The Institute for Healthcare Reform - Additions to the board announced.

[Oakvale]

Hello, everyone.

Today I'm announcing the foundation of the Institute for Healthcare Reform, a cross-party think tank dedicated to finding a way of reforming our broken healthcare system, ensuring that it's sustainable for generations to come, and guaranteeing a high quality of access for all citizens of Atlasia.

The recent Senate healthcare debate revealed glaring fundamental flaws with our current system. I can think of no better explaination than Institute board member Averroës Nix's summary of the system as it stands -

1. Since 2009, every Atlasian resident has been eligible for coverage under the Atlasion National Healthcare Program (a.k.a. "Fritzcare"), and all health care providers are required to cover Fritzcare enrollees.

2. Fritzcare is a comprehensive health care program (including elements of care that are often neglected IRL, such as mental, dental, and vision).

3. Existing government health care programs (Medicare, Medicaid, and Tricare) have been abolished and rolled into Fritzcare.

4. Prior to 2012, copayments or deductibles on required benefits could not be billed to Fritzcare recipients.

5. Since 2012, the percentage of expenses covered by Fritzcare A) varies based on personal income and B) is capped at a percentage of household income. Preventive care remains free of charge to individuals.

6. HOWEVER, even after the reforms of 2012, "Licensed health care clinicians who accept any payment from the Atlasian National Health Care Program may not bill any patient for any covered service."

7. Fritzcare funding comes from A) former funding for Medicare and Medicaid, including the payroll tax; B) a progressive (by personal income) tax on health insurance benefits; and C) raising what the Medicare payroll tax (now called the "Health Care Payroll Tax") from 1.45% to 6.5%.

9. Public benefit corporations ("Community Health Partnerships") established in each region are responsible for administering Fritzcare.

8. Private health insurance may continue to exist, but health insurance companies must join an "Exchange."

Currently, simply put, "Fritzcare" as it's popularly known is unsustainable. It'd be a miracle if many healthcare providers haven't already been forced to declare bankruptcy. A large part of the supposed funding for our healthcare system is from a tax on private insurance plans, but given that we have by law guaranteed citizens the right to the same standard of care with or without insurance, it's not clear why anyone would purchase a private insurance plan. An insurance mandate may be one of the many ideas for reform that we will be discussing.

In the Senate debate, Senator Tyrion called for a centralised place to discuss healthcare reform. My hope is that this Institute will be just that, and that we can co-operate with the Senate to publish a manageable, affordable and comprehensive proposal that will overhaul our healthcare system to ensure its continued survival.

I look forward to the debate, and am hopeful that we will be able to work out a generally agreeable white paper on this crucial topic,



Chairman of the Institute for Healthcare Reform

   Board Members

                 Oakvale (TPP-CA)
                 Averroës Nix (LAB-NY)
                 Cincinnatus (TPP-NY)
                 Dereich (FED-MS)
                 Riley Keaton (FED-WV)
                 Scott (FED-AR)
                 Superique (TPP-AK)

[Oakvale]

Applications to join the board should be PMd to me. We'll consider all applicants but bear in mind that we will strive for balanced representation of parties and ideologies.

[The world will shine with light in our nightmare]

Wow.  I was long under the impression that all Atlasians were automatically enrolled in the program.  I take it we simply have a public plan that competes with private companies?

[Potus]

Cost containment and responsible reform must be top priorities of every Atlasian politician. The bill that I wrote does that, but the True Left stands tall to pontificate about the great sins of individual freedom and consumer choice. Not only do the supporters of our broken healthcare system deny any moral imperative of reform, they fail to consider the economic imperative.

A more cost effective, consumer-driven healthcare system is key to increasing the wellness of our population and making Atlasia economically viable in the future.

[Snowstalker Mk. II]

I will oppose this reactionary organization.

[Oakvale]

I will oppose this reactionary organization.

Congratulations on supporting a broken system that doesn't make mathematical sense.

[Snowstalker Mk. II]

I will oppose this reactionary organization.

Congratulations on supporting a broken system that doesn't make mathematical sense.

There are issues with Fritzcare, principally that it is still a semi-private system.

[Simfan34]

I support this endeavor. We must remain true to the original goals of Fritzcare- taxpayer funded, sustainable, high-quality health care for every Atlasian. We cannot afford for narrow ideologism to cloud our judgement when dealing with such an important issue, and so I think this multi-partisan organization will be able to play a key role in reform. I would sign up to join but... uh, yeah.

[Fritz]

Time for a single-payer system.

