Healthcare Congressional Committee

[Southern Senator North Carolina Yankee]

This specific post is probably best since you won't have to dig through ten pages to find the final text: https://uselectionatlas.org/FORUM/index.php?topic=191318.msg4211876#msg4211876


Keep in mind the backdrop. Atlasia had passed two healthcare laws previously, both of which were poorly designed (The National Healthcare Act of 2009 and The New National Healthcare Act of 2012). The first was single payer with private supplemental insurance and carried the named ANHC or alternatively Fritzcare after its sponsor. It was never probably funded and one clause in one section essentially banned all private insurance among many other conflicting text problems. The New National Healthcare act was basically an amendment of the first. It was better funded, but still contained numerous flaws and adopted a "Sliding Scale of Coverage" to cut costs. Atlasia had also merged Medicare, Medicaid and Tricare into that same system as well, before 2014 and thus before the 2014 law was passed. The first two in the 2009 act and the latter in the 2013 Tricare Reform Act.

In early 2014, Potus2036 presented me with a proposal to significantly alter the healthcare system. I introduced it for him, but it was a few months before it came to the floor. At the time there was a general consensus that the healthcare system as established in the New National Healthcare Act of 2012 and subsequent amendments was badly flawed. Concurrently, there was a much narrower bill from the Duke administration dealing mainly with technology and delivery that was passed in February 2014.  

But wider reform was necessary and that proposal came to floor. It was nearly completely rewritten by the end resulting in the law you see linked above, joining with members from four different parties (Fed, DR, TPP and Labor) to produce a working substitute that restored competition, empowered the regions and still ensured adequate care for seniors, vets and the poor. Federally created, regionally administered exchanges were created in all five regions, with like two or three Federal regulations. Fritzcare was transformed from an entitlement to a public option that was offered by default in every exchange and regions could determine who else to allow onto the exchange. All plans, including fritzcare charged premiums, thus re-establishing the possibility for competition with other options as determined by regions once again and a "sliding scale premium subsidy" was included to ensure proper coverage while not paying for Bill Gate's healthcare. The subsidy was designed by then Senator Shua who specialized in crafting benefit scales to avoid coverage cliffs. He did this in several bills and healthcare was designed likewise to avoid the problem of sudden drop offs on slight income increases that harm people from taking promotions and finding better jobs.

I realize there are a lot of components that some might take issue with, be it a public option for the right or emphasis on the market and regions for the left. Keep in mind the presence of a public option was necessary because medicare, medicaid, tricare had already been phased into the general public healthcare system. For our purposes now, including such, could likewise facilitate a similar consolidation and there are immense benefits to doing so again. Quality improvements, greater choices in doctors and savings both from consolidation of agencies and also through the expansion of competition. Likewise the regional component allowed for regions to determine the nature of their exchanges. They could for instance only allow the public option, supplement the subsidy 100% and have a single payer system. They could create their own regional level public option, they could create co-opts, and/or they could allow for private sector insurance to be offered. This level of decision making would empower and strengthen regions, creating debates over the nature of that region's healthcare system, by giving them a range of options within a set of a few minimal federal requirements.

We have seen proposals like those of Scott, which would need to be altered obviously to reflect any federal law, but it shows the potential and frankly lost potential back then when both myself and Scott were taken out of commission a month after passage. There is appetite for regional involvement in healthcare clearly and with both the public option and a sliding scale subsidy there is no need for concern that people will be left without care if a region does nothing. At the same time, regions can fully expect to be able to compete with the public option with their own plans, co-opts private plans etc, in most every segment of the healthcare market. Private insurance for instance has difficulty when it comes to seniors for obvious risk pricing reasons, hence once again the importance of a public option if medicare is consolidated in.

The subsidy created and funded federally also ensures availability of resources to ensure regions don't face the funding problems that places like CO, VT and CA faced when they tried to go go it alone essentially.

