Atlasian National Healthcare Bill (Law'd)

[Southern Senator North Carolina Yankee]

The poor statistics are likely a result of lack of access to healthcare....for those that have access, the U.S. probably does have the best system in the world.

I think either a public option or direct subsidies are definitely necessary to ensure that all Atlasians are able to get the healthcare they need.

I don't see why we can't reach near-universal coverage without the government having direct control.

I would be willing to help the honerable Senator  craft an altnerative to this. I beleive that expanding coverage is definately important and I think that the Gov't has to play a role in that. However to illegalise Health Insurance because it competes with the Federal Gov't is just insane. Also in case no one has noticed this bill makes no provision for paying for itself other then the existing revenue clause.

Here is my basic plan
1. Reduce/simplify regulations that discourage competition
2. Introduce new regulations to break the cartel like relationship between Insurer and Doctor(allow people more flexibility in choosing there doctors and drugs)
3. Introduce and encourage comparison shopping(reduces prices)
4. Create either a Gov't plan or a Gov't subsidation
     a. paid for by premiums paid based on a sliding scale/ make up the cost of covering the poor off the Marijuana, Tobacco, and alcohol tax.
     b. Reduce hospital compensation(since everyone will be insured they won't need as much)
5. Mandate the purchase of Health Insurance(either private or the plan created by clause 4)
6. Create a Health Tax credit for all the middle class people, that get less then 50% of the premium covered by Gov't, to help them buy health care coverage. This should be about $4500.
7. Expand Tax Free Health Savings Accounts
8. Invest heavilly in medical technology. The millions we could save by preventing Cancer, Alzeheimers, Diabetes, Aids, and Parkinson's will far outweight the so called extra costs created by new Technology(remember most new medicines will have to compete with existing treatments due to clause 1 and 2, and any treatments that prevent or reduce the number such ailements as listed above are more then worth there costs due to the savings to the Health Care system at large.)

[Southern Senator North Carolina Yankee]

Here is my basic plan
1. Reduce/simplify regulations that discourage competition
2. Introduce new regulations to break the cartel like relationship between Insurer and Doctor(allow people more flexibility in choosing there doctors and drugs)
3. Introduce and encourage comparison shopping(reduces prices)
4. Create either a Gov't plan or a Gov't subsidation
     a. paid for by premiums paid based on a sliding scale/ make up the cost of covering the poor off the Marijuana, Tobacco, and alcohol tax.
     b. Reduce hospital compensation(since everyone will be insured they won't need as much)
5. Mandate the purchase of Health Insurance(either private or the plan created by clause 4)
6. Create a Health Tax credit for all the middle class people, that get less then 50% of the premium covered by Gov't, to help them buy health care coverage. This should be about $4500.
7. Expand Tax Free Health Savings Accounts
8. Invest heavilly in medical technology. The millions we could save by preventing Cancer, Alzeheimers, Diabetes, Aids, and Parkinson's will far outweight the so called extra costs created by new Technology(remember most new medicines will have to compete with existing treatments due to clause 1 and 2, and any treatments that prevent or reduce the number such ailements as listed above are more then worth there costs due to the savings to the Health Care system at large.)

I'm not extremely well informed on the intricacies of public healthcare, but what does your compromise do to ensure that the millions of uninsured get full, quality health coverage?

Per Clauses 4 and 5, Everyone will have insurance. Clause 2, 3, and 8 will ensure quality.

[Southern Senator North Carolina Yankee]

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.

[Southern Senator North Carolina Yankee]

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.

Sure you did, sure . Does tyhat mean you find the "Regulation clause two" as an exceptable way of changing the Insurance industry. No matter which way we go in Clause 4 I want all the other clauses. Also do you agree that Clause 1(De-Regulatory/Regulatory reform), Clause 2(New Regulations), and Clause 8(research investment) will reduce costs?

[Southern Senator North Carolina Yankee]

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.

Whats your opinion on my plan, PS?

You must be logged in to read this quote.

I have explained a great deal about in response to Marokai's and Hashmite's questioning. Just look through the last few posts. If you still have questions I will be glad to answer them.

