where is all this money coming into play from and who will be footing the bill on this as it continues on? doesn't this mean that i am paying more taxes out to support this program as it grows? i thought we were a country of choice and freedom, not regulation and reform, i feel we are turning into a third world country who are being led by dictatorship, the big brother syndrom. this program doesn't work, take a look at europe, they have this system set into place or had it and it is difficult, you do not receive quality care, you have to go to who you are assigned to, no deviation, specialty treatment, now there's a concept, what will it take an act of god to receive once we are put onto regulated care. you state that we have a voice, but once an individual starts to voice his/her opinion they are shut up, especially when the now government feels that we are out of line and should not be questioning such issues.

All federal legislators:

We the undersigned implore you to read this petition in its entirety and take the recommended steps to bring medicare (the likely candidate for "single payer") up to acceptable, equitable, and humane standards so that when we do overhaul our health-care re-imbursement system we do not lose our dedicated providers.

Medicare is classified an "entitlement" program; but every quarter it continues to add cuts, restrictions, and new "administrative guidelines" causing the "entitled" (the patient and the presumably well-to-do practitioners/doctors) to bear the burden of costs for supplementation, deductibles, restrictions, and cuts.

In many "single-payer" models the practitioner is employed by the "one-payer," beholden to the rules, laws of the payer (government in most cases). Practitioners are on the front-lines, and most innovation is born from these 1:1 encounters. That innovation in the current oppressive state of medicare would suffocate, limiting innovation to researchers. However, in our current reimbursement model practitioners are also disgusted and struggling. So, stuck between a rock and a hard place; universal health care would sound like the reasonable solution. But make it such that a reasonable healthcare provider and a reasonable patient would feel that the sacred patient/provider relationship is of paramount importance in the delivery of healthcare; confident that medical needs will be met and providers will be paid the wages that will keep them entering the profession, energized to continue caring, and lessen the overall and currently excessive administrative load of all offices.

TO DO THIS: Medicare or the "Single Payer" must:
1. Eliminate the "Fiscal Intermediary" (FI) — a For Profit middle man contracted by medicare to manage the distribution of payments. EX: (Trailblazers a subsidiary of Blue-Cross/Shield, Noridian, Mutual of Omaha, Empire Medicare Services, and more). The reasons: a. "entitlement programs" shouldn't be losing benefits to administrative overhead and profitable administrative subcontractors. b. more excuses for delayed, lost, denied, partially paid claims due to administrative error or gaps between MC/FI. c. Scapegoatism from either side avoiding accountability and leaving patient and providers seemingly powerless to get what is rightfully theirs (quality care and payment for services). OR MEDICARE SHOULD Step aside if the single payer option is not the answer, and let the for-profit insurance agencies run the entire show, therefore eliminating a federal government agency as the single payer in all 50 states with 50 different sets of insurance laws, with the following conditions: (a). Insurance premiums may increase no more than inflation and that increase may only occur once annually. (b). The insurance companies own administrative costs must be equal to or less than the percentages of those required of 501-C3's (c). There is no "pre-existing" disqualification. (d). Benefits are transferable and life-long. These are the same stipulations placed on insurance companies bidding for participation with the Office of Personnel Management: http://www.opm.gov/insure/health/index.asp
EITHER WAY the following continued changes should take place:
2. ACCOUNTABILITY: Medicare or the payer system must be accountable to their own rules.
3. TRANSPARENCY: Medicare's rules and their own compliance records must be public record, easily accessible, and regularly reported.
4. TIMELY: Medicare or the payer system must pay claims in full within thirty days of submission, or incur late fees and finance charges.
5. Information Technology and initial costs and costs of updates and training must be paid for by the "single payer" as far down as the smallest private practice office in downtown or rural America - equally. The IT system must be fairly uniform.
6. Restrictions to streamlining IT such as HIPPA must be revised.

7. SIMPLIFIED / COMPREHENDABLE / REALISTIC: Rules, laws, and administrative requirements imposed by medicare or whatever the payer system is must be completely re-approved by the public or a representative vote. Any new rules, laws, or administrative requirements must be limited to once every two years and public or representative vote. Examples: Just this week medicare proposed (I'm paraphrasing from a reliable medical publication) that doctors and hospitals be paid together in one lump payment a pre-determined amount for a hospital stay depending on the admitting diagnosis. If a beneficiary has maximized benefits, but wants to pay cash for continued services, they may not do so because that provider is prohibited from arranging a cash-contract as long as he accepts medicare payments for services. For years there are certain provider types who, if they enroll once in medicare, are then unable to "opt-out" of medicare preventing them from ever working on a "cash contract" with a patient if they so choose. If a therapist billed for services provided in a public pool, there must be documentation that the entire pool is closed to just the therapist and the one patient. The extraneous and excessive dictates of medicare undermine each professional%u2019s practice act, integrity, and serve only to breed suspicion and contempt between patient and provider. The examples could fill hundreds of pages, and would baffle the ordinary citizen. These must be overhauled. Get rid of the waste, simplify things, streamline IT, and suspicious providers/patients should be easier to identify! Don%u2019t use the extremely few fraudulent or abusive providers as an excuse to make the remaining 99.9% of compliant and cooperative providers and patients pay.
8. ACCESSIBILITY: ALL licensed providers in rural and other demographically underserved areas must be able to qualify for the supplementation similar to Rural Health status — not just hospitals, doctors, or immunization clinics.

9. MANAGEABLE: Choices of insurance plans must be narrowed down to a realistic and manageable number (25 or less): EX: 400 Medicare Advantage plans reeks of deception.

This is a reasonable start that will put our healthcare delivery system on an even playing field with the rest of the world. We pay more for healthcare than almost any other nation, and we fair considerably worse than many in overall health, and are frighteningly close to some nations recently considered third world. Your dedication to this solution is appreciated and imperative for the overall health and prosperity of our country. We are losing providers, and patients and providers are bearing undue burden of a system rot with confusion.

Thank you for your action.

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