HR676...

[Moooooo]

Brief Summary of Legislation:

The United States National Health Insurance Act (HR676) establishes a new American national health insurance program by creating a single payer health care system. The bill would create a publicly financed, privately delivered health care program that uses the already existing Medicare program by expanding and improving it to all U.S. residents, and all residents living in U.S. territories. The goal of the legislation is to ensure that all Americans, guaranteed by law, will have access to the highest quality and cost effective health care services regardless of one's employment, income, or health care status.

With over 42 million uninsured Americans, and another 40 million who are under insured, the time has come to change our inefficient and costly fragmented health care system. The USNHI program would reduce overall annual health care spending by over $50 billion in the first year. In addition, because it implements effective methods of cost-control, health spending is contained over time, ensuring affordable health care to future generations.

In its first year, single-payer will save over $150 billion on paperwork and $50 billion by using rational bulk purchasing of medications. These savings are more than enough to cover all the uninsured, improve coverage for everyone else, including medication coverage and long-term care.

Employers who currently provide coverage for their employees pay an average of 8.5% of payroll towards health coverage, while many employers can't afford to provide coverage at all. Under this Act, all employers will pay a modest 3.3% payroll tax per employee, while eliminating their payments towards private health plans. The average cost to an employer for an employee earning $35,000 per year will be reduced to $1,155, less than $100 per month.

95% of families will pay less for health care under national health insurance than they do today. Seniors and younger people will all have the comprehensive medication coverage they need.

Who is Eligible
Every person living in the United States and the U.S. Territories would receive a United States National Health Insurance Card and i.d number once they enroll at the appropriate location. Social Security numbers may not be used when assigning i.d cards. No co-pays or deductibles are permissible under this act.

Benefits/Portability
This program will cover all medically necessary services, including primary care, inpatient care, outpatient care, emergency care, prescription drugs, durable medical equipment, long term care, mental health services, dentistry, eye care, chiropractic, and substance abuse treatment. Patients have their choice of physicians, providers, hospitals, clinics, and practices.

Conversion to a Non-Profit Health Care System
Private health insurers shall be prohibited under this act from selling coverage that duplicates the benefits of the USNHI program. They shall not be prohibited from selling coverage for any additional benefits not covered by this Act; examples include cosmetic surgery, and other medically unnecessary treatments.

Cost Containment Provisions/ Reimbursement
The National USNHI program will annually set reimbursement rates for physicians, health care providers, and negotiate prescription drug prices. The national office will provide an annual lump sum allotment to each existing Medicare region, which will then administer the program. Payment to health care providers include fee for service, and global budgets.

The conversion to a not-for- profit health care system will take place over a 15 year period, through the sale of U.S. treasury bonds; payment will not be made for loss of business profits, but only for real estate, buildings, and equipment.

Funding & Administration
The United States Congress will establish annual funding outlays for the USNHI Program through an annual entitlement. The USNHI program will operate under the auspices of the Dept of Health & Human Services, and be administered in the former Medicare offices. All current expenditures for public health insurance programs such as S-CHIP, Medicaid, and Medicare will be placed into the USNHI program.

A National USNHI Advisory Board will be established, comprised primarily of health care professionals and representatives of health advocacy groups.

Proposed Funding For USNHI Program: $1.86 Trillion Per Year
A payroll tax on all employers of 3.3%. Maintain employee and employer Medicare payroll tax of 1.45%. Implement a variety of mechanisms so that low and middle income families pay a smaller share of their incomes for health care than wealthiest 5% of Americans; i.e, a health income tax on the wealthiest 5% of Americans, a small tax on stock and bond transfers, and closing corporate tax shelters. A repeal of the Bush tax cut of 2001. For more details, see PNHP's "Financing National Health Insurance."

[Moooooo]

Nay (D)

[Emsworth]

No. The bill is horribly oppressive.

[Bleeding heart conservative, HTMLdon]

Nay (R), I'm still unconvinced that a single-payer health care system would be any better than what we've got now.

[Moooooo]

Im turned off by the fact that 5% of the population is expected to fund a program that they will never use.  At least with Medicare and SS everyone pays into the system.  This bill creates a tax that will only be imposed on the rich for a system that they will never use.

[Jake]

Im turned off by the fact that 5% of the population is expected to fund a program that they will never use.  At least with Medicare and SS everyone pays into the system.  This bill creates a tax that will only be imposed on the rich for a system that they will never use.

Indeed and that is why I would vote against it.

[dazzleman]

I vote no.  I don't like the fact that copays and deductibles are not required.  This invites abuse of the sytem, and will surely drive up costs by a lot more than the amount that would be recovered by copays and deductibles.

I am very sceptical that the cost savings would be real.  If this program would really save employers the difference between the 8.5% they are said to be paying now, and the 3.3% tax this plan would impose, they'd be lining up to support it.

