"The Health Economy" Survey

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1. “Accountable care organizations” (ACOs) are private, investor owned companies providing comprehensive, prepaid, health care. ACOs are supported by most health policy experts, practicing clinicians, and political parties.

The Health Economy plan calls for health services to be provided by private, competing "accountable care cooperatives" (ACCs) instead of ACOs. There are two important differences between ACOs and ACCs. Whereas, ACOs are owned by investors (physicians and hospitals) that profit from their investments, ACCs will operate as nonprofit cooperatives owned by all the enrollees. Whereas, ACOs are regulated by government guidelines and benefit packages determining covered and not covered medical interventions, ACCs will be self-regulating and determine their own medical treatment guidelines.

Do you agree the proposal of delivering patient-centered care with ACCs that are patient owned and self-regulating with saving going to increased patient services and lower premiums rather than ACOs that are investor owned, operate under government approved treatment guidelines, and savings from efficiencies go to ACO investors and public or private insurers.

2. With the current health care system, private insurance companies decide who to insure, what health interventions to cover, and how much to pay providers for services. The allocation of government medical insurance (e.g., Medicare, Medicaid, Veterans, etc.) also comes with burdensome bureaucracy and tight control over the services authorized and amount of payment per service.

In the Health Economy, private, competing health insurance companies will cover all the 300 million+ U.S. residents who voluntarily enroll. Under contracts from ACCs, private insurance companies will collect insurance funds from enrollees ($1.3 trillion) and from the federal government ($683 billion). The insurance companies will allocate insurance funds for health care services as dictated by ACCs. Insurance companies will compete with each other by, among other things, promptness in complying with ACC fund allocation requests.

Do you agree with this simplified patient-directed approach to health insurance?

3. The social indicators of health (e.g., poverty, education, housing, nutrition, etc.) account for much more of the variability in health outcomes (longevity, infant mortality, etc.) than medical interventions. Social safety net spending by various branches of government is currently inefficiently delivered and poorly coordinated.

In the Health Economy, government welfare funding ($735 billion pin 2011) would be merged with health funding and allocated through the patient-selected ACCs.

Do you agree with merging health and social safety-net administration and funding?

4. Other than the U.S. government's increasingly desperate efforts to grow the overall economy with deficit spending and currency devaluation, it has no strategy to create permanent, good-paying jobs.

In the Health Economy, ACCs would allocate and administer public and private funds for job creation:

A. ACCs could pay for personal care of elderly and disabled people by family and friends (up to 30 million currently unpaid workers becoming paid)
B. ACCs could provide funds to parents to enhance child care (up to 20 million unpaid parents becoming paid)
C. ACCs could directly or indirectly create over 14 million new jobs for enrollees in agriculture, greener technologies, manufacturing, conservation, and for-profit and nonprofit businesses.

Do you agree with ACCs receiving the mandate and the funds to become the job-creation alternative to the government and the private sector?

5. Litigation consumes about 2% of the U.S. GDP (about $290 billion in 2011), about twice the percentage of the GDP of other developed countries.

With the Health Economy, ACCs would allocate $50 billion (about $160 per capita) for prepaid legal services to enrollees. These legal services through ACCs and other Health Economy medical malpractice and tort reform measures are designed to reduce the cost of legal services to 1% of GDP, saving about $150 billion per year.

Do you agree with this approach?

6. Wall Street traders, bankers, insurers, brokers, and investors will charge U.S. residents about $820 billion in 2011, (about $2,700 per capita). Financial reform legislation has not reduced the risk of another financial meltdown or decreased obscene profits in parts of the financial sector.

The Health Economy's financial services reform approach is to allocate $75 billion (about $240 per capita) for prepaid financial services to enrollees, including financial education, income tax preparation assistance, and financial counseling regarding loans and investments. These ACC-provided services are designed to reduce the cost of financial services to about $400 billion, saving Americans about $420 billion per year.

Do you agree with this approach?

7. Financial security provided by Social Security to aged and/or disabled people is not sufficient to cope with increased costs for health care, food, shelter, and other basic needs. To make matters worse, Social Security payroll taxes will not adequately fund Social Security benefits as promised for the next generation.

With the Health Economy, a fee on equities traded on stock markets will be earmarked for the Social Security Trust Fund, making Social Security fully funded to meet all its future obligations. The responsibility and accountability for Social Security would be shifted from the U.S. government to the ACCs. ACC staff would collect Social Security premiums directly from employers of enrollees by law and would distribute funds to enrollee recipients. For each Social Security recipient and future recipient, the choice is between depending on federal government bureaucrats and politicians for current or future financial security or on pension managers in the local ACC he/she selects.

Do you agree with this approach to retirement financial security?

8. According to a range of education experts, the U.S. education system is failing. Despite top-down subsidies from the U.S. Department of Education linked to standardized testing, teacher evaluations, and other requirements the U.S. has markedly declined in worldwide education system rankings.

With the Health Economy, the U.S. Department of Education would be eliminated and its $94 billion per year budget would be distributed to the ACCs to help schools and students as decided by local stakeholders. An additional $100 billion would be transferred from welfare to education and also distributed through local ACCs. The current $907 billion of public funding for education would continue to be allocated by those in charge now.

ACC supplemental education funds could serve entire communities and be used in ways that best suited students, parents, teachers, and other stakeholders. Examples of ways to allocate ACC education funds include for tutors, classroom aids, smaller classes, increased teacher pay, enrichment activities, paid internships, community service learning projects, mentors for teachers, college scholarships, educational summer camps, experimental education programs, special education for autism spectrum children etc. ACC enrollees and local education stakeholders will hold ACC administrators accountable for effectively and efficiently allocating supplemental education funds.

Do you agree with this grass-roots rather than top-down education reform strategy?

9. A fiscally sustainable economy has a frugal, efficient government, low taxes, and no deficit spending.

With the Health Economy overall government revenue generation would be changed as follows:

A. A new $683 billion "health fee" on nonrenewable energy (fossil fuel and nuclear energy: equivalent to $1.33 per gallon of gasoline) would be levied to pay the government's portion of personal health care. The health fee will help decrease consumption of non-renewable energy by 30%, saving over $400 billion per year.

B. Federal, state and local taxes, including the nonrenewable energy "health fee" as a tax, would be reduced by over $1 trillion (16%) compared with 2011.

C. Compared with borrowing $1.6 trillion in 2011, the federal government will borrow nothing and reduce the deficit by $250 billion per year by sending Social Security Trust Funds to ACCs.

Are these changes acceptable?

10. Political preferences are in unusual flux these days, with many people disillusioned with all the available choices of parties and candidates. Others may be more strongly committed to their long-standing political ideologies. Many people now identify with some of the agendas of two or more parties or political movements.

Please check the political parties or movements that you identify with strongly or at least to some degree and those you oppose.