A solution to healthcare with no federal, insurance or employer directives. We manage our own healthcare and immediately reduce costs 25-40%, not to mention systemic changes that bend the cost surve downward over time.

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We need a bridge between Republicans, who oppose more government interference in our lives, and Democrats, seeking universal healthcare coverage for all. This plan eliminates employer based plans, which prevent free choice, and uses the free markets with regulation to control costs while utilizing Wall Street and the insurance industry to fund the securitization of healthcare costs on a global, not individual medical transaction, level. There is free choice, no insurance company intermediary, no new federal bureaucracy in the plan and it also provides banks with a new business segment. The plan is cost efficient and provides flexibility to increase or decrease funding, via deductibles and tax credits to meet a targeted federal budget, depending upon the economic state of the nation. Healthy outcome incentives may be superimposed upon the plan to provide encouragement to providers and patients and further reduce our healthcare costs. And technological and other clinical cost saving measures would be completely compatible with this plan. Features in the plan take the best from conservative and liberal platforms, which should satisfy both political parties.

We must change the way present insurance, public or private, is used to micromanage each medical transaction's costs, as it only results in rationing of services coupled with poor quality of care. The present business model will never work and substituting “managed care” government insurance or cooperative “managed care” for private insurance will not fix it. What WILL work is the ‘revolution' proposed in this plan.

The following is a road map for terminating the present dysfunctional healthcare system and creating high quality universal healthcare for all Americans in a cost efficient manner:

1. We need more American trained doctors to reduce costs and increase supply, which will increase the quality of healthcare

1. Dramatically increase the number of medical school attendees
2. Eliminate unnecessary barriers to entry to medical school. Many medical school required undergraduate courses have little bearing on the quality or knowledge needed to be a doctor. Such impediments have kept excellent potential doctors from entering the field.
3. Test students with the aptitude and interest in becoming a doctor. Put them in a curriculum that fast tracks courses needed for medical school and eliminates courses not needed for this purpose, saving time and money to cultivate a doctor.
4. Eliminate the 24 hour shift and other antiquated rules imposed on medical students and residents, which serve no purpose but may alter the path of a potentially good doctor.
5. Increasing the supply of doctors will reduce or eliminate the need to source foreign doctors to fill our healthcare needs.
6. Do the exact same things listed above for nurses to increase their numbers.
7. Medical professionals would be paid market rates for their services so that so that a shortage of doctors in one practice area will be supplied by market forces.
8. Quality and continuity of care from medical professions has decreased significantly as time spent with patients is minimal due to financial pressures of the present healthcare system. This has affected the health and well being of every patient in one way or another via errors, misdiagnoses or stress to the patient who cannot get the time of day with his or her doctor and has become a number, not a person, in the scheme of things.

2. Hospitals and Clinics need to be regulated like Utilities in the Public Interest

1. Charges for drugs, tissues and a toilet seat cover may be ten times higher than the market cost when a hospital charges for these items.
2. Charges for use of an MRI or surgery room are disproportionate to a reasonable return on investment for the real estate and the equipment used.
3. Just like a utility, hospitals and clinics should be allowed to make a regulated fair return on investment but no more. They would remain privately owned entities. Certainly, one's healthcare costs at a reasonable price areas much a right as one's right to reasonable utility charges for heating one's home. Since like utilities, hospitals are licensed by the state and, in addition, are limited in numbers of beds permitted in a community, a resident of that community has little choice, if ill, other than to go to the psuedo-monopolistic owner of the hospital beds in his or her community. And with only a handful or large chain owned hospital owners controlling our emergency rooms, hospital and clinics around the country, regulation is imperative. Penalties would include return of annual excess permitted earnings to those who paid them that year.
4. Licensing of hospitals and beds should be granted based on objective criteria such as existing beds per capita in a community, not politically granted.
5. To improve quality of care, we must end the practice of hospital owners hiring contracted nurses that rotate every day so patients do not get a nurse that stays with them and knows their particular medical and emotional needs in depth. This has resulted in poor quality of care and higher costs resulting from worse outcomes. A regulated hospital would be required end this practice.

