Controlling exhorbitant prices of hospital procedures and doctor's fees

First, we need to develop a medical webservice that manages the hospital and doctor's appointments, rate the performance of them by the patients. The rating parameter will be mainly on recovery ( 2.5 points ), cost control ( 1.5 points ) and patient experience ( 1.0 points ) on a total scale of 5 points. The web service will take all the cost structure a patient gets without revealing patient's identity. Only patients and attendants of the patient can rate the treatment.

The process of putting a cap on the price a hospital or a doctor bills will be given below.

Step 1. Find all the hospitals which is rated top A% and above and take their minimum rating, which will be the standard to calculate further proceeding.

Step 2. Among those hospitals, find hospitals offering your area of treatment.

Step 3. Among those hospitals, find all the hospitals which has least pricing, covering 10% of patients in the hospitals rated R and above, catering your area of treatment.Take their average pricing.

Step 4. No hospital in that state charges L times that of that average least price, with proper explanations for exceptions to claim  L+ times. Only successful medical treatment can charge L or L+ times. Failures will be L- times.

This 1.5 point for least per patient will be based on who charges least and as long as other hospitals don't deviate from the least charged hospitals, they may get fair scores too.

Webservice will take into account these ratings for evaluating doctors for a minimum of P year period, no matter if they change hospitals or not. We will track them in every hospital.

Doctors working in that average least price hospitals, ( rating 4.5 and above, remember this rating includes not only the price, but also good results ) will be taxed less or no tax, during the period they serve in those hospitals. And may also given preferential treatments for higher studies in Medical universities. Because they are the best and ethical doctors, universities can provide.

We can divert all the Medical Aid renumerations spent by the government solely to top Medical Universities, going to deserving talented Medical Students. And to higher education fees for highest rated doctors.

High positions in American Medical Association will be held by 4.5 and above rated doctors.

As high the score of doctors in a hospital, more treatments with high criticality will be given to them.

Hospitals can give high salaries to doctors with high scores but not based on per patient expense. It will be like hospitals paying more to bring the cost of patients fees. This is capitalism at its best.

Controlling exhorbitant price of drugs in America

I am suggesting a method to control the exhorbitant prices of drugs and medical equipments in America. The idea is setting a maximum price on the drugs and medical equipments based on certain parameters and two pricing periods.

1st period : Recovery period

In this period, the drug companies and medical equipments manufacturers can set any price, till they recover two times the R&D they spent on finding drugs and medical equipments.

2nd period : Patent period

In this period, the price of the drugs and medical equipments should be based on four parameters.

1. Total money the company spends on all R&D, the more money you spend on R&D, the more points you gain, not withstanding breakthroughs you made or not.

2. The number of breakthroughs, the company has gained by spending on R&D, the more drugs you find, more the points.

3. The price the company spent on R&D on that particular drug or Medical equipment. More money spent, more points

4. The amount that is required to produce the drug. More amount to produce, more points.

Based on these parameters, we can set the maximum price, a company can sell their drugs and medical equipments. Government won't interfere in the number of pills you sell. It's just the points that will determine the maximum price of a single pill or a medical equipment.

Educational Reforms

1. Universities should form a collaboration with or complete take over by industries. There can be two types of Education centres. Research centres and Industry run universities. Research centres will give diploma and employ the students, by paying them salaries. Industry run universities may charge fees from students.

2. Big organisations like NASA can start a NASA lab and nurture school students and find their talents, which is the best way of evaluation. NASA should start a university, typically catering to the areas of their interest. Evaluated students from NASA lab will be given admission to these universities.

3. Universities can encourage entrepreneurship by having Venture Capitalists meet and getting 5% stake in the start-ups without investing. Research centres will not have this kind of meets.

4. Industry run universities should encourage full - scholarships for students, based on their talents, which will be profitable to these industries, no matter they start a new venture or not.

