Atlasian National Healthcare Bill (Law'd)

[Vepres]

A few suggestions:

1. Address the fact that our health industry is not very modernized when it comes to health records and paperwork. Computerize health records and such.

2. Deregulate some things, a doctor spends so much time doing paperwork, much of it caused by unneeded or redundant regulations. I'll let you Senators deal with specifics here .

3. Subsidize health insurance for those who cannot reasonably afford it.

4. Malpractice insurance reform.

5. Provide a public catastrophic insurance program. If a person must pay over x amount for medical care due to something they didn't intentionally cause, then subsidize them for that care only from that point on.

Then you can worry about universal coverage, but deal with these first. Fritz's plan doesn't deal with some of these issues.

[Vepres]

A few suggestions:

1. Address the fact that our health industry is not very modernized when it comes to health records and paperwork. Computerize health records and such.

2. Deregulate some things, a doctor spends so much time doing paperwork, much of it caused by unneeded or redundant regulations. I'll let you Senators deal with specifics here .

3. Subsidize health insurance for those who cannot reasonably afford it.

4. Malpractice insurance reform.

5. Provide a public catastrophic insurance program. If a person must pay over x amount for medical care due to something they didn't intentionally cause, then subsidize them for that care only from that point on.

Then you can worry about universal coverage, but deal with these first. Fritz's plan doesn't deal with some of these issues.

Glad to know someone actually agrees with me to an extent. There are a lot of things that are just brush aside and pushed under the rug. If anything this bill is what is the unrealistic "simple" solution as Marokai accused mine of being.

Yeah, in my opinion, the problem with our health care costs is actually many small problems that together are a big problem. Universal solves the problem of hospitals treating the uninsured and then getting no money for it, thus charging the insured more, but it ignores many of these problems. You just take those problems, and move them from the business area to the government area.

[Vepres]

For heaven's sake, for all of those of you who want this little dinky reforms and market regulation changes, propose them and we can include them. I'm tired of reading the same old proposals over and over again, but nothing formally written. If you want to computerize records, institute malpractice reform, and all these other minor reforms, write them up, don't use them as an excuse to vote against the bill.

I just think they should be dealt with simultaneously, the current bill does little control costs, which is the main issue at hand in my opinion.

[Vepres]

A few suggestions:

1. Address the fact that our health industry is not very modernized when it comes to health records and paperwork. Computerize health records and such.

2. Deregulate some things, a doctor spends so much time doing paperwork, much of it caused by unneeded or redundant regulations. I'll let you Senators deal with specifics here .

3. Subsidize health insurance for those who cannot reasonably afford it.

4. Malpractice insurance reform.

5. Provide a public catastrophic insurance program. If a person must pay over x amount for medical care due to something they didn't intentionally cause, then subsidize them for that care only from that point on.

Then you can worry about universal coverage, but deal with these first. Fritz's plan doesn't deal with some of these issues.

Glad to know someone actually agrees with me to an extent. There are a lot of things that are just brush aside and pushed under the rug. If anything this bill is what is the unrealistic "simple" solution as Marokai accused mine of being.

Yeah, in my opinion, the problem with our health care costs is actually many small problems that together are a big problem. Universal solves the problem of hospitals treating the uninsured and then getting no money for it, thus charging the insured more, but it ignores many of these problems. You just take those problems, and move them from the business area to the government area.

Our health system is the best in the world in terms of quality, doctors, treatments, technology and protective Regulations. The problem is one of Access. Malpractice, lack of competition, and irresponsiblililty on the part of those buying drugs or getting procedures account for at least 40% to 50% of the problem. Most of the rest is because of the lack of preventive care and the subisidization that already goes on in the current system. Those last two are dealth with in Fritz bill the other 3 are not and should be. There is no reason for a myriad pathwork of  conflicting bills when we can do it all at once in one bill and reduce confusion.

Indeed.

[Vepres]

Here's an idea I had for an amendment, what do you guys think about it?

Section 4 or 5 (depending on if afleitch's amendment is added or no)

1. All laws regarding what health insurance companies must cover are hereby repealed.

2. Health insurance companies may not deny coverage nor discriminate against nor adjust the premiums of an individual's plan based on said individual's race, gender, ethnicity, geographic location, sexual orientation, age, preexisting conditions or treatments, past conditions or treatments, or religion.

3. All customers of said companies shall be offered a clear, written, and simple explanation of the company's various plans, including, what they do and do not cover and their cost. The company may not allow the person to buy any plan until they offered the person the document described above.
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Obviously it is poorly worded, but you get the general idea. Of course, it doesn't matter unless a Senator wishes to introduce this or something like this. Just an idea to foster competition.