3. Drug Company revenue business models must change to contain costs

1. Costs of drugs need to be contained by opening up competition to the American drug companies such as foreign drug access.
2. Drug companies should be made competitive by changing the monopoly they have on producing drugs that they patent. Any drug company should be permitted to pay a royalty, say 5%-20%, depending on type of drug and remaining useful patent life, to the patent owner to manufacture any drug. This will end the monopoly of drug companies to manufacture and sell all drugs it researches and patents. At the same time, the royalties will justly reimburse the patent holder its research costs and provide a profitable return on its investment from manufacture of its own drugs as well as royalties from others. Patients should benefit from this business model change in drug production.
3. Drug companies should be given a choice to maintain a longer patent term if they reduce prices substantially during the original patent term for popular drugs like statins, diabetic drugs or others.
4. Alternatively to increasing the patent term, drug companies should be given another option of receiving unlimited royalties on generics introduced after patents expire, if the drug company reduces the cost substantially during the original patent term.
5. US government volume guarantees on certain medicines would be used to extract lower drug costs from manufacturers for all patients. Private pharmacies would issue all prescriptions and inventory the drugs so no drugs would be handled or owned by the US government. Charges would be made to each patient's National Health Credit Card.

4. Eliminate third party “managed care” insurance intermediaries

1. The administrative costs added unnecessarily to the present healthcare system are bankrupting it. Stopping these inefficient attempts to manage each medical transaction could save 25-40% of the cost of medical care. Why? Because in addition to the administrative overhead cost savings at both the insurance company and medical offices, the insurance company profits eliminated will not need to be included in calculating the comparable cost of healthcare when provided by the proposed universal plan. For example, United Healthcare in their SEC filed 2008 Form 10K and Annual Report, showed premium and service revenues that could have been reduced between 2006 and 2008 by 23-25% (gross profit) if these were to cover only the medical costs they paid within these years. In other words, the premiums actually charged paid for more than medical costs; and in the proposed universal healthcare plan, health costs could decrease by these amounts which paid for overhead and profits at UnitedHealthcare. This does not include inefficiencies and added administrative costs at the doctor's office or in lost patient wages as patients try to deal with the present bureaucracy... nor does it include the medical cost savings that should result from other suggestions outlined in this paper.

2. The present blocking of benefits and arbitrary payment for services by insurance companies results in:

1. Poor quality of time with the doctor for the patient as doctors are paid by number of patients seen, eliminating incentives for high quality care, which has sent some frustrated doctors into concierge medicine.

2. Patient out of pocket costs that have bankrupted families because while the patient believes he/she has contracted for a policy limit on out of pocket costs, including deductibles, they come to find that they have exceeded deductible and out of pocket advertised limits due to legal loopholes in the insurance contract which allow claims to be paid based on usual and customary provider costs, as the insurance company defines them. This problem is inherent in every health insurance contract involving medical transaction management, which is why eliminating the present system is necessary.

3. Preexisting conditions presently block those who most need coverage from getting it and as a result the insurance companies skew coverage toward healthy customers. This problem must stop.
4. Limitation in the choice of doctors is an absurd result of the third party insurance system. It must be ended so each person has freedom to choose his or her doctor, generalist or specialist with no one's approval needed. This will end the issue of continuity of care whereby one has been forced to change doctors that are not providers under a newly adopted insurance plan.
5. Eliminating third party insurance intermediaries will cause the demise of the employer-employee connective relationship with regard to healthcare. This connection resulted from tax law changes years ago and is partly responsible for our present problems. Choices of insurance companies and premiums have been forced on employees, resulting in terrible and often minimal coverage for workers. Premiums paid by employers for employees should be added back to the employee's wages, by law, to compensate for the benefit lost by the employee. To keep employees status quo taxwise, employees would be exempted from income taxes on these “added back to salary” benefits.

5. Replace the present third party insurance system with one that has the patient and doctor (or hospital or clinic) negotiate the cost of services directly.