I don't think it does the American people any favor to try to tell them that they can receive the same quality of health care, plus insure those without health insurance, for significantly less money.  Even if this were possible, a government program would be the least likely way to bring this about.  Our health care is expensive because we demand the best, don't want to recognize our own mortality, don't want to make cost/benefit analyses on when to curtail care for those with no hope of survival, and we have a legal system that can be easily convinced that legal liability automatically comes with death and illness.

[opebo]

Im turned off by the fact that 5% of the population is expected to fund a program that they will never use.  At least with Medicare and SS everyone pays into the system.  This bill creates a tax that will only be imposed on the rich for a system that they will never use.

They might use it if you believe that they could ever possibly become poors.  Hence the concept social insurance.

But of course the rich must 'pay' for such ameliorations of their complete control of society - power is redisributed downwards, and with it economic rewards.

[nini2287]

No (D) for the reason Emsworth gave.

[TeePee4Prez]

By and large yes though dazzleman has a point on copays, but not deductibles.  You also have to remember Wal-Mart abuses states' Medicaid systems yet reap huge profits so make the pay, not us!

[7,052,770]

I didn't actually read that long paragraph, but based on who's against it, and my own beliefs about health care, I'd guess I'd probably support it.

[True Federalist (진정한 연방 주의자)]

Nay.  I'm not opposed to the idea of a National Health Insurance per se, but this proposal has all the earmarks of being a disaster for the reasons that dazzleman touched on.

[CARLHAYDEN]

No. No. A thousand times NO!!!

Whoever came up with the math on this one desperately needs help!

[Max Power]

No (D) for the reason Emsworth gave.

^^^^^

[A18]

No. The bill is horribly oppressive.

^^^

[Bandit3 the Worker]

This bill creates a tax that will only be imposed on the rich for a system that they will never use.

Aww the poor poor rich people.

[Bandit3 the Worker]

I vote yay.

Anything is better than the awful health care system we have now.

[MaC]

nay.  No reason the public should fund something for the greater good, especially when it's likely to cost more and deliver less than projected.

[Alcon]

Nay.

[Bono]

By and large yes though dazzleman has a point on copays, but not deductibles.  You also have to remember Wal-Mart abuses states' Medicaid systems yet reap huge profits so make the pay, not us!

Two wrongs make a right falacy.

[TheresNoMoney]

Im turned off by the fact that 5% of the population is expected to fund a program that they will never use. 

Why wouldn't they use it?

[TheresNoMoney]

While I don't think the bill is perfect, it is certainly much better than the current system we have. I would vote yes.

I would probably slightly change the way it was funded, but overall I think it would make a very positive change for our country.

[TheresNoMoney]

I vote no.  I don't like the fact that copays and deductibles are not required.  This invites abuse of the sytem, and will surely drive up costs by a lot more than the amount that would be recovered by copays and deductibles.

I would agree with you there. The optimal system would institute a small co-pay with each treatment.

I am very sceptical that the cost savings would be real.  If this program would really save employers the difference between the 8.5% they are said to be paying now, and the 3.3% tax this plan would impose, they'd be lining up to support it.

You're missing the whole proposal. There would be a 3.3% tax on employers, plus the 1.45% they already pay for medicare, plus the 1.45% employees already pay for medicare, plus some type of tax on the wealthiest 5%, plus the closing of various corporate tax loopholes that would bring in additional revenue. I'm not saying that this is the best way to fund it, but just wanted to point out that you were missing the whole picture.

And for the 500th time on this board, I'll say that universal health care would cost much less. The proof is in the pudding. The administrative/overhead cost for Medicare is 3-4%, while the administrative/overhead cost for private insurance is approximately 24-30%. The difference between the two systems' administrative/overhead costs is where most of the potential cost savings would be realized. Of course, bulk purchasing of drugs would also add to the cost savings by many billions per year ($50 billion according to this proposal).

I don't think it does the American people any favor to try to tell them that they can receive the same quality of health care, plus insure those without health insurance, for significantly less money.

Of course we should tell the American people that, because it's the truth.

Even if this were possible, a government program would be the least likely way to bring this about.

There you go being an idealogue again. The government would merely fund health care, it would not deliver health care. Overall, there wouldn't be a huge change to our current system, except for the fact that it would cost less. Also, people would have more freedom in choosing their doctors and treatments.

[dazzleman]

I wish I could believe you Scoonie but I can't.

If the past is any indication, under government 'funding,' health care would end up costing more, and the quality would go down.  Saying 500x that it will be cheaper doesn't make it so.

I have no faith in any other outcome.  I'm not an ideologue but I am a realist.  And what would happen to the cost-shifting that medicare and medicaid are now doing effectively by paying less than services actually cost?  Who's going to pick that up under a full government funding scenario?

What you don't seem to get is that if the government is funding health care, the government will control it.  And that means it will be substandard.

[Jake]

Why wouldn't they use it?

They can afford something far better.