Health Care

[_JS]

How it is funded is really irrelevant to the healthcare debate.

I don't see why. In fact i see it as central to the debate.

You are proposing a new service. How do you plan to fund it.

The feds can run a deficit. The states can't. Is this why you want it at a federal level?

Not at all. Also, I did propose a method of funding it.

[Christians4LessGvt]

"How it is funded is really irrelevant to the healthcare debate"

translation: gvt will just print the money or hide a tax in form of corporate tax or tax weathly, and we can offer "free" medical to illegals
you do think we should offer "free" medical care to illegals right?
after all if we can not deny them a DL  how could we be so mean and deny them doctor visits for free too

[BT]

Payroll tax is as regressive as sales tax yet it doesn't get contributions from everyone.

What rate are you proposing for FICA to cover all these new services?

[_JS]

"How it is funded is really irrelevant to the healthcare debate"

translation: gvt will just print the money or hide a tax in form of corporate tax or tax weathly, and we can offer "free" medical to illegals
you do think we should offer "free" medical care to illegals right?
after all if we can not deny them a DL  how could we be so mean and deny them doctor visits for free too

We currently offer them the most expensive form of medical care - Emergency Room treatment. It would be illogical, if not stupid to not offer them a cheaper form.

And your "translation" is crap. We currently pay more per patient and more as a percentage of GDP than any nation on Earth for healthcare. I'm offering a more cost effective solution.

[_JS]

Payroll tax is as regressive as sales tax yet it doesn't get contributions from everyone.

What rate are you proposing for FICA to cover all these new services?

It is only more regressive because we cap the maximum amount that allows contributions.

We need a National Insurance tax with no upper limit ceiling.

[BT]

We need a National Insurance tax with no upper limit ceiling.

That may bring in more revenues but it doesn't alleviate the burden at the lower end.

And how do you make sure folks in the underground economy pay for these services?

With sales tax there is no cap and everybody pays.

[_JS]

We need a National Insurance tax with no upper limit ceiling.

That may bring in more revenues but it doesn't alleviate the burden at the lower end.

And how do you make sure folks in the underground economy pay for these services?

With sales tax there is no cap and everybody pays.

No revenue system is absolute. We could install a VAT to pay for it as well, but as I said, paying for it is a secondary issue. We are already paying for it and paying too much.

[BT]

I presume when you are speaking of a VAT you are speaking of a so called luxury tax. Otherwise we are back to a sales tax.

Using your model of a National Insurance Tax, and assuming Medicare and Medicaid would go by the wayside if it were replaced with UHC what percentage of wages would you tax to ensure the programs solvency. Currently we are at 7.65 % for SS and Medicare.

[_JS]

I presume when you are speaking of a VAT you are speaking of a so called luxury tax. Otherwise we are back to a sales tax.

Using your model of a National Insurance Tax, and assuming Medicare and Medicaid would go by the wayside if it were replaced with UHC what percentage of wages would you tax to ensure the programs solvency. Currently we are at 7.65 % for SS and Medicare.

I'm not sure, I'd have to look at the figures and see what the savings would be. Also, cutting the ceiling out (which now stands at $97,500) should help quite a bit.

[BT]

Medicare does not have a ceiling on earnings. Hasn't had one since 1994.

[_JS]

FICA only taxes the first $97,500 of income. Anything after that is exempt (this is the case in 2007).

It can be changed to be less regressive, it can be graduated, or an allowance can be put in - or both.

I'm not seeing the problem BT. As someone who has studied public economics, I can come up with dozens of methods of funding that will be less regressive than a sales tax. If that is the only issue, then really that isn't a massive problem. We'll still be saving money on the whole than what we pay now to insurance companies and Medicare/Medicaid.

[Henny]

By Johnathon Ross, Toledo Blade
Posted on August 21, 2007, Printed on August 21, 2007
http://www.alternet.org/story/60312/
Shame on all of us, especially those of us in positions of public trust. Forty-five million of our friends, family, and neighbors, including 1.3 million Ohioans, have no health-care coverage at all.