1. Direct payment by the patient to the doctor will keep costs lower as the doctor will not have the added costs of administering a third party insurance reimbursement; these savings can be passed on to the patient in lower fees.
2. Doctors (or hospitals or clinics) and insurance companies will no longer play pricing games with service fees to influence the amount of “reasonable and necessary” and “allowed” reimbursements from insurance companies. Patients have been misled into thinking they have a policy with out of pocket and deductible limits only to find insurance companies and doctors trying to bill the patient additional amounts to cover service fees not fully covered by reimbursements to doctors (or hospitals or clinics) from insurers. This is a trap perpetuated on patients by a system geared toward convincing the patient that he or she is covered in full when the healthcare policy has loopholes that boost the actual costs to the consumer, sometimes to the point of financial collapse. Transparency between patient and doctor will end this problem.
3. Doctors have opted out of family practice to focus on specialties due to the financial disincentives caused by the present insurance system. Dealing directly with patients without per capita insurance incentives and without the administrative insurance nightmares that exist, more doctors should enter or remain in family practice. The shortage that now exists in the number of family doctors has resulted in large numbers of patients having to deal with fewer of these first line of defense doctors.
4. The personal relationship between doctor and patient will allow for the doctor to financially accommodate the patient in certain circumstances, such as volume visit discounts or some other arrangement.
5. The patient will have a vested financial interest in controlling costs and holding the doctor accountable for unnecessary charges. Under the present system, this does not occur properly as the insurance company drives prices and payments without direct knowledge of care quality or outcomes or patient input.
6. Doctors, hospitals and clinics will be required to post fees for various services in a transparent system to allow the patient to know exactly who charges what price and this will encourage competitive pricing choices. Fees for services will be the same for each patient and not be discriminatory. Patients that cannot afford the fees will be addressed within the universal healthcare plan and not at the medical provider level. No longer will one patient pay one fee and another pay a higher fee for the same service, an immense disruption to a fair and efficient system of healthcare.

6. Ensure that patients pay only for all out of pocket medical costs above an annual deductible amount, established by taxpayer income and family size and number of medical transactions. Use tax returns filed with IRS to reconcile annual medical costs. Use a new National Health Credit Card issued by banks on behalf of the US government to charge all medical costs.

1. Doctors, hospitals and clinics and pharmacies will break down medical costs into types:

1. Elective, not medically necessary

2. Preventive

3. Diagnostic

4. Remedial.

This will facilitate tracking of costs and reimbursements. Further refinements are possible. For example, the cause of the medical cost, such as diabetes, cancer, a cold, etc. could be a tracked subcategory of each type of cost above.

2. Patients will carry a National Health Credit Card which will do two things.

1. Track medical costs by type with charges paid at point of service on a regular credit card machine. The credit card will be issued and processed by banks for the US government, which will pay providers for all medical costs in excess of the deductible and hold the debt receivable, which would be owed by the patient/taxpayer.

2. Carry medical records of the patient in a separate corner of the card to enable scanning of these medical history records anywhere in the world. This use may need to be implemented sequentially after the credit card is in use first for a year or two.

3. Every month the patient/cardholder will receive a credit card bill. All amounts on the credit card must be paid in full on a timely basis until the full deductible amount is reached within each month, after which, no payments need be made until the annual reconciliation at year's end, when the annual IRS Form 1040 is filed. Normally no payments will be due at that time.
4. The annual deductible will consist of two elements:

1. Fixed Deductible Amount, which limit will not change within the year.

The annual fixed deductible amount should approximate the annual amount

that would otherwise be paid under the current healthcare system for

premiums and deductibles but adjusted downward for cost savings

attributable to both widening the universe of covered patients and changing

the process of healthcare payments under the proposed new universal

healthcare program.

2. Variable Deductible Amount, which is based on number of medical transactions, similar to a co-pay of our present healthcare system. Each month, the variable amount will fluctuate on the credit card bill. If 4 prescriptions and 2 doctor visits were made within a month, then there would be 6 medical transactions to which a standard variable deductible charge, perhaps $20, would apply to each transaction. Alternatively, the variable deductible amount could be based on a percentage of each medical transaction, such as 20% up to a maximum of say $500 per medical transaction. The concept is to keep prices lower by giving patients incentives to negotiate each medical transaction knowing that each one will cost the patient money; this should reduce unnecessary trips to the doctor. In addition, the variable deductible (and tax credits described below) could be different for each of the four types of medical transactions to establish incentives for efficient use of the system, e.g. preventive medical transactions.

3. All deductibles would be fully tax deductible for Federal income taxes to lessen the after tax effect to patient/taxpayers.

4. By increasing employee salaries for amounts now paid by employers to insurance companies and by requiring employees to pay the proposed fixed deductible out of pocket cost, the employee/patient will feel the pain of each doctor's visit until this deductible is met. Contrast this with our present system where the employee/patient does not see any payment made from the employer to the insurance company on his/her behalf and does not see the amounts paid by the insurance company to the medical provider; hence, the patient perceives little cost for each provider visit. A major benefit of the proposed plan should be a much more medically cost conscious patient, even with the same dollar outlay for “medical coverage” but structured differently. For example, a $500 monthly employer paid premium under our present system, would become a $6,000 annual fixed deductible to the employee/patient under the proposed plan. This should ensure a universal healthcare plan that is very cost efficient.

