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

[Southern Senator North Carolina Yankee]

I thought Labor was against complex bills that no one could sink their teeth into? I remember something about Nix and bore mentioning it once or twice.

[Southern Senator North Carolina Yankee]

I genuinely believe that part of the things that TNF is posting looks pretty nice but I would like to see limited-profit providers being included as part of bi-partisan agreement and introducing an scaled premium system as the main part of funding for this "new" healthcare system.

EDIT: Now I've seen that this is copy and pasting but we could use partially the structure of it and fine-tune it for Atlasian Standards.

Partially, maybe. But I fear that, even without the difference over signal payer versus a market competing-premium based and supported public option, that the size of the bill would render either version impassable based on the size alone.

so Hostile.

[Southern Senator North Carolina Yankee]

I genuinely believe that part of the things that TNF is posting looks pretty nice but I would like to see limited-profit providers being included as part of bi-partisan agreement and introducing an scaled premium system as the main part of funding for this "new" healthcare system.

EDIT: Now I've seen that this is copy and pasting but we could use partially the structure of it and fine-tune it for Atlasian Standards.

Partially, maybe. But I fear that, even without the difference over signal payer versus a market competing-premium based and supported public option, that the size of the bill would render either version impassable based on the size alone.

so Hostile.

Fine then. Endorsed!

Endorsed? what you mean endorsed man?

[Southern Senator North Carolina Yankee]

Cincy ou got some leftovers on a copy and paste job there it would seem man.

NAY

A more condense version or perhaps a guidepost, could be effectuated from that real life text I agree and some of it looks like parts of the Fritzcare law, like the covered treatments so I think it or a predecessor may have already been used in this fashion.

[Southern Senator North Carolina Yankee]

5-5-0-0

Second one of these today.

Two days left o nthis vote.

[Southern Senator North Carolina Yankee]

One day left.

[Southern Senator North Carolina Yankee]

Time is up.

Vote on Amendment 60:67 by TNF

Aye (5): Alfred F. Jones, bore, Talleyrand, TNF, and Tyrion
Nay (5): DC al Fine, Goldwater, Lumine, NC Yankee and shua
Abstain (0):

Didn't Vote (0):

Tied, Cincy you need to end the vote and break the tie of course.

[Southern Senator North Carolina Yankee]

We have already fixed sixth in thep resent text

I just found something else:

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Is this bold meant to be a limit on the reintroduced co-pays?

[Southern Senator North Carolina Yankee]

NAY.  

I support single-payer.  I want single-payer.  I don't want this copy and pasted amendment.  The entire reason we have a non-functioning healthcare system as it is, is because of our collective failure to understand what we're passing, and administrating.  If a collective body, or the Senator wants to craft legislation that some Senators will actually read, I will, to the best of my legally granted ability, shove it up the queue.  Focus on the fact that we have an amendment that everyone can grasp, and is readily attainable.       

The President has told me no less than six times privately and twice in public that he opposes single payer.

I look at it like this. What are the priorities we want with healthcare reform?
Lower Costs
Higher Quality
Access for Poor, Mentally ill, Veterans nad Seniors
Focus on early and Preventative care as opposed to Emergency "sick care" when it is more expensive.
Anything I am missing?

We can do all that with a properly functioning public option system. The only difference provided by a single payer system is we all get to pay for Warren Buffet and Bill Gate's Healthcare. If some rich fat cat wants to live a life of excess, he should pay (through the nose at that) on the private market and that way avoid that cost being spread around to everyone else or have it taken from the same source as everyone else. Single Payer doesn't allow for that and so the cost gets eaten by same funding source that is funding everyone else. If cost cutting becomes necessary, chances are the one with the most influence will be the last one to get cut. 

[Southern Senator North Carolina Yankee]

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I came up with this outline late last night, so it is rather preliminary. ANHC will almost certainly dominate the market in any case and some regions may just opt for it ot be the only provider.

[Southern Senator North Carolina Yankee]

I disagree because you got to look at the long term picture and not just the short term picture.

