FT 15.05 - Medical Price Control Act (LAW)

[KoopaDaQuick 🇵🇸]

AN ACT
to guarantee fair and affordable medical coverage for all people

Section 1 (Title)
i. The title of this Act shall be, the "Medical Price Control Act."

Section 2 (Price cap)
i. No hospital, clinic, practice, or other medical provider may charge for any service, procedure, or product in excess of 100% the real cost to the provider.

Section 3 (Enforcement)
i. For any provider found to have violated the provisions of this Act, the penalty for the first offense shall be probationary oversight by the Ministry of Health and Human Services (MHHS) for twenty-four months.
ii. The penalty for the second offense shall be revocation of the relevant medical or pharmaceutical license.
iii. The Commonwealth Insurance Commissioner shall have full power to enforce the provisions of this Act.

Section 4 (Implementation)
i. This legislation shall take effect 1 January 2021.

Sponsor: Harry S Truman, FM (Fianna Frémont—Labor, North Dakota)

The first minister now has the floor.

[Unconditional Surrender Truman]

My thanks to the speaker.

The issue is simple enough. We began as a country by declaring that all people are created equal —that in this equality, all have an inalienable right to life, liberty, and the pursuit of happiness. It need hardly be said that you cannot enjoy any of those three whilst your are dead. By this measure, healthcare is a right, and rights may not be commodities. The reckless inflation of medical costs in this country is directly tied to the charging of exorbitant fees by medical providers —under the so-called "chargemaster" —and this to the principle that practicing medicine should yield a profit for the CEO or board of directors who by accident of fate control access to life-sustaining drugs, doctors, and medical equipment the public literally cannot live without.

I do not begrudge an experienced, highly-skilled medical professional the right to earn a handsome salary —nor would this bill so prevent them. What the legislation I have proposed would do, is bar medical providers from charging their patients more than 100% of the cost of providing a particular drug or performing a particular procedure. While I believe this should be an uncontroversial proposal, I suspect it may not be; in either event I welcome your questions and commentary.

[OBD]

Hm. It seems like this would be a boon to Frémonters (especially those with medical conditions), but how would the companies keep paying the good people who make the production and distribution of the drugs possible without profits? If 'real cost' includes the costs of paying workers (from laborers to the CEO themselves), this is a moot problem, but there's also some issues with creating a concrete definition for 'real cost'. If the First Minister could clarify the definition of 'real cost', as well as the salary issue, I'd be more than happy to back this bill.

[Esteemed Jimmy]

Hm. It seems like this would be a boon to Frémonters (especially those with medical conditions), but how would the companies keep paying the good people who make the production and distribution of the drugs possible without profits? If 'real cost' includes the costs of paying workers (from laborers to the CEO themselves), this is a moot problem, but there's also some issues with creating a concrete definition for 'real cost'. If the First Minister could clarify the definition of 'real cost', as well as the salary issue, I'd be more than happy to back this bill.

Popping in from Lincoln: I echo this sentiment. While medical costs are definitely overcharged, no profits will be made under this law, which would be unsustainable.

[AustralianSwingVoter]

Strongly supportive of this legislation. Charging a profit on a person's life is morally abhorrent, however the profit is levied.
However, I would like clarification. Does this law apply to absolutely everyone, or only to public hospitals and public doctors. If it applies to everyone that rather defeats the point of a public/private system.

[Unconditional Surrender Truman]

In answer to the member from Oregon, I consider the "real cost" of any given procedure or pharmaceutical to include administrative expenses relative to running the hospital, clinic, or dispensary what provides that service, including salaries. As Frémont has already legislated to prevent huge disparities in wages between the highest and lowest ranks within a place of employment, while I would otherwise be concerned that including executive salaries in the "real cost" would allow inflation to continue unabated, I am less so in this case. So to address the thesis presented by the chancellor for Lincoln, "profit" consists only of money charged in excess of what is necessary to pay for the materials and labor necessary to provide a service. If your motive for practicing medicine is to get rich selling insulin to a diabetic, I am prepared to predict with some confidence your ultimate consignment to the Hellfire.

To the member from Washington, this bill would apply to both public and private actors.

