You list items by section, and you list items without citing what you think are the problems. (0.00 / 0)

In the pdf I dl'ed there is no "section 130"

I am not a lawyer, nor have I attempted to compare word for word with the Canada Health Act, but the similarities are striking.

What are your objections? What do you mean when you say you want to support a universal health system?

Change
"We must break up the banks and never again let them get so big that they distort our politics and take down the economy.

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by: HousesofProgress @ Mon Nov 02, 2009 at 10:47:17 AM CST

Well I didn't cite a section 130 (0.00 / 0)

I did cite a section 103. I don't know what PDF you were examining, the one I point to is: http://www.pnhp.org/docs/nhi_b... where starting on page 6 line 8 you get the following:

SEC. 103. QUALIFICATION OF PARTICIPATING PROVIDERS.
(a) REQUIREMENT TO BE PUBLIC OR NON-PROFIT.-
(1) IN GENERAL.-No institution may be a participating provider unless it is a public or not-for-profit institution. Private physicians, private clinics, and private health care providers shall continue to operate as private entities, but are prohibited from being investor owned.
(2) CONVERSION OF INVESTOR-OWNED PROVIDERS.-For-profit providers of care opting to participate shall be required to convert to not-for-profit status.
(3) PRIVATE DELIVERY OF CARE REQUIREMENT.-For-profit providers of care that convert to non-profit status shall remain privately owned and operated entities.
(4) COMPENSATION FOR CONVERSION.-The owners of such for-profit providers shall be compensated for reasonable financial losses incurred as
a result of the conversion from for-profit to non-profit status.
(5) FUNDING.-There are authorized to be appropriated from the Treasury such sums as are necessary to compensate investor-owned providers as
provided for under paragraph (3).
(6) REQUIREMENTS.-The payments to owners of converting for-profit providers shall occur during a 15-year period, through the sale of U.S. Treasury Bonds. Payment for conversions under paragraph (3) shall not be made for loss of business profits

Meaning you can own a business but can't actually make a profit. And while Uncle Sam will in effect buy any outside investor's interest out, it won't compensate them for forgone profits and they only get their principal out over a 15 year period. That seems to cross the limit from eminent domain to outright expropriation of property Soviet style.

______________________

I support a universal single-payer system based on Medicare for All where practitioners and clinics can accept Medicare reimbursement rates or not regardless of their corporate structure. Under this bill Wal-Mart and Safeway and Payless Drugs have to convert to non-profit status or shutter their pharmacies. And physicians groups can't sell stock or accept outside investment to open a new clinic. That is just nutty.

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by: Bruce Webb @ Mon Nov 02, 2009 at 11:55:02 AM CST

On the later, I think that is also the law in Canada. (0.00 / 0)

In Canada it is illegal to pay or charge for covered services. The hosptials in canada are, for the most part, all owned publicly, and the moves that have been made lately to allow what are called Public Private Partnerships (3P's) are considered by most to be thin edge privatization and drift toward American Style Health Care.

"American Style Health Care" is huge insult in Canada, politicians regularly deny they trying to set up, or drift towards "American Style Health Care " - its considered loony.

Why should a government pay for forgone profits? People who were selling marijuana for example, before it became illegal were not given a billion dollars each to cover their "lost profits" as one says to the redundant in every company, here's a weeks wages, go get a real job.

When the unemployed are thought to deserve "lost wages" they would have received for the rest of their lives, I'll consider what criminally counter productive organizations like private insurance deserve.

Change
"We must break up the banks and never again let them get so big that they distort our politics and take down the economy.

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by: HousesofProgress @ Mon Nov 02, 2009 at 19:35:00 PM CST

[ Parent ]

serious policy proposal? yes (4.00 / 2)

i'm the 'wow, it goes that far?' vote. my preference is for expanding the vha to cover everyone, giving us a totally govt-run national health system like the uk has. these are the cheapest and most efficient systems for delivering health care. failing that, i like the canadian model.

hr676 is modeled after canada's medicare. lbj admired canada's medicare back in the day, and modeled his [now, our] medicare on canada's. canada's medicare started in one province and spread geographically over the next few years. our medicare started in one age group with the hopes that it would eventually expand to cover the whole population.