Tens of millions more are at risk of bankruptcy even though they have insurance. Their coverage is too skimpy to protect them financially.

What do the current conservative leaders of many states and the nation have to say about the fact that we spend twice as much as any other industrial democracy in the world and yet fail to cover 16 percent of the population? To paraphrase Marie Antoinette, "Let them buy high-deductible health plans."

But who are the uninsured? They are mainly (75 percent) lower-income working people and their kids. Most of these folks struggle to keep food on the table and the lights on. They can't afford even bare-bones policies.

What are the facts, not the hype, on market-based reforms such as Health Savings Accounts (HSAs), high-deductible health plans, and mandated insurance (a la Massachusetts)? These represent the next bogus effort to keep private insurers in charge of our crumbling sickness care non-system. Remember how they promised that a competing insurance market of Health Maintenance Organizations was going to save American health care?

Unfortunately, despite the nostrums of the market ideologues, health-care costs have continued to soar at twice the growth rate of the gross domestic product while 10 million more have gone uninsured. Pound as they might on the square peg of market forces, health care will never be a nice round market commodity.

Why? The consumer's not sovereign. The doctor, not the patient, orders the care. There's no easy exit from the market for patients. When critically (and expensively) ill, you buy or die. The most expensive health care is not necessarily desired. If open-heart surgery were on sale would you have two?

There's often inadequate information to make wise purchasing decisions. Sometimes the best doctors are unsure of the wisest course of action for a patient. It is the uncertainty of illness and its attendant costs that creates the need for insurance in the first place.

The profit motive runs contrary to the best cooperative and Samaritan traditions of medical practice and training. There are lots of natural monopolies. Should we build another hospital in Bowling Green so that the competition will leave them both half-empty? The market for medical services fails these tests of an effective market and will fail in the guise of health savings accounts.

The 10 percent of patients who are very ill generate 70 percent of the costs, averaging $39,000 per year. They will never save anything in their HSAs. Studies confirm that high out-of-pocket costs, the hallmark of HSAs, yield worse health outcomes for the poor, elderly, and chronically ill.

The health-care bureaucracy already consumes 31 percent of spending. The fees for tracking 300 million individual HSAs would only aggravate this shameful waste.

Half of personal bankruptcies are due to uncovered health-care bills, again the hallmark of HSAs. Even boosters of HSAs (Mckinsey and Co.) find 56 percent of employees less satisfied with their new accounts than their old health plans.

There is a national health insurance program (HR 676) in front of Congress and the Health Care for All Ohioans Act (HCFAO) in front of the Ohio General Assembly. Either of these plans would create an improved and expanded Medicare for all Ohioans.

Taxes would replace private insurance premiums and out of pocket payments. Taxes would go up but premiums and out of pocket payments would go down by even more. These funds, added to current public spending, would create a single insurance pool adequate to cover all for no more than we spend now.

How can this be? In a multi-payer system, the complexity yields high administrative costs. Each insurer, hospital, and doctor must keep track of myriad contracts, discount arrangements, benefit packages, formularies, limited referral networks, and insurance rules and regulations designed to reduce utilization and profit the insurers. HSAs leave this insurance and billing bureaucracy in place and then add the complexity of tracking millions of individual savings accounts.

Studies by the Government Accountability Office and the Congressional Budget Office both confirm this surprising fact - the administrative simplicity of a single universal insurance pool, such as Medicare, yields savings that allow comprehensive coverage for all at current levels of spending. A tax-based public system is simple and efficient. There is simply a lot less work to do.

How do we know it can be done? Because every other western industrial democracy already has a national health insurance program, each has managed to cover all their citizens at about half of what we spend and they still have better health outcomes than the U.S.

Business owners should realize that the health-care system provides the maintenance on their work force, just as other experts provide maintenance on their expensive and complex industrial and business machinery.

