KEY AREAS OF FOCUS:
Medicare Advantage is the most popular health plan in the United States. A Trump Medicare Advantage For All Americans (TMA), especially the 30 Million uninsured and low-wage workers, along with an integrated health and wellness program, will lower our National Healthcare GDP by $1.3 Trillion Dollars in the first two years. This will ultimately reduce our National Health Care GDP from 18% to 12% by eliminating half the cost of chronic illness. These huge savings will more than pay for the TMA program. This will also give United States businesses a more competitive and secure cost of doing business with other nations around the world and help preserve U.S. Manufacturing and other American businesses upon which we rely for our prosperity. We can reduce Chronic Disease risk by transforming our medical care regimen and improving our health. The medical transformation has already started with a bold New-Paradigm we see in the delivery of medical care.
The bold New Paradigm for health care delivery in the United States that is being pioneered by medical practitioners, who have seen the “light”. The light is showing them a way to navigate to a safe harbor that helps the American people to improve their health, wellness, and well being. Our academic, medical, governmental, and bio-medical establishments are fast transforming the way we deliver medical care in the United States. This New Paradigm for medical care is embodied in many medical practices, patient care demonstrations, and clinical care programs generating hard data on how we can permanently improve our health care delivery system and quality of life. And, we can spend less money doing it. In some cases, a lot less money!
OLD PARADIGM: The medical care Old Paradigm narrowly views a patient’s symptoms of illness, treats just those symptoms; and then requires the patient to pay for the prescribed specific treatments or cures.
NEW PARADIGM: The medical care New Paradigm takes a holistic (full and personal) view of the patient, treats any symptoms of illness but also takes the time to assess the lifestyle. The New Paradigm (PPPM) uses a comprehensive genetic analysis to Predict future illness whenever possible, Prevent it from happening and Personally intervene and motivate the patient into a state of wellness. The patient is responsible to pay for the treatments and prescribed guidance necessary to sustain health and well being. This medical care model is called Predictive, Preventive, Personalized Medicine (PPPM).
A good example of this is childhood and adult obesity. This is a huge problem in the United States. Every doctor observes it's onset, but rarely do they do anything about it. In and of itself, the condition when first observed is medically symptom-less. However, if we were serious about our future health, as a nation, the early onset of obesity would be subjected to prescriptions for practical solutions to avoid it, thereby preventing future illness. Harvard's T.H. Chan School of Public Health predicts about half of the adult U.S. population will have obesity and about a quarter will have severe obesity by 2030.
The CDC says that currently 40% of adults in the U.S. are obese and 18% have severe obesity. The current prevalence of childhood obesity is 18.5%, affecting about 13,7 Million children. Obesity prevalence was 13.9% among 2 -5 year-olds, 18.4% among 5 of 6 - 11-year-olds, and 20.6% among 12 -19 years olds. The latest studies indicate that only 20% of adolescents currently meet HHS exercise recommendations. "Obesity, and especially severe obesity, are associated with increased rates of chronic disease and medical spending, and have negative consequences for life expectancy." Need we wonder where almost 40% of obese adults in the U.S. come from? The need to address this condition with the New Paradigm for medical care is painfully obvious.
MAKE AMERICA HEALTHY AGAIN!
We need to make a National Wellness Program to focus the attention of the American people on the importance of the problem. The American people can do anything we put our minds to doing. We just need a challenge. The goal of this National Wellness Program is to achieve the lowest national health care GDP of all the industrialized countries in the world by 2030.
The Good News is that we are doing a lot about our deplorable health status but there is much more that needs to be done! And, our backs are up against a wall. The need for greater coordination and focus and bold action has never been greater. And, the Time is NOW! What we need is a sound national goal to which we can commit as a nation. Achieving the lowest National health care GDP of all the developing nations of the world by 2030 is just such a goal. It is not only critical to our future economic survival and future prosperity in the world economy; it is critical to our health and well being as a people and it will save a lot of lives. We also need a thoroughly modern Defined Contribution Trump Medicare Advantage Plan. Please see our Trump Medicare - Program That Works page for more details.
We also need a Health Care Czar with the power to pull together the resources necessary to address and END this chronic illness epidemic. We need to design a comprehensive program that has the potential to generate a known savings of $1.3 trillion dollars in GDP. This is a problem that we can no longer ignore. Solving it is critical to the health and well-being of our people. This crisis could quite literally take our national budget down and drag our economy down right along with it? It is that serious!
Why have we let ourselves get so fat? Why has it taken us so long to recognize that this is a threat to our national security? President John F. Kennedy first warned that we were getting soft Sixty (60) years ago. Why did it take the HHS so long to issue in the First Edition of Physical Activity Guidelines (2008)? Why did the Second Edition take another 10 years? Why has the USDA diet recommendations gone through so many unhealthy iterations to arrive at the healthy My Plate diet? This is bureaucratic government, pure and simple. And, if you think our government can get us out of this mess faster than they got us into it, more power to you!
Our government is like an ocean liner. Once you turn the wheel, it tends to be slow to react to a new course, but once we are firing on all cylinders, great things can happen. Consider how we have handled the health hazards of cigarette smoking. Remarkable results were achieved in a relatively short period of time. The American Cancer Society says more than ten (10) times as many U.S. citizens died prematurely from cigarette smoking than have died in all the wars fought by the United States. While smoking is still the leading cause of preventable death in the United States, over this last decade new lung cancer cases have declined 2.5% per year for men and 1.2% for women. Our over-all cancer death rate in the U.S. has declined by 27% over the last 25 years. To appreciate the importance of this progress, consider the fact that the World Health Organization asserts that the number of people dying from cancer worldwide is actually increasing. But, in the U.S., the number of cancer deaths is declining!
In 1965, Congress passed the first hazard warning on cigarettes. Twenty (20) years later the cigarette warnings were associated with cancer. Now we can't smoke on airplanes, in restaurants, and most public places. Smoking has become a stigma. If you do smoke, you don't admit it. President Barack Obama smoked cigarettes but he was (and is) never seen smoking in public. In the last Fifty years, we successfully reduced the cost and incidence of lung cancer to well below the worldwide incidence of this illness. This is proof positive that we can successfully improve our health status if we put our minds to it!
We have also been working on improving our diet and exercise routines for a long time. Ten (10) years ago HHS and the Department of Agriculture issued the first recommended guidelines on diet and exercise together. As with our delayed response to the effort to reduce lung cancer, we have not been able to reduce our waistlines or improve our diets, slow down the cost of chronic illness or reduce the National Health Care GDP. Now with our backs are against the wall because our health condition has made health insurance unaffordable.
What we need to do now is authorize the Secretary of Health and Human Services to consult with all the relative Departments, Agencies and all parts of the federal government and all the parts of the immediately applicable interests of our private health care economic sector to devise a Trump Medicare Advantage to All Americans. A good start was the development of the new set of Physical Activity Guidelines released by HHS and new diet recommendations by USDA in 2018.
HHS Physical Activity Guidelines for Americans
The Department of Health and Human Services issued their first-ever Physical Activity Guidelines for Americans in 2008 to help Americans understand the types and amounts of physical activity that offer important health benefits. The content of the Physical Activity Guidelines complimented the Dietary Guidelines for Americans developed jointly with the Department of Agriculture. Together the two documents provided guidance for physical activity and a healthy diet to promote good health and reduce the risk of chronic illness.
Physical activity is any form of exercise or movement of the body that uses energy. Some of our daily life activities—doing active chores around the house, yard work, walking the dog—are examples. HHS has just now released the second edition of the Physical Activity Guidelines for Americans. The Key Findings of their studies which inspired the new guidelines were:
- Only 26 percent of men, 19 percent of women, and 20 percent of adolescents meet the Department of Health and Human Services’ exercise recommendations.
- Adults need 150 minutes of moderate to vigorous aerobic activity each week and two days of muscle-strengthening activities to stay healthy.
- Children and adolescents ages 6 to 17 need 60 minutes of moderate to vigorous physical activity every day.
Aerobic and non-aerobic exercise is to date, the only non-pharmacologic therapy we have against Alzheimer's Disease. In randomized controlled trials aerobic exercise and non-aerobic exercise and cognitive stimulation had positive effects on cognitive function, while a systematic review also found that exercise has a positive effect on overall cognitive function and has a positive and beneficial effect on the rate of cognitive decline in Alzheimer's patients. If you ask psychiatrists to come up with a "one" word treatment recommendation for mental illness, the word would likely be "exercise". It stimulates the body, facilitates sound sleep, and increases the level of serotonin in the brain.
In a recent study by the New York Academy of Science never exercising and being obese is as dangerous to your health as smoking 15 cigarettes a day, being an alcoholic, or the victim of chronic loneliness and isolation. All of these conditions are unnecessary. They can all be treated with a prescription for exercise and other treatments that cost a fracture of social and economic costs for these chronic conditions.
USDA Dietary Guidelines for Americans
The U.S. Department of Agriculture has come up with new dietary recommendations with their Start Simple with MyPlate Program at www.ChooseMyPlate.gov.
Diet is perhaps the biggest piece of the puzzle, especially when it comes to obesity. The U.S. has provided dietary advice for the public for more than 100 years. A turning point was reached when the Senate Select Committee on Nutrition and Human Needs released the first dietary guidelines in 1977. These guidelines have been refined by scientific research and evolved over the years to culminate in the My Plate guidelines below and this accompanying this ChooseMyPlate website.
