Healthcare Congressional Committee

[Bleach Blonde Bad Built Butch Bodies for Biden]

Yankee explained things better than I could have and I'm excited that the Congress is interested in taking on the issue of healthcare again.  Like the distinguished Eternal Senator, I believe that crafting a healthcare system which incorporates both public care and regional autonomy is the best prescription for the country.  And for that reason, I would advise this body to consider plans that allow the regions to maintain enough flexibility over their own healthcare and health insurance regulations while maintaining appropriate standards that guarantee universal access to quality care and a wide range of options in the insurance market.

Currently, I am in the process of drafting a possible model for the North that specializes in the introduction of a regional public option as well as subsidies and price controls for prescription drugs.  With this, I believe a federal public option would be welcomed in our region to facilitate market competition.  But, I do not yet know the budgetary impact that this model would have for the region, which will influence how I proceed in pursuing this project at the federal level.  (These matters will be dealt with after our government is formed, and this is an issue I would like to tackle as a candidate for the legislature.)

With that in mind, although I am not a member of this body, I will gladly work with any member of Congress to craft a bipartisan healthcare plan for the nation.

[Bleach Blonde Bad Built Butch Bodies for Biden]

I wholeheartedly accept the invitation.

[Bleach Blonde Bad Built Butch Bodies for Biden]

With respect to Obamacare, I don't think that an outright repeal of the law, at this point, would be the ideal course of action if doing so would cut the number of people insured, which has increased substantially since it was enacted and Healthcare.gov was put into place.  I believe it would be wiser to institute any new healthcare system as, rather, a transition from the status quo and only remove key parts of the law if doing so would reduce costs - namely, the individual mandate and the ban on private insurance companies denying clients with pre-existing medical conditions.  Incidentally, I had a system akin to the German healthcare program in development before realizing that the logistics of a single region adopting it could be complicated at best and unsustainable at worst.

Nonetheless, such a model might be ideal for the nation long-term.  One successful feature of Germancare has been its ability to incentivize doctors and hospitals not to over-utilize care for patients.  Like Obamacare, Germancare requires individuals to purchase health insurance.

Where do the regions come in?  In Germany, the "sickness funds" are divided into various regions.  (In Atlasia, we would have the option of dividing sickness fund associations on either a region or state-by-state basis - if that is the type of model we're looking to adopt.)  Regions would retain much control over their own markets and public programs, and also have a much greater role in determining things such as physician pay.

The downsides?  Physicians would likely be reluctant to become part of anything that involves negotiating their own pay or regulating how much they can treat their patients, even if doing so will reduce public and private costs long-term.  I recommend watching the video above for a better overview of Germancare and the pros and cons that come with it.

Lastly, in addition to Blair's points, we need to decide which areas of care we want to subsidize or reform.  I think the following (mostly taken from Fritzcare) are worth noting:

Primary care and prevention (arguably the most important for keeping costs down)
Inpatient care
Outpatient care
Emergency care
Prescription drugs
Durable medical equipment
Long-term care
Palliative care
Mental health services
The full scope of dental services (other than cosmetic dentistry)
Substance abuse treatment services
Chiropractic services
Basic vision care and vision correction (other than laser vision correction for cosmetic purposes)
Hearing services, including coverage of hearing aids
Podiatric care
Paid sick/family leave (not part of Fritzcare)
Contraceptives (added to Fritzcare in subsequent legislation)
End of Life Care - Shall be limited in hospital settings up to the cost of such care when attained through a hospice setting (added to Fritzcare in subsequent legislation)

[Bleach Blonde Bad Built Butch Bodies for Biden]

I believe it would be wiser to institute any new healthcare system as, rather, a transition from the status quo and only remove key parts of the [ACA] if doing so would reduce costs - namely, the individual mandate and the ban on private insurance companies denying clients with pre-existing medical conditions.

Just to clarify, there would be a public insurer in this scenario, right? Otherwise, allowing private insurers to deny coverage to people with pre-existing conditions restores the most odious reality of the pre-ACA world: that the people who need medical care the most cannot afford it.

Sorry - to clarify, I favor retaining the individual mandate and the ban on denying claims for people with pre-existing conditions in the new law.  I would only support repealing the mandate if it isn't necessary to ensure universal coverage or prevent a free-rider problem from happening.   I would say that the mandate on pre-existing conditions should remain in place, as well, unless the public plans are competitive enough to prevent people from being denied insurance by private companies.

I'm actually not sure how we addressed the free-rider problem with Fritzcare.*  I know we didn't address the problem of foreign visitors in this country becoming sick or injured during periods of stay here, either, so that needs to be another priority for any new healthcare overhaul.

I second Yankee's recommendation to invite shua as a special advisor here.  His expertise was essential in overhauling healthcare a couple years ago.

*EDIT: Nevermind.  The free-rider problem wasn't an issue for Atlasians under the law, though I'm not sure how it would've addressed foreign nationals.

[Bleach Blonde Bad Built Butch Bodies for Biden]

For convenience of the members, here are the older healthcare policies:

Atlasian National Healthcare Act ("Fritzcare") (2009)
The New Atlasian Healthcare Act (2012) Amended by subsequent acts
Reforming Public Healthcare Act of 2014

[Bleach Blonde Bad Built Butch Bodies for Biden]

For convenience of the members, here are the older healthcare policies:

Atlasian National Healthcare Act ("Fritzcare") (2009)
The New Atlasian Healthcare Act (2012) Amended by subsequent acts

It is probably most helpful to read them in order too:
Reforming Public Healthcare Act of 2014

So I will put this one with the others.

Noted.

[Bleach Blonde Bad Built Butch Bodies for Biden]

Right now, I'm personally leaning in favor of a Baucus Care-type plan with additional subsidies for prescription drugs and a public option.

