How a state could opt out of the Federal Health Care Reform law

and implement its own plan.

The Federal Government has said that a state can opt out of the Health Care Reform
(the Patient Protection and Affordable Care Act.)
passed in 2010 and the Federal Government will help the state do it.

For a state to Opt Out, it's plan must meet the following criteria

1-Must cover as many people as the Federal plan. (Almost everyone)
2-The coverage must be at least as comprehensive as the Federal plan. (Good quality care)
3-It must not be more expensive than the Federal plan (Control costs)

How can a state do it?
Answer: This way

A- Increase the number of, and License Nurse Practitioners to practice under limited supervision.

B- Allow payments to providers for patient home visits using IP cameras, and other
 innovative services.
Some patients would not have to come to the office but seen at home with the use
 of IP cameras.
Use of the Internet whenever possible (like patients making their own appointments
 on the web)
These are examples of ways providers could innovate and compete for patients once
 they know they will be compensated regardless of how they provide services people want.

C- Subsidize HMOs so they can have and control their own E.R.
be able to have their own main specialties on salary or capitation
(Obstetrics/Gynecologists, Cardiologists, Orthopedic Surgeons, Ophthalmologists, General Surgeon)

In recent years HMOs have acquired a rather bad reputation. Close supervision of the HMOs
by the government(Fed or State)is therefore a must, if HMOs are to regain the public's trust.
All financial incentives to providers to ration care must be outlawed. And HMOs must be liable
for malpractice (this may require a change in the present laws)as are physicians and hospitals.

D- Supervision of health care practices using software (Reviewing outcomes,
reviewing the use of standard services like pap smears and colonoscopies)
in order to prevent rationing.

E- Use of surveys of patient's satisfaction. Also, undercover law enforcement agents posed as
straw patients (Used successfully by government agencies in other industries)

The keys of this Health Care Plan are

1- Curtailing duplication and eliminating unnecessary services (About 50% of all services provided
 are not medically necessary and are done only because of a financial motive, fear of malpractice
  or because of provider ignorance)

2- Increasing competition among providers.

3- Increasing efficiency in the provision of health care services

4- Quality control (Using software)

5- Adopt reasonable liability laws.

At the heart of this proposal is the promotion of paying physicians a salary or capitation.
Why: Because the conflict of interest inherent in the fees for service system (FFSS)
can not be significantly curtailed.

The conflict of interest of the salary or capitation systems to ration care can be significantly
curtailed by eliminating economic incentives to providers to ration care and by the other
measures described above (D and E)

An example of an HMO who has control over the E.R as well as specialists and hospital and pays
physicians a salary is the JacksonHealth system in Miami, FL.
They have started to implement some software and Internet features similar to those mentioned.

The states can do all this. They have the power and the resources needed to implement.