[Southern Senator North Carolina Yankee]

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

Well as I said there are two paths mentioned in Clause 4.
1. Gov't Subsidized Health Care based on income. Everyone pays a premium and the Gov't will pay a percentage based on Income paid for by the Taxes I mentioned in there and reducing reimburesments to Hospital(No one will be uninsured).

2. Public plan for Middle and Lower class. Everyone pays a premium to fund the plan the. How much you pay is based on your income. Funding for this plan is the same as option 1.

Overall there would be some kind of Income level cut off thats the same for each plan, like 100,000 or something. Under the Subsidiziation they are just priced out of the sliding scale and have to buy it on there own. Under the Gov't plan they could still purchase the Gov't plan(You know if they are considered to high risk for private insurance or whatever) but the rate would be the same as the going market rate. The Tax cut is for these people only and for those in the sliding scale that have only 50% subsidization or lower.


Why do you oppose allowing the purchase of insurance across state lines? I didn't put that in the plan but its one of many possible changes I had in mind for Clause 1(REgulatory Reform).


Our main goal is to provide every one with access to Quality Health Care, correct? Does the program really matter as much as long as that is taken care off, costs are driven down, and people have a fair shake instead of being shaken down?

[Southern Senator North Carolina Yankee]

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?

The government can cost cut in ways that are uncompetitive and just as bad as monopolies or cartels. Corporations that provide employees with health care will look for the cheapest plan, without necessarily considering quality, which means people will not actually be choosing for themselves. Their cheap bosses will be.

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.

@NC Yank, I agree with your ideas, but I need to see what it looks like written up as legislation. There are also a few additions I would include per my comments thus far.

Well as I told Franzl and ironically he has the same problem is that while I am great at writing outlines and broad proposals, micro sub details just isn't my cup of tea. I could try but writing this up would take hours and it will be long, very long. For now I would prefer to just discuss these ideas, get as many senators onboard as possible and then together with 1 or 2 other Senators I could write up an alternative bill. Plus I want to look and see what has been previously passed on these issues, espeically if I am going to be able to due Clause 1(Regulatory Reform).

[Southern Senator North Carolina Yankee]

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.

If you are referring to my plan, I would appreciate that you acknowledge two things

1. THere is more to my proposal then a Subsidy and a Tax break

2. There are two paths one of which would mean no Subisidization program. We will have to decide which one to persue, though.

I didn't realise the big problem with compromising is opponents do not even notice, care, or read all of your proposals. jeez .

[Southern Senator North Carolina Yankee]

Marokai


1. I already said I would be willing to allow everyone in the public option in clause 4 even Bill Gates if the said Bill Gates can't get private insurance cause he is "Too high-risk". But I think Bill Gates should pay for all of his bill, don't you?   

2. I intended to nationalise all Regulatory standards in Clauses 1 and 2 of my plan anyway. Regional Rights never came into my mind. Don't make broad based assumptions based on party labels

3. If you want the plan to make a profit, as I previously said, charge premiums and have the amount people pay go down the as you descend the income levels eventually the poorest would pay nothing. And you recoup the cost of the reduced pricing for the poor by taxing Tobacco, Alcohol, etc and reducing reimbursements to Hospitals.

4. Has medicaid insolvency even been addressed in Atlasia other then temporary fixes?

I want to bring a single payer plan to a vote.  Any amendment that alters this bill such that it is no longer a single payer plan is a complete re-write of my bill, and should be introduced as competing legislation- not as an amendment to this bill.

In my opinion this bill is unamendable. I had every intention of offering a separate altenative and not as an amendment.

[Southern Senator North Carolina Yankee]

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.

http://www.thenation.com/blogs/thebeat/396919?rel=hp_picks

You must be logged in to read this quote.

I don't know that this plan would destroy that very man jobs. Sure, private insurance plans would no doubt need to cut back (and I am fine with section f being removed), but private insurance companies still exist and are profitable in many countries with public insurance plans. At the same time, the government would no doubt need to hire many people to run the new program. Finally, by removing the burden of providing health insurance to employees, we would be helping out many struggling businesses, from small businesses right up to large corporations like the auto makers, which would in the long run save jobs and prevent wage cuts.

Also, if this bill does not pass and I still believe that it can, I would not sign on to any bill that did not include a robust public option available to all Atlasians, especially if it includes a mandate to buy insurance, as that would essentially amount to a health insurance company bailout.

