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

[Southern Senator North Carolina Yankee]

I should probably re emphasize what private healthcare is like in the UK. It means you get a nicer room in the hospital, and access to very very expensive but not incredibly effective drugs and a fast track for non essential operations.

So basically they have access to better care because they can afford it.

[Southern Senator North Carolina Yankee]

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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]

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. All leftover revenue from this tax shall go to funding the other provisions of this Act.

3. Limits and/or guidelines for premiums, co-pays, deductibles:
a. The total out of pocket payment for co-pays and deductibles for you or your family for the whole year may not exceed beyond 5% of your income.

b. This co-pay limit shall apply to all services mentioned in Part II, Section 2 of this Act.

Part II - Changes to ANHC
1. See This Post

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

[Southern Senator North Carolina Yankee]

I am going to include the changes to ANHC (Part II) in a second post from now on to cut down on length).

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[Southern Senator North Carolina Yankee]

If you see something that seemingly vanished, it is probably altered or in another part of the text. I am really taking a light hand to it at this juncture, preserving as much as possible so as to avoid people getting lost, which 90% probably already are.

[H.E. VOLODYMYR ZELENKSYY]

I've got things to do IRL right now, so I'll go over the changes later, but I can stomach rich people getting better things like cosmetic surgery (though sometimes said surgery might not be totally unnecessary).

[Southern Senator North Carolina Yankee]

I've got things to do IRL right now, so I'll go over the changes later, but I can stomach rich people getting better things like cosmetic surgery (though sometimes said surgery might not be totally unnecessary).

What happened to equality above all else?

[H.E. VOLODYMYR ZELENKSYY]

I've got things to do IRL right now, so I'll go over the changes later, but I can stomach rich people getting better things like cosmetic surgery (though sometimes said surgery might not be totally unnecessary).

What happened to equality above all else?

Unlike a certain orange avatar I could name, I'm not actually a communist. I don't think you should get ten different nose jobs for free, but then we run into the problem of people who could actually need cosmetic surgery. I suppose we could have some board determine what's needed and what's not, but even I'm not that crazy.

[Southern Senator North Carolina Yankee]

I will do some more owrk on the text tomorrow.

[Fmr. Pres. Duke]

I don't think we need a board determining anything. While I'm sure abuse will happen, as it always does when you're providing a public service, a board to determine whether you need something or not is unnecessary.

I'll wait to see what Yankee produces today before I comment further. I've been reading about Singapore extensively, but I plan to check out some other systems as well.

[Southern Senator North Carolina Yankee]

I had planned to do some work on Part III, being Memorial day and such, but I got on to late.

I am in need of some ideas for the various savings component as well. Duke, the singapore plan had a savings component, based on your research how did the savings component function in that and could it work with a few alterations of course, in more broadly market based system then that of Singapores?

[Southern Senator North Carolina Yankee]

I think there are three ways to handle Part III.

1 Use Fritzcare in a medicare like form to cover the veterans and those with mental illness, maybe even those with pre-existing conditions.

2. Use the main subsidized pre-medium sysrem for as many of those as possible with some kind of fall back for the rest.


3. Some kind of self-contained VA like system branched off of the Fritzcare public option.


I think three is the most complex, expensive and considering the recent RL information, it might wall them into an inferior model and we don't want that. They should get the best not the worse. So maybe some combination of 1 and 2.

[Fmr. Pres. Duke]

The savings component in the Singapore model functions much like a 401K. Employees and employers make contributions to an individuals account, which they can draw on whenever they receive medical treatment. These accounts are all pooled and maintained by a government run entity, and they can be shared amongst extended family members if one account is not sufficient. These accounts are mandatory.

The government pays 80% of all medical costs for those who can afford to pay 20%, and if they cannot, then they are enrolled in a program much like Medicaid, where their healthcare is covered 100%. I don't know how to make it more "market based." But that is how it works in Singapore. 

[Lumine]

I think there are three ways to handle Part III.

1 Use Fritzcare in a medicare like form to cover the veterans and those with mental illness, maybe even those with pre-existing conditions.

2. Use the main subsidized pre-medium sysrem for as many of those as possible with some kind of fall back for the rest.


3. Some kind of self-contained VA like system branched off of the Fritzcare public option.


I think three is the most complex, expensive and considering the recent RL information, it might wall them into an inferior model and we don't want that. They should get the best not the worse. So maybe some combination of 1 and 2.