5. To ease the financial strain of monthly payments due for the annual fixed deductible limits, the annual fixed deductible amount will be divided by 12 and the patient/cardholder will be given the option of capping the monthly fixed deductible cash payment outlay at the amount of the monthly prorated fixed deductible amount.
6. At the end of a calendar year, the National Health Credit Card charge summary for the year will be sent to the cardholder with a breakdown of total medical costs by type for the entire year with detailed charges listed, as well as totals. This summary will be an official tax form similar to a Form 1099 and will be filed simultaneous with the IRS, similar to the 1099 form.
7. The cardholder will reconcile all medical costs on his or her Form 1040 income tax return regardless of whether or not one itemizes or takes the standard deduction. Medical costs will create a tax credit for all amounts paid in excess of the annual deductible. The tax credit may be earned by applying the unpaid National Healthcard Credit Card balance, still owed by the patient/taxpayer, against the permitted tax credit on Form 1040. Interest on credit card balances is a matter for further discussion, as to whether it should be charged or not.
8. IRS presently permitted Health Saving Accounts, HSA's, could be used by the taxpayer to meet the annual deductible amount.
9. For patients that do not need to otherwise file a tax return or do not have enough income to require filing, the simplified Form 1040A or a new simple form for reconciliation would be required to be filed for the medical cost tax credit and the resulting zeroing out of National Health Credit Card balances on a yearly basis, in preparation for the next year's medical cost processing.
10. For patients that are deemed financially challenged, the deductibles will be reduced or eliminated, based on income, so that everyone receives medical care in the new system.
11. The use of tax credits and deductibles, as suggested above, will create funding flexibility unlike the static employer based health care plans now in existence. By adjusting the tax credit and deductible amounts according to the state of the economy, type of medical costs incurred and income levels of patients, it will be possible to globally keep federal costs within budget. With this feature of funding flexibility, the plan can be designed initially around a targeted spending budget, without affecting quality or continuity of care. As the economy improves and after time and experience, the plan allows for a simple way to increase funding to accommodate a larger federal budget for wider coverage by simply adjusting the deductibles and tax credits.

7. Reduce the insurance costs of doctors to cover medical malpractice by establishing guidelines for doctors to avoid such lawsuits.

1. A medical professional board should establish pre-approved best practice protocols for certain diagnoses which require high risk treatments.
2. If the doctor follows the best practices treatment option pre-approved guidelines for a diagnosis then any malpractice suit may not be brought if such suit is based on questioning the doctor's choice of treatments for the patient. However, a patient, who decides to use a procedure that is outside the realm of best practice protocols could execute an informed consent form and the doctor will then be exempt from malpractice litigation due to use of that “extracurricular” procedure. Negligence, however, would be cause for litigation regardless of the procedure undertaken.
3. Limit all malpractice recoveries to out of pocket costs of the injured party with pain and suffering recovery limited to a maximum permitted amount and recovery of future economic suffering and lost income of the injured party, and his or her family, permitted. Pain and suffering judicial awards on both attorney earned fees and patient earned awards exceeding an agreed minimum would be taxed at very high rates, in order to discourage them.

8. Utilize reinsurance by private insurers at a global level, instead of at the individual patient medical transaction level as now exists, to minimize costs to the US government.

1. For the health care amounts which fluctuate above a long term moving average baseline of monthly universal health care costs, private insurers could pool their resources and participate in bids to receive premiums from the US government in return for the insurance companies' participation in taking on the risk of funding these fluctuating monthly amounts. The private insurers would then be required to pay the US government an amount equal to abnormal increases in the principal amounts above the baseline. The US government would cap its risk exposure and private insurers would absorb the fluctuation risk above that cap. Monthly risk level calculations would be made to coincide with the time of monthly disbursements to the medical providers charged on the National Health Credit Card. This concept keeps the insurance company in the risk business instead of the management business, which has not worked to date. It enables them to insure a diversified pool of insurance risk at a global level instead of managing individual medical transactions, which have proven costly, inefficient and damaging to our economy.
2. Wall Street securitization of the monthly health debt incurred by the US government could be accomplished by private sector buyers of obligations of the US government issued to cover non-patient contributed health care costs incurred on the National Health Credit Card.
3. Tranches or different risk bands of investment in each debt sale could be sold off at different interest rates similar to CMBS securities in the real estate markets. On the least risky lower tranches, this could result in receipt by the US government of debt purchase bids at interest rates lower than those on other US government obligations, resulting in more cash received than the par value of the least risky tranches being sold.
4. Combining the participation of insurance companies on the fluctuating riskiest healthcost tranche with Wall Street participation in the less risky tranches may provide a method for optimizing costs of capital and outstanding debt under the universal healthcare system proposed.

