SENATE BILL: Reforming Atlasian Public Health Act of 2014 (Debating)

[Sopranos Republican]

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Sponsor: North Carolina Yankee

Senator, you may begin advocating for this.

[Southern Senator North Carolina Yankee]

This was originally a bill sponsored by Tmthforu94. I have taken this over because I am generally favorable to the idea of HSAs, though I am willing to be rather flexible on any of the details present here, including the numbers in section 1.

[TNF]

I oppose this attack on public health services, and encourage the Senate to kill this bill.

[🐒Gods of Prosperity🔱🐲💸]

Allowing HSAs may be a good thing, but I am wary of the levels of reductions in benefits, especially given the huge amount people at all income levels are paying in taxes to fund the program.

[Sec. of State Superique]

The CSSRA calculation!

[Napoleon]

As much as I like the guy, there is no such thing as "Fritzcare". But honestly that's the least of this bill's problems, which I am trying to figure out the purpose of. Is this designed to completely undermine national healthcare or is that inevitable result going to be considered an "unintended consequence"? I'm genuinely curious what problem this is supposed to solve.

[Potus]

As someone who worked very closely on the development of this legislation, I will be arguing for it as a citizen. I recently laid out the merits of the bill in the Federalist Policy Development thread for all to see, I would encourage the Senators to read my description and consider it when voting.

Allowing HSAs may be a good thing, but I am wary of the levels of reductions in benefits, especially given the huge amount people at all income levels are paying in taxes to fund the program.

We can include a tax relief component, if you'd like. However, this does reduce the cost of care that everyone pays, which provides some relief to taxpayers.

The benefit adjustments work to address the flaws with the insurance model of healthcare. The way the benefits are currently set encourage overutilization, which I've discussed a couple times before. The benefit adjustments also provide a high level of savings and increases the market's information in determining prices, fees, etc. which in turn reduces what is essentially defensive pricing(pricing higher than is necessary due to lack of information and fear of the unknown). That lowers costs on consumers and on the government

As much as I like the guy, there is no such thing as "Fritzcare". But honestly that's the least of this bill's problems, which I am trying to figure out the purpose of. Is this designed to completely undermine national healthcare or is that inevitable result going to be considered an "unintended consequence"? I'm genuinely curious what problem this is supposed to solve.

The terminology can be cleared up to eliminate use of the word "Fritzcare." The purpose of the bill is to improve the efficiency of the healthcare system, move towards a cost containment approach, and improve the quality of life for the Atlasian people.

Like shua noted, Atlasians are levied a heavy tax burden to pay for this program. The removal of market forces and other quality-ensuring mechanisms inevitably lead to a decline in efficiency and increase in cost. The bill cuts costs, saves everyone involved money, and improves the quality of the healthcare system.


I'll give you all the quick and dirty version of the post found here: https://uselectionatlas.org/FORUM/index.php?topic=189028.msg4090762#msg4090762.

Moving from an insurance model to an HSA model decreases overutilization. The way it works now is essentially like having car insurance that covers 90% of your oil change, which is ludicrous. By shifting the benefits away from insurance benefits and into HSA benefits, we will reduce the costs incurred by both consumers/patients and the Fritzcare program.

It's important to note that the benefits really aren't being cut. They're being moved. The insurance benefits are being converted into Health Savings Benefits, High Risk Benefits, and Wellness Benefits. These new categories do more to empower patients and save money while simultaneously increasing the quality of care than the blanket insurance model.


The bill makes economic sense. It's better for consumers, good for the budget, and good for healthcare. I go into detail in the post I've mentioned on the benefits of each provision of the bill. I'll be glad to answer questions about that description or other questions about the bill.

[TNF]

This bill will literally deny care to people who already receive it.

Motion to table.

[Napoleon]

Making his healthcare more efficient=making healthcare more expensive for all but the wealthiest of Atlasians? Ok.

This bill seeks to return to the days of old, where preventative care was disregarded. That benefits those who want to profit off of the livelihood of atlasians "we can fix you once you get sick". Well excuse me for supporting a system that encourages early cancer detections via regular screenings and actually getting well instead of sitting around the house watching tv while sick as US flu deaths set records in many states.

All these HSAs do is add more bureaucracy and reduce benefits- the worst of both worlds.

