Atlasian National Healthcare Bill (Law'd)

[Marokai Backbeat]

Handing out subsidies does nothing to lower costs or solve the inherent problems in healthcare, nor would it give everyone insurance anyway. We would be throwing a money-bandaid at the problem and not properly reforming private insurance. A government program provides much lower administrative costs, doesn't discriminate, and assures people that their costs on an individual basis will be covered, as opposed to handing people a few thousand dollars and hoping that covers everything.

I support single payer, however, I will also support a two-tiered private/public plan, but I hope the President vetoes any legislation that doesn't include some sort of government healthcare program, whether it's single payer or a public option.

[Marokai Backbeat]

Handing out subsidies does nothing to lower costs or solve the inherent problems in healthcare, nor would it give everyone insurance anyway. We would be throwing a money-bandaid at the problem and not properly reforming private insurance. A government program provides much lower administrative costs, doesn't discriminate, and assures people that their costs on an individual basis will be covered, as opposed to handing people a few thousand dollars and hoping that covers everything.

I support single payer, however, I will also support a two-tiered private/public plan, but I hope the President vetoes any legislation that doesn't include some sort of government healthcare program, whether it's single payer or a public option.

Do you have a problem read my posts Marokai?

If you look back over it you find that 90% of your objections are dealt with. Clause 4 will provide coverage to those who can't afford it and Clause 5 mandates that everyone not covered by Clause 4 namely the rich buy insurance. Clause 1, 2, and 8 together will reduce costs. The Regulations in clause 2 will take care of problems within the industry, I will even let you write part of Clause two to make sure that it does.

The only debate is which path too take in Clause 4 since I laid out two different ways to do it. Either way is paid the same way essentially you charge people premiums and the have a sliding scale based on income of how much you pay(under Gov't plan) or how much the Gov't pays(under a subsidization plan), The costs of the Gov't share in each plan(especially for those below a certain level will have the Gov't cover all of the premium) are taken care of later down in the outline. There are no co-pays in either, or deductible. That debate would be between you and Franzl since he prefers the later and you prefer the former. Personally I like both.

I did read it this time, actually My post was a longwinded way of saying the a government health program is superior to a subsidy check.

[Marokai Backbeat]

Whoa, I miss a lot on Saturdays.

I support Franzl's amendment. There is no reason to outright ban private health insurance plans.

For the public plan idea, the only way it works without pummeling private health insurance companies is by preventing companies that provide employer-based coverage from switching to the public plan. We also need a mechanism that keeps the public plan competitive, but not unreasonably so to the point where private companies can't lower costs enough to compete.

Is there a reason we should care about that should it happen? There's a reason private insurances costs so much, you know. (Administrative costs being triple or quadruple administrative costs of Medicare, for instance.)

If people choose to turn over to the public plan there's no reason we should just decide to stop them. The only way it will destroy private insurance is if people decide for themselves that it's better. Why are we just arbitrarily deciding to put limits on a public plan?

[Marokai Backbeat]

Your ideas are mostly simple and uncontroversial for the most part, Yankee, it's the whole "give people checks and subsidize costs" silliness that bothers me.

Edit: I would also like to state that I'm opposed to allowing people to buy insurance across state lines

[Marokai Backbeat]

I still don't know why we should even bother if we're not prepared to have the guts to take this all the way, as I've complained in the stimulus bill. If we're going to make it so only people around a certain income area can get into the program, we're just throwing glitter on Medicaid. There is no reason we can't create a government program that anyone can get into if they choose to, that provides basic care for everyone.

As for opposing buying insurance across state/regional lines, it's because it allows insurance companies to skirt state/regional regulations. There's a reason the boundaries exist as they do today. (Although it's partially to just create health insurance monopolies.) If California, for instance, outlaws excluding people because of "pre-existing conditions" and Utah doesn't, where would you set up shop? The state that forces you to be fair and give insurance to everyone, or the state that allows you to determine who you give care to or not because you don't want to actually spend money? We could get around that by creating a system of national regulations, but those would override "regional rights" or what have you.