It makes good sense to get the most comprehensive maintenance system for the best price. More for the same money - value - is what tax-financed universal health insurance system can provide. Those businesses avoiding the cost of insuring their employees are the recipients of cost shifting. This occurs through higher taxes to fund indigent care and higher prices paid when doing business with companies who continue to insure their employees and pass along the costs shifted to them in the price of their products.

Patchwork solutions such as Medicaid expansions, vouchers, tax credits, or medical savings accounts won't work. They mainly serve to enrich the insurance bureaucracy. They fail to control costs and fail to cover everyone. Fundamental reform is what we need.

The Institute of Medicine estimates that 18,000 Americans die each year from lack of health insurance alone. A tax-financed universal health insurance system will save lives and save dollars. It's good for business and our health. Counter-intuitive or not, businessmen and all of us should support a single-payer universal health insurance solution. Financially, we already are.

What's the bottom line? America needs affordable universal health insurance. We can build it with administrative savings and public accountability but not with health savings accounts designed to profit Wall Street and the insurance industry. HR 676, the National Health Insurance Act or the Health Care for All Ohioans act would create an expanded and improved Medicare for all Ohioans. We know it would work because Medicare works. It would save lives and save money and it is the right thing to do.

Johnathon S. Ross MD, a Toledo internist, is past president of Physicians for a National Health Program (pnhp.org) and a member of the Ohio council of Single Payer Action Network (spanohio.org).
? 2007 Independent Media Institute. All rights reserved.
View this story online at: http://www.alternet.org/story/60312/

[BT]

H.R.676
United States National Health Insurance Act (or the Expanded and Improved Medicare for All Act) (Introduced in House)

SEC. 101. ELIGIBILITY AND REGISTRATION.

      (a) In General- All individuals residing in the United States (including any territory of the United States) are covered under the USNHI Program entitling them to a universal, best quality standard of care. Each such individual shall receive a card with a unique number in the mail. An individual's social security number shall not be used for purposes of registration under this section.

      (b) Registration- Individuals and families shall receive a United States National Health Insurance Card in the mail, after filling out a United States National Health Insurance application form at a health care provider. Such application form shall be no more than 2 pages long.

      (c) Presumption- Individuals who present themselves for covered services from a participating provider shall be presumed to be eligible for benefits under this Act, but shall complete an application for benefits in order to receive a United States National Health Insurance Card and have payment made for such benefits.

SEC. 102. BENEFITS AND PORTABILITY.

      (a) In General- The health insurance benefits under this Act cover all medically necessary services, including--

            (1) primary care and prevention;

            (2) inpatient care;

            (3) outpatient care;

            (4) emergency care;

            (5) prescription drugs;

            (6) durable medical equipment;

            (7) long term care;

            ( mental health services;

            (9) the full scope of dental services (other than cosmetic dentistry);

            (10) substance abuse treatment services;

            (11) chiropractic services; and

            (12) basic vision care and vision correction (other than laser vision correction for cosmetic purposes).

      (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.

      (c) No Cost-sharing- No deductibles, copayments, coinsurance, or other cost-sharing shall be imposed with respect to covered benefits.

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.

            (2) CONVERSION OF INVESTOR-OWNED PROVIDERS- Investor-owned providers of care opting to participate shall be required to convert to not-for-profit status.

            (3) COMPENSATION FOR CONVERSION- The owners of such investor-owned providers shall be compensated for the actual appraised value of converted facilities used in the delivery of care.

            (4) 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).

            (5) REQUIREMENTS- The conversion to a not-for-profit health care system shall take place over a 15-year period, through the sale of US Treasury Bonds. Payment for conversions under paragraph (3) shall not be made for loss of business profits, but may be made only for costs associated with the conversion of real property and equipment.

      (b) Quality Standards-

            (1) IN GENERAL- Health care delivery facilities must meet regional and State quality and licensing guidelines as a condition of participation under such program, including guidelines regarding safe staffing and quality of care.

