H.R. 676
I've been thinking about this a lot lately. A few posts here, articles there, NPR discussions there, and comments from our posters. I've been thinking about how we can push for health care. But I'm saving that for another post, soon to come. In this one, I'd like to look at a piece of legislation that is currently "pending."
Introduced by John Conyers, every year since 2003. This year it has 93 co-sponsors. Naturally, it's currently stuck in committee.
But take a look at it with me and figure out if we think it's something worth fighting for.
Covers services "medically necessary," including primary care and prevention, inpatient and outpatient care, emergency care, prescription drugs, durable medical equipment, long term care, mental health services, dental (not cosmetic), substance abuse treatment, chiropractic care, vision care and correction (not cosmetic, i.e. laser correction), and hearing (including hearing aids.)
So that's all pretty good. I'd question who gets to decide which services are "medically necessary," as that's often one of those vague wordings we have to battle with the insurance companies. Anyone who's ever had to go through the nightmare of submitting "letters of medical necessity" knows. Mental health and substance abuses services are great, most insurance companies now offer woeful coverage of those conditions that require years of treatment. The Mental Health Parity Act helped with some of that, but anyone with preexisting conditions or non-employer provided health care is still getting royally screwed. I'd also wonder where things like occupational, speech, and physical therapy come in.
Participating providers have to be public or non-profit, institutions have 15 years for conversion (and financing that has something to do with T-bonds). Freedom of choice in doctors and providers. It's unlawful for private health insurers to sell insurance that duplicates the benefits of the Act (but doesn't prohibit coverage for benefits not covered.)
Presumably, this is to maintain equity and eliminate the rich-poor health care gap, but I suspect this is one of the more contentious aspects of the bill.
Budget includes provisions for health professional education, including amounts for continuing funding of resident physician programs.
Hopefully also for nursing and allied health profession education as well. Or something to address the serious shortages we're facing in those fields. And we need to talk about how to address the primary physician shortage.
The budget of the providers are set through annual negotiations. Payment methods to practitioners include fee-for-service (negotiated annually), salaried positions in institutions receiving global budgets, and salaried positions in group practices or non-profit HMOs. Providers submit simple forms (or electronically) to regional directors and receive interest if it's not paid out in 30 days. Patients do not receive balance bills, for remaining amount charged after accepting payment from program.
Ok, so one, we're talking salary caps here, no? And also, Medicare/Medicaid reimbursements, as I understand it, are a serious problem. What provides that the same won't happen?
Prescription drugs are on a formulary, in other words, a list of approved drugs, and you have to get an exception approved for others not on the list. This is to "encourage best-practices in prescribing." It's updated regularly and clinicians and patients can petition to add/remove drugs.
Ok, so I like the petition bit, but insurance companies already do this formulary bit, and it's usually worked out through whichever pharma company they work with. So who decides here? Potential for problems.
How to pay for it? (The big question.)
1, "Existing sources of federal government revenues for health care." (Anyone have an explanation of that one?)
2, By increasing personal income tax on the top 5% of income earners,
3, a "modest and progressive excise tax on payroll and self-employed income,"
4, A small tax on stock and bond transactions, and
5, System savings as a source of financing.
This probably would be the most contentious bit of the bill. (Other than it being "socialism".) Personally, I don't think they should increase income tax on the top 5%.
I think they should increase it on everyone, if we're really getting "free" health care at every other turn. Right now, I pay over $6,000 a year for private, direct-pay insurance for my son and I. Over $500 annually for prescription drugs. And I don't have a guess on the copays and balances for other stuff. Let's lowball it and say $500. They could take another 7% of my income for it, and I'd still be paying less than I am now. Granted, the current state of the economy changes all this a bit, but I'm thinking long-term.
The excise tax. I don't really get how that works, so I'd love an explanation, but it sort of sounds like crap to me.
So what do you guys think of the bill?
I'm left with a couple questions, other than the ones I already mentioned. How did other countries pay for their single-payer systems? Increase in income tax was my understanding of it. Are there other sources for the budget of it? Additionally, is supplementary insurance allowed? Is it utilized often?
