Atlasian National Healthcare Bill (Law'd)

[Purple State]

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.

[Purple State]

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.

[Purple State]

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.

[Purple State]

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?

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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.
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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.)
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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.

[Purple State]

Aye

[Purple State]

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

[Purple State]

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

[Purple State]

Alright, alright enough. It's bad enough that we can't reach any sort of consensus on this bill, we don't need a full-on brawl on the Senate floor.

Yank, could you give me a quick summary, preferably clean and in a list form of where your proposals for the health care mechanism stand as of now.

Marokai, if you would provide a brief compilation of points on how you want to pay for health care reform, that would be greatly appreciated.

[Purple State]

Aye

This just removes clause f? Sounds good, but a lot of work to go still.

[Purple State]

I'm going to work on a provision that details exactly how we plan on financing this. We need some sort of CBO to score things. Perhaps the GM? Or SoFA?

[Purple State]

I'm going to work on a provision that details exactly how we plan on financing this. We need some sort of CBO to score things. Perhaps the GM? Or SoFA?

I promise to have a more detailed response in regard to finances by the time I go to sleep. I'm just taking a bit of a break right now

(But please, no de-facto tax hikes on the poor.)

No, I plan on taxing benefits in a progressive fashion.

[Purple State]

I'm going to work on a provision that details exactly how we plan on financing this. We need some sort of CBO to score things. Perhaps the GM? Or SoFA?

I promise to have a more detailed response in regard to finances by the time I go to sleep. I'm just taking a bit of a break right now

(But please, no de-facto tax hikes on the poor.)

No, I plan on taxing benefits in a progressive fashion.

I was hoping we could have a rough outline of where funding would come from in this bill, as well as lining out the fact that finances, personnel, and services from Medicaid and Medicare would be phased out ans transferred to this new program. In doing so, we could avoid any major financial meltdown in regard to the new program for quite some time, as it would take time to implement anyway.

Because of that, I wanted to propose a separate Revenue Act that dealt with raising revenue in general, as opposed to trying to have a fight over detailed financing in this bill, taking the focus off the issue at hand.

We can't do health care piecemeal. I don't support reform if we can't pay for it. So it takes us an extra week. It will be worth it to pass a comprehensive bill.

[Purple State]

I'm going to work on a provision that details exactly how we plan on financing this. We need some sort of CBO to score things. Perhaps the GM? Or SoFA?

I promise to have a more detailed response in regard to finances by the time I go to sleep. I'm just taking a bit of a break right now

(But please, no de-facto tax hikes on the poor.)

No, I plan on taxing benefits in a progressive fashion.

I was hoping we could have a rough outline of where funding would come from in this bill, as well as lining out the fact that finances, personnel, and services from Medicaid and Medicare would be phased out ans transferred to this new program. In doing so, we could avoid any major financial meltdown in regard to the new program for quite some time, as it would take time to implement anyway.

Because of that, I wanted to propose a separate Revenue Act that dealt with raising revenue in general, as opposed to trying to have a fight over detailed financing in this bill, taking the focus off the issue at hand.

We can't do health care piecemeal. I don't support reform if we can't pay for it. So it takes us an extra week. It will be worth it to pass a comprehensive bill.

Well, the problem is we don't know where the hell we're coming from in regards to income, and other, taxes. Even if we presume sin taxes and income taxes are the same as the US right now, we've got to make changes and It would be rather frustrating to deal with raising or lowering taxes on a set of brackets that don't exist.

Hence the need for a CBO-equivalent.

[Purple State]

Amendment

Section 2 shall read as follows:

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I am up for recommendations to alter this before bringing it to a vote.

[Purple State]

I like the intent of this bill, and indeed, universal coverage should be a goal at some point in the future. But the bigger issue is not those who aren't insured (though that is a big problem) but the people losing coverage because it's too expensive despite a middle-class income.

If you provide universal coverage through a government plan, but don't try to control the rate of increase in health care costs (without rationing), then you simply shift the problem to the government. The system cannot, and will not be sustainable if costs are not simultaneously dealt with. I realize that universal coverage helps control costs, but more must be done.

Using my great influence as Midwest Lt. Governor , I urge all Senators to vote nay on this bill unless more is done to control the rising costs.

My proposed tax on health care benefits was actually intended to do just that. I agree we will need to find additional ways to cut costs (currently reading through 5 CBO reports, so I'll be some time), but it is definitely on my list of things to do.

[Purple State]

I like the intent of this bill, and indeed, universal coverage should be a goal at some point in the future. But the bigger issue is not those who aren't insured (though that is a big problem) but the people losing coverage because it's too expensive despite a middle-class income.

If you provide universal coverage through a government plan, but don't try to control the rate of increase in health care costs (without rationing), then you simply shift the problem to the government. The system cannot, and will not be sustainable if costs are not simultaneously dealt with. I realize that universal coverage helps control costs, but more must be done.

Using my great influence as Midwest Lt. Governor , I urge all Senators to vote nay on this bill unless more is done to control the rising costs.

