John Russell for U.S. Congress

I acknowledge here the influence of former Presidential Candidate John Edwards plan to re-design how America cares for its citizens. I do this because just like many others believed, John Edwards plan was the best plan among all of the candidates vying for the Democratic nomination. As a health care professinal, I still believe that to be the case. As a candidate for Congress in 2008, I promised to advocate for a National Health Care Plan that incorporated many if not all of the characteristics embodied in the Edwards Plan. Mr. Edwards proposal represented the architecture of a plan that would function as a "pathway" to a National Single Payer Health Care Plan. Excerpts from the Edwards Plan apear below as well as a link to the archived website of John Edwards.

The American health care system is broken. There are 47 million Americans who lack health insurance, and 18,000 people die every year as a result. Health care costs are skyrocketing and premiums are up 90 percent since 2000. Even families with insurance are often unprotected from catastrophic events when insurers fight legitimate claims, impose coverage caps, and seek excuses to revoke coverage when its needed most. Half of families entering bankruptcy are driven there by high medical costs. Many people who have health insurance are "underinsured" and postpone needed health care because of their meager coverage. [Census Bureau, 2007; IOM, 2002; KFF, 2006; Warren et. al., 2005; Consumer Reports, 2007]

As a former North Carolina Senator and Presidential Candidate, John Edwards championed the Patients' Bill of Rights to fight managed care and insurance company abuses. Now more than ever, the health insurance industry needs to be kept honest. While companies have an obligation to treat their customers with fairness and dignity, too often companies put their own profits and executive pay first. On his campaign website, Edwards outlined his plan to make sure that families with insurance have the health care safety net they pay for and need.

Insurance Industry Abuses: The current health care system is broken, often letting down even families with insurance. The abusive behavior of insurance companies includes:

* Designing confusing forms and procedures that make it very difficult for patients to claim the benefits they deserve and forcing patients to hire paperwork consultants. [Pryor et. al, 2007; NY Times, 10/13/2005]

* Using complex and unfair rules to cancel insurance policies after people get sick, despite accepting past payments. California regulators fined one insurer, Blue Cross of California, $1 million for violating state rules and abusively canceling insurance policies from 2004 to 2006. Another insurer, Health Net, paid bonuses based upon the number of patients whose policies were canceled for technicalities. [Pryor et. al, 2007; Sacramento Bee, 8/29/2007; LA Times, 3/28/3006 and 11/9/2007]

* Wrongly denying medical treatment needed to live and covered by insurance. [Wall St. Journal, 11/16/2007]

* Charging patients more for "out-of-network" doctors at "in-network" hospitals, leading patients to unwittingly incur thousands of dollars in bills despite trying to follow the rules.

* Creating procedural barriers and paperwork that keep doctors from providing needed care.

Lack of Competition: In 299 of 313 markets recently surveyed, one health plan controls at least 30 percent of the market for health maintenance organizations and preferred provider organizations. In the last 12 years, the Department of Justice has only challenged two of more than 400 insurance company mergers. There is a merger pending in Nevada that would put 80 percent of the state's HMO market in the hands of one insurance company. High levels of market consolidation raises concerns that the insurance market may not be competitive, hurting the health care system. [AMA, 2007; Velazquez, 2007]

Huge Levels of Executive Pay: As premiums skyrocket and some patients are denied care they need, insurance company CEOs are often paid tens of millions of dollars a year. In 2006, it was reported that the CEO of one of the world's largest insurers, UnitedHealth Group, had been awarded an astonishing $1.1 billion in stock options, enough to cover roughly 750,000 uninsured children with health insurance for one year. [AFL-CIO, 2007; NY Times, 10/16/2006]
Fighting for Families' Rights to Basic Insurance

John Edwards has fought special interest groups his entire career and knows that we need a health care system that works for everyone. His health plan will reform the health insurance industry to help us all get the insurance we need. Today, he proposed new laws to prevent abuses, stronger enforcement of insurance rules, and more competition and choice in insurance markets. Americans will no longer be on their own against insurance companies.

