Today on Blogcritics
Home » Culture and Society » National Health Care in Under 1,000 Words Instead of 1,000 Pages

National Health Care in Under 1,000 Words Instead of 1,000 Pages

Please Share...Print this pageTweet about this on Twitter0Share on Facebook0Share on Google+0Pin on Pinterest0Share on TumblrShare on StumbleUpon0Share on Reddit0Email this to someone

At the risk of jeopardizing my reputation as a free marketeer and anti-tax crusader, I feel it's time that someone lay out the absolute truth about the current health care crisis and provide the obvious solution which no one in government seems to have the brains or integrity to propose.

As a caveat, I do not generally advocate government solutions to problems or any program which redistributes wealth through taxation, but if we as a nation are hell-bent on keeping the quality of health care that we have now while also making it available to all of our citizens, there is only one solution which makes sense and it isn't the 1,000-page pile of idiocy that President Obama and the Congress have cobbled together.

I've had enough of the ridiculousness, because the solution to our current health care problems is simple and elegant and can be explained very briefly and does not involve mandates or nationalization or any more health care rationing than we already have now. It won't destroy the insurance industry or bankrupt the population and it won't add a cent to the deficit.

It requires only five very simple steps:

1. Tax every citizen at a rate of 10% of their adjusted income after exemptions and deductions to pay for national health care. Eliminate the Medicare tax, so the real increase in taxation is actually just around 6% for most taxpayers. Those with low incomes would pay very little, if anything, because they have little or no taxable income. This would raise about $600 billion.

2. Give every citizen a yearly $2,000 voucher which can only be used to pay for health insurance. Allow them to pay any amount they wish above that voucher for enhanced coverage or any other special services the insurance companies can sell them. This would cost about $600 billion a year.

3. Prohibit insurers from denying coverage based on preexisting conditions, but allow them to increase the cost of coverage by up to 100% above their standard rates for patients with chronic conditions.

4. Require that all health insurance be purchased individually instead of through group plans and eliminate all tax credits for businesses or other organizations for providing workers with insurance. Also, eliminate state restrictions on health insurance and establish simple nationwide standards.

5. Partially privatize Medicare/Medicaid and gear it towards offering a basic but very limited health coverage plan which is, by design, inferior to private insurance except that it has low co-pays for preventive care and the use of clinics or a family doctor instead of an emergency room. Fix the price of that plan at $2,000 for anyone earning under two times the poverty level — about $22,000 a year.

Step 1 raises the necessary money, but does it at a reasonable rate, which is not more than the average taxpayer would currently pay for very basic private insurance. I don't like the idea of raising taxes at all, but once you accept the idea of national health care then it is inevitable. Step 2 limits voucher values based on the money raised, but the vouchers would be enough to provide adequate, minimal insurance from a very basic, public plan or provide a substantial base for those who would want better coverage by throwing in some of their own money. This makes the government the single, primary payer but leaves control of insurance choices entirely in the hands of the consumer without creating significant additional health care bureaucracy. Being able to augment your coverage reduces the problems with rationing of care, which you see in Europe and Canada. Step 3 might raise rates somewhat, but that would be mitigated by the existence of a basic, semi-public plan and more competition. Step 4 is essential to end the monopolistic practices of the insurance giants and reintroduce competition which will bring prices down. Step 5 provides health care for those who can't afford or won't pay for it under the current system, but at a level which will not compete with private plans.

The result of these five steps is universal health coverage at a rate of taxation which is not significantly higher than what we are paying into the system now through taxes for Medicaid and what we are paying for private insurance, with the assumption that most consumers will pay somewhat more than the voucher provides out of their own pocket to enhance their coverage. This proposal takes care of the problem of the uninsured and does all of this while encouraging free market competition and not eliminating private insurance companies, though it does take away some of their special protections and pressures them to be more competitive.

Obviously this is only the bare bones of a plan and would require some fine tuning, but the basic math works and the plan would be effective in accomplishing all of the objectives which our political leaders claim they want but seem unable to actually include in their legislation.

Remember, I don't really endorse this type of a solution. Yet if I can see it despite my obvious dislike for some aspects of it and admit that it would work, tell me why the proposals which the President and Congress are considering make so little sense and bear so little resemblance to this simple plan?