Yea nothing like saying no to and all possible compromises. Why do I even bother?

I wonder how many of those jobs would be created under my plan as well. I assume many of them are in Hospital Staffing(doctors, nurses etc) and employees of Pharma companies. Any plan we pass yours, or mine will subsidize expansion in big Pharma. I see no reason if you feel you can regulated big Pharma to operate in an acceptable way, why you can't do the same with the insurance companies. After all you aren't planning to Nationalise big Pharma are you? So you must be planning to regulate them.

[Southern Senator North Carolina Yankee]

I want to bring a single payer plan to a vote.  Any amendment that alters this bill such that it is no longer a single payer plan is a complete re-write of my bill, and should be introduced as competing legislation- not as an amendment to this bill.

A re-write that seeks to accomplish the same goals and relates to the same topic really should not have to be done through competing legislation. The nature of compromise is to allow legislation, initially introduced, to change drastically from the initial form. Just look at the Mideast legislation passed by the Senate when DWTL introduced it way back when.

If this body chooses to amend your bill, that is appropriate enough. It is a democratic body.

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?

You must be logged in to read this quote.

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.)
[/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.

@Lief: I have no problem with including a public plan and I am happy to see you are willing to remove clause f. While it may create a chunk of jobs in new government agencies, it would destroy just as many. In addition, while it may inject money into the economy, you also further expand the government's expenditures in Medicaid. The fact is, Medicaid siphons far too much money from government already. Adding such a large number of people to the plan would exponentially increase the amount lost, likely equalling anything injected into the economy. Essentially, doing this is at best a neutral situation that steepens our debt, at worst (as could very well be as the group conducting that study was a union, not exactly the most objective of sources) a losing initiative.
[/quote]

I was hoping someone would bring that up. People are already making broad based assumptions about me I didn't want to add being Anti-Union to the mix.

[Southern Senator North Carolina Yankee]

I would oppose the amendment for the same reasons as Fritz stated pertaining to 1 b and what is covered.


Also I still don't like the way this is funded. I would prefer that we raise taxes to make sure this program isn't leching off the general fund. I would suggest tax high priced insurance policies such as thoughs that cost over $17,000 a year. I wasn't even aware that they had insurance that expensive but appearently they do in NY and other areas, some of them are over $25,000 a year. By taxing these plans we will discourage them from being used while at the same time provide new revenue. I agree with using the sin taxes that have already been mentioned on Tobacco, Alcohol, and Marijuana. But I think that should be made more specific and deal with any conflicts like programs already being funded by those taxes. Plus nothing is mentioned about the subsidation of hospitals to operate at a deficit. If everyone will have insurance these should either be reduced or eliminated with that revenue being put towards funding whatever program we adopt.

Next there is no mention of any previous laws in this bill that I am sure have been passed in preceding senates dealing with Health Care. These bills need to either be repealled our modified in the language of this bill to fit the program.

I am uncomfortable with getting rid of Medicaid and Medicare.

I am uncomfortable with Subsidising Bill Gate's Health Care. If he wants to get into plan, then fine, but he should pay the going rate.

Next this is more of a bandaide approach then mine, Marokai. The reason is, it does nothing about encouraging comparison shopping or competition as far as I can tell. It does nothing about junk lawsuits which involve another form of insurance. Lawsuit Liabililty Insurance premiums for which are soaring due the soaring amounts paid out to defend doctors against lawsuits. All I see this plan doing is taking several Million into a program, subisidising all there costs and not doing a thing on these above issues. It also doesn't properly fund a program of this scale. The problem in Atlasia is we no longer due budgets, but that doesn't mean we shouldn't take cost into consideration. This program would probably cost about 250 Billion or more a year an most of that will fall to the General fund leading to substantial tax increases on all Atlasians not just to subsidize the care for the poor, but also people as rich as Warren Buffet or Bill Gates.

Lastly if the amendment to the underlying legislation passes, there will still be a large number of uninsured people. Ironically my Market based plan covers everyone while this amendment to the underlying bill would create a boondoggle of a program that is essentially underfunded according to the language of the bill and yet millions would go without coverage remaining a burden to health care system at large and the only think that is Insured about this is that prices will continue to spiral upward.