hr676 not only expands medicare to everyone, it fixes the problems with our present less-than-perfect medicare, such as closing the donut hole, making physician pay more rational, giving each hospital a global budget to work with, rather than having hospitals charging the payer for each separate service [this would save tons]....

in canada, the hospitals, clinics, etc are all non-profit, with some exceptions [the p3s] which, as hop says, is the free-marketeers' attempt to return canada to american-style health care. they don't seem to be hurting for lack of investors.

actually, here in the us, most of our hospitals are non-profits. back in the day, before corporate greed started taking over everything, hospitals were all non-profit or govt-owned. then along came the profit motive.

as for the big-name, most-admired health maintenance organizations and co-ops -- mayo clinic, cleveland clinic, group health, intermountain health, geisinger, kaiser-permanente -- non-profits all.

that should dispel the notion that investors are necessary. if investors want to park their money somewhere, let them buy govt-issued hospital bonds. like war bonds, only these would be for saving lives, not killing people.

as for non-profit walgreens and perle vision and so forth, i'm not sure about that. the language in this part of the bill needs to ne more precision, i agree, but it looks like 'provider' in this section is limited to providers of care [services]. purveyors of pills and glasses would probably be providers of items, not services.

as for the neighborhood dentists, etc, professional practices like dentists, doctors offices, lawyers, are often partnerships or professional associations, which doesn't make them non-profits exactly, but doesn't make them investor-owned either. so probably this section of the bill needs more precise language.

in canada, health insurance companies cannot sell health insurance that duplicates whatever the national health insurance covers. they can only sell supplemental insurance that pays for extras. hr676 would allow that here too, so yes, under hr676 you could get your private room, etc, if you wanted to buy supplemental insurance.

yes, the financing is specified only vaguely. possibly this is to be added after cbo scores the bill. after all, the whole purpose of cbo scoring is to get an idea of how much a piece of legislation is going to cost the federal govt if enacted. have to either make cuts in other parts of the budget or raise taxes to pay for those costs.

folding the indian health service into the new medicare would probably be doing that program a favor. ihs owns some clinics and hospitals and employs some doctors, but it's way underfunded and contracts out a lot of its work, and it's STILL providing woefully inadequate care. no reason the govt couldn't still own those same clinics and hospitals and employ those same doctors under the new medicare, and folded into the new medicare the ihs would have access to more and more stable funding.

same for the vha. republicans have been trying to gut funding for this program even as they call for ramping up the maiming and killing in wars and more wars. yay for idiocy.

as for the short length and lack of complexity in language, yes, it's just about the same length as the one that governs canada's medicare.

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by: hipparchia @ Tue Nov 03, 2009 at 00:56:13 AM CST

Language is loose (0.00 / 0)

Which is why I dismiss this as a serious proposal.

Sec. 102 includes as a covered benefit "Inpatient care" which on the face of it covers everything associated with hospitalization. It also covers 'Long-term care' 'medical health services' and 'substance abuse treatment' which pretty much covers any other kind of treatment that provides you with a bed. That same section says the provider can not charge you extra for anything associated with those four categories of care: "(c) NO COST-SHARING.-No deductibles, copayments, coinsurance, or other cost-sharing shall be imposed with respect to covered benefits."  No copayments means no cash, no coinsurance means no supplemental insurance.  Is there enough lee-way in Sec 104 to allow for hospital coverage supplementals?: "(b) CONSTRUCTION.-Nothing in this Act shall be construed as prohibiting the sale of health insurance coverage for any additional benefits not covered by this Act, such as for cosmetic surgery or other services and items that are not medically necessary."

Sec 103 gives us the following: "SEC. 103. QUALIFICATION OF PARTICIPATING PROVIDERS.
(a) REQUIREMENT TO BE PUBLIC OR NON-PROFIT.-
(1) IN GENERAL.-No institution may be a participating provider unless it is a public or not-for-profit institution. Private physicians, private clinics, and private health care providers shall continue to operate as private entities, but are prohibited from being investor owned."  The bill gives us no definition for 'institution' or 'provider'. On the other hand it doesn't limit the latter to doctors as there is a distinction between 'private physicians' and 'private health care providers'. And the language of 102 (b) suggests that includes anyone with a license to practice anything  "(b) PORTABILITY.-Such benefits are available through any licensed health care clinician anywhere in the United States that is legally qualified to provide the benefits." 102 (a) explicitly allows for coverage of hearing-aids (14) and durable medical equipment (6), does this mean that every person needing 'vision correction' (13) gets their choice of lenses and frames? Where is the line between "full range of dental services" and "cosmetic dentistry? Given the language on hearing aids and durable medical equipment can you possibly say that private provision of "items" would be exempt as opposed to "services"?