Powered by

About Dave Nalle

  • http://ruvysroost.blogspot.com Ruvy

    Looks like a good plan – except for clause 3. Better to raise the tax (clause 1) to 12% and allow insurers to increase the rate by a maximum of 10% all tolled for chronic conditions.

    One could add a 6th clause – a co-pay of $5 for visiting a GP, a co-pay of $20 for visiting a specialist, a minimum price of $5 for a generic scrip from a mandated pharmacopia, and a maximum of $25.

    It’s a damned good alternative to whatever crap Obama suggests. It’s simple, short and sweet.

  • Mark

    …tell me why the proposals which the President and Congress are considering make so little sense and bear so little resemblance to this simple plan?

    Because monopoly capital(ists) rule.

  • http://www.whalertly.com/wordpress Robert M. Barga
  • Jordan Richardson

    I played NationStates once and totally balanced the budget while giving my country a great health care plan AND not succumbing to attacks from neighbouring Tittiwanga.

  • Mark

    Jordan for king 2010

  • http://www.republicofdave.com Dave Nalle

    Ruvy, this plan assumes that there will be co-pays on some plans, especially the cheaper ones, but they would be set by the market for the most part rather than legislatively.

    And yes, the tax rate could be raised, but it’s already set about as high as I think the American public would accept. They’d certainly balk at anything in double digits.

    Bliffle seems to have gotten the point. Despite protestations to the contrary, the lack of a plan like this does mean that Obama and the Dems have sold out to the insurance industry.

    Dave

  • Lumpy

    Sounds a bit like a less fascist version of the system in Singapore which is rated 6th best in the world.

  • Glenn Contrarian

    Dave –

    I like a lot of your points except for #5 – because if you hobble the government option, you make it a source of ridicule and fodder for subsequent political campaigns. What’s wrong with the government option being equal – in quality and in price – to that of the others? After all, with the tax hike you described, the premiums would be low enough for just about everyone.

    And FYI – you keep referring to Obama’s ‘monstrosity’ of a plan. Who should you blame for that? Easy – the government that allows corporate lobbying and corporate campaign financing, because even now the health care industry is forking over $1.4M per DAY in lobbying efforts.

    If you want change, then work towards getting rid of the lobbyists, towards public-financing-ONLY of political campaigns. Then, once our politicians are NOT beholden to the corporate sector, we’ll see some REAL change.

  • Clavos

    If you want change, then work towards getting rid of the lobbyists, towards public-financing-ONLY of political campaigns. Then, once our politicians are NOT beholden to the corporate sector, we’ll see some REAL change.

    You don’t really think all those pols are going to be willing to kill the goose that lays the golden eggs, do you Glenn?

  • Glenn Contrarian

    No, Clavos, I don’t. But the point was to place the blame where it truly belongs…

    …and let’s not forget who it was that voted into LAW a requirement that Medicare could not negotiate drug prices as other federal agencies do. That, sir, was your Republicans – and now they all complain about how bloated the Medicare budget is.

    Sheesh!

  • http://www.republicofdave.com Dave Nalle

    I like a lot of your points except for #5 – because if you hobble the government option, you make it a source of ridicule and fodder for subsequent political campaigns. What’s wrong with the government option being equal – in quality and in price – to that of the others? After all, with the tax hike you described, the premiums would be low enough for just about everyone.

    The idea is for the government plan to form a baseline of minimally adequate insurance and for the private plans to start at that level and work their ways up. If you make the government option more competitive and more comprehensive then you push private insurance into a higher price range where it can make money, but takes much less risk and you put that risk onto the taxpayer instead. I prefer to make them work a bit harder.

    And FYI – you keep referring to Obama’s ‘monstrosity’ of a plan. Who should you blame for that?

    Obama, because many of the worst ideas in it are ones which he specifically demanded from Congress.

    Easy – the government that allows corporate lobbying and corporate campaign financing, because even now the health care industry is forking over $1.4M per DAY in lobbying efforts.

    And do we shut down lobbying from unions, NGOs and citizen advocacy groups? No more UAW, AARP, NEA, NRDC, Sierra Club or NRA lobbying? Because their influence is JUST as destructive.