* Insurance that Is Always There: John Edwards will stop insurance industry "rescissions," the practice of dropping individuals from insurance for technical reasons after they need their coverage. Edwards will pass a guaranteed issue law requiring insurance companies to sell insurance to everyone, regardless of their preexisting conditions, and preventing from denying coverage after a condition develops.
* A Fair Price for Good Insurance: Today, insurance companies will charge certain occupations and individuals with preexisting conditions more for insurance, such as police officers, firefighters, and construction workers. Edwards will put a stop to this practice, requiring community rating so that all people have access to insurance at a fair price.
* Ensure that Premiums Help Patients: Enacting health care reform to expand insurance to all families also requires establishing new rules so insurance companies cannot continue charging hardworking families excessive premiums, while pocketing the savings. Edwards will require insurers to spend at least 85 percent of their premiums on patient care as several states already do. The plan will force insurers to cut wasteful spending and pass savings on to families and employers.
* Empower Consumers: John Edwards will remove the mystery in what insurance companies cover. New "truth-in-insuring" rules will require insurance companies to be transparent and honest about what they will ultimately cover. The rules will set standards on explaining private insurance products and understandable medical bills.
* Guaranteed Comprehensive Benefits: Some states mandate that insurance companies must provide benefits like preventive care to children and screening tests like mammograms. Some insurance companies leave out these common-sense procedures. Under the Edwards plan, every American will have comprehensive benefits including preventive care and important tests.
* Creating a Bill of Rights for Patients and Providers: Now more than ever, Americans need a Patients' Bill of Rights for insurance and managed care companies. In 2001, John Edwards fought for the original Bill of Rights, which passed the Senate but was eventually blocked by insurance company lobbyists. As president, Edwards will help create an updated Bill of Rights to solidify the protections discussed in 2001 and reflect today's need to reform insurance companies' practices.

It is also time to protect doctors and hospitals from insurance company abuses. By making it difficult for health care providers to collect on their claims, insurance companies make it difficult for patients to get the care they need. Complex forms, long hold times on the phone, and inappropriate denials of payment for needed treatments are just some of the insurance company tactics. Edwards will develop strict rules for insurance companies that will make it easier for doctors and hospitals to get paid for and deliver needed care.
Stronger Enforcement:

* Maintaining Accountability: All Americans need and deserve a strong line of protection against insurance companies. Edwards will revolutionize the individual and small group insurance markets with his new Health Care Markets, which will negotiate plans and carefully enforce protections for families. Edwards will also ask the Department of Justice and work with states to oversee insurance markets.
* Create an Advocate for Patients: In California, when a patient has a dispute with a managed care company, the state reviews the case to make sure the company acted within the law. Every patient deserves an advocate when he or she needs it. Edwards will look to models like California's and build a national resource for regular people to get the help they need in negotiating with for insurance companies and HMOs. Edwards will also establish a medical home for Americans with chronic diseases, giving patients a primary care doctor who can advocate against insurance companies for needed care.

More Competition

* Stop Insurance Company Monopolies: Edwards will apply rigorous standards and block mergers that could hurt consumers, doctors and hospitals. He will direct the U.S. Department of Justice to conduct an immediate and comprehensive review of the health insurance market and make recommendations on how to ensure a competitive market. Where monopolies already exist, he would break them up to ensure competition. He will also revisit the insurance company exception to the nation's antitrust laws.

* New Competition for Private Insurers: The Edwards plan creates new choices for American families. The new Health Care Markets will be available to everyone who does not get comparable insurance from their jobs or a public program and to employers who choose to join rather than offer their own insurance plans. Families and individuals will choose the plan that works best for them. The markets will include a new public plan similar to Medicare.

The markets will include a new public plan similar to Medicare. In this Public Option Plan people could choose between continuing with their employer based or private insurance plan or choose to enroll in the public "Medicare for All" option.

In this plan, people of any age could enroll in Medicare paying a "premium" based on their ability to pay. The "premium" would be progressive according to income but with a maximum cap that would ensure for example that someone such as Warren Buffett would not pay any more for his premium than Donald Trump. I envision this plan at a minimum to be at least 40% less expensive than any comparable private insurance alternative due to inherent efficiencies associated with eliminating insurance company costs on many levels.

Medicare's current and projected financial outlook is less than optimal without some adjustment to its financial mechanism. Currently, the demographic that describes Medicare's population of enrollees is largely composed of people who on the whole are greater than average utilizers of health care services. The new Medicare as I envision it will prosper as my plan broadens the natural composition of the population to include younger people who are on average minimal users of health care services. These new younger enrollees will however through their premiums will be dramatically strengthening the fiscal status of Medicare while simultaneously being the momentum for single payer universally accessible health care in this country.

