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.
I would like to see this changed to say: …All individuals LEGALLY residing in…
SEC. 102. BENEFITS AND PORTABILITY.
(a) In General- The health insurance benefits under this Act cover all medically necessary services, including at least the following:
(4) Emergency care.
(c) No Cost-Sharing- No deductibles, copayments, coinsurance, or other
cost-sharing shall be imposed with respect to covered benefits.
I would like to see a provision added that would provide for a substantial penalty, copay, fine (call it what you will), for visiting an emergency room in a non-emergency situation.
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.
Why? What is the fear from any clinic/hospital being a for profit?
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–
(C) reimbursement levels for providers consistent with subtitle B
No different than the current system of government price controls.
SEC. 201. BUDGETING PROCESS.
(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.
Who would be eligible for these funds? Would it only be government owned facilities or would any facility be able to get money for these purposes? Who would decide who needed improvements and who didn’t? Lot’s of room for pork-barrel spending here.
SEC. 202. PAYMENT OF PROVIDERS AND HEALTH CARE CLINICIANS.
(a) Establishing Global Budgets; Monthly Lump Sum-
(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.
“Global budget of providers set through negotiations”? Does this mean the government is now going to mandate the operating budgets of private businesses? How much closer to socialism, no communism, can you get?
SEC. 202. PAYMENT OF PROVIDERS AND HEALTH CARE CLINICIANS.
(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).
This seems to say that only individual providers, not hospitals or clinics, are eligible for the “fee for payment” option. Why can organizations such as hospitals and clinics not be paid on a fee for service basis?
SEC. 202. PAYMENT OF PROVIDERS AND HEALTH CARE CLINICIANS.
(b) Three Payment Options for Physicians and Certain Other Health Professionals-
(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.
How is this any different at all from the current Medicare/Medicaid system? You still have the government dictating to providers how much they will be paid for each of their services. How does this in anyway prevent the current situation from happening wherein the provider receives payment for services that is below what it costs to provide the service? You say I cannot compare the newly proposed system to the current Medicare/Medicaid system, yet this part of the bill tells me that comparing the two systems is comparing apples to apples, period.
SEC. 202. PAYMENT OF PROVIDERS AND HEALTH CARE CLINICIANS.
(b) Three Payment Options for Physicians and Certain Other Health Professionals-
(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.
Explain to me how this does not say that I, as an RN and employee of a hospital, will have my salary mandated by the government through the budget control process pointed out above? I, as a professional, do not want any government controls placed on what I am allowed to make. How is this better for me than where I am now, where I negotiate a salary for myself? Not all nurses do this, of course. I am able to because I travel as a nurse. I work for a company that finds nursing openings in areas of the country where I want to go and in the type of units I work in. A salary is then negotiated between the hospital, my employer and myself. There is a contract involved spelling out all the details. Will this new system put this entire industry out of business? Why should I not have the FREEDOM to decide how I wish to make my career and how much I can make?
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.
Explain to me how this is any different than the current system that both the government programs and private insurance companies use now? Read my forum topic entitled “Universal Healthcare Won’t Work” for my discussion of my personal experiences with this very point. Also, who is to make the decision as to what is medically necessary? Will it be as it is now with non-medical business people making that call for every claim? How does this make any sense? On this point, the bill is way too generalized and open to interpretation.
SEC. 211. OVERVIEW: FUNDING THE USNHI PROGRAM.
(c) Funding-
(1) IN GENERAL- There are appropriated to the USNHI Trust Fund amounts sufficient to carry out this Act from the following sources:
(B) Increasing personal income taxes on the top 5 percent income earners.
(C) Instituting a modest and progressive excise tax on payroll and self-employment income.
Why only the top 5%? Why not simplify the tax code as has been discussed with a flat tax and appropriating a portion of this? Also, I have concerns in subparagraph C of the use of the word progressive. When it comes to money and accounting, progressive means gradually increasing. To what point? Until the budget can be met?
SEC. 211. OVERVIEW: FUNDING THE USNHI PROGRAM.
(c) Funding-
(3) ADDITIONAL ANNUAL APPROPRIATIONS TO USNHI PROGRAM- Additional sums are authorized to be appropriated annually as needed to maintain maximum quality, efficiency, and access under the Program.
