Doyle proposes $10M to expand use of electronic medical records

This will be interesting to discuss at the CIO/CEO conference, and especially the WTN Healthcare Technology Conference.

Physician acceptance and other change management issues can also be significant barriers to a successful EMR implementation; clinical processes must also be addressed.

We need a universal, single-payer, national health care system, that is actuarially advance funded using The Entry Age Normal Cost Actuarial Cost Method (EANC ACM)--and then:

1. Set up a pc based national database system that provides up to date information on best practices on every disease and illness; and on local physician and hospital/clinic price and quality information for same, and

2. That measures every aspect of health care plan design to make suitable adjustments to that design.

Plan design is not the horse that drives the cart of low and stable health care cost, although it is very important in the long run to be sure.

Good medical plan design is a forever thing - a good guess to start off with, and then make adjustments downstream as better information becomes available and, importantly, as the healthcare system itself changes due to better technology and thinking, and often adapts, sadly too often to try and take advantage of third party payments.

In other words, you cannot do good design first and there is no sense in trying to spend all your time trying to do it, because tomorrow it will all be different anyway. So set up the proper foundation - that first sentence has it - and then work on the rest.

And by all means get rid of the 2000 + health insurance companies as they are a large part of the problem.

The cost savings from eliminating this enormous duplication and waste will be more than $300 billion per year. This is enough to cover the 47 million uninsured and actuarially advance fund both healthcare and Social Security, with money left over.

On the other hand they might be useful in an ASO (Administrative-Services-Only) context, as well as putting them in competition with one another and with Medicare too, to put out ideas on that design and on removal of fraud and advantage taking so that the government (which must be in control of this system), does not let bureaucracy seep into the system and control it.

I began my career as an actuary in the life and health care field - 12 to 15 years, before I became a pension consulting actuary - and I have known how to fix Social Security since 1964 and health care for several decades now.

While the former is not a crisis as Bush says, it is a real problem since only Bill Clinton in Washington ever said how to fix it (and he got it from me in mid-1998) but still easily fixed by making it a real defined benefit system, instead of the Potemkin Village one it is now.

You do this by replacing the Partial PayGo way of financing it—which gets far too little investment returns to help pay the benefits (with the same method needed for that national health care system) and also by adding strong laws with teeth to protect the assets and the past service accrued benefits from being cutback.

These two major components are missing in action.

It is interesting to note that they were put into defined benefit pension laws for private industry in 1974, but because of laws in them that entire system is near collapse. See my PS for more information.

This type of advance funding and this type of collective system will enable enough money to be invested long-term in stocks so that the returns on the whole portfolio will pay for more than two of every three dollars, once the initial unfunded past service accrued benefit liability is paid off.

It will also stabilize the costs as a percentage of pay and at low levels - maybe under 3 percent of pay - and determine the right cost so that the design of the system can improved.

The former is essential because every developed nation on earth is getting older due to increased life expectancy and fewer births, both good things for the planet but deadly for PayGo systems like Social Security and Medicare. And every undeveloped nation will in time also, according to a recent UN report.

When national demographics make nations older, there are fewer workers to every retiree (or older person) and this makes PayGo’s problems obvious.

Also, when you get older you consume far more healthcare, making actuarial advance funding the only way to level these costs and lower them adequately.

The latter, the Entry Age Normal Cost, is necessary because you cannot design a sound affordable system, Social Security or healthcare, without knowing what it is and what the long-term cost of the system is.

Any questions you may post here or simply e-mail me, andyclang@comcast.net.

I am Andy Lang and I am the only one in the world who known how to fix these systems and is willing to say it publicly.

Sadly, other actuaries are too busy screwing people out of defined benefit pensions and pushing privatization of both Social Security and Medicare.

PS. AAF was invented by some great mathematicians in the 18th century — the forerunner of the actuarial profession — was used extensively for level premium cash value whole life insurance until that industry got much too greedy, migrated to the pension industry in the 1920s, added stock investing in the 1950s and then morphed into the EANC ACM by the '80s when the system began its collapse.

Mike Milken first began to exploit the flaws in pension laws in the 80s and many pension actuaries then helped him do it.

However, before Milken, the initial actuaries that exploited these flaws in 1974 were fake actuaries, life insurance agents in disguise (members of ASPA, The American Society of Pension Actuaries) enrolled by the government to perform the specialized calculations in annual required actuarial valuations, who used their new powers to set up major league tax shelters for rich owners, like wealthy doctors and dentists.

When numerous laws were then passed to try and contain their obvious excesses, these laws succeeded instead in beginning the process of destroying the larger DB pension plans and then, ironically, the real accredited actuaries, instead of fixing those laws (and also in calling attention to these phonies in the first place), helped Milken exploit them for the big bucks.

As Kurt Vonnegut might say, so it goes, but we can stop it if you want to. Do you want to?