Healthcare Congressional Committee

[Clark Kent]

Members:

Blair2015
ClarkKent
darthebearnc

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[Blair]

X Blair

[Clark Kent]

x ClarkKent

[Blair]

I'd be willing to become Chair, even though with 3 members that may not be a major issue

[/]

I'm apparently part of this committee

for some reason

so x me

[tmthforu94]

I'm apparently part of this committee

for some reason

so x me

This is the reason:

It has been noted already - the level of activity and attention to detail in this Congress has been very underwhelming. In order to help address this concern, I am establishing four congressional committees. Each committee will deal with a "big issue" that needs to be discussed in Atlasia.

To my knowledge, here is the most recent amendments to our previous national healthcare law. I think it would be a great starting point for the committee to look at. It was amended by Justice Yankee and I know he has some ideas with this, so hopefully he can help with this.

[Southern Senator North Carolina Yankee]

This specific post is probably best since you won't have to dig through ten pages to find the final text: https://uselectionatlas.org/FORUM/index.php?topic=191318.msg4211876#msg4211876


Keep in mind the backdrop. Atlasia had passed two healthcare laws previously, both of which were poorly designed (The National Healthcare Act of 2009 and The New National Healthcare Act of 2012). The first was single payer with private supplemental insurance and carried the named ANHC or alternatively Fritzcare after its sponsor. It was never probably funded and one clause in one section essentially banned all private insurance among many other conflicting text problems. The New National Healthcare act was basically an amendment of the first. It was better funded, but still contained numerous flaws and adopted a "Sliding Scale of Coverage" to cut costs. Atlasia had also merged Medicare, Medicaid and Tricare into that same system as well, before 2014 and thus before the 2014 law was passed. The first two in the 2009 act and the latter in the 2013 Tricare Reform Act.

In early 2014, Potus2036 presented me with a proposal to significantly alter the healthcare system. I introduced it for him, but it was a few months before it came to the floor. At the time there was a general consensus that the healthcare system as established in the New National Healthcare Act of 2012 and subsequent amendments was badly flawed. Concurrently, there was a much narrower bill from the Duke administration dealing mainly with technology and delivery that was passed in February 2014.  

But wider reform was necessary and that proposal came to floor. It was nearly completely rewritten by the end resulting in the law you see linked above, joining with members from four different parties (Fed, DR, TPP and Labor) to produce a working substitute that restored competition, empowered the regions and still ensured adequate care for seniors, vets and the poor. Federally created, regionally administered exchanges were created in all five regions, with like two or three Federal regulations. Fritzcare was transformed from an entitlement to a public option that was offered by default in every exchange and regions could determine who else to allow onto the exchange. All plans, including fritzcare charged premiums, thus re-establishing the possibility for competition with other options as determined by regions once again and a "sliding scale premium subsidy" was included to ensure proper coverage while not paying for Bill Gate's healthcare. The subsidy was designed by then Senator Shua who specialized in crafting benefit scales to avoid coverage cliffs. He did this in several bills and healthcare was designed likewise to avoid the problem of sudden drop offs on slight income increases that harm people from taking promotions and finding better jobs.

I realize there are a lot of components that some might take issue with, be it a public option for the right or emphasis on the market and regions for the left. Keep in mind the presence of a public option was necessary because medicare, medicaid, tricare had already been phased into the general public healthcare system. For our purposes now, including such, could likewise facilitate a similar consolidation and there are immense benefits to doing so again. Quality improvements, greater choices in doctors and savings both from consolidation of agencies and also through the expansion of competition. Likewise the regional component allowed for regions to determine the nature of their exchanges. They could for instance only allow the public option, supplement the subsidy 100% and have a single payer system. They could create their own regional level public option, they could create co-opts, and/or they could allow for private sector insurance to be offered. This level of decision making would empower and strengthen regions, creating debates over the nature of that region's healthcare system, by giving them a range of options within a set of a few minimal federal requirements.