My plate is a model for planning healthy meals. it shows us the types and amounts of foods that should go on our plates. Fruits and vegitable make up about half of the desirable plate and grains and protein make up the other half. A serving of dairy is included on the side of the typical plate. The amount of calories and serving sizes depend upon your age, gender, weight and height.
This Start Simple Program with MyPlate gives us tips, ideas and a personalized plan to meet your food group targets. Find what works for you and your family within your food preferences, health goals, and budget. To get started with tips from the MyPlate Food Groups go to the USDA website Start Simple with MyPlate.
||Fruits - Focus on whole fruits:
Eat seasonally! Checking what fruits are in season in your area can help save money.
Craving something sweet? Try dried fruits like cranberries, mango, apricots, cherries, or raisins.
To meet your fruit goal—keep fresh fruit rinsed and where you can see it. Reach for a piece when you need a snack.
||Vegetables - Vary your veggies:
Vary your veggies by adding a new vegetable to a different meal each day.
Add color to salads with baby carrots, shredded red cabbage, or green beans. Include seasonal veggies for variety throughout the year.
Vegetables go well with a dip or dressing. Try a low-fat dip or hummus with raw broccoli, red and yellow peppers, sugar snap peas, celery, cherry tomatoes or cauliflower.
||Grains - Make half your grains whole grains:
Popcorn is a whole grain! Pop a bag of low-fat or fat-free popcorn for a healthier snack.
Whole grain pasta is great in baked dishes or pasta salad. If you choose refined grain pasta, make sure it's enriched by checking the ingredient list.
Ready-to-eat, wholegrain cereal is a tasty breakfast option or can be enjoyed as a whole grain snack.
||Protein Foods - Vary your protein routine:
Make dinner once and serve it twice. Roast a larger cut of lean meat. Make a second meal using the ‘planned-over’ meat.
For car trips, pack a mixture of unsalted nuts, seeds and dried fruit for a crunchy, protein-packed snack.
Keep seafood on hand. Seafood, such as canned salmon, tuna, or crab and frozen fish is quick and easy to prepare.
||Dairy - Move to low-fat or fat-free milk or yogurt:
Make a smoothie by blending fat-free milk or yogurt with fresh or frozen fruit. Try bananas, peaches, or mixed berries.
For breakfast try low-fat or fat-free yogurt. Mix in cereal or fruit for extra flavor, texture and nutrients.
Adding 8 oz. of low-fat or fat-free milk to your meal is one of the easiest ways to get dairy.
||Limits - Drink and eat less sodium, saturated fats and added sugars:
Tips for Salt and Sodium:
Many processed foods contain high amounts of sodium. Choose fresh vegetables, meats, poultry, and seafood when possible.
Using spices or herbs, such as dill, chili powder, paprika, or cumin, and lemon or lime juice, can add flavor without adding salt.
Tips for Saturated Fats:
Keep it lean and flavorful. Try grilling, broiling, roasting, or baking—they don’t add extra fat.
Simple substitutions can help you stay within your saturated fat limit. Try using nonfat yogurt when you make tuna or chicken salad.
Tips for Added Sugars:
Split the sweet treats and share with a family member or friend.
Cut calories by drinking water or unsweetened beverages. Soda, energy drinks, and sports drinks are a major source of added sugars.
This Trump Medicare Advantage For All plan's target population includes the 30 Million uninsured Americans, some of whom are working, plus the 8.4 Million plus Obamacare subscribers, 75% of which receive federal subsidies in order to make the ACA programs affordable. If our Trump-Medicare-Advantage-For-All. Com program is able to impact just half of the people suffering from chronic illness in 2018, we will potentially save $1.314 Trillion Dollars and lower our National Health Care GDP to less than 12% (64% cost reduction).
What about the other 50% of the people. A program like the one we are proposing will have a massive RIPPLE effect. As you know, the vast majority of our people are covered by group insurance programs that are sponsored by private employers. Our private employers, especially the larger ones, have a lot more experience with successful health and wellness programs than any other entity on the planet. There are literally thousands of studies that document successful Employee Health & Wellness programs with a positive return on investement. The CDC even has a Work Place Health Promtion Program on their web site which covers the basics. The use of effective workplace programs and policies can reduce health risks and improve the quality of life for American workers. The same principles used in group health & Wellness programs used by businesses to lower the cost of their group insurace programs can be used by health insurance carriers in individual health insurance plans sponsored by the Trump Medicare Advantage for All programs. Maintaining a healthier population will lower health care costs and health insurance premiums. It will also positively impact absenteeism and worker productivity.
To improve the health of the general public, employees, businesses, the Trump Medicare Advantage plan can create a wellness culture that provides supportive environments where health can emerge as anational priority; and provides access and opportunities for people to engage in a variety of health programs. This includes coverage for YMCA and gym memberships, personal trainers and weight loss programs.
Workplace health and wellness programs refer to a coordinated comprehensive set of strategies which include programs, policies, benefits, environmental supports, and links to the surrounding community designed to meet the health and safety needs of all employees. These same elements need to be incorporated into the Trump Medicare Advantage For All plan where people covered will receive informed PPPM medical care from value oriented providers, who will have the incentive to closely follow their patients progress in dealing with chronic illness conditons. Particpants will be directly rewarded for improved health conditons with more benefits or lower premiums.
Employer Wellness and Well Being programs have much experience with carrot and stick rewards. they have documented what works and what doesn't work. Most people naturally value and protect their health and well being. However, everyone can benefit from personal incentives, knowledge of what can be done and the fasascilitation of activities to improve their health.
Examples of workplace health, wellness and well being program components and strategies include:
- Health education classes.
- Access to local fitness facilities.
- Company policies that promote healthy behaviors such as a tobacco-free campus policy
- Health insurance coverage for appropriate preventive screenings, YMCA and gym memberships, personal trainers and weight loss programs.
- A healthy environment created through actions such as making healthy foods available and accessible through vending machines or cafeterias.
- A work environment and communities free of recognized health and safety threats with a means to identify and address new problems as they arise.
If we are successful in lowering the health care cost with a Trump Medicare Advantage (TMA) plan that includes an integral health and wellness component; the employers and TMA health plan carriers will quickly incorporate these features in all of their programs. Eventually, everyone, except perhaps fee-for-service Medicare and collective bargaining agreements, will have state of the art health and wellness programs that will lower everybody's rates and improve the general health of the vast majority of Americans.
If nothing changes - nothing changes! We have had all of these programs under study for years. We have spent hundreds of thousand of dollars studying wellness programs, fitness and dietary recommendations, etc. and thus far nothing has made a decernable difference in the American consumers health behavior on a personal level, except with smoking and lung cancer. By and large, patients (voters) are still pawns on the big chess board of the health care business which is dominated by more important players. we have to make the patient the most important part of the system.
If we do this right, the health plans and health providers will be rewarded like they are under the STAR program, with more money based on their ability to improve patient outcomes, improve patient health status and reduce the cost of their health care. The American people will be personally rewarded with more insurance coverage or lower premiums, not to mention their improved health status. The effect of this reduction will lower the cost of health care and health insurance for individuals and businesses and will increase our health condition, our productivity and our competitiveness as a nation in world markets. This is how we will pay for the Trump Medicare Advantage For All and how we will win, win win, while Making America Healthy Again.
ACADEMIC MEDICAL CENTER'S & PREDICTIVE, PREVENTIVE AND PERSONALIZED MEDICINE
Our renown Academic Medical Centers (AMCs) are studying new models for paying for and delivering medical care. Johns Hopkins, Lahey Clinic and Dana Farber and many others are creating high-performing health care systems, establishing operational evidence for how to transform health care delivery and to train the next generation of medical practitioners to better address the needs of the patient. There is a clear priority on the treatment of high-need, high-cost individuals, because they are the most expensive patients to heal. The AMC New Paradigm often uses a multi-disciplinary team focused on developing a deeper understanding of their patient populations, working toward identifying and implementing programs that offer them high-quality medical care at the lowest possible cost. Our AMCs are greatly accelerating the path to improving the medical care for these most expensive patients, both here and around the world.
Olga Golubnitschaja and Vincenzo Costigliola published a landmark European study in EPMA 2012 introducing a practice of integrative medicine called Predictive, Preventive and Personalized Medicine (PPPM). This approach uses advanced diagnostics (including DNA and family history), targeted prevention and treatments tailored to the patients, in such a way as to deliver the most cost-effective health care. In a related study, Dr. Guglielmo M. Trovota, a noted Italian physician found that:
“The combination of the main healthy lifestyle factors -- maintaining a healthy weight, exercising regularly, following a healthy diet and not smoking --seem to be associated with as much as an eighty percent (80%) reduction in the risk of developing the most common and deadly chronic diseases. This reinforces the current public health recommendations for the observance of healthy life style habits, and because the roots of these habits often originate during the formative stages of life, it is especially important to start early in teaching important lessons concerning healthy living.”
This finding sounds trite. Something we have all heard before. Nothing really newsworthy, except this is really newsworthy! In fact, this common-sense conclusion is both monumental and integral to the solutions to the problems we Americans have with the high cost of our health care! You have to actually read this text a new. Sometimes the answers to your problems are staring you right in the face. And, you just can't "See" the answer because you are not looking in your right-mind.