 First off, you are presuming that the non-ANHC heathcare providers would be monolithic, for-profit healthcare, which is not going to be case. Under the outline I posted above, it would be perfectly reasoanble for a region to require all authorized insurance opertations other than ANHC, to be non-profit coorperative, or even offer a public option of their own to compete with ANHC. When you live in a world that is dominated by such non-traditional providers, you are going to see those remaining for-profit operations are going to look and operate much differently, because as Nix said, 1) people can easily choose a gov't or non-profit option and 2) they are deprived of the monopolitistic even oligarchic hold that they hold over the life world of healthcare. In fact I would argue that in a system free of any government involvement, you would actually have no free market just as much as you wouldn't in single payer because you have this tendency to monopolize to a large extent through the provider networks and in real life the gov't has done little to stop that process.

Second of all, you assume that single payer is the natural end state and that it is the preferable end state. If we have it now it is because both, Fritz and Napoleon structured it so that we would have this as the defacto situation. Healthcare, regardless of the "Its a Right" is primarily a responsibility, taken or thrown away whenver you drink a beer, light a cigarette or pig out on junk food. I am for personal responsbility and freedom of choice, but a society on freedom requires that people are held responsible for their own actions. In a system with no premiums, how do you incenvize responsible behavior? How do you put a higher cost, reflective of the cost to society on those who are not? Think of it like the push for a carbon tax, seeing the put a price on the carrying capacity of the environment to handle a particular amount of carbon.

Single Payer is a disaster in the making. The only real presence of a cost cutting measure is the ability of the government to dictate prices to the doctors, nurses, hospitals, suppliers and drug companies. I have no love for any of these has institutions, not even hospitals after what happened last month so I can play that game too, but such is not a good basis for proper policy. What is a good basis is to play out that process of time. The gov't can make it work in the short term defraying the cost of people's poor lifestyle choices, but eventually they will have to choose. They can keep going with the short-term focused cost cutting, and risk people's access from lack of supply as too few go into the profession, develop and produce drugs or manufacture equiptment, or come up with some criteria for the denial of care to certain people.

Unlike some, I do believe that fate is avoidable if we develop a system that provides access to preventative care (done) and prices in poor decisions making with some system of premiums. That way we move towards a lower cost environmnet slowly over time as opposed to having to take the drastic steps at the back end. I think that is far cheaper and more effective care for more people then continuing as we are and one thing is for sure, Single Payer isn't capable of addressing this issue.

[Southern Senator North Carolina Yankee]

The consequence of this is that single payer advocates are arguing for reforms that would be less drastic in their effects than the reforms that would be necessary to make Fritzcare compatible with a thriving private insurance market. There isn't really any viable ground between the two.

Since when has Atlasia really give a damn about the drastic consequences of policies it enacts? Fritzcare, as he originally introduced it, was an inoperable mess.  Yet it likely would have passed the Senate in 2009, because people were far more concerned with not voting against the concept universal helathcare, then finding what worked. Fortunately, Franzl and Afleitch did insist on some minimal improvements.

Or how about the transition of tri-care into Fritzcare last year? Rather simplistic approach in my view. Howe about the transition of medicare and medicaid into barely functioning Fritzcare in 2009?

I am confident that if properly structured, we have less to fear from the establishment of exchanges and switching ANHC over to a premium system, then continuing down the single payer road to hell.

[Southern Senator North Carolina Yankee]

The goals I have in mind for our healthcare reform are that 1) I don't want to sacrifice quality of care 2) I don't want to nationalize all hospitals; we have many, many prestigious hospitals in universities in this country that offer some of the best care in the world; I don't want to lose that, 3) I don't particularly want to roll back our healthcare system though to where people lose coverage. If there is a way to accomplish all of those things, great.

