The Fundamental Reform of our Health Care system
and Providing Everybody the Basic Health Care Coverage
by Dr. Georsen
September 2009, New York
I. Introduction:
The era of new health care is about to begin. We have reached the breaking point to stop us from continuing to sink into the black hole of our failing health care system, where a new solution must be found. However the proposed plans are unfeasible and do not satisfy our people, triggering conflicts and arguments. Actually the majority of people are uncertain and do not know whether we are going to have a better plan in the future to save our health care system.
I am a physician actively engaged in medical practice for many decades. Recently I saw a patient who was a young housewife of a family with four household. She was in tears in front of me and said that they had to pay $1,300 per month for health insurance, which takes up almost one third of their family total monthly income. Still, she had to pay $57.00 extra for a prescription of 60 generic stomach pills. She said, “Really we cannot afford it, maybe I am unable to see you for a while.” I am sure these kinds of stories are so common and happen all over our country.
Yes! Our present health care system is a mess, not only people cannot afford it, business owners are hard to keep up with the payments of coverage and it is also threatening the financial security of our nation. According to statistic data in 2007, we paid $7,290 per person per year for health care coverage (compared to only $3,895 for Canadians). American health care coverage is the highest in the world, but we are not satisfying with what we have, and there are still 47 million people who do not have any health care coverage and some additional 27 million will join them. The premium of health care insurance increased rate was several times higher than the consumer inflationary rate, but it is still increasing unlimitedly. Soon it will become untouchable to average income people.
First of all we have to blame to our government because they do not take good care of our people and do not provide adequate health care (the Medicare and Medicaid coverage are insufficient ). Health care is a basic human need, it is an important security coverage for our living. Similar to education, it should be considered a basic, fundamental welfare benefit which the government is responsible to provide. Looking at the world now, all of the leading industrial countries (G8), with the exception of the United States, have provide the health care coverage for their people. Are they all wrong or only we are right? Actually our current health care scenario already directly answered this question.
It seems that whatever the government involved in is wrong: it is socialism; it is a competition with private sectors and takes the business away from the people; we do not need government standing between insurance and us; we don’t want a big government, etc. These sound like campaign slogans and are not necessarily to be true. The total dollar amount of our annual health care expenses in the United States have reached our GDP of 16% (2.3 trillion dollars) and will soon be up to 20%, it is too much and too big for the private companies to handle. This is the time in which we need Uncle Sam to intervene! There is no issue of “too big” or “too small” but rather “need” or “not need.”
Secondly, we have made a fundamental mistake, which follows the proverb, “We have let our life and death issues be handled by the businessman.” If we are “sick” the insurance companies will count it as a “loss” and of course they will try their best to cut the “loss” otherwise they would not be in business. Therefore, they squeeze you (the insurance policy holder) to reduce and limit your coverage, and also squeeze and control our health care providers, making it difficult for us to follow and stay in practice. The American traditional medical practice is centered around a good patient and doctor relationship, we always have our family doctor, and everyone respects the free choice and the free competition. However, many doctors today do not take insurance. “Your doctor does not participate in our plan.” One simple word breaks the patient-doctor relationship, regardless of how many years it has been, and also eliminates the free choice and free competition. You also frequently hear: “this is a pre-existing condition” ; “this procedure or this medicine is experimental your plan is not covered” ; “this drug is not in our formula” ; “the test your doctor ordered was not approved” ; “the length of the stay cannot be extended...” It causes people to be very frustrated and disappointed. For more than four decades we have given private insurance companies the chance to take care of our Americans but they have failed to do the job well. According to statistical data of 2006, Canadians’ life expectancy was 80.1 years and the newborn mortality was 0.5%. Americans’ life expectancy was 78.1 years and the newborn mortality rate was 0.67%. Nonetheless, Canada’s personal annual medical expenses were just 53.43% of ours. The real numbers have been revealed. Canada clearly provides a superior solution.
II. The New Plans:
The fundamental reform of our health care system keep the good parts of our system in place as they have been there for long time and we are used to having it. At the same time, we should adapt parts of the successful systems from other countries. Two systems in place accommodate and support each other to complete our ideal health care service. The goal of the system is affordable and universal, meaning “it is affordable and everybody will have one.” The principle, logistics and discussions of this plan are as follows:
I). First system − the basic health care coverage:
1. Principal:
A public administrative health care system to provide affordable, universal hospitalization care (in-patient care) coverage to all of our citizens and qualified peoples of the United States. This is a mandated health care plan which will automatically be provided to us all as basic health care coverage and acts as a security blanket for us to live with.