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It does matter. A public program costs less because it doesn't spend a huge amount of it's costs on trying to push people off the insurance rolls, a public program gives care to everyone, no matter what, a public program run by the government can also get drugs at a cheaper cost than private insurance companies. The private market relies on covering as little high-risk people as possible (that term along disgusts me) and charging people as much as possible. The drug companies have one of the largest manufacturing costs to profit ratios of any market out there. Allowing that sort of institution to stand unchallenged is not something I'm going to vote for.

Not to mention, Medicaid/care have far lower overhead costs, but still lose money! That is the pitfall of cost-cutting like that. This plan can't be fashioned after Medicaid. It has to be at least able to be profit/loss neutral, if not profitable with a commitment to return profits to investments into innovation. This means higher costs and actual competition.

Then we raise taxes, or institute minimum fees, or something. We don't start purging people or banning certain practices to get into the government program. We're in this position because we have a system that did things for profit the entire time, we don't need to repeat that mistake under a government program.

Also, Medicaid/care runs at a deficit largely because of corporate welfare, lack of responsible financing, and because it pushes off a large portion of the responsibilities onto state and local governments, all of which are far less capable of funding a said program. This is for the greater good, even if we did run at a deficit for awhile until we get the funding situation tampered out properly.

(Also, this is going to save us money in the long-run. I agree we don't need to operate them precisely the same, but a government program lowers both care and management costs, which will save businesses and individuals thousands of dollars. Of course, subsidies and tax rebates don't do this, and could actually cost more.)

With that, I need to take a shower!



Jesus Christ, people, five replies while I'm writing one? Cool your jets!

I'm fairly opposed to keeping the current employer-provided health insurance system in place. The entire system is an accident of history, and doesn't really make any sense at all. I'd prefer not to simply to a bandaid over it by throwing around subsidies and tax breaks.

And what do you propose we do with all the jobs that the plan will destroy? In the middle of a major recession.

What jobs, the insurance market? I didn't here these objections from you when we banned payday loan lending!

Any jobs that will be lost in the insurance market, which by the way we are not banning under a two-tiered system, will be more than overcompensated for by the much lower costs of a government healthcare plan. Businesses will no longer be forced to provide ballooning healthcare benefits to their employees and individuals won't be going bankrupt. (Or the thousands that die each year because of a lack of insurance, they'll now, you know, be able to work.)

[Marokai Backbeat]

Not to mention, Medicaid/care have far lower overhead costs, but still lose money! That is the pitfall of cost-cutting like that. This plan can't be fashioned after Medicaid. It has to be at least able to be profit/loss neutral, if not profitable with a commitment to return profits to investments into innovation. This means higher costs and actual competition.

Then we raise taxes, or institute minimum fees, or something. We don't start purging people or banning certain practices to get into the government program. We're in this position because we have a system that did things for profit the entire time, we don't need to repeat that mistake under a government program.

Also, Medicaid/care runs at a deficit largely because of corporate welfare, lack of responsible financing, and because it pushes off a large portion of the responsibilities onto state and local governments, all of which are far less capable of funding a said program. This is for the greater good, even if we did run at a deficit for awhile until we get the funding situation tampered out properly.

(Also, this is going to save us money in the long-run. I agree we don't need to operate them precisely the same, but a government program lowers both care and management costs, which will save businesses and individuals thousands of dollars. Of course, subsidies and tax rebates don't do this, and could actually cost more.)

Whoa, what purges and bans are you talking about? I am saying massive corporations that provide health insurance to their employees should not be able to participate in the public plan. That could and likely would result in wholesale shifts to different health care systems, against the will of the individuals involved. I thought you were all about choice. Where do the workers get to choose in this equation?

Nor am I saying that the government should do this for profit. But we certainly can't institute uncompetitive practices with the intention of running it at a loss. How is that anything close to competition?

Well, yourself and NCY were talking about charging people for the program, as I understood, and even talking about income requirements. That sort of thing is absolutely worthless as a solution and, as I said, just throws glitter on Medicaid.