    If you want change, then work towards getting rid of the lobbyists, towards public-financing-ONLY of political campaigns. Then, once our politicians are NOT beholden to the corporate sector, we’ll see some REAL change.

    I’m just not ready to shut down free speech yet. There are lobbyists to reperesent every possible interest and they are well funded on both sides of most issues. In most cases they balance each other out pretty effectively and they make our wishes known to the legislators in a way which is much more effective than just voting.

    Dave

  • Paul

    Surely you know that it is not fair to tax everyone equally Dave. The “rich” simply must continue to pay disproportionately higher rates, and the poor must continue to pay, um, well, receive more free stuff from the rich. Just look how fair it is now. On second thought – I really like that plan of yours.

  • Bliffle

    Dave says:

    “I’m just not ready to shut down free speech yet.”

    You don’t have to: the guy with a million dollar amplifier and speakers already does that by drowning out the other voices.

    “There are lobbyists to reperesent every possible interest ….”

    Where do I sign up? I want the lobby that will institute a society that worships 72 yr. old elders, lives in a beautifulplace with a moderate climate. Oh, and I could use a comely Shulamite to warm my bones at night.

    “…and they are well funded on both sides of most issues.”

    BOTH sides! Good thing no issues have more than two sides.

  • Bliffle

    Oh, Dave, I also need a $10million PA system set up in DC so that I can exercise my Free Speech rights in proper proportion to my wisdom and virtue.

  • Glenn Contrarian

    Paul –

    Ever hear of tax breaks and exemptions? If you’ll check, even though America has the second-HIGHEST corporate tax rate in the world, the actual percentage of tax income RECEIVED is something like the second-LOWEST in the world.

    Also, if you check, the top marginal tax rate in the 1950’s was 91% (including during the entirety of the Eisenhower administration) – back in the days when there were not so many tax breaks and exemptions.

    If we were to propose even a 50% top marginal tax rate today, the entire conservative bloc would howl in anger and outrage because they’d be SURE that this would wreck the economy…

    …but when we had a 91% top marginal tax ratge, how was our economy? It was the envy of the world. Not only that, but we were able to pay off the federal debt from WWII, which was proportionally even greater than what we have now.

    So there’s your choice, Paul – go with conservative thought and Republican talking points, or go with the hard evidence we see in history.

  • Glenn Contrarian

    Dave –

    Good reply. I disagree with much of it (of course), but you did make good, thoughtful points.

    On the ‘minimally effective’ government health care plan, let me riposte with a rather uncomfortable metaphor…but one that a Texan like yourself would understand better than I.

    What’s the biggest resource of any country? The people, of course. Just as a rancher’s biggest resource is his cattle, just as a sheepherder’s biggest resource is his sheep, a country’s biggest resource is its people.

    The healthier the cattle and the sheep are, the wealthier the rancher and the sheepherder will be. Same thing with a country – the healthier the people are, the more work they will do, the more they will accomplish, the more taxes they will pay in to the national kitty.

    Now, what would happen to any rancher or sheepherder who wasn’t watching over the health of one-sixth of his herd? He’s not going to be able to compete well against his competitors – just as we’re losing our competitive edge against the other modern industrialized democracies of the world.

    It’s not about whether it’s ‘socialized’ or ‘unAmerican’. It’s about what keeps our most important resource, our greatest source of money, healthiest and best able to produce and to achieve. We’re losing against our competitors – and the twenty-seven of our competitors who are more successful than us in this arena all have UHC of one sort or another.

    They’re taking care of their most important resource. They’re ENABLING their most important resource. Why the richest nation in the world provide free education but not provide for the health care that would enable someone to put that education to use…is beyond me.

    This is a matter of pragmatism, of practicality. UHC works and it’s proven to work. Keep your resource healthy, and your resource will provide for your future. It’s true with ranchers, with sheepherders…and with governments.

    Also, I would remind you that on the health care debate, there is no one able to match the lobbying funding that the HMO’s and big pharma are shelling out.

  • http://www.republicofdave.com Dave Nalle

    Also, I would remind you that on the health care debate, there is no one able to match the lobbying funding that the HMO’s and big pharma are shelling out.