1) Then you don't want single payer, it will remove competition, reduce incentives to get early and preventative care, and discourage both supply and research of new and improved procedures, technology and facilities.
2) Then you really don't want single payer. Single payer would essentially mean that gov't would spend about three decades financialliy depriving hospitals as well as all the other facets of healthcare until it realize the hard way that such wouldn't work long term. At that point all the hospitals would likely already have been nationalized because the reimbursements would be too low to sustain them without the treasury eating the red ink.
3) Shua's recommendation I believe, is for a more gradual stair stepping up the premium ladder. Its hard to comapre because the present system is not presently a sliding scale premium one but a sliding scale of benefits. I think there are three, maybe four steps that all drastic, after which supplemental insurance is required (at exhorbinant costs most likely). You could lower the payroll tax (regressive taxation so lowering it helps the poor by default) in a premium system and provide a much more gradual stepping up, easing the pain on the poor and middle class.

I do believe that single payer may be the natural progression from where we are now, but I know very little about healthcare law and at the moment, I am in the middle of my final law exams, and I don't have time to research it till this weekend or next week.

It is not so much knowledge of law (I assume you mean real life law where we are well beyond now) as it is an understanding of economics, monopolies and behavior, such you have showed much understanding of it in other areas in the past so while you are right to want to find out as much as possible, I am sure you possess more then enough basis from which to approach this debate as it is. The confusing part is where it gets into the nature of the disconnect between the product or service being sold and the person buying it becuase insurance, gov't or private is in between, and of course what appears to be a natural tendency towards monopilzation. Single payer doesn't fix the former and is unnecessary to address the latter.

As for the time, that is a problem regardless and unfortunately I am undet the gun myself but from bad weather hence why these are all rather rushed.

[Southern Senator North Carolina Yankee]

I have to say, speaking as someone from Britain, this whole debate bemuses me. For one thing the costs of the NHS are, while by no means low, cheaper than in almost every other developed countries.

This is not the first time I had to contend on the "British Perspective" whilst having a debate over healthcare. Afleitch was rather forcefull in defending NHS as I recall. It is not just a question of cost, but also cost relative quality. I also recall a substantial controversy surronding some recent reforms to NHS proposed by Cameron. Did these pass and what were they and why was he pushing them?

The other point I'd make is people don't not drink beer or not smoke because they think they'll have to pay for it. No one thinks lung cancer is worth smoking but 100 grand in hospital fees are not.

Then why have taxes worked so well over the last thirty years to reduce smoking? Again you missed my point, it is not so much just about discouraging or incentivizing the use, but also defraying the cost to the general healthcare inflation and to the treasury, since any system we adopt would in effect have substantial government subsization. This way we avoid the risk of reduced access for one person on the account of the actions of another they have nothing to do with.

 

As well, a comprehensive, free at the point of delivery healthcare service does not preclude private insurance. In Britain a bit more than 10% of people have private insurance, because it gets you a slightly nicer room, and it's a status symbol, among other things.

Then NHS is not a pure single payer system by definition, regardless, no?

[Southern Senator North Carolina Yankee]

We have already fixed sixth in thep resent text

I just found something else:

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Is this bold meant to be a limit on the reintroduced co-pays?

That is how I have always understood it.

That is still a lot of money for a person below the poverty line. I think about $900 for the lower category, but that is a rough calculation as I am in a hurry.

[Southern Senator North Carolina Yankee]

I have to say, speaking as someone from Britain, this whole debate bemuses me. For one thing the costs of the NHS are, while by no means low, cheaper than in almost every other developed countries. The other point I'd make is people don't not drink beer or not smoke because they think they'll have to pay for it. No one thinks lung cancer is worth smoking but 100 grand in hospital fees are not. As well, a comprehensive, free at the point of delivery healthcare service does not preclude private insurance. In Britain a bit more than 10% of people have private insurance, because it gets you a slightly nicer room, and it's a status symbol, among other things.

I do recognise though that I'm out of the mainstream on this issue, in that I'd prefer to nationalise hospitals, and pay for it out of general taxation, in a similar way to the NHS operates, so I'm not going to try and push that.

What's especially amusing about this is that government health care spending as a % of GDP is a bit over 9% in the UK and a bit under 9% in the United States. Yet another 10% of our GDP goes toward health care in the form of private spending... and we have lower life expectancies, more preventable deaths, and higher mortality rates for everything other than cancer.

What I find especially amusing is that you are comparing the pre-Obamcare United States to the NHS Britain when the debate is between a single payer system and a public option.