Let me state a few facts.

1. I keep hearing about the need to cover those who can't afford it as reason to support this bill. My proposal does the same thing, it just doens't subsidize people as rich as Bill Gates like this bill does. I would love to know what is wrong with my proposal that makes it glitter on Medicaid, please explain this unfounded charge.

2. Lets remember that not all the 47 million uninsured are poor. 20 Million make more then $70,000 a year. 7 million are college students who have been forced off there parents plan. There are simple solutions two the both of these.


Also I want to know why there is a problem with charging people premiums? The biggest problem that is driving up costs is irresponsibility on the part of the people. They don't take care of themselves when they are health and they don't comparison shop when they are sick. This is the biggest driver of raising costs. Charging people premiums would require people to take responsibility for there own health care. Again the premiums would have little or no impact on the poor. We can't create a sense of a free ride hear, people are going to have to sacrifice to get this and I see no reason why these so called Progressives are adocating to subsidize the rich on the back of the Middle class while not even guarrenteeing all the poor are covered first. And this will lead to substantial Income tax increase if it is reliant on the General fund. These will not be born primary by the rich but substanitally on the backs of the middle class.

There is a fundamental disagreement here. Our health care is the best in the world. If we have a problem, it is a problem of access. Once people have access we have the best doctors, the best equiptment, the best procedures, the best regulations and protections, and the best technology. We shouldn't scrap a system that is a Mansion on the inside. All we need to do is to get people through the front door. This bill tears the mansion down and replaces it with  a shed. Those pushing this bill prefer to throw the baby out with the bath water, and refuse to acknowledge the areas in which we are superior to any other country in terms of health care.

I would remind all Senators that if this bill fails we will still get a Health Care reform through. Though a certain group of people might whine and complain, and few may threaten to take there toys and leave, in the end cooler heads will prevail, a consensus will be reached, and Atlasians will get the reform they need and the not the reform we may each prefer due to partisanship. No Senator who has severe misgivings about this bill should feel pressured into voting for this because, nothing will get done. WE WILL GET THIS DONE. If not through this bill then through a common sense, realistic, and bipartisan compromise that expands access, decreases costs, preserves our level of quality, encourages competition, discourages junk lawsuits and preserves choice while at the same time ensuring everyone has some kind of coverage. I would encourage all Senators to defeat both the amendment and the underlying bill.

[Southern Senator North Carolina Yankee]

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.

Oh you better stop right there you SOB. My motivations have nothing to do with credit. I don't won't to write this up. If I were to do so it would take 3 posts just to put on here. I have my own motivations for making sure a realistic program that is actually responsibily funded gets through.

You must be logged in to read this quote.

Oh, wah. Then go find them.

I didn't write this bill, Fritz did. Again the precise reason why I don't want to have to write this up. This is your guy's ball and if something needs to be added then do it. I oppose this bill.

You must be logged in to read this quote.

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.

Yes they have no motivations, but they still can, and that the problem. The bill is nothing but a Liberals naive wet dream.

You must be logged in to read this quote.

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.

Marokai you don't listen, you don't read, you guess, you assume, and then you attack on false pretences. You don't charge the poor premiums. You tier the system with a sliding scale. And the cost of not charging or charging less in premiums is made up using realistic revenue sources. Thats fair, thats how unemployement, Social Security and many other programs are done through premiums known as FICA taxes. You would do the same with the premuims in my proposal. Last time I checked the essential job of Business was to provide people with the Goods and Services they need to survive. That is what Business is about. The Gov't itself is a business and a really big one at that. Business is not good our evil, its job is to provided to those Goods and Services and make a profit for doing it. People as individuals make businesses bad. Businesses in and of themselves are good for society.

So basically you can't stand it when people disagree with you. When I graduate High School next year in the top 25 of my class I will remember that insulting comment you just made you egotisical bastard.

You must be logged in to read this quote.

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.

I never said that the bill didn't allow for insurance to exist, that was already dealt with last night. I am not SPC, so stop assuming this Bullsh**t about me. Would you like me to stereo type you you elist prick.

