Atlasian National Healthcare Bill (Law'd)

[Fritz]

I already agreed to this, so Aye

[Franzl]

Aye

[Franzl]

A quick review of Franzl's proposals.

Amendments to Section 1 are to dissimilar to what was introduced later into the NHS in Britain, namely that there were prescription charges that were not cost prohibative and were waived entirely for people on low incomes, senior citizens etc. So that is not unreasonable.

Striking out the full scope of dental services is however unreasonable. All dental 'check-ups' should be free for and secondly all treatment, including orthodontic treatment should free for minors. Immediate emergency dental work should also be free fo including reconstructions as a result of injury.

Amendments to 'd' help clarify wording, however it should be assured that all persons are presumed to be 'enrolled' within the national system unless their insurance allows them to make use of private healthcare in all or specific circumstances. Likewise should an individual choose to waive treatment offered privately (because sometimes state care is materially 'better' - particularly secondary care) they shall not incur any charges in the national healthcare system as a result.

On Section 2, I agree with the need to widen the method of funding, but feel that a system of National Insurance (see - http://en.wikipedia.org/wiki/National_Insurance) may be preferrable.

Just a question about National Insurance: Is there any difference to simply cashing in on premiums except the employer matching a certain amount? Or am I missing something?

Concerning the possibility that somebody with private insurance should be eligible to get state care if he wants it...I would have to respectfully disagree with that. I think it should be reasonable to demand "all or nothing", and that anybody that refuses the state insurance system should be responsible for his health insurance privately. Of course he should be eligible to switch to government insurance entirely if he so desires.

I'm willing to put the dental care you described back in.

[Purple State]

Aye

[Hash]

aye

[tmthforu94]

Aye

[MasterJedi]

With 7 Ayes, 0 Nays and 0 Abstentions this amendment has passed.

[Marokai Backbeat]

Franzl, I absolutely do not support such a thing being stuck to one's income. I'm fine with fees for drugs, that's not terrible and I think, personally, Is actually a quite reasonable additional fee for some drugs and for certain people, but raising what essentially is a minimum of a 5% tax hike on people making 25k a year and higher penalties for those making more is not acceptable to me.

As for your other reforms, they seem rather uncontroversial. The bit about Atlasians being able to purchase insurance from anywhere in the country, however, seems a bit redundant, considering that the Senate has already previously passed legislation allowing for purchase across state lines. But again, as for your double-taxing of the lower class, I can't accept that.

[afleitch]

Franzl, I absolutely do not support such a thing being stuck to one's income. I'm fine with fees for drugs, that's not terrible and I think, personally, Is actually a quite reasonable additional fee for some drugs and for certain people, but raising what essentially is a minimum of a 5% tax hike on people making 25k a year and higher penalties for those making more is not acceptable to me.

I would agree that this should be adressed which is why I had floated the idea of employer matched contributions.

Concerning the possibility that somebody with private insurance should be eligible to get state care if he wants it...I would have to respectfully disagree with that. I think it should be reasonable to demand "all or nothing", and that anybody that refuses the state insurance system should be responsible for his health insurance privately. Of course he should be eligible to switch to government insurance entirely if he so desires.

I cannot agree to that. It would be bureaucratic to break down someones private insurance and cut off access to state healthcare accordingly. If a receptionist at a chiropodists is offered a small amount of private cover for any chiropractic services but is covered nationally does that mean that when chiropractic treatment is recommended 2/3rds of the way into a recouperative hospital stay post injury she has to be wheeled out to get private treatment or someone private has to come in to see her?

The only way to have a healthy relationship between public and private provision of services and as I have pushed for, allowing the state to buy into the private sector to provide patient specific care, you cannot lock those who have private insurance, whether full or partial out of the national healthcare system.

[MaxQue]

Concerning the possibility that somebody with private insurance should be eligible to get state care if he wants it...I would have to respectfully disagree with that. I think it should be reasonable to demand "all or nothing", and that anybody that refuses the state insurance system should be responsible for his health insurance privately. Of course he should be eligible to switch to government insurance entirely if he so desires.

No. In real life, I am under the mandatory government insurance who covers basics needs, but I have also a private insurance for drugs (government forces us to take a private insurance for drugs if we are able) and more specialised healthcare, like physiotherapy.

[Vepres]

Should something be added to the bill to prevent rationing from occurring?

[afleitch]

Should something be added to the bill to prevent rationing from occurring?