What do you think the National Health Care GDP would be if 66% of adult Americans were NOT over-weight? We know that weight is the leading cause of diabetes. Diabetes costs us $327 Billion Dollars per year. Forty-eight (48) Million Americans have pre-diabetes and as you will see below, aggressive but careful application of exercise combined with a good diet can change the physiology of Type 2 diabetes and lead to a reversal of insulin resistance in a relatively short period of time.
This is so important and so critical to the ability for our Country to continue to be a beacon for truth and justice in the free world that Berkshire Hathaway, J.P. Morgan and Amazon, three of the largest and most successful businesses in their fields, have teamed up to create a new Company called Haven. This Company is dedicated to coming up with answers as to how the corporate world can lower the cost of health care in the United States. Warren Buffet believes that the cost of our health care system is the biggest issue facing American businesses competing abroad. American employers paying 18% of GDP when their international competitor’s pay Zero Dollars ($0) for employee health care is a huge disadvantage. Warren Buffet asserts that the United States is:
“a rich country and we can get along doing the wrong thing for some time, but we can’t get along doing the wrong thing indefinitely!”
The next highest comparable country’s national Health Care GDP is Switzerland at 13% and all of the other high-income nations in the world have lower Health Care GDP's; in some cases, much lower! We can debate whether the medical care "WE THE PEOPLE" are getting from our healthcare system is worth what we have to pay for it, but the most important and immediate thing that WE must do as a nation, is lower the cost of health care. Lowering the cost of health care in the United States is much easier than you think! At Medicare-Advantage-For-All. Com, we believe:
The correct path forward to lowering the U.S. health care GDP is to creat a Trump Medicare Advantage plan for All Americans under the age of 65 and have HHS require the health plans to implement an integral health and wellness program. The Health plans should be granted generous incentives to reward the New Paradigm treatment of patients. Providers should also be given incentives for accepting the full risk for health care quality and patient outcomes under a new CMS approved value-based model payment initiatives. Based on the cost of chronic illness and the professional estimates of potential reductions in health care utilization, a reduction of six percent (6%) in the total U.S. GDP, to 12%, is a "practical reality". Anything less than this "path forward" will continue the escalation of the National Health Care GDP by 5.5% a year through 2030, during which time the number of our retirees over age 65 citizens will double. And, according to CBO, we will also add 5 Million more people uninsured, bringing the total of uninsured Americans to 35 Million and the cost of treating chronic disease in the U.S. will Explode, to the point where nationalization of the U.S. health care system will become inevitable.
THE DOCTORS ARE IN!
Dr. Mark A. Miller, DC: Dr. Miller and Associates of True Health Solutions, Lexington, KY practices medicine that is boldly transforming the lives of his patients, healing their illness and improving their quality of life. He describes his practice as follows:
We seek to treat the causes of disease and discomfort, not just the symptoms, by treating each patient as a unique individual and using a comprehensive integrated approach”. Getting well and staying well is what you want. These are the goals for you being a client here. Getting well is usually a shorter process, whereas staying well is the life process you do for life. Getting results is part of it. Keeping results is what truly changes your life, for life. Getting and staying well through the sustainability of optimal health. Sustainability is the key.
At Medicare-Advantage-For-All.Com, we advocate for better health insurance. The insurance industry and the federal governement can do a lot to make Dr. Miller's job a lot easier. We need changes in the laws, reimbursement practices, insurance contracts, and government regulations. But (now that you are aware of Dr, Miller's practice) the most important take-away for you today is that he is practicing the New Paradigm NOW, despite the obstacles. He sometimes charges a global fee for service, which may or may not be reimbursable by health insurance. He tends to follow his patients closely over long periods of time providing advice and support and receiving regular feed-back on their progress fighting an illness or improving their health. This is the essences of the PPPM approach to medicine that we advocate should be the New Paradigm for health care in the united States. Many medical practitioners now charge an annual concierge fee that is not covered by health insurance. The fee is not generally used to actually treat their patients. It just gives some of their patients priority access to their practices.
Dr. Miller has devoted his life and his medical practice to this New Paradigm of medical care, in what we can accurately describe as an "inhospitable medical environment". Dr. Miller, and medical practitioners like him, have not benefited from any sort of sea change in reimbursement practices. Such change is happening slowly in our health insurance systems. You can read about the focus on medical outcomes in our Academic Medical Centers (AMCs) and we hear about Seema Verma constantly talk about value at HHS. But, the important thing to note is that, whatever the obstacles, Dr. Miller has not been prevented from pioneering a different practice of medicine and positively transforming the lives of his patients in the process. His success in reversing debilitating illness and teaching patients how to live healthy and productive lives is truly impressive.
Dr. Jim Roach, MD, ABIHM, ABOIM: Dr. Roach is known as the "America's Healer". Following in his father's footsteps in Midway, KY, his approach to medicine is more than finding creative solutions. He has a fresh philosophy of patient care that transforms the way he views his patients illness. He believes the conventional approaches to medicine compose just a fraction of the successful treatments available. He states, "there are hundreds of thousands of studies on natural approaches to health – this information simply needs to be applied." Dr. Roach and Dr. Clawson have studied under Don Yance, to whom his latest book is dedicated. Don Yance, who is perhaps the best spiritual healer in the United States, has achieved remarkable results that we never dreamed were possible."
Dr. Roach has just released a new book, entitled, "Vital Strategies In Cancer" which may become the most vital source of information on the holistic treatment and prevention of cancer ever written. Cancer is still the number two killer in the United States, claiming almost 600,000 lives annually (22.5% of all deaths). Dr. Jim has dedicated his career to helping patients and training medical professionals worldwide on his integrative cancer interventions. In a special note to his readers, he writes:
"The biggest factor in cancer success may not be which oncologist you choose, or which chemotherapy they use. The most important factors may be peacefulness, connection, nutrition, circulation, physical activity, comprehensive assessment and monitoring, non-standard approaches and love. Reinventing your life can profoundly affect survival and happiness. Most important of all may be a new and powerful spiritual foundation. Prepare for metamorphosis!"
After Dr. Roach participated in 44 national conferences, thousands upon thousands of hours in study, and reading 10 to 20 studies a week from his mentor, Donnie Yance (also one of the greatest healers of our time) on botanicals, tumor markers, blood tests, and chemotherapy, over the last 10 years, he determined that the knowledge base on integrative cancer interventions was there. Then with 12 years of medical experience treating hundreds of cancer patients; and improved cancer outcomes, on average his patient's life expectancy doubled, chemotherapy and radiation side effects halved and the quality of their lives were substantially improved. And, recently he says he can see the prospects for greater outcome-improvement becoming even brighter.
If you are a believer in the value of taking supplements to alleviate symptoms of illness, the following are recommendations from Dr. Roach on managing your health during flu season and this Coronavirus pandemic:
11th Street Family Health Services: The Commonwealth Fund recently showcased this Clinic in Philadelphia, PA for taking a new approach to the treatment of diabetes. They have a team of specialists, including a nutritionist and instead of taking the more traditional approach of advising the diabetic patient on what they can't eat, their nutritionists finds out what a patients favorite foods are and then comes up with ways to help them eat healthier versions of it. Their Clinic also offers a wide range of creative art therapies, including yoga and dance. They strive to be a place where patients come to be healthy, not just when they are sick.
Cardiac Risk Reduction Center (CRRC): The Millennium Physicians Group in Naples, FL has developed this CRRC to facilitate the New Paradigm treatment of patients at higher risk for cardiac disease. Cardiovascular disease is still a major cause of death for persons over the age of 65 and this illness is drastically facilitated by obesity and lifestyle factors. The disease can evidence symptoms as early as age 30 and the Center treats many patients, who are simply at risk, due to their genetic background. Dr. John Diaz, M.D., FAAFP and Julie Diaz, FNP-BC (husband and wife team) head up this Center, which was established to give their fellow physicians in the large and successful Millennium Group Practice, a resource for identifying and managing patients who suffer from cardiac disease. The CRRC is a good example of the Best Practice of traditional medicine. Dr. John and Julie Diaz have successfully created a group practice collaboration within their traditional physicians group, without having to establish a more formal group practice model. CRRC allows their fellow primary care practitioners to do what they do Best, while making secure referrals to treat their patients with higher risk for cardiac illness. As the Center has matured a significant number of their patients refer other patients directly to their practice. This is the kind of professional collaboration that is the essence of, and enables the success of Accountable Care Organizations.
Center For Relationships: We can not heal the body without first healing the Mind. Spiritual Fitness may be the most important thing that any human being can do for their health and well-being. The Center For Relationships in Nicholasville, KY was created by Dr. Jan Cottrell, M.A. M.Div. D. Min, LPC, and Dr. Ken Cottrell, O.D. (husband and wife team) to provide Spiritual Direction, which is considered by many to be the province of the church. Unfortunately, many people who desperately need spiritual direction have been wounded and hurt by religious communities or religious institutions. The Center For Relationships was established to provide the resources for everybody, including the disenfranchised, to act as an aide and guide them towards wholeness and spiritual healing. Spiritual healing is for real! Spiritual direction is an ancient and vital practice of healing, in which individuals seeking spiritual awakening meet with a trusted guide or mentor to develop spiritual fitness that is a necessary for getting well and staying well.
