Healthcare Congressional Committee

[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

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.

Noted.

[Kingpoleon]

Do any congressional members of this Committee have any questions for any of us?

[Blair]

Do any congressional members of this Committee have any questions for any of us?

I'm stuck at work for the whole of this weekend as I'm having to go on the road- I'll post some of my thoughts tonight when I've got access to hotel WIFI

[Clark Kent]

I feel like the best job for the federal government would be to let the regions handle their own healthcare, allowing insurers to compete across state lines, and funding the regional public healthcare systems through block grants (because let's be honest, there's going to be some public aspects even if it's almost entirely privatized).

[Kingpoleon]

I feel like the best job for the federal government would be to let the regions handle their own healthcare, allowing insurers to compete across state lines, and funding the regional public healthcare systems through block grants (because let's be honest, there's going to be some public aspects even if it's almost entirely privatized).

I would appreciate any criticisms or remarks of BaucusCare or the Wyden-Bennett Act that you or any other member has. When I privately spoke to Chairman Blair, he seemed very interested in my plan.

[The world will shine with light in our nightmare]

Right now, I'm personally leaning in favor of a Baucus Care-type plan with additional subsidies for prescription drugs and a public option.

[Kingpoleon]

BaucusCare itself is pretty great, but I'd like to see Wyden-Bennett in action. Wyden-Bennett's efficiency is its best asset.

[The world will shine with light in our nightmare]

With Wyden-Bennett being so similar to Obamacare (as Yankee stated), I don't know if it would pass this Congress, seeing as there's an appetite to repeal and replace the ACA with a different model.  I'd be willing to back the HAA provided it includes the provisions I suggested, but I don't think it will pass in this Congress.

(Of course, any healthcare plan is going to provoke so much debate that its chances of getting an up-or-down vote before the next elections are slim to none.)

Later today I'll write a list of specific proposals I'd like to see and we can compare ideas.

[The world will shine with light in our nightmare]

So, here is a full outline on what I would propose:

- Retainment of the individual mandate and ban on insurance companies from denying people with pre-existing conditions

- Creation of non-profit "health insurance cooperatives" that compete with private insurers, which would receive $6 billion to start off, but operate independently thereafter

- The dissolution of Medicaid, substituted with an expansion of Medicare that automatically enrolls individuals/families making less than $90K a year

- A Medicare buy-in option for individuals/families making more than $90K, but less than $500K, after which customers must buy private insurance

- Allowing regions to regulate their health care markets, including health insurance cooperatives, and to introduce a region-based public option (or request a waiver for the establishment of a single-payer system)

- $5,000 tax credit per plan to offset out-of-pocket drug costs that exceed 5% of annual income

- Tax Incentives for doctors and hospitals to reduce waste and over-utilization of care

- Reining in frivolous lawsuits

- Foreign nationals required to be insured by their country of origin or to buy private insurance in Atlasia prior to visiting the country (the latter for work visas and periods of academic study) [I'm not sure if this would be tenable, actually, but we can get into immigration laws and all that crap when everything else is finished]

A good combination, I think, of policies that liberals and conservatives can get behind.  The public option will exist in the event that private health insurance cooperatives prove ineffective or lack bargaining power, and the tax code will be amended to incentivize healthcare savings (rather than require doctors to negotiate their pay, as is done in Germany).  Tort reform is a whole other animal and I'm honestly not sure how we could go about addressing that, but fewer lawsuits will modestly bring down the costs of healthcare.

[Kingpoleon]

May I suggest an expansion of healthcare for those in the active military/reserves, police and bureacracy/government workers/officials making under, say, $150,000 per year. The former two are obvious choices, while the latter one simply insures such part time workers are willing to stay on.

I also suggest a tax reduction of, say, 15% on corporations who offer an expansion of healthcare to workers making under $125,000 per year.

[The world will shine with light in our nightmare]

May I suggest an expansion of healthcare for those in the active military/reserves, police and bureacracy/government workers/officials making under, say, $150,000 per year. The former two are obvious choices, while the latter one simply insures such part time workers are willing to stay on.

I also suggest a tax reduction of, say, 15% on corporations who offer an expansion of healthcare to workers making under $125,000 per year.

I could get behind those ideas, yes, though I would prefer we shift healthcare away from employer-provided insurance (a goal of the Wyden-Bennett legislation).  That will almost certainly require major reforms to the tax code - which would be simpler as a result.

[Kingpoleon]

I generally agree about employers, but it seems unfair for people not working for the government making a chunk less to not have the same quality of healthcare.

[Blair]

As I've said since we only have 3 members of this committee and we're working on such a complex issue this is the exact type of discussion I want- open, and policy focused.


Some questions

I know that one problem with the co-ops is that they'd struggle with the funding issue- the 6 billion should be enough?

If the regions established their own plans (as I'm sure the North will do, and most likely the other 2) they'd be the option of 'Non-Profit co-ops, a regional plan, expanded medicare and private options

[The world will shine with light in our nightmare]

Honestly, I'm not sure.  Kalwejt is going to have to crunch the numbers for us on most of these things and shua can provide recommendations if he wants to be a part of this.  The $6 billion figure comes from the original Baucus plan.