    Sure there is. The unions and the AARP have very deep pockets.

    As for your analogy, it’s fine, if you accept the premise that we want our government to be responsible for determining how we live and when we die. I don’t like the idea at all.

    Did you hear about the euthanasia provisions in the healthcare bill?

    Dave

  • Paul

    Glenn, your history lesson missed a few important points. While the top marginal tax rate was still above 90 percent well into Kennedy’s term, he pushed for tax cuts, which were enacted in 1964 after his assassination. The top marginal tax rate was reduced from 91 percent to 70 percent by 1965. What followed was a major expansion in the economy. Real gross domestic product rose in the four years after the tax cut by an average of 5.1 percent per year. Unemployment averaged 3.9 percent, compared to a 5.8 percent average in the four years prior to the tax cut.

    The Reagan tax cuts of 1981 dropped the top marginal rate from 70 percent to 50 percent, with additional cuts in the tax on capital gains. The top marginal rate was further reduced to 28 percent by 1988. The result was again an increase in growth in the economy. Real GDP grew by .9 percent per year between 1978 and 1982, and grew by 4.8 percent per year from 1983 to 1986. The unemployment rate was 9.7 percent in 1982. It fell to 7.0 percent by 1986, and was 5.3 percent in January of 1989.

    By the way, although I am fiscally conservative, I am not a Republican.

  • http://biggesttent.blogspot.com/ Silas Kain

    You know what? We need to spend less time debating Reaganomics and the mistakes of past Administrations — both Democrat and Republican. I’ve thought long and hard about this health care debate and there’s one thing that has become crystal clear. Congress is working in tandem with the health care industry in maintaining a capitalistic approach to the same.

    Bill Maher asked a very good question the other night on his show concerning when did health care become a for profit enterprise? He’s right. I’ve said many times before that there was a time when religious organizations (especially Roman Catholic)provided incredible health care to the neediest of our people. And somewhere along the way the corporations saw an opportunity, paid off a bunch of legislators and what we’ve got left is a grand cluster f__k.

    Those on the Far Right talk about morality and family values. What is immoral about a health care system that operates on a not for profit basis? What’s immoral about teaching our children preventative care and ramping up the pressure on those companies that feed us pure, unadulterated crap for our diets?

    Maher also made a point to quote FDR who said “I don’t want to see a single war millionaire created in the United States as a result of this world disaster.” This concerned World War II. Can we say today that no millionaire has been created out of Vietnam, Iraq, Afghanistan and Iraq again? Somewhere along the way we have our definition of “morality” screwed up. It isn’t about who you sleep with in the bedroom. The same people who vociferously scream morality are the same ones who propagate an immoral system.

    Not one member of this Congress has closely read the Heath Care bill. And, let’s call a spade a spade. The majority of those we have sent to Congress don’t have the intellect to comprehend the structure of legislation much less its content. We need an honest dialog in this country that excludes the health care providers, insurance companies and the pharmaceuticals. When a pharmaceutical company which specializes in age defiance drugs and plastic surgery performs better in the stock market than a company which can provide a cure for cancer, that’s immoral. When insurance companies like Aetna, Blue Cross and Cigna can arbitrarily reject claims using racial profiling (don’t kid yourselves, it goes on every day), that’s immoral. When a member of Congress accepts campaign contributions from insurance, pharmaceutical and financial PACS and forgets why they were sent to Congress in the first place, that’s not only immoral, it borders on criminal.

    There is plenty of legislation being shoved down our throats these days by a cowardly Congress and a media savvy President. Abraham Lincoln said “Government of the people, by the people, for the people, shall not perish from the Earth.” Well, that government is on life support, folks. It’s in a deep coma and needs something to wake it up. If we don’t do something now, then when?

  • Clavos

    Silas,

    You make some good points in your comment #19.

    However, I think this one:

    When a pharmaceutical company which specializes in age defiance drugs and plastic surgery performs better in the stock market than a company which can provide a cure for cancer, that’s immoral.

    …is not a reflection on the pharma company so much as it is on the American people in general. That pharma is doing well selling those kinds of remedies to them, which is why it performs well on the stock market. I don’t see it as immoral that they manufacture those kinds of meds, do you?

