Monday, August 3, 2009

RTRP: CommentaramaCare Summarized and Priced

Last week we finalized the CommentaramaCare proposal. At the time, we posted both the final piece, reforming the way we pay for health care, and the conclusion. Several people have told us since then, that the conclusion got lost in being published on the same day. So today, we repost the conclusion to CommentaramaCare, which summarizes the proposal and puts a price tag on it.

The United States health care system is broken. It costs too much and achieves too little, its costs are out of control, not enough people have access to insurance, and it suffers from poor quality control. CommentaramaCare fixes each of these problems: it cuts costs dramatically, it expands coverage to 22 million people -- while still saving the taxpayer $245.7 billion, and it improves the quality of care.

Problem One: Cost Control

The primary problem with the American system is that it costs too much. The American system now eats up $2.26 trillion a year, and it is growing by the second. This problem is the result of (1) a payment system that has little incentive to control costs, (2) a regulatory scheme that generates excessive administrative costs, (3) the prescription of a vast number of medically unnecessary procedures/tests, and (4) an intrusive tort system. CommentaramaCare proposes the following solutions:
1. Fixing The Payment System
Under the current insurance system, buyers of health care (patients) do not negotiate the price of services directly with the sellers (doctors). This interferes with the parties’ incentives to keep costs under control. To solve this, CommentaramaCare proposes making health insurance more like car insurance or home owners insurance, where individuals make routine payments out of their own pockets and then use the insurance only as a form of quasi-catastrophic protection. This quasi-catastrophic coverage would kick in after a person had spent $5,000 on health care during the year, and would cover all remaining health care costs that person experiences during the year.

This change would give patients the incentive to keep costs down for most procedures, as they seek to avoid spending the first $5,000. At the same time, this system protects people from being bankrupted by serious illness. This system also should slightly reduce the insurance cost borne by the average American -- even before considering any specific cost savings that result under the plan.

To assist buyers in pricing their health care, CommentaramaCare requires providers to make available to any patient or potential patient, in advance, a price list for all procedures that they offer, so that potential patients can compare providers and seek competition. It also requires providers to use joint billing for individual procedures.

CommentaramaCare further proposes freeing providers to arrange their business and billing practices in more innovative ways, such as the fixed-price arrangement discussed previously.

Potential savings: Unknown
2. Eliminating Excessive Administrative Costs
According to Harvard Medical School, 31% of health care spending goes to pay administrative/overhead costs (this is nearly double the 16% percent spent in Canada). A reduction to even Canadian levels would save Americans $339 billion annually.

The primary reason administrative costs are so high in our system is that health care is regulated at the state level. Thus, every administrative function is repeated fifty or more times, often with different rules. Complicating this, the federal government provides health care through a half dozen agencies, each with their own bureaucracies, requirements, and rules -- many of which are enforced through state budgets.

To fix this, CommentaramaCare proposes:
• Removing states entirely from this process by replacing state regulation with one, consistent federal regulatory scheme to be organized under a Federal Medical Board (“FMB”). This will eliminate fifty state agencies.

• Allowing the FMB to issue licenses that are valid nationwide, so that providers can move freely and need only satisfy one regulator.

• Eliminating the half dozen agencies in Washington that control different (and overlapping) parts of the health care system and replacing them with one single agency and set of regulations, controlled by the Health Care Administration (“HCA”).
The potential cost savings from these changes could be as high as $339 billion.

Further, rather than trying to develop separate insurance plans for recipients of government-sponsored insurance (i.e. those currently on Medicare/Medicaid, etc.), the government would instead buy those persons the commercial catastrophic insurance, as discussed, and would subsidize some portion of the $5,000 deductible. Even assuming that the full $5,000 is provided for each recipient, this could save the government $3,700 for each of the 81 million current recipients, for a total potential cost savings to the taxpayer of $299.7 billion.