9. Good outcome incentives to both the patient and provider can be used to reduce system costs.

1. Patients can be paid money to change their behavior to reduce smoking, obesity and to exercise, all factors proven to improve health and reduce healthcare costs. Other preventive procedures, medicines and diagnostic tests can be structured to benefit the patient financially as incentives.
2. Doctors and other medical providers can be rewarded for providing outcomes better than the averages for a type of medical cost within a local or national grouping of doctors.
3. Use of statistics gathered, initially from the IRS and bank reporting system, and then ultimately from a national medical data bank, could be the basis for such rewards.
4. Good outcome incentives could be structured as cash payments or tax benefits allowed on the patient's and/or doctor's IRS annual tax return.

10. Free markets need some regulation when competition is limited or the consumer is a captive to possible unfair trade practices such as price gouging.

1. As mentioned above, hospitals and all clinics, whether doctor owned and not, would be regulated like utilities to ensure profitability with a reasonable return on investment.
2. As indicated above, drug companies would be offered longer patent lives and/or royalties on their exclusive and/or generic drugs in return for lower initial costs on drugs during the present patent life. To ensure compliance, audits would be performed using statistical analysis. These audits would be under the auspices of the FDA, the agency that regulates drugs. During the drug approval process, the price of the drug would become a component of the approval process.
3. Doctors would be free to charge whatever fees they choose under the proposed transparent system where all services, maximum fees and credentials would be open for all patients to see and make an informed choice. A patient seeking a lower cost from a doctor would be free to move to a different physician. In an industry where one's life and well being should not be a factor of one's net worth, certain global constraints should be considered on how much a doctor may charge for a service.

1. Averages for service fees of doctors in a local or national grouping can be used to expose doctors charging excessively.

2. Use of statistics gathered, initially from the IRS and bank reporting system, and then ultimately from a national medical data bank, could be the basis for such “averages” information.

3. Doctors could be penalized financially if their fees for a particular service exceed a certain tolerance above the relevant average, e.g. say no greater than 20% above such average.

4. Using negotiated contracted amounts for particular services already in existence with today's managed care providers, the proposed plan could also limit service fees to no more than present contractual rates being earned by doctors" plus some added tolerance level. This could be the base from which doctors, over time, would be permitted to raise service fee rates, as the economy improves and as the supply of doctors increases, such that fees would then be subject to more competition. The faster the supply of doctors increases, the faster the medical community would see this limitation peeled away.

11. Do not create a new US government bureaucracy, or national cooperative, to manage healthcare. The free market is the only system that will work, if proper competition, regulation and controls are instituted as suggested above. Micro managing each medical transaction will never work efficiently; as already proven in our present system.

1. Replacing or compounding the inefficient and costly ways of the present third party beneficiary system with a governmental bureaucracy is simply adding fuel the fire and will fan the flames of patient/taxpayer outrage and suffering.
2. Medicare and the Veterans Administration are examples of what can go wrong when government manages or mismanages healthcare. The same system as above should be used for medicare and the VA to eliminate bureaucracy and reduce costs as well as improve quality of care.
3. Consideration should be given to privatizing the VA hospital system to reduce federal costs. The current VA budget in total is almost $90 billion. These hospitals could then fall under this proposed healthcare plan and they would be regulated like other hospitals under this plan.

12. A national or local cooperative which does not manage care but instead is a voluntary membership group could be layered on top of the proposed plan.

1. Such an entity would need to be voluntary on the part of medical providers and patients.
2. The cooperative could offer service and product discounts similar to pharmacy member discount cards that exist now.
3. Such a cooperative could give independent groups of medical providers an opportunity to compete with vertically integrated medical providers like the Cleveland Clinic or Mayo Clinic without the need to be physically located in the same building.

13. This plan is fully compatible with other cost and efficiency methods.

1. Technological advances such as digitized and shared medical records would be easily usable under this plan. A national data bank of medical records would be a goal.
2. The IRS and bank reporting system alone will provide nationally collected real time medical data for the first time and yield certain useful information on major categories of cost, with accuracy not presently existing.
3. Any new cost reduction innovations will not need preapproval by anyone for the patient to use them. For example, new procedures created or low cost clinics built for medical care will be immediately usable by patients, unlike the approval methods required presently with managed care. The patient will choose ways to save costs simply because costs will be more painful under this plan than under managed care, as each dollar spent will now be transparent to the patient.

