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An open letter to senators

To Senators Amy Klobuchar and Al Franken:

This letter is long so I suppose it might not get read. If you're just looking for my short opinion, it is:

1. We need a public option insurance plan or nothing will change.

2. We need a law that says no economically advanced country can get lower prices for drugs than we get.

Well ... it appears that the forces for the status quo are back. The "swift boat veterans" and the bull-horned agitators who were pounding on the doors, disrupting the 2000 election recount in Dade County, are massing again so we probably won't have meaningful health care reform for another generation or two unless our elected representatives and president show a lot of courage to stand up to the lies and "rotten fruit" being thrown at them. I really appreciate your difficulties; don't give up. America needs you now.

I think a big problem with the Health Plan proposals so far is that everything has been too complicated for people to understand. This whole discussion needs to be simplified.

Public Option Idea: Medicare plus 10 percent. It's simple and fair.

I was thinking that perhaps the only way we could get anything meaningful now would be to expand medicare and allow anybody to buy it who wants to, regardless of their age, while still making it free for 65 and over seniors. I read where the Mayo Clinic in Rochester spends about $3,500 per year on the average medicare recipient. McAllen, Texas, spends about $6,800, and El Paso spends about $4,500. So people my age (61) would probably cost less, say about $4,000 per year on average, (probably less than $3,000 in Rochester). If they added 10 percent, it would average about $4,400 nationally. Each age group would have a different cost per year based on actuarial facts. As the groups get younger, they would cost less. Medicare spends about 98 percent of its income on medical claims so even adding 10 percent, it would always be very competitive for all age groups. I spend $12,000 per year on monthly premiums for my wife and me ($6,000/year for each of us just for monthly premiums) and basically 100 percent of the first $3,000 of actual medical visits, drugs, etc., for each of us, another potential $6,000 per year. With this kind of expense, I seriously considered having no insurance but the insurance industry has the cards stacked against anyone who thinks about insuring himself since the prescription drugs cost a lot more without an insurance card. It varies but many of them are 50 percent more. Medical clinics and hospitals have also negotiated special discounts for insurance companies, which means they have to charge other people more to make up for the insurance company discounts. It's almost impossible for an ordinary citizen to find out what these discounts are. You would have to actually go to the hospital without insurance and then go later with insurance for the same procedure to find out. The reason I know about the drug discounts is that I got prices on all my wife's asthma meds before I retired to see if I could afford to retire and got these really high numbers. Previously, we had a policy that had the same co-pay on all drugs. With the high deductible plan (MCHA, the only one I could get after retiring), I assumed that I would be paying the pharmacy directly but what actually happens is they program your insurance card in, and the computer calculates your discount, drug by drug, and then I pay 100 percent of that until the deductible number is reached, when it eventually drops down to 0 percent. I've never gotten to 0 percent, but my wife gets there in about four months. We spend close to $20,000 per year on health care for the two of us, more than three times what the Mayo Clinic spends on average on medicare recipients who would be about 10 years older than my wife and I are and should therefore cost more money instead of less. I personally think that pharmacies, hospitals, and health clinics should not be allowed to give individuals, corporations, or other groups special discounts; everybody should get the same price, and they should publicize their prices.

Anyway, if people could buy Medicare plus 10 percent, the 10 percent "profits" could go toward making Medicare more financially stable for the older, 65+ folks and would also give the private insurance companies a chance to compete. I read where in 1993, when the Clintons tried to change health care, the typical insurance plan spent 90 to 95 percent on medical claims and 5 to 10 percent on overhead, executive pay, and profits. In 2007 they spent 80 to 81 percent on medical claims and 19 to 20 percent on overhead, executive pay, and profits. It seems unlikely, with better computers etc., that overhead has gone up so the difference is in executive pay and profits, which appear to have doubled. Medicare spends 98 percent of its "income" on medical claims but doesn't have any highly paid C.E.O.s or profit-hungry Wall Street analysts to worry about, so if the private insurance companies can match Medicare's overhead cost, they would still have 8 percent to pay C.E.O.s multi-millions per year and Wall Street profits. If they can't make it on 10 percent like they did in the early '90s then they should be allowed to evaporate from the face of the Earth. We don't owe them a living.

Drug Cost Controls - simple and fair

The drug industry has spent more than $40 million during the last three months to lobby congress and have already made sure any new plan doesn't allow any nationwide drug price negotiations or any importation from any other nation that does have national drug price negotiations, so Canada will still have cheaper drugs.

I think we shouldn't bother to negotiate drug prices either. We should just pass a law that says that no economically advanced nation can have a lower negotiated price for drugs than we get and let the foreign countries negotiate for us. This law should have an actual list of countries that are considered economically advanced (Canada, England, France, Switzerland, Germany, Spain, Japan, Taiwan etc.). Most people don't know, but the government already has a law (at least military purchasing has this rule) that says all things being equal, you cannot sell them anything for more money than you charge any other customer. Someone could probably just go to court and demand that this law be applied since the government pays directly and indirectly for a lot of prescription drugs. I imagine the drug companies would spend as much on lawyers to prevent this as the tobacco companies spent trying to prove that cigarettes were safe. They will be throwing a lot of rotten fruit.

Thank You.

John Belisle