Then this: "yes, the financing is specified only vaguely. possibly this is to be added after cbo scores the bill. after all," CBO scores explicitly include net impact on the deficit which includes revenue effects. You have to have some specificity on that end or the score means nothing at all. I don't see that this bill CAN be scored.

And there is no magic in the word "non-profit" as relates to hospitals or just about anything else. Some of the best paid people in the country are non-profit hospital administrators, university presidents, and leaders of endowed foundations all of which are 'non-profit' for tax purposes. Concluding that 'greed' only applies to institutions whose proceeds are taxable smacks of some bill writer who thinks "from each according to his means, to each according to his needs" is something operational rather than aspirational.

Someone went way too far. They took a program which provides a strictly limited set of medical services, i.e. Medicare, within a public-private framework and decided to extend that range of services to just about everything and to eliminate the private component and then proclaim they have simply provided 'Medicare for All'. Well no this is a totally different thing, a kind of NHS Plus that validates every screech of every reichnut out there.

Finally as to the comparison between Canada's Medicare language and this bill. First there is a big difference between a 'legal framework' and 'implementing legislation', those who promote H.R.676's relative brevity as opposed to H.R.3962's length as being a positive ignore the difference between vague expressions of aspiration ('Single Payer Now") and serious attempts at establishing scorable implementing code language. Scoffing at the current House Bill because it actually nails down the not-so-insignificant details is somewhat misguided.

And don't even get me started on the politics of the whole thing. Posturing I said and posturing I meant.

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by: Bruce Webb @ Tue Nov 03, 2009 at 09:21:31 AM CST

[ Parent ]

selectively answering some of your points... (4.00 / 1)

Given the language on hearing aids and durable medical equipment can you possibly say that private provision of "items" would be exempt as opposed to "services"?

well, yes. reading the bill in its entirety, i see a distinction between the two, but i haven't asked an expert in health care law for their opinion. have you?

Is there enough lee-way in Sec 104 to allow for hospital coverage supplementals?: "(b) CONSTRUCTION.-Nothing in this Act shall be construed as prohibiting the sale of health insurance coverage for any additional benefits not covered by this Act, such as for cosmetic surgery or other services and items that are not medically necessary."

sure, why not? one of the great beauties of the french health care system is that the doctors have HUGE autonomy to decide what's "medically necessary" and for the most part, the insurance system just pays for whatever the dr orders. the french get superb care at something like half the price we pay for so-so care.

those who promote H.R.676's relative brevity as opposed to H.R.3962's length as being a positive ignore the difference between vague expressions of aspiration ('Single Payer Now") and serious attempts at establishing scorable implementing code language. Scoffing at the current House Bill because it actually nails down the not-so-insignificant details is somewhat misguided.

have you read all 1990 pages? there are an awful lot of pet projects in there that are going to make an awful lot of special interests happy.

for instance, do we really need pages and pages and pages of detailed descriptions of accountable care organizations, medical homes, transitional care models? especially given that these are all in there as proposed demonstration/pilot projects. why not just spend a page [or a few] to set up some general rules about demonstration/pilot projects in general? why pick just some specific projects to enshrine in law?

can't remember where i've seen it, but you can find scattered around the internet, in various places, lists of items in this bill that were originally proposed as stand-alone pieces of legislation in the past, but have been all tucked into this one bill now that there's a bandwagon for everybody to jump onto.

And there is no magic in the word "non-profit" as relates to hospitals

true, although there are credible studies that (1) for-profit hospitals cost more yet kill more patients and (2) that non-profit hospitals engage in a sort of nuclear arms race in spending once a for-profit hospital enters a formerly all non-profit market.

smacks of some bill writer who thinks "from each according to his means, to each according to his needs" is something operational rather than aspirational.

i've been a low-income person for much of my working life and as such have not paid a whole heck of a lot of payroll taxes into medicare. if i live long enough to make it to medicare age and need lots and lots of care i will get that care no matter how little i may have paid into the system. that "communistic" system has now been operational for 44 years. what's more, people like it.