            (2) LICENSURE REQUIREMENTS- Participating clinicians must be licensed in their State of practice and meet the quality standards for their area of care. No clinician whose license is under suspension or who is under disciplinary action in any State may be a participating provider.

      (c) Participation of Health Maintenance Organizations-

            (1) IN GENERAL- Non-profit health maintenance organizations that actually deliver care in their own facilities and employ clinicians on a salaried basis may participate in the program and receive global budgets or capitation payments as specified in section 202.

            (2) EXCLUSION OF CERTAIN HEALTH MAINTENANCE ORGANIZATIONS- Other health maintenance organizations, including those which principally contract to pay for services delivered by non-employees, shall be classified as insurance plans. Such organizations shall not be participating providers, and are subject to the regulations promulgated by reason of section 104(a) (relating to prohibition against duplicating coverage).

      (d) Freedom of Choice- Patients shall have free choice of participating physicians and other clinicians, hospitals, and inpatient care facilities.

SEC. 104. PROHIBITION AGAINST DUPLICATING COVERAGE.

      (a) In General- It is unlawful for a private health insurer to sell health insurance coverage that duplicates the benefits provided under this Act.

      (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.

TITLE II--FINANCES

Subtitle A--Budgeting and Payments

SEC. 201. BUDGETING PROCESS.

      (a) Establishment of Operating Budget and Capital Expenditures Budget-

            (1) IN GENERAL- To carry out this Act there are established on an annual basis consistent with this title--

                  (A) an operating budget;

                  (B) a capital expenditures budget;

                  (C) reimbursement levels for providers consistent with subtitle B; and

                  (D) a health professional education budget, including amounts for the continued funding of resident physician training programs.

            (2) REGIONAL ALLOCATION- After Congress appropriates amounts for the annual budget for the USNHI Program, the Director shall provide the regional offices with an annual funding allotment to cover the costs of each region's expenditures. Such allotment shall cover global budgets, reimbursements to clinicians, and capital expenditures. Regional offices may receive additional funds from the national program at the discretion of the Director.

      (b) Operating Budget- The operating budget shall be used for--

            (1) payment for services rendered by physicians and other clinicians;

            (2) global budgets for institutional providers;

            (3) capitation payments for capitated groups; and

            (4) administration of the Program.

      (c) Capital Expenditures Budget- The capital expenditures budget shall be used for funds needed for--

            (1) the construction or renovation of health facilities; and

            (2) for major equipment purchases.

      (d) Prohibition Against Co-Mingling Operations and Capital Improvement Funds- It is prohibited to use funds under this Act that are earmarked--

            (1) for operations for capital expenditures; or

            (2) for capital expenditures for operations.

SEC. 202. PAYMENT OF PROVIDERS AND HEALTH CARE CLINICIANS.

      (a) Establishing Global Budgets; Monthly Lump Sum-

            (1) IN GENERAL- The USNHI Program, through its regional offices, shall pay each hospital, nursing home, community or migrant health center, home care agencies, or other institutional provider or pre-paid group practice a monthly lump sum to cover all operating expenses under a global budget.

            (2) ESTABLISHMENT OF GLOBAL BUDGETS- The global budget of a provider shall be set through negotiations between providers and regional directors, but are subject to the approval of the Director. The budget shall be negotiated annually, based on past expenditures, projected changes in levels of services, wages and input, costs, and proposed new and innovative programs.

      (b) Three Payment Options for Physicians and Certain Other Health Professionals-

            (1) IN GENERAL- The Program shall pay physicians, dentists, doctors of osteopathy, psychologists, chiropractors, doctors of optometry, nurse practitioners, nurse midwives, physicians' assistants, and other advanced practice clinicians as licensed and regulated by the States by the following payment methods:

                  (A) Fee for service payment under paragraph (2).

                  (B) Salaried positions in institutions receiving global budgets under paragraph (3).