  • http://biggesttent.blogspot.com/ Silas Kain

    Point well taken, Clavos. That being said, Americans really need to rethink their priorities. What good is a face lift, age defying drug or breast implant if your body is going to be ravaged by liver disease or cervical cancer? There are some very inexpensive treatments for Hepatitis B which can’t make it out of clinical mouse trials because pharmaceutical companies see no profit in manufacturing the vaccine due to the low cost of manufacture. That, my friend, is immoral.

  • Clavos

    Well, Silas, I’ve always though that our pharma industry was skewed in a number of ways. One of the most egregious ones to me is the fact that all the meds which actually work are prescription only — this is not the case in many other countries, where most meds are available without a prescription.

    Just changing that one aspect of how we do business would lower costs, if only by the fact one would not have to see a doctor first in order to obtain say, an arthritis drug, or metformin for a diabetic, etc.

  • http://biggesttent.blogspot.com/ Silas Kain

    I agree, Clavos. For example, I take coumadin because of a genetic blood disorder. Every month I fill my prescription, the cost changes depending on the mood of my provider. Secondly, I have to be tested twice a month which costs $440 per month. I have been fighting to get my own monitoring machine now for 6 years. The cost of the unit is $4,000. If I were allowed to monitor my Coumadin levels daily I could keep a better control on my dosage. I’ve been on it long enough to know what dose to take. At one time my doctor had it arranged whereby I could call the lab for my test results and adjust my dosage accordingly. Then the suits at the hospital stepped in and said no way. Had I been given the opportunity, I could have saved my insurance company over $25,000 in the last 5 years.

  • http://www.republicofdave.com Dave Nalle

    …is not a reflection on the pharma company so much as it is on the American people in general. That pharma is doing well selling those kinds of remedies to them, which is why it performs well on the stock market. I don’t see it as immoral that they manufacture those kinds of meds, do you?

    Not only that, but it’s a matter of marketability. There is a small market of people who have cancer, but there’s a huge market of people who have erectile disfunction or are fat. The good thing is that the cancer drugs often have their costs underwritten by the profits of the trendy self-improvement drugs, and that is what is good about the for-profit system.

    Dave

  • http://biggesttent.blogspot.com/ Silas Kain

    Perhaps that point has some validity, Dave. But again, why should our collective health system be for profit? Even in a free marketplace there can be civility and morality. Enough is enough. Whatever health care plan passes, it is destined for complete failure.

  • http://www.republicofdave.com Dave Nalle

    Well of course the healthcare plan as proposed and as likely to pass – if it passes – will be entirely awful. It may well make things far worse than they are now.

    As for profit, I don’t see any reason why profit and altruism can’t exist side by side. What better than to make a living doing good for people? That ought to be the goal of any business. Few businessmen set out to make their living by exploiting and oppressing others.

    Dave

  • http://biggesttent.blogspot.com/ Silas Kain

    True, few businessmen do, Dave. We’ll leave that to Bank of America, Bernie Madoff and every damned executive who gives $5,000 to a member of Congress.

  • http://www.republicofdave.com Dave Nalle

    Silas, I suspect that most businessmen do want to do good with their businesses in whatever way they can, but some people are made of sterner stuff and have more moral fiber than others.

    That’s what I tried to point out earlier when I mentioned Mellon and Carnegie and Morgan and Stanford. They may have been the richest men of their time, but despite all their wealth and power they were selfless and charitable in proportion to their wealth.

    Dave

  • http://biggesttent.blogspot.com/ Silas Kain

    To whom much is given, much is expected in return. I would love the opportunity to be able to live up to that philosophy of life. Unfortunately, the government, big business and the American consumer won’t afford me the chance.

  • winslow

    Germany has had a national health care system in place ever since the early 1900’s

    They are not socialist nor are they communist. The conservatives always scream Socialism whenever national health care is mentioned.

    The Germans are smart people and know how to spend their tax dollars wisely.

    We should look to them to show us what to do because they are obviously more on top of the game. Why not learn from the enlightened countries of Europe that have good systems in place?

    Why sit around forever never getting this problem solved? Why? Because we are Americans.

