FE11: 1184AZ-Peebs Affordable Healthcare Act (Vetoed)

[Pragmatic Conservative]

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Sponsor 1184AZ Federalist

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48 hours for debate

[Representative simossad]

Although I believe that this bill does not go far enough in some points, I will strongly support this bill, which will provide healthcare standards and transparent procedures.

[Lumine]

Not a Representative, but I feel I must ask, why are private companies barred with competing with Health Fremont? Seems this would end private hospitals and private clinics (perhaps it's just me reading the bill the wrong way), and in the general sense, this does appear to be rather restrictive on the private sector (particularly since Health Fremont is basically being granted powers for price controls).

[Unconditional Surrender Truman]

This is a very interesting proposal. As a lifelong supporter of universal healthcare, I'm generally supportive of what this bill is trying to do, but also sympathetic to the concerns raised by the former president. I'd like to hear more from the sponsor about what the implementation of this program would cost, as well as an explanation of the extent of the powers granted this new agency under Section 6b; regardless, this is an excellent opportunity for the Assembly to have a substantive discussion of serious policy issues, and I trust it will not be wasted.

[Pragmatic Conservative]

Thanks for all the support so far for this legislation. Healthcare is an essential service, and it should be the governments responsibility to both properly fund and regulate health care not the private corporations. This bill does just that in what I believe is a sustainable manner. While the $300 billion dollar price tag may seem pricey to some, in reality it is truly affordable. This program Health Fremont will be funded by a 5% sales tax and as well as monthly healthcare premiums, the maximum an individual person would pay a month would be $75. Which in my belief is excellent value for high quality and easily accessible healthcare.  I will have Dkrol get me some exact budget amounts for you.

While some will cringe at the regulations in this bill or call me a Socialist over this bill. I will say this medical treatment is not a choice that people choose to seek but instead something they need in order to survive. That is the reason I so strongly  believe we need government regulated healthcare. Private medical clinics and Hospitals will gouge patients, and current insurance plans do not go far enough. That is why I believe we need Health Fremont.

[Lumine]

I don't really wish to be disrespectful to the Legislature by intervening too much as a mere citizen, so I'll move my concerns into a different thread after this final intervention. Bit a long post, so I've divided it and tried to make it less tiresome to read (sorry, this issue drew my attention):

The Problem: True, we all want healthcare to work better for our citizens, but a particularly belief in a determined answer to healthcare (in this case, that the government and virtually only the government is the answer) should not be a reason to handwave what are not only matters of principle, but serious, practical questions of implementation of something that affects the citizens of the entire region. It's not about calling the effort "socialist" (I don't think I've done that), or dismissing it out of hand because of a personal belief that government shouldn't involved to that rather extensive and highly regulatory role, it's because the bill itself raises some relevant questions as it stands, and could perfectly do harm despite good intentions.

General Concerns: The problem, Mr. Speaker, is that the Commonwealth of Fremont is being forced into the use of this new Health Fremont organization in a way that is excessively regulated, and rather less than kind towards some fundamental freedoms both for the individual and for the free market itself. Instead of focusing on the improvement of the quality of current hospitals, or even doing our best to provide affordable to those who are in need of it, we're given an organization with incredibly sweeping powers, immediately put in a situation in which there is simply no possible competition because Health Fremont is now in charge of all the hospitals, all the medical centers, even the emergency clinics are not spared. Even more, Health Fremont is then able to set the prices at a whim.

Competition and Price Controls: So we go ahead, and Health Fremont grows out of nowhere (as this bill has no timetable, Health Fremont takes over an entire area of services out of the blue), eliminates most of its direct competitions in services, and then establishes price control, which when implemented in health care in places such as Japan or the Netherlands appeared to have made the situation worse, removing the potential for profit, driving down innovation and the desire to continue providing these services under such an unfair playing field, and ensuring a drain towards other regions with a more welcoming environment for healthcare innovation, unless we're taking of government handling the innovation process in a way that requires more research and government agencies, more fiscal spending and a situation that appears rather more inefficient.

