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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

 

 

New Federal Health Claims & Appeals Laws & Regulations

for 193 Million Americans

Effective 09-23-2010

©2010, Jin Zhou, ERISAclaim.com

Photo of President Gerald R. Ford signing Employee Retirement Income Security Act of 1974

President Obama Signing Health Bill on 03/23/2010

President Gerald R. Ford Signing ERISA on 09/02/1974

New Webinars, Seminars & Certification Classes Announced for New Federal Health Claim Appeals Regulations on July 22, 2010 from HHS, DOL & IRS, Effective On Sept. 23, 2010 for 193 Million Americans

DOL Seal - Link to DOL Home Page

UNITED STATES

DEPARTMENT OF LABOR

(Links to DOL) ©2010, Jin Zhou, ERISAclaim.com

Patient Protection and Affordable Care Act

Statutory Laws [PDF] [PDF]

 

 

Employee Retirement Income Security Act — ERISA

Webinars, Seminars & Certification Classes for New Federal Health Claim Appeals Regulations

 

ERISAclaim.com - Free Webinars - New Federal Claims & Appeals Regulations, Effective Sept. 23, 2010, for 193 Million Americans

 

ERISAclaim.com: Seminars - 2010 Two-day Basic ERISA Appeal Seminars - Denials and Overpayment Appeals

 

ERISAclaim.com - 2010 PPACA & ERISA Claim Specialist Certification Programs in Chicago, Illinois

 

ERISAclaim.com:  Create An Appeal Department for Your Hospital or Practice (In-house, onsite ERISA Claim Specialist Certification Programs)

 

 

"What's Bad/Good for GM Is Bad/Good for America!"

by Jin Zhou, 02/28/2005

 

 

Rx for GM

 

Healthcare Crisis Caused by GM

Must be Fixed by GM,

not by White House and Congress

"To Mr. Rick, Car Man."

 

Rx: Why & How

by Jin Zhou, 02/28/2005

© 2005, Jin Zhou, ERISAclaim.com

 

Health-Care Crisis = GM Leukemia
Heart Attack = GM Bankruptcy
Cost Shifting = Transfusion between Two Hands of Same Body
Zhou ERISA Rx = GM Bone Marrow Transfusion

 

   

 

No. 1:  Crisis

 

Health Care Costs for 2005: [Black Hole (Forbes.com)]

 

GM $5.6 Billion, $1,500 Per Car

(Big 3 $/Car?)

 

USA: $1.9 Trillion, 15.7% of GDP

 

GM posts $1.1 billion loss (Washington Post, DC)

 

GM Can't `Unilaterally' Cut Retiree Health, UAW Says (Update4) (Bloomberg) 

 

General Motors Says Second-Quarter Loss in Part Attributable to Rising Employee Health Care Costs (Daily Health Policy Report - Kaisernetwork.org)

 

GM chief warns of healthcare costs crisis (Telegraph.co.uk, United Kingdom)

"The Chief executive of General Motors admitted yesterday the company was failing to deal with its healthcare crisis as the car maker said its North American operations had lost almost $1.2billion (£700m) in the past three months."

GM reports higher US sales but still posts loss (International Herald Tribune, France)

 

GM sees no government relief on health care (Reuters)

"DETROIT, July 20 (Reuters) - General Motors Corp. (GM.N: Quote, Profile, Research) said on Wednesday that it sees no near-term relief from the U.S. government on its massive health-care costs.

 

"I don't think there's any enthusiasm at the political level to do anything on health care, period," said GM Chief Financial Officer John Devine."

Production cutbacks, material and health care costs result in $1.2 billion loss in North America (DetNews.com, MI)

"Wagoner and Chief Financial Officer John Devine promised to attack health care costs, excess manufacturing capacity and purchasing costs with new urgency, but analysts were downbeat."

 

No. 2: Diagnosis

 

Dx from U.S. Supreme Court?

(Copyright © 2004-5  by Jin Zhou,  ERISAclaim.com)

Is Health Care Issue Beyond GM Management's

Control EVEN with "ERISA Discretionary Clause"?

If Yes = Chapter 11; If No, What to Do?