2. Logistics:
a. All taxpayers will be surcharged with a biannual health-care tax with the exception of persons enrolled in Medicare part A program; people below the true poverty line as a Medicaid recipient, and all children under the age of 18 (who will be covered under a new proposed Medicare part C). The reimbursement of this tax from the employers is optional and is negotiable between the employee and employer. For the Medicare part A recipients, the enrollment fees are paid through by social security monthly payments. Medicaid recipients are paid for by state and federal Medicaid funds. The new Medicare part C plan will be biannually paid for by the children’s parents or guardians and the fee should be minimal. The paid health care tax or health care insurance payments are tax-exempt and it should be deducted from the gross incomes.
b. The plan coverage covers all the expenses of in-patient care (including medication), the ambulatory surgeries (regular non-therapeutic cosmetic surgeries are not covered), and extended care which is provided by the institutions of rehabilitation.
c. All the hospital or rehabilitation centers and their affiliated licensed physicians or other medical personnel are mandated to participate in the plan. The plan must also accept them as the providers.
d. A new management department − the Bureau of Health Care (abbreviated as BHC) will direct and manage the health care services. This portion of the health care plan may be named “U.S. Hospitalization Care Plan (abbreviated as USHP) and may be identified with the “blue card.” Those who hold this “blue card” are entitled to have the same opportunity and quality of care from the health plan. If an emergency occurs and a “blue card” holder checks into a hospital while traveling out of town or abroad, the expenses also will be covered.
e. A proper screening process to determine the eligibility of admission is an important factor for controlling costs. Before being admitted to a hospital, every patient, whether it is an emergency or elective, the hospital has to provide two licensed affiliated physicians to examine the patient and sign the “justification of admission,” which will be the same as the signing procedure for DNR (Do Not Resuscitate). If any dispute occurs, then a third physician’s opinion and signature are required. For any elective surgical cases, the surgical department of the hospital has to be informed and must review the case before the procedure is scheduled.
f. The current hospital system, its operations and business conduct should remain intact and should not be changed. The hospital is still following the DRG (diagnosis related group) system and follows the codes of CPT (current procedure terminology) and ICD (International Classification of Diseases) to receive a fixed payment for every individual case from the plan (USHP). The only difference is the payment of the physician who provides the care to the patient. At present, payment is counted by the number of visits, but with new plan the payment will follow the DRG system to charge a fixed price to the plan (USHP). This change will definitely helpful shorten the patient’s length of stay in the hospital and cut the hospitalization costs significantly.
g. We should pass “the Family Custodian Care Act” to waive the responsibility of the hospital to carry out care of custodians. Taxpayer should not be burdened with the cost of caring for family members.
h. To create and set up the regulatory, management offices of the Bureau of Health Care (BHC) and Councils of the Arbitration, the details to be followed.
3. Discussions:
a. During our life time nobody can avoid sickness or injuries, and when those times come we must check into the hospital for life saving, treatment, get well, and get back to daily living. However the costs of hospitalization in the US is so expensive, if someone must be hospitalized, (unless one is superrich) then otherwise the person might be bankrupt in a very short period of time. It is something everybody is afraid of. Actually buying the health care insurance is basically to cover the hospitalization, which is essential and is the basic security that we need. And we may say that the hospitalization care coverage is the basic health care coverage.
b. In view of the “Canada Health Act” it is safe to say that their system is actually a good system. The principals of the Act are public administration, comprehensiveness, universality, portability and accessibility, but this might be due to their limited budget and some human factors, therefore the shortage of health care facilities and personnel cause patients to be subject to delays and waiting. Actually, the case of delaying treatments or operations which caused negligent damages are rare, otherwise the Canadian government would not be able to afford it. Our system is different, with the exception of VA system as our hospitals and medical personnel are not owned or paid for by our government and we have enough hospitals, medical facilities and personnel in most places of our country. The Canadian health care scenarios will not happen here.
c. The amount of health care tax we going to pay will be much less than what the average Canadian pays because we will solely covers hospitalization while the Canadian system covers all aspects of health care except for outpatient medications. This new plan should cost much less than what we are paying to medical insurance companies now. Because the Bureau Health Care (BHC), we do not need to donate so much campaign money as a contribution to our Washington lawmakers; we do not need to pay the highest average salaries for their management personnel, and do not need to spend on very expensive advertisements.
