Atlasian National Healthcare Bill (Law'd)

[afleitch]

I fully support Fritz's (welcome!) original bill. I can see that this is a heated debate and it's good to see a bill that splits the Senate this way. I am open to compromise as I believe many of us are, however this bill has my full support as currently tabled.

I cannot see any reason why we cannot have a system as Fritz has proposed, I do not see why we owe anything to the private sector, I cannot see why it infringes on the private sector's ability to attract customers or affect the private sector which continues to thrive and flourish in the UK some 60 years since the creation of the NHS.

Once I have recovered from my holiday I will create an amendment to introduce regional elected health boards to manage resources rather than a centralised body.

[afleitch]

I fully support Fritz's (welcome!) original bill. I can see that this is a heated debate and it's good to see a bill that splits the Senate this way. I am open to compromise as I believe many of us are, however this bill has my full support as currently tabled.

I cannot see any reason why we cannot have a system as Fritz has proposed, I do not see why we owe anything to the private sector, I cannot see why it infringes on the private sector's ability to attract customers or affect the private sector which continues to thrive and flourish in the UK some 60 years since the creation of the NHS.

Once I have recovered from my holiday I will create an amendment to introduce regional elected health boards to manage resources rather than a centralised body.

Really? Well, now you're making me consider taking back my amendment

I could have an ideological reason to oppose this, but with personal experience of using such a system I would be hypocritical to oppose a style of system that has treated me well when I was born and throughout my life.

Other than setting a budget (to ensure a fair deal for the taxpayer) centralised government need have little control over what such a system does and how it is organised. Put into the hands of regional elected boards and local people then it becomes a far more democratic system than one driven by market forces and the swagger of pharmaceuticals

[afleitch]

I would propose the addition of a Section 4 to this bill.

Section 4 -

a- The provision of healthcare and the administration of budgets and services shall be the responsibility of Community Health Partnerships (CHP's) congruent to the existing Regions  These shall be established as public sector corporations. Each CHP shall be headed by a board consisting of one executive and further elected non-executive directors.

b- All boards shall be required to have an audit committee consisting only of non-executive directors on which the chair may not sit. This committee shall be entrusted with the supervision of financial audit and of systems of corporate governance within the CHP.

c- CHP's shall have responsibility for delivering primary and community services and commission them from other providers, and are involved in commissioning secondary care. Each CHP shall have their own budget and set their own priorities and shall directly provide a range of community health services including but not exclusive to;

i. The provision of funding for general practitioners and medical prescriptions.
ii The commission of hospital and mental health services from the private sector.

d- All members, directors and associated bodies shall be accountable to the Director (of Health) as outlined in Section 3 of this bill.

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For the record, the elected posts would be 'non playable'

[afleitch]

I think this is a step in the right direction myself and thus I support this needed addition dealing with administering the program. I also like the audits. There is no reason to create a boondoggle here and thus we should have some measures of accountabililty involved. What about transparency? Should any of the program be made open to public view as long as it doesn't violate peoples privacy?

Quite simply yes. I hope to introduce an Open Government Bill shortly which will cover this (and other government bodies too) However I think given the nature of this legislation it should be stated within the legislation.  A further section requesting this as well as the publication of health 'league tables' on health progress, treatment, waiting times, expenditure would be worth consideration.

[afleitch]

A quick review of Franzl's proposals.

Amendments to Section 1 are to dissimilar to what was introduced later into the NHS in Britain, namely that there were prescription charges that were not cost prohibative and were waived entirely for people on low incomes, senior citizens etc. So that is not unreasonable.

Striking out the full scope of dental services is however unreasonable. All dental 'check-ups' should be free for and secondly all treatment, including orthodontic treatment should free for minors. Immediate emergency dental work should also be free fo including reconstructions as a result of injury.

Amendments to 'd' help clarify wording, however it should be assured that all persons are presumed to be 'enrolled' within the national system unless their insurance allows them to make use of private healthcare in all or specific circumstances. Likewise should an individual choose to waive treatment offered privately (because sometimes state care is materially 'better' - particularly secondary care) they shall not incur any charges in the national healthcare system as a result.

On Section 2, I agree with the need to widen the method of funding, but feel that a system of National Insurance (see - http://en.wikipedia.org/wiki/National_Insurance) may be preferrable.

[afleitch]

I hereby open up a vote on this amendment. Please vote Aye, Nay or Abstain.

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Aye

You have a difficult job organising this

As the same issue creeps up over here on 'dual coverage' and given the many reasons for striking it, I will vote Aye.

[afleitch]

Franzl, I absolutely do not support such a thing being stuck to one's income. I'm fine with fees for drugs, that's not terrible and I think, personally, Is actually a quite reasonable additional fee for some drugs and for certain people, but raising what essentially is a minimum of a 5% tax hike on people making 25k a year and higher penalties for those making more is not acceptable to me.

I would agree that this should be adressed which is why I had floated the idea of employer matched contributions.

Concerning the possibility that somebody with private insurance should be eligible to get state care if he wants it...I would have to respectfully disagree with that. I think it should be reasonable to demand "all or nothing", and that anybody that refuses the state insurance system should be responsible for his health insurance privately. Of course he should be eligible to switch to government insurance entirely if he so desires.