LAB Committee Hearing Transcript for 02/08/2005 - "ERISA Discretionary Clauses"

PEGRAM et al. v. HERDRICH

Decided 06/12/2000

Healthcare Quality by State Laws or ERISA?

RUSH PRUDENTIAL v. MORAN

Decided June 20, 2002

Medical Necessity by State Laws or ERISA?

Kentucky Assn. of Health Plans, Inc. v. Miller

Decided: April 2, 2003

Managed Care Networks by State Laws or ERISA?

AETNA HEALTH INC. v. DAVILA

Decided June 21, 2004

Health Care Quality & Cost Control by State Laws or ERISA?

 

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."

 

ERISA For GM from the U.S. Court of Appeals for the Sixth Circuit:
 

Hill, et al v. Blue Cross of MI,

05/13/2005

 

OPINION

_________________


"KAREN NELSON MOORE, Circuit Judge. Plaintiffs-Appellants John L. Hill, Francine Barnes, Franchot Barnes, Francesca Barnes, and Glory Celestine (“Plaintiffs”) filed the instant putative class action against Defendant-Appellee Blue Cross and Blue Shield of Michigan (“BCBSM”), the third-party administrator for Plaintiffs’ employer-sponsored health insurance program (“the Program”). Plaintiffs allege that BCBSM’s handling of their claims for emergencymedical-treatment expenses resulted in the wrongful denial of benefits and constituted a breach of BCBSM’s fiduciary duties to Program members under the Employee Retirement Income Security Act of 1974 (“ERISA”). The district court granted BCBSM’s motion to dismiss Plaintiffs’ suit without prejudice on the ground that Plaintiffs failed to exhaust administrative remedies available under the Program prior to filing suit. Plaintiffs now appeal, alleging, inter alia, that exhaustion is not required for claims for breach of fiduciary duty, that exhaustion of administrative-review procedures would be futile, and that Plaintiff Hill has in fact exhausted his administrative remedies. For the reasons set forth below, we AFFIRM IN PART and REVERSE IN PART the district court’s order granting BCBSM’s motion to dismiss Plaintiffs’ complaint."

 

Comment from Jin Zhou, ERISAclaim.com: This case ruling indicates the entire GM health plan claim ERISA practice needs to be re-visited or revamped, as ERISA failure is the root cause of GM healthcare cost crisis and junk bond status, yet this GM ERISA bunker is least likely checked by GM for GM healthcare crisis and possible chapter 11. (Please e-mail  Jin Zhou at ERISAclaim.com for details of this Dx and more Rx)

 

Jin Zhou's Prophesiable Dx from ERISAclaim.com:

(Unofficial, 06/21/2008)

"We hold that Bush and GM courses of action, brought to remedy "U.S. Health Care Crisis", for health care "quality and costs" control by shifting costs, such as HSA, AHP and CDH,  for either small businesses or GM, only the reduction or 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 "ERISA Reality Channel". The current BUSH or GM plan is reversed, and the cases are remanded for further proceedings consistent with this opinion.  It is so ordered."

No. 3: Rx & Options for GM

 

 

1.

2.

3.

White House Rx

GM

Plan & Rx?

Jin Zhou ERISA Rx

 

White House Rx:

$1,000 HSA Personal Responsibility + AHP with More "ERISA Advantage" for "Widespread Plan Insolvencies and Fraud" and "A Prescription For Disaster".

Association Health Plans: No State Regulation Means Loss of Protections for Consumers, Small Biz (PDF) (Blue Cross and Blue Shield Association)

GM Plan & Rx?:

June 14, 2005: "Report: GM sets deadline for UAW


"Auto firm gives union until June 30 to agree to health care savings, or it will slash costs itself.
 

NEW YORK (CNN/Money) - General Motors Corp. is set to take unilateral action to reduce its health care expenses if it doesn't get concessions from the United Auto Workers union by the end of the month, according to a published report."

 

Report: GM warns UAW on health benefits | wkyc.com

 

"The Wall Street Journal reports that GM has set a goal of reducing the burden of its annual health-care costs by one billion dollars this year and another billion in 2006."