d. The medical part C for our children is a completely new concept. During our long period of health care history we always focus on the elderly and setting up Medicare A&B for them. Is it because they are old and easily get sick? Is it because they have paid taxes during their productive years? Or because of they have voting powers? We have made a big mistake by neglecting the care of our youngsters. The rule of mandated immunization for going to school is not enough. Is it because nobody stands up for them or because they have no political influences? We should heed the proverbs, “The youngsters are our future master, a healthy youngster will grow up a strong adult”. If our health care programs start from childhood and our children grow up healthy, not only will it substantially reduce our health care cost in the future but it will also improve the productivity of our society. This is a little investment now with enormous future returns!
e. The Medicaid recipients will have equality of care, similar to other “blue card” holders, and will no longer be “second class citizens” in our health care system. This shall adapt to the guidelines of the Canadian system to reverse the true poverty line. In doing so we will be able to improve the service by reducing the numbers of recipients.
II). Second System – the out-patient health care coverage:
1. Principal:
This is the supplement, optional, voluntary health care coverage provided for all out-patient cares, emergency visits (if the patient is not admitted), laboratory tests, imaging studies, prescription drugs and long-term skilled nursing facility cares.
2. Logistics:
a. The out-patient health care coverage provided by our existing private health care insurance companies. The reimbursement or payment of the insurance premium is optional and is negotiable between the employee and employer.
b. Medicare part B, Medicaid program and the new Medicare part C also will participate in out-patient care. Its financial sources are the same as the hospitalization care plan. It also will be managed and controlled by the Bureau of Health Care (BHC). Current private insurance assigned Medicare and Medicaid programs should be terminated and should let the BHC handle it. The plan conducted by BHC may be named the “US Out-Patient Care Plan” (abbreviated as USOP) and will be identified with the “white card” (so we will have the “white card” for out-patient care coverage and the “blue card” for in-patient care coverage). The “white card” might indicate the name of primary physician, different co-payments, different drug plans, etc.
c. All licensed medical personnel, approved pharmacies and medical facilities are mandated to take part in out-patient health care. All insurance plans and the BHC should also be mandated to accept them as the providers. This reestablishes the traditional free choices and free competition and let our family doctors and personal pharmacists to be restored.
d. Medicare part C out-patient care, the plan (USOP) will only provide our children with the complete immunization programs, the annual physical and its related laboratory and imaging tests, annual ophthalmologic or optometrist examination, and annual auditory check up.
e. The “co-payment” is an effective method to discourage the abuse of the system. The rules should be applied and reinforced by the law to all kinds of services and purchases, including office visits, laboratory tests, imaging studies, prescription drugs and medical supplies etc. The range of co-payment should be reasonable and be string attached to a maximal affordable amount for the expensive items, such as office procedures, MRIs, CT Scans, and drugs for chemotherapy etc.
f. The Bureau of Health Care (BHC) is the main management office of our future health care system. Control of the costs and wastes are its primary job. The BHC would establish and manage a comprehensive database utilizing the existing NPI (National Provider Identification) number system, with complete, up-to-date information on every eligible provider. This data includes everything from hospital information and patient management to individual practitioner information, such as referral requests, orders for expensive imaging studies or procedures, drug prescription patterns, service billing codes, frequency of service and admissions etc. Providers will receive the periodical evaluation reports from the BHC that clearly indicate their standing point on the standard statistical curves. This feedback mechanism would help individual providers correct their mistakes and improve their performance. Every provider is subject to audit by the BHC, especially those providers who are not in the average range of the standard curve. The standardization of request forms of patient’s referrals, laboratory tests and imaging studies, etc., on the NPI number system would be critical for efficient utilization purposes.
g. We should establish Councils of the Arbitration at a federal level with regional offices. The councils will consist of members from different interest groups representing government or layman, professional or non-professional, unions or non-unions. Its functions will include all the aspects of our healthcare system, such as peer reviews, public hearings, determination of the regional free profiles, decision of subjects which the insurances are covered, legal conflicts, contract disputes etc.