Where shall these additional funds be appropriated from? More additional taxes? I thought one of the lynch pins of the argument for single-payer, universal healthcare was that it could be done by spending even less than what we do now? Comparisons are always made to countries who have UHC and how they spend less than we do? So why the need throughout this entire section about the need for additional revenue to pay for the program?
SEC. 303. REGIONAL AND STATE ADMINISTRATION; EMPLOYMENT OF DISPLACED CLERICAL WORKERS.
(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.
Again, how is this any different from the current system wherein states are required to administer the federal program? Talk to any state legislator about how big a bite is taken out of the state’s budget to administer federally mandated federal programs. Shouldn’t a new, comprehensive reform to the healthcare system relieve the states of at least some of the fed’s unfunded mandates?
SEC. 303. REGIONAL AND STATE ADMINISTRATION; EMPLOYMENT OF DISPLACED CLERICAL WORKERS.
(d) State Director’s Duties- Each State Director shall be responsible for the following duties:
(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.
Why should the government (any government state, federal or local) be in control of how a hospital may wish to expand their offerings? How is the government in any better position to decide whether or not an area can support a hospital expansion? Would a hospital expand their facility if their market could not support it? Are the people running hospitals that bad when it comes to running a business? Where is your precious freedom of choice if the government is going to ration the availability of services?
SEC. 303. REGIONAL AND STATE ADMINISTRATION; EMPLOYMENT OF DISPLACED CLERICAL WORKERS.
(e) First Priority in Retraining and Job Placement; 2 Years of
Unemployment Benefits- The Program shall provide that clerical,
administrative, and billing personnel in insurance companies, doctors
offices, hospitals, nursing facilities, and other facilities whose jobs
are eliminated due to reduced administration–
(1) should have first priority in retraining and job placement in the new system; and
(2) shall be eligible to receive 2 years of unemployment benefits.
I see no provision for how exactly this will be funded. Will these people then be bumping the people who are already enrolled in these programs or who become eligible in the future? If not, then there must be a new funding source for this section. Has there been any investigation done to determine what just this will cost?
SEC. 305. NATIONAL BOARD OF UNIVERSAL QUALITY AND ACCESS.
(a) Establishment-
(1) IN GENERAL- There is established a National Board of Universal Quality and Access (in this section referred to as the Board’) consisting of 15 members appointed by the President, by and with the advice and consent of the Senate.
(2) QUALIFICATIONS- The appointed members of the Board shall include at least one of each of the following:
(A) Health care professionals.
I would like to see some kind of provision here that this will include those people ‘on the front lines’, not just management. Were you aware that the organization of nurses in supervisory positions (AONE, American Organization for Nurse Executives) is a subsidiary of the American Hospital Association? Therefore, the people involved in nursing leadership may not actually represent the needs of the majority of working nurses. This must be addressed.
Bottom line is this, yes I have read the bill, but I cannot support it in it’s current form. To gain my support, and others in my position, these weaknesses I have pointed out must be addressed. Secondly, without reform to Malpractice Litigation Reform as a part of this type of system, I will NEVER be able to support it. I am for COMPREHENSIVE reform of the healthcare industry, NOT band-aids and quick fixes. I see a start in the right direction here, but much more needs to be done. However, you and I both know that as an individual working class American, my voice will NEVER BE HEARD, no matter who the candidate or office-holder is. We can discuss and debate and iron out the kinks here all day, but what we discuss here will not be taken into consideration. I would welcome the opportunity to sit down and discuss these points with someone who can actually do anything about it, but alas, that will never happen. This when I currently live INSIDE the DC beltway, albeit in Virginia. I am sincerely hoping I am wrong on this point and we really are being listened to. I think any politician who could admit to not knowing everything and be open to discussing things with ‘commoners’ would be a REAL breath of fresh air.
My final point is this. I do think that nurses salaries need to be brought more in line with the job we do, however with the government (AKA Congress) setting salaries, this will never happen. How many doctors and laywers are in congress vs. nurses? You do the math.
I sincerely hope that I am coming across as discussing these points with respectful disagreement. If I come across any other way, please know this hope is my intent. I mean do disrespect or disregard for anyone else’s opinion and I sincerely hope others can view my opinion likewise.
1 comment:
This is a well laid out and detailed post. Keep up the good work.
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