[Lumine]

I discussed some aspects of this bill with Riley a long time ago (although I didn't believe I would be in the Senate in time to discuss it), and I believe it's a proposal that we should at least discuss in depth. The numbers in section 1 will probably need change considering the obvious consequences to cutting those benefits, but in my opinion, the whole HSA concept has the chance of becoming quite useful.

Just like Nix I have some doubts about the current Atlasian system, but speaking from my personal experience the current Health Care system in Chile (which involves a free market approach similar to this bill) could be considered a success thanks to said free market approach in regards to having Health Savings Accounts. That said, one of the weaknesses of the Chilean Health Care system is the fact that the free market elements often lack the necessary regulation they need, which often leads to people losing a good amount of their future pensions if they are unlucky with the investments. With this bill (and if the current system works as I imagine it does) Atlasia would see the introduction of a free market element into Health Care with a decent amount of regulations (being insured by the government, for example). The current system looks quite beaurocratic to me, so I feel this would indeed improve efficiency.

[bore]

I'd like to echo what Nix said- healthcare is one of those subjects where it's difficult to know what our current policies actually are.

In general though, and this should not surprise anyone given I'm British, (No one serious in Britain opposes a free at the point of use system) I favour a free healthcare system paid for out of general taxation. It seems to me to be much simpler and more efficient for the government to control hospitals because that leads to much cheaper deals and no money is wasted on dividends. Having said that, even if the British system was more expensive and wasteful I would prefer it, because for me healthcare is a moral issue. I don't think anyone should have to suffer poor care simply because they can not afford it, and that's a danger if people have to think about if they can afford a visit to the doctors.

[Napoleon]

While I don't have the time to offer a wholesale explanation of the system, I can answer specific questions related to the system.

[The world will shine with light in our nightmare]

Section 2 of this bill violates our constitution's right to unionize, and "Fritzcare" doesn't mean anything; it is merely a popular nickname for our national healthcare bill.  This whole bill would have to be revamped for it to even be viable.  I certainly hope the sponsors reviewed our previous health care laws before writing this.  It doesn't take that long to read, so it's not even worth explaining the major elements.

The only part of this bill I can agree with is the section that removes the ceiling on out-of-pocket costs for wealthy individuals - which is certainly a good idea, but I doubt it will reduce costs that much at all.

Do the sponsors of this bill have any raw numbers on its effects?  How much will this save, exactly?  Where is the evidence that people will be better off?

[The world will shine with light in our nightmare]

It doesn't take that long to read, so it's not even worth explaining the major elements.

I didn't ask for an explanation because it's a long read; I asked for an explanation because it's difficult to make sense it and I often get the sense that not everyone shares the same understanding of its text. When I sponsored the TRICare Reform Act on behalf of then-SoEA Sjoyce, I had to read through all 9 pages of debate (plus 13 pages of debate on the original Atlasian Healthcare Act) to figure out what the New Atlasian Healthcare Act meant, and even then I wasn't entirely sure what was going on. It's also not the only major piece of health care legislation that we've passed.

The AG should probably work on organizing our health care policies on the wiki.  The IDS has a similar problem with our militia-related bills, so it's hard to get a clear picture of what the policy is.

[Napoleon]

The only part of this bill I can agree with is the section that removes the ceiling on out-of-pocket costs for wealthy individuals - which is certainly a good idea, but I doubt it will reduce costs that much at all.

Do the sponsors of this bill have any raw numbers on its effects?  How much will this save, exactly?  Where is the evidence that people will be better off?

Even that is a terrible idea. The cap is there for a reason- no one should have to spend their entire income on simply staying alive. A family making $250, 000 a year could conceivably afford to spend $50, 000 on healthcare but if you havea child with leukemia or a horrible car accident or even a kidney failure...these are expensive treatments. The cap prevents out of pocket costs from skyrocketing and allows families to preserve some stability through tough times, and families with those incomes already pay extremely high taxes and a lot of money on the health care payroll tax. This program is designed to ease the burden on all Atlasians even if the less fortunate receive the greatest benefits.

[Napoleon]

So lets examine what Federalists are trying to do here, because the premise of this bill is truly infuriating to me. Slashes benefits to lower income Atlasians while leaving the benefits for wealthier Atlasians intact. Removes the pay cap for the wealthy that could result in a family going bankrupt because of a major catastrophe. Denies worker's rights to hospital employees, becahse cheaper is always better of course. Moves the system away from preventative care and toward an archaic HSA approach, which will make health care more expensive for all, less effective for all, without any proper reason or objective for doing so.