CBO scores explicitly include net impact on the deficit which includes revenue effects. You have to have some specificity on that end or the score means nothing at all. I don't see that this bill CAN be scored.

you may remember that the bills we're currently looking at now have been scored and rescored and partially scored multiple times throughout the process. a suggested scenario: hr676 gets scored 'as is'... cbo says it will cost $___ trillion over the next 10 years... congress then has to decide whether to raise the payroll tax x amount, add a stock transaction tax of x amount, etc... cbo rescores the bill.

And don't even get me started on the politics of the whole thing.

heh. well, i am curious about your take on that part, actually. if you'd like to share.

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by: hipparchia @ Tue Nov 03, 2009 at 22:21:17 PM CST

[ Parent ]

Score revenues without rates (0.00 / 0)

Can't be done. Each bill whether HELP, HR3200, or 3962 has been scored for net impact on t he deficit incuding revenue effects. I don't see how this works.

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by: Bruce Webb @ Wed Nov 04, 2009 at 01:13:06 AM CST

[ Parent ]

easy (4.00 / 1)

first scoring is with no source of revenue written into the bill, but there will be savings from efficiencies gained by getting rid of the insurance companies, for example.

the this adds hugely to the deficit, but now you know how much you need to raise taxes by [or decide what not to cover after all] and can design a tax scheme [or choose more than one, with each to be scored separately. at least one of the present bills did this at one point, asking cbo to score three different versions of the public option to see which cost the least].

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by: hipparchia @ Wed Nov 04, 2009 at 01:53:43 AM CST

[ Parent ]

CBO Scoring doesn't work that way n/t (0.00 / 0)

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by: Bruce Webb @ Thu Nov 05, 2009 at 00:19:02 AM CST

[ Parent ]

you sure about that? (0.00 / 0)

from the cbo director's blog:

By law, CBO is responsible for providing cost estimates for bills (other than appropriation bills) when they are approved by a full committee of the House or Senate. Those estimates, which constitute the majority of CBO's formal estimates, are sent to both the Chairman and the Ranking Minority Member of the committee that approved it and are promptly posted on CBO's Web site.

CBO sometimes prepares cost estimates at other stages of the legislative process. For example, the agency is sometimes asked to estimate the budget impact of various alternatives during the developmental stages of the legislative process before lawmakers have decided exactly what legislation they want to propose. Thus, CBO may prepare preliminary estimates for alternative proposals to be considered by a committee, subcommittee, or the full House or Senate, including draft bills not yet introduced, or for amendments to be considered at committee markups. Estimates provided at these stages in the legislative process are often informal and convey preliminary indications of budgetary effects. They are generally used by Members or committees as they work through the decisionmaking process of formulating legislation.

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by: hipparchia @ Thu Nov 05, 2009 at 15:47:30 PM CST

[ Parent ]

From an American in Canada (0.00 / 0)

A few points about the system in Canada versus what's in H.R.676 that some here might not know.  First, Canadian Medicare does not cover prescription drugs, dental or vision care at all.  These are paid for through supplemental insurance (often employer provided) or through various means-tested programs for the poor, with a smaller or greater amount needing to be paid out of pocket, depending on the coverage.  My employer-provided coverage is incredibly generous, others' is much less so.  Some people have no coverage at all.  I think lack of government coverage of these things, especially prescription drugs, is a weakness of the Canadian system, and there are proposals from the left up here to include them, but that's not likely to happen any time soon.

Second, pharmacies and vision centers are private, for-profit businesses up here, dominated by chains, just like in the States.  I'm not aware of any restrictions on dentists.  Doctors' offices are private, with most of their revenue coming from Medicare of course.  I don't know if they're technically required to be "non-profit," or what restrictions there might be on outside investors, but they have no trouble getting started that I can see.  Walk-in clinics are everywhere, and my family doctor's group practice just moved to a beautiful new office.

Third, the system is actually run by the provinces under federal guidelines in the Canada Health Act, with a fair amount of leeway for provinces to set their own policies, but I'm afraid I'm vague on the details of this.

