  We need not force people into a health care program.  To me, forcing them is just not the American thing to do.  We usually have options.  You don’t have to have car insurance.  Of course, if you don’t, you just can’t, or rather legally you can’t, drive a car.  However, and this is critically important, just like driving a car illegally, seeking medical services without the ability to cover charges will be illegal, and seen as an egregious act against your fellow American taxpayers. 

Demand 5:

By not signing up for insurance after the age of majority each American is responsible for the risk of covering their own medical expenses.  If an individual seeks medical services and cannot pay they will immediately at that moment be logged in the national medical database as a member of the Kennedy Medicare Program,and will incur penalties, as well as interest on the outstanding service fee.  The new enrollee will stay on the Public Plan for a specified amount of time AFTER penalties and interests have been paid.  This shows good faith and an ability to pay.  At this point, they will have the option to go with a private company.

Demand 6:

Enroll the indigent in the Kennedy Medicare Program immediately.  Allow Americans 55 and older to enroll in Kennedy Medicare in the first year.  In the second year allow Americans 45 and older to enroll in Kennedy Medicare. In the third year allow Americans 30 and older to enroll in Kennedy Medicare.  In the fourth year allow all Americans to enroll in Kennedy Medicare if they so choose.  All enrollees go through a validation process to guaranty America citizenship. No person currently enrolled in Medicare will be dropped through this process.   

Demand 7:

For small businesses that seek services in the Exchange we will provide strong cost discounts on coverage plans determined by an applicable scale based on business performance factors such as income, balance, and cashflow.  This will be preferable to tax credits, and far easier to understand.

Demand 8:

End discrimination against people with pre-existing conditions for any insurance company participating in the Health Care Exchange.  This will allow companies to pursue insurance options that might cater to a customer with factors that make them eligible for a different product outside the Base 12 because of their health status.  It fosters innovation, includes high risks, and creates even more competitive options.

Demand 9:

All health care companies industry-wide are prevented from dropping coverage when people are sick.

Demand 10:

All health care companies industry-wide must set caps on out-of-pocket expenses.

Demand 11:

Enact immediate health care policy changes on Medicare.

If you are a doctor that services Medicare patients you now have a choice.  Medicare must be shifted to salary-based programs on an aggressive timetable.  This will give doctors the time they need to choose.  If they elect to stay with Medicare they must adjust their practices.  If they want to keep seeing Medicare patients, they can choose to create business models that satisfy the Mayo model cost structure.  This opens the door to innovative programs that adhere to a basic cost framework.  In the finest American tradition this also allows a doctor to not see Medicare patients and charge whatever he likes for each service, if his service is just that good.  Doctors can operate niche markets to cater to those that want to pay top dollar for their services, which should be above and beyond the 12 Basic Base Plans. 

Demand 12:

Elimination of insurance subsidies for private insurance companies.  As those billions are funneled back into the core program, it is imperative that Medicare Advantage customers see no discernable impact to their level of service.  The patient is always our first priority.  Kennedy Medicare will be able to maintain the same level of service without the extra funds because there will be no need to cover the excessive administrative costs private insurance companies must have in their business models in order to maintain and increase market share and profit.

Demand 13:

Removal of state barriers against competition. 

It is clear that state barriers are part of the model that has created health care monopolies across the nation.  The elimination of state barriers is core to increasing the level of competition between public, private and private, and absolutely essential to lowering health care costs.

Demand 14:

Utilize costs savings to enact the American Wellness Initiative.  Establish an applicable cost savings structure within the Health Care Exchange that applies discounts on services that are eligible. Eligibility will be based on accepted standards of health and the ability to improve in a given area, such as risks for cardiovascular disease.  In addition, it will provide quarterly bonuses to Exchange doctors and nurses that actively promote and succeed in improving the wellness of their patients.   This will also serve as a model for private insurers outside the exchange and will help spur competition. 

Demand 15:

Utilize costs savings to give immediate financial relief on loans to medical professionals. Utilize funds to offer grants to students seeking careers in the medical field, especially nurses and primary care physicians.

Demand 16:

Tort Reform must be enacted immediately.  It is tearing the industry apart.  Enact aggressive tort reform analysis and employ an immediate action program with a phased time horizon in order to enact changes to tort laws, protecting all citizens from abuse, patients aswell as doctors.

Demand 17:

Immediately establish a program to drive the Health Care Exchange to contract with the very best Information Technology companies in the world to develop and deploy in multiple phases (getting services online quickly) the best Electronic Medical Analysis and Record system ever established.  The system will retain doctor, nurse, and patient information.  It will establish interfaces and analytics to examine and analyze data such as pharmacology, giving likely responses by patients to medicines and procedures.  In later phases it will serve as a Medical Knowledge Engine, leveraging information as an incredibly powerful tool facilitating successful medical outcomes formedical facilities across the nation, and citizens around the globe. 

Demand 18:

Establish a multi-tiered trigger option with cost impact over the entire Health Care initiative that is executed in the event of cost overruns.  Costs for the program must not exceed $900 Billion, and must be absolutely neutral to the deficit.   If for whatever reasons costs exceed the limit and begin to be accretive to the national debt an emergency committee is to be convened immediately and enact cost cutting measures to the program, being as sensitive as possible, but nevertheless ensuring cost containment first and foremost, and then costs reduction.

Those are my 18 demands for Health Care reform.   In my humble opinion, I see these 18 policy initiatives as a clear and concise path towards Critical Success for all Americans.  Health Care reform as a goal attained will not only make those of us alive today healthier and more financially sound, but so to our posterity. 

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