We have seen proposals like those of Scott, which would need to be altered obviously to reflect any federal law, but it shows the potential and frankly lost potential back then when both myself and Scott were taken out of commission a month after passage. There is appetite for regional involvement in healthcare clearly and with both the public option and a sliding scale subsidy there is no need for concern that people will be left without care if a region does nothing. At the same time, regions can fully expect to be able to compete with the public option with their own plans, co-opts private plans etc, in most every segment of the healthcare market. Private insurance for instance has difficulty when it comes to seniors for obvious risk pricing reasons, hence once again the importance of a public option if medicare is consolidated in.

The subsidy created and funded federally also ensures availability of resources to ensure regions don't face the funding problems that places like CO, VT and CA faced when they tried to go go it alone essentially.

This approach was balanced, tackled virtually all aspects of the healthcare market, promoted competition and regional control while still ensuring adequate protections for vets, seniors and the poor and middle class. There are areas where things would need to be tweaked, and consolidation of the healthcare market would require a complex transition, that had already been completed prior to 2014. That said, I think this was the best approach then, and is the best approach now with some necessary alterations to deal with differing backdrop (entitlements aren't consolidated in, employer based healthcare still exists etc) post reset.

[Blair]

If there's no opposition I'd like to assume the duties of Chair, to get this moving.

[Clark Kent]

I support Blair as Chairman.

[The world will shine with light in our nightmare]

Yankee explained things better than I could have and I'm excited that the Congress is interested in taking on the issue of healthcare again.  Like the distinguished Eternal Senator, I believe that crafting a healthcare system which incorporates both public care and regional autonomy is the best prescription for the country.  And for that reason, I would advise this body to consider plans that allow the regions to maintain enough flexibility over their own healthcare and health insurance regulations while maintaining appropriate standards that guarantee universal access to quality care and a wide range of options in the insurance market.

Currently, I am in the process of drafting a possible model for the North that specializes in the introduction of a regional public option as well as subsidies and price controls for prescription drugs.  With this, I believe a federal public option would be welcomed in our region to facilitate market competition.  But, I do not yet know the budgetary impact that this model would have for the region, which will influence how I proceed in pursuing this project at the federal level.  (These matters will be dealt with after our government is formed, and this is an issue I would like to tackle as a candidate for the legislature.)

With that in mind, although I am not a member of this body, I will gladly work with any member of Congress to craft a bipartisan healthcare plan for the nation.

[Blair]

My first duty as chair is to invite Yankee, A.Scott and KingPoleon to be expert witnesses to this panel- I've heard from all three of them about their healthcare ideas, and it's clear they've all got a lot of good ideas. I hope that they can contribute to this panel

[The world will shine with light in our nightmare]

I wholeheartedly accept the invitation.

[Blair]

As chair I officially call this committee to session


Firstly I know that healthcare can be a very complex issue- even as someone who spend 6 months studying global health policy I still find vast parts of  healthcare law very complex, and tricky. This is why I invited various members, and hope that we can find a good balance here.

Before cracking onto policy this is a very good read, and provides a good background of US health indicators. What's important is working out what is needed in the long term, rather than what is best in the short term.

http://www.commonwealthfund.org/publications/issue-briefs/2015/oct/us-health-care-from-a-global-perspective

[Kingpoleon]

I accept the invitation to be an "expert witness". My plans have been circulated through three or four members of Congress, and I will provide the current rough draft to this Committee in short order.

[Kingpoleon]

Here is the CliffNotes version:
1. Repeal ObamaCare/the ACA.
2. Institute BaucusCare/AHFA(The Atlantic: Details of BaucusCare) for twelve to twenty-four months.
3. After that time is up, the Healthy Americans Act/Bennett-Wyden Act(Wall Street Journal: Wyden's Third Way(on healthcare)) will come into effect.

I'm willing to look at the German healthcare model and any other healthcare systems/bills anyone suggests for modifications.

[Blair]

Before we look at the specific plans (I'm aware there's several versions going around) I'd like to lay out in my view the 5 major decisions we have to make.