3. Discussions
a. Because the out-patient care coverage plan is voluntary, supplemental and optional, healthy individuals aged 18 to 45, since they would already carry the basic health care coverage (hospitalization care ─ in-patient care coverage), might decide not to buy the out-patient care plans, even though they will pay for annual check up, some emergency or urgent illness out-of-pocket. This would save a significant amount on health care expenses.
b. Child obesity in the United States is at about 25% to 34%, depending on different racial groups. This group of youngsters will most likely developed Metabolic Syndrome (obesity plus hypertension, high lipids, and insulin resistant diabetes mellitus) in the future. To take care of these illnesses and its complications are enormously expensive. Most parents only bring their children to see a doctor for immunizations and to address acute symptoms. Parents must be educated to take a more precautionary stance with their children’s well-being. The proposed Medicare part C plan would provide limited out-patient care for children. Pediatricians and other medical personnel would be able to provide guidance and care, making early diagnoses and treating the child, correcting visual or auditory disorders and helping children in learning. This should help children grow up healthily and reduce child obesity.
c. Recently CNN news reports indicated the health care insurance companies have already spent nearly $400 million on lobbying, TV ads and political donations to influence the debate. The health care insurance industry pays some of the highest average salaries to their managements. They hire outside companies for precertifying tests and prescription drugs or procedures ordered. Insurance companies also post assessors at doctors’ offices and expect full unlimited access to private patient’s records. These expenses make absolutely no contribution to the quality and availability of healthcare for our citizens. Health insurance companies have essentially replaced the State Professional Licensing Department to do the credential work. They say this is protecting their policy holders, but actually they are eliminating or selecting who has the right to practice. What is the State government doing? Is this the insurance company cleverly using the policyholder’s money to control everybody? Are the insurance companies trying to maneuver, to control or to use the medical professional without paying one penny for their long year’s education and training (at least 23 years for a practicing MD)? The healthcare practitioner has already passed the stiff requirements and tests to be qualified to practice, let the State Licensing Department do the job, and let the Bureau of Health Care (BUC), if any, to conduct the work.
d. The recently proposed government subsidized health care plan is going to be rather difficult to implement. If the subsidiary portions are not large enough, then a lot of peoples are still going to be left uncovered. But if we are going to pay close to a trillion dollars to expand the Medicaid coverage or similar plans that would lead to insurmountable problems. Not only the government is unable to afford it, also it will let us feel like we are living in the society of unfairness and a lack of trust. “Using your money to pay my insurance” is worse than socialism; it is a practice of communism! This plan should be held as a last resource until the private insurance companies are unable to hold down the healthcare costs in the future.
Based on June 2008 Charity Navigator’s Metro Market Charitable Analysis Study, the program expenses of the charity organizations of major 30 cities in the US was 78.4% - 85.5% of their total revenue. That means only about 15.5% -21.6% of the donated money goes to recipients. Will you choose the charity organization or non-profit group to manage the healthcare business?
e. For all those people who are unable or not willing to buy health insurance and to charge them an “excise tax” is definitely “a penalty” because it is not universal and is not equal. The auto insurance is different from health care insurance, because auto accidents always involve to other people’s injuries, life, and damages to other persons’ or public properties that should be protected and reinforced by the law. The setting of people’s annual income range and to charge them with a penalty or health care tax is not incentive. Instead, that will cut down the productivities and people will always find the loopholes to avoid it or move away to other countries to totally eliminate it.
III. The Cost Controls:
The cost reduction and control of our existing health care system are important issues for successful reform. This is everybody’s responsibility and we may expect some sacrifices from everyone:
1. Control drug costs:
a. We should pass a law for generic drugs to require the drug manufacturers to prove the drugs are of the same quality control and specificity of the brand named drugs, otherwise the manufacturers are responsible for its fraudulent charges or criminal conducts. This would improve the credibility and perception about generics drugs and increase usage. The name of generic drug manufacturers and the drug expiration date should be shown on the drug labels.
b. There is no reason for us to pay the large percentage of more money to buy the drugs than Canadians do. From the CNN news reports we also learned that the drug companies paid 80 million dollars of campaign contributions to the special group of our Washington representatives. Is this one of the reason our drugs are more expensive? Has anyone tried to cut the drug price in the United States? We should demand that our government do something about it.
c. For past several years the insurance policyholders have been advised or limited to mailing out the prescriptions to the named drug company, which is possibly insurance company related, to dispense their drug. Because of this policy, many small pharmacies have closed their doors. The health care insurance companies should have same payment as all the pharmacies for the drugs prescribed to ensure free competition.