Would such a system make Medicare/Medicaid obsolete?
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Hello . . .
If you'll notice, the title of the act is:
"United State National Health Insurance Act"
(or the Expanded and Improved Medicare for All Act)
I think that title alone answers your query as to whether or not the act would make Medicare/Medicaid obsolete.
~OGD!
January 30, 2009 11:59 AM | Reply | Permalink
LOL. Consider me embarrassed. So would they just shut down all the bureaucracy around those programs (and other health care programs like the SCHIP) immediately and fold the administration and insurees into this program? I guess I'm just trying to work through the transition process. Same thing goes for insurance companies. What happens to all those folks?
January 30, 2009 12:10 PM | Reply | Permalink
That is something they have to do:
Automobile No-Fault Ins--50 plans--five hundred providers?
Workers Compensation--50 plans--? total providers
Federal Workers Comp--1 plan--providers?
Railroad Retirement--1 plan
Veteran' Insurance--1 plan
Individual plans--500 plans?
Small, small business--____plans?
Small biz (1200 emp or more)- _____plans?
Big Biz--_____plans?
Medicare
Medicaid
Drug legislation--give away to _______companies
SCHIP
Olden Golden just showed in blog that 2.6 million jobs would be created with one payer system
January 30, 2009 12:52 PM | Reply | Permalink
It is important to ask the questions. It is the only way you will get the answers.
January 30, 2009 6:59 PM | Reply | Permalink
Good post, Hillary!
To me this program could be funded if literally everyone is folded into it. That would fold in people now in the VA and Military health systems, which are already structured as free systems with formularies and doctors paid at set rates. It would fold in Medicare, which basically already sets rates. And MedIcaid, which is now done state by state but would benefit from being part of much larger system. SCHIP as well. I'd also fold in Public Health and the NIH. The more you fold in, the more your overall budget is really lowered - because so much money is already flowing into these other systems.
Frankly, I'm for whatever gets us universal care and which in effect reforms everything that is already going on.
For those who prefer private care instead of this, ok. I would not force them into this.
Thanks for this timely post.
Anybody who's for this bill, if you don't want it to wait till another year:
January 30, 2009 12:17 PM | Reply | Permalink
Ahhh! I am glad you dropped that reminder to call in there! :)
January 30, 2009 7:06 PM | Reply | Permalink
Solidarity, buddy! :)
January 30, 2009 7:21 PM | Reply | Permalink
single-payer healthcare isn’t something that can wait."
Call me naive, (everybody does...) but I am deeply convinced that the first "opportunity" that my fellow Joffrey alum Rahmbo will extract from this "crisis" is medicare for all as soon as the government owns the big three.
The cost savings to the economy over all (Health Care, 18% of a 14 trillion dollar gdp, one half privately financed, that half burdened with a 20% insurance company vigorish.) is low hanging fruit when we are in financial free fall.
January 30, 2009 12:45 PM | Reply | Permalink
Once again, if you want your voice heard most effectively, do not call, but do FAX.
Also, the person to really inundate in thise case (in addition to your own elected representative) is the Chair of the House Rules Committee (who is presently Representative Slaughter). This is the person who decides what and how bills are presented to the House.
But, again, promise me: no calls, no website textboxes, but FAX!
January 30, 2009 1:41 PM | Reply | Permalink
The best way is to call, fax, email and write them... And if you ever see them in person (go out of your way to do this if you can) tell them to their faces.
I can not stress enough that it is important to be as respectful as you can (unless they blow you off?). It's that "more bees with honey" thing.
January 30, 2009 7:10 PM | Reply | Permalink
I suggest you read the blog I linked to where I pointed out the most effective way of dealing with your elected rep. And if you try to call, fax, and email them (assuming you can even email them), you will limit your chances on getting a meeting having distinguished yourself as a pain in the ass.
January 30, 2009 9:00 PM | Reply | Permalink
good grief!
January 30, 2009 9:44 PM | Reply | Permalink
.