I'm saying we should get rid of the practice of employers providing healthcare altogether, as Lief has said as well. The process is absolutely archaic and forces a huge burden onto businesses, and is one of the chief reasons why our automakers are bogged down in huge costs. I do support a choice, but employer healthcare is a great burden on our economy and on job creation. If we're going to keep it, I see no reason, however, why that burden should be relieved by the government plan. If people don't want it, they can get their healthcare elsewhere.

Also, many countries, including (I believe) Canada, do not have dental or eye care under their national healthcare programs, and many two-tiered countries are built the same way. This program doesn't have to have these things. I'll talk about this lower, but moving onto what you said about operating at a loss, I'm not, under any circumstances, saying we should operate this at a loss. But we shouldn't be afraid of potentially running it at a deficit for some of the initial years, as we set up the funding apparatus and get the entire program into place. We can't have the attitude that we must never run the program at a deficit because it is, at times necessary. At some point you have to temporarily suspend your concerns for the greater good.

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And what do you propose we do with all the jobs that the plan will destroy? In the middle of a major recession.
[/quote]

What jobs, the insurance market? I didn't here these objections from you when we banned payday loan lending!

Any jobs that will be lost in the insurance market, which by the way we are not banning under a two-tiered system, will be more than overcompensated for by the much lower costs of a government healthcare plan. Businesses will no longer be forced to provide ballooning healthcare benefits to their employees and individuals won't be going bankrupt. (Or the thousands that die each year because of a lack of insurance, they'll now, you know, be able to work.)
[/quote]

You are eliminating countless jobs in the health insurance industry. Payday loans are harmful to people and deceptively so. Most people are happy with their private insurance plans, so why should we simply eliminate them?

I have no problem with a competitive public plan in the mix, but to say that a significant number of jobs won't be lost by allowing these companies to provide "nonessential" services is incorrect. We can mix things up and make these companies compete, we can break up cartels, but we can't outlaw entire sectors.

Instead, adding competition to the mix will most likely result in competitive pricing from current insurance companies, reducing costs and resulting in exactly what you stated in your second paragraph there.[/quote]

First of all, while it's technically true that most Americans are happy with their healthcare, Americans routinely give stupid self-centered answers to polls like that. In the same polls, you can find that a majority of Americans support a government healthcare program, are worried about costs, and are unhappy with the quality of the care. These sort of "there are problems but not with me" answers to polls are ridiculously common, and you can see that sort of thing in other polls and even election results. (Examples: The education system is awful, but my kid is doing fine. Parents need to do a better job, but I'm a great parent. Congress always has low approval ratings, but I'll re-elect my congressman, etc.)

With that out of the way, I would just like to state that I'm not trying to defend outlawing private health insurance, as always our philosophy towards governing here at the JCP is aim high to compromise in the middle I think Fritz's bill is, at the core, superb, but I do support striking the outlawing of private health insurance from the bill and modifying the scope of the care provided.

I do concur that introducing a robust public program would drive competition and would lower prices, however, do keep in mind that any plans that fall short of doing just that likely will not reach that conclusion. (Such as the government writing a few thousand dollars in a check or subsidizing absurd costs instead of running a program themselves.)

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Did someone send you to conservative camp when I wasn't looking? Let me spell this out in bulletins.

• Private insurance will not be banned under a two-tiered system, it will simply force the system to reform and adapt to a new market. No serious job losses will go un-compensated for elsewhere.
• Drug insurance can still be purchased, covering prescription drug costs, as is done in many countries, including Canada. Further supplement insurance programs can be purchased, as already exist for Medicare for instance, providing additional dental, vision, and other services.
• New jobs will be created, in the public sector to run the newly established program and to carry out the care, and in the private sector because of the burden of huge healthcare costs being lifted from big and small businesses alike. This will more than compensate for the fact that some jobs, not all jobs, will be lost from the private insurance market.