                  (C) Salaried positions within group practices or non-profit health maintenance organizations receiving capitation payments under paragraph (4).

            (2) FEE FOR SERVICE-

                  (A) IN GENERAL- The Program shall negotiate a simplified fee schedule that is fair with representatives of physicians and other clinicians, after close consultation with the National Board of Universal Quality and Access and regional and State directors. Initially, the current prevailing fees or reimbursement would be the basis for the fee negotiation for all professional services covered under this Act.

                  (B) CONSIDERATIONS- In establishing such schedule, the Director shall take into consideration regional differences in reimbursement, but strive for a uniform national standard.

                  (C) STATE PHYSICIAN PRACTICE REVIEW BOARDS- The State director for each State, in consultation with representatives of the physician community of that State, shall establish and appoint a physician practice review board to assure quality, cost effectiveness, and fair reimbursements for physician delivered services.

                  (D) FINAL GUIDELINES- The regional directors shall be responsible for promulgating final guidelines to all providers.

                  (E) BILLING- Under this Act physicians shall submit bills to the regional director on a simple form, or via computer. Interest shall be paid to providers whose bills are not paid within 30 days of submission.

                  (F) NO BALANCE BILLING- Licensed health care clinicians who accept any payment from the USNHI Program may not bill any patient for any covered service.

                  (G) UNIFORM COMPUTER ELECTRONIC BILLING SYSTEM- The Director shall make a good faith effort to create a uniform computerized electronic billing system, including in those areas of the United States where electronic billing is not yet established.

            (3) SALARIES WITHIN INSTITUTIONS RECEIVING GLOBAL BUDGETS-

                  (A) IN GENERAL- In the case of an institution, such as a hospital, health center, group practice, community and migrant health center, or a home care agency that elects to be paid a monthly global budget for the delivery of health care as well as for education and prevention programs, physicians employed by such institutions shall be reimbursed through a salary included as part of such a budget.

                  (B) SALARY RANGES- Salary ranges for health care providers shall be determined in the same way as fee schedules under paragraph (2).

            (4) SALARIES WITHIN CAPITATED GROUPS-

                  (A) IN GENERAL- Health maintenance organizations, group practices, and other institutions may elect to be paid capitation premiums to cover all outpatient, physician, and medical home care provided to individuals enrolled to receive benefits through the organization or entity.

                  (B) SCOPE- Such capitation may include the costs of services of licensed physicians and other licensed, independent practitioners provided to inpatients. Other costs of inpatient and institutional care shall be excluded from capitation payments, and shall be covered under institutions' global budgets.

                  (C) PROHIBITION OF SELECTIVE ENROLLMENT- Selective enrollment policies are prohibited, and patients shall be permitted to enroll or disenroll from such organizations or entities with appropriate notice.

                  (D) HEALTH MAINTENANCE ORGANIZATIONS- Under this Act--

                        (i) health maintenance organizations shall be required to reimburse physicians based on a salary; and

                        (ii) financial incentives between such organizations and physicians based on utilization are prohibited.

SEC. 203. PAYMENT FOR LONG-TERM CARE.

      (a) Allotment for Regions- The Program shall provide for each region a single budgetary allotment to cover a full array of long-term care services under this Act.

      (b) Regional Budgets- Each region shall provide a global budget to local long-term care providers for the full range of needed services, including in-home, nursing home, and community based care.

      (c) Basis for Budgets- Budgets for long-term care services under this section shall be based on past expenditures, financial and clinical performance, utilization, and projected changes in service, wages, and other related factors.

      (d) Favoring Non-Institutional Care- All efforts shall be made under this Act to provide long-term care in a home- or community-based setting, as opposed to institutional care.

SEC. 204. MENTAL HEALTH SERVICES.

      (a) In General- The Program shall provide coverage for all medically necessary mental health care on the same basis as the coverage for other conditions. Licensed mental health clinicians shall be paid in the same manner as specified for other health professionals, as provided for in section 202(b).