My proposed tax on health care benefits was actually intended to do just that. I agree we will need to find additional ways to cut costs (currently reading through 5 CBO reports, so I'll be some time), but it is definitely on my list of things to do.

I look forward to hearing misguided congressional mumbo-jumbo.

As for controlling costs, there's only so much you can do. The program itself lowers costs, (I've said this routinely) simply on the virtue of being less profit-based and spending much less in administrative costs. The government is not going to take on all of the costs from the private market (like you somehow believe it will) because the private market creates a ton of costs on their own to make obscene profits and push people off the insurance rolls. (Also, many insurance companies don't like to pay for procedures, so they force you to undergo additional test after additional test, when they're not necessary. This will not happen, at least to the same extent, under a government plan.)

Many other costs can be controlled, but at some point you've got to focus on raising money, plain and simple. As for revenue, if we had, pardon my french, the balls to do it, we would raise taxes. But we have no tax brackets on the books, and no one here wants to do that. One side wants to double-tax the poor to raise revenue, another side wants to tax benefits, but no one wants to do the sensible thing and tax the upper class. If you want us to get serious about controlling costs and raising revenue, talk to your side, Vepres, don't complain to us.

Why is taxing benefits misguided? It helps control costs by providing incentives for people to join plans with lower premiums, leading them to shop for the best plan at the lowest price. There are options to tax only the higher priced benefits, of course at the expense of the effectiveness of the tax at lowering costs.

And why is a non-partisan group of health and economic experts weighing in "mumbo-jumbo"? They may not propose ideas that you agree with, but they sure are effective and know more about these things than any of us.

[Purple State]

Oh I haven't a problem with a modest tax on some benefits like you proposed, I just wish we could get serious with more potent measures of raising revenue. (Instead of targeting things at the middle class.)

So propose something. I already geared health benefits taxes to a progressive increase according to income, so further taxing the rich would be a bit much at this point. But I left my amendment open to suggestions, so give me ideas that will raise revenue or reduce costs or both.

[Purple State]

Oh I haven't a problem with a modest tax on some benefits like you proposed, I just wish we could get serious with more potent measures of raising revenue. (Instead of targeting things at the middle class.)

So propose something. I already geared health benefits taxes to a progressive increase according to income, so further taxing the rich would be a bit much at this point. But I left my amendment open to suggestions, so give me ideas that will raise revenue or reduce costs or both.

I'll propose more serious revenue raising in another bill, as I believe I've said repeatedly. If we're going to raise taxes, I want a set of tax brackets on the books.

Also, if you think many rich or upper-class individuals are going to take part in this plan..

It's not for this plan. It is all health benefits. Combined with a mandate...

And I will not be voting for a bill that doesn't include all facets of the proposal. Passing a plan without effective revenue clauses is a mistake.

[Purple State]

Oh I haven't a problem with a modest tax on some benefits like you proposed, I just wish we could get serious with more potent measures of raising revenue. (Instead of targeting things at the middle class.)

So propose something. I already geared health benefits taxes to a progressive increase according to income, so further taxing the rich would be a bit much at this point. But I left my amendment open to suggestions, so give me ideas that will raise revenue or reduce costs or both.

I'll propose more serious revenue raising in another bill, as I believe I've said repeatedly. If we're going to raise taxes, I want a set of tax brackets on the books.

Also, if you think many rich or upper-class individuals are going to take part in this plan..

It's not for this plan. It is all health benefits. Combined with a mandate...

And I will not be voting for a bill that doesn't include all facets of the proposal. Passing a plan without effective revenue clauses is a mistake.

Obviously I agree we need to do this right and fund it properly, I just don't want the Senate to have two major fights over revenue raising and lose sight of the real issue here, which is healthcare. With sin taxes, coupled with a taxing of healthcare benefits, and phasing out Medicare and Medicaid in favor of this new program, revenue will not be a problem for awhile.

Health care is a zero-sum game. We either pass a whole package, including systemic reform, cost reductions and revenue, or nothing at all, in my opinion. The individual pieces are crap. It is the total package that counts.

[Purple State]

Can someone tell me what exactly this amendment does and what its impact will be?

[Purple State]

Abstain

I would still like to know what we just did.

[Purple State]

(Not that I'm worried about this, but...) I ask that a final vote not be brought tomorrow on this or the stimulus, as I won't be able to vote on it. I also think this definitely has a lot of work to go before it is truly viable for passage.

[Purple State]

Can we see a current version of the bill? Just so I refer to things correctly in the amendment I plan to introduce.

[Purple State]

Abstain

I would still like to know what we just did.

We created regional authorities to manage the healthcare program.

Sensible enough then. Aye ftr.

[Purple State]

Abstain

I would still like to know what we just did.

We created regional authorities to manage the healthcare program.

Sensible enough then. Aye ftr.

Which I guess the Southeast could just use to ignore the program.

No, since the program is independant of regions.

That's what it looked like when I read it. These are federal organizations that are designated to run health care in specific regions. The regions cannot deny their existence and people are free to access the government run plan.