Potential savings: $339 billion
Potential savings to the taxpayer: $299.7 billion
3. Reducing Medically Unnecessary Procedures
It is estimated that $500-$700 billion is spent annually on treatments, tests, or hospitalizations that do nothing to improve health. Studies have shown the best ways to reduce these costs are to (1) change the billing method, (2) improve knowledge of the standards of care, and (3) establish effective tort control. Thus, CommentaramaCare proposes:
• Changing billing methods as outline above, which should reinvigorate the incentive for patients to control costs;

• Allowing the introduction of more fixed-price services (or other plans);

• Improving knowledge of the standards of care by having the FMB establish standards of care and disseminate them, and allowing doctors to use those as “legal safe harbors”;

Reducing the filing of meritless lawsuits by (1) requiring all medical malpractice actions to be brought in federal court; (2) requiring plaintiffs to obtain certificates of merit before filing, and (3) shifting fees to the prevailing party; and

Reducing outrageous jury awards by (1) eliminating punitive damage awards and (2) capping awards for non-economic harm at one million dollars.
Potential Savings: $500-700 billion
4. Tort Reform
It is estimated that an additional $11.3 billion can be saved in malpractice insurance premiums through the introduction of effective tort reform.

Potential Savings: $11.3 billion
** Certain problems are not addressed specifically at this time, including (1) medical innovation costs, (2) drug costs, and (3) long-term care costs. It is unclear to what extent the realignment of cost reduction incentives will influence those items. Thus, further reform may be needed after these effects can be evaluated.

Problem Two: Improving Access To Health Care Coverage

The second group of problems with our health care system are related to access to health insurance. Not only is there the issue of the “46 million” uninsured, but there are issues related to illegal aliens, uninsurable persons, and the problem that loss of employment currently also means loss of health care. CommentaramaCare proposes the following solutions:
1. The “46 Million Uninsured”
Of the 46 million uninsured, only 7.3 million persons fall into the category of those who cannot obtain insurance due to lack of income. Assuming the projected cost of $7,400 per person, providing these people with fully paid insurance and income subsidies (in other words -- no cost to them) would cost $54 billion dollars per year.

Projected Cost to Taxpayer: $54 billion
Additional People Covered: 7.3 million
2. Illegal Aliens
Another 9.7 million of the 46 million uninsured are non-citizens, whose health care expenses should be paid for by their country of origin. Only the federal government has the power to stem the flow of illegal immigration and to deal with foreign governments. Thus, CommentaramaCare proposes (1) that the federal government fully reimburse providers for the costs of providing such care, and (2) that the federal government seek to charge the home countries for the costs incurred.

Projected Savings: Unknown (should zero out)
Additional People Covered: 9.7 million
3. The Uninsurable
Another 5 million of those without insurance are considered uninsurable because of pre-existing conditions. CommentaramaCare solves this problem by requiring bidders on the HCA insurance contracts to accept all persons who apply, at the same fixed price, without regard to pre-existing conditions, and by prohibiting such insurers from terminating individuals who experience high medical costs.

Projected Cost to Taxpayer: $0
Additional People Covered: 5 million
4. The Link Between Loss Of Employment And Loss Of Health Care
Currently, 59.3% of Americans receive their health insurance coverage through an employer. The unemployment rate is 9.5% and growing. Moreover, the composition of the 9.5% changes every day. Thus, vast numbers of Americans are at risk of losing their insurance because they face the prospects of becoming unemployed. To solve this problem, CommentaramaCare proposes to break the link between employment and health care by:
• Making health care premiums tax deductible to the individual, but not the employer;

• Allowing the creation of HSAs wherein individuals can save unused deductible costs, which should eventually build up to cover future deductibles;

• Ensuring that the HCA plans are available to any person at any time, without regard to employment; and

• Continuing government subsidies for low-income and unemployed persons to obtain health insurance coverage.
This method should ensure that anyone can get access to such insurance, regardless of employment status.

Problem Three: Improving Quality Control

Finally, the current system exposes patients to an amazingly high risk of under-treatment and over-treatment, and results in an incredible number of preventable medical injuries. The existing mechanisms for monitoring quality control are simply inadequate.

According to a study by Dartmouth’s Institute for Health, patients had just a 50% chance of receiving the right treatment for common ailments. Other studies have shown that between $500-$700 billion in medically unnecessary tests or procedures were ordered in 2007, that nearly 200,000 avoidable hospital deaths occur each year, and that another 1.5 million preventable drug-related injuries occur each year. The costs of treating injuries resulting from preventable medical error could be as high as $520 billion per year.

At the core of each of these findings was the conclusion that the lack of clear national standards, and the fact that many doctors lack adequate information about the standards of care, were the direct cause of the majority of these failures.

