Atlasian National Healthcare Bill (Law'd)

[afleitch]

I would propose the addition of a Section 4 to this bill.

Section 4 -

a- The provision of healthcare and the administration of budgets and services shall be the responsibility of Community Health Partnerships (CHP's) congruent to the existing Regions  These shall be established as public sector corporations. Each CHP shall be headed by a board consisting of one executive and further elected non-executive directors.

b- All boards shall be required to have an audit committee consisting only of non-executive directors on which the chair may not sit. This committee shall be entrusted with the supervision of financial audit and of systems of corporate governance within the CHP.

c- CHP's shall have responsibility for delivering primary and community services and commission them from other providers, and are involved in commissioning secondary care. Each CHP shall have their own budget and set their own priorities and shall directly provide a range of community health services including but not exclusive to;

i. The provision of funding for general practitioners and medical prescriptions.
ii The commission of hospital and mental health services from the private sector.

d- All members, directors and associated bodies shall be accountable to the Director (of Health) as outlined in Section 3 of this bill.

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For the record, the elected posts would be 'non playable'

[Southern Senator North Carolina Yankee]

As already stated, I don't see why we can't expect premiums to be paid based on income in exchange for government health services.

I'm not sure yet whether the government program should be open to all. I tend to think it should actually...it's not like Bill Gates would take the public care, is it?

Well it depends on who gets the burden of taxation to pay for it as well. If the income tax proposals raise taxes on the rich then I would think our of fairness the rich should be included despite my personal misgivings.

I would propose the addition of a Section 4 to this bill.

Section 4 -

a- The provision of healthcare and the administration of budgets and services shall be the responsibility of Community Health Partnerships (CHP's) congruent to the existing Regions  These shall be established as public sector corporations. Each CHP shall be headed by a board consisting of one executive and further elected non-executive directors.

b- All boards shall be required to have an audit committee consisting only of non-executive directors on which the chair may not sit. This committee shall be entrusted with the supervision of financial audit and of systems of corporate governance within the CHP.

c- CHP's shall have responsibility for delivering primary and community services and commission them from other providers, and are involved in commissioning secondary care. Each CHP shall have their own budget and set their own priorities and shall directly provide a range of community health services including but not exclusive to;

i. The provision of funding for general practitioners and medical prescriptions.
ii The commission of hospital and mental health services from the private sector.

d- All members, directors and associated bodies shall be accountable to the Director (of Health) as outlined in Section 3 of this bill.

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For the record, the elected posts would be 'non playable'

I think this is a step in the right direction myself and thus I support this needed addition dealing with administering the program. I also like the audits. There is no reason to create a boondoggle here and thus we should have some measures of accountabililty involved. What about transparency? Should any of the program be made open to public view as long as it doesn't violate peoples privacy?

[afleitch]

I think this is a step in the right direction myself and thus I support this needed addition dealing with administering the program. I also like the audits. There is no reason to create a boondoggle here and thus we should have some measures of accountabililty involved. What about transparency? Should any of the program be made open to public view as long as it doesn't violate peoples privacy?

Quite simply yes. I hope to introduce an Open Government Bill shortly which will cover this (and other government bodies too) However I think given the nature of this legislation it should be stated within the legislation.  A further section requesting this as well as the publication of health 'league tables' on health progress, treatment, waiting times, expenditure would be worth consideration.

[Southern Senator North Carolina Yankee]

I think this is a step in the right direction myself and thus I support this needed addition dealing with administering the program. I also like the audits. There is no reason to create a boondoggle here and thus we should have some measures of accountabililty involved. What about transparency? Should any of the program be made open to public view as long as it doesn't violate peoples privacy?

Quite simply yes. I hope to introduce an Open Government Bill shortly which will cover this (and other government bodies too) However I think given the nature of this legislation it should be stated within the legislation.  A further section requesting this as well as the publication of health 'league tables' on health progress, treatment, waiting times, expenditure would be worth consideration.