d. We should reduce the sky high prices of the new drugs. When the drug manufacturer applies for an approval of a new drug from the FDA, the processes may be divided into two parts: the manufacturing part and the other is price determination. While the manufacturing part is approved and the patent obtained, then the manufacturer shall submit the suggested price of the new drug (accompanied with the comparable price of the drug from other countries if it is available) to the Federal Council of the Arbitration. After the settlement price of the drug has been achieved, then the final approval of the new drug from FDA will be granted.
e. The new combination of established existing drugs (such as blood pressure medicine plus water pill or lowering cholesterol agents) or changing the drug release mechanism (such as extendedly released pill) should not be counted as the new drugs and should not be granted the patent.
2. The price of laboratory tests also increased significantly. We may use the AMA
suggested panels or profiles for different systems or diseases, and extended them to all the other systems, then charge it as a package fee. That will save a significant amount of costs.
3. If there is a shortage of funds in our Medicare program, we may consider raising the enrolling year of the Medicare program to 67 years of age, but there should be no change for the year required in obtaining the other social security benefits. We may cut down or stop funding the secondary benefits or luxury items, such as senior day care program conducted by nursing homes, excess-a-ride service, home aid program, using the electric operation luxury medical equipments, etc.
4. Medicaid funds are in a state of serious shortage in most of the states of the United States today. Recently, Governor Paterson of New York made a statement that if current expenditure trends continue, Medicaid expenses would reach to 41% of total annual budget of New York State in the next decade. Therefore we should seriously consider reducing this expenditure.
We may adapt the guideline from Canadians, to determine “the true poverty line” or other better policies to change the existing fact of “it is too easy to get it in the US.” The biannual or periodical field inspections, case re-evaluation and re-
determination are required.
5. Disability expenses are enormous, once the determination of disability is made as our tax payers are responsible for their expenses of health cares and welfare benefits for the rest of their lives. Therefore the determination process is crucial and important. With the exception of short term disability, personal doctors should not make determinations or inferences to the determination because it is difficult for the doctor to refuse to make a favorable command for their own patient. The Division of Disability Determinations of States should provide their own office of medical examination or should be assigned to a major medical center to do the job. The diagnosis of the disease is important for the determination, but the current functional levels should be the key factors in making the decision. A so called “permanent disability” is still required to have the periodical re-evaluation.
6. To change an important issue of the immigration law for persons who obtained the legal status through the reason of “family gathering and supports.” The U.S. government should issue a “special visa” ( but not a green card ) for this group of people to stay with their families so long as the sponsoring family member is able to provide the annual sponsorship documents for them. This group of people usually come to the United States with empty hands and are instantly eligible for our welfare and free health care programs which makes America become a so called “retirement heaven.” This is unfair! So with this little change of law we may save a lot of Medicare and Medicaid.
7. In our health care reform one important item is the malpractice issue that disturbs
our medical community so deeply and effects the health care in a costly manner. The litigation of medical malpractice is the most lucrative one. Some attorneys may think if they have won one or two cases that it is enough for them to go on vacation for the rest of the year. There are so many cases and so easy to file for malpractice that it has driven the premium of malpractice insurance to a sky-high level and this has directly affected our medical costs. One of my colleagues made a comment, “When we take care of the patients, we have to watch every word what we say or write and every step that we take. The work that we are doing seems to be a most dangerous one!” This is so sad and too bad, the profession of trying to save lives and to ease peoples’ pain and suffering has now become “the most dangerous job.” We have tried numerous times to ask for change in the law, however, no progress or change has been achieved. Is it because many of our lawmakers are the members of the BAR? Is this the time for our government, AMA, and our people to do some change about it now?
The Following suggestions could be very helpful:
a. All litigations are filed, at first, should be submitted to the Regional Council of the Arbitration for reviewing and determination and with the time scheduled, the case should be made with the decision of whether it should be dismissed, settled or referred to the court. This is a screen procedure and a time limited process. It will save a lot of time and expenses.
b. If the case is in court and the jury found it is in favor of the plaintiff then the sentences or rewards should be decided by the judge in charge of the case, not by the jury.
c. If the plaintiff’s side loses the case, they should be responsible for the fee and cost of the court, the defender’s attorney’s fee and its related expenses.