CommentaramaCare proposes the following solution:
• Federalizing the oversight/regulation of the entire health care profession (doctors, nurses, psychologists, therapists, hospitals, etc.) under the FMB;

• Making the FMB responsible for licensing medical providers as well as investigating complaints against medical providers and disciplining those where necessary;

• Making the FMB responsible for issuing national standards of care, which the FMB would disseminate to doctors in the field -- the FMB also would issue best practices guidelines and would regulate continuing legal education requirements; and

• Reversing the legal changes that allowed hospitals to avoid liability for the actions of doctors who practice at the hospital, to encourage hospitals to conduct thorough oversight.
Projected Savings: Up to $520 billion


As outline above and as explained in greater detail in the prior posts on this topic, CommentaramaCare has the potential to dramatically improve each of the three main problem areas in the current health care system. Moreover, it does so without stripping patients, doctors or insurers of their freedoms -- in fact, each group is freed from considerable amounts of regulation.

Under CommentaramaCare, an additional 22 million people would be able to obtain health care. Yet, taxpayers should be able to save $245.7 billion, even as coverage is expanded.

The country as a whole should benefit as well. It is difficult to determine exactly what the potential savings would be, as many of the $1.3 trillion potential savings identified above likely involve duplicate costs. Still, it is clear that dramatic savings could be achieved. Also, a reduction on the order of one trillion dollars is not as outlandish as it sounds. That would reduce the amount Americans send on health care to between 9% and 10% of GNP, which would put us in line with the amounts spent by other Western countries.

If Washington wants a plan that works, here it is.



LawHawkSF said...

Andrew: You obviously don't know what you're talking about. First of all, how can the issue of the millennium even be considered in less than a thousand pages? Second, what kind of idiot actually expects someone to read a proposal before accepting it? Third, what kind of plan uses private businesses and private doctors to fund and run a plan which actually requires government intervention into everything down to our toenails?

A plan this coherent, this logical, this mathematically-sound, which actually increases access to better doctors and better treatment while cutting the government bureaucrats out of the day-to-day operations and not bankrupting the nation must be fatally flawed. I'm going to call ACORN right now to report you. Or maybe I'll just call the mental health cops.

AndrewPrice said...

Lawhawk, LOL! I'm glad you hate it. Call your Congressman, tell them you don't want them to do this. . . maybe that will get them to pass it?

Seriously, I think the numbers are stunning. Even if these reforms end up only working half as well as estimated, the change would be dramatic.

MegaTroll said...

Andrew, this has been a great series and a great plan. Both of today's articles were really good, and I really like the plan. It makes sense.

I hope somebody in Congress is paying attention.

You guys are doing great work, keep it up!

LawHawkSF said...

Andrew: I'm a bottom-line kinda guy. I can see all the mathematical savings inherent in your plan, and I see nothing but red ink resulting in terrible medical care in the Pelosi plan. Once again their answer comes down as always to throwing money at a problem, creating an even greater problem which can only be solved by, guess what, throwing even more money at it. At least the Obama/Pelosi plan has one thing going for it--it will spend more money for worse results than Johnson's war on poverty.

I hope everyone follows your suggestion and talks to everyone they know while sending copies of your articles to their elected representatives.

CrispyRice said...

Brilliant. I'm looking for a giant "RESET" button so we can wipe the system clean and implement CommentaramaCare. ;)

Seriously, I'm will absolutely forward this to my congressmen and all the talk radio guys I listen to.

AndrewPrice said...

Thanks CrispyRice, tell your friends too! The more people who start to see alternative solutions like this, the better for all of us.

I like that. . . a reset button! :-)

Tennessee Jed said...

A lot of thought and effort went into this, and I certainly commend you for this series. You are a good man, Andrew; one who rises so far above the level of most bloggerss, it is uncanny. Of course, no system is perfect, and there are plenty of pitfalls that won't run as smoothly as anticipated. That is the law of unintended consequence. And yes, no matter what system is in place, there will be room for politics and unscrupulous people to take advantage. Nor can you be expected to accurately predict the cost breakout.

However,even if only part of the cost savings are remedied, it would be a great improvement over what we have now. And almost any thinking person agrees, we do need some sort of reform that attacks real costs. As you know, I am a strong advocate of minimizing government involvement. They should never be a provider, but there is a place for government as regulator and your plan adresses it. The Price Plan, a.k.a. Commenterama Care deserves strong consideration since it out performs any of the existing plans being floated in Congress right now. Well done, my man!