One of the biggest variablies that are thus not accounted for in the aTlasia-America difference is that we cover preventative care and those with pre-existing conditions, have since 2009, and will continue to under any product resulting from this debate and therein, combined probably with exentuating factors like lifestyle choices and so foth are probably the bulk of the lower outcomes. And as you yourself have pointed out, most of the pre-existing private companies that sap up a lot of the private side of that are also gone. It is frnkaly and apples to oranges compairson.

[Southern Senator North Carolina Yankee]

I said "US" in that post rather than Atlasia deliberately. I didn't mean to confuse by mentioning a RL issue, but you implied in an earlier post that single payer produces worse outcomes, and this example shows that that claim is false.

I've been deliberately cagey about what I favor in Atlasia, because I'm not exactly sure. To clarify, I lean toward supporting Fritzcare with reforms to encourage healthier behaviors, but with the understanding that this will probably lead toward government ownership of many hospitals and the effective end of private health insurance. But I'm not necessarily satisfied with that outcome, so I remain undecided.

relative to what? Worse relative to what, Nix? Where did I say NHS Britain was worse then pre-Obamacare US?

[Southern Senator North Carolina Yankee]

I have to say, speaking as someone from Britain, this whole debate bemuses me. For one thing the costs of the NHS are, while by no means low, cheaper than in almost every other developed countries.

This is not the first time I had to contend on the "British Perspective" whilst having a debate over healthcare. Afleitch was rather forcefull in defending NHS as I recall. It is not just a question of cost, but also cost relative quality. I also recall a substantial controversy surronding some recent reforms to NHS proposed by Cameron. Did these pass and what were they and why was he pushing them?

Have you ever wondered why both me and afleitch, despite him being a torie and me a labour supporter who disagree on almost everything, both support the NHS so strongly

The Cameron reforms basically made GPs like businessman who bought their own services, and generally marketized the NHS. They were initially far more radical, but public outcry watered them down at least twice. As for why he supported them, my answer would be because he's an idealogue who is emotionally attached to the idea of a free market.

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

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Then why have taxes worked so well over the last thirty years to reduce smoking? Again you missed my point, it is not so much just about discouraging or incentivizing the use, but also defraying the cost to the general healthcare inflation and to the treasury, since any system we adopt would in effect have substantial government subsization. This way we avoid the risk of reduced access for one person on the account of the actions of another they have nothing to do with.

Taxes work well because they are an immediate cost to the buyer, increasing the cost of healthcare doesn't because it is a possible cost 30 years down the line, so people don't factor it in. I'd be willing to bet that the people less able to afford the costs of risky health habits are those most likely to have risky health habits- people aren't rational accountants.

I accept that if there was a real shortage of medicines or services then single payer is basically subsidising some people over others- although I think that's true for any system, it's just different people get discriminated against. Besides, I don't think that's it's all that big a problem anyway- certainly in Britain there is not really a problem of "deserving" people losing out on treatment to "undeserving" people.[/quote]

A premium surchage, whilst still on a sliding scale basis mind you to factor in the financial situation obviously, is not a direct cost to the buyer? Insurance companies are pricing into the premiums the risk these activities pose, Life insurance has done it for quite a while.

Maybe not, but it is a substnatial source of the overall cost of healthcare and the inflation and one of the reason America dwarfs those of other countries, aside from not covering the cheaper earlier treatments, is a culture that some objective people might say is rather irresponsbile or even stupid, to the point that they probably need as much of a kick in the ass as possible, financially or otherwise. One thing I do think Atlasia probalby does still possess from America is that.

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Then NHS is not a pure single payer system by definition, regardless, no?

It depends how you define single payer. Wikipedia seems to think it is, because the government is the single payer for all healthcare, but I think this is more a semantic dispute than anything.
[/quote]

I disagree, if there is a still a healthcare insurance market and insurance is not banned from private sources, that makes it far more of a market dominating public option then "Single-payer" as I would understand it.

[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.

[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.

[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. 

[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.

[Southern Senator North Carolina Yankee]

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