All of these Doctors Are In because they are practicing medicine in the New Paradigm and they deeply care about their work. They are finding ways to treat their patients in a more dynamic way than the fee-for-service reimbursement system normally facilitates. Some aspects of these professional medical and spiritual healing practices are NOT supported by the governement. However, for many reasons, traditional medicine has been handsomely rewarded for the treatment of symptoms, while in some cases ignoring the root causes of illness. These traditional reimbursement practices pay practitioners for their specific services rather than their ability to keep their patients sustainably healthy and well. In fact, may We be so bold as to suggest that the reimbursement system is designed to reward medical practitioners and hospitals for keeping their patients coming back for more?
According to Seema Verma, Administrator for CMS, "For example, Medicare’s payment policies for specialty care and primary care were locked in place decades ago, and generally result in greater payment amounts for specialty care. The role of the primary care doctor has become more complex and important over time, but Medicare’s payment policies have not kept up, and we continue to pay less for primary care than the value that these doctors are providing. The all-too-predictable consequence has been a shortage of primary care doctors – and this gap in our system has led to less coordination, more fragmentation, and higher costs." "As we break through the old, creaky government-centric status quo and empower patients, our payment systems must change to reward providers that offer the best value – we can't just pay for the volume of service." On October 24, 2019, the Seventh Annual LAN Summit which brought together more than 600 payers, providers, purchasers, policymakers, and patients to share resources, best practices, and mobilize stakeholders around the theme of Aligning for Shared Accountability, the secretary of HHS, Alex Azar announced the recently released Primary Care First RFA request. this is a ground breaking effort to shift the emphasis of government sponsored insurance programs to primary care.
The CDC produces an annual report on Health in the United States. There last report was in 2017. This report shows that over the last two decades Americans have lived longer. However, every morbidity factor except heart disease over age 65 has deteriorated. These morbidity factors include all other heart disease, cancer, diabetes, hypertension, hypercholesterolemia, and obesity. These results may indicate the life expectancy has increased in spite of the incidence of our medical conditions. It also indicates that our health care system is completely failing to reduce the health risks suffered by the American people.
A more recent study by the National Institute of Aging recently uncovered the fact that all Americans aged 25 - 64 have increased rates of death from ALL causes. These increases shockingly affected all racial and ehtnic groups in the seven years ending 2017. The Study's lead author was quoted as saying "The whole country (U.S.) is at a health disadvantage compared to other wealthy nations. (U.S.) Employers have a sicker workforce." We are not only sicker; we are dying earlier than in comparable nations that spend much less money than we do on health care. Our congress has absolutely failed "We the People". And, congress needs to look no further than theMedicare Advantage program that really works, and impliment a Trump Medicare Advantage plan that we already know is the right solution!
The focus of the Department of Health and Human Services has on quality outcomes, star ratings and innovative value care reimbursement practices which enhance the practice of medicine in the NEW Paradigm are critical components to the health reform that is absolutely necessary to turn around the chronic disease epidemic and reduce the cost of health care in the United States of America.
ACADEMIC MEDICAL CENTERS
The U.S. health care delivery systems, including Academic Medical Centers (AMCs), are increasingly focused on improving care for our most vulnerable, high-need, high-cost patients, in part because the value-based payment models offer the promise of financial returns, or at least the avoidance of losses. AMC and other providers participating in Medicare and Medicaid value-based payment demonstration projects have developed insights into the characteristics of successful programs for treating the chronically ill, high-need, high-cost patients. As more AMCs embrace value-based payment methods, they should have greater flexibility to provide the services that address the medical and nonmedical needs of clinically complex patients and thereby reduce avoidable health care utilization. AMCs have many opportunities to create high-performing health systems, establish operational evidence for how to transform delivery systems, and train the next generation of providers to better address the care of high-need, high-cost individuals. some of the programs in this area, include the following:
- Inter-professional Student Hot-Spotting Learning Collaborative: The AAMC, the Camden Coalition of Healthcare, Primary Care Progress, and the Council on Social Work Education have jointly developed a six-month graduate training program for interdisciplinary teams of students from schools around the country to use a patient-centered approach to working with individuals with complex medical and social needs.
- Kaiser Permanente School of Medicine: This is high-performing health system is training students to identify and address both their patients’ medical and nonmedical needs, working as a team and using all the evidence to inform clinical decisions.
- Accelerating Change in Medical Education Consortium: With funding from the American Medical Association, 32 U.S. medical schools are trying to figure out how to better prepare medical students to succeed in evolving health care systems. Participants are identifying new roles for medical students, including patient navigators, health coaches, care transition facilitators, and patient safety analysts, which should enhance their education and improve patient care.
Right now these programs are focused primarily on treating high-risk patients because they are the most costly patients to treat and savings in this area has the greatest ROI.
What they should be learning in the process is that the practice of integrated medicine in accordance with the New Paradigm will save money by fostering the sustainability of patients at every level of risk in the system. Although these programs may amount to a lot of lip service in pursuit of the New Paradigm at the present time, A Health Care CZAR could put some political power and influence behind these efforts and drive them more forcefully in the right direction. AMC programs need more government money and we need more effort on their part. The American public should not have to fund important health care research on New Paradigm through their health insurance premiums. And, that is exactly what has often been happening when this work is not funded by grants. These programs are the future of the New Paradigm in medical care (which we needed yesterday) and the federal governments must respond to both the needs of these big institutions and provide support for the Dr. Miller's and like-minded pioneers who must deliver integrated True Health Solutions as an independent medical practitioners. These efforts are going to save a lot of money and we need to support them like our backs are up against a brick wall.
CMS INNOVATION CENTER FOR AMERICANS
Although a CMS "Innovation Center" may seem a somewhat oxymoron given the general dis-function of government in health care, the CMS Innovation Center is a legitimate effort to develop new payment and service delivery models in accordance with the requirements of section 1115A of the Social Security Act. Additionally, Congress has defined – both through the Affordable Care Act and previous legislation – several specific demonstrations to be conducted by CMS. Some of these demonstrations are associated with the annual inflation in ACA Silver Plan premiums, which averaged 105% over the last five years.
The Innovation Center also plays a critical role in implementing the Quality Payment Program, which Congress created as part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) to replace Medicare’s Sustainable Growth Rate formula to pay for physicians’ and other providers’ services. In this new program, clinicians may earn incentive payments by participating to a sufficient extent in Advanced Alternative Payment Models (APMs). In Advanced APMs clinicians accept some risk for their patients’ quality and cost outcomes and meet other standards. It is in this area that the Innovation Center may be most useful to HHS in the implementation of the Medicare Advantage For All program (MAA).
As is necessary for TMA, the Innovation Center is working in consultation with clinicians to increase the Alternative Payment Models (APM) available to ensure that a wide range of clinicians, including those in small practices and rural areas, have the option to participate. One of the most important the focuses of APM is to see the expansion of value-based care and to learn how to properly pay for it. They are up against a strong bias amongst our providers.
For instance, in a recent Modern Healthcare Survey of top executives, 50% of CEO's said they want to see the expansion of value-based care, however, they don't want it to translate into pay cuts. One executive said that whenever he hears the term value-based reforms, "I hear that you will get paid less money. We know we'll get paid less, " he added. "So the question is how do we best utilize the resources we have?"
The Innovation Center's payment models are organized into the following areas of expertise:
- Accountable Care
Accountable Care Organizations and similar care models are designed to incentivize health care providers to become accountable for a patient population and to invest in infrastructure and redesigned care processes that provide for coordinated care, high quality and efficient service delivery. ACOs saved HHS hundreds of thousands of dollars over the last three years but unlike the MAA health plans, ACO’s are embarrassingly, almost unanimously reluctant to assume the financial risk of their patients. In other words, they are willing to be paid more to be accountable ACO, (but unlike the MAA health plans), ACO’s really don't want to assume any financial risk. You can't blame them. They are more or less pretending to organize themselves to provide integrated health care. They are not willing to accept financial responsibility because they really can't handle it. ACO’s were the product of AMC and HHS wishful thinking, and the dismal results prove that you cannot just organize effective integrative medical group practices with the stroke of a pen. The Mayo, Cleveland and Lahey Clinics have been doing integrative health care for decades and unless forming more group practices like these is a likely outcome of this program, the value of it may be limited. With such disappointing net financial savings, HHS is re-thinking the entire program.
- Episode-based Payment Initiatives
Under these models, health care providers are held accountable for the cost and quality of care that beneficiaries receive during an "episode" of care, which usually begins with a triggering health care event (such as a hospitalization or chemotherapy administration) and extends for a limited period thereafter. This is Old Paradigm fee-for-service personified.
- Primary Care Transformation
Primary care providers are a key point of contact for patients with health care needs. Strengthening and increasing access to primary care is critical to promoting health and reducing overall health care costs. Advanced primary care practices – also called “medical homes” – utilize a team-based approach, while emphasizing prevention, health information technology, care coordination, and shared decision making among patients and their providers. This is the path to the future. We are wary of this so-called "medical domesticity", but team-based integrative medical care is critical to the New Paradigm. We see the Community Health Centers developing these skills in the management of health care for our most vulnerable low wage working population.