Its really a shame. As the primary author/architect/whatever of the current system, the goal of the New Atlasian Healthcare Act was a bipartisan reform to fix a broken, bloated healthcare system. Left and right were able to work together to reduce prescription drug costs, consolidate various existing programs, move away from government healthcare to subsidized private plans that could compete against each other to lower costs while making sure we had universal access and affordability. I left the Senate before the bill was passed and most of the legislative dirty work was taken up by two great and dedicated FEDERALISTS- namely Scott and Sbane. We made healthcares budget impact rather neutral and strengthened our institutions. To undo that, for "cost saving purposes" (presumably to offer tax cuts to the rich down the road or something) we undo a stable and successful program tbat Atlasians enjoy for no good reason.

We don't have a healthcare problem. We certainly don't need this "solution".

[President Tyrion]

I am inclined to side with Napoleon on this, but I'll do more research. As Nix has mentioned, Healthcare in Atlasia takes a while to fully understand.

[Napoleon]

Also you can't just roll over 25% of unused funds to the general fund, the regions are responsible for the administration of costs and services and therefore it would carryover each year. You can't really just snatch the money back.

[🐒Gods of Prosperity🔱🐲💸]

For the benefit of everyone involved, could someone who knows Atlasia's current healthcare system briefly explain its major elements, particularly those that differ from the American system? I've read the relevant laws in the past, but I still don't have a great handle on the subject. I suspect that the same holds true for most people who would like to participate in this debate.

The simplest way to describe its main feature I think is a taxpayer-funded public option. It is a two-tiered system rather than single payer in the sense that it doesn't pay for everything and people can buy supplementary insurance.   Beyond that I can try to help explain it but I'm not sure where to start.  At some point it gets complicated and perhaps contradictory.

[Southern Senator North Carolina Yankee]

Making his healthcare more efficient=making healthcare more expensive for all but the wealthiest of Atlasians? Ok.

This bill seeks to return to the days of old, where preventative care was disregarded. That benefits those who want to profit off of the livelihood of atlasians "we can fix you once you get sick". Well excuse me for supporting a system that encourages early cancer detections via regular screenings and actually getting well instead of sitting around the house watching tv while sick as US flu deaths set records in many states.

All these HSAs do is add more bureaucracy and reduce benefits- the worst of both worlds.

Read the last sentence here Nappy. It clearly preserves complete funding for the very preventative care you are referring to:

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You will also note that in the speech I made last month on healthcare, I stated that it is essential to fund such preventative care for precisely the reason you describes, as well as the fact that success rates are higher and it is by far cheaper then the alternative.

[Southern Senator North Carolina Yankee]

So lets examine what Federalists are trying to do here, because the premise of this bill is truly infuriating to me.

Why should it be? We are just having a debate.

Slashes benefits to lower income Atlasians while leaving the benefits for wealthier Atlasians intact.

Doesn't it remove the cap on out of pocket expenses for wealthy though?

Removes the pay cap for the wealthy that could result in a family going bankrupt because of a major catastrophe.

Would it be acceptable at a million a year?

Denies worker's rights to hospital employees, becahse cheaper is always better of course.

I understand the need for them to be repesented, they have a tough job. But on the flip side I tend to be reminded of the fact that public unions don't organize against the personal self interest of a private enterprise and it's owners, but against the public interests of taking care of the sick and spending of tax payer dollars. There has to be balancing act to be sure, but when it comes to public servants there is no balance whatsoever for obvious reasons lest the public good be sacrificed.

Moves the system away from preventative care and toward an archaic HSA approach, which will make health care more expensive for all, less effective for all, without any proper reason or objective for doing so.

As stated previously, the text appears to do the exact opposite. Now granted, it might be at cross purposes one section to the next, but that is a problem of structure and consistency and can be fixed obviously.

Its really a shame. As the primary author/architect/whatever of the current system, the goal of the New Atlasian Healthcare Act was a bipartisan reform to fix a broken, bloated healthcare system. Left and right were able to work together to reduce prescription drug costs, consolidate various existing programs, move away from government healthcare to subsidized private plans that could compete against each other to lower costs while making sure we had universal access and affordability. I left the Senate before the bill was passed and most of the legislative dirty work was taken up by two great and dedicated FEDERALISTS- namely Scott and Sbane. We made healthcares budget impact rather neutral and strengthened our institutions. To undo that, for "cost saving purposes" (presumably to offer tax cuts to the rich down the road or something) we undo a stable and successful program tbat Atlasians enjoy for no good reason.