I would personally recommend using the first one. Much as I support introducing more and more free market elements (like the Health Savings accounts), I believe the least we could do for the veterans is to have them covered (mental illness is also a tricky issue). And, from a political point of view, it might give this bill a great chance if keep those benefits. Still, I recall that an earlier TNF bill stated that the health care benefits of the veterans were to be increased, perhaps it was one of the anti-imperialism bills?

[Potus]

Popping back in to support a new policy, albeit a very market-oriented one.

I have talked about healthcare on the forum a lot. The original bill I proposed was really more of a tweak to the system than a legitimate reform. The original bill reduced Fritzcare costs significantly and saved the government billions of dollars. It also introduced plenty of cost-cutting policies. But, all in all, it's more of a major fix than a real reform.


Since we're now attempting to model a whole new healthcare system, I would encourage the Senate to fully repeal Fritzcare and replace it with a better, freer system. This starts with a standard $7,000-$9,000 annual, refundable tax credit to purchase healthcare. This credit would be the same no matter what plan the person purchased. This creates an incentive to avoid overutilization. Implement an HSA policy, similar to the original bill, that will allow people to save for the more routine costs.

Develop a new set of risk management practices. Provide a high risk pool and a senior pool, for example, that negotiates prices and provides an additional subsidy to acquire insurance. These two policies make care accessible to every single Atlasian. Period. Universal access.

We've also got to look at cutting the actual cost of care, which everyone seems to be neglecting. Create a tax advantage for providers that reduce costs and overhead and in turn reduce prices. Think of it like a tax deduction. You can deduct 30% of your savings from the previous year on this year's taxes. If you increase costs, it's a negative deduction. It would increase your tax bill. This provides a strong incentive for coordinating care and reducing cost.

There is, of course, the standard regimen of pro-competition reforms. Tort reform, allow sale of insurance across state lines, and establish exchanges. We can explore further cost-cutting fixes later. Some might include stripping a lot of regulations off the book, allowing providers to set the educational standard for becoming a doctor, and legitimately tackling the college affordability issue in a smart, pro-market way.

[bore]

Healthcare is not, and never will be, like selling paperclips, the market is not particularly well equipped to supply it.

For one thing, insurance plans are very very complicated, by launching a brave new world where consumers (horrible word) choose their own care policy you'll leave behind the vulnerable, who'll be preyed upon by used car salesman who sell flashy but useless schemes. People don't want choice, they just want not to have to worry about paying for healthcare when they're suffering serious illnesses, and not be crippled with huge costs.

For another, a lot of healthcare is a natural monopoly- you'll only have one general practitioner in a remote town, you'll only have one A and E in a city, you'll only have one local oncology department. Most of the time choice is illusory.

The experience of almost all developed countries around the world is that the cheapest way to provide quality healthcare is not a pure market system, but comes through the economies of scale that one buyer provides.

Finally the idea of loosening regulations seems to me incredibly dangerous. I know enough about the NHS in both England and Scotland, and they are very different systems, to know that there is bureaucracy and waste. In Scotland, incidentally, the waste and bureaucracy is far less because there is almost no market in healthcare. No one is opposed to reducing that, but the idea of allowing vested interests to certify doctors is insane. I can guarantee that it would not be long before there was a scandal because an incompetent doctor ended up killing a patient due to lack of training.

[Potus]

The "used car salesman" thing is taken care of by establishing exchanges. It prevents people from basing all of their healthcare decisions on advertising or whatever. By having a simple, side-by-side comparison of insurance plans, we counteract the used car salesman. That solves that problem.

Choice in insurance is plentiful. The variety of insurance networks also creates a sort of backdoor choice in providers. Empowering patients to pick insurance that is cost effective and is what they need while allowing them to save would work wonders. It addresses the vast majority of cost drivers in healthcare.

By guaranteeing universal access and empowering savings, we can finally focus on cutting costs at the provider level. The efficiency deduction I talked about above would go a long way to creating an incentive to make care better in quality. It improves delivery. The original bill here included employer wellness programs, which are an effective way of reducing longterm costs.

