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

[Lumine]

If we cannot achieve tangible progress in the thread, we can at least keep discussing these other related factors and thus seeding bills in the process that can be offerred whilst I work out issues behind the scenes.


So about the billing by result instead of procedure?

I've been researching the "paying based on outcomes" as you describe it, and so far my reaction is rather mixed after seeing some of the downsides (which involve both results and implementation). If we assume our current Health Care system has not butteflied this, there should be a growing number of clinics in the United States using the system, with the Mayo Clinic being the prime example. It's supposed to increase quality (a Mayo Clinic Doctor said: "you get what you pay for") and provide a far better service, but the initial experiments in the United States never accounted for the cost, which apparently shot through the roof.

Now, the results in Hospitals and Clinics were initially better, but as time went on and the rest of the Hospital catched up with other programs there was virtually no difference. Paying based on outcomes also has to rely on independent organizations to check on the results, organizations that we are going to have to pay for (and I suspect the cost will be  rather high in light of how many Hospitals and Clinics they will have to follow). One of the sources I checked (http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=78) also stated that some Hospitals feared to be "shamed" (as such a method was bound to hurt poorer zones and such).

I still have to do more research on this, but so far it seems overtly complicated and expensive to implement (this is still an experiment since there's no Obamacare, so it will definetly require more experimentation if we want to go forward).

Why did the costs go up? What were the quality downsides that you referenced

Also what forms of experimentation woudl you be willing to support?

Mostly because the experimentation so far has focused on quality alone, which meant there was a disregard of the potential costs of the system. Increased experimentation and a focus on cost as well (as some clinics have started to do in the past year) would probably help reduce this, but then again it will take some time before it's efficient enough to be implemented (at least that's what I think). With quality downsides I didn't mean that quality would go down, but the actual increase was not really impressive once the rest of the hospitals and clinics were able to catch up through modernization programs.

I guess we could perfectly set up a few clinics (some private and the rest public via the SoIA, perhaps?) with a determined span of time and the directive to focus on the combination of quality/cost, but that would take some time.

[Fmr. Pres. Duke]

I've been reading a book on the Singapore system and how it got started, and they did begin it using clinics. Through these clinics, they charged a small fee to whoever used it, and they noticed that if a patient was charged a fee, they were more likely to listen to their doctor instead of ignoring them because they had a vested, financial interest in the pills they were given. Thus, their society became healthier because they pushed personal responsibility when it came to their health, not putting it on the state.

I understand some here want a "single payer" that is entirely taxpayer funded and in return, everyone receives unlimited care, but that is not sustainable or financially feasible. We either make a massive tradeoff of quality or we rework this system so the poor have adequate care and those who can pay are asked to pay more for their healthcare.

Remember, single payer systems like the ones in Canada have a severe resource problem. I believe I read somewhere that the state of Rhode Island has more MRI machines than all of Canada. We don't want that in Atlasia. Imagine the troubles we'd develop with preventive care.

I am also reading about the French system, which is more single payer. I will share my thoughts on that once I know more.

[Fmr. Pres. Duke]

https://docs.google.com/document/d/1ZXjgQvLF91-ov0zqcC7X9uV9_s89gatl1N-ciSAyCWM/edit?usp=sharing

Starting to put pen to paper. Not sure where this is going but I think it's time we starting going somewhere with this. I will update this as the days go on.

[Southern Senator North Carolina Yankee]

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Reforming Atlasian Health Care (Working bill) The following is intended to replace F.L. 32-12  Section I: Establishing MediSave  Part I: Framework
1. All employers who employ citizens of the country of Atlasia on a full-time basis are hereby required to establish, for each full-time employee, an interest bearing MediSave account. Any self-employed individual earning more than $6,000 a month is also required to open and contribute to a MediSave account. The federal government will set the contributions required by the self employed based upon reported income.

 2. The MediSave account shall be funded by both employee and employer contributions where the employer matches the contributions made by the employee at a 1:1 ratio. 

3. Saving accumulated in MediSave accounts are not considered taxable either at the time of contribution nor at the time of withdrawal. 

4. MediSave accounts are capped at a maximum of $60,000. Any further contributions shall go to an individual’s retirement fund. 

5. Individuals aged 65 and older must hold a balance of at least $32,000; failure to meet this criteria will require funds be transferred from other retirement accounts into the MediSave account. 