+ Do we want to expand medicare coverage for 55 year olds, and expand medicaid coverage?

+ Do we want a public option? ( A government/ or govt supported insurance scheme)?

+ Do we want to put market controls on drug companies regarding prices/imports etc?

+ Do we want to allow the regions to have their own plans to compete?

+ What about Obamacare do we want to keep or remove?

[The world will shine with light in our nightmare]

With respect to Obamacare, I don't think that an outright repeal of the law, at this point, would be the ideal course of action if doing so would cut the number of people insured, which has increased substantially since it was enacted and Healthcare.gov was put into place.  I believe it would be wiser to institute any new healthcare system as, rather, a transition from the status quo and only remove key parts of the law if doing so would reduce costs - namely, the individual mandate and the ban on private insurance companies denying clients with pre-existing medical conditions.  Incidentally, I had a system akin to the German healthcare program in development before realizing that the logistics of a single region adopting it could be complicated at best and unsustainable at worst.

Nonetheless, such a model might be ideal for the nation long-term.  One successful feature of Germancare has been its ability to incentivize doctors and hospitals not to over-utilize care for patients.  Like Obamacare, Germancare requires individuals to purchase health insurance.

Where do the regions come in?  In Germany, the "sickness funds" are divided into various regions.  (In Atlasia, we would have the option of dividing sickness fund associations on either a region or state-by-state basis - if that is the type of model we're looking to adopt.)  Regions would retain much control over their own markets and public programs, and also have a much greater role in determining things such as physician pay.

The downsides?  Physicians would likely be reluctant to become part of anything that involves negotiating their own pay or regulating how much they can treat their patients, even if doing so will reduce public and private costs long-term.  I recommend watching the video above for a better overview of Germancare and the pros and cons that come with it.

Lastly, in addition to Blair's points, we need to decide which areas of care we want to subsidize or reform.  I think the following (mostly taken from Fritzcare) are worth noting:

Primary care and prevention (arguably the most important for keeping costs down)
Inpatient care
Outpatient care
Emergency care
Prescription drugs
Durable medical equipment
Long-term care
Palliative care
Mental health services
The full scope of dental services (other than cosmetic dentistry)
Substance abuse treatment services
Chiropractic services
Basic vision care and vision correction (other than laser vision correction for cosmetic purposes)
Hearing services, including coverage of hearing aids
Podiatric care
Paid sick/family leave (not part of Fritzcare)
Contraceptives (added to Fritzcare in subsequent legislation)
End of Life Care - Shall be limited in hospital settings up to the cost of such care when attained through a hospice setting (added to Fritzcare in subsequent legislation)

[Kingpoleon]

I'd happily agree to an ObamaCare inclusion clause.

With all due respect to ObamaCare, it's not nearly as efficient as Wyden-Bennett, BaucusCare, or the German system.

[Unconditional Surrender Truman]

I believe it would be wiser to institute any new healthcare system as, rather, a transition from the status quo and only remove key parts of the [ACA] if doing so would reduce costs - namely, the individual mandate and the ban on private insurance companies denying clients with pre-existing medical conditions.

Just to clarify, there would be a public insurer in this scenario, right? Otherwise, allowing private insurers to deny coverage to people with pre-existing conditions restores the most odious reality of the pre-ACA world: that the people who need medical care the most cannot afford it.

[Southern Senator North Carolina Yankee]

I accept the invitation obviously.

I believe it would be wiser to institute any new healthcare system as, rather, a transition from the status quo and only remove key parts of the [ACA] if doing so would reduce costs - namely, the individual mandate and the ban on private insurance companies denying clients with pre-existing medical conditions.

Just to clarify, there would be a public insurer in this scenario, right? Otherwise, allowing private insurers to deny coverage to people with pre-existing conditions restores the most odious reality of the pre-ACA world: that the people who need medical care the most cannot afford it.