Summary

The proposed universal healthcare plan roadmap entails a public-private partnership while maintaining crucial elements of the free market system. Using market forces of supply and demand, combined with boundary regulations and incentives, is the only way to achieve all that we want and need in a quality healthcare system.

Reducing costs will be accomplished by increasing the supply of medical professionals and fee competition, by providing incentives for drug companies to lower their prices, by eliminating the third party insurance payment plans together with their market inefficiencies, by reducing medical malpractice costs to medical providers and by regulating the hospitals and clinics like utilities to give them a reasonable and fair return on their assets. Other plan regulations would provide disincentives for price gouging and healthy patient outcome incentives to both patients and doctors, further reducing and controlling healthcare costs.

Eliminating the third party insurance reimbursement present system in favor of direct patient to medical provider payments should result in 25-40% cost savings in our national healthcare costs because present administrative costs of both the insurance company and doctor's office disappear, as will the profits now earned by the insurance companies. These savings would benefit the patient and the US government as they would reduce the cost of care under the proposed universal plan, when compared to our present system.

Doctor-patient relations will be direct and result in better quality of care as well as financial cost control and accountability. The dual purpose National Health Credit Card, managed by private banks similar to Master Card or Visa, will provide easy administration of the universal healthcare plan without reams of paperwork or a new huge bureaucracy. Instead, the existing reporting mechanisms to the IRS and the audit capabilities of the IRS can be used to monitor the simplified reporting of medical entitled benefits and costs. Medical cost types and further details will be able to be tracked historically on a national basis. Medical histories of patients will ultimately be embedded in the same National Health Credit Card which is used to charge medical costs.

Costs will also be controlled by requiring the patient to pay an annual deductible, including a variable medical transaction deductible, to ensure the patient has ‘skin in the game' with each medical transactions he or she decides to do. To meet federal budget constraints, the plan uses a system of tax credits with the deductibles to create funding flexibility, which can be adjusted very simply, according to the state of the economy, experience over time, type of medical costs incurred and income levels of those benefiting from the plan.

Most importantly the patient will have freedom of choice to go to any doctor he or she wishes, unlike the present system where one must change doctors when the employer chooses a new insurance company. No longer will medical benefits be tied to the employer's opinion as to what plan is least costly to its business, which results in disastrous consequences to employees monetarily and in terms of healthcare continuity.

By using the insurance companies at a global pool level to insure or reinsure portions of the US government paid health cost portfolio against the risk of abnormal increases in benefits that must be paid out on a monthly basis, the cost and predictability of cost to the US government may be optimized. In addition, Wall Street may be able to securitize tranches of the US government debt that will be issued to cover non-patient contributed health costs incurred on the National Health Credit Card, which could optimize capital costs and the amount of debt required to fund the universal healthcare system proposed.

The plan does not address cost reductions that could result from technology and other innovations like low cost clinics and voluntary cooperatives that may compete with present medical providers in the future. These would be in addition to the savings in healthcare that would result from changing the business model as suggested.

Finally, the ideas presented in this paper are structural building blocks. Much work needs to be done to refine these ideas. The author invites feedback and discussion on these concepts.

Authors Website: Under construction

Authors Bio:
Alan Scharf, through his own firm, A.B.Scharf and Company Ltd., provides strategic, operational, organizational and financial consulting services to a wide variety of businesses. The firm's specialty is corporate restructurings, financial engineering, turnarounds, and workouts of troubled businesses, including real estate. He has been personally responsible for the development, asset management, analysis and/or workouts of portfolios of assets, including non performing loans, in excess of $6 billion. Clients have included several New York Stock Exchange firms, institutions and privately held entities. Formerly with a major international accounting firm, Alan is a Florida licensed Certified Public Accountant, Real Estate Broker and Mortgage Broker. Alan graduated Cum Laude with both a Bachelor of Science in Economics in 1972 and a Master of Science in Accounting in 1973 from the Wharton School of Business of the University of Pennsylvania. He financed his college education by performing as a disc jockey, both on radio and in private appearances. In the healthcare arena, Mr. Scharf has been interviewed by Clear Channel radio, the Washington Post and on national television. He has also written words and music and co-produced a radio commercial, and is the author of an, as yet, unpublished comic strip.