My plan would start with guaranteeing access and the ability to save. From there we would focus on cutting the cost of care at the point of delivery. The standard credit actually becomes worth more over time. By addressing cost drivers of care, the cost of insurance is reduced because of competitive pressures in the exchange and across state lines. It makes life easier on everyone in the medical system.


I like the idea of the real world REINS Act. The act made all regulations that would cost over $100 million be passed through Congress, here it could be the Senate. We should have a full audit of our medical system in terms of cost of government. Then we should focus on reducing the cost of government.

[Fmr. Pres. Duke]

Healthcare is not, and never will be, like selling paperclips, the market is not particularly well equipped to supply it.

For one thing, insurance plans are very very complicated, by launching a brave new world where consumers (horrible word) choose their own care policy you'll leave behind the vulnerable, who'll be preyed upon by used car salesman who sell flashy but useless schemes. People don't want choice, they just want not to have to worry about paying for healthcare when they're suffering serious illnesses, and not be crippled with huge costs.

For another, a lot of healthcare is a natural monopoly- you'll only have one general practitioner in a remote town, you'll only have one A and E in a city, you'll only have one local oncology department. Most of the time choice is illusory.

The experience of almost all developed countries around the world is that the cheapest way to provide quality healthcare is not a pure market system, but comes through the economies of scale that one buyer provides.

Finally the idea of loosening regulations seems to me incredibly dangerous. I know enough about the NHS in both England and Scotland, and they are very different systems, to know that there is bureaucracy and waste. In Scotland, incidentally, the waste and bureaucracy is far less because there is almost no market in healthcare. No one is opposed to reducing that, but the idea of allowing vested interests to certify doctors is insane. I can guarantee that it would not be long before there was a scandal because an incompetent doctor ended up killing a patient due to lack of training.

My aim isn't really to loosen regulations. I think in some cases, especially in the healthcare market, we need regulations. But I also think we can and should have both a functioning public insurance market and private market for those who want to purchase private insurance.

In the Singapore model, the government heavily regulates the private insurance markets in so far as it sets both policies and prices they can charge. Of course, not everyone can purchase private insurance, but that's what the public system is for, everyone is enrolled in it automatically and everyone pays into the system so they can use it in the event they need it.

[Southern Senator North Carolina Yankee]

I think there are three ways to handle Part III.

1 Use Fritzcare in a medicare like form to cover the veterans and those with mental illness, maybe even those with pre-existing conditions.

2. Use the main subsidized pre-medium sysrem for as many of those as possible with some kind of fall back for the rest.


3. Some kind of self-contained VA like system branched off of the Fritzcare public option.


I think three is the most complex, expensive and considering the recent RL information, it might wall them into an inferior model and we don't want that. They should get the best not the worse. So maybe some combination of 1 and 2.

I would personally recommend using the first one. Much as I support introducing more and more free market elements (like the Health Savings accounts), I believe the least we could do for the veterans is to have them covered (mental illness is also a tricky issue). And, from a political point of view, it might give this bill a great chance if keep those benefits. Still, I recall that an earlier TNF bill stated that the health care benefits of the veterans were to be increased, perhaps it was one of the anti-imperialism bills?

Yea, even two eventually becomes one with the "fall back measure anyway" and three would be even more complex. For simplicity sake, since this will have several moving parts, I think you are right.

[Southern Senator North Carolina Yankee]

The "used car salesman" thing is taken care of by establishing exchanges. It prevents people from basing all of their healthcare decisions on advertising or whatever. By having a simple, side-by-side comparison of insurance plans, we counteract the used car salesman. That solves that problem.

Choice in insurance is plentiful. The variety of insurance networks also creates a sort of backdoor choice in providers. Empowering patients to pick insurance that is cost effective and is what they need while allowing them to save would work wonders. It addresses the vast majority of cost drivers in healthcare.

I agree with you about the exchanges, and the effect they have and that along with some necessary regulation helps to keep those excesses in check.


The problem is that we cannot just go back to 2009 and startover with healthcare and for five years we have had Frizcare. While the choice is plentiful in RL, it is not here as a result of us having had a system like Fritzcare designed so that we would be lucky if the hospitals are still open at this rate, more or less private insurers of any kind. Granted, options would be come available, but you cannot just erase ANHC from a page and expect to be able to formulate a plan as if it never existed. That is one of the main reason why I am looking to convert it to a market competing public option, but keep it nonetheless.