Spending and Taxation: Then we reach the issue of spending, in a context in which we would open a budget hole of $300 billion at a time in which the region has not had a stable government until recently. But fine, we make that spending committment, and going by the bill we keep it close through a 5% sales tax whose only exclusion is groceries while taxing all other goods. I can see why some would think it a good idea considering the services it would pay, personally, I find it rather irresponsible to place that burden on small busineness and most of the region as a whole at a time which is already uncertain in economic terms due to a lack of political stability, which again, does not make for the best environment for future economic growth.

Semi-Conclusion: The general problem, then, appears to come in two different aspects: One, that this takes a basic principle of believing that healthcare is an essential service (which is perfectly valid and a sentiment most of Atlasia probably shares) but combines it with the belief that certain areas of private healthcare to "gouge" patients, which I find a bit of an offensive context for the work of private professsionals in health services, and thus goes too far in terms of empowering this organization for the sake of this version of the goal. And Two, that even separating this rather negative view of the private sector (which I must say, surprises me) and taking the noble goal the Speaker defends with sincerity, we're with a bill which is not accounting for many of the realities of implementation and consequences.

[Lumine]

In conclusion, the bill as written could present us with:

• The immediate implementation of an immense government organization without a timetable, with the subsequent bureaucratic nightmare, lack of efficiency, potential waste of resources, and so on.
• The destruction of an important part of healthcare services in the private sector, which could either mean closing all of these private hospitals, clinics and centers (thus raising unemployment) or moving into "nationalization".
• This potential nationalization or "regionalization" (does the word exist in english?) will either have a large, additional cost (by buying these institutions) or will be done in way which will probably worry many in the private sector and reduce trust in the Commonwealth of Fremont as a good place to invest.
• The implementation of price controls for the additional remaining private services in healthcare, with a negative impact in innovation and the profit of most of these companies, which can lead to the before mentioned loss of confidence, or the departure of these companies or individuals into other areas less hostile to their benefits.
• By the points before, the reduction of a large part of the services provided by the private sector, which even with the presence of Health Fremont will mean a loss in coverage and the situations we can cover, even when these private clinics or hospitals can save lifes.
• Furthermore, we're removing the fundamental freedom of any Fremont citizen to seek private healthcare if he so desires, and forcing him into using Fremont Health no matter the quality or context, or even if Fremont Health is not coping with the demand.

Sorry for the excess in words, but as you can tell I have some serious concerns about this bill and Health Care is precisely an issue in which we shouldn't rush into action without a good plan. I share the words of the Governor that this is indeed an excellent opportunity for a serious, detailed debate on the matter, and hope the Assembly does this with the responsibility they've shown in their past debates. But I would have to strongly assert that the bill as currently written would probably not be in the best interests of Fremont.

[Blair]

I'd definitely recommend waiting until the House+Senate gets our version of healthcare passed, because as someone who has helped with the bill I know that we've put in funding/help for the regions to pass healthcare bills like this- but if you passed it before we pass the national version you're jumping the gun.

[Unconditional Surrender Truman]

I offer the following amendment:

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This is by no means the only change I would like to see made to this bill, but it seems like the best place to start. No matter what the final version of this bill says, it's clear that - for the reasons given by former Presidents Lumine and Blair - simply dropping a public insurer out of the sky would be reckless in the extreme and likely result in severe strains on the market and access to medical care. By giving the health sector two years to prepare for this change (quite a long time when you consider that events move faster in Atlasia than in real life), we negate the potential for a panic and ensure that whatever system we end up implementing is functional on day one.

[Pragmatic Conservative]

The amendment is friendly and has been adopted.
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Extending debate an additional 24 hours on this bill.