- Initiatives Focused on the Medicaid and CHIP Population
Medicaid and the Children’s Health Insurance Program (CHIP) are administered by the states but are jointly funded by the federal government and states. Initiatives in this category are administered by the participating states. Many state Medicaid programs are now professionally managed by health insurance carriers. Seema Verma, our talented CMS Administrator wants to give States more control over innovation by giving them as much flexibility as possible. She also wants to hold them more accountable for health outcomes and what they are doing with federal money we give them. Conservatives are for capping entitlement spending with similar capitation reimbursement schemes that CMS uses with the MAA health plans. Treating states like MAA carriers is good management.
- Initiatives Focused on the Medicare-Medicaid Enrollees
The Medicare and Medicaid programs were designed with distinct purposes. Individuals enrolled in both Medicare and Medicaid (the “dual eligible”) account for a disproportionate share of the programs’ expenditures. A fully integrated, person-centered system of care that ensures that all their needs are met could better serve this population in high quality, cost-effective manner. AMC demonstration projects and MAA health plans have demonstrated the ability to reduce the cost and improve the quality of care for that high-need, high-cost beneficiaries. We think dual eligibility is unnecessary, but like any other entitlement, once extended it is difficult to take away. Perhaps a new program for the "dual eligible" would be more effective than trying to coordinate managing their health care with two?
- Initiatives to Accelerate the Development and Testing of New Payment and Service Delivery Models CMS believes that many innovations necessary to improve the health care system will come from local communities and health care leaders from across the entire country. By partnering with these local and regional stakeholders, CMS needs to work on the value-based New Paradigm models actively delivering patient care. An improved risk-based reimbursement system breakthrough is needed Now, not tomorrow. Medicare-Advantage -For-All would be a step in the right direction.
- Initiatives to Speed the Adoption of Best Practices
Recent studies indicate that it takes nearly 17 years on average before best practices - backed by research - are incorporated into widespread clinical practice—and even then, the application of the knowledge is very uneven. The Innovation Center is partnering with a broad range of health care providers, federal agencies professional societies and other experts and stakeholders to test new models for disseminating evidence-based best practices and significantly increasing the speed of adoption. Seventeen (17) years is the eternity, upon which death and burial of the American Health Care System as we know it, can be expected.
- Accountable Care
Amy Bassano, Deputy Director of CMS Innovation Center was interivewed at the last HCP-LAN Summit and can be seen on video at: https://www.lansummit.org/ She covers many of the key Center initiatives along with Alex Azar and many other distinguished speakers.
SO HOW DO WE PAY FOR THIS MEDICARE ADVANTAGE FOR ALL PROGRAM?
We are going to pay for Trump Medicare Advantage For All through the savings that the program is going to generate in the overall expenditure of health care paid for by the federal and state governement and American businesses. We envision two stages to the process. the first stage is the extension of a generic Defined Contribution Medicare Advantage For All Plan to the American people with an integral Health & Wellness program. The second stage would be the introduction of a revolutionary next generation Medicare Advantage plan we are calling Apollo after the successful space program.
The first stage program will initially be financed similarly to the Obamacare / ACA. Government subsidies will be provided to those residents that meet certain income guidelines. There will be an income level above which the subsidies will be tax benefits received at the time taxes are paid and the beneficiaries take advantage of tax credits. Anyone above that income level would pay premiums for the programs without any governement assistance. The premiums themselves would be graduated according to the ability for the participants to afford the coverage to afford the coverage. Market place exchanges would be phased out if Obamacare enrollment deteriorates.
In sum, the programs will be less expensive, but initially mostly because the excessive federal regulations would be removed. Coberasge would be streamlined to reflect the reall needs of the americasn people. Coverage for hospital days, maternity, psychiatric care, etc. would have options in the Platinum, Gold, Silver and Bronze gradations.
All new federal health plans are usually over subsidized and underpriced (as was the case with both Medicare and Obamacare) but after the first two years, cost at approximately current levels would likely stabilize until the positive effects of the Health and wellness program could kick in and lower the actual cost of health care. These programs have a lot of moving parts and it is the cumulative functioning of all the moving parts that generates the largest and most noticeable savings. This will take a few years. However, all of the benefit plans will start out being less costly than Obamacare Qualified Plans for several reasons.
First, they will be engineered by insurance experts using all of the latest information. The programs will not be subject to federal regulations forcing health insurance companies and health providers to offer benefits for people that don't actually need them. Unlike the requirements of both the Sanders and the Jayapal "Medicare for All" bills in the Senate and the House (in which cost sharing is illegal) carriers will be free to designate the benefit and design elements that focus on consumer cost, program cost containment and health and wellness. For instance, some contracts are likely to limit the number of inpatient days to less than 365 and the number of fully covered physician medical visits to four. Most healthy Americans never have a hospital admission lasting more the 7 days and have more that four diagnostic physician visits a year. Almost all Defined Benefit contracts cover 365 days and include unlimited physician medical visits. Some carriers may choose to optionally cover maternity, prescription drugs, rehabilitation services, dental coverage, pediatric care and mental health and substance abuse benefits, which are all required benefits for qualified ACA programs. Some of these benefits would be optional and covered by copays and deductibles, because it is obviously All Americans don't need full coverage all of these services. This was the commercial approach to health insurance before Obamacare and that's why most Americans that still have those contracts will not give them up. Americans must be responsible for choosing the level of coverage they want. They must be aware of the coverage they have. And, they must make wise decisions about what medical care they receive and where they get it. Making informed buying decisions is helps insureds understand the risks that they are assuming and how to best use their benefits to promote their own health. An integral health and wellness plan would be required tor all contracts. We have to shift the responsibility for health care back to the people and away from the medical professionals and the governement.
Secondly, the Department of Health and Human (HHS) services would cooperate with the carriers to work out constructive capitation reimbursement schemes that effectively shifts the risk from the federal governement to the carriers, requiring them to assume responsibility for the health and wellbeing of their members. . In addition, HHS will participate in favorable provider cost negotiations to make the first generation product as cost effective as possible.
Thirdly, adverse selection will be minimized. The old world provisions of waiting periods for certain benefits will be allowed. Pre-existing conditions will be accepted and covered immediately, but not necessarily by all the contracts. The underwriting of those conditions should be more cost plus and a shared responsibility between the federal and state governments. For those people without pre-existing conditions, all participants will participate in the integral health and wellness program. These programs will be carrier driven based on their experience with the employer health and wellness programs and the latest wellness and cost containment features, like the use of the techniques that have proven successful in lowering the cost of patients with chronic illness, including the use of nurses for patient interaction, etc. The wellness programs will establishing a base line for subscribers and plans to improve their health outcomes. The beginnings of a focus on Predictive, Preventive, Personal Medical (PPPM) and reinforcement for the physician practice patterns that will identify, prevent, reverse or eliminate the development of chronic illness will be introduced in a big way.
These initial programs, like all new programs sponsored by the governement, will be experimental investments. We believe the next generation Defined Contribution plans will be truly revolutionary. They will have benefited properly assigning risks between the governement, the carriers, the insured and the providers and these relationships will have the necessary financial support required for full participation. The next generation contracts will divest themselves of the vestiges of Defined Benefit Contracts and concentrate on producing more effective Defined Contribution "Premium Support" Plans that will by be designed to provide positive tangible health benefits and / or financial savings. Every participants will be underwritten as an individual with full consideration of their specific health condition. Their rates will be directly associated with health condition and changes in that condition. This is kind a like car insurance. if you have a lot of accidents, you get a lot of speeding tickets and you are generally considered a BAD driver, you are going to pay more than someone that has a clean record, never had a ticket and never had an accident. This is common sense but we don't use common sense when it come to health insurance because some politicians want to remove all personal responsibility for a persons health condition in favor of the governement. In Switzerland, for example some of their health plans provide premium reductions over five years and bonuses for those who do not file insurance claims as noted in, "Regina Herzlinger's, Who Killed Health Care?, McGraw Hill, 2007, Page 195.
The governement is going to have to play a very important roll in this new age contract to insure that the process is non-discriminatory on the basis other than health and health conditions over which a person has no control will not prevent them from being treated fairly under the new system. The new Defined Contribution Trump Medicare Advantage Contracts will require special underwriting. The traditional underwriting for these programs will have to be substantially restructured to allow for individual participants to pay vastly different rates for essentially the same benefit programs based on their health condition. Some plans may wish to allow beneficiaries to enroll for two and three year periods. These longer term contracts would have stronger economic incentives for both the carriers and the beneficiaries to promote wellness and preventative care. Provider reimbursement in the next generation product will presumably have progressed in development to the point that quality outcomes are expected. The ability for the medical practitioner to initiate, reinforce, support and monitor their patients will be properly rewarded and supported. The entire insurance product will not look anything like what we know today and it will require creative financing especially to deal with those participants who suffer from serious illnesses and never have any opportunity to improve their health or participate positively in changing n their life-style or those for which doing so would have minimal effect on their health status.
If health ploolicy in the United States keeps going the way it is, a Big Governement nationalized healthcare system is inevitable. The ten (10) year cost of $32 Trillion Dollars for Bernie Sanders Bill for a Medicare for All in the Senate is political fodder for Bernie Presidential bid. The Democrat leadership has not signed on as supporters. Unfortunately, We can't even afford the current Medicare Plan covering the 59.8 Million retired Americans. The Social Security office of OASDI has declared the Medicare Trust Fund will be 100% GONE ($ 0) by 2026. If Senator Sanders knew there was a way to avoid the needless deaths of millions of Jews in the Second World War he would be the first to support it. We are hoping to convince him that the health and welfare of the american people can be substantially improved by supporting Medicare Advantage For All.