[Bleach Blonde Bad Built Butch Bodies for Biden]

With Wyden-Bennett being so similar to Obamacare (as Yankee stated), I don't know if it would pass this Congress, seeing as there's an appetite to repeal and replace the ACA with a different model.  I'd be willing to back the HAA provided it includes the provisions I suggested, but I don't think it will pass in this Congress.

(Of course, any healthcare plan is going to provoke so much debate that its chances of getting an up-or-down vote before the next elections are slim to none.)

Later today I'll write a list of specific proposals I'd like to see and we can compare ideas.

[Bleach Blonde Bad Built Butch Bodies for Biden]

So, here is a full outline on what I would propose:

- Retainment of the individual mandate and ban on insurance companies from denying people with pre-existing conditions

- Creation of non-profit "health insurance cooperatives" that compete with private insurers, which would receive $6 billion to start off, but operate independently thereafter

- The dissolution of Medicaid, substituted with an expansion of Medicare that automatically enrolls individuals/families making less than $90K a year

- A Medicare buy-in option for individuals/families making more than $90K, but less than $500K, after which customers must buy private insurance

- Allowing regions to regulate their health care markets, including health insurance cooperatives, and to introduce a region-based public option (or request a waiver for the establishment of a single-payer system)

- $5,000 tax credit per plan to offset out-of-pocket drug costs that exceed 5% of annual income

- Tax Incentives for doctors and hospitals to reduce waste and over-utilization of care

- Reining in frivolous lawsuits

- Foreign nationals required to be insured by their country of origin or to buy private insurance in Atlasia prior to visiting the country (the latter for work visas and periods of academic study) [I'm not sure if this would be tenable, actually, but we can get into immigration laws and all that crap when everything else is finished]

A good combination, I think, of policies that liberals and conservatives can get behind.  The public option will exist in the event that private health insurance cooperatives prove ineffective or lack bargaining power, and the tax code will be amended to incentivize healthcare savings (rather than require doctors to negotiate their pay, as is done in Germany).  Tort reform is a whole other animal and I'm honestly not sure how we could go about addressing that, but fewer lawsuits will modestly bring down the costs of healthcare.

[Bleach Blonde Bad Built Butch Bodies for Biden]

May I suggest an expansion of healthcare for those in the active military/reserves, police and bureacracy/government workers/officials making under, say, $150,000 per year. The former two are obvious choices, while the latter one simply insures such part time workers are willing to stay on.

I also suggest a tax reduction of, say, 15% on corporations who offer an expansion of healthcare to workers making under $125,000 per year.

I could get behind those ideas, yes, though I would prefer we shift healthcare away from employer-provided insurance (a goal of the Wyden-Bennett legislation).  That will almost certainly require major reforms to the tax code - which would be simpler as a result.

[Bleach Blonde Bad Built Butch Bodies for Biden]

Honestly, I'm not sure.  Kalwejt is going to have to crunch the numbers for us on most of these things and shua can provide recommendations if he wants to be a part of this.  The $6 billion figure comes from the original Baucus plan.

The idea is that the regions will be able to do whatever they want using this framework to provide universal coverage, while consumers will have a wide range of options to choose from regardless.  A region can manage the co-ops (or let them become independent after federal funding expires), provide their own public option, or request a waiver from the law and implement single-payer.  (But the last of those three is not a very realistic option, at least if Vermont's experiment is any indication.)  Or, if a region doesn't want to support any part of the plan, their constituents will always have the federal public option.

[Bleach Blonde Bad Built Butch Bodies for Biden]

Do we want to get the ball rolling on this again?

[Bleach Blonde Bad Built Butch Bodies for Biden]

Ugh.  Three competing healthcare plans isn't exactly something I was prepared (or hoping) for, honestly...

The best thing for us might be to vote on same bare-bones proposals and then submit an outline which the rest of the Congress can build on when it hits the floor.

I'm going to try and open debate the same way I did in the Senate procedure thread, and list some fundamental questions for this committee to consider.

- Do we want to keep the Affordable Care Act and merely expand on it, repeal in entirely, or repeal certain provisions but keep others?

- If we want to repeal only certain provisions of the ACA, which parts of the law do we want to keep? (e.g. individual mandate, pre-existing conditions clause)

- To what extent should the Federal and Regional governments bear costs?  Do we want a single-payer system like Canada and the United Kingdom, a mixed public/private system like that of Germany, a totally private but heavily regulated health insurance market similar to Switzerland, or something of a different model?

- How would each proposal affect pay and subsidies for doctors and hospitals?


(Oh, and we also need to determine a chair.  I'm fine with keeping Blair on if he likes, but whoever it is needs to stay up to task on this.)

[Bleach Blonde Bad Built Butch Bodies for Biden]

3. What do you mean bear costs? The problem that the system should address in this category is to minimize subsidization of inflation, which is a significant barrier to expanded access (high bar, means more money to reach same level of coverage), while not leaving people who cannot afford coverage to die in the street or people for whom private coverage is likely not feasible (seniors and vets because or risk pricing) to die in the street.

Sorry, I was half-stoned when I wrote that.  What I meant by that is regional and federal involvement in healthcare in general; in other words, regional and federal public options, allowing regions to develop their own universal systems in exchange for waivers from federal law, etc.

I also prefer option c, which is included my plan.

[Bleach Blonde Bad Built Butch Bodies for Biden]

All right.  To prevent further delay, I'm going to issue this committee an ultimatum: I will wait one week for fellow members to post their own outlines and proposals.  During this time, I will attempt to reconcile these ideas and write up the first draft, and post it to the Senate Legislation Introduction Thread.  If nobody submits any proposals, I'll move ahead with my plan and introduce it for the entire Senate to deliberate and build on from there.

Sound good?