This approach was balanced, tackled virtually all aspects of the healthcare market, promoted competition and regional control while still ensuring adequate protections for vets, seniors and the poor and middle class. There are areas where things would need to be tweaked, and consolidation of the healthcare market would require a complex transition, that had already been completed prior to 2014. That said, I think this was the best approach then, and is the best approach now with some necessary alterations to deal with differing backdrop (entitlements aren't consolidated in, employer based healthcare still exists etc) post reset.

[Southern Senator North Carolina Yankee]

I accept the invitation obviously.

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.

Yes, that would be my assumption. Under the 2014 bill, there was not an individual mandate for instance. The only mandate was that all providers had to cover preventative care. Scott listed what the public option covered (it inherited the same coverage areas from the 2009 bill plus subsequent amendments). But on the flip side 1) There were no private insurers left by that point by most estimates as a result of previous legislation and its impacts and 2) Regions alone could decide whether or not to allow competition onto the exchanges and what that competition looked like.

The Public Option (and all providers for that matter public or private) was subsidized on a sliding scale as well (I would recomend you invite shua as well if he is interested in participating), and would have been the primary provider for seniors since Fritzcare had medicare rolled into itself in 2009. Like with those with pre-existing conditions, seniors face difficulty getting covered absent medicare because of the risk-pricing would make it completely unprofitable. It would have worked in the same manner for those with pre-existing conditions as well.

[Southern Senator North Carolina Yankee]

Here is the CliffNotes version:
1. Repeal ObamaCare/the ACA.
2. Institute BaucusCare/AHFA(The Atlantic: Details of BaucusCare) for twelve to twenty-four months.
3. After that time is up, the Healthy Americans Act/Bennett-Wyden Act(Wall Street Journal: Wyden's Third Way(on healthcare)) will come into effect.

What is the point of steps 1-3? If you want to move to Wyden-Bennett, you might as well just reform Obamacare into it. They are like 95% similar, both rest on private plans competing in exchanges under an individual mandate. Both 2 and 3 were formulated prior to the final version of Obamacare passing and thus any references to Obamacare refer to it in an earlier form as opposed to its final form. So it doesn't serve much purpose to cause such a disruption if the end result is so similar, when you could simply amend Obamacare to achieve the same results.

That said I like co-opts and I like moving away from employer based care, but I don't much care for Wyden-Bennett since it is so similar to Obamacare, I really don't see much desire in switching towards it.

[Southern Senator North Carolina Yankee]

I would presume that foreign nationals were not dealt with direclty in 2009 or 2012 and the issue was not brought up in 2014 to my knowledge. So that is one more detail that would have to be addressed.

[Southern Senator North Carolina Yankee]

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.

[Southern Senator North Carolina Yankee]

It is very tough to address an issue like this, even with a large committee format.


I'll assist to the extent practical once again, if the committee so desires it.

[Southern Senator North Carolina Yankee]

This is what happened in 2014. There was a massive committee equivalent push back in early 2014 that fizzled because everyone wanted something different. Eventually, once interest had died, was when I finally picked up the pieces, got the power brokers together and pushed through a bill before any of the nay sayers could block it in the name of single payer or whatever.

[Southern Senator North Carolina Yankee]

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

Really, what about that is out of character for "this setup" in "this game"?

1. I would prefer to start over, with transitional issues dealt with and some components maintained but altered (like exchanges for instance would be kept but altered to give more regional authority on the regulatory function).

2. Exchanges most certainly come to mind if you are going to have a private component as well as the Regional level alternatives, co-opts etc etc

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.

For an analogy in a different issue, education. The rising cost of tuition has led to calls for free college, barring gov't mandate cuts, that necessarily means tax payers eat the cost of inflation and creating a vicious cycle.

 a. Complete nationalization  and by extention rationing
 b. Regulated subsidization, but you run the risk of regulations being out of date b/c of cost and technology and not keeping up
 c. Subsidization with some kind of natural check on inflation, ie, a cheaper alternative or competition. You would have regulations here too, but it is not your first line of defense.

All other options either 1) Let it run rampant with at best tweaks at the edges or 2) leave people to die on the street from lack of access.

I opt for c.