ERISAclaim.com

 

"Failure of Imagination"
Order FAQ & Disclaimer Copyright New Partners Discussion

 

USHealthcareCrisis.com

Seminar Schedules in IL NC, PA, VA, OH, SD, Teleconference

 
What's New
ERISA or PPO
ERISA & Your Money
ERISA & Your Insanity
New Appeal Dept
Seminars
Appeal Book & Systems
On-site Education
Certification Program
ERISA, Who?
Rx for GM Health Crisis
ERISA for Hospitals
Medical Device Makers
CMS New Appeal Rules
Executive Brainstorming
"Failure of Imagination"
U.S. Healthcare Crisis Rx
Employers, Insurers, TPA's
Integrated Systems
ERISA 1-2-3
ERISA Demystified
Medicare & ERISA
HSA & ERISA
ERISA Criminal Enforcement
Consulting Service
Claim Recovery
Appeal Networks
950,000 MD's & ERISA
Medical Claim Denials
"Overpayment" Refund
Prompt Pay Crisis & Rx
Downcoding & Bundling
Pre-existing Cond. Denial
DOL Final Rules
DOL New Guidance
Court Watch
Company Info
Contact Us
 
 

Advertisement

 

Moukawsher & Walsh, LLC
Pension and Employee Benefit Law

Benefitlawyers.com

 
 

Pomerantz Haudek Block Grossman & Gross LLP ("PHBG&G")

ERISA and Healthcare-Related Class Actions

SPD's for FEHB

FEHB Open Season and FSA Open Season

 

Federal Employees Health Benefit Plan

 

Federal Employees Health Benefits Program
-
FEHB Plan Brochures

 

Links to Plan Brochures for 2003

 

Links to Plan Brochures for 2004

 

Links to the FEHB Open Season for 2005 Brochures

 

 

Federal Employees Health Benefits Program

FEHB HANDBOOK

 

 

Icon
TRICARE Handbook


Icon
TRICARE Manuals

 

SPD's for NJ State

NJ STATE
HEALTH BENEFITS PROGRAM

SUMMARY PROGRAM DESCRIPTION (SPD)
for employees and retirees

January 2003 (pdf)

 
 
 

U.S. Healthcare Crisis Turnaround?

U.S. A.

Drs. & Hospitals Employers

$1.0 Trillion / Year

$$$ ERISA $$$

50% Savings

The Only Company with Compliant Solutions for All of You

"Failure of Imagination" Again?

 

 

THE 9/11 COMMISSION REPORT (pdf)

Congress Finds No Simple Solutions to Current Pension Problems (The Washington Post; one-time registration required)

 

NASA identifies foam flaw that killed astronauts (Reuters)

 

Jin Zhou Identifies "ERISA Failure" That Killed U.S. Healthcare

 

Health-Care 9/11 Report of 2005

Health-care WMD

 

by Jin Zhou, 02/05/2005

© 2005, Jin Zhou, ERISAclaim.com

Unanimous US Supreme Court: Employer-Sponsored Health-Care Is Completely Governed by ERISA laws and rules; Aetna Health Inc. v. Davila, 06/21/04
Congressional Leaders: One Administration = One Voice = ERISA Self Enforcement only, or No Enforcement?
Health-care Terrorists?

"ERISA Advantage" bogus plans, "unlimited and frequent premium increases, and the potential for rampant fraud with little, if any, regulatory recourse" in 30 years of ERISA self enforcement.

Health-care WMD (Weapons of Mass Destruction)

"Medical Inflation,  WMD" for "ERISA Advantage" from ERISA Failure - "Failure of Imagination" Again for US Healthcare:

USA: $1.9 Trillion, 15.7% of GDP

GM:  $5.6 Billion, $1,500 Per Car

Economists: Federal deficit a bigger risk than terrorism (USA Today)

"The survey, taken between Feb. 28 and March 8, found U.S. businesses had three nearly equal concerns about longer-term risks: health care, the aging population and the federal deficit."

USA 2005:
  1. Personal Bankruptcy

  2. GM Chapter 11,

  3. National healthcare expenditure $$1,9 trillion

  4. One nation under debt

  5. GAO Report: Tax Expenditures Represent a Substantial Federal Commitment and Need to Be Reexamined (PDF) (U.S. Government Accountability Office) Abstract Highlights-PDF PDF 

White House Rx:

 $1,000 HSA personal responsibility + AHP with More "ERISA advantage" for "widespread plan insolvencies and fraud" and "A Prescription For Disaster".