 

 

I: "GM looks to gain ground in Asia, control costs back home" (Detroit Free Press - www.freep.com)

"We invest it there, we get a higher return and we can use that to pay off the obligations here."

II. GM to trim up to 2,000 workers (The Detroit News, March 21, 2005)

White-collar staff to be cut by more than 10% in some areas, company says.

"GM is seeking to cut costs as it faces vastly reduced profits this year and an expected first-quarter loss due to rising health care costs, disappointing sales and shrinking market share in North America."

III. GM considering asking for same health plan (businessweek.com)

"GM's salaried workers pay 27 percent of their total health care costs, while the company's hourly workers, who are covered by the United Auto Workers union, pay 7 percent, according to GM data. The average U.S. corporate employee pays 32 percent of the cost of health care, GM said.

 

"Our salaried employees have one of the absolute best health care plans, probably in the world, but definitely in the United States. The UAW hourly health care is way, way richer than that," Lutz said. "We've got to get to the point where all of our employees, hourly and salaried and the UAW have the same health care contract. ... That would mean huge sums of money for us."

IV. MSMS Sues Blues (msms.org) (ERISA SEARCH)

"DOCTORS SUE BLUE CROSS OVER AUTO/UAW HEALTH CARE PLANS

EAST LANSING – The Michigan State Medical Society and the Michigan Osteopathic Association today jointly filed a lawsuit against Blue Cross Blue Shield of Michigan alleging that BCBSM is wrongly fixing the fees physicians charge for office visit services provided to enrollees in the new “preferred provider organization” health care plans for United Auto Workers under the most recent UAW/automaker contracts......

MSMS is the professional association of 14,500 medical doctors. MOA is the professional association of 4,500 osteopathic physicians."

V. Big Three, UAW say they must solve crisis before 2007 contract (DetNews.com)

 

UAW to GM: Hands off our contract (MLive.com, April 15, 2005)

"DEARBORN -- United Auto Workers President Ron Gettelfinger says the union is willing to help ailing General Motors Corp. trim its out-of-control health care costs. But forget about reopening the 2003 labor contract."

 

""But Anderson said the federal government needs to trim paperwork and bureaucracy in the Medicare- and private insurance-driven system. Some health care experts say administrative costs and insurance company profits represent as much as 50 percent of all health-care spending in the United States."

VI. "Hill, et al v. Blue Cross of MI, 05/13/2005"

 

AND

 

Doctors fight Blues over fees - 09/10/04 (The Detroit News)

 

State medical society suit threatens reduced amount UAW workers pay for office visits.


"The lawsuit was filed after discussions between Blue Cross and the medical societies failed to resolve the issue.

 

"We disagree and are obligated to administer health care benefits in accordance with the health plan design requirements of our automotive customers," Blue Cross said in a statement.

 

Automakers and the UAW are taking a hands-off approach to the dispute.

 

"The UAW is not a party in the Michigan State Medical Society's suit against Blue Cross-Blue Shield of Michigan, and we have no comment on the suit at this time," the UAW said in a statement.

 

Ford, GM and Chrysler declined to comment directly on the lawsuit.

 

GM spokesman Kerry Christopher said the matter "is between Blue Cross/Blue Shield and the Michigan State Medical Society."

 

VII:  GM plans to close more US factories (Detroit Free Press, MI)

 

"Some of Wagoner's comments also seemed to be aimed at the UAW -- and telling the union a plan to reduce GM's health care costs must be worked out, with the union or without it."

 

VIII UAW Members OK GM Health Care Proposal (ABC News)

"DETROIT Nov 11, 2005 — General Motors Corp. got some relief from its spiraling health care costs as auto workers agreed to pay more of their health costs, but analysts said the ailing automaker must do more to turn around its North American operations."

Jin Zhou ERISA Rx

 

U.S. Healthcare Crisis Turnaround?

 

 

Jin Zhou ERISA Rx Is the Only Power that Can Stop Medical Inflation and Waste

Zhou's Prudent Healthcare Model ($700/Car) to get GM out of GM "Black Hole", to spare "the death of GM 'Michelle'", to avoid GM "John Q. ERISA Enforcement", to spare Bush & Congress from stopping "the bondholders to pull the feeding tube" from "the corporate version of poor Terri Schiavo, with all options for survival exhausted":

"50% savings on health care costs without simply shifting the uncontrollable burden that would actually inflame the medical inflation!"