6. The interest rate for interest bearing MediSave accounts shall be set by the Health Directorate each quarter. 

 Part II: Usage 1.    https://uselectionatlas.org/FORUM/index.php?topic=191318.msg4166361#msg4166361  https://uselectionatlas.org/AFEWIKI/index.php/Atlasian_National_Healthcare_Act  https://uselectionatlas.org/AFEWIKI/index.php/The_New_Atlasian_Healthcare_Act https://uselectionatlas.org/AFEWIKI/index.php/Comprehensive_Drug_Reform_Act https://uselectionatlas.org/AFEWIKI/index.php/Equality_in_Healthcare_Act https://uselectionatlas.org/AFEWIKI/index.php/TRICARE_Reform_Act_of_2013 https://uselectionatlas.org/AFEWIKI/index.php/Senior_Care_Act 


Damn thing kept crashing. IE 8 is not even four years old and everywhere I look, it is being deemed non-compatible. Previous browsers had a much longer lifespan. OF course the dirty little secret is that its Micro$hits way of pushing us to give up XP. They can suck my...

[Southern Senator North Carolina Yankee]

First off, did I get all of it? It looks cut off at the bottom


That said, what will the allowed withdrawals be?

[Fmr. Pres. Duke]

I'm going to do more work on this today, so I'll let you know as soon as I figure that part out.

[Fmr. Pres. Duke]

I have begun to include some of the limits on withdrawals for kinds of procedures now, but the bill is still far from finished. I'm about to get to the portion for the low income people.

[Southern Senator North Carolina Yankee]

I am waiting MR. PResident?


I think I have the basics down for Part III, I just got to committ them to a text. It will probably be shorter then either of the others.

We just need to lay out the framework for those sub groups and figure out how the mechanics of it will function. We will use the exchanges and since everyone is starting off with ANHC anyway, it won't be as complex as I first thought.

One big variable I am facing is how much is covered in real life. For instance, I assume Veterans are fully covered through the VA Tricare, etc? How does that work, how are family members treated with regards to such, etc?

[Fmr. Pres. Duke]

I'm not going to be able to do much on this until this weekend given my bar studies. If anyone else was to help work on this, feel free. I don't want to do this alone.

[Southern Senator North Carolina Yankee]

Well I am going to fill in Part III, but until we can figure out the savings component, the other sub section gaps in my framework (near top of page 3 or 4 I think), will have to wait until this weekend.

Also, I might need a seperate bill to do this (several parts need seperate bills), but there are some adaptations to the Fritzcare Cards that I definately want to make for Veterans and the like as well. Once I see how big Part III gets I can decide on the best approach.

I also recommend that all healthcare related policy that is not directly related in some way the public system or reform thereof, be pursued through independnet legislation like bore did with the Doctor thing, which is now law. The same could be done with Riley Efficiency Deduction thing, Malpractice and liability reform and the like that have been discussed.

[Southern Senator North Carolina Yankee]

These cut-outs really help to keep the main text post manageable in size.

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I am uncertain as whether to put pre-existing conditions in Part One or in here. Also it might be that these changes to the Fritzcare cards might need to be done in a seperate bill. Section 3, clause 3 needs to be beefed up, I know it is a just a place holder for now.

[Southern Senator North Carolina Yankee]

Putting this here so that I don't have to keep changing pages.

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I do like Section 1, Clause 7, on the other hand we have a problem with children getting lost, falling through the cracks of the system has they become adults, progress gets lost and the patients end up regressing. We need to balance protecting privacy (which can boomerang around and hurt the patient if it is not  protected) and ensuring that they don't fall through the cracks of the system.

[TNF]

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[Southern Senator North Carolina Yankee]

Ah, TNF that is the Healthcare Modernization Act of 2014 passed back in February. I put it there for cross referencing. Are seeking to replace the current text (see OP) with an amendment to said Act?

[Simfan34]

I very strongly support Singapore-style anything, but their healthcare model in particular is a model to be followed.

I don't know if you're being a bit hyperbolic, but Singapore is incredibly authoritarian about some things. Are you sure you want that?

Will given Simfan's distaste for democracy, it wouldn't really be surprising.

The Senator from the Midwest is not wide of the mark.