      (b) Favoring Community-Based Care- The USNHI Program shall cover supportive residences, occupational therapy, and ongoing mental health and counseling services outside the hospital for patients with serious mental illness. In all cases the highest quality and most effective care shall be delivered, and, for some individuals, this may mean institutional care.

SEC. 205. PAYMENT FOR PRESCRIPTION MEDICATIONS, MEDICAL SUPPLIES, AND MEDICALLY NECESSARY ASSISTIVE EQUIPMENT.

      (a) Negotiated Prices- The prices to be paid each year under this Act for covered pharmaceuticals, medical supplies, and medically necessary assistive equipment shall be negotiated annually by the Program.

      (b) Prescription Drug Formulary-

            (1) IN GENERAL- The Program shall establish a prescription drug formulary system, which shall encourage best-practices in prescribing and discourage the use of ineffective, dangerous, or excessively costly medications when better alternatives are available.

            (2) PROMOTION OF USE OF GENERICS- The formulary shall promote the use of generic medications but allow the use of brand-name and off-formulary medications when indicated for a specific patient or condition.

            (3) FORMULARY UPDATES AND PETITION RIGHTS- The formulary shall be updated frequently and clinicians and patients may petition their region or the Director to add new pharmaceuticals or to remove ineffective or dangerous medications from the formulary.

SEC. 206. CONSULTATION IN ESTABLISHING REIMBURSEMENT LEVELS.

      Reimbursement levels under this subtitle shall be set after close consultation with regional and State Directors and after the annual meeting of National Board of Universal Quality and Access.

Subtitle B--Funding

SEC. 211. OVERVIEW: FUNDING THE USNHI PROGRAM.

      (a) In General- The USNHI Program is to be funded as provided in subsections (b) and (c).

      (b) Annual Appropriation for Funding of USNHI Program- There are authorized to be appropriated to carry out this Act such sums as may be necessary.

      (c) Intent- Sums appropriated pursuant to subsection (b) shall be paid for--

            (1) by vastly reducing paperwork;

            (2) by requiring a rational bulk procurement of medications;

            (3) from existing sources of Federal government revenues for health care;

            (4) by increasing personal income taxes on the top 5 percent income earners;

            (5) by instituting a modest payroll tax; and

            (6) by instituting a small tax on stock and bond transactions.

SEC. 212. APPROPRIATIONS FOR EXISTING PROGRAMS FOR UNINSURED AND INDIGENT.

      Notwithstanding any other provision of law, there are hereby transferred and appropriated to carry out this Act, amounts equivalent to the amounts the Secretary estimates would have been appropriated and expended for Federal public health care programs for the uninsured and indigent, including funds appropriated under the Medicare program under title XVIII of the Social Security Act, under the Medicaid program under title XIX of such Act, and under the Children's Health Insurance Program under title XXI of such Act.

TITLE III--ADMINISTRATION

SEC. 301. PUBLIC ADMINISTRATION; APPOINTMENT OF DIRECTOR.

      (a) In General- Except as otherwise specifically provided, this Act shall be administered by the Secretary through a Director appointed by the Secretary.

      (b) Long-Term Care- The Director shall appoint a director for long-term care who shall be responsible for administration of this Act and ensuring the availability and accessibility of high quality long-term care services.

      (c) Mental Health- The Director shall appoint a director for mental health who shall be responsible for administration of this Act and ensuring the availability and accessibility of high quality mental health services.

SEC. 302. OFFICE OF QUALITY CONTROL.

      The Director shall appoint a director for an Office of Quality Control. Such director shall, after consultation with state and regional directors, provide annual recommendations to Congress, the President, the Secretary, and other Program officials on how to ensure the highest quality health care service delivery. The director of the Office of Quality Control shall conduct an annual review on the adequacy of medically necessary services, and shall make recommendations of any proposed changes to the Congress, the President, the Secretary, and other USNHI program officials.