  • Bliffle

    Here’s your weekend study assignment:

    HR 3200 healthcare bill summary

    HR 3200

    look for ‘official bill text’ in upper right of page
    ——————————————————————–

    OpenCongress Summary
    This is the House Democrats’ big health care reform bill. Broadly, it seeks to expand health care coverage to the approximately 40 million Americans who are currently uninsured by lowering the cost of health care and making the system more efficient. To that end, it includes a new government-run insurance plan to compete with the private companies, a requirement that all Americans have health insurance, a prohibition on denying coverage because of pre-existing conditions and, to pay for it all, a surtax on households with an income above $350,000. A more detailed summary of the bill by the House Committee on Education and Labor can be read here (four-page .pdf).

    here’s the summary: (4 pages)

    summary

    SUMMARY
    America’s Affordable Health Choices Act provides quality affordable health care for all Americans and
    controls health care cost growth. Key provisions of the bill released today include:
    COVERAGE AND CHOICE
    *
    AFFORDABILITY
    *
    SHARED RESPONSIBILITY
    *
    CONTROLLING COSTS
    *
    PREVENTION AND WELLNESS
    *
    WORKFORCE INVESTMENTS
    *
    I. COVERAGE AND CHOICE
    The bill builds on what works in today’s health care system and fixes the parts that are broken. It
    protects current coverage – allowing individuals to keep the insurance they have if they like it – and
    preserves choice of doctors, hospitals, and health plans. It achieves these reforms through:
    * A Health Insurance Exchange. The new Health Insurance Exchange creates a transparent and
    functional marketplace for individuals and small employers to comparison shop among private and
    public insurers. It works with state insurance departments to set and enforce insurance reforms
    and consumer protections, facilitates enrollment, and administers affordability credits to help low-
    and middle-income individuals and families purchase insurance. Over time, the Exchange will be
    opened to additional employers as another choice for covering their employees. States may opt to
    operate the Exchange in lieu of the national Exchange provided they follow the federal rules.
    * A public health insurance option. One of the many choices of health insurance within the health
    insurance Exchange is a public health insurance option. It will be a new choice in many areas of our
    country dominated by just one or two private insurers today. The public option will operate on a
    level playing field. It will be subject to the same market reforms and consumer protections as
    other private plans in the Exchange and it will be self-sustaining – financed only by its premiums.
    * Guaranteed coverage and insurance market reforms. Insurance companies will no longer be able
    to engage in discriminatory practices that enable them to refuse to sell or renew policies today due
    to an individual’s health status. In addition, they can no longer exclude coverage of treatments for
    pre-existing health conditions. The bill also protects consumers by prohibiting lifetime and annual
    limits on benefits. It also limits the ability of insurance companies to charge higher rates due to
    health status, gender, or other factors. Under the proposal, premiums can vary based only on age
    (no more than 2:1), geography and family size.
    * Essential benefits. A new independent Advisory Committee with practicing providers and other
    health care experts, chaired by the Surgeon General, will recommend a benefit package based on
    standards set in the law. This new essential benefit package will serve as the basic benefit package
    for coverage in the Exchange and over time will become the minimum quality standard for
    employer plans. The basic package will include preventive services with no cost-sharing, mental
    health services, oral health and vision for children, and caps the amount of money a person or
    family spends on covered services in a year.
    II. AFFORDABILITY
    To ensure that all Americans have affordable health coverage the bill:
    * Provides sliding scale affordability credits. The affordability credits will be available to low- and
    moderate- income individuals and families. The credits are most generous for those who are just
    above the proposed new Medicaid eligibility levels; the credits decline with income (and so
    premium and cost-sharing support is more limited as your income increases) and are completely
    phased out when income reaches 400 percent of the federal poverty level ($43,000 for an
    individual or $88,000 for a family of four). The affordability credits will not only make insurance
    premiums affordable, they will also reduce cost-sharing to levels that ensure access to care. The
    Exchange administers the affordability credits with other federal and state entities, such as local
    Social Security offices and state Medicaid agencies.
    * Caps annual out-of-pocket spending. All new policies will cap annual out-of-pocket spending to
    prevent bankruptcies from medical expenses.
    * Increased competition: The creation of the Health Insurance Exchange and the inclusion of a
    public health insurance option will make health insurance more affordable by opening many
    market areas in our country to new competition, spurring efficiency and transparency.
    * Expands Medicaid. Individuals and families with incomes at or below 133 percent of the federal
    poverty level will be eligible for an expanded and improved Medicaid program. Recognizing the
    budget challenges in many states, this expansion will be fully federally financed. To improve
    provider participation in this vital safety net – particularly for low-income children, individuals with
    disabilities and people with mental illnesses – reimbursement rates for primary care services will be
    increased with new federal funding.
    * Improves Medicare. Senior citizens and people with disabilities will benefit from provisions that fill
    the donut hole over time in the Part D drug program, eliminate cost-sharing for preventive services,
    improve the low-income subsidy programs in Medicare, fix physician payments, and make other
    program improvements. The bill will also address future fiscal challenges by improving payment
    accuracy, encouraging delivery system reforms and extending solvency of the Medicare Trust Fund.
    III. SHARED RESPONSIBILITY
    The bill creates shared responsibility among individuals, employers and government to ensure that all
    Americans have affordable coverage of essential health benefits.
    * Individual responsibility. Except in cases of hardship, once market reforms and affordability