AndrewPrice said...


Thanks! I'm really happy that you approve. :-)

I was waiting to hear what you thought, particularly with your experience in the insurance industry.

I think you sum it very well. It is impossible to predict accurately exactly how any reform will work. But I think these are sound, and they seem to work in other fields. And, because of the huge potential, even a partial improvement on these lines could be extraordinary.

Plus, I think that what this reform has, which all the others lack, is that (despite the federalization), it really does free up the system to let the millions of Americans make these decisions -- and history has shown that they're a pretty smart group when they put their heads to something. I trust the public at large long before I trust a group of bureaucrats.

I hope that people in DC consider this proposal, though right now they seem to be stuck on repeating the same old plans.

If you like the plan, let me again encourage anyone and everyone to contact your friends, your Congress people, etc. All it takes is for a couple of them to wake up and maybe we can make the country a little better?

Hottie said...

I don't agree with this health care reform at all.

I don't see how they are going to fund it without taxing more. And who will be taxed? The middle class. - me, my parents, my friends, HARD WORKING citizens who are already being taxed like crazy.

And when, in our recent history, have we EVER seen the government be responsible with our tax dollars? Our education system sucks, and that's government regulated. And teachers get paid crap. Whose to say the doctors won't too? And so now we will get crappy doctors to go along with our crappy teachers. Good doctors won't be able to get paid more, and crappy doctors will be paid just as much. A competitive system keeps things in check. Leveling everything out will screw us all.

Obama is making a lot of HUGE financial mistakes, and this health care is one of them. I mean all those billions of dollars to the car industry and greedy ass banks? Please! Obama should have used that to help students pay off their student loans, help people prevent foreclosures, or even paid all the slutty men and women to get themselves castrated so they can stop dumping kids into foster care and welfare that everyone else ends up paying to raise.

And the government will not help the greedy expensive cost system of today's healthcare, because they themselves are greedy bastards. It's going to dump us into tons of debt, that they will just run from when they are finally held accountable.

It's the "have now, everyone deserves happiness, pay later" mind set that has really gotten our country in such a crappy state. It's a sad truth, but not everyone deserves happiness, prosperity, or healthcare. And I only think that because I know there are a lot of lazy ass free loaders that I just waiting for this thing to pass so they can take advantage of my hard earned money.

I do NOT want to pay for someone else's health care if they can't keep a job, if they didn't keep at school, if they are slutty, fat, smoking idiots. Those are the ones that are blowing up our health care costs.

And this gives the government WAY too much control. Instead of privatized health companies (that you can pick and chose from and keep the competition up), the government will be able to decide for us. And I don't like that.

It will turn people into profit and product instead of individuals.

Don't tell me those congressman aren't out to just get their own slice of wealth at our expense.

Because that's bullshit.

Hottie said...

and on a second note, I think some of our politicians really are trying to fix some stuff, and I encourage that...

But I don't think this reform is what we need.

There must be some other options, but socializing our government is not the way to do it.

Other countries have socialized health care and their sick wait in lines for ever to see doctors (who don't entirely give a shit because the government controls them).

AndrewPrice said...

Hottie, this isn't the Obama plan. We've already critiqued the Obama/Pelosi plan here and here.

The plan above does not create a government option, nor does it limit private insurance in any way.

P.S. Please try to keep the language a little clear.

LawHawkSF said...

Hottie: Anyone who has been following our blogsite since its inception knows that nobody has a more intense dislike for big government than I. Andrew's plan is a prescription for the federal government to exercise one of its few legitimate Constitutional domestic powers (regulation of interstate commerce) to REDUCE government interference in the delivery of medical care and REDUCE the costs of providing that care.

I suggest that you re-read the proposal, and note that in each instance where the federal government is expected to become involved, it is to remove power over health care from federal hands and restore it to the doctors, the states, and the market. What federal intervention there is is for the purpose of making medical care competitive by taking out the incentives for government funding and federal control. Instead of being "the boss," the federal government becomes "the referee." And all at huge savings to health care consumers and the restoral to doctors of the ability to practice medicine instead of defensive accounting.

ScottDS said...

I actually referred Hottie to this article. She's a friend from improv class who posted something about healthcare on Facebook so I replied with a link to this site. Perhaps I should've been a little clearer with regards to what you guys are up to. :-)

AndrewPrice said...

