Health Care Blogs

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Americans' Future In One Plan
I know that most of you are busy to read my book. As I explained previously that Taman Health Plan (www.trafford.com) takes care of all the health care, Medicare, Medicaid and social security. It will threw away all bureaucracies out of window. Let me explain shortly how it works:
1- There will be no more health care insurance companies, no Medicare, Medicaid or Social Security. My plan will take care of all.
2- Basically will be only one Big Health care organization (Taman Health Plan or THP).
3- The center of the plan will be in Washington while the health departments in every state will be the branches.
4- One organized body will be taking care of the Health Care and long term care of all Americans replacing 1500 insurance companies, Medicare, Medicaid and Social Security.
5- This will allow us to provide a uniform service to all Americans every where in both inpatients, outpatients and long term care.
6- When you go to any Duncan Donuts branch your expectation is to have a fresh coffee and a donut with no long wait. We will try to provide a similar predictable service everywhere as Duncan Donuts. With having only one body will be able to do that.
7- The Capital of the plan will be the funds of Medicare and Social Security (before the bankruptcy of both systems). The maintenance will be a yearly tax from each of us (will replace our yearly social security and Medicare holding taxes). A percent of each of us go to his account cards and a percent go to THP itself. The money of the plan will be invested by the investing sector of the plan very likely in Wall Street.
8- We will have 5 ATM cards with a corresponding accounts. Card A (children), Card B (working group 18-65years old), Card C (Medicare card >65 years old), Card D (Medicaid card), Card E ( expensive medicines or investigations).We will have the health cards devoted to health care and long term care. Thus we will have: health cards, banks with accounts to each card and credit card machines in outpatients care and hotelling part of hospitals and nursing homes.
9- Cards will pay for the outpatient medical care including doctors, emergency room visits, investigations, medical supplies, pharmacies and the hotelling part of hospitals and nursing homes. While the medical part of hospitals and nursing homes will be budget by the plan itself.
10- In the first year of issuing cards: Card B and C (most of people) will have a bonus it could be a percent of their Medicare and social security withholding (70 % or so). We will try to be fair to every one but every one has to know that most of us already lost a lot of money with the HMO's. For next year new comers to card B at age of 18 when first issued will have a bonus of 50,000 dollars. It will change every year by a percent a according to inflation.
11- Every one of us will get a statement every one or two months of his card account. Card B account will phase in card C at the age of 65. If card C account is vanished Card D will be issued (hoteling part will be less luxurious). Only few of Card B will have card D if there account vanish most likely those with severe medical problems.
12- So basically most of us will have our own account Card B then card C. Say you are 45 and you have now in your account $ 200,000 you can take one or more years out of work, you Can retire early if you like and with your card you will control all the medical services and its prices.
13- With this card system we will end all bureaucracies of health care, Medicare and Medicaid. No one will stand between you and any medical or long term service (only your card). Shop around with you card, have early health care security and responsibility and invest in your health.
14- We will not need Social Security since after age of 65 we will be able to use our cards to stay in any nursing home each according to his account in card C or card D. So when you invest well in your health you will be able to enjoy a nicer nursing home when you get old (actually it will be also a kind of tourism).
15- The money in cards do not get inherited when we pass away but recycle in the plan to support the next generations.
16- The plan will have very positive effects not only in simplifying our care, save a lot of waste in health care, give early health care security and responsibility to Americans it will also have a positive effect on the economy, saving billions of dollars to Americans, creating jobs in health care and cutting outsourcing.
Very likely, you figure it out by now I could have sold the plan to one of the presidential candidates before the 2004 election for millions of dollars (they already spent 2 billion dollars). It is my gift to the American people (it will help the healing process of the two worlds America and the Muslim/Arabs).
Maged Taman.

Smelik v. Humana
San Antonio, Texas
July 1, 2005 verdict

This case is important because it challenged managed care not on the basis
of denial of care but for not doing what Humana’s own Member Handbook,
Physicians’ Administration Manual, and internal guidelines, policies and
procedures say Humana is supposed to do. The jury found that Humana did not apply Case Management to Joan Smelik as a process of identifying patients with “chronic or potentially catastrophic” diseases.

Case Management was also supposed to deal with patients with complex
diseases. Joan Smelik was a complex patient who according to Humana never
hit the “triggers” to qualify for case management. And Humana’s own
computer records for Mrs. Smelik showed that Humana knew of her diseases even down to the size of each of her small kidneys which were indicative of “chronic” disease. Still, Humana approved Vioxx after she had a documented episode of acute renal failure and paid for the exact same 3-drug toxic cocktail of prescription drugs that had put Mrs. Smelik into renal failure five months earlier. Mrs. Smelik died from complications of renal failure requiring emergency dialysis.

This case could have fallen under ERISA but did not because co-counsel did
not plead it as a denial of care case. They did plead it as a mismanaged
managed care case. That is why it gives hope to all those 130+ million HMO
enrollees who are under ERISA and believe that AETNA v Davila pre-empts
their ability to sue their HMO when HMOs don’t do the right thing by them.
Denial of care could be just of symptom of mismanaged care. In this (Smelik
v. Humana) case, counsel said: “Humana, your policies and procedures are
great on paper. What you didn’t do is do what you promised Joan Smelik you
said you were going to do for her.”

The appellate counsel, Renee McElhenny, is with Cox Smith Matthews, which is the largest law firm in San Antonio, and not traditionally known as a
plaintiff firm. This firm came on board about thirty days before trial
because they believed in the importance of the case and understood the
potential national implications of the case.

The judge, Honorary Renee Diaz, is a conservative Republican recently
appointed to the bench by Texas Governor Rick Perry. Diaz recognized the
importance of the case from the beginning by bringin! g in a larger than usual
jury venire panel, appointing two alternate jurors, and by allowing the
jurors to be paid the legal maximum per day -- $50. Judge Diaz comes from
most recently an insurance defense background prior to being appointed to
the bench.

And one last note of interest: The defense firm, Wilson, Elser, Moscowitz,
based in NYC, bills itself as the largest (pure) insurance defense firm in
the world.

Here is the contact information for interview consideration:

Jon Powell, JD
Office: 210-225-9300
Cell: 210-336-0330
Home: 210-408-8041

Brant S. Mittler, MD; JD
Office: 210-408-1189
Cell: 210-827-4246

John Smelik (Husband of Joan Smelik)
Tel: 830-885-2462

Health care" means preventative, diagnostic, therapeutic, rehabilitative, maintenance or palliative care, services, procedures or counseling, including appropriate assistance with disease or symptom management and maintenance, that affects an individual's physical, mental or behavioral condition, including individual cells or their components or genetic information, or affects the structure or function of the human body or any part of the human body

I think we need to be planning to control, monitor and regularize health care process.