    credits are in effect, individuals will be responsible for obtaining and maintaining health insurance
    coverage. Those who choose to not obtain coverage will pay a penalty of 2.5 percent of modified
    adjusted gross income above a specified level.
    * Employer responsibility. The proposal builds on the employer-sponsored coverage that exists
    today. Employers will have the option of providing health insurance coverage for their workers or
    contributing funds on their behalf. Employers that choose to contribute will pay an amount based
    on eight percent of their payroll. Employers that choose to offer coverage must meet minimum
    benefit and contribution requirements specified in the proposal.
    * Assistance for small employers. Recognizing the special needs of small businesses, the smallest
    businesses (payroll that does not exceed $250,000) are exempt from the employer responsibility
    requirement. The payroll penalty would then phase in starting at 2% for firms with annual payrolls
    over $250,000 rising to the full 8 percent penalty for firms with annual payrolls above $400,000. In
    addition, a new small business tax credit will be available for those firms who want to provide
    health coverage to their workers. In addition to the targeted assistance, the Exchange and market
    reforms provide a long-sought opportunity for small businesses to benefit from a more organized,
    efficient marketplace in which to purchase coverage.
    * Government responsibility. The government is responsible for ensuring that every American can
    afford quality health insurance, through the new affordability credits, insurance reforms, consumer
    protections, and improvements to Medicare and Medicaid.
    IV. PREVENTION AND WELLNESS
    Prevention and wellness measures of the bill include:
    * Expansion of Community Health Centers;
    * Prohibition of cost-sharing for preventive services;
    * Creation of community-based programs to deliver prevention and wellness services;
    * A focus on community-based programs and new data collection efforts to better identify and
    address racial, ethnic, regional and other health disparities;
    * Funds to strengthen state, local, tribal and territorial public health departments and programs.
    V. WORKFORCE INVESTMENTS
    The bill expands the health care workforce through:
    * Increased funding for the National Health Service Corp;
    * More training of primary care doctors and an expansion of the pipeline of individuals going into
    health professions, including primary care, nursing and public health;
    * Greater support for workforce diversity;
    * Expansion of scholarships and loans for individuals in needed professions and shortage areas;
    * Encouragement of training of primary care physicians by taking steps to increase physician training
    outside the hospital, where most primary care is delivered, and redistributes unfilled graduate
    medical education residency slots for purposes of training more primary care physicians. The
    proposal also improves accountability for graduate medical education funding to ensure that
    physicians are trained with the skills needed to practice health care in the 21 st century.
    VI. CONTROLLING COSTS
    The bill will reduce the growth in health care spending in a numerous ways. Investing in health care
    through stronger prevention and wellness measures, increasing access to primary care, health care
    delivery system reform, the Health Insurance Exchange and the public health insurance option,
    improvements in payment accuracy and reforms to Medicare and Medicaid will all help slow the
    growth of health care costs over time. These savings will accrue to families, employers, and taxpayers.
    * Modernization and improvement of Medicare. The bill implements major delivery system reform
    in Medicare to reward efficient provision of health care, rolling out innovative concepts such as
    accountable care organizations, medical homes, and bundling of acute and post-acute provider
    payments. New payment incentives aim to decrease preventable hospital readmissions, expanding
    this policy over time to recognize that physicians and post-acute providers also play an important
    role in avoiding readmissions. The bill improves the Medicare Part D program by creating new
    consumer protections for Medicare Advantage Plans, eliminating the “donut hole” and improving
    low-income subsidy programs, so that Medicare is affordable for all seniors and other eligible
    individuals. A centerpiece of the proposal is a complete reform of the flawed physician payment
    mechanism in Medicare (the so-called sustainable growth rate or “SGR” formula), with an update
    that wipes away accumulated deficits, provides for a fresh start, and rewards primary care services,
    care coordination and efficiency.
    * Innovation and delivery reform through the public health insurance option. The public health
    insurance option will be empowered to implement innovative delivery reform initiatives so that it is
    a nimble purchaser of health care and gets more value for each health care dollar. It will expand
    upon the experiments put forth in Medicare and be provided the flexibility to implement value-
    based purchasing, accountable care organizations, medical homes, and bundled payments. These
    features will ensure the public option is a leader in efficient delivery of quality care, spurring
    competition with private plans.
    * Improving payment accuracy and eliminating overpayments. The bill eliminates overpayments to
    Medicare Advantage plans and improves payment accuracy for numerous other providers,
    following recommendations by the Medicare Payment Advisory Commission and the President.
    These steps will extend Medicare Trust Fund solvency, and put Medicare on stronger financial
    footing for the future.
    * Preventing waste, fraud and abuse. New tools will be provided to combat waste, fraud and abuse
    within the entire health care system. Within Medicare, new authorities allow for pre-enrollment
    screening of providers and suppliers, permit designation of certain areas as being at elevated risk of
    fraud to implement enhanced oversight, and require compliance programs of providers and
    suppliers. The new public health insurance option and Health Insurance Exchange will build upon
    the safeguards and best practices gleaned from experience in other areas.
    * Administrative simplification. The bill will simplify the paperwork burden that adds tremendous
    costs and hassles for patients, providers, and businesses today.
    PREPARED BY THE HOUSE COMMITTEES ON WAYS AND MEANS, ENERGY AND COMMERCE, AND EDUCATION AND LABOR
    JULY 14, 2009

