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

[Southern Senator North Carolina Yankee]

There is a reason for many people to purchase private insurance in the current set-up, which is that above a certain income level, the government benefits leave a whole lot left to pay.  You are correct though that this provides an adverse selection problem.  You may be right that creating a subsidized private option as I have suggested is a more radical change at this point than moving to full single-payer, though that's not enough to stop me from wanting to try to do it.  It seems like some sort of sliding-scale premium is being put forward as the middle ground - whether or not that's viable I don't know.

Yes, there is there supplemental insurance market and like I said it is probably at exhorbinant prices to cover that last gap.

It depends on whether you mean politically viable or viable economically. I figure you would have premiums priced accordingly from either the public option or approved competitors based on the risk etc, and then the gov't would subsidize gradually descending across the income brackets.

One big variable is that there is no special process for the seniors and the veterans, so they are lumped into the general process. The circumstnaces related to for instnace a seniors getting healthcare would have to be considered when changing to another process for the general population and if necessary and secondardy setup put in place for them.

[bore]

What would Afleitch say about why Cameron was pushing them? or Cameron himself?

You'd have to ask him Although IIRC afleitch was against the reforms. Cameron claimed he was doing them for the usual reasons, to improve patient care, cut costs etc.

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I suppose I just don't think that abstract insurance premiums or possible costs in the future actually effect how people live their lives. If that were true, wouldn't you expect there to be a negative correlation between, say, smoking and income? Our problems with regard to that sort of thing seem to me to be far deeper social ones. Besides a punitive insurance scheme will also end up costing lots of people who are just plain unlucky.

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Maybe. I guess that means I'm pushing a market dominating public option then

[Southern Senator North Carolina Yankee]

What would Afleitch say about why Cameron was pushing them? or Cameron himself?

You'd have to ask him Although IIRC afleitch was against the reforms. Cameron claimed he was doing them for the usual reasons, to improve patient care, cut costs etc.

I often find that whilst a party is necessitated to adapt to get with the times (Get Gubermint out of Medicare), there is still a core that has never adapted. This was especially the case once the Republicans took over Congress 1990's and began pouring over various stuff going back decades and even back to the Depression. The British system discourages this, but in your "biased" opinion, how many Conservatives deep down want NHS abolished?

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I suppose I just don't think that abstract insurance premiums or possible costs in the future actually effect how people live their lives. If that were true, wouldn't you expect there to be a negative correlation between, say, smoking and income? Our problems with regard to that sort of thing seem to me to be far deeper social ones. Besides a punitive insurance scheme will also end up costing lots of people who are just plain unlucky.

The main target though is the rich or relatively rich invincibles (both young and old) so to speak, they would be the most effected by such a scheme. And regardless of whether or not it works tochange their habits, it will defray the cost to the general healthcare system atleast for that group and provide cash for research and helping the poor, the same way the taxes do, just in amore specialized arena.

In general you have seen the cost, amongst other factors true, have a substantially postive effect in this regard over thel ast thirty years. Insurance is about risk, about pricing risk and it is therefore all about probablilities and numbers. These activities, these lifestyles are proven to cause higher rates of disese and illness later in life, all of which are very expensive for someone to deal with. The process of pricing that into the premium is a means by which the cost of action taken today, but incurred decade or more down the road, is brought to bear on the wallet today. A person may indeed get lucky and not suffer the consequences before they die from something else, but thereagain the whole point is the percentages and increased risk that they will.

What do you mean by unlucky? By pricing this in, it will put downward pressure on healthcare costs and free up resources long term (either from the fewer people getting sick from those irresponsbile choices, or by way of providing more resources paid for by the higher premiums those people pay) to those who get sick from some other source such as exposure to some kind of pollution maybe, or some other reason natural or man caused that leads to them becoming ill.

A premium system gives you more flexibility to manipulate behavior and in a situation where so much is the result of poor decisions made in the short term, versus those in the long term, it gives the ability to move costs from the future into the present time.

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Maybe. I guess that means I'm pushing a market dominating public option then

I would recommedn finding more out about the restrictions that NHS imposes on prviate insurance. If the well to do can buy gold played private plans as a status symbol as you said and leave the peasants on the government system, that certainyl cast doubts on it being single payer and sounds more like Atlee and the boys created more of two tiered class based system, either intentionally or unintentonally.

[bore]

I often find that whilst a party is necessitated to adapt to get with the times (Get Gubermint out of Medicare), there is still a core that has never adapted. This was especially the case once the Republicans took over Congress 1990's and began pouring over various stuff going back decades and even back to the Depression. The British system discourages this, but in your "biased" opinion, how many Conservatives deep down want NHS abolished?