It was an improvement to be sure, but in terms of it being perfection itself, I have my doubts.

We don't have a healthcare problem. We certainly don't need this "solution".

That is the biggest factual innaccuracy in this entire thread if for no other reason then Mental Health remains a disgrace as do numerous other aspects of the system.

[Southern Senator North Carolina Yankee]

Also you can't just roll over 25% of unused funds to the general fund, the regions are responsible for the administration of costs and services and therefore it would carryover each year. You can't really just snatch the money back.

That is also innaccurate. The program is administered by the communitty Health Partnerships, and they are public corporations created by the Atlasian Senate with authority delegated to them, probably under Art 1, Section 7, Clause 28,  but function independently beyond that. The only connection to the Regions, is the borders in which these CHPs operate.

Your bill's Section:

Regional Administration
1.The provision of healthcare and the administration of budgets and services shall be the responsibility of independent Community Health Partnerships (CHPs) congruent to the existing Regions These shall be established as public sector corporations. Each CHP shall be headed by a board consisting of one Executive and further non-executive members.
2.CHP members shall be selected by the Health Directorate and shall be a non-partisan gathering of experts in the medical, pharmaceutical, and health insurance and administration industries.
3.All boards shall be required to have an audit committee consisting only of non-executive members on which the chair may not sit. This committee shall be entrusted with the supervision of financial audit and of systems of corporate governance within the CHP.
4.CHP's shall have responsibility for delivering primary and community services and commission them from other providers, and are involved in commissioning secondary care. Each CHP shall have their own budget and set their own priorities and shall directly provide a range of community health services including but not exclusive to;
1.The provision of funding for general practitioners and medical prescriptions.
2.The commission of hospital and mental health services from the private sector.
5.All members, directors and associated bodies shall be accountable to the Health Directorate as outlined in Section 3 of this Act.


Fritz's
Section 4- Regional Administration
(a.) The provision of healthcare and the administration of budgets and services shall be the responsibility of independent Community Health Partnerships (CHPs) congruent to the existing Regions These shall be established as public sector corporations. Each CHP shall be headed by a board consisting of one Executive and further non-executive members.
(b.) CHP members shall be selected by the Health Directorate and shall be a non-partisan gathering of experts in the medical, pharmaceutical, and health insurance and administration industries.
(c.) All boards shall be required to have an audit committee consisting only of non-executive members on which the chair may not sit. This committee shall be entrusted with the supervision of financial audit and of systems of corporate governance within the CHP.
(d.) CHP's shall have responsibility for delivering primary and community services and commission them from other providers, and are involved in commissioning secondary care. Each CHP shall have their own budget and set their own priorities and shall directly provide a range of community health services including but not exclusive to;
1.The provision of funding for general practitioners and medical prescriptions.
2.The commission of hospital and mental health services from the private sector.
(e.) All members, directors and associated bodies shall be accountable to the Health Directorate as outlined in Section 3 of this Act.

It came from a Scottsman though
https://uselectionatlas.org/FORUM/index.php?topic=99368.msg2079105#msg2079105

[DemPGH]

I would oppose, and veto, this bill.

Yes, clause 2 is unconstitutional. I also view high risk pools, other "options," and so forth as unnecessary. Worse, I don't see how the overall bill doesn't end up shifting more financial burden to the patient (i.e., "consumer" - isn't that awful?) in the final analysis.

Most troubling, and most heartless, is that healthcare is being associated here with profit margins and expense lines. We don't want to go in that direction; we don't want to look at it through that prism, because to do so means quality goes down, and quality is worth cost. As long as our HC system is not breaking the bank, and it is not, and as long as it is working, and it very clearly is, there is no reason to "fix" it, most especially with something like this.

[Sec. of State Superique]

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So, then we have a loophole in the law? Aren't we saving any money at all?

[Napoleon]

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So, then we have a loophole in the law? Aren't we saving any money at all?

I'm not sure whether I'm missing something, but it seems as if we are paying health care providers less and telling them that they can't bill patients for the difference. At this point I wonder whether we have any hospitals that haven't declared bankruptcy.

It would go through the insurance.