8. Prevention is a major factor in the reduction of our medical expenses. Our daily recommended calorie intakes say that about one third of calories come from carbohydrates (starches). However, in our modern life, average people are not active enough, we do not use our muscles that much, and therefore the amounts of carbohydrates consumed are always in excess of what we need. Besides high fat foods and lack of exercise, too much carbohydrates are another major cause that induces obesity. Therefore we should change our daily carbohydrate intake recommendation to the public − from 33% to individual needs of 5% to 25% (this schedule works very effectively for my patients). Large scale scientific studies are still needed. Then the percentage of the people who developed metabolic syndrome will be significantly reduced and save our health care costs.
9. Another subject of prevention is our current seasonal flu immunization program that follows the recommendation of the CDC to choose three kinds of viruses to produce the vaccine. Most other countries in the world by the same year period also select the same kinds of viruses. In this case these three viruses are definitely prohibited during the years the vaccine is effective. But other than this we are not protected from hundreds of different kinds of viruses. The recent out break of H1N1 flu is an example. Therefore we should change our tactics to use the Zone Protection Programs in different places of the world. If three zone plans are chosen and each zone has the vaccine covering three kinds of viruses, then we are protected from nine different kinds of viruses. If this change happens we are not going to get “the cold” that often.
IV. Conclusion:
The so called “health care reform” actually targets the private health care insurance companies. To protect the big business and huge profits, it is understandable that the insurance companies donate the biggest campaign contributions to our Washington’s lawmakers and to fight the different public opinions at each level of our country. But to let our life and death issues be handled by business, that is fundamentally wrong. As a human being, while people are very sick we are supposed to give them the sympathy, support and care if we can, however insurance company sees it as a business “loss.” Is it not humane? Is it the time for private insurance companies to keep some hands off? Since the private health insurance companies are the major campaign contributors or sponsors to our Washington lawmakers, now let them vote on the issue to oppose to their sponsors. Is it a conflict of interest? Has our political system been compromised?
The health care matter is so important and it affects everybody’s daily lives, our future, and the financial stability of our country. It seems to me that it is more important than the presidential election, therefore a general public referendum or voting on this issue is necessary and appropriate. After a public voting we can then ask our representatives who is representing our district, according to the result, to cast the final vote in Washington for us. Hopefully it can happen!
This fundamental healthcare reform proposes to have our existing private healthcare insurance companies stay in place, and is adapting the workable public administrative system from other leading industrial countries. These two systems accommodate and support each other to create a totally new system in the world to feasibly meet our “American Way.” This proposal from the theoretical points to its workable details are all thoughtfully discussed and explained. It is suitable for our current situation, meets our needs and challenges and it will achieve the first goal of the healthcare reform of “it is affordable and everybody will have one”. And this plan could be the best solution that we may have!
Basic healthcare coverage of the hospitalization care plan is a taxpayer paid self supporting and sufficient system; it provides us a safety blanket and security for living. Our existing private healthcare insurance companies provided out-patient healthcare plans are optional and supplemental. Because of its reducing coverage and services (without in-patient cares) and cutting their operating expenses as suggested, it should be much less costly and more affordable. Medicare part B and Medicaid out-patient care programs remain unchanged. The proposed new Medicare part C plan for our children, is also mainly a self supportive plan, which allows our healthcare program start from early childhood and to help our children grow up healthy. With a little investment put in now we will receive huge rewards in the future. It is so important and is a good program that should have overwhelming public support.
The cost reduction measurements for our existing programs which are proposed in the second part of this article are righteous, proper, and suitable and will save a lot of money for us.
Regarding our unsettled healthcare issues, the entire world is now watching our lawmakers and peoples who are fighting each other in our capitals, town halls and street demonstrations. They are interested to see how we swallow “this very big and hard pill.” With this new plan and our people’s wisdom and courage, I am sure that we will resolve and conquer this difficult issue and have a good feasible healthcare system for us in the future. To quote President John F. Kennedy: “Ask not what your country can do for you, ask what you can do for your country”. Yes! For the healthcare reform we have to try our best to help our country and make some sacrifices if necessary, but our healthcare expenses have reached 16% of our total annual GDP (about 2.3 trillions dollars) and soon will be up to 20%, that is too large for our people or the private insurance companies to handle. This is a crucial time when our government must live up to its motto: “for the people!” May God bless America! Thank you!
