HOUSE BILL: The Reforming and Regionalizing Public Healthcare... (Passed)

[Southern Senator North Carolina Yankee]

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To be continued

[Southern Senator North Carolina Yankee]

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Sponsor: NC Yankee
Co-Sponsors: Fhtagn and JGibson
House Designation: HB 1140 I think

[Southern Senator North Carolina Yankee]

So before people go crazy let me state clearly what does this.

1. Expands Regional Involvement in Healthcare.

- It is easy to write up and bill and have Nyman make all decisions and both Conservatives and Liberals have presented plans that do just that. Aside from the subsidy, a few minimal regulations and public option (which I will explain later, so please hold off the guillotine), most every major decision regarding the nature of the healthcare system will and can be determined by the Regional Governments. This will therefore stimulate discussion and activity and regional elections by having elections of real consequence at that level. This will include but is not limited to the decision of whether or not to have single payer/individual mandate. With the passage of this bill, that will become a regional decision.

It is important to consider healthcare as an issue, but it is also important to remember that this is a game and the things we do policy wise should stimulate the game and the regions, not shut them down.

2. Yes there is a public option in this bill. But guess what, we already have public Option(s) and the "s" is important. Depending on which special group you are, you have your own little siloed public option. This bill takes all those public options and consolidates them into one federal public option, and paves the way (if a regional opts for such) for everyone to have alternatives. This means that seniors, vets, the poor, will now have greater access to choice and quality healthcare, will preserving the important promises we have made to our seniors etc.

3. Replacing the multitude of public options with one public options enables us to eliminate a metric f@$kton of government programs and offices that will now longer be necessary, or to trim down others that will remain with a smaller objective.

4. This is the Middle Ground on healthcare between a one sized fits all, top down program, and the real life healthcare situation which I think everyone agrees is a mess. It borrows from non-single payer systems that still ensure universal access like Germany, expands the degree of local control and expands the competition and choice to greatest number of healthcare consumers. In the process of doing so, it consolidates the roll that Nyman plays in healthcare, bringing simplicity, lower cost and higher quality to those who currently depend on Medicare, Medicaid, the VA, etc.

5. This was a massive bipartisan effort and there are elements that all sides can get behind. I am especially grateful for the hard work and patience (especially patience) of Senator Scott, as well as the contributions of Senator PiT (whose math skills were invaluable), President Dfw, Vice President Goldwater and numerous, numerous others. I also want to do like wise for former and hopefully soon to be Representative Potus, who while probably not thrilled with the overall proposal, some of his recommendations from his proposal this spring are present or shaped similarly to those he proposed, including untaxed HSA's and the incorporation of age into the formula was inspired by his use of age along with income in his tax credit proposal.

[Southern Senator North Carolina Yankee]

I will also note once again that once we reform the public health care, it will be necessary to then pursue with reforms to other aspects of health care including but not limited to:

1. Delivery
2. Medical Records
3. Technology
4. Tuition Inflation
5. Malpractice Liability
6. Drugs
7. Mental Health

These will best be handled in subsequent bills and if attempted here would make this bill too large and complex.

[Southern Senator North Carolina Yankee]

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Offering this because PiT is absent minded.

[Southern Senator North Carolina Yankee]

I forgot to post this this morning, but "Sponsor has 24 hours (already commenced) and members have an additional 48 hours beyond that offer responses.

[Southern Senator North Carolina Yankee]

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[JGibson]

As a co-sponsor of this bill, these are achievable solutions to make healthcare better for Atlasian citizens, and this bill hits the sweet spot.

[fhtagn]

As a co-sponsor, I think this bill presents a wonderful opportunity to provide quality healthcare to the people of Atlasia. It may seem like a lot to take in for those who haven't had a chance to read, but there is so much potential for amazing things to come from it, and I am very excited that this has finally hit the floor.

Let's do some good, folks!

[Southern Senator North Carolina Yankee]

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Sponsor Feedback: Origination
Status: Representatives have 24 hours to object.

[Southern Senator North Carolina Yankee]

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Sponsor Feedback: Origination
Status: Representatives have 24 hours to object.

[CMB222]

I commend the sponsors and co-sponsors on their hard work and ability to put forth a bi-partisan healthcare bill. It looks great for the most part and the only part I really find disagreeable is "End of Life Care". If that were amended or taken out I would like this even more. But again, great work!

[JGibson]

The changes listed in the amendment are acceptable to me.

[fhtagn]

The changes listed in the amendments are acceptable to me.

[Southern Senator North Carolina Yankee]

I commend the sponsors and co-sponsors on their hard work and ability to put forth a bi-partisan healthcare bill. It looks great for the most part and the only part I really find disagreeable is "End of Life Care". If that were amended or taken out I would like this even more. But again, great work!

What is your concern with end of life care as present in the section? The list in the Public Option of covered items derives from the list as it existed in Fritzcare before the reset.

End of Life Care was not originally in it, but was added in I think in 2011 or 2012. I will fetch the debate on it.