[OBD]

In answer to the member from Oregon, I consider the "real cost" of any given procedure or pharmaceutical to include administrative expenses relative to running the hospital, clinic, or dispensary what provides that service, including salaries. As Frémont has already legislated to prevent huge disparities in wages between the highest and lowest ranks within a place of employment, while I would otherwise be concerned that including executive salaries in the "real cost" would allow inflation to continue unabated, I am less so in this case. So to address the thesis presented by the chancellor for Lincoln, "profit" consists only of money charged in excess of what is necessary to pay for the materials and labor necessary to provide a service. If your motive for practicing medicine is to get rich selling insulin to a diabetic, I am prepared to predict with some confidence your ultimate consignment to the Hellfire.

To the member from Washington, this bill would apply to both public and private actors.

Thank you for this information, and I can now say that I'll back this initiative. However, I do think your definition for 'real cost' should be incorporated into the bill, lest future Parliaments interpret it differently and use it to radically change how our medical system works.

[KoopaDaQuick 🇵🇸]

To be honest, maybe we could afford it by providing more government funding to Frémont hospitals?

[Continential]

I strongly support this as forcing people to pay money or their life is morally wrong.

[AustralianSwingVoter]

To the member from Washington, this bill would apply to both public and private actors.

Well then what's the point of the private sector? If rich people want to waste their money on paying for a profit margin so they can get a fancier room and nicer food, why not let them waste their money and ease the burden on the public purse?

[Unconditional Surrender Truman]

Well then what's the point of the private sector?

Well said.

[Unconditional Surrender Truman]

To be honest, maybe we could afford it by providing more government funding to Frémont hospitals?

Forgive my lack of perception, but what exactly is the "it" we could maybe afford?

[Unconditional Surrender Truman]

In answer to the member from Oregon, I consider the "real cost" of any given procedure or pharmaceutical to include administrative expenses relative to running the hospital, clinic, or dispensary what provides that service, including salaries. As Frémont has already legislated to prevent huge disparities in wages between the highest and lowest ranks within a place of employment, while I would otherwise be concerned that including executive salaries in the "real cost" would allow inflation to continue unabated, I am less so in this case. So to address the thesis presented by the chancellor for Lincoln, "profit" consists only of money charged in excess of what is necessary to pay for the materials and labor necessary to provide a service. If your motive for practicing medicine is to get rich selling insulin to a diabetic, I am prepared to predict with some confidence your ultimate consignment to the Hellfire.

To the member from Washington, this bill would apply to both public and private actors.

Thank you for this information, and I can now say that I'll back this initiative. However, I do think your definition for 'real cost' should be incorporated into the bill, lest future Parliaments interpret it differently and use it to radically change how our medical system works.

Technically it would be the ministry and not parliament who would interpret the law, but I suppose it wouldn't hurt to draw up an amendment just in case I lose my internet connection or die.

[KoopaDaQuick 🇵🇸]

To be honest, maybe we could afford it by providing more government funding to Frémont hospitals?

Forgive my lack of perception, but what exactly is the "it" we could maybe afford?

The commonwealth's hospitals being able to not fall into massive debt.

[Unconditional Surrender Truman]

To be honest, maybe we could afford it by providing more government funding to Frémont hospitals?

Forgive my lack of perception, but what exactly is the "it" we could maybe afford?

The commonwealth's hospitals being able to not fall into massive debt.

So, are you proposing that the region pay hospitals' administrative expenses?

[KoopaDaQuick 🇵🇸]

To be honest, maybe we could afford it by providing more government funding to Frémont hospitals?

Forgive my lack of perception, but what exactly is the "it" we could maybe afford?

The commonwealth's hospitals being able to not fall into massive debt.

So, are you proposing that the region pay hospitals' administrative expenses?

For the most part, yeah. While I am a huge supporter of giving Frémonters fair hospital bills that aren't needlessly expensive, the hospitals still need someone to pay the staff, buy equipment, pay for the building and its maintenance, et cetera. This is a good idea, hospitals shouldn't charge outrageously high prices to its patience, but they still need to break a little even. I'd say either use tax money or have the hospitals rely on donations, unless if you have a better way to fund it.