2005 for Michael Moore? "John Q. ERISA Enforcement"???
Congressional conclusion 2008:

"Failure of Imagination" Again, with No One's Responsibility and Accountability.

 

 

Unanimous US Supreme Court Ruling

In US Health Care Crisis

by Jin Zhou, 02/11/2005

© 2005, Jin Zhou, ERISAclaim.com


Managed-Care Nightmares?

Health-Care Crisis without True Solutions?

 

What Does an Unanimous US Supreme Court Say?

 

On June 21, 2004, an unanimous US Supreme Court ruled that claim processing and denials of benefits under the employer-sponsored health plans, ERISA-regulated benefit plans, for both self-insured and fully-insured (through purchase of insurance) health plans, are completely governed by federal law ERISA, that supersedes and invalidates state laws.

 

How Can Anyone in USA, from Congress to General Motor to the White House, from Industry Experts to Patient Advocates, Solve US Health Care Crisis without Even Thinking of ERISA?


"Failure of Imagination" As a Nation Is the Real Tragedy

 

ERISAclaim.com - Supreme Court Managed Care ERISA Watch

 

Unanimous US Supreme Court Ruling In US Health Care Crisis

 

Aetna Health Inc. v. Davila

06/21/04

Opinion of the Court

 

"Held: Respondents’ state causes of action fall within ERISA§502(a)(1)(B), and are therefore completely pre-empted by ERISA §502 and removable to federal court. Pp. 4–20."

 

"We hold that respondents’ causes of action, brought to remedy only the denial of benefits under ERISA-regulated benefit plans, fall within the scope of, and are completely pre-empted by, ERISA §502(a)(1)(B), and thus removable to federal district court. The judgment of the Court of Appeals is reversed, and the cases are remanded for further proceedings consistent with this opinion.7 It is so ordered."

 

 

 

"Failure of Imagination" Again?
(Copyright © 2004 by Jin Zhou,  ERISAclaim.com)

08/20/2004


"Failure of Imagination" Again Led to

U.S. Health-Care Disaster,

"Labor Market Impotence",

"Pension Anemia/Failure",

New Economy Recession &

"John Q. ERISA Enforcement"

in 2006 for

"Failure of Imagination" As a Result of Political Viagra

 

"ERISA FAILUR"  = "FOAM FLAW"

"ERISAflation": The combination of ERISA preemption, medical inflation, tax incentive protection and cost shifting to preserve inflated health-care coverage and to stabilize short-term premiums, and to ignore long-term health-care, labor market, pension and social security disasters.  -- Jin Zhou, 10/11/2004.

Kydland and Prescott win Nobel economics prize ((Reuters)
(Mon 11 October, 2004)

"Their 1977 article on the "time consistency problem" showed that policy makers tend to abandon longer-term aims to milk shorter-term benefits -- for example, setting out to keep prices stable, but then fomenting inflation to reduce debt."

 

 

U.S. HMO 9/11

"John Q. ERISA Enforcement"

in 2006 for

(Copyright © 2004 by Jin Zhou,  ERISAclaim.com)

10/08/2004

 


John Q.: My son is dying, no one seemed to care.

 

HMO Hospital: We are sorry, your insurance won't cover the care, it was determined not necessary, besides, the heart surgeon you "kidnapped" last time has been out on strike for medical malpractice tort reform.

 

The Employer: We have just switched to a new HSA consumer driven plan.

 

HMO Insurance: If we let your son live, that will increase healthcare costs, HMO premiums and more uninsured.

 

Supreme Court: All nine of us read ERISA last night, and found Davila guilty, it's up to Congress.

 

The President: I'm the only one to protect you, but ERISA is tough, I must take it back.

 

Congress: Patient's Bill Of Rights (+R) + Medical Malpractice Tort Reform (-R) = Ground Zero (0), Adjourned.

 

John Q.: HMO and Congress under new management, put my son on donor's list and no one gets hurt or ....

 

John Q.'s Neighbors and Co-workers: John, we are with you....

 

 

ERISA Failure Syndrome

U.S. Healthcare Crisis Trilogy

(Copyright © 2004 by Jin Zhou,  ERISAclaim.com)

 

ERISA
Medical Killing
ERISA
Medical Inflation
ERISA
Insurance Robbery
"Health Insurance Challenges: Buyer Beware" 3-3-04
Hearing, Senate Committee on Finance

Read Making a Killing

?

 

?

Bar graph showing trends in hospital charges and revenues in California from 1995-2002

?

 

?

GAO-04-312

?
 

?

American Job ExportING!