There are a few people like this guy who want something more like an american system. But, as Ike said "Their number is negligible and they are stupid". Almost everybody torie or not, supports a free at the point of use system, though tories tend to prefer things like competition in the service and private providers bidding for services.

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I don't think we actually disagree on that much, then. My preferred system, the NHS system, works because the rich (of whatever health status) subsidises it, your's seems to be similar, except it's a different way of execution. Again though, I don't see insurance costs being a massive deterrent to people smoking or drinking, if we're going to get people who take risks with their health to pay more, a tax on fast food or cigarettes (though IIRC smokers actually end up costing less because they die sooner) seems much more effective. What I meant by unlucky is people who are born with higher chances of illness.

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All private healthcare does is guarantee you a nicer room when you go to hospital, and maybe things like plastic surgery or very expensive but only slightly beneficial medicines. The vast, vast majority of doctors in the UK work for the NHS, and if your disease is in any way serious (cancer or whatever) insurance or not, you will be treated by the NHS, in exactly the same way. It's a two tier system in the same way as an education system where there were only public schools, but anyone could hire private tutors or buy books.

[Southern Senator North Carolina Yankee]

"Die Sooner" is not as cost effective as you might thing, particularly if they go out needing hundreds of thousands of dollars in medical treatments. I also don't thnk we need to go down that road.


Yes, we already do tax those various items and a rather high rate, which helps cover the costs of research and the poor and so forth. My point is that you also want to defray the cost from general healthcare costs as well so that it is not a contributor to general healthcare inflation as well as providing yet one more incentive, that way the system as a whole will face less cost providing for the vast bulk of the populace because that smaller group is defraying the costs of there actions, which will improve the quality of the service the majority of the people are provided with. Its hard to explain succintly because it treats inflation of healthcare almost like a precious resource (think like carbon for instance in environmental policy) and it requires putting together basic understanding of markets and demand driving prices with the behaviors that underly a large portion of that, but rather then price people out as a market would normally do (since that means letting people die) to relieve the shortage, you price it aiming to minimize a generalize increase in cost for everyone even while still covering them and still brining more supply onto the market to relieve the shortage. 

[Cincinnatus]

What do we want to do here? 

[Southern Senator North Carolina Yankee]

If we move to a system in which Fritzcare is to be a component of, rather than a whole affair. Then we need at least a two sectioned bill, maybe three.

You need a section that defines the market(s) in which the competing plans are to be offerred and contain restrctions and or regulations that apply to all of them in come, and of course the subsization system. You then need another section altering the New Atlasian Healthcare Act of 2012, to alter Fritzcare to operate in the new environment.

You then probably need a third section dealing with Veterans, Seniors, disabled and those with prexisting conditions as well as several other groups. This would have to done last to ensure that that it is designed to work in the most compatiable way with the system brought about by section 1. Section 2 also would have to change Fritzcare in a way that is compatible with Section 1.

So therefore the best place to start would be Section 1.

[Southern Senator North Carolina Yankee]

Just throwing stuff down here, I would have the following in Section 1.

- Establish a system of exchanges with one in each region. ANHC has to be offered in each.
- You then have a set of regulations establishing any limits on co-pays, deductibles or mandated coverage like preventative care (or you could just give everyone ANHC coverage for the preventative side, whatever works best)
- Any other regulations deemed necessary
- Subsidization Scheme

If I am not mixing up what people have proposed here, I would like to see what shua had it mind in terms of the numbers on the last part.

[Southern Senator North Carolina Yankee]

I can start putting some texts together tomorrow.

[🐒Gods of Prosperity🔱🐲💸]

Just throwing stuff down here, I would have the following in Section 1.

- Establish a system of exchanges with one in each region. ANHC has to be offered in each.
- You then have a set of regulations establishing any limits on co-pays, deductibles or mandated coverage like preventative care (or you could just give everyone ANHC coverage for the preventative side, whatever works best)
- Any other regulations deemed necessary
- Subsidization Scheme

If I am not mixing up what people have proposed here, I would like to see what shua had it mind in terms of the numbers on the last part.

My thought was to make the subsidy whatever ANHC costs for a person up to 150% of the poverty line, and then a sliding scale from there, but I hadn't figured out precise figures.

[Southern Senator North Carolina Yankee]

Would you be willing to formulate a scale that would be acceptable to you?