[Southern Senator North Carolina Yankee]

For one thing, insurance plans are very very complicated, by launching a brave new world where consumers (horrible word) choose their own care policy you'll leave behind the vulnerable, who'll be preyed upon by used car salesman who sell flashy but useless schemes. People don't want choice, they just want not to have to worry about paying for healthcare when they're suffering serious illnesses, and not be crippled with huge costs.

I said back in February and I meant it, that the poor, the veterans, mentally ill and those with pre-existing conditiosn would be taken care of and that preventative care had to be maintained as accessible. Any plan I formulate will do this and any plan that will get my vote has to as well.

To an extent though we have to get people more focused on their healthcare not necessarily for the sake of wanting them to desire a choice, but to get them to make more responsbile choices lest it bankrupt the system. Anyway I have to go again.

Damn it, I never have enough time... 

[Southern Senator North Carolina Yankee]

The savings component in the Singapore model functions much like a 401K. Employees and employers make contributions to an individuals account, which they can draw on whenever they receive medical treatment. These accounts are all pooled and maintained by a government run entity, and they can be shared amongst extended family members if one account is not sufficient. These accounts are mandatory.

How does that compare to like the way the savings accounts operate in Chile for instance?

Remember even if we don't keep a Medicare like model overall, chances are a similar model will be used for Part III as Lumine and I discussed.

[Potus]

For one thing, insurance plans are very very complicated, by launching a brave new world where consumers (horrible word) choose their own care policy you'll leave behind the vulnerable, who'll be preyed upon by used car salesman who sell flashy but useless schemes. People don't want choice, they just want not to have to worry about paying for healthcare when they're suffering serious illnesses, and not be crippled with huge costs.

I said back in February and I meant it, that the poor, the veterans, mentally ill and those with pre-existing conditiosn would be taken care of and that preventative care had to be maintained as accessible. Any plan I formulate will do this and any plan that will get my vote has to as well.

To an extent though we have to get people more focused on their healthcare not necessarily for the sake of wanting them to desire a choice, but to get them to make more responsbile choices lest it bankrupt the system. Anyway I have to go again.

Damn it, I never have enough time... 

We just need to transition the healthcare sector. Gradual repeal, not "wake up to a different" level of change. Start phasing out benefits, maybe start-up grants for private medical providers and insurers. We can transition the country to the model I proposed fairly easily.

[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.

What’s the reason for Singapore’s success? It’s not government spending. The state, using taxes, funds only about one-fourth of Singapore’s total health costs. Individuals and their employers pay for the rest. In fact, the latest figures show that Singapore’s government spends only $381  per capita on health—or one-seventh what our government spends. 

Singapore’s system requires individuals to take responsibility for their own health, and for much of their own spending on medical care. As the Health Ministry puts it, “Patients are expected to co-pay part of their medical expenses and to pay more when they demand a higher level of service. At the same time, government subsidies help to keep basic healthcare affordable.” 

The reason the system works so well is that it puts decisions in the hands of patients and doctors rather than of government bureaucrats and insurers. The state’s role is to provide a safety net for the few people unable to save enough to pay their way, to subsidize public hospitals, and to fund preventative health campaigns. 

[Simfan34]

Here is some good reading on the Singapore system:

http://www.american.com/archive/2008/may-june-magazine-contents/the-singapore-model

[Potus]

This is alright, though a tad complicated. Of course, not as complicated as Fritzcare. The mandated savings accounts are definitely intriguing, but I have my reservations. The public hospitals, in my mind, would end up being similar to RL HMO's that become second-class care facilities.

The way this addresses cost drivers is similar to the way my model addresses cost. The standard health credit would do everything the Singapore model does. I'd love to have a legal framework for matching contributions into an HSA.

Really, the only bureaucracy my plan has is the people that mail out the money for insurance. This system, and the Fritzcare system, seem to have a lot more messy, faceless government nonsense in the way.

The efficiency deduction I talked about also creates an incentive for coordinated care and increasing efficiency. That is a major cost driver that the public option in Yank's and Shua's plan tries to address with a public option and Singapore addresses with VA-style hospitals. Those are both much, much costlier than creating a tax incentive to lower cost and a tax disincentive to increase cost. It is an easy fix that will yield results without the cost of single-payer, a public option, or VA-style hospitals.