I'm not sure why you're being so obtuse about this, you're usually far more reasonable. The private insurance market will not go anywhere under a public option. It will simply contract (somewhat), reform, and adapt to a new market system. We have more than 45 million people with no health insurance, thousands of people die each year because of a lack of insurance coverage, and millions more who are under-insured. If you admit that much of the jobs will be compensated for, at least in some fashion, that's fine, but you need to remember why we're doing this. Ballooning costs on individuals and millions of people vulnerable.

I'm working on some changes as we speak. Some of them were a bit of a bitter pill for me to swallow, but I think it's a reasonable snipping of the original bill.

[Marokai Backbeat]

I propose the following amendment: (Please give a shot, Fritz )

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I think I've ceded plenty of ground here, any further compromise better have a good reason.

[Marokai Backbeat]

NCY, stop whining, all you want to do is take the credit. Any issues you have with the bill that haven't been included yet, such as regulations or opening up the private market, are minor and could be easily written up and included.

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Oh, wah. Then go find them.

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Why? With the Atlasian National Health Care Program they become completely useless. That seriously makes no sense.

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To pretend that any wealthy person would enroll themselves into a basic government healthcare program is not just silly, it's completely ignorant. Wealthy individuals have no reason to sign themselves into a government program that only covers basic procedure and basic care.

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Sometimes when I'm talking to you, I think you're one of my favorite Senators because you're always so interested in the debate. Other times I wonder how someone made it out of junior high. We're talking about the health of individuals, poor or otherwise, who can't afford any premiums at all. All your asking is for the government to get into the same business as the private market, which is making a business out of people's lives.

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It scraps nothing, does rid of nothing, eliminates nothing, pushes aside nothing. It creats a separate, very basic program, that provides "free" care for all those who need it. Private health insurance will still exist.

Shitloads of other countries have the same basic two-tiered system of what I'm proposing, some of them even go further, and those countries still have a very active and profitable insurance industry. This bill leaves private insurance to continue to exist. It still leaves the room for supplemental insurance programs (such as what exist today to accommodate Medicare users), it leaves the room for dental insurance, vision care insurance, drug insurance.. the list goes on. This bill creates a limited program for basic care, and allows people to get out of it and buy something more lucrative if they so desire it.

Your proposal is to charge people, make an income requirement (so people are still forced to buy into the insurance industry), give people a few thousand dollars in a check, or subsidize huge costs. You live in a fantasy land where simple solutions will solve the problems we're having, that the insurance industry will cut costs themselves, and that if we just open up the private market all our ills will magically solve themselves.

I, on the other hand, am looking across the world at dozens of successful examples, and none of their private markets collapsed. If you want to propose something to deal with the regulation of the private market, I'm all for that, go ahead. But there's nothing wrong with the program that's been proposed, so cease the histrionics.

[Marokai Backbeat]

If Marokai will make some changes to 1b back, I might be willing to accept it as friendly.

I changed it back to "all" instead of "most basic." In retrospect that was a silly change.

As for the other clauses, I would be fine with including some of them back in it, but I'm trying to have it written up so such a public plan wouldn't be so broad that it does start to eliminate the private insurance market altogether.

I guess I could change back the section on drugs, but the other sections will have to remain stricken, so private insurance can still exist around those things.

[Marokai Backbeat]

I don't see why a certain contribution can't be justified.....why can't somebody be expected to pay....let's say, 5-10% of his income in exchange for membership in the national healthcare system. Obviously it would remain free for people with no income.

You complained to me earlier this morning that you hated such a system!

[Marokai Backbeat]

I fully support Fritz's (welcome!) original bill. I can see that this is a heated debate and it's good to see a bill that splits the Senate this way. I am open to compromise as I believe many of us are, however this bill has my full support as currently tabled.

I cannot see any reason why we cannot have a system as Fritz has proposed, I do not see why we owe anything to the private sector, I cannot see why it infringes on the private sector's ability to attract customers or affect the private sector which continues to thrive and flourish in the UK some 60 years since the creation of the NHS.