The idea is that the regions will be able to do whatever they want using this framework to provide universal coverage, while consumers will have a wide range of options to choose from regardless.  A region can manage the co-ops (or let them become independent after federal funding expires), provide their own public option, or request a waiver from the law and implement single-payer.  (But the last of those three is not a very realistic option, at least if Vermont's experiment is any indication.)  Or, if a region doesn't want to support any part of the plan, their constituents will always have the federal public option.

[Kingpoleon]

I'd gladly support a committee in the North dedicated to this, composed of health insurance specialists and executives of similar companies, alongside maybe some health insurance labor union leaders.

[The world will shine with light in our nightmare]

Do we want to get the ball rolling on this again?

[Southern Senator North Carolina Yankee]

It is very tough to address an issue like this, even with a large committee format.


I'll assist to the extent practical once again, if the committee so desires it.

[Blair]

I've been planning a version of healthcare reform myself; whilst several others like Scott and KingPoleon have been working on their own versions which is why we've had rather slow progress on this

[Southern Senator North Carolina Yankee]

This is what happened in 2014. There was a massive committee equivalent push back in early 2014 that fizzled because everyone wanted something different. Eventually, once interest had died, was when I finally picked up the pieces, got the power brokers together and pushed through a bill before any of the nay sayers could block it in the name of single payer or whatever.

[The world will shine with light in our nightmare]

Ugh.  Three competing healthcare plans isn't exactly something I was prepared (or hoping) for, honestly...

The best thing for us might be to vote on same bare-bones proposals and then submit an outline which the rest of the Congress can build on when it hits the floor.

I'm going to try and open debate the same way I did in the Senate procedure thread, and list some fundamental questions for this committee to consider.

- Do we want to keep the Affordable Care Act and merely expand on it, repeal in entirely, or repeal certain provisions but keep others?

- If we want to repeal only certain provisions of the ACA, which parts of the law do we want to keep? (e.g. individual mandate, pre-existing conditions clause)

- To what extent should the Federal and Regional governments bear costs?  Do we want a single-payer system like Canada and the United Kingdom, a mixed public/private system like that of Germany, a totally private but heavily regulated health insurance market similar to Switzerland, or something of a different model?

- How would each proposal affect pay and subsidies for doctors and hospitals?


(Oh, and we also need to determine a chair.  I'm fine with keeping Blair on if he likes, but whoever it is needs to stay up to task on this.)

[Southern Senator North Carolina Yankee]

Ugh.  Three competing healthcare plans isn't exactly something I was prepared (or hoping) for, honestly...

Really, what about that is out of character for "this setup" in "this game"?

1. I would prefer to start over, with transitional issues dealt with and some components maintained but altered (like exchanges for instance would be kept but altered to give more regional authority on the regulatory function).

2. Exchanges most certainly come to mind if you are going to have a private component as well as the Regional level alternatives, co-opts etc etc

3. What do you mean bear costs? The problem that the system should address in this category is to minimize subsidization of inflation, which is a significant barrier to expanded access (high bar, means more money to reach same level of coverage), while not leaving people who cannot afford coverage to die in the street or people for whom private coverage is likely not feasible (seniors and vets because or risk pricing) to die in the street.

For an analogy in a different issue, education. The rising cost of tuition has led to calls for free college, barring gov't mandate cuts, that necessarily means tax payers eat the cost of inflation and creating a vicious cycle.

 a. Complete nationalization  and by extention rationing
 b. Regulated subsidization, but you run the risk of regulations being out of date b/c of cost and technology and not keeping up
 c. Subsidization with some kind of natural check on inflation, ie, a cheaper alternative or competition. You would have regulations here too, but it is not your first line of defense.

All other options either 1) Let it run rampant with at best tweaks at the edges or 2) leave people to die on the street from lack of access.

I opt for c. 

[The world will shine with light in our nightmare]

3. What do you mean bear costs? The problem that the system should address in this category is to minimize subsidization of inflation, which is a significant barrier to expanded access (high bar, means more money to reach same level of coverage), while not leaving people who cannot afford coverage to die in the street or people for whom private coverage is likely not feasible (seniors and vets because or risk pricing) to die in the street.

Sorry, I was half-stoned when I wrote that.  What I meant by that is regional and federal involvement in healthcare in general; in other words, regional and federal public options, allowing regions to develop their own universal systems in exchange for waivers from federal law, etc.

I also prefer option c, which is included my plan.

[Blair]

I wouldn't let the three plans be a major headache as they all seem broadly similar

[The world will shine with light in our nightmare]

All right.  To prevent further delay, I'm going to issue this committee an ultimatum: I will wait one week for fellow members to post their own outlines and proposals.  During this time, I will attempt to reconcile these ideas and write up the first draft, and post it to the Senate Legislation Introduction Thread.  If nobody submits any proposals, I'll move ahead with my plan and introduce it for the entire Senate to deliberate and build on from there.

Sound good?

[Blair]

Yes- with my other matters in congress, a new term in uni and my Presidential bid I won't have time in the next 7 days to put out a healthcare plan of high enough standards