People over 70,000 will be forced to buy insurance, but I don't see why thats a problem cause if you reduce costs which my plan also does, they should be able to afford it. I don't live in a fanasty land anymore then you do for not even creating a proper way to fund this damn bill. All I see is you ensure everyone and the Gov't gets a little from the taxes Fritz mentione and 99% of it gets dumped on the general fund. If you want to raise income taxes then put in the bill which ones will be raised and how much. You also neglect that I propose massive regulations on Insurance companies as well as Pharma to get costs down. I nevered said the Private market magically solves all ills, you are once again stereotyping me.

You may think there is nothing wrong with this program but when I look at it taking my own partisanship aside I see an incomplete piece of legislation at best. There is just so much past statute that has be changed or modified thats not dealt with, a proper way to actually fund and administer this(looks like Afleitch has a good idea on the Health Boards), and lastly at least something to deal with soaring costs.

[Southern Senator North Carolina Yankee]

A few suggestions:

1. Address the fact that our health industry is not very modernized when it comes to health records and paperwork. Computerize health records and such.

2. Deregulate some things, a doctor spends so much time doing paperwork, much of it caused by unneeded or redundant regulations. I'll let you Senators deal with specifics here .

3. Subsidize health insurance for those who cannot reasonably afford it.

4. Malpractice insurance reform.

5. Provide a public catastrophic insurance program. If a person must pay over x amount for medical care due to something they didn't intentionally cause, then subsidize them for that care only from that point on.

Then you can worry about universal coverage, but deal with these first. Fritz's plan doesn't deal with some of these issues.

Glad to know someone actually agrees with me to an extent. There are a lot of things that are just brush aside and pushed under the rug. If anything this bill is what is the unrealistic "simple" solution as Marokai accused mine of being.

[Southern Senator North Carolina Yankee]

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.

[Southern Senator North Carolina Yankee]

A few suggestions:

1. Address the fact that our health industry is not very modernized when it comes to health records and paperwork. Computerize health records and such.

2. Deregulate some things, a doctor spends so much time doing paperwork, much of it caused by unneeded or redundant regulations. I'll let you Senators deal with specifics here .

3. Subsidize health insurance for those who cannot reasonably afford it.

4. Malpractice insurance reform.

5. Provide a public catastrophic insurance program. If a person must pay over x amount for medical care due to something they didn't intentionally cause, then subsidize them for that care only from that point on.

Then you can worry about universal coverage, but deal with these first. Fritz's plan doesn't deal with some of these issues.

Glad to know someone actually agrees with me to an extent. There are a lot of things that are just brush aside and pushed under the rug. If anything this bill is what is the unrealistic "simple" solution as Marokai accused mine of being.

Yeah, in my opinion, the problem with our health care costs is actually many small problems that together are a big problem. Universal solves the problem of hospitals treating the uninsured and then getting no money for it, thus charging the insured more, but it ignores many of these problems. You just take those problems, and move them from the business area to the government area.

Our health system is the best in the world in terms of quality, doctors, treatments, technology and protective Regulations. The problem is one of Access. Malpractice, lack of competition, and irresponsiblililty on the part of those buying drugs or getting procedures account for at least 40% to 50% of the problem. Most of the rest is because of the lack of preventive care and the subisidization that already goes on in the current system. Those last two are dealth with in Fritz bill the other 3 are not and should be. There is no reason for a myriad pathwork of  conflicting bills when we can do it all at once in one bill and reduce confusion.

[Southern Senator North Carolina Yankee]

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.

Okay but there must be a set stream of revenue to fund this. This program should have a firm set and specific funding source. If we have to come back later and address this funding issue thats fine. On implementation would be nice if some dates were put in the bill regarding implementation.

[Southern Senator North Carolina Yankee]

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.

Actually I am willing to compromise. By having a public plan in the first place. If you hate the term "Premium" why don't you just use the word tax instead. I envisioned it being similar to fica taxes. I am willing to give in and accept your guys proposal if you are willing to incorporate some "more" things to get costs done a serious overhaul of regulations.

[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.

-----

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?

[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?

[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

You must be logged in to read this quote.

 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:

You must be logged in to read this quote.

Other then that I would support Franzl's amendment.

[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.

[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.

[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.

You shouldn't take it so personally, NCY.

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

Its obvious someone can't read.