QUACK!!! QUACK!!! QUACK!!! QUACK!!!
Birds of a feather and all that, ya' know.
~OGD~
January 31, 2009 5:11 AM | Reply | Permalink
Hey 99. Here we have:
- limits on drugs, procedures etc. available, so the core costs don't go wild.
- no salary cap, just fee-for-service. Docs can work more, or take on additional private clients.
- we allow richer people to buy more services in privately if they want.
- VAT-like taxes of 7-8%. Not quite the same as a Sales Tax, but is imposed at various stages in the chain. But it shows up on your retail purchases like a sales tax.
I'd suggest a VAT/Sales tax at the core, but also add in a tax on the wealth tucked away over the last 10 years by the uberwealthy, or maybe a tax on the top 5%. Just for general justice purposes.
January 30, 2009 5:08 PM | Reply | Permalink
Thanks for the info Q. I especially love the dropping of things like VAT tax, of which I know nothing. (How many kinds of taxes are there, anyway?)
What was the transition to that system like though?
January 30, 2009 8:39 PM | Reply | Permalink
The national transition was a walk in the park. You literally never hear a story about its difficulty. Which is partly why I want to shout at people when they raise these red herrings.
The only hard part was when the very first province - Saskatchewan - developed & implemented it. Why? Because the doctors went on strike... and the entire the American & Canadian doctor/medical establishment backed them... so it was one little Prairie political party up against that. And they won. A few years later, the National Government adopted it.
Look. Doing it makes absolute economic sense. Practically, there's issues of training & retraining people, etc. But all you're really doing is moving MONEY. Who pays who. Where do they get that money from. The opponents make it sound like the Gestapo will be picking your doctor for you, tubes will be pulled from the noses of the sick, on and on. The whole debate is just overlaid SO heavily in the US with this weird commie/socialist stuff, and a load of fundamentalist blather about markets & freedom - ideology of the worst sort. Add big money to the equation, and hey voila. Mess.
Other people, in other countries? Look. If this shit wasn't so real, they'd laugh. It's like not having evolution taught in schools. It's backward. Dumb. Dysfunctional. And for those involved, and being hurt... it's frigging tragic.
January 30, 2009 9:30 PM | Reply | Permalink
Hey, no need to convince me of the sense of it, I'm already in, just trying to take a critic's eye to it for a second so I know better what I'm talking about.
Got into a talk about this over the holidays with someone and he was asking me some questions I didn't have answers for. (I hate that.) Most about the switchover. A lot of the myths from the propaganda pushers have taken a little bit of hold, just want the right answers for 'em.
But this one: "this weird commie/socialist stuff" just baffles the mind. I never know what to say when I run into that. It's like an immediate switch where I know rational discussion will no longer be.
January 30, 2009 10:44 PM | Reply | Permalink
Sorry 99. Those last 2 paras weren't directed at you. That was me, having read a lot of posts on this issue these past 2 weeks (which is good, and we should have them daily) just letting off steam at those voices that make this thing sound not just technically & practically hard, but somehow also unAmerican.
When I'm in the states, I'll hear utterly sane people roll out these weird lines about health care. I mean, people who can talk about global warming science, and Iraq, and the UN with great insight. And then, they hit health care and out come the most uninformed, illogical, comments. They can stare straight into the eye of a system that costs waaaaay more than other countries, and say, "But it'll cost so much more." Or talk as though they'll have to bear years long line-ups for anything - without even relating it to the people they've met in other countries, who clearly are living long healthy lives.
Anyhoo. The earlier paras were just steam coming out of ears, eyes staring into the distance. Sorry 99!
January 31, 2009 12:03 AM | Reply | Permalink
Here's what we're up against down here Q. This 'opinion' piece in a New Hampshire rag showed up today. It's written by a Republican state representative, and amounts to the same tired meme, stirring fears of transition to single-payer. I all ready sent in a long letter to the editor rebutting just about all of the points the author made, but even if they publish my letter, how many will have all ready read this bozo's disinformation campaign? One thing that's dawned on me is that if this clown can get a column or two in his local rag, perhaps we can as well. I'm gonna start righting my own opinion piece for my local paper, and encourage the rest of you to do the same.