Yes, that would be my assumption. Under the 2014 bill, there was not an individual mandate for instance. The only mandate was that all providers had to cover preventative care. Scott listed what the public option covered (it inherited the same coverage areas from the 2009 bill plus subsequent amendments). But on the flip side 1) There were no private insurers left by that point by most estimates as a result of previous legislation and its impacts and 2) Regions alone could decide whether or not to allow competition onto the exchanges and what that competition looked like.

The Public Option (and all providers for that matter public or private) was subsidized on a sliding scale as well (I would recomend you invite shua as well if he is interested in participating), and would have been the primary provider for seniors since Fritzcare had medicare rolled into itself in 2009. Like with those with pre-existing conditions, seniors face difficulty getting covered absent medicare because of the risk-pricing would make it completely unprofitable. It would have worked in the same manner for those with pre-existing conditions as well.

[Southern Senator North Carolina Yankee]

Here is the CliffNotes version:
1. Repeal ObamaCare/the ACA.
2. Institute BaucusCare/AHFA(The Atlantic: Details of BaucusCare) for twelve to twenty-four months.
3. After that time is up, the Healthy Americans Act/Bennett-Wyden Act(Wall Street Journal: Wyden's Third Way(on healthcare)) will come into effect.

What is the point of steps 1-3? If you want to move to Wyden-Bennett, you might as well just reform Obamacare into it. They are like 95% similar, both rest on private plans competing in exchanges under an individual mandate. Both 2 and 3 were formulated prior to the final version of Obamacare passing and thus any references to Obamacare refer to it in an earlier form as opposed to its final form. So it doesn't serve much purpose to cause such a disruption if the end result is so similar, when you could simply amend Obamacare to achieve the same results.

That said I like co-opts and I like moving away from employer based care, but I don't much care for Wyden-Bennett since it is so similar to Obamacare, I really don't see much desire in switching towards it.

[The world will shine with light in our nightmare]

I believe it would be wiser to institute any new healthcare system as, rather, a transition from the status quo and only remove key parts of the [ACA] if doing so would reduce costs - namely, the individual mandate and the ban on private insurance companies denying clients with pre-existing medical conditions.

Just to clarify, there would be a public insurer in this scenario, right? Otherwise, allowing private insurers to deny coverage to people with pre-existing conditions restores the most odious reality of the pre-ACA world: that the people who need medical care the most cannot afford it.

Sorry - to clarify, I favor retaining the individual mandate and the ban on denying claims for people with pre-existing conditions in the new law.  I would only support repealing the mandate if it isn't necessary to ensure universal coverage or prevent a free-rider problem from happening.   I would say that the mandate on pre-existing conditions should remain in place, as well, unless the public plans are competitive enough to prevent people from being denied insurance by private companies.

I'm actually not sure how we addressed the free-rider problem with Fritzcare.*  I know we didn't address the problem of foreign visitors in this country becoming sick or injured during periods of stay here, either, so that needs to be another priority for any new healthcare overhaul.

I second Yankee's recommendation to invite shua as a special advisor here.  His expertise was essential in overhauling healthcare a couple years ago.

*EDIT: Nevermind.  The free-rider problem wasn't an issue for Atlasians under the law, though I'm not sure how it would've addressed foreign nationals.

[The world will shine with light in our nightmare]

For convenience of the members, here are the older healthcare policies:

Atlasian National Healthcare Act ("Fritzcare") (2009)
The New Atlasian Healthcare Act (2012) Amended by subsequent acts
Reforming Public Healthcare Act of 2014

[Southern Senator North Carolina Yankee]

I would presume that foreign nationals were not dealt with direclty in 2009 or 2012 and the issue was not brought up in 2014 to my knowledge. So that is one more detail that would have to be addressed.

[Southern Senator North Carolina Yankee]

For convenience of the members, here are the older healthcare policies:

Atlasian National Healthcare Act ("Fritzcare") (2009)
The New Atlasian Healthcare Act (2012) Amended by subsequent acts

It is probably most helpful to read them in order too:
Reforming Public Healthcare Act of 2014

So I will put this one with the others.