Your thoughts?

[Vepres]

I will now admit to the fact that I am really not the author of this bill.  I used HR 676 as a template, and snipped it down considerably- the original I believe had 6 sections and was 8 pages long.  The amendment proposed by Afleitch addresses much of what I snipped from section 3.  I did this snipping because I was thinking in terms of the context of the game.  I didn't want to add actual offices at the regional level that would need to be filled with actual game participants.

NCYankee, you do nothing to advance your positions by calling someone an SOB or an egotistical bastard.  I find that to be conduct unbecoming of a Senator on the floor of the Senate.  If you have an amendment to propose, please propose it.  With Afleitch and Hashemite on board, we appear to have the necessary votes to bring this to a tie that BK would have to break.

I don't understand why you practically get rid of private insurers. I would think that competition, even if the government is one of the participants, is the best way to get cost effective and high quality products and services in the vast majority of scenarios.

For example, the amendment I wrote above (which nobody has commented on ) attempts to foster competition while allowing people access to health care while creating competition by forcing the companies to be honest with their customers.

[Vepres]

I believe Marokai's amendment addresses your concern regarding private insurers.

Most of your proposed amendment does not seem to be needed to me, I don't think that insurance companies are discriminating based on race, gender, etc.  Pre-existing conditions, however, may be a valid point.

Well, it simplifies it, as well as tries to encourage people to educate themselves by giving them the information to do so in clause 3.

The main thing is that plan must have a set price regardless of pre-existing conditions or past conditions. The others there can at worst do nothing, but it's good to have them there.

[Vepres]

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

[Vepres]

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.

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.

Or something like, oh, your treatment/test is expensive so we'll put it off for a few months.

[Vepres]

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.

Oh, certainly, but I don't want the government to give less care to the very elderly because they want to save money by saying it's not worth the cost (even if their lives may be extended by years).

The other thing that needs to be addressed is the government no covering new procedures or tests because they're too expensive, even if they're proven to be more effective.

[Vepres]

I'm going to work on a provision that details exactly how we plan on financing this. We need some sort of CBO to score things. Perhaps the GM? Or SoFA?

I promise to have a more detailed response in regard to finances by the time I go to sleep. I'm just taking a bit of a break right now

(But please, no de-facto tax hikes on the poor.)

No, I plan on taxing benefits in a progressive fashion.

I was hoping we could have a rough outline of where funding would come from in this bill, as well as lining out the fact that finances, personnel, and services from Medicaid and Medicare would be phased out ans transferred to this new program. In doing so, we could avoid any major financial meltdown in regard to the new program for quite some time, as it would take time to implement anyway.

Because of that, I wanted to propose a separate Revenue Act that dealt with raising revenue in general, as opposed to trying to have a fight over detailed financing in this bill, taking the focus off the issue at hand.

We can't do health care piecemeal. I don't support reform if we can't pay for it. So it takes us an extra week. It will be worth it to pass a comprehensive bill.

Well, the problem is we don't know where the hell we're coming from in regards to income, and other, taxes. Even if we presume sin taxes and income taxes are the same as the US right now, we've got to make changes and It would be rather frustrating to deal with raising or lowering taxes on a set of brackets that don't exist.

Hence the need for a CBO-equivalent.

Or we could make BrandonH do it.

[Vepres]

I like the intent of this bill, and indeed, universal coverage should be a goal at some point in the future. But the bigger issue is not those who aren't insured (though that is a big problem) but the people losing coverage because it's too expensive despite a middle-class income.

If you provide universal coverage through a government plan, but don't try to control the rate of increase in health care costs (without rationing), then you simply shift the problem to the government. The system cannot, and will not be sustainable if costs are not simultaneously dealt with. I realize that universal coverage helps control costs, but more must be done.

Using my great influence as Midwest Lt. Governor , I urge all Senators to vote nay on this bill unless more is done to control the rising costs.

[Vepres]

Oh I haven't a problem with a modest tax on some benefits like you proposed, I just wish we could get serious with more potent measures of raising revenue. (Instead of targeting things at the middle class.)

So propose something. I already geared health benefits taxes to a progressive increase according to income, so further taxing the rich would be a bit much at this point. But I left my amendment open to suggestions, so give me ideas that will raise revenue or reduce costs or both.

I'll propose more serious revenue raising in another bill, as I believe I've said repeatedly. If we're going to raise taxes, I want a set of tax brackets on the books.