Mass layoffs up in January 2004

Weirton Steel cancels 10,000

GM: $67.5 billion in 2003

One Nation under Debt: U..S. economy threatened by aging of America

 

Healthcare Disaster at Fault Verdict Index:

U.S. Government 30%

U.S. Employers & Insurers 30%

Healthcare Providers 30%

Consumers 10%

(ERISA Failure + Managed-Care) Destroyed US Healthcare
(ERISA Failure + Managed-Care + HSA) Invite US Federal Budget Deficit & Social Security Disasters = 100X 9/11 Attacks

 

GAO: Current and Emerging Fiscal and Retirement Security Challenges, American Benefits Council/MetLife Conference, Washington, DC, on January 14, 2005

 

  1. Rising Health care Costs Have Many Implications (Direct)

  2. Rising Healthcare Costs Have Many Implications (Indirect)

 

Rx-1  $$$$$$$$$ERISA"Health Insurance Challenges: Buyer Beware" 3-3-04
Hearing, Senate Committee on Finance
$$$$$$$$$$  Rx-2

 

The Root of U. S. Healthcare Crisis

Jin Zhou, ERISAclaim.com

 

The Hearing at Senate Committee on Finance on 3-3-04, [View Video "Health Insurance Challenges: Buyer Beware" 3-3-04
Hearing, Senate Committee on Finance
or Transcript (PDF) (KaiserNetwork.org)]  revealed the mechanism, nature and extent of ERISA failure and nonenforcement as the reasons for "Growth in Bogus Health Insurance Plans Targeting Desperate Small Business Owners", as being concluded as "No the results are not good. It’s a tragedy." by Ann Combs, assistant secretary of DOL. The mechanism, nature and extent of ERISA failure and nonenforcement as presented at the Hearing are universally true and applicable to all health care claim denials and delays in managed care environment from all employer sponsored health plans as the root of U. S. healthcare crisis.

 

This is a 911 call on "healthcare 9/11 disaster"!

THE 9/11 COMMISSION REPORT (pdf)

 

 

"Failure of Imagination" Again?
(Copyright © 2004 by Jin Zhou,  ERISAclaim.com)

 

 

EFS-- ERISA FAILURE SYNDROME--Fatality: 31 YOA

Rx-1  $$$$$$$$$ERISA"Health Insurance Challenges: Buyer Beware" 3-3-04
Hearing, Senate Committee on Finance
$$$$$$$$$$  Rx-2

 

ASO+HMO+PPO-SPD=$1.8 Trillion/Y US Healthcare Crisis

 

ERISA+SPD-HMO-PPO-ASO=50% Savings

 

ERISA Failure, Noncompliance and Nonenforcement of ERISA SPD and Claims Procedure Rules, Is the Damaged or Missing Foam on U.S. Healthcare Wings!

HMO Crisis Is Really An ERISA Crisis!

HMO & PPO Managed Care Contracting to 
Disregard & Substitute
ERISA SPD & Claims Procedure
Is
The Primary & Inevitable Cause of Medical Inflation

Costly Managed Care & Medical Malpractice Lawsuits
American Job Export!

 

ERISA Failure Damages Are Greater Than
9/11 and Pearl Harbor Tragedies Combined

U.S. Health-care Crisis & ERISA Criminal Enforcement

 

(ERISA Failure + Managed-Care) Destroyed US Healthcare
(ERISA Failure + Managed-Care + HSA) Invite US Federal Budget Deficit & Social Security Disasters = 100X 9/11 Attacks

AHP +HSA + Managed Care =

Winning Battle, But Losing War on Medical Inflation

 

Only practical solution is to cut the skyrocketing healthcare care costs and increase the healthcare coverage and benefits at the same time without having to go to Congress to reinvent another new "Mars Project" or "Universal Uninsured Bill of Right" - "John Q. ERISA Enforcement".

 

Zhou's Medical Inflation Projection Through 2008:

$1,000 Deductible (HDHP / HSA) + $1,500 Discount (HHS / Indigence)
[Deductible + UCR + PPO Disc.] 
"Discretionary Spending" + "Price Gouging"
 500% Medical Inflation in 5 years   

 

The United States General Accounting Office

---

HEALTH CARE SYSTEM CRISIS:
Growing Challenges Point to Need for
Fundamental Reform

---

January 13, 2004

 

 

First page Back Continue Last page Overview Text

HMOs Earn $10.2 Billion in 2003, Nearly Doubling Profits, According to Weiss Ratings; Blue Cross Blue Shield Plans Report 63% Jump in Earnings (BUSINESS WIRE)--Aug. 30, 2004