  • http://www.republicofdave.com Dave Nalle

    Germany has had a national health care system in place ever since the early 1900’s

    Healthcare rationing in the German system killed my wife’s grandmother a few years ago. Their policy is not to replace pacemaker batteries even if they are beyond their battery replacement date until the battery actually fails. You see, batteries are expensive. The problem is that when you’re 75 with a congenital heart defect and your pacemaker fails you die, even though with a new battery and otherwise good health you might have lived for another decade.

    And this anecdotal example is born out by massive statistics showing a higher rate of preventable death for almost cancers and cardiac causes in Germany than in the US. So don’t even talk to me about the German healthcare system.

    Dave

  • http://drdreadful.blogspot.com Dr Dreadful

    And this anecdotal example is born out by massive statistics showing a higher rate of preventable death for almost cancers and cardiac causes in Germany than in the US.

    I wonder how the death rate from cancer and heart disease among the uninsured in the US compares to Germany?

  • http://handyfilm.blogspot.com handyguy

    Right on, Doc.

  • Bliffle

    DD asks:

    “I wonder how the death rate from cancer and heart disease among the uninsured in the US compares to Germany?”

    An interesting question. Perhaps we will never know.

    It seems to me that the Private Health Insurance business has successfully gagged reporting of several sensitive matters so that the US public is uninformed.

    One of those matters is the extent of financial fraud in the Private Health Insurance business. They regularly trumpet reports of medicare fraud, usually exaggerated, while keeping an almost absolute veil of silence about Private Health Insurance fraud.

    There are a great number of topics regarding the failures of the private health insurance business that we never hear about.

    I suspect that the industry associations use their tremendous power and money to manipulate the mainstream press.

  • Phil

    even with vouchers, half of americans still wouldn’t do anything without being given everything for free