Also, if you think many rich or upper-class individuals are going to take part in this plan..

It's not for this plan. It is all health benefits. Combined with a mandate...

And I will not be voting for a bill that doesn't include all facets of the proposal. Passing a plan without effective revenue clauses is a mistake.

Obviously I agree we need to do this right and fund it properly, I just don't want the Senate to have two major fights over revenue raising and lose sight of the real issue here, which is healthcare. With sin taxes, coupled with a taxing of healthcare benefits, and phasing out Medicare and Medicaid in favor of this new program, revenue will not be a problem for awhile.

Health care is a zero-sum game. We either pass a whole package, including systemic reform, cost reductions and revenue, or nothing at all, in my opinion. The individual pieces are crap. It is the total package that counts.

Agreed. You cannot sustain health care insurance that is rising many times faster than inflation. You have to get it at or close to inflation, or you're just asking for a budget crisis down the road.

Marokai, I know your plan will slow the rate, but I feel it is not enough. While we shouldn't remove the profit aspect of health care we need a way to prevent redundant tests and procedures from occurring. Computerizing the system would help tremendously, as doctors could easily share information with each other.

[Vepres]

I am pleased with the direction this bill is taking. I'll reiterate a few concerns however.

1. There needs to be a way to encourage quality over quantity. Computerizing records will help in that tests won't need to be repeated. Still, more should be done. As to what, I'm not sure.

2. Perhaps this belongs in a separate bill, but I think we need to somehow encourage healthy lifestyles. Getting people to exercise and eat healthier foods, sleep more, among other simple things can cut down on ER visits significantly, which could save lots of money down the road.

3. I realize the public insurance will help with this, but we need to get the insurance companies competing more.

4. Also, we need to ensure that businesses don't drop covering their employees over the public system, especially if their provided plan is superior.

5. I don't believe you've addressed discrimination against people for current, pre-existing, or past conditions. (Correct me if I'm wrong)

I'm very pleased overall, though.

[Vepres]

I am pleased with the direction this bill is taking. I'll reiterate a few concerns however.

1. There needs to be a way to encourage quality over quantity. Computerizing records will help in that tests won't need to be repeated. Still, more should be done. As to what, I'm not sure.

2. Perhaps this belongs in a separate bill, but I think we need to somehow encourage healthy lifestyles. Getting people to exercise and eat healthier foods, sleep more, among other simple things can cut down on ER visits significantly, which could save lots of money down the road.

3. I realize the public insurance will help with this, but we need to get the insurance companies competing more.

4. Also, we need to ensure that businesses don't drop covering their employees over the public system, especially if their provided plan is superior.

5. I don't believe you've addressed discrimination against people for current, pre-existing, or past conditions. (Correct me if I'm wrong)

I'm very pleased overall, though.

1. We are waiting on that

2. The only thing we could do on that is to raise the Tax on Tobacco, Alcohol, etc considerably like 50% taxation, however I doubt this Senate has a stomach for that option. I am sure there are other things we could do as well.

I can think of some things to do, but they're more of a regional responsibility, at least in my opinion. For example, government employed teams that work with GPs and pediatricians to ensure their patients are living healthy lives. The physician could refer the people to these teams, which could include a nutritionist, a psychologist, perhaps an exercise expert, among other things. This service would charge a modest fee, just enough to break even. Besides, they won't need fancy equipment or anything.

However, that seems like a regional thing to me. I plan on introducing something like this if/when I become governor.

I have a few other ideas, but again, they are regional things in my mind.

[Vepres]

I would not. Don't count on my vote with such absurd regressive tax increases in this bill.

Honestly, fellow Senators, man up and raise income taxes, stop pussy-footing around the finance issue with ass-backwards revenue raising schemes.

This has nothing to do with the finances, you fool. It has to do with discouraging the irresponsible use and consumption of products that can be damaging to ones health and thus increasing the burden on society and the overall cost of Health Care. Don't think that this won't be an issue with your precious public plan simply because its on the Taxpayers dime, in fact its because of that we should consider these measures.

We already have obscene taxes on those "undesirable" activities. If drinking and smoking hasn't been taxed and stigmatized to death by now, there's no sense in harming average Atlasians further. If this isn't about finances, then simply spend some money on an advertising campaign, or research on their harmful effects. There's no reason to hurt poor people, who are most of our smokers, and probably most of our drinkers.

Agreed. Another point, if your addicted to something, then I highly doubt a "sin tax" will deter you.

[Vepres]

Goodbye Grandma, it was a good run.