Steps to decrease income inequality

US government can make mandatory for large corporations beyond certain value to distribute a certain part of its shares to general public through equity or mutual funds (dedicated only to these large corporations, taking mutual funds route is highly recommended), restricting the sale to middle class and low economic class in equity or mutual funds. Companies, when reach the designated threshold should redistribute their shares to general public, may even give a preference to low income households, among those who apply for their shares initially and thereafter restrict sales to middle and low economic class. This will distribute wealth to the middle class and to a certain amount to low income households. The institutional investors can invest in startups and SMEs till it reaches the threshold and sell their shares thereafter. These investors will now invest in new ventures and companies which need investment, inturn rekindling economic activity, further generating growth in the US economy. Share prices may increase less to some extent, compared to earlier model, since we are restricting the sale of shares to people of middle and low income class, but organic growth will not be affected, which will bring profits to the middle class and the poor. All tricks like tax evading, showing losses like amazon does, anything big companies fathom does, will not affect the middle and poor class. It can only increase their wealth. This policy inturn will help solve the huge salary inequalities between top paid workers like CEOs to down the ladder workers. From the 1% to the 99%, without affecting the economy and the core principles of capitalism.

Education Reforms for grade 8 to 12 students

1. Students to study that or those subject(s) they love to read. Within each subject, the topics they study is also by choice and evaluated by same online teaching softwares. They can even goto advanced topics taught in colleges, based on their capabilities and interests. All students need to do is pass minimum number of topics, overall in all subjects, not in each subject, as per their choice.

2. Obviously Technology will replace teachers and teachers will be mere guides and mentors.

3. Practical labs will be setup in each district headquarters, where students will pursue basic practicals at will guided by professionals. These labs will be privatised, means government will pay money to private companies, to run these labs on a contract basis, with more money based on feedback from students. Students who need knowledge on certain exclusive high tech industry, Online Video Chat will be enabled with Industry. This will reduce the cost of running practical labs for every field, substantially. Students will be given free student pass on public transports, authorised by school staffs, for every visit.

4. Common Entrance Tests will be conducted post higher secondary only on subjects students wish to pursue in college. Like if u want to study physics or mechanical engineering, you need to write CETs only on physics and topics relevant to mechanical engineering. Even those topics is as per your choice in a variety of topics, in that stream. With certain minimum number of topics of ur choice as compulsory. All government colleges will need CET.

5. Patents of new inventions and ideas will be considered as booster of CET scores and will be given as much importance as CET scores. Colleges will reserve certain amount of seats for patents alone and patents will be evaluated by industry and college professors. This point will have further discussions.

6. Universities wholly run by Industries will have a free hand selecting their students, even purely based on interviews. Government run colleges will have CETs and will collaborate with industry. CET will be a separate international governing body, like GMAT or GRE and only government run colleges are bound by its results. Industry run colleges can consider, partly consider or not consider the CET score.

7. History will be compulsory for each grade, with few basic topics. History will be included in the course material, with each country having it's own material.

8. The advantage of this system is students can pursue degree on the subject they love, and nobody can force them to study anything other than their interests. When you study what you love, there will be a huge increase in the number of inventions and the whole education system will go to next level of advancement.

9. Private companies running the labs can negotiate with the student inventors to share their inventions and patents with them for a fee, which is acceptable to the students. These inventions will put students under the industry and the world's radar and give them very good exposure to the outside world, which the companies must do. This will earn money for students, while studying itself and encourage private companies to setup labs at probably less fee from the government.

10. All class 5 to 9 ( optionally 10 ) students of government schools which has language other than English, as a medium of instruction, will go through a bridge course for a year, where they will be taught terms of English in mathematics to science, along with English speaking skills. For all those patrons of native language, you can always study till class 7 in ur mother tongue and take a bridge course for a year, which is a stupid idea. Because there is no college degree in STEM course which has language other than English as a medium of instruction. You may say that Germans study in German, French people in french. One thing you should remember is there is only french in France, German in Germany. But in India, there are hundreds of languages. We recommend students to study in English, because in universities, you will struggle. But, government will provide courses in major regional languages, with scientific and other important terms only in English.