SEC. 303. REGIONAL AND STATE ADMINISTRATION; EMPLOYMENT OF DISPLACED CLERICAL WORKERS.

      (a) Use of Regional Offices- The Program shall establish and maintain regional offices. Such regional offices shall replace all regional Medicare offices.

      (b) Appointment of Regional and State Directors- In each such regional office there shall be--

            (1) one regional director appointed by the Director; and

            (2) for each State in the region, a deputy director (in this Act referred to as a `State Director') appointed by the governor of that State.

      (c) Regional Office Duties-

            (1) IN GENERAL- Regional offices of the Program shall be responsible for--

                  (A) coordinating funding to health care providers and physicians; and

                  (B) coordinating billing and reimbursements with physicians and health care providers through a State-based reimbursement system.

      (d) State Director's Duties- Each State Director shall be responsible for the following duties:

            (1) Providing an annual state health care needs assessment report to the National Board of Universal Quality and Access, and the regional board, after a thorough examination of health needs, in consultation with public health officials, clinicians, patients and patient advocates.

            (2) Health planning, including oversight of the placement of new hospitals, clinics, and other health care delivery facilities.

            (3) Health planning, including oversight of the purchase and placement of new health equipment to ensure timely access to care and to avoid duplication.

            (4) Submitting global budgets to the regional director.

            (5) Recommending changes in provider reimbursement or payment for delivery of health services in the State.

            (6) Establishing a quality assurance mechanism in the State in order to minimize both under utilization and over utilization and to assure that all providers meet high quality standards.

            (7) Reviewing program disbursements on a quarterly basis and recommending needed adjustments in fee schedules needed to achieve budgetary targets and assure adequate access to needed care.

      (e) First Priority in Retraining and Job Placement- The Program shall provide that clerical and administrative workers in insurance companies, doctors offices, hospitals, nursing facilities and other facilities whose jobs are eliminated due to reduced administration, should have first priority in retraining and job placement in the new system.

http://thomas.loc.gov/cgi-bin/query/F?c109:1:./temp/~c109ObWsPr:e4258:

[BT]

SEC. 211. OVERVIEW: FUNDING THE USNHI PROGRAM.

      (a) In General- The USNHI Program is to be funded as provided in subsections (b) and (c).

      (b) Annual Appropriation for Funding of USNHI Program- There are authorized to be appropriated to carry out this Act such sums as may be necessary.

      (c) Intent- Sums appropriated pursuant to subsection (b) shall be paid for--

            (1) by vastly reducing paperwork;  OK
            (2) by requiring a rational bulk procurement of medications; OK

            (3) from existing sources of Federal government revenues for health care; OK

            (4) by increasing personal income taxes on the top 5 percent income earners; NO

            (5) by instituting a modest payroll tax; and (define modest)

            (6) by instituting a small tax on stock and bond transactions. OK

SEC. 212. APPROPRIATIONS FOR EXISTING PROGRAMS FOR UNINSURED AND INDIGENT.

      Notwithstanding any other provision of law, there are hereby transferred and appropriated to carry out this Act, amounts equivalent to the amounts the Secretary estimates would have been appropriated and expended for Federal public health care programs for the uninsured and indigent, including funds appropriated under the Medicare program under title XVIII of the Social Security Act, under the Medicaid program under title XIX of such Act, and under the Children's Health Insurance Program under title XXI of such Act.  Well, duh!

[Michael Tee]

<<The state could set residency requirements and charge out of state fees for those who seek treatment from neighboring states.

<<Kind of like what they do for college tuition. >>

Students go to college for a few years and then are free to move on.  They're kind of a special category.

The conflict (for the non-students) is between universality of coverage and mobility rights.  In a federal state such as the U.S.A. or Canada, mobility rights for citizens are essential.  If the health care system is not universally accessible from coast to coast, you are not going to be able to achieve 100% mobility for the citizens.  It's gotta be an all-or-nothing plan in terms of state or provincial participation.