An excellent idea. Should the Game Moderator be charged with simulating at least some of the content so the Senate can come back and make improvements to the program?

[Vepres]

Here's an idea I had for an amendment, what do you guys think about it?

Section 4 or 5 (depending on if afleitch's amendment is added or no)

1. All laws regarding what health insurance companies must cover are hereby repealed.

2. Health insurance companies may not deny coverage nor discriminate against nor adjust the premiums of an individual's plan based on said individual's race, gender, ethnicity, geographic location, sexual orientation, age, preexisting conditions or treatments, past conditions or treatments, or religion.

3. All customers of said companies shall be offered a clear, written, and simple explanation of the company's various plans, including, what they do and do not cover and their cost. The company may not allow the person to buy any plan until they offered the person the document described above.
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Obviously it is poorly worded, but you get the general idea. Of course, it doesn't matter unless a Senator wishes to introduce this or something like this. Just an idea to foster competition.

Your thoughts?

[Fritz]

I don't know what the rules are on this (I'm a little bit new at this being a Senator thing),  but if I still can, I accept Marokai's amendment as friendly.

[Fritz]

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.

[Vepres]

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 understand why you practically get rid of private insurers. I would think that competition, even if the government is one of the participants, is the best way to get cost effective and high quality products and services in the vast majority of scenarios.

For example, the amendment I wrote above (which nobody has commented on ) attempts to foster competition while allowing people access to health care while creating competition by forcing the companies to be honest with their customers.

[Fritz]

I believe Marokai's amendment addresses your concern regarding private insurers.

Most of your proposed amendment does not seem to be needed to me, I don't think that insurance companies are discriminating based on race, gender, etc.  Pre-existing conditions, however, may be a valid point.

[Vepres]

I believe Marokai's amendment addresses your concern regarding private insurers.

Most of your proposed amendment does not seem to be needed to me, I don't think that insurance companies are discriminating based on race, gender, etc.  Pre-existing conditions, however, may be a valid point.

Well, it simplifies it, as well as tries to encourage people to educate themselves by giving them the information to do so in clause 3.

The main thing is that plan must have a set price regardless of pre-existing conditions or past conditions. The others there can at worst do nothing, but it's good to have them there.

[Ebowed]

b. Funding for this Act shall be appropriated from existing sources of Federal Government revenues for health care, and from an additional sales tax on all alcohol, tobacco, and marijuana products.

Regressive taxation which, theoretically, should be a declining source of revenue over time (at least as far as tobacco is concerned).

Please find a better way to finance your proposals.

[Franzl]

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.

Some of us are prepared to filibuster under certain circumstances. I'll propose something in a little while....see if it goes anywhere.

[Marokai Backbeat]

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.

Some of us are prepared to filibuster under certain circumstances. I'll propose something in a little while....see if it goes anywhere.

Even I can accept when a bill hasn't gone my way, if you can't win a vote then you can't win a vote, we have fairly straightforward rules towards votes. Feel free to delay it for a week or two, you'll accomplish nothing.

Your proposals are more than welcomed, but cannot, and should not, demolish the public plan or start slicing off portions of incomes off of those enrolled. (Which, I'll say again, is what you  made sure to ask me to not include less than 24 hours ago.)

[Associate Justice PiT]

     I would be interested in seeing a filibuster. Not so much because of any ideological issues I may have with this bill as it is that the filibuster is a sorely underused tactic in Atlasia.

     Also, may I remind everyone that back in the 30th Senate a filibuster succeeded in killing a bill to institute a more progressive income tax structure (with 6 supporters of the bill as put forth compared to 5 here, no less!).

[Marokai Backbeat]

I welcome the dishonorable Senators to give it a shot.

[Franzl]

Your proposals are more than welcomed, but cannot, and should not, demolish the public plan or start slicing off portions of incomes off of those enrolled. (Which, I'll say again, is what you  made sure to ask me to not include less than 24 hours ago.)