Once I have recovered from my holiday I will create an amendment to introduce regional elected health boards to manage resources rather than a centralised body.

Really? Well, now you're making me consider taking back my amendment

[Marokai Backbeat]

If Marokai will make some changes to 1b back, I might be willing to accept it as friendly.

Let's do this a different way, then:

I'll revoke my amendment if you agree simply to striking out banning private insurance and changing the whole financing section accordingly (or just leaving my part for that in place.)

[Marokai Backbeat]

If I'm reading you right, we leave 1b as it was originally written, and amend the other sections as per your amendment.  Correct?

Yes, just take your original bill, strike the part about banning private insurance, keep the changes in the financing and administration sections, and keep everything else.

[Marokai Backbeat]

I withdraw my previous amendment and present the following to be accepted as friendly (I hope )

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[Marokai Backbeat]

Should my new amendment be accepted as friendly, the system will be all well and good, and I'm done listening to any ideas in that regard.

Other minor things such as malpractice reform, or modernizing records, they can be tacked on or dealt with in minor legislation. No problems there.

As for NCY earlier, he asked what we had passed earlier in the Senate, so I just did a quick look for him:

https://uselectionatlas.org/AFEWIKI/index.php/Health_Care_Access_Expansion_Act

https://uselectionatlas.org/AFEWIKI/index.php/Health_Care_Reform_Act_of_2004

The latter is especially interesting, because it already de-regulated health insurance boundaries when it comes to state lines. But neither of these dealt with universal coverage.

[Marokai Backbeat]

For heaven's sake, for all of those of you who want this little dinky reforms and market regulation changes, propose them and we can include them. I'm tired of reading the same old proposals over and over again, but nothing formally written. If you want to computerize records, institute malpractice reform, and all these other minor reforms, write them up, don't use them as an excuse to vote against the bill.

Should my new amendment be accepted as friendly, the system will be all well and good, and I'm done listening to any ideas in that regard.

Other minor things such as malpractice reform, or modernizing records, they can be tacked on or dealt with in minor legislation. No problems there.

As for NCY earlier, he asked what we had passed earlier in the Senate, so I just did a quick look for him:

https://uselectionatlas.org/AFEWIKI/index.php/Health_Care_Access_Expansion_Act

https://uselectionatlas.org/AFEWIKI/index.php/Health_Care_Reform_Act_of_2004

The latter is especially interesting, because it already de-regulated health insurance boundaries when it comes to state lines. But neither of these dealt with universal coverage.

The last one should be improved, and incorporated in with an overall program. There is one more thing and it isn't minor but yet it doesn't change the program, and that is the funding. If income taxes are to be raised then put it into the bill which ones and how much. I would also hope that the increase will be realisticly large enough to get the job done.

We don't even have a tax code yet. Since the program would take some time to establish, and Medicare and Medicaid personnel and services would be transferred to the new program, we're not going to have a funding crisis for awhile. I was hoping we could deal with a separate Revenue Act which would institute a basic set of income tax brackets to deal with the funding of everything.

[Marokai Backbeat]

The simple fact of the matter here is that you don't want to compromise, you simply don't want a government program at all, and if you do, you want income requirements and premiums being charges and a host of other conditions. You don't want to propose other ideas because your ideas represent scrapping the current bill almost entirely.

As I said, if you want to mess with these little reforms, propose them and we can talk. The not-so-dirty-little-secret though is that you just want to scrap what Fritz and I have worked on. Your proposal is a system of patchwork changes.

As for costs, which you're apparently whining about, the public program itself does this, and has done so in various other countries. Countries that have a government program in addition to private insurance have much lower costs and spend much less than we do per-capita, and we are an almost entirely private system, and we're being gouged. Saying "more private competition" will not solve the problem.

[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.)

[Marokai Backbeat]

I welcome the dishonorable Senators to give it a shot.

[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.

[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.

[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..

[Marokai Backbeat]

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

[Marokai Backbeat]

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.

You shouldn't take it so personally, NCY.