Tough one. There should be efforts to ensure that there isn't a 'zipcode lottery' where care and coverage varies upon where you live rather than who you are but some 'rationing' has to naturally occur in any health service (you have one liver, who gets it the baby or the drunk etc) Likewise there will be restraints on the provision of healthcare based on lifestyle and need; if you have to loose weight to get an operation then you have to loose weight. I think 'rationing' due to need cannot be legislated. Rationing by political choice alone can be, through the introduction of elected boards which I have proposed.

[Vepres]

Should something be added to the bill to prevent rationing from occurring?

Tough one. There should be efforts to ensure that there isn't a 'zipcode lottery' where care and coverage varies upon where you live rather than who you are but some 'rationing' has to naturally occur in any health service (you have one liver, who gets it the baby or the drunk etc) Likewise there will be restraints on the provision of healthcare based on lifestyle and need; if you have to loose weight to get an operation then you have to loose weight. I think 'rationing' due to need cannot be legislated. Rationing by political choice alone can be, through the introduction of elected boards which I have proposed.

I mean more like, oh, you're 73 years old and therefore treatment x for condition y is not worth it. From personal experience, my grandfather received surgery at age 72 for cancer. He lived for 15 more years.

Or something like, oh, your treatment/test is expensive so we'll put it off for a few months.

[afleitch]

I mean more like, oh, you're 73 years old and therefore treatment x for condition y is not worth it. From personal experience, my grandfather received surgery at age 72 for cancer. He lived for 15 more years.

I would not support age discrimination (I need to check to see if we have anything relating to that in the statute). Often doctors can advise 'it's not worth it' to people of any age depending on circumstances, but I would be against denying or allowing treatment based on age alone.

[Purple State]

I have recently (through debate here, but more so through discussions IRL) realized that I know far less about the dynamics of health care than I would like. Because of that, I feel the need to ask everyone throwing ideas around why yours works and, probably more important, what issues your idea could run into.

[Vepres]

I mean more like, oh, you're 73 years old and therefore treatment x for condition y is not worth it. From personal experience, my grandfather received surgery at age 72 for cancer. He lived for 15 more years.

I would not support age discrimination (I need to check to see if we have anything relating to that in the statute). Often doctors can advise 'it's not worth it' to people of any age depending on circumstances, but I would be against denying or allowing treatment based on age alone.

Oh, certainly, but I don't want the government to give less care to the very elderly because they want to save money by saying it's not worth the cost (even if their lives may be extended by years).

The other thing that needs to be addressed is the government no covering new procedures or tests because they're too expensive, even if they're proven to be more effective.

[Southern Senator North Carolina Yankee]

Aye ftr on the previous amendment.

[Southern Senator North Carolina Yankee]

Section 1- Eligibility and Benefits

a. All individuals residing in Atlasia are eligible covered under the Atlasian National Health Care Program entitling them to a universal, best quality standard of care.
b. The health care benefits under this Act cover all medically necessary services, including at least the following:
1. Primary care and prevention.
2. Inpatient care.
3. Outpatient care.
4. Emergency care.
5. Prescription drugs. I'd like something like a maximum $25 fee or something for any prescription drug filling.
6. Durable medical equipment.
7. Long-term care.
8. Palliative care.
9. Mental health services.
10. The full scope of dental services (other than cosmetic dentistry).
11. Substance abuse treatment services.
12. Chiropractic services.
13. Basic vision care and vision correction (other than laser vision correction for cosmetic purposes).
14. Hearing services, including coverage of hearing aids.
15. Podiatric care.
c. Such benefits are available through any licensed health care clinician anywhere in Atlasia that is legally qualified to provide the benefits.
d. No deductibles, co-payments, coinsurance, or other cost-sharing shall be imposed with respect to covered benefits from patients enrolled in the National Healthcare System, but additional insurance from private sources is not forbidden.
e. All private and public hospitals and doctors are required to be participating providers, and are not permitted to deny care on the basis of one's enrollment in the Atlasian National Health Care Program.