I'm aware of that....but I've changed my mind on collecting some sort of premiums. If this public plan is to be open to everybody irrespective or income or employment status, I think it's fair to charge a fee. That doesn't mean that premiums would be the only revenue source for healthcare....of course not, but it's surely a good way of helping to pay for services, especially in our current economic state. This would not not have an unfair impact on the poor, as it would be a small percentage of total income, and people with no income wouldn't be paying anything.

[Fritz]

Franzl, I am happy to hear your proposals.

[Marokai Backbeat]

Your proposals are more than welcomed, but cannot, and should not, demolish the public plan or start slicing off portions of incomes off of those enrolled. (Which, I'll say again, is what you  made sure to ask me to not include less than 24 hours ago.)

I'm aware of that....but I've changed my mind on collecting some sort of premiums. If this public plan is to be open to everybody irrespective or income or employment status, I think it's fair to charge a fee. That doesn't mean that premiums would be the only revenue source for healthcare....of course not, but it's surely a good way of helping to pay for services, especially in our current economic state. This would not not have an unfair impact on the poor, as it would be a small percentage of total income, and people with no income wouldn't be paying anything.

It just has a further regressive effect in the end. Adding some sort of requirement to pay a portion of one's income would hurt the lower classes disproportionately. (In fact, I would argue almost entirely.) Funding would have to come from other sources, which will end up being income taxes and additional sin taxes, which also disproportionately affect the lower classes. I'm not comfortable with paying for a program on the backs of the poor and middle class. It can be paid for just like every other government service without charging some sort of premium or income percentage.

This is seriously a silly proposal that doesn't really serve any end, and if you and everyone else here just had the balls to do it, we'd propose an income tax set of brackets with higher taxation on the upper class. But alas, no, instead of living in the real world and viewing, objectively, the history of tax rates and their effect on the economy over the decades in the US, we're content sitting here trying to either have our cake and eat it too, or have our cake and make people making $40,000 a year bake it for us.

What sort of percentage are you talking about, for the sake of discussion?

That sort of brings me to another point. For all the bitching and moaning going on in this thread from the people who oppose our (constantly changing) proposals, I've not heard one damn thing formally written from any of you. Propose something concrete for heaven's sake, either yourself or NCY. You want to sit around and constantly stick your nose into everything for fun and play the filibuster move, but none of you seem to have any interest in proposing anything on your own.

It's either because you have no ideas, you have no consensus, or you (I'm including NCY here) know that scrapping a public plan and going with some patchwork set of reforms is not going to solve our problems. No one has told you that you can't propose anything, Lief, Fritz, and myself have been trying to pry proposals out of your people for pages so we can dissect them.

[Marokai Backbeat]

I need to get to sleep, as my sleep schedule is out of wack lately and I've been dealing with a near-migraine all night, but I'll just say I'm willing to consider some fees here and there, transactions, costs on minor drugs, etc.

But I'm not willing to support what amounts to a tax hike on the lower class. (Who's going to be the people in this program? Them.) A percentage of their income being taken from them is the same as a tax, and that's unacceptable to me as a solution, I think. Anyhow, goodnight.

[Franzl]

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.

[Fritz]

I don't necessarily object to charging a premium, as long as it is affordable.  Myself, being a single man with no children, would have a far easier time paying 5% of my income, than a married couple with 3 children whose income is comparable to mine.  Numbers of dependent children needs to be taken into account in this equation.  I also think the percentages are a little steep.  How about 2.5%, 5%, and 10%, with a reduction for dependents.

[Franzl]

Yeah, I agree with you there, didn't consider dependent familiy members.....I'm certainly willing to accept that.

[afleitch]

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.

[MasterJedi]

I hereby open up a vote on this amendment. Please vote Aye, Nay or Abstain.

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Aye

[afleitch]

I hereby open up a vote on this amendment. Please vote Aye, Nay or Abstain.

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Aye

You have a difficult job organising this

As the same issue creeps up over here on 'dual coverage' and given the many reasons for striking it, I will vote Aye.