[Unconditional Surrender Truman]

To be honest, maybe we could afford it by providing more government funding to Frémont hospitals?

Forgive my lack of perception, but what exactly is the "it" we could maybe afford?

The commonwealth's hospitals being able to not fall into massive debt.

So, are you proposing that the region pay hospitals' administrative expenses?

For the most part, yeah. While I am a huge supporter of giving Frémonters fair hospital bills that aren't needlessly expensive, the hospitals still need someone to pay the staff, buy equipment, pay for the building and its maintenance, et cetera. This is a good idea, hospitals shouldn't charge outrageously high prices to its patience, but they still need to break a little even. I'd say either use tax money or have the hospitals rely on donations, unless if you have a better way to fund it.

Well, the idea behind this bill is that the expenses you mentioned would be included in the calculation of the "real cost" to the provider. But I'm certainly open to discussing public funding as well, if parliament would rather go in that direction! (Perhaps that would answer the member from Washington's quibbles as well.)

[KoopaDaQuick 🇵🇸]

To be honest, maybe we could afford it by providing more government funding to Frémont hospitals?

Forgive my lack of perception, but what exactly is the "it" we could maybe afford?

The commonwealth's hospitals being able to not fall into massive debt.

So, are you proposing that the region pay hospitals' administrative expenses?

For the most part, yeah. While I am a huge supporter of giving Frémonters fair hospital bills that aren't needlessly expensive, the hospitals still need someone to pay the staff, buy equipment, pay for the building and its maintenance, et cetera. This is a good idea, hospitals shouldn't charge outrageously high prices to its patience, but they still need to break a little even. I'd say either use tax money or have the hospitals rely on donations, unless if you have a better way to fund it.

Well, the idea behind this bill is that the expenses you mentioned would be included in the calculation of the "real cost" to the provider. But I'm certainly open to discussing public funding as well, if parliament would rather go in that direction! (Perhaps that would answer the member from Washington's quibbles as well.)

Ah, I understand now. It is a good idea. However, maybe we could give the hospitals a wee bit more dough to spend on stuff that would be spent outside treating specific patients, such as building new parts of the building, buying extra first aid just in case, helping to spread health information, maintaining websites, et cetera. I don't know if this is included in your "real cost" of the treatment, however, it would be nice for the hospitals to have a little bit more money, perhaps sent from the government, to have just in case of emergency and/or for funding new projects.

[OBD]

To be honest, maybe we could afford it by providing more government funding to Frémont hospitals?

Forgive my lack of perception, but what exactly is the "it" we could maybe afford?

The commonwealth's hospitals being able to not fall into massive debt.

So, are you proposing that the region pay hospitals' administrative expenses?

For the most part, yeah. While I am a huge supporter of giving Frémonters fair hospital bills that aren't needlessly expensive, the hospitals still need someone to pay the staff, buy equipment, pay for the building and its maintenance, et cetera. This is a good idea, hospitals shouldn't charge outrageously high prices to its patience, but they still need to break a little even. I'd say either use tax money or have the hospitals rely on donations, unless if you have a better way to fund it.

Well, the idea behind this bill is that the expenses you mentioned would be included in the calculation of the "real cost" to the provider. But I'm certainly open to discussing public funding as well, if parliament would rather go in that direction! (Perhaps that would answer the member from Washington's quibbles as well.)

Ah, I understand now. It is a good idea. However, maybe we could give the hospitals a wee bit more dough to spend on stuff that would be spent outside treating specific patients, such as building new parts of the building, buying extra first aid just in case, helping to spread health information, maintaining websites, et cetera. I don't know if this is included in your "real cost" of the treatment, however, it would be nice for the hospitals to have a little bit more money, perhaps sent from the government, to have just in case of emergency and/or for funding new projects.

Maybe we could raise the funding threshold from 100% to a number like 105% or 115%, as a sort of 'tip' for doing the remarkably important service of turning raw materials into life-saving medicine. I'm not insisting on this change, but I think it'd be a very appropriate one, especially given that we tip our food service industry on a regular basis for a similar service (though, of course a far less significant one).

[KoopaDaQuick 🇵🇸]

AN ACT
to guarantee fair and affordable medical coverage for all people

Section 1 (Title)
i. The title of this Act shall be, the "Medical Price Control Act."