If our design for the TrumpMedicare Advantage For All plan just impacts half (50% not 80%) of the risks associated with chronic illness, it will should ultimately save more than $1.3 Trillion Dollars and reduce the NHC-GDP by at least Sixty-eight percent (64%) to $2.34 Trillion Dollars, or 12% of Total GDP. This will put a huge dent in the incidence of chronic illness, reducing by at least half. The CDC estimates that 90% of the nations $3.65 Trillion Dollar NHC-GDP was for chronic and mental health conditions. It is generally accepted that 20% of the population generates 80% of the health care expenses. Currently, we have about 195 Million Americans suffering from at least one chronic illness. We know that higher rates of chronic illness is associated with lower incomes. KFF also confirmed that the main reason most uninsured Americans don't buy health insurance is because they can't afford it. Therefore, it is logical to conclude that most of the chronic illness is suffered by the target population for our Medicare-Advantage-For-All. Com program.
This target population includes the 30 Million uninsured Americans plus the 8.4 Million plus Obamacare subscribers, 75% of which receive federal subsidies in order to make the ACA programs affordable. We beleive that a substantial number of our uninsured population suffer from chronic illness. Further they are probably the most needy group of residents needing health care for their conditions. Cominig up with an adequitely subsidized affordable health insurance options with the integral health and wellness programs will allow us to get those conditions under treatement and on a path to reduction or elimination. The Medicare-Advantage-For-All is not looking to replace Obamacare. On the contrary, there is no reason why both programs should not be compatible with one another. What we want to do is create a program that the America people can afford. A program that will give Americans a choice and hopefully attract most of the uninsured Americans that Obamacare has failed to attract.
There is a general consensus among medical professionals that 80% of the risk of chronic disease can be either reduced or completely eliminated with the proper medical treatment, commonly referred to in Europe as Predictive, Preventative, Personal Medicine or PPPM and the patients observance of healthy lifestyle habits. Therefore, we can assume that approximately $2.628 Trillion Dollars can be reduced or eliminated. Our uninsured people are the most likely segment of our population that require the most help. In a collaborative study completed by the Urban Institute and the Center on Society and Health in April 2015, they documented higher rates of disease among lower income Americans, accompanied by higher rates of risk factors. Uniformly, as an American's income increased, their prevalence of disease decreases. The World Health Organization has also documented that 80% of the chronic disease in the world, occurs in the nations low-income and middle-income levels. So, this logical phenomenon it is not only evident in people within a nation, but also evident in nations across the world.
Reducing the incidence of treatement for chronic illness will put upward pressure of provider prices, which will need to be restrained with effective contractual arrangements. Eventually, the size of the health care system will be inder pressure. Our road to "Making America Healthy Again" may be a bit bumpy but the end result is predictable. A healthier population will genenrate a lower volume of medical and surgical care required to maintain the health and well being of the American people. this in turn will lower the overall cost of health care and result in a lower National Health Care GDP. The extent to which we address ourselves to the need for this change will determine the extent to which we can genenrate a lower cost. Given the extent of the national budget health care eats up, we recommend a full oln Apollo type national commitment to achieving the lowest GDP of any developed nation in the free world.
As we said earlier, if our Trump-Medicare-Advantage-For-All.Com program is only able to impact just Half of the people that suffered from chronic illness in 2018, we will potentially save $1.314 Trillion Dollars down the road and lower our National Health Care GDP to less than 12% (64% reduction). What about the other 50% we don't reach? A program like the one we are proposing will have a massive RIPPLE effect. As you know, the vast majority of Americans are covered by group insurance programs that are sponsored by employers. If we are successful with an affordable comprehensive MAA insurance plan with an integral health and wellness component, the health plans will quickly incorporate these features into all of their programs. Eventually, everyone, except perhaps fee-for-service Medicare and collective bargaining agreements, will have state of the art health and wellness programs that will lower everybody's rates and improve the general health condition of the vast majority of Americans. Remember, if we do this right, the health plans will be rewarded like they are under the STAR program. The more money they save based on their ability to improve outcomes, improve health status and reduce the cost, the more money they make. The effect of this reduction will lower the cost of health care and health insurance for individuals and businesses and will increase our health condition, our productivity and our competitiveness as a nation. This is how we will pay for Medicare Advantage For All and how we will ALL win in the process.
IS CHRONIC ILLNESS REALLY THAT MUCH OF A PROBLEM?
In August 2018, the Milken Institute Study documented that obesity is by far the greatest risk factor contributing to the burden of chronic disease in the United States. The prevalence of obesity in the U.S. population has increased steadily since the 1960s. President John F. Kennedy wrote an article in Sports Illustrated back in 1960 complaining that American’s were getting soft. At that time, less than fifteen percent (15%) of Americans were obese. In the last 50 years, the rate of obesity has increased by 300%. Today, sixty-six percent (66%) of Americans are overweight (meaning that their Body Mass Index -(BMI)- is 30 or above). Maintaining a BMI of less than 30 is a challenge. If you are 5.5' tall and you weigh more than 148 pounds you are considered overweight. If you weigh more than 179 you are obese. As True Americans, we take pride in our ability to produce enough food to feed ourselves and much of the world's population. Unfortunately, we also take pride in eating it.
According to our Centers for Disease Control (CDC) most recent CDC report, nearly 40 % (124.4 Million) Americans are obese, and that is gross! HHS projects that, without making any changes by 2030, Half of all adults in the U.S. will be obese. Currently, one out of every 5 children between the ages of 6 and 19 is obese. And, overweight adolescents have a 70% greater chance of becoming overweight or obese adults. HHS estimates that in 2018, obesity alone cost the U.S. twenty-one percent (21%) of our total health care costs - $344 Billion Dollars.
According to the National Institutes of Health (NIH) Survey in 2013 -2014, two out of every three adults (66%) were considered overweight. In 2015, the chronic illnesses that were directly related to our being overweight accounted for over Forty-Seven percent (47.1%) of the total cost of chronic diseases in the U.S. In 2015, the Partnership for Chronic Disease (PFCD) estimated that chronic disease was responsible for $480.7 Billion Dollars of DIRECT health care costs plus $1.24 trillion of indirect costs related to the loss of productivity. Now the CDC beleives the DIRECT health care costs to be 90% of our NHC, or $3.285 Trillion Dollars. This includes 5.7 Million Americans that suffer from Alzheimer's' Disease (ALZ), which alone cost $277 Billion in 2018. The PFCD estimated the current (2017) total economic impact of chronic illness to be about Twice the Direct costs. If that relationship holds true today, the Total economic cost to the U.S. is over $6 Trillion Dollars. This is 29% of our total National GDP!
According to the recent U.S. Department of Health and Human Services (HHS) announcement of revised Physical Activity Guidelines for Americans, only twenty-six percent (26%) of men, nineteen percent (19%) of women and twenty percent (20%) of adolescents meet the former 2008 HHS Exercise Recommendations. HHS claims that failing to meet the suggested levels of aerobic physical activity adds nearly $117 billion in annual health-care costs and contributes to 10 percent of all premature mortality. According to Dr. James Roach of the Midway Center for Integrative Medicine mentioned above, 18.8% of children and adolescents ages 1 - 18 covered by Medicaid in 10 states used chronic medications; with about half of them receiving multiple medications for chronic conditions. He states that there are 400 studies that investigate the underlying causes of this illness and they show that exercise can reduce this risk, such that Rx medicine should be rarely needed. He states that central nervous system agents are the most commonly used therapeutic medication group. Dr. Roach beleives that the consequence of taking these medications is always damage to the brain, because of its complexity. So we wonder what is happening to our young people? We are damaging their brains unnecessarily. Why are we cutting back on school recesses? These 400 studies show that exercise can reduce the risk of depression and anxiety. Blood flow to the brain increases and the pain diminishes.
No one can dispute that these over all chronic conditions impose massive upward pressure on health care spending in the United States! As we all know, the United States is the #1 spender (1st) on health care on the planet earth; spending substantially more than all the other high-income industrialized countries. This is despite the fact that obesity is something of an epidemic on an international scale. Most industrialized European countries suffer from very high obesity rates, with England topping their list with sixty percent (60%) of their subjects overweight and twenty-six percent (26%) obese. In 2016, health spending per person in the U.S. was approximately $10,348, thirty-one percent (31%) higher than Switzerland which has the next highest per capita health expenditure in the world. Switzerland also coincidentally has only 43% of their population overweight (vs. our 66%) and their obesity rate is lower as well. This is evidence of a correlation between national rate of obesity and the national cost of health care.
In 2015, 30.8 million Americans suffered from three or more chronic illnesses. By 2030, it is estimated that number will increase to 83.4 million people in the United States. By 2030, the Milken Institute estimates that seven chronic diseases will have a total (direct and indirect) economic impact of $4.2 Trillion Dollars in treatment costs and reduced economic output. The increasing trends in the prevalence and costs of chronic diseases in the U.S. are projected to continue well into the future. Moreover, these trends will be magnified by the aging of the U.S. population. By 2060, the U.S. population aged 65 years and older is projected to more than double — from 46 million Americans today to more than 98 million Americans. These trends make it very clear that the U.S. will need to identify and implement effective policies to prevent and manage chronic diseases. That is if we True Americans are ever going to arrest the increasing cost of health care and remain internationally competitive as a producer of goods and services for the world.