Union OKs GM health care cuts (Oakland Press, MI - Nov 12, 2005)

 

Will increased co-pays and deductibles really save  GM as much as it anticipated?

 

The past history of managed care reality is clear: high co-pay with high deductible always caused higher inflation of medical claims in the past 20 years.

 

Can GM healthcare crisis be fixed without having to change UAW contract and to  shift burden/crisis to UAW members?

 

Yes, but only through a fundamental solution to fix medical inflation/healthcare costs, and someone else would have to lose significantly from GM $5.6 billion "fortune opportunity pie", that may never happen.....

 

Why Can't GM Learn From HMO's for $5.8 Billion?

($1.9 Trillion - $5.7 Billion (%±GM/HMO) = $300/Car?)

Weiss Ratings: HMO & Health Insurance News Releases

5/24/2005   Profitability Continues to Surge for the Nation's HMOs
2/7/2005    

50% of HMOs Financially Strong as Profitability Continues

Industry Earns $5.8 Billion in First Half of 2004

2/7/2005    

Higher Co-Pays for Drugs and Doctors Cited as Most Significant Change to Health Insurance Coverage

 

 

 

White House to GM: HSA & AHP Only. 

Get ready for "ERISA Advantage"!!!

A letter emailed to GM from ERISAclaim.com

2/28/2005 11:45:58 A.M. Central Standard Time

 

Dear Mr. Rick Wagoner: 

 
RE: Bush offers no silver bullet for automakers' health care costs (boothnewspapers.com)
 

It is time for automakers to wake up from political hallucination: White House solutions to automakers nightmare and Rx the doorsteps of Chapter 11.

 

It is absolutely clear to any reasonable mind of commonsense leadership that:

 

1. White House and the President does not have any solutions as you anticipated, if he did have a solution, he would have given to you without you asking;

 

2. The president is absolutely determined, as determined as on his war strategy and no one can change him, that HSA and AHP are the solution to US health care crisis, which is exactly the cause of GM health-care crisis: "ERISA Advantage" with PPO medical inflation, as I explained to GM and the USA for three years;

 

3. Does President Bush make a complete mistake? Did GM proposal fall on deaf ears?

 

No!

 

HSA & AHP are as bad as Wagoner/GM's proposal: They Both failed to identify and fix the fundamental failure of the employer-sponsored health-care delivery and administration system = ERISA Failure and Medical Inflation!

 

4. "Mr. Rick, Car man" has as many deaf ears as the President Bush, "Failure of Imagination" Again in Health Care. If a GM automobile engine is not running or running poorly, we all need to get down to the engine to identify the problems and fix the problems where originated, as a commonsense, but this commonsense has not been followed by GM and the President in health care crisis management.

 
 

"But Bush, acknowledging that health care costs are hurting businesses - "whether it be the automaker or the family restaurant in Michigan" - said the first priority should be making health insurance more affordable for small businesses. "

 

"More than half of the uninsured are small business employees," said Bush, who was flanked by GM Chairman Rick Wagoner, Ford Motor Co. Chairman Bill Ford Jr. and Chrysler Group President Dieter Zetsche on the dais. "To me, that makes sense to start there."

 

Apparently and completely determined by President Bush, HSA and AHP for small businesses and uninsured are the priorities for the next four years, if no one can change President Bush on his war strategy, no one in his lifetime can change President Bush's HSA and AHP strategies.

 
 

"Bush said businesses should be allowed to band together to buy health insurance at cheaper rates.

 

But many business groups are opposed to the idea. They say the president's proposal, known as association health plans, wouldn't be subject to state regulations and would allow the plans to deny coverage to older, more expensive workers. "

 

 

"ERISA Advantage"= "More "ERISA Advantage" for "Widespread Plan Insolvencies and Fraud". (With hyperlinks to references )

 

GM relied upon  ERISA advantage for 30 years and end up  with $5.6 billion in yearly health-care costs and $1500 per car

 

President Bush firmly believed that small business should be allowed to bind together to do exactly what GM has done in the past 30 years: "ERISA Advantage" and PPO Saving ("Medical Inflation, WMD")

 

Click the following hyperlinks To learn What Blue Cross Blue Shield Actually says About ERISA advantage for Small businesses And AHP

 

$1,000 HSA Personal Responsibility +AHP with More "ERISA Advantage" for "Widespread Plan Insolvencies and Fraud".