11. Online education syllabus through tablets will need a huge participation by professors, online teaching companies and the industry. Every topic should go deep, very very deep. Like if i start studying solar power technology, the students should reach the summit where they should know how solar panel generates power,the areas it can be applied, what are the cost effective ways and new techniques in that field, also practically he must be able to create one from basic tools. Stage by stage the progress should go without too much of jargons. Finish the topic you have chosen, which is what i call immersive learning. Syllabus should start with certain number of topics in each subject and should keep on increasing every year with more topics and updating the old ones. It should be a continuous process.

12. The strength of this method lies in the  education software. Even complex topics should be explained easily step by  step. Normally 80% of each topic will be easy to understand. Remaining 20% will summarize the topic. U will have simple questionnaire at the end of each of the chapter. U should clear it to go to next chapter. You just have to clear the minimum number of topics, per grade.

13. The government can bring in an international organisation to bring in best minds in the world, to contribute to developing the course material, with basic principle of easy step by step approach. This will reduce the cost of the course material, bringing in high standards, which is also mutually beneficial to all the co-operating countries.

14. CET will be an international governing body, which will not only conduct tests but update and add topics the course material. CET will give text course material. Government colleges will need CET for admission and all government engineering colleges will be converted to purely academic purpose, producing professors holding phd. Admission to those colleges, means u r admitted to do masters and doctorates as well. Medical colleges will need CET.

15. Online libraries, with each topic, containing 3 - 5 books recommended for them should be available on the App. Government can negotiate with the publishers to give Rs. 10 for lending each book for 3 month period. Government paying the whole set of books will result in unnecessary ad-hoc lending of books, resulting in wastage of funds. This CET App can be downloaded on any tablet, with authentication allotted for each student. Those who can't afford tablets , should be provided tablets with subsidy, allowing only the prescribed library books.

Service Tax

Service tax in a line. Each and every service providers should have a Merchant Bank Account. Customers as usual will get 8% cashback and accrual of points. More the points, more the chance of getting lucky lot price from the government. So, customers would like to get more points. But Merchants can't bloat bills, because more bills, more service tax. Let's put service tax at 15% or 20%. Merchants can't increase the price, because there is an open competition from other Merchants.

Suppose the government charges 20% service tax, 5% may be reserved for lucky draw. This is for small customers, but beyond certain lakhs or crores, 5% reduction of service tax can be given, for like big software companies and they should transfer this benefit to high value customers.

Sales Tax and Cashbacks

I suggest a simple method of making every sales being taxed. First, Government of India should give a cashback of 8% on all sales of goods and services, below 10,000 rupees. All cashbacks are eligible only with online bills, which will be simplified by just scanning the merchant's QR code. Every Merchant will be obviously required to move on to using UPI and cashless retail, otherwise you will lose customers to shops using UPI money transfer, who gives 8% cashbacks. Ofcourse, MRP can't be raised and for other goods, competition will crack the price hikes, if merchants try. This in turn will make every retailer to show their full sales report, recorded by their UPI and online bills. The sales tax will be 15% on the MRP of the product, apart from the 8% cashback all retailers and online markets should pay. It is compulsory for all packaged products to print an MRP. Also, above 10,000 purchases will have online bills, without which there will be no guarantee/warranty.

Example with 10% sales tax and 8% cashback for illustrative purpose. So, let's consider this scenario. Suppose, a customer wants to buy an electronic goods or toy or groceries worth 5000. Remember agricultural products are not taxed. So, the merchant says, if you buy with the bill, you will get a cashback of 8%. If you buy without bill, i will give you 10% reduction. 2% is your profit. Profit for merchant is 8% black money. What the government should do is retrieve 10% sales tax at the source. That is when a merchant buys from a dealer, he has to pay a sales tax of 10% to the dealer, beforehand. So, eventually, when he sells the product to the customer, two things he can do. Either sell the product with bill and pay the remaing 8% sales tax to the government. Or sell it in the black market with no bill, eventually getting the same 8% profit. What if he couldn't sell the product. Just return the product to the dealer and retrieve back the sales tax and the cost of the product, which only happens, when you are closing the shop. There's lot of advantage in selling with bill, because you can always get a loan from the bank, if you show healthy money transactions. And you can be a good and honest citizen of the country, which is actually Profitable.