Damn you Scott. . . we'll get you for this!!! Just kidding. I think she probably assumed this was the Obama plan. Or maybe she really hated it? Who knows...

Speaking of which, what do you think Scott?

StanH said...

Your suggestions Andrew are solid lets hope those in Washington seek a free market solution and perhaps your suggestions will be listened to, as it stands today the Marxist are set on a massive power grab. Have you seen the hell that’s being raised at the politicians town hall meetings, great stuff. I believe 2010 is going to be most interesting.

Hottie said...

Okay then... Insert foot in mouth.

So firstly, I apologise for misunderstanding what this was. I kind of came into it with my guns blazing. I told Scott I should have cooled for I posted my comment. So sorry. And for the record, I don't consider ass a curse word because it's in the Bible, or shit because I'm from the south. But I promise this explanation will be the last of my uses on your blog. My bad.

Secondly, I apologise for not reading this through all the way. I admit I kind of "skimmed" assuming it was Obama's plan. But as in my first apology, I was fired up. Which kind of makes me an idiot. But I'm not. And I hope I prove that by allowing myself the obligation of admitting when I made an oops.

Thirdly, I will reread this....rather, actually read this and post thoughts later.

Politics are just recently becoming something I'm paying attention to more thoroughly. And I apparently have some ettiquette to learn. :-p

ScottDS said...

Andrew -

"Speaking of which, what do you think Scott?"

This is like the part in Trading Places when someone asks Eddie Murphy, "What do you think, Valentine?" and the music cuts out as everyone in the restaurant turns to face him. :-)

Well... considering I'm not an expert (and not insured but I could be), I have to say it sounds very nice, at least in theory. Like one of the posters above said, you never know until you put it into practice. I'm all for more QC (as should everyone) and competition. The idea of making health insurance like car insurance sounds interesting and I like the idea of getting a price list in advance. If my analogy is correct, it would be like choosing a cell phone provider...? And the best part is, I am the ONLY ONE who would be choosing it.

I can see the whole "federalize it" idea being an issue but, like you said in a previous post, it simply means bringing everything up to one uniform standard (assuming I understood that correctly).

That's all for now. I'm actually flying to Houston tomorrow for my NASA physical. I've applied to participate in a NASA study and, even though there is no guarantee I get in, I still have to get a physical. Imagine... uninsured and I get the fanciest physical known to man! All I had to pay for was the flight. :-)

CrispyRice said...

Hi Hottie - I'm fairly new to getting all riled up about politics myself. Luckily, the Commentarama folks seem very kind to us political newbies. :D

I just received an e-mail about the health care vote from my local House Rep (Doug Lamborn from Colorado and one of the few conservatives there) and he wrote -

"We cannot let the guise of a compromise overshadow the fact that I believe it will do nothing but damage the health of millions of American families, not to mention the fiscal health of our nation. Despite so-called compromises, nothing has changed the fundamental dynamic of this bill, it still includes:

- Taxes on individuals who cannot afford health coverage—or do not purchase “bureaucrat-approved” plans;

- 53 new boards, commissions, programs, and bureaucracies created in the bill as introduced;

- Harmful cuts to Medicare Advantage plans that would cause millions of seniors to lose their current coverage;

- New government price controls throughout the health care sector; and

- Determination of required health benefits by a board of federal bureaucrats—which would likely result in federal taxpayer funding of abortion coverage.

Rest assured I will continue to fight for free-market health care reform."

I'm trying to get him to read CommentaramaCare, I really am!!

AndrewPrice said...

Scott, NASA? Good luck!! Seriously! That sounds really cool.

But don't let them shoot you off to Mars are anything (they haven't worked out the bugs yet), or turn you into a big green monster.

And if you get to go to the moon or something like that, . . . then you've got to wear a Commentarama t-shirt! (We'll supply it!) ;-)

P.S. Your summary of the plan is basically correct. Even though some of it sounds like more regulation, the idea is to reduce regulation. How Zen...

AndrewPrice said...

Hottie, Don't worry about it, happens to us all -- especially with the jokers in DC running around right now trying to hand our health care system over to the government. A lot of people are very angry about that.

Stan, what is going on at the town hall meetings is fantastic. Nothing scares a Congressman more than the prospects of having to go home and meet an angry mob.