[RFayette]

I strongly oppose part 5 of the resolution as I believe private competition is essential for any marketplace, though I still support the idea of a public option.  As such, I cannot support it in its present form.  However, I would be willing to consider support were part 5 to be removed.

[Unconditional Surrender Truman]

I strongly oppose part 5 of the resolution as I believe private competition is essential for any marketplace, though I still support the idea of a public option.  As such, I cannot support it in its present form.  However, I would be willing to consider support were part 5 to be removed.

My mind tends this way as well. Do you want to introduce an amendment?

Realistically, if we Section 5 (Section 3.1 in the amended version), we also need to remove the clause granting Heath Fremont power to set prices for the entire industry.

[RFayette]

I strongly oppose part 5 of the resolution as I believe private competition is essential for any marketplace, though I still support the idea of a public option.  As such, I cannot support it in its present form.  However, I would be willing to consider support were part 5 to be removed.

My mind tends this way as well. Do you want to introduce an amendment?

Realistically, if we Section 5 (Section 3.1 in the amended version), we also need to remove the clause granting Heath Fremont power to set prices for the entire industry.

Indeed.  Both sections would need to be removed, and that is the amendment I propose.

[Southern Senator North Carolina Yankee]

As I told Scott in a PM this morning, my preference is to create a system (federally) that is flexible enough to ensure the involvement of the regions in this fashion, yet still provides for basic imperatives. This was how the 2014 law was structured and it is pretty close to the latest text that Scott has in his bill.

Basically every region has an exchange with a default federal public option and the region can then decide what competition to allow beyond that (regional public option, co-opts and private plans). All competitors charge premiums and the federal gov't administers and pays for the sliding scale subsidy, which people can use with any plan that meets basic guidelines, removing the cost burden that has prevented regional action since the federal gov't can draw from a greater pool of resources than a single region can.

[Pragmatic Conservative]

I would request that if anyone has any amendments they would like to make on this bill that they do it in the next 24 hours, before I bring this bill to a final vote.

[Unconditional Surrender Truman]

Since RFayette didn't offer a formal amendment, I'll do it for him:

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[Representative simossad]

I object.

I strongly oppose this amendment. The economy profits from competition, that is true. Competition is great when we are talking about basic utensils, luxury goods and everyday things.

But healthcare should not be part of our economy. Healtcare should not be a marketplace.

A free market based on competion means that it is possible that monopolies evolve. Monopolies mean that the consumers are dependent on the goodwill of the companies, and, putting this in the context of the bill, the consumers health is dependent on what the companies do and what they offer. And once our own healthcare program has been displaced through competition with private companies, it will be hard to rebuild it and to make it a viable alternative again.

That is why I oppose this amendment, and that is why I think that the only group that shall have a monopoly on heatlcare is the only institution which is designed to help the people, and that is the government.

[Pragmatic Conservative]

As their is an objection made to a proposed ammendment, we will hold a 24 hour vote on the amendment.Please vote Aye,Nay or Abstain on the proposed amendment.
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Nay

[Representative simossad]

Nay.

[Pragmatic Conservative]

With 2 votes opposed and 1 not voting, this amendment fails. I will now put this bill up for a final 24 hour vote, please vote Aye, Nay, or Abstain on this bill.
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Aye

[Representative simossad]

Aye.

[RFayette]

Nay

[Pragmatic Conservative]

With 2 votes in favor and 1 opposed, this bill passes and goes to the Govrenors desk for his signature or veto.

[Unconditional Surrender Truman]

I'm going to have to think about this one. Personally, I don't think the bill was ready to be brought to a final vote; there are still several knots that needed to be worked out, such as how this will fit with the federal healthcare initiative currently being considered in Congress, and whether existing private hospitals/health centers will be nationalized or merely shut down. I'm also not entirely comfortable with 3.ii, specifically the fact that there is no guidance provided on the matter of price setting.

[Lumine]

This bill clearly wasn't nowhere near ready to be made into law, and I find it very distressing and disappointing that it was passed so casually.