Merchants need not bother about the details of every bill. It is enough, as far as government tax is concerned, to give the bill amount in total. Giving detail bill is only for customers and Merchants own purposes. If customers purchase products and avail cashbacks, these cashbacks will be recorded in Merchant App, linked with the Merchant Bank Account and those cashbacks has to be returned to the government as part of the remaining Sales Tax. Non-packaged Agricultural goods are not taxed, but those selling these products as part of their business or solely selling these products should nevertheless maintain a Merchant Bank Account. For Non - packaged agricultural goods, merchants have to increase the price of the products to 8% and then record their transactions in Merchant App, before collecting the price through UPI. They have to return this 8% as sales tax to the government.

Government can't make cashless compulsory for now. Because, and some may be in unavoidable circumstance like some emergencies, with only cash at that time. If someone buys with cash, Merchants can sell and should sell the product at 8% premium not below that. Even Agro-products sellers, when receiving cash should increase the price of their products to 8%. This cash should be deposited at the Merchant Bank Account once in a month and the extra 8% will not be taxed. Only if customers go cashless, they can avail cashback. Each retailer can sell at any price below MRP for cashless transactions. You just have to return the 8% cashback. There is no necessary to change any existing billing softwares. Just bill amount for cash transactions.

We are neither increasing nor decreasing the price of any goods or service. It will always be determined by the market force. What we intend to do is bring every Merchant under tax net, which will be very good for the economic development of the country and making the economy cashless.

There is no income tax for retailers selling products selling below Rs. 10,000, Only for those specific products. Individual products which costs above 10,000, will be billed and should pay income tax on the profits earned and those products will have a different Sales Tax. Online markets will have same tax as brick and mortar stores. Cashbacks will also be there for Online markets. In case, the tax earned by the government reduces, we will simply increase the sales tax, at source to a few percentage. Income tax is approximately just 15-20% compared to sales tax.

How to avoid bloating of Merchant Accounts through maintaining Dealers inventory

As usual, i have a simple idea to do this. Manufacturers will obviously declare their inventory, to pay sales and income tax. Messing with that will put them behind the bars, with their reputation and company going bust. Dealing with them is easy. Now, we will step in to dealers and sub dealers. Manufacturers when declaring their tax, should also declare the total inventory price, they sell it to dealers, to as many as they wish. These dealers should declare the total inventory price they sell it to sub dealers and then to retailers. When the inventory reaches every stage, we keep the MRP as well, which is easy. And on reaching the retailer. He can't sell above the total inventory MRP. That will check their rule of law of selling not more than MRP. 

Let's take two possible scenarios. Dealers clandestinely procure the inventory from some source, very unlikely. The problem with this is, retailers will not be benefitted from this sale. Because, retailers have to declare their inventory to the government. And that only brings them advantages of bank loans, easy processing of money. The profits margin has nothing to do with clandestine or non- clandestine products. In this scenario, retailers cannot bloat their bank account details, because clandestine products can't be sold through Merchant Bank Accounts, Government has their inventory total. No detail of inventory products is necessary. Just the total amount from each dealer. The government has to provide a separate tax app to keep track of these details.

Let's consider this scenario of retailers bloating the bank accounts themselves by selling their products to bogus customers and buying them back. How will they? We have their inventory total. And if they route through manufacturers, they have to pay income tax as well as sales tax, everytime they re-route it. Dealers can't bring any products into their kitty, without a manufacturer declaring so. Also, banks when considering loans based on Merchant Accounts should consider the number of customers, median of sale, among others, while giving loans.

Only products which have MRP is going to get tax for the government. Remaining products will be of no use for tax. So, we can probably put two separate bills. And wait till Technology penetrates Agricultural products as well. Mostly those who sell non-packaged agro products will not need much money as their investment. Banks need not consider loans based on non packaged Agro-products, as of now. So, for now we will separate the two. But all merchants should digitise using bank accounts.

For two bills, we don't need necessarily two times scan. One scan will give two account details and we can put two separate amounts and authenticate both at once. Only for Merchant Accounts, who declare themselves of selling both products. If it is absolutely necessary, in case there isa huge amount of both transactions happening at once. Also, any bank, UPI or credit/debit card can be used to get government cashbacks and avail its schemes.