I would like to hear more about Medisave. Perhaps, if the Senator would like, we could compromise and also establish a Housing & Development Board, which I trust would be to his liking. More Singaporeaness for everyone.

[Simfan34]

I very strongly support the formation of Singapore-style Medisave accounts. I very strongly support Singapore-style anything, but their healthcare model in particular is a model to be followed. Central Provident Fund and all. Indeed, I'd support repealing healthcare taxes and having it be completely paid out of Medisave funds, with means-tested subsidisation when necessary funded through transfers and direct subsidies from the general fund to the ANHC.

Can you explain this I am confused. If you repeal the healthcare taxes, how do you pay for the subsidization? If you take it out of the general fund that would require something rather substantial to be cut in the rest of the budget, no?

It would come out of general taxation revenues. The assumed savings would keep the scheme revenue-positive.

[Southern Senator North Carolina Yankee]

I very strongly support the formation of Singapore-style Medisave accounts. I very strongly support Singapore-style anything, but their healthcare model in particular is a model to be followed. Central Provident Fund and all. Indeed, I'd support repealing healthcare taxes and having it be completely paid out of Medisave funds, with means-tested subsidisation when necessary funded through transfers and direct subsidies from the general fund to the ANHC.

Can you explain this I am confused. If you repeal the healthcare taxes, how do you pay for the subsidization? If you take it out of the general fund that would require something rather substantial to be cut in the rest of the budget, no?

It would come out of general taxation revenues. The assumed savings would keep the scheme revenue-positive.

The savings would have to rather substantial to cover 100% of its own cost.

[Simfan34]

We would establish Medisave accounts. For people who are unable to contribute enough to cover their regular expenses, the government would make up the difference though grants to their accounts.

[Southern Senator North Carolina Yankee]

I get that thE Medisave accounts, people would contribute to instead of paying taxes basically. Then the general revenues would be used to cover the difference for those who cannot afford to contribute enough to their account, and savings reaped from the general system would then be expected to defray that cost in turn, no?

Seems kind of thin, though.

[Simfan34]

The system would cut out a lot of waste. As is the case in Singapore. I've pointed out government health care expenditure there is essentially the lowest in the world. If we execute it properly I don't see why should not be able to replicate the successes here.

Provided we don't unionise disease or something like that.

[Sec. of State Superique]

Does anyone know anything about this "paying based on outcomes" as opposed to by the number or procedures. I recall hearing about in various discussions but I have forgotten the details. Isn't that what they do at the Mayo clinic?

From what I can remember it sounded like a good way to boost quality, cut costs and reduce those unnecessary procedures we discussed, whereas most measures do one at the expense of the other like tort reform requires balancing the need to guard against mal practice whilst trying to reduce unnecessary procedures and costs and a lot of cost cutting can also come at the expense of quality and so for.

So how does this process work, can it be done on a large scale or should it be done experimentally first?

I don't know if you aknowledge that but there are alternatives to fee-for-service style of payment; there are things like a Global Budget or Bundled Payments which looks much better than the current system.

[Southern Senator North Carolina Yankee]

TNF, if you wish to amend the Healthcare Moderanization Act, I would recommend pursuing it via independnet legislation.

[Southern Senator North Carolina Yankee]

Actually scract that, I will deem the amendment as friendly. But I would urge Cincy to condense the text down to just those passages that are being altered for the sake of space.

[Southern Senator North Carolina Yankee]

Does anyone know anything about this "paying based on outcomes" as opposed to by the number or procedures. I recall hearing about in various discussions but I have forgotten the details. Isn't that what they do at the Mayo clinic?

From what I can remember it sounded like a good way to boost quality, cut costs and reduce those unnecessary procedures we discussed, whereas most measures do one at the expense of the other like tort reform requires balancing the need to guard against mal practice whilst trying to reduce unnecessary procedures and costs and a lot of cost cutting can also come at the expense of quality and so for.

So how does this process work, can it be done on a large scale or should it be done experimentally first?

I don't know if you aknowledge that but there are alternatives to fee-for-service style of payment; there are things like a Global Budget or Bundled Payments which looks much better than the current system.

What are these and do you have an information on them?

[Sec. of State Superique]

http://www.minnesotamedicine.com/Past-Issues/Past-Issues-2011/February-2011/Five-Payment-Models-The-Pros-the-Cons