January 31, 2009 12:18 AM | Reply | Permalink
and two rights don't make a write... :(
January 31, 2009 12:20 AM | Reply | Permalink
Q, I tried a blog on a value added tax on stock trades. Like they do in Europe. Since they do it in Europe, where would our traders flee?
Trillions of dollars every year in value are traded.
1% would bring in so much money. And those involved in trading, buying or selling would simply take it into consideration. Do I sell now and take the capital gain treatment--up to you but it costs 1% off the top. No deductions. A sales tax.
Blog went nowhere but it might have been timed wrong like my piece on Rush and WSJ today.
Do you think this is in the offing?
January 30, 2009 9:32 PM | Reply | Permalink
That was a good blog, Dick. Just recommended it! the link to Baker's paper was interesting too, but - to answer your question - he suggests you shouldn't bring a STET in during a "financial crisis. Makes me mad just reading it though, and remembering my futile attempts to get a more limited measure - a Tobin tax - introduced. The damn things work to REDUCE speculative bubbles and slow hyper-activity down. But of course, once everybody's going nuts, churning money, nobody wants a TAX! So... we can;t bring one in during a crisis, and they won;t let you bring one in once they've got fast cash fever. Probably have to hit that sweet spot, just in-between. (Interesting too to see that both Summers and Stiglitz wrote papers supporting such taxes. Wonder if Summers has ate his words on that?)
January 30, 2009 10:09 PM | Reply | Permalink
Hell, just take everything everyone owns and be done with it. Much simpler that way. Don't have to figure any percentages, or calculate added value. Much more efficient system.
January 30, 2009 5:29 PM | Reply | Permalink
Now, now - calm down. And bite my tiny shiny warty little skinny green ass! Ribbit!
January 30, 2009 5:55 PM | Reply | Permalink
Legzz. Maybe zee legzz. If we get hongree 'nuff. Yezzz!
January 31, 2009 5:41 AM | Reply | Permalink
.
Oh no . . .
Geez ... Thanks for dropping that fart.
Does this mean we're required to take Oklahoma and Idaho too? Texas is tough enough.
Now someone light a match... please...
Dingbat!
~OGD~
January 31, 2009 5:27 AM | Reply | Permalink
Can we get health insurance in little dribs and drabs? Or do we need a massive demand from the uninsured to make this happen in one comprehensive act? All the details worry this uninsured woman. How about this: I'll take what the members of Congress get. I'll take what the President gets. I'm tired of being a beggar.
January 30, 2009 6:04 PM | Reply | Permalink
If we can get single payer universal health care... They will have the same plan as every single one of us.
January 30, 2009 7:12 PM | Reply | Permalink
Kali, I'll take what the members of Congress get, too.
(You know, I bet if they had their health insurance yanked out from beneath them like so many of us have, they'd be pretty dang quick to make it available to every citizen. But, I digress.)
As I understand it, the same coverage Congress has is just one of the options given in the plan the Obama team came up with. If you are not covered you will have the option of shopping around to find a plan to your liking and buying it. If you can't afford the entire cost, you will get help from the government to cover the remainder.
Begging doesn't enter into the scenario. You will be paying what you can afford to pay for adequate coverage.
And I am of the opinion that health coverage and access is a RIGHT.
January 30, 2009 7:18 PM | Reply | Permalink
It is - in the UN Universal Declaration of Human Rights. :)
January 30, 2009 7:20 PM | Reply | Permalink
Ain't dancing 'cross the tightrope without a net grand...
January 31, 2009 7:28 AM | Reply | Permalink
Renaye: Overreact much? It's socialised medicine, not socialised everything.
Kali Star: How is asking for the government to provide you with health insurance you do not have now not begging?
Conyers' bill is one of the better proposals I've heard for socialised medicine in the United States. Of course, as an opponent of socialised medicine generally, I think it's a bad idea. Advanced technological health care is a luxury, not a right; one look at the cost of a dialysis machine should convince anyone of that (Not to mention the cost of educating a doctor).