Section 2 (Price cap)
i. No hospital, clinic, practice, or other medical provider may charge for any service, procedure, or product in excess of 100% 100.5% the real cost to the provider.

Section 3 (Enforcement)
i. For any provider found to have violated the provisions of this Act, the penalty for the first offense shall be probationary oversight by the Ministry of Health and Human Services (MHHS) for twenty-four months.
ii. The penalty for the second offense shall be revocation of the relevant medical or pharmaceutical license.
iii. The Commonwealth Insurance Commissioner shall have full power to enforce the provisions of this Act.

Section 4 (Implementation)
i. This legislation shall take effect 1 January 2021.

Proposing an amendment, allowing for a small increase of profits while still providing a reasonable and fair price tag for patients. 24 hours to file any objections.

[Unconditional Surrender Truman]

Amendment is unfriendly. I am open to expanding the definition of "real cost" or providing regional funds to cover administrative expenses. Profit, however, should not be a factor in delivering medicine. I would need to do some more research on the topic, but I strongly suspect projects such as the speaker describes are funded by grants and individual donations, not by charging the patient an extra buck and a half for their open heart surgery. Furthermore, the proposed percentage is arbitrary and based neither on demonstrated need nor any theory of value. Invoking tips in the food service industry is rather crass, in my view, especially as the practice of counting tips as part of compensation is a very bad one.

[Unconditional Surrender Truman]

Draft of an alternate amendment. Thoughts?

AN ACT
to guarantee fair and affordable medical coverage for all people

Section 1 (Title)
i. The title of this Act shall be, the "Medical Price Control Act."

Section 2 (Price cap)
i. No hospital, clinic, practice, or other medical provider may charge for any service, procedure, or product in excess of 100% the real cost to the provider, inclusive of personnel salaries and administrative expenditures.

Section 3 (Hospital expansion)
i. The parliament of Frémont will assume responsibility for the balance of all improvements to facilities, instruments, and like expenditures necessary and proper for the function of a hospital or clinic not raised through private or federal contributions.


Section 4 (Enforcement)
i. For any provider found to have violated the provisions of this Act, the penalty for the first offense shall be probationary oversight by the Ministry of Health and Human Services (MHHS) for twenty-four months.
ii. The penalty for the second offense shall be revocation of the relevant medical or pharmaceutical license.
iii. The Commonwealth Insurance Commissioner shall have full power to enforce the provisions of this Act.

Section 4 (Implementation)
i. This legislation shall take effect 1 January 2021.

[Unconditional Surrender Truman]

I do want to emphasize that we're not talking about raising money for a new cancer treatment facility when we discuss profits in healthcare. This is the article run by TIME several years back detailing the practice by which medical providers charge exorbitant fees to patients in order to serve the interests of private insurers. As for recognition of "the remarkably important service of turning raw materials into life-saving medicine" —the people who work at drug companies are already paid huge salaries. This bill would not affect that. There's no reason why the company should be turning a profit for hiring the geniuses who cured polio, and that's what is being proposed by the amendment brought by the honorable speaker.

[OBD]

I support the hospital expansion clause of the First Minister's amendment - however, I still have serious qualms about Section II of this act. To me, the termage of 'personnel salaries' and 'administrative expenditures' seem to be incredibly vague - and they could be a potential loophole if the administration of these companies decide that they deserve an extra-large paycheck (which will fall under 'personnel salaries'). I don't see how this act defines a reasonable limit for these costs - which seem to me a large part of drug price inflation - and even if a limit was defined, how would we do so in a reasonable and concrete manner?

Also, change the lower Section 4 to Section 5, please.

[Unconditional Surrender Truman]

I don't see how this act defines a reasonable limit for these costs - which seem to me a large part of drug price inflation - and even if a limit was defined, how would we do so in a reasonable and concrete manner?

This act doesn't. Legislation adopted by the Fourteenth Parliament, however, caps executive salaries at three times the salary of the lowest-paid employee at that company —so I am less concerned about this potential loophole than I otherwise would be. That said, I am definitely erring on the side of brevity and am willing to tighten up the language if the member still feels it necessary.