[TNF]

Time for a single-payer system.

It's the only way forward. Preferably with government ownership of hospitals.

[Flake]

Time for a single-payer system.

[sentinel]

I'll sign on to this if permitted.

[Maxwell]

I'll be interested in the findings of this institute.

[Sec. of State Superique]

X Superique

[Simfan34]

Time for a single-payer system.

It's the only way forward. Preferably with government ownership of hospitals.

No thanks.

[Gass3268]

Time for a single-payer system.

It's the only way forward. Preferably with government ownership of hospitals.

Truly this is the way to go.

[Fmr President & Senator Polnut]

Time for a single-payer system.

It's the only way forward. Preferably with government ownership of hospitals.

Truly this is the way to go.

Single-payer works... if you increase coverage and access, in fact guarantee them, you improve standards and outcomes.

Mixed health systems, despite the arguments being in favour of taking pressure off the public system, actually have the impact of increasing pressure on the public system and expanding waiting lists. You do not strengthen the public system because you've strengthened the private, you strengthen the whole health system by having everyone have an equal stake.

[Simfan34]

Well... perhaps not with state owned hospitals. I assumed Fritzcare was a single-payer program. More proof that this country has turned sharply to the left in recent years.

[Fmr President & Senator Polnut]

Well... perhaps not with state owned hospitals. I assumed Fritzcare was a single-payer program. More proof that this country has turned sharply to the left in recent years.

Most hospitals in single-payer countries are publicly owned. It puts patient care ahead of profits... I'm fully supportive of it.

[Fmr. Pres. Duke]

Yep, nix is right.

I'm not sure how to handle this honestly. I'm not entirely opposed to single payer, but I'm a little leery of making all hospitals government owned. I'm aware that I probably have to pick a side because a single payer system with private hospitals seems like an implausible scenario.

[Oakvale]

I'm not particularly comfortable with mass-nationalization of healthcare given that the government apparently didn't notice that the current system is entirely unfunded for several years after its implementation (to say nothing about the loss of efficiencies). I suppose you could argue that an internal market system like the UK has might work, but I'm wary.

[Cincinnatus]

I'm not particularly comfortable with mass-nationalization of healthcare given that the government apparently didn't notice that the current system is entirely unfunded for several years after its implementation (to say nothing about the loss of efficiencies).

That is certainly a valid concern, given our enormous oversight.  I think the point that needs to be made is that, healthcare in Atlasia should be free at the point of service.  Discussion on how best to achieve that goal, should be priority, though I'm in favor of single-payer.

[DemPGH]

I'd be in favor of single payer system as well. I think in the end concern and care for a patient should be prioritized above cost cutting.

[Simfan34]

In this country at present, the best hospitals are almost universally the private ones. I think we must be mindful of the uniqueness of the Atlasian experience- most countries moved from completely out-of-pocket systems to single payer. Other countries' never had the private insurance networks that we have.

Similarly, most countries have never had "private universities" until fairly recently, yet it would be quite unfounded to use this to support the idea of nationalising universities- the best universities in the world are Atlasian private universities. I don't think we can look at foreign countries' experiences to make wholesale conclusions about our own when we've had quite divergent histories.

Continuing the university example, I think we should do is to look towards the universities as a model. All the great universities of this country are not-for-profit. Perhaps it would be worthwhile to expect hospitals and insurance providers to operate under the same conditions? That is, we would have a gradual non-profitisation of the healthcare provider sector.

There is no reason we cannot rely on the regulated free market- which has since time immemorial delivered results- to lead the way.  I think analysis and research on models such as these is the worthwhile route, and not a merely ideologically-derived rush towards nationalisation (which, it seems is the answer that some people seem to have for everything nowadays).

I think one worth examining would be integrated delivery systems along the lines of Kaiser Permanente of California. A focus on preventative care and the managing of chronic disease is what has brought significant results for users. There are no easy answers. Finding them will take time.

[🐒Gods of Prosperity🔱🐲💸]

Wow.  I was long under the impression that all Atlasians were automatically enrolled in the program.  I take it we simply have a public plan that competes with private companies?

It doesn't really compete with private companies, since everyone gets some amount of healthcare coverage from the public system. The more income your family has, the less public coverage you get. What private insurance mostly does is fill in the gaps. 

What we have is something that used to be single-payer, but in order to cut costs we moved away from that, and so now is a hybrid, but I don't think it's structured in a particularly sensible way.  I think we should consider having single-payer catastrophic coverage, and then having a subsidy for private insurance or HSAs for more routine coverage.