But as socialised medicine goes, it beats NHS: there are real limits, real opportunities, and real market elements.
To be honest, I don't have THAT many objections to free primary care (as long as getting your shots is a prerequisite). It isn't that expensive and the prevention element is a net benefit. But "mental health treatment"? "Long term care"? "CHIROPRACTIC"??????
Seriously, this is to be done with money we're taking from people by force?
January 30, 2009 6:38 PM | Reply | Permalink
Socialised medicine would not involve private practitioners. Single payer is NOT socialised medicine. Though, you might be right in calling it the payment system side of it socialist. But not the private practice delivery of services side of it.
January 30, 2009 7:21 PM | Reply | Permalink
Er... doesn't the Conyers bill require medical providers who participate to be public or "not-for-profit?" They are not exactly "private practitioners" anymore if they want to participate in the system, so it is a socialized system.
January 31, 2009 10:43 AM | Reply | Permalink
No. They are private practitioners working for themselves (or a hospital or partnership, etc.) just as they are now. The one big change for them? They bill one outfit (the government or a board/group funded by the government).
February 10, 2009 10:09 AM | Reply | Permalink
Honestly, I was surprised to see chiropractic in there too. But mental health treatment and long term care should be in there.
What I'm mostly trying to understand is the transition from what we have to what we want (in that currently theoretical world.), and what the barriers are to successful implementation. I don't just want to push for the legislation for the sake of it: I want it to work. Well.
January 30, 2009 8:28 PM | Reply | Permalink
I've not finished reading the piece but there is a long essay in The New Yorker about the transistion to nationalize health care that is very interesting. It is here http://www.newyorker.com/reporting/2009/01/26/090126fa_fact_gawande
Worth a copy and paste.
January 31, 2009 6:57 AM | Reply | Permalink
Definitely worth the read. Migwetch (thanks) bluesplashy.
January 31, 2009 8:52 AM | Reply | Permalink
Participating providers have to be public or non-profit, institutions have 15 years for conversion (and financing that has something to do with T-bonds). Freedom of choice in doctors and providers. It's unlawful for private health insurers to sell insurance that duplicates the benefits of the Act (but doesn't prohibit coverage for benefits not covered.)
Presumably, this is to maintain equity and eliminate the rich-poor health care gap, but I suspect this is one of the more contentious aspects of the bill.
What it seems to be trying to do is to make it so that doctors who do not wish to participate in the system and wish to participate in a parallel private system must be paid directly. The goal is obviously to make it as difficult as possible for doctors who wish to operate independently of the single-payer system.
I also find the desire "to maintain equity" to be rather totalitarian. Essentially, the goal is to make it hard to get private care so that if the government system sucks, people will not have any other options to compare it to. The goal is also to make certain that it is difficult to buy things outside the system so that if healthcare is crappy, people who could afford to use private alternatives will be banned from doing so because those who can't would be jealous of them.
January 31, 2009 9:33 AM | Reply | Permalink
I actually think people should be allowed to buy supplemental insurance as well. I hadn't thought about it from the doctor perspective though, i.e. a way of working outside of the system.
January 31, 2009 10:25 AM | Reply | Permalink
Anybody have the link to that video someone put up the other day: the BBC video on the RAM clinics? I can't find it again.
January 31, 2009 10:23 AM | Reply | Permalink
Here you go Hil.
http://tpmcafe.talkingpointsmemo.com/talk/blogs/connecticut_man1/2009/01/dodd-and-larson-get-an-earful.php
January 31, 2009 1:07 PM | Reply | Permalink
Thanks M!
January 31, 2009 5:44 PM | Reply | Permalink
Looks like I missed this one. Good post though, hadn't heard about this one.
I've talked to a lot of folks lately about health care. It might be my imagination, but it seems like more and more people who actually have health care are starting to have problems. This isn't just something the uninsured have to worry about. I'd like to see a movement afoot.
February 2, 2009 2:41 PM | Reply | Permalink