For those who unable to pay, their status as non-paying patients will change. They will be enrolled in the "Medicare for All" public fund as a matter of course as subsidized patients as far as their Medicare premiums are concerned, but fully paying patients from the perspective of providers and facilities that provide health care services. No longer will providers be asked to bear the burden of financing those who are unable to pay.

Often an inequitably distributed burden, the care of the poor is most often concentrated disproportionately in large urban tertiary care centers. If each patient is a paying patient as my plan envisions, then the distribution of care provided for those of meager means will be more evenly distributed by institution and more convenient for the patient. Increased patient convenience no matter their individual socio-economic status should result in improved patient compliance with treatment plans as well as preventative care and education.

The Plan must be comprehensive including basic dental, prescription coverage as well as long-term care and home health. A comprehensive effort targeted at improving the health of the American people will reward both patients and care providers for reaching individual benchmarks such as weight loss, smoking cessation, diabetes prevention/management and control of blood pressure.

Every health care provider knows that preventative care is the "Ticket" to improved health care outcomes. America today ranks not #1 according to World Health Organization Statistics but 37th! Improved outcomes through improved patient education and compliance with issues such as weight loss, diabetes prevention/management, smoking cessation and blood pressure will decrease major risk factors for morbidity/mortality, and will help America to climb up the ladder to improved quality and length of life for all Americans.

A healthier America it can be shown will be a more productive America and with the cost burden of a grossly inefficient means of financing and organizing health care lifted from the back of our economy, a more competitive and prosperous America will be our reward.

It is reliably anticipated that enough people will choose the public plan, that the US will then evolve towards a single-payer plan IF our elected officials allow such a plan to be approved. This IS the reason WHY the major health insurers are fighting tooth and nail against the Public Health Care Financing Option i.e., Single Payer. In the event that proponents of a National Single Payer Plan prevail, the predictable result will be that private insurers will face new rules and competitive pressures to hold down their costs and deliver better coverage. Could it be that private corporate insurers would rather NOT have to compete with a Public Health Care Financing Option?

If enough people choose the public plan, then the US will evolve towards a single-payer plan.

As a result, private insurers will face new rules and competitive pressures to hold down their costs and deliver better coverage.

As a health care professional who has observed in the delivery of health care services many of the problems specifically outlined in John Edwards discussion, I have concluded that the most efficient way for America to extricate itself from the legalistic tentacles of the private insurance industry as it pertains to the financing of health care services, is to advocate for a plan such as this. While in 2006 I did advocate for HR676 the process of transitioning to it would be far more laborious and fraught with peril as the private insurance lobby fought its emergence.

In John Edwards plan the mere fact that its implementation arises via a market competitive model, immediately defuses much of the opposition's thunder, while public acceptance of the model will in the end determine its fate. It is imperative that as a nation we decide whether or not we are going to place as a priority the care of ALL of our people. As a Congressman from the Fifth Congressional District of Florida, I will! Case managers at the hospital where I work have told me that the volume of "Self Pay" patients has increased dramatically as the economy has declined. Not surprising as I heard similar concerns from a group of real estate professionals who in a down economy were finding it difficult to make their health care premiums every month.

There is an impact on all concerned as providers are not reimbursed for their services, and patients that delay treatment until finally presenting to the Emergency Room with what is often a much more serious illness; that might have been more inexpensively and expeditiously treated had the patient requested treatment sooner. Patients delay treatment very often because of fear of the $BILLS that follow a trip to the hospital or doctor. Episodes of chest pain may be cast aside for weeks until finally a BIGGER chest pain that cannot be ignored and does not ... go away strikes. I have seen this myself and time IS as they say ... "Heart Muscle." So the patient may survive but with significant disability relating to what is now a very badly damaged heart. Removing this fear of $Cost will pay dividends in avoiding the costly disability that is so very common. Preventative care that incorporates patient education on a broad scale for issues that encompass for example diabetes, smoking and weight control can pay our society tremendous dividends as well.

Insurance companies are in business to make money. Nothing wrong with that except for the fact of how they make their money. Insurance companies make money through health insurance in several ways, none of which are particularly beneficial to the consumer. The more complex the insurance instrument as John Edwards plan outlines in some detail, the more room there is for shenanigans that basically leaves the insuree high and dry without insurance or with a big hole in his/her pocket. Money is made by the insurer by either denying coverage or pricing coverage rediculously high or denying or delaying payment to providers. This IS our current system. A plan similar to the one offered by John Edwards should be the health care system that we as Americans strive to achieve as its successor... and soon!