Section 2- Finances

a. The Atlasian Government, through the Atlasian National Health Care Program's regional offices, shall be financially obligated to cover all costs from services and benefits provided to the enrolled by the participating providers.
b. Licensed health care clinicians who accept any payment from the Atlasian National Health Care Program may not bill any patient for any covered service.
c. Funding for this Act shall be appropriated from existing sources of Federal Government revenues for health care, such as income taxes and additional sales tax on all alcohol, tobacco, and marijuana products. In addition, members of households making between $25,000 and $39,999 shall pay premium equal to 5% of their income. Members of households making between $40,000 and $59,999 shall pay a premium equal to 7.5% of their income. Members of households making $60,000 or more shall pay a premium equal to 12.5% of their income. In addition, the income tax rate of individuals making greater than $200,000 shall be raised by 1.5%.
Section 3- Administration

a. This Act shall be administered a Director appointed by the President and confirmed by the Senate.  The Director may hold other office.
b. Medicare and Medicaid shall be phased out, with all necessary personnel and services being transferred to the Atlasian National Health Care Program upon its establishment.

Section 4 - Other reforms

a. All patients shall have computerized records, and all medical providers must be able to read, process and use these records.

b. People with private insurance shall be legally able to obtain private health insurance anywhere in Atlasia.

c. A committee shall be formed to suggest ways to cut costs by reducing bureaucracy, and shall report its findings within 6 months of implementation of this program.


I hope NCYankee can come up with some more ideas as well.

I would say that charging 5% on some making 25,000 isn't that bad, it comes out to about $26 dollars before taxes per week and from experience if you have health insurance the cost per week would probably be more like $50 or $75 a week. So its still a pretty good deal and this program would out compete any private program.

Also I would suggest that a privacy clause be added to Clause a of Section 4. For Example

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 As for Clause b which would allow the purchasing of Insurance accross state lines has already been made law in Atlasia back in the day according  to the info provided by the honerable Senator Marokai. I would suggest however that a provision should be made dealing with a difference in state and regional regulations.

For example:

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Other then that I would support Franzl's amendment.

[Marokai Backbeat]

If I proposed a tax hike on the rich to pay for this program, it would probably be shot down by the econ. conservatives here. Yet we're perfectly comfortable paying for a national health care program on the backs of the poor..

[Associate Justice PiT]

If I proposed a tax hike on the rich to pay for this program, it would probably be shot down by the econ. conservatives here. Yet we're perfectly comfortable paying for a national health care program on the backs of the poor..

     Economic libertarians? In the 32nd Senate? I think you see a different Senate than I do.

[Southern Senator North Carolina Yankee]

I will now admit to the fact that I am really not the author of this bill.  I used HR 676 as a template, and snipped it down considerably- the original I believe had 6 sections and was 8 pages long.  The amendment proposed by Afleitch addresses much of what I snipped from section 3.  I did this snipping because I was thinking in terms of the context of the game.  I didn't want to add actual offices at the regional level that would need to be filled with actual game participants.

NCYankee, you do nothing to advance your positions by calling someone an SOB or an egotistical bastard.  I find that to be conduct unbecoming of a Senator on the floor of the Senate.  If you have an amendment to propose, please propose it.  With Afleitch and Hashemite on board, we appear to have the necessary votes to bring this to a tie that BK would have to break.

I don't want to start this up again but I would say to the honerable Senator Fritz, that I found my statements no more despicable then those of the honerable Senator Marokai and any condemnation of me should be accompanied by a similar condemnation of him. We had a reasonable disagreement and a few issues that are really insignificant compared to the overall bill and yet he felt compelled in his response to not only question my judgment but also my intelligence level and insult my integrity. As such I felt that while my comments while definatly not appropriate Senate behavior were indeed adequate and appropriate at the time to defend myself. I would say to any Senator that if you want me to treat you with dignity and respect you shall have it as long as you can avoid personally insulting me, however if this is too difficult a concept then I find it too difficult to treat them with respect. I would also remind the members of the Senate that this is not the first time that Senator Marokai has choosen to take this route and there will probably be other occasions. I have always had a level of respect for those who disagreed with me, however I am coming to the conclusion that some people who disagree with me not only not have that respect but hold me in contempt for those positions. I am what I am as you are what you are. I also don't believe any one side has all the answers, as my support for the stimulus bill opposed almost entirely by my party has shown. So I should not be steretyped as the archetype of a Conservative by Sen. Marokai.

If either Senators Marokai, Fritz or anyone else feels compelled to respond to this post please do so via PM.

[Marokai Backbeat]

Believe it or not, NCY, I've told many people in private that you're one of my favorite Senators.

[Southern Senator North Carolina Yankee]

Believe it or not, NCY, I've told many people in private that you're one of my favorite Senators.

I feel sorry for those you despise, they must be completely tormented for eternity.

[MaxQue]

Please, stop it. Personal arguments should not happen on Senate floor, I think.

[Purple State]

So what are the proposals currently out there to amend the bill?