Edit: 2013 - https://uselectionatlas.org/FORUM/index.php?topic=177637.0

[Southern Senator North Carolina Yankee]

Without objection, Amendments H7:03 and H7:04 are adopted.

[CMB222]

Oh, never mind then.

[Southern Senator North Carolina Yankee]

Oh, never mind then.

If you have any concerns I am eager to try and address them.

[Southern Senator North Carolina Yankee]

Seeing as debate has slacked off generally, I would like to also move towards a final vote this weekend, barring an amendment or issue being raised in the interim period.

[Potus]

This needs a full cost estimate and coverage projection. Why would we vote on a comprehensive, behemoth of a healthcare bill without a score?

[JGibson]

POTUS has the right idea. This bill needs a CBO score before we vote on it.

[Southern Senator North Carolina Yankee]

This needs a full cost estimate and coverage projection. Why would we vote on a comprehensive, behemoth of a healthcare bill without a score?

Practical reality of the game. If such can be obtained then yes, but in its absence, the game has to move forward. This was what kept the old Senate moving despite the absence of a working GM for the vast bulk of the time. And then the GM quit doing scoring all together for a few years before the reset.

POTUS has the right idea. This bill needs a CBO score before we vote on it.

We don't have a CBO, any scoring would have to be done by the GM and would be dependent on whether or not AZ as a policy does scoring on legislation. Some GMs have not because it is a tedious process and takes away time and effort from story creation. If he does not, then any cost estimates would have be made by us.

[Southern Senator North Carolina Yankee]

Like I pointed out in the House thread, this needs a full score of fiscal, healthcare, and economic impacts before an honest, real debate can occur.

This is more far reaching then what you called for in the House bill.

Also keep in mind that it is difficult to score the full range of impacts because this is not a centralized healthcare structure. Since this attempts to decentralize regulation authority, it would be difficult to pin down the full range of impacts because each of the three regions can take any number of different approaches to implement this.

We can get the budgetary effects, but it is difficult to get the healthcare impact.

Once this passes and then knowing this is in place, a regional gov't could get a study of the healthcare impacts based on what legislation they are proposing.

X+Y=Z   X being this federal law, Y being the subsequent regional law and z being the final impact for that region.

Aside from that, you can assume a default variable, but it is going to change the minute the regions pick up the ball and run with it.

I don't think responsible legislating and regionalization/game enrichment are necessarily at cross purposes and both are important, but when the former gets in the way of the latter, I think the game should come first.

[The world will shine with light in our nightmare]

Encke and Yankee raise good points here.  Any assessments of how this bill would affect the economy or healthcare market would be totally arbitrary, especially as regions begin to model their own systems around the new program.  As far as the budget is concerned, the subsidies would cost, according to PiT's estimates, about $465 billion.  (I posit that Atlasia would spend notably less on healthcare as a percentage of GDP than the United States does, although I can't prove this definitively.  However, I'll note that countries which do guarantee universal access to healthcare for their citizens spend considerably less than the United States does.)

[Southern Senator North Carolina Yankee]

I'll have to say that I completely agree with Yankee here.

The basic issue with asking for calculations of the economic impact of a piece of legislation is that there is no real economy that can respond to it, and thus it is difficult to quantitatively determine effects accurately. As such, any economic impacts would be left to the discretion of the GM department, allowing it to effectively control what legislation gets passed and what legislation doesn't.

The problem of accuracy gets worse as time progresses. Realistically, each piece of legislation should have its own economic effects, and thus the statistics and figures from RL that are used to develop budget analyses gradually become obsolete as other economic figures (e.g. unemployment) gradually diverge from reality. Consistency becomes a problem, and then everything ultimately becomes arbitrary.

If realistic economic simulation is to become a part of the game, then it needs to be built from the ground up (as well as contained entirely within the game), rather than the top-down approach that is currently being taken.

Encke and Yankee raise good points here.  Any assessments of how this bill would affect the economy or healthcare market would be totally arbitrary, especially as regions begin to model their own systems around the new program.  As far as the budget is concerned, the subsidies would cost, according to PiT's estimates, about $465 billion.  (I posit that Atlasia would spend notably less on healthcare as a percentage of GDP than the United States does, although I can't prove this definitively.  However, I'll note that countries which do guarantee universal access to healthcare for their citizens spend considerably less than the United States does.)

Healthcare expenditures would gradually decline as a percentage of a GDP. Not just because of this bill, but because of bills we have also passed previous (Drugs and stuff) and will pass subsequently as well on interrelated matters. Once again why it is hard to quantify this bill alone over a longer term period.

The subsidy cost is the most important one to look it. If one were to look at total cost and total revenues, you would probably get 1.6 Trillion and 1.4 Trillion, but 1.4 Trillion of each is already existing expenses and revenues being shifted to a different umbrella (Medicare, Medicaid, CHIP etc) and hopefully those costs will also be brought under control (both because of this, laws on drug costs etc). Since that encompasses so much existing expenses (80%), it obscures the picture gives the impression that this bill is larger than it actually is.