So how is this relevant to H.R. 676?  I'd never read it before, and it does seem the language is loose and incomplete.  This may be unfortunate, but the authors know perfectly well it's not going to pass in the near future, so of course it's symbolic, or "posturing," if you prefer.  Some of what's in the bill is essential for single-payer to work, notably the ban on private insurance for covered procedures.  I like that prescription drugs, dentists, and vision are covered, but if and when single-payer has a serious chance of passing, those could be areas of compromise.  I doubt that the authors intend to ban your neighborhood Walgreens or Perle Vision Center, and if they do I think that's crazy, so that needs to made clear or changed as the case may be.  Language on financing of providers' practices may need to be fixed too, to make sure they have no problems.  I don't think a state role is necessary or particularly useful, but if it's set up like it is in Canada it would work fine, and serves as another possible compromise.  Americans love their federalism, as apparently do Canadians, at least to some degree.

Finally, even in it's present form, H.R. 676 does not set up a "government run" system any more than Canada's is.  It's a government financed system of private, non-profit providers.  Britain's system is largely government-run.  As for the politics, single-payer has it's issues, but I hope they can be overcome in the future.  As I suggested, this bill needs to be clarified, and perhaps changed a bit.  Certainly banning private pharmacies and vision centers is a non-starter.

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by: dedelste @ Tue Nov 03, 2009 at 10:37:49 AM CST

not entirely accurrate on canadas services (4.00 / 1)

First, Canadian Medicare does not cover prescription drugs, dental or vision care at all.

This is not true. Several provinces have policies that do [provide these services, and at times others have as well. It might be correct to say that the canada Health Act does not require coverage to be provided by the province.

Dental care, eye care and other services

Dental care is not required to be covered by the government insurance plans. In Quebec, children under the age of 10 receive almost full coverage, and many oral surgeries are covered for everyone. [13] Canadians rely on their employers, individual private insurance, pay cash themselves for dental treatments, or receive no care. In some jurisdictions, public health units have been involved in providing targeted programs to address the need of the young, the elderly or those who are on welfare. The Canadian Association of Public Health Dentistry tracks programs, and has been advocating for extending coverage to those currently unable to receive dental care.[14]

The range of services for vision care coverage also varies widely among the provinces. Generally, "medically required" vision care is covered if provided by physicians (cataract surgery, diabetic vision care, some laser eye surgeries required as a result of disease, but not if the purpose is to replace the need for eyeglasses). Similarly, the standard vision test may or may not be covered. Some provinces allow a limited number of tests (e.g., no more than once within a two-year period). Others, including Ontario, Alberta and Saskatchewan, do not, although different provisions may apply to particular sub-groups (e.g., diabetics, children).

Change
"We must break up the banks and never again let them get so big that they distort our politics and take down the economy.

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by: HousesofProgress @ Tue Nov 03, 2009 at 13:04:26 PM CST

[ Parent ]

Thanks for the clarification (0.00 / 0)

I'm in Ontario.  I know that Chiropractors and other "non-traditional" practitioners were covered in Ontario until recently, but no longer are.

What is your source for the info above?

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by: dedelste @ Tue Nov 03, 2009 at 13:30:42 PM CST

[ Parent ]

HR3962 (0.00 / 0)

Covers vision and dental for children.

Doesn't cover designer sunglasses and teeth caps for adults.

Sloppy.

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by: Bruce Webb @ Wed Nov 04, 2009 at 01:19:57 AM CST

[ Parent ]

well, i don't have kids [think of the savings!] (0.00 / 0)

but i do wear glasses. so yeah, they coulda done better.

teeth are still in good shape though.

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by: hipparchia @ Wed Nov 04, 2009 at 01:57:30 AM CST

[ Parent ]

canada health act (0.00 / 0)

Insured health services are medically necessary hospital, physician and surgical-dental services provided to insured persons.

Insured hospital services are defined under the CHA and include medically necessary in- and out- patient services such as accommodation and meals at the standard or public ward level and preferred accommodation if medically required; nursing service; laboratory, radiological and other diagnostic procedures, together with the necessary interpretations; drugs, biologicals and related preparations when administered in the hospital; use of operating room, case room and anaesthetic facilities, including necessary equipment and supplies; medical and surgical equipment and supplies; use of radiotherapy facilities; use of physiotherapy facilities; and services provided by persons who receive remuneration therefore from the hospital, but does not include services that are excluded by the regulations.