CrispyRice, I like Lamborn a lot, he's a good guy.

ScottDS said...

Andrew - thanks. Zen indeed!

As for NASA, I don't want to derail this thread so I'll leave all that for a future open thread. In the meantime, check this out for more info at your leisure:

BevfromNYC said...

Welcome Hottie! Where are you from "from the south"! I am always looking for Southern brethren and sisthren...

ScottDS: You are living my NASA dream! Good Luck!

CrispyRice: At least you get responses from your reps. I get junk mail...

Monica said...

I'm all for CommentaramaCare - it actually makes sense. As someone who recently declared bankruptcy, in large part due to medical bills, I'm all for a decent insurance solution and more doctor accountability. (Not to mention the thought of paying for anyone illegal really makes me angry.)

Writer X said...

Andrew, thanks again for all the work you put into putting this series together. It's so incredibly informative. I've forwarded it to so many people, including my AZ Representative, Harry Mitchell. I believe that I may now be on Janet Napolitano's watch list, given how many times I've tried to contact Mitchell. To no avail, by the way. Apparently he doesn't have time for his constituents, especially his Republican ones.

Anyway, if you hear about a Phoenix writer taken away in handcuffs to a super-secret government location, it's probably me. Send help.

AndrewPrice said...

Scott, I'm not sure if I should wish you good luck now or not. That looks kind of brutal. Well, I guess somebody's got to do it. Good luck man.

Monica, I'm glad you like it. I think this would make for a pretty good policy, and I think it would have a much better chance of preventing what happened to you than anything they are doing in Congress right now.

Writer X, Thanks! :-) We'll break you out... er, we'll use our legal accumen to get you the freedom that you so richly deserve!

Seriously, thanks for forwarding it. I hope the Republicans start proposing a true alternative plan, not just the Democrat-lite plan that they are currently offering.

Hottie said...

BevfromNYC- I'm from Milton, Florida. Which basically is south Alabama. I grew up about 30 minutes from the beach, and 30 minutes from the Alabama/Florida state line. Which means you will likely see rednecks with camo bathing suits or actually... just wearing see-through underwear they got from walmart (true story... it was disgusting).

What about you?

USS Ben USN (Ret) said...

That is an excellent plan, Andrew!
And the best parts are it doesn't FORCE anyone and it doesn't destroy any of our liberties.

I can only think of one thing to add, which is a money saving idea that works but it's not used by all hospitals, due to the current status quo.

That is emergency services. ER visits are expensive by necessity.
I think most folks realize that and understand, for the most part, why it's so expensive.

One thing that adds to ER costs is folks who show up who don't need emergency care. Especially if they can't pay for the services.

These are the people with the colds, low level fevers, sore throats, ear aches, small cuts, headaches, minor coughing, minor sunburn, tooth aches, sore muscles, and some of the most ridiculous complaints you can imagine (and some you can't).

I observed this while working in an ER for a few years.
The docs and nurses always complained because they hafta spend time triaging the patients that don't need emergency care and eventually treating them to the extent they can (there STILL is no cure for colds. Amazing how many folks still believe that somehow an ER doc can somehow cure their cold).

Some do realize it, but they go simply because it's "free" for them, and they can get the same meds they can buy at Walmart to relieve symptoms, only it costs more because of the venue.
And they don't hafta wait until usual working hours to go to some clinic.
All this stems from the "I have a right" and "it's free" attitude.

These people don't generally appreciate the "free" care, and some don't care that it impedes emergency care to those that really need it, and will even complain they hafta wait so long.
Much the same as many of our reps and senators who want Obama's healthscare plan (and who make sure they won't be required to usee it).

But regardless, ER docs are forced to give these jerks free medical care.

Some hospitals have come up with the great idea to have a seperate medical clinic to handle these
non-emergency ailments, and iot's a lot less expensive to operate, because they can use PA's, NP's and RN's to treat these non-emergencies.

Not only that but it frees up the ER staff to treat the real emergencies, opens up more beds and waiting room chairs, and helps to lower the costs of the ER.

Anyway, I think it would be a good idea for all hospitals to do this.
Also, if the doc, PA or NP prescribe something they could recommend Walgreens, K Mart, Walmart,
etc., to lower the costs of the meds rather than using the hospital
pharmacy, if possible.

I'll be sending your plan to my reps and senators, Andrew. Very sensible ideas!

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