I cannot agree to that. It would be bureaucratic to break down someones private insurance and cut off access to state healthcare accordingly. If a receptionist at a chiropodists is offered a small amount of private cover for any chiropractic services but is covered nationally does that mean that when chiropractic treatment is recommended 2/3rds of the way into a recouperative hospital stay post injury she has to be wheeled out to get private treatment or someone private has to come in to see her?

The only way to have a healthy relationship between public and private provision of services and as I have pushed for, allowing the state to buy into the private sector to provide patient specific care, you cannot lock those who have private insurance, whether full or partial out of the national healthcare system.

[afleitch]

Should something be added to the bill to prevent rationing from occurring?

Tough one. There should be efforts to ensure that there isn't a 'zipcode lottery' where care and coverage varies upon where you live rather than who you are but some 'rationing' has to naturally occur in any health service (you have one liver, who gets it the baby or the drunk etc) Likewise there will be restraints on the provision of healthcare based on lifestyle and need; if you have to loose weight to get an operation then you have to loose weight. I think 'rationing' due to need cannot be legislated. Rationing by political choice alone can be, through the introduction of elected boards which I have proposed.

[afleitch]

I mean more like, oh, you're 73 years old and therefore treatment x for condition y is not worth it. From personal experience, my grandfather received surgery at age 72 for cancer. He lived for 15 more years.

I would not support age discrimination (I need to check to see if we have anything relating to that in the statute). Often doctors can advise 'it's not worth it' to people of any age depending on circumstances, but I would be against denying or allowing treatment based on age alone.

[afleitch]

Aye on the amendment.

[afleitch]

I'd also like to remind the Senate that the income tax system is similar to the US barring a higher rate of tax for high earners to pay for education (see two Senates ago) and a 0% tax rate for low earners (see many many Senates ago )

I would hold that any system of payment must ensure that those covered by the existing 0%  rate still pay 0% on their income.

That is assuming we are linking this to income.

[afleitch]

Aye!

[afleitch]

That's what it looked like when I read it. These are federal organizations that are designated to run health care in specific regions. The regions cannot deny their existence and people are free to access the government run plan.

Exactly. They are essentially 'providers' in the sense they deliver local servives that are tailored to meet the needs of the populace. They are bodies based on the regions but only contiguous to them and are elected independently.

[afleitch]

While I extend gratitude to you Jedi for managing this...tricky thread I will have to speak to Franzl on this amendment. We had had a discussion and he had agreed to putting dental care back into the bill for minors, reconstructive dentistry etc; unfortunately and understandably it wasn't amended. I have no issue with the rest of the amendment but won't vote on it just yet.

[afleitch]

I don't know if anyone said anything about it yet but the main reason this won't work is there aren't enough doctors to go around. There isn't enough as it is now to care for everyone and the number of doctors and nurses is dropping each year. If we pass anything we'll be bringing on rationing in all but name so say bye bye to any care for old people and many others.

I would disagree with that. There are many reasons to oppose this sort of system but to say there is a 'lack of doctors' so therefore it won't work is a bit off field. Cuba has more doctors per head than the UK, but the UK provides a better quality service. We have something like 2.2 per 1000 as opposed to 2.3 in the US and 3.3 in Sweden and 4.1 in Italy. Its not resources that are the issue but how they are best utilised.

[afleitch]

Could the honerable Senator explain what he means by "best utilised"? What do you think is a poor utilization of medical resources?

Poor utilisation of medical resources would include non reconstructive cosmetic surgery. However the example I was alluding to is that the standard of healthcare is low in Cuba despite a high number of doctors due to poor infrastructure, poor investment in medicine etc. The promotion of good health among the population can also help; encouraging children to brush their teeth, people to eat healthily etc. The government goes not have to support this of course, it can simply be a 'culture of health.'

In doctors work better if they are supported; if they have the tools to do the job. Same goes with any profession.

[afleitch]

Aye FTR

[afleitch]

Kudos to all

[afleitch]

Wow, interesting to see where "Mr. Conservative" will vote on this

I'm sure Mrs Thatcher would approve

[afleitch]

I oppose the bill because it is overextending the government's power and creating a dangerous situation as well as robbing tax dollars away from the American public.  My point here was only to alert others in my party that a faux conservative keeps trying to win us over

Then take it off this thread.

[afleitch]

May I add, I got what I wanted out of this bill not only in my amendment but also with regards to the way in which the whole premise was presented. I hope it satisfies enbough people in general to allow it to pass.

And thank you to Fritz for bringing this to the table; it was one of your first bills (?) and quite a risk.

[afleitch]

Aye

[afleitch]

Aye

[afleitch]

Nay


Keep your hands off our Healthcare, and keep your hands off my medicaid.

Sorry but I just can't vote for this.

I have to say I am a little suprised! Given this post;

Don't be confused though. This bill currently falls well within the confines of reform and as such it is not socialist, unlike the bill that was orginally introduced. I do think the market manipulation is a little overdone by the provisions here, but it doesn't fundamentally conflict with my personal views in regards to the gov't role in the economy like it did before. It does however still grate on me in terms of how much that should be. I guess I could say I am really undecided how to vote on this bill. When I first approached this debate, my primarly goal was to make the Private market work as much as possible and only having the Gov't intervene to the extent necessary to make that happen and solve a few problems such as the fate of the Uninsured. Coming in third was not extending the Gov't beyond what I though necessary to achieve this goal.

Fair enough on the 'nay'; but the 'hands off!'?