[🐒Gods of Prosperity🔱🐲💸]

Would you be willing to formulate a scale that would be acceptable to you?

I can give it a try.

[🐒Gods of Prosperity🔱🐲💸]

here's a possible formula:

x = household income  (measured in terms of poverty line)
y = subsidy (measured in terms of full cost of public option coverage)

y= 1 when x <= 1.5 (150% of poverty line)
y= -.4(x - 4) when x >= 1.5



changes may be considered more gradual than appears in this graph, for ex.:
for a family of 4, household income of $36000 (150%), subsidy is 100% of public option rate
for that family with household income of $48000 (200%), subsidy is 80% of rate, etc.

[DC Al Fine]

I support shua's formula & his graphs.

[Southern Senator North Carolina Yankee]

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[Southern Senator North Carolina Yankee]

We'll fill in as we go.

[bore]

If we're doing one giant omnibus bill, could we take the opportunity to repeal all of our current statute on the record?

A quick scan of the wiki produces these healthcare related bills:

Comprehensive Drug Reform Act
TRICARE Reform Act of 2013
Equality in Healthcare Act
The Duke-Yankee Mental Helath Care Reform Proposal Part 1
Healthcare Reform Act of 2004
Repeal of the Prescription Drug and Medicare Improvement Act of 2003
Addition to the Prescription Drug Reimportation Act
Senior Care Act
and, of course,
The New Atlasian Healthcare Act

[Southern Senator North Carolina Yankee]

That isn't possible or practical. My approach was going to be to amend or repeal only on an as needed basis with regards to past legislation. If this thing gets too big it will end up like the Mental Health bill did.

We were going to get rid of HRC of 2004 anyway and there will be modifications to The New Atlasian Healthcare.

As for the presence of Mentality ill, that only extends to coverage for such persons and there families whereas The D.Y.C.O.Y dealt with research and such forth asn was always going to be a multi-part project.

It does help to have an nice post to use as a reference guide though,

[Southern Senator North Carolina Yankee]

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2. Funding for the subsidy shall be derived from the healthcare payroll tax set at 6.1% as amended by Residential Taxation Reform Act of 2014, and the Insurance Tax in established in the Finance Section of the New Atlasian National Healthcare act:

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3. Limits and/or guidelines for premiums, co-pays, deductibles:
a.

b.

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Part II - Changes to ANHC
1. Clauses 1 and 3 of the Finance section of The New Atlasian Healthcare Act are stricken with Clause 2 renumbered as Clause 1 and amended as follows:

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Part III - Seniors, Veterans, Mentally Ill and Pre-existing Conditions.
[/quote]

[Southern Senator North Carolina Yankee]

I threw away the first part of clause 1 and inserted the last half of that clause into clause 3 of this possible text I am building here. That is going to need to be altered most likely but for right now consider it a copy and pasted placeholder if nothing else.

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This is already baked into the pie, dropping the language isn't going to undo it.

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Need to reinsert this into this text, though we may want to drop it or lower it.

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The current payroll tax is set by the Residential Taxation Reform Act of 2014 at 6.1%, there is no need to preserve this outdated schedule of increases that has already been implemented and subsequently altered.

[Southern Senator North Carolina Yankee]

shua, let me know if you prefer a better wording to implement your formula. I do plan to include the graph, but I intentionally broke the link to cut the length until we are nearing completing.

[H.E. VOLODYMYR ZELENKSYY]

I'm confused. Did that new thing scrap the old bill or are we proposing creating an all new healthcare system?

[Southern Senator North Carolina Yankee]

I'm confused. Did that new thing scrap the old bill or are we proposing creating an all new healthcare system?

This new thing hasn't don't anything as of yet.

It is going to amend the current Healthcare law, striking some stuff, altering others and it will create a universe it which it will function. ANHC (Fritzcare) will still be a part of that though.

My previous post just parced out what I did with the various parts of the finance section from the New Atlasian National Healthcare act. 

[Southern Senator North Carolina Yankee]

shua, what are thoughts on the portion text I wrote implementing your formula (five posts back from this one)? I would appreciate any improvements or even a wholesale replacement of that clause if you desire. I want it to work.

[🐒Gods of Prosperity🔱🐲💸]

I think this would be good for now (we can amend it later if need be):

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where y is the subsidy (measured in terms of full cost of public option coverage) and x is defined as household income (measured in terms of poverty line).[/quote]

I'm thinking we may need to amend the actual ANH Act itself, given we are redefining it as a public option that may be purchased with a subsidy alongside other plans.