When asked why the American health care system cost so much, Patrick Massey, an informed author in an Op-Ed that appeared in a National Health Institutes publication wrote, “It is because eighty-seven percent (87%) of the total health care expenditure is for the management of the chronic disease. The majority of this expense is for Americans under age 65.” Chronic disease accounts for 81% of all hospital admissions and over 90% of prescription drug costs and 76% of all physician visits.
Whatever the right numbers, this American behavior is a Heavy-Drag on our economy and we can no longer afford to ignore the seriousness of treating chronic disease in America. Warren Buffet says even though we are a rich country, "we can not continue to do the WRONG thing indefinitely. If the private sector doesn't make some improvements, it's going to go public." Speaking about his new venture - Haven, he said," If the private sector doesn't supply (change) over a period of time, people will say 'We give up. We've got to turn this over to the governement.' which will probably be even worse." He was absolutely right. We have to teach ourselves how to treat chronic illness conditions more successfully and prevent them before they manifest themselves.
HOW DO WE SAVE MONEY TREATING CHRONIC ILLNESS?
As mentioned earlier, all but one conditions of illness in the United States has decreased over the last two decades. In other words, the extent to which the American people suffer from all illness conditions, including heart disease, cancer, diabetes hypertension, cholesterol and obesity have all increased. What we need to do is adopt a number of national efforts supported by a health insurance program that will decreases in incidence of these illnesses in the United States. And, we need to do it right away. In a recent finding reported in the New England Journal of Medicine, patients being treated for chronic illnesses in the United States, receive only Fifty-six (56%) of the medical care they need to adequately treat their conditions. This is an enormous deficiency!
On March 07, 2018 · Premier Inc. announced that fact that they Identified $8.3 Billion in savings that could be achieved with more preventative and coordinated ambulatory care. Analysis reveals wide variation in the number of patients with chronic conditions presenting themselves to emergency departments. In a recent study, Joe Danmore, Senior Vice President of Population Health Consulting at Premier said, " While providers face the challenges of perverse incentives that have impeded coordinated, cost-effective delivery, alternative payment models create an incentive for providers to organize high-volume networks …"
PPPM promises effective prevention and treatment of most chronic illnesses. It is the only prevention and non-pharmaceutical treatment we have for ALZ, which is now the 6th leading cause of death in the U.S. The CDC claims that currently one out of every three Americans could be diagnosed as pre-diabetic. For those of you that are not familiar with diabetes; Type 2 diabetes is a very serious condition that affected 26.7 Million Americans in 2016. Type 2 diabetes is often the natural result of uninformed lifestyle choices. According to Dr. George Guthrie, MD, MPH, CDE, CNS, and pundit on this issue:
“the right treatment for dealing with the underlying physiologic cause of Type 2 diabetes is to decrease caloric intake while increasing the calories expended. This would mean adding exercise and changing dietary habits. Aggressive but careful application of exercise combined with a good diet can change the physiology of Type 2 diabetes and lead to a reversal of insulin resistance in a relatively short period of time.”
On their web site, the CDC has developed a Workplace Health Promotion program with a Worksite ScoreCard to help employers reduce the incidence of chronic disease among their employees. Their explanation of why the Scorecard is so important, backs-up everything we have been writing about chronic illness:
The United States is facing an unparalleled health epidemic, driven largely by chronic diseases that are threatening American businesses’ competitiveness because of lost productivity and unsustainable health care costs. The medical care costs of people with chronic diseases accounted for more than 90% of the nation’s $3.3 trillion in medical care costs in 2016. For example,
•Cardiovascular disease costs the United States more than $329 billion each year, more than any other health condition. This includes $199 billion in direct medical costs and $130 billion in indirect costs including productivity loss from premature mortality.
•Medical costs of obesity were estimated from $147 billion to $210 billion per year.
•In 2017, the National Diabetes Statistical Report identified 30.3 Million Americans in the U.S. with diabetes. The economic costs related to diabetes were estimated at $327 billion. This figure includes $237 billion in direct medical expenses and $90 billion in indirect costs from disability, presenteeism, work loss, and premature mortality.
•The total economic cost of smoking is more than $300 billion a year. This figure includes nearly $170 billion a year in direct medical costs and more than $156 billion a year in lost productivity.
Although chronic diseases are among the most common and costly of all health problems, adopting healthy lifestyles can help prevent them. A wellness program that seeks to keep employees healthy is a key long-term strategy that employers can use to manage their workforce. To curb rising health care costs, many employers are turning to workplace health programs to make changes in the worksite environment, help employees adopt healthier lifestyles, and, in the process, lower employees’ risk of developing costly chronic diseases.
The approach that has proven most effective is to implement an evidence-based, comprehensive health promotion program that includes individual risk reduction programs that are coupled with environmental supports for healthy behaviors and coordinated and integrated with other wellness activities. However, only 11.8% of US employers offer a comprehensive worksite health promotion program, according to a 2017 national survey.
Several studies have concluded that well-designed worksite health promotion programs can improve the health of employees and save money for employers. For example,
•In 2005, the results of an analysis of 56 financial impact studies conducted over the past 2 decades showed that medical or absenteeism expenditures were 25%–30% lower for employees who participated in worksite health promotion programs than for those who did not participate.
•In 2010, a literature review that focused on cost savings garnered by worksite wellness programs found that the return on investment (ROI) for medical costs was $3.27 for every dollar spent. The return on investment (ROI) for absenteeism was $2.73 for every dollar spent.
Studies have also found that worksite health promotion programs can take 2 to 5 years to see positive ROIs.
CDC encourages employers to provide their employees with preventive services, training and tools, and an environment that supports healthy behaviors.The ScoreCard includes questions on many of the key evidence-based and best practice strategies and interventions that are part of a comprehensive worksite health approach to addressing the leading health conditions that drive health care and productivity costs.
WHAT WE NEED (ALEX) A ZAR TO BE OUR HEALTH CARE CZAR
PPPM is the answer to our Chronic disease epidemic and our ability to lower the Health Care GDP. Learning how to properly educate providers, to pay for PPPM, and convince the medical community that they MUST change their practice patterns to support the prevention of illness and the swift correction of conditions that can be reversed, needs a Health Care CZAR. We need A CZAR, like Alex perhaps! The Medicare for All plan legislation proposed by the Democrats in the House and in the Senate, rely heavily on the "Secretary" to basically implement their ideas for the Medicare for All Plans. Our desire is likewise to let the Secretary do the advance work to define and implement the Trump Medicare Advantage for All plan.
Alex Azar has done an excellent job working with health care providers and drug companies to disclose their charges and lower the cost of prescription drugs. He is in the process of writing the regulations for Hospitals and medical providers to comply with the Executive Order of transparency. His actions are making health care more accessible and affordable for All True Americans. We have a crisis in American health care. We have an opioid crisis that is causing unnecessary death and destruction in our society. Our health care system is out of control and threatening the health and well-being of our people and the viability and competitiveness of our economy. The costs involved with the treatment of addiction, our health care, and the national debt level, all threaten to sink our nation-state. We need to pass A Bill authorizing the Secretary of Health and Human Services to act on our behalf, in accordance with the job description and the Mission of the Department. We need to give this Department the responsibility to come up with a proposal for Congress that addresses the real needs of the American people and not the egos of personal partisan politicians or the economic interests of our providers, who generally oppose everything that portends to lower their reimbursements. See the Fifth Edition of the True American for more information.
The Fifth Edition of the True American dated May 2019 includes the first page of a Draft Bill proposed by "WE THE PEOPLE OF THE UNITED STATES" to the Senate leadership. The BILL authorizes the Secretary of Health and Human Services to consult with all of the Departments, Agencies, and entities of the federal government and all of the immediately applicable interests of our private health care economic sector in order to devise a plan to extend Medicare Advantage to All Americans. The Secretary is required to recommend the rules and the necessary criteria for a firm and reasonable proposal and time frame for extending the Medicare Advantage to All Americans in an affordable, accessible, universal and feasible fashion.
Implicit in the New Paradigm is the development of a Wellness Program for the American people that goes beyond exercise and diet guidelines. The private sector and the health plans have the experience necessary to create an integrated health and wellness program that will reduce the incidence of chronic illness and improve the health and productivity of the American people. the AMCs need to formalize what they have learned about value-based care and introduce it effectively to the medical profession. HHS must develop a bold New Paradigm risk-based capitation reimbursement system. Secretary Azar recently said, "We can also enhance value through payments in Medicare Advantage, where we want to open up more opportunities for MA Plans …. including creative value-based design arrangements, moving care to the home and the community, and new ways for MA Plans to improve patient's health over the long term," He gets it! We just have to give him the power to design that plan, not just implement it.
Despite these challenges, there needs to be some de-regulation, giving the states more control and getting some of the power out of Washington D.C. We are cautiously optimistic that these goals can be simultaneously realized, but it will take Magi! We have a national chronic disease crisis on our hands. We need an HHS - CZAR (Alex M. Azar) to act as a CZAR should act to deal with this crisis. The economic viability of our nation and the general welfare of our people depend upon this effort.