Insured physician services are defined under the Act as "medically required services rendered by medical practitioners." Medically required physician services are generally determined by physicians in conjunction with their provincial and territorial health insurance plans.

Insured surgical-dental services are services provided by a dentist in a hospital, where a hospital setting is required to properly perform the procedure.

Extended health care services as defined in the CHA are certain aspects of long-term residential care (nursing home intermediate care and adult residential care services), and the health aspects of home care and ambulatory care services.

[...]

In addition to the medically necessary insured hospital and physician services covered by the CHA, provinces and territories also provide a range of programs and services outside the scope of the Act. These are provided at provincial and territorial discretion, on their own terms and conditions, and vary from one province or territory to another. Additional services that may be provided include pharmacare, ambulance services and optometric services.

The additional services provided by provinces and territories may be targeted to specific population groups (e.g., children, seniors or social assistance recipients), and may be partially or fully covered by provincial and territorial health insurance plans.

A number of services provided by hospitals and physicians are not considered medically necessary and thus, are not insured under provincial and territorial health insurance legislation. Uninsured hospital services for which patients may be charged include preferred hospital accommodation unless prescribed by a physician, private duty nursing services, and the provision of telephones and televisions. Uninsured physician services for which patients may be charged include telephone advice, the provision of medical certificates required for work, school, insurance purposes and fitness clubs, testimony in court and cosmetic services.

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by: hipparchia @ Wed Nov 04, 2009 at 02:09:03 AM CST

[ Parent ]

sorry link was just wikipedia (0.00 / 0)

http://en.wikipedia.org/wiki/M...

quick and dirty.

The thing to remember about Canada's health system is that the Canada Health Act is not 2000 pages of detail, it is a set of requirements that provinces meet as they can. The federal government then pays both direct medical care supplementals, and there are also transfers to provinces and territories, (called surprisingly enough Transfer Payments) that bring poorer provinces up to national standards on a wide range of services.

Change
"We must break up the banks and never again let them get so big that they distort our politics and take down the economy.

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by: HousesofProgress @ Wed Nov 04, 2009 at 08:40:44 AM CST

[ Parent ]

It's far more serious than what we're getting now. (0.00 / 0)

There has not been any serious attempt in Congress to pass HR 676, the only viable health care reform bill that has been written in recent years by that legislative body (I think there's a Senate version, but I don't know its status).  This is because it was decided a long time ago that it was better to try to pass a bad bill in hopes that it might survive a Republican filibuster than to use any and all legislative means at Democrats' disposal to pass real reform.

Why is it that the serious bill, the one that would help every American, is considered not to be serious, while the bills that do little or nothing and maybe even will make the health care crisis worse is considered serious?

Single-Payer is the ONLY viable public option.

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by: Single-Payer Advocate @ Wed Nov 04, 2009 at 09:52:51 AM CST

Google "Kennedy-Dingell April 2007" (0.00 / 0)

Kennedy and Dingell did not re-introduce this bill, knowing from bitter experience that they didn't have the votes but instead as original lead authors of the HELP and Tri-Committee bills started from a more realistic spot. Leaving the CPC room to posture by introducing HR676.

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by: Bruce Webb @ Thu Nov 05, 2009 at 00:26:10 AM CST

[ Parent ]

Yeah, I got that already. (0.00 / 0)

No serious effort to pass HR 676 was made.  Its perceived impossibility was something decided, not learned.  As Paul Krugman wrote in today's NYT (emphasis mine):

Administration officials would presumably argue that they were constrained by political realities, that a bolder policy couldn't have passed Congress. But they never tested that assumption, and they also never gave any public indication that they were doing less than they wanted. The official line was that policy was just right, making it hard to explain now why more is needed.

By deciding that the task of passing real reform was impossible, without ever having tried to pass it in the first place to see if it was, the impossibility of it became a self-fulfilling prophesy.  You're making excuses that hold no weight for politicians who haven't earned such defense.

Single-Payer is the ONLY viable public option.

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by: Single-Payer Advocate @ Fri Nov 06, 2009 at 10:44:02 AM CST

[ Parent ]