 

"unlimited and frequent premium increases, and the potential for rampant fraud with little, if any, regulatory recourse"

 

When President Bush has decided to share  ERISA advantage with small businesses,  someone is finally telling the truth:   ERISA Advantage Will  Be as bad as WMD. 

 

7. "Bush offers no silver bullet for automakers' health care costs" (boothnewspapers.com)

"Last summer, Wagoner urged the winner of the presidential election to appoint a high-powered panel of business, labor and political leaders to propose ways of at least slowing health care costs, which have been rising more than 10 percent a year recently.

 

Wagoner said last month his proposal had fallen on deaf ears."

 
 
"Mr. Rick, Car man", President Bush, Congress and USA all have Deaf EARS:

 

 

8.  SOS For GM bottom line:  HSA & AHP can never help GM but speed up Chapter 11 for our national icon.

 
 
Respectfully, but no Deaf ears.
 
 
Jin Zhou
President
ERISAclaim.com
630-736-2974

 

 

 

Subject:
Rx!!!: "Facing losses of up to $2 billion":

GM Wagoner Shuffle Lutz & Cowger

Date: 4/10 1:31 PM
Dear Mr. Wagoner:
 
The conventional strategies have been proven to be failing for GM  & Big Three. Cost shifting and tighter managed care will cause more bleeding, medical inflation, and  more possible headaches, nationwide union strikes, similar to that recently triggered by "GE show-down" "yesterday".
 
GM and Big Three are at the most critical time in the history to make some critical and correct decisions to stop medical inflation caused by GM and Big Three.
 
Sincerely,
 
 
Jin Zhou
President
ERISAclaim.com
630-736-2974
 
 
 
Executive Suite Shuffle

Sunday, April 10, 2005; Page F02

 

Executive Suite Shuffle

"Facing losses of up to $2 billion in its North American auto business this year, General Motors chief executive G. Richard Wagoner Jr. said he would run the division himself, pushing aside two trusted deputies, Robert A. Lutz and Gary L. Cowger. GM's market share in the first quarter declined, to 25.7 percent from 27 percent a year earlier. Wagoner's challenges will be to lower health costs, close unneeded plants, develop a line of cars that excite consumers, and wean the company off its dependence on rebate-induced sales.
"

 

"What's Bad/Good for GM Is Bad/Good for America!"

by Jin Zhou, 02/28/2005

 

 

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.

 

 

 

Tort Reform, Fraud & Healthcare Crisis?

New From Center for Justice & Democracy: 

 

***New Study*** Falling Claims and Rising Premiums in the Medical Malpractice Insurance Industry (July 7, 2005) Appendix

 

News Release: New Study Leads Attorneys General to Proclaim “No Excuse” and “A Matter of Life and Death” (July 7, 2005) PDF

 

"Joanne Doroshow, Executive Director of the Center for Justice & Democracy, which commissioned the report, stated, “To put it bluntly, if you look at what the insurance companies say about why they raise premiums, and then look at the data in this report, thenumbers just don’t add up.  The facts are very simple: medical malpractice payouts are down yet insurance companies have significantly increased premiums.  This shows that the entire campaign to limit liability for doctors over the last several years by capping compensation to injured patients has been a fraud, and that based on these data, insurers must know that it has been a fraud.”

 

Study Backgrounder (July 7, 2005) PDF

ERISAclaim.com - A $1.0 Trillion Nuclear Solution to U.S. Health-care Crisis & $44 Trillion Budget Deficits

 

A New Diagnosis & Solution

 

by Jin Zhou, 02/05/2003

© 2003-5, Jin Zhou, ERISAclaim.com


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

 

 

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!

GM "Black Hole"

 

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

 

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".

 
   
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