We at trump-Medicare-Advantage-For-All.Com have demonstrated that the savings from the improved treatment of chronic illness and the restructuring of the health care markets should easily exceed 6% of the total GDP. Long story short, it should be abundantly clear to everyone, who reads these facts, that it is well within our power to reduce our cost of health care. We have the skill and the expertise to simultaneously reduce the cost of our health care and our Health Care GDP to a competitive world market level, secure our exceptional and unique health care financing system and improve the health, productivity, and insurability of the American people with a properly designed, expertly administered and adequately regulated Trump Medicare Advantage for All program. A Trump-Medicare-Advantage-For-All will be instrumental in making this happen.
KEY NOTE REMARKS BY SEEMA VERMA AT BETTER MEDICARE ALLIANCE
This Key Note Address on July 22, 2019, is the latest NEWS on the current state of health insurance and health care delivery in the United States. As the head of CMS, Seema Verma is in charge of the largest national insurer in the country responsible for Medicare, Medicaid, and Obamacare exchanges. She sees the challenges of government-run programs first hand. These remarks are a road map for Medicare-advantage-for-All.Com and should be a sign to All Americans that this web site and our movement are exactly what we need to get the "Better" health and the "Better" health insurance that we deserve.
WE CAN ELIMINATE NEUROPATHY, OBESITY, HIGH CHOLESTEROL & MORE
Health & Wellness Magazine, Vol. 16, Issue 1, October 2018
Health & Wellness Magazine interviewed a patient treated by Dr. Mark Miller of True Health Solutions, who practices medicine under the New Paradigm and the patient's results speak for themselves. We don’t have to change our health care system with large medical groups protocols or implement new health insurance value-based reimbursement systems to get health care with a holistic approach, addressing the patient’s lifestyle, treating illness, and ensuring that the patient realizes what Dr. Miller calls, “the victory of eliminating the causes of neuropathy and obesity.” Dr. Mark Miller provides clear instructions on lifestyle improvements to eliminate poor health and then teaches the patient how to stay healthy, today and every day. It is just an uncommon sense that some of the medical practitioners have now and we need to perpetuate it.
THE COST OF CHRONIC DISEASE IN THE U.S.
Americans’ chronic health problems and diseases not only come at the expense of individuals’ well-being, but they also constitute a massive burden on the U.S. economy. When including the costs of lost economic productivity, the total costs of chronic diseases in the U.S. is equivalent to almost one-fifth of the American economy.
AMERICAN MEDICAL CENTERS AND HIGH-NEED, HIGH-COST PATIENTS: A Call to Action
AMCs and other providers that have participated in Medicare and Medicaid demonstrations and value-based payment programs have important insights to offer about the features of successful and promising programs for high-need, high-cost patients. AMCs have many opportunities to create high-performing health systems, establish operational evidence for how to transform delivery systems, and train the next generation of providers to better address the care of high-need, high-cost individuals.
BEHAVIOUR, NUTRITION AND LIFESTYLE IN A COMPREHENSIVE HEALTH AND DISEASE PARADIGM: SKILLS AND KNOWLEDGE FOR PREDICTIVE, PREVENTIVE, AND PERSONALIZED (PPPM) MEDICINE.
In this comprehensive 2012 study, Dr. Guglielmo M. Trovota, an Italian Physician of note, in which he reviewed the benefits of the Mediterranean diet, he asserted that “The combination of healthy lifestyle factors – maintaining a healthy weight, exercising regularly, following a healthy diet and not smoking seems to be associated with as much as an eighty percent (80%) reduction in the risk of developing the most common and deadly chronic diseases.”
Dr. Guglielmo M. Trovota. Springer EPMA Journal. 2012; 3 91) 8:3. Open Access at http://creativecommons.org/licenses/by/2.0
GENERAL REPORT & RECOMMENDATIONS IN PREDICTIVE, PREVENTIVE, AND PERSONALIZED (PPPM) MEDICINE 2012: WHITE PAPER OF THE EUROPEAN ASSOCIATION FOR PREDICTIVE, PREVENTIVE AND PERSONALIZED MEDICINE
This report is the collective product of world-leading experts working in the branches of integrative medicine by predictive, preventive, and personalized medicine (PPPM) under the coordination of the European Association for Predictive, Preventive, and Personalized Medicine. The general report has been prepared as the consortium document proposed at the EPMA World Congress 2011 which took place in Bonn, Germany. This forum analyzed the overall deficits and trends relevant to the top-science and daily practice in PPPM focused on the patient. Follow-up consultations resulted in a package of recommendations for consideration by research units, educators, healthcare industry, policy-makers, and funding bodies to cover the current knowledge deficit in the field and to introduce integrative approaches for advanced diagnostics, targeted prevention, treatments tailored to the person and cost-effective health care. Olga Golubnitschaja 1 and Vincenzo Costigliola2, EPMA
The full report can be viewed as PDF here: http://www.epmajournal.com/content/pdf/1878-5085-3-14.pdf/ and http://europepmc.org/articles/PMC3485619/
CMS INNOVATION CENTER
The Innovation Center was established by section 1115A of the Social Security Act (as added by section 3021 of the Affordable Care Act). Congress created the Innovation Center for the purpose of testing “innovative payment and service delivery models to reduce program expenditures …while preserving or enhancing the quality of care” for those individuals who receive Medicare, Medicaid, or Children’s Health Insurance Program (CHIP) benefits.
PHYSICAL ACTIVITY GUIDELINES FOR AMERICANS
HHS has now released the second edition of the Physical Activity Guidelines for Americans. This second edition of the Physical Activity Guidelines for Americans provides science-based guidance to help people ages 3 years and older improve their health through participation in regular physical activity.
NEARLY HALF OF ALL AMERICANS HAVE HEART DISEASE
This is a new Annual Report released by the American Heart Association on January 31, 2019, increasing the estimate of the number of Americans suffering from heart disease. They have lowered the blood pressure guidelines which identify more Americans at risk. The old AHA guidelines were set pre-hypertensive levels, making us think that less than 10% of Americans were at risk. Their new Annual Report makes some progress with disabusing us of this illusion.
2018 ALZHEIMER'S DISEASE FACTS AND FIGURES
Alzheimer's Disease (ALZ) affects over 5.7 million Americans today, indirectly costing the economy over $277 Billion Dollars in 2018. The number of people suffering from the illness is expected to rise to 14 Million in 2050 and cost the economy as much as $1.1 Trillion Dollars. Alzheimer's Disease is the 6th leading cause of death in the United States, more than breast cancer and prostate cancer combined. While there is no cure for the illness, the Alzheimer's Association believes the best non-pharmaceutical prevention for ALZ is the same as that for most Chronic illnesses, the Mediterranean diet, a combination of aerobic and non-aerobic exercise. This and early diagnosis will save Billions.
HOW ARE INCOMES AND WEALTH LINKED TO HEALTH AND LONGEVITY
In a collaborative study completed by the Urban Institute and the Center on Society and Health in April 2015, they documented higher rates of disease among lower-income Americans, accompanied by higher rates of risk factors. Uniformly, as Americans' income increased, their prevalence of disease decreases. The WHO has also documented that 80% of the chronic disease in the world, occurs in the nation's low-income and middle-income levels. So, this logical phenomenon is not only evident in people within a nation, but also evident in nations across the world.
CDC WORKPLACE HEALTH PROMOTION PROGRAM
This workplace Health Promotion program description covers the Worksite health Scorecard and provides sources for the assumptions associated with the savings that can be realized by employers that adopt this kind of program. the page was created by the Division of Population Health of the National Center for Chronic Disease Prevention and health promotion and was last updated on January 18, 2019
INTEGRATIVE MEDICINE - A PATHWAY TO COMPLETE HEALTH
There has been so much evidence, confirmation, and positive outcomes demonstrating that integrative medicine, beyond conventional approaches, offers a secure pathway to complete health. Integrative medicine is an encompassing thoughtful approach using highly comprehensive blood assessment, nutritional and digestive advice to provide lifestyle strategies, spirituality, and nutrient support.
Be prepared to take charge of your health. You will be educated on how to achieve your health goals, in an often non-invasive, predictive, and preventative manner. Healing has occurred with this approach where many of the nation’s top medical centers have failed. A major focus for Dr. James Roach is cancer – where those patients with discipline, an open mind, and resourcefulness have had major successes, revitalization, and healing. Patients have also experienced exciting improvements in cognitive impairment, ADHD, Parkinson’s, Asperger’s, Multiple Sclerosis, and other brain impairments. Autoimmune disorders, chronic fatigue, and fibromyalgia often have excellent responses. Irritable bowel syndrome and other gastrointestinal concerns usually respond to our advanced approaches. Dr. James Roach, Midway, KY is definitely a resource you should know about. His new book, ”Vital Strategies In Cancer” is all about spirituality. And, it is a great book.
SPIRITUAL FITNESS REQUIRES SPIRITUAL DIRECTION
It is not possible to nurture and sustain a spiritual life alone; we need the company, support, and challenges of others. Spiritual Direction is a particular kind of companionship. It is less about "directing" another person than it is about being fully present to them and listening, together, for the movement of Spirit in their life. At the Center for Relationships is a private counseling practice offering outpatient mental health counseling, substance abuse treatment, psychological assessments, parenting and family counseling, and couples and marriage counseling. Therapists offer counseling and referrals for a wide range of mental health needs. A variety of counseling approaches are supported, augmented by a spiritual perspective, with referrals available for testing, psychiatric evaluations, and psychiatric medicine.