Americare health care plan (HR1481): How does this compare to candidates' proposals?

[Clarkie1]

Here's in an e-mail I received from Congressman Pete Stark who introduced this proposal:


Nearly forty-five million Americans are uninsured. Unless action is taken, that number is expected to rise to 56 million by 2013. This is a national tragedy that demands a Congressional response.

The Commonwealth Fund, a nationally recognized foundation that provides independent health care research, recently analyzed each of the leading Congressional and Bush Administration reform proposals to expand health insurance coverage.

According to the study, the “AmeriCare Health Care Act” I introduced last month is the best way to ensure quality, affordable coverage for all Americans and reduce overall health care spending. The Commonwealth Fund analysis found that by building on Medicare and the employer-based system, my proposal would provide for truly universal coverage, insuring all 47.8 million uninsured Americans; reduce health system spending by tens of billions of dollars by building on Medicare, a program significantly more efficient than private insurance; and decrease costs for households, employers, and state and local governments.

The “AmeriCare Health Care Act” combines what works in Medicare with what works in employer-based coverage to produce a health care plan that works for all Americans.

Under my legislation, people would continue to obtain health benefits through their employer or they would be covered under “AmeriCare,” a new health care program modeled on Medicare.

AmeriCare would provide comprehensive and affordable health care benefits. It would ensure that all Americans have access to the best that our health care system has to offer – medical innovation and the world’s most advanced providers and facilities – while addressing the shortcomings that exist today – high cost, complexity, and gaps in health insurance coverage.


Here's some info from the Congessman Stark's website:

STRUCTURE AND ADMINISTRATION: Creates a new title in the Social Security Act, “AmeriCare.” Provides universal health care for all U.S. residents, with special eligibility for children (under 24), pregnant women, and individuals with limited incomes (<300% FPL). Sets out standards for supplemental plans with a focus on consumer protection. Requires the Secretary to negotiate discounts for prescription drugs.

BENEFITS: Adults receive Medicare Part A and B benefits; preventive services, substance abuse treatment, mental health parity; and prescription drug coverage equivalent to the BC/BS Standard Option in 2005. Children receive comprehensive benefits and Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) coverage with no cost-sharing.

COST SHARING: There is a $350 deductibles for individuals and $500 for families and 20% coinsurance. Total spending (premiums, deductibles, and co-insurance) is capped at out-of-pocket maximum of $2,500 individual/$4,000 family, or 5% of income for beneficiaries with income between 200% - 300% FPL and 7.5% of income for beneficiaries with income between 300% - 500% FPL. There is no cost sharing for children, pregnant women, low-income (below 200% FPL). Sliding scale subsidies are in place for cost-sharing for individuals between 200% and 300% FPL.

FINANCING: At April 15 tax filing each year, individuals either demonstrate equivalent coverage through their employer or pay the AmeriCare premium based on cost of coverage and class of enrollment (individual, couple, unmarried individual with children, or married couple with children). Employers may either pay 80% of the AmeriCare premium or provide equivalent benefits through a group health plan (the contribution for part-time workers is pro-rated). AmeriCare does not affect contracts or collective bargaining agreements in effect as of the date of enactment, and employers may choose to provide additional benefits. Employers with fewer than 100 employees have until January 1, 2012 to comply (employees of small businesses would still only pay 20 percent of the premium).

More details here....

http://www.house.gov/stark/news/legislation.htm

I'm interested in a discussion of how this proposal compares to proposals by Presidential candidates, and the pros and the cons of each. It's easy to forget that it's not just Presidential candidates who have good health care ideas and proposals.

[Cleita]

1. Banging my head against a wall.

Extended and improved Medicare would work. However, it has to cut the insurance and privatized health care systems out. They are part of the problem not the solution.

Again, here is the website of Harvard doctors who have answers:

http://www.pnhp.org

[Clarkie1]

3. What country has the most successful single-payer system?

And thanks for the link.

[Cleita]

5. Our Canadian neighbors to the north have a very successful

single payer universal system regardless of the propaganda put out about it by our American right wing press. There is a Canadian Forum here in DU. Drop by and ask them what they think of their health care system.

[Bitwit1234]

10. My Canadian "Cousins"

told me when he had to have cataract operation that it took six months to get an appointment. Then it had to be done over because the put the wrong lens in. But I don't think he paid hardly anything for the service. I am fortunate that I have medicare and BC/BS PPO which means I don't pay anything to the doctors or the hospital for health care. It cost me about 80 dollars for Medicare and 150 for the BC/BS and prescription. I suppose that is cheap compared to some.

What is the best cost saver is the prescription plan. I pay five dollars for prescriptions up from three but I now get them for 45 days instead of 30. I do have to pay fifteen dollars and have to wait to have it approved for special medicine.

[kath]

25. That's a VERY good website! Thanks so much for linking it, Cleita.

Will have to spend some time checking out all their info later tonight...

The blood-sucking parasitic insurance companies need to be eliminated from the US healthcare system.

[Merlot]

2. Any insurance prgram that forces me to purchase insurance

is unacceptable.

Also, good plan MUST do something about the insurance companies and how they've become the profit-making middlemen between caregivers and patients.

[Clarkie1]

4. Theoretically, it makes sense to get rid of the health insurance companies

and have all Americans contribute to a government siingle-payer fund for thier "insurance." Theoretically, the government is a non-profit entity and thus should save on costs. My only trepedation is the governement seems to make everything it takes over more inefficient.

[Cleita]

6. Actually, Social Security and Medicare have been run

very efficiently by the government. Those programs of course suffer everytime the Repubs defund them. Yet, since I have experience with both. since my parents were on them. then my husband and now me, I can't complain except for the Republican politicians who keep making it harder for those agencies to do their job.

[Merlot]

7. I agree with your theory

But tell me, how can the government make our medical services any less efficient than the insurances companies have?

I've also heard that medicade/medicare is well run.

[ieoeja]

15. Name 1.

"government seems to make everything it takes over more inefficient."

We hear that saying all the time, but is it true?


I worked for the Veterans Administration when Reagan tried privatizing/outsourcing their IT. I did not personally work on that project, but shared an office with the people who did. The VA would have been the third gov't agency to go this route under Reagan, so the first thing our guys did was review the previous two processes.

They learned that in each case initially both costs and efficiency decreased. Lots of those things they did routinely at work without thinking about, they failed to think about when writing the requirements. By the second year at both gov't agencies costs had increased to cover the original gaps in type of service, while efficiency decreased as quality of service was sacrificed to limit those cost increases.

By the time the VA finished writing up the requirements -- "tape load requests must be completed within 30 seconds 90% of the time; 2 minutes, 99% of the time" etc -- all but one private company walked away from the process. The bid from the one private company that stuck it out came in way over the existing VA cost. They tried to force the VA to accept the only bid anyway, but the Democratic controlled congress wouldn't let Reagan get away with that.

[ProudDad]

19. It's NOT true that government systems are automatically inefficient

Medicare's overhead costs are about 3%.

The average for private insurance is over 30%.

Medicare recipient's satisfaction surveys are overwhelmingly positive.

We're talking about a government single-PAYER system NOT single-PROVIDER systems like England.

To answer another of your posts -- EVERY single-payer system in the world works better than our privatized system of insurance company bandits.

[avrdream]

8. Not good

Expanded Medicare would break doctors. Reimbursements are already pitiful, with docs actually losing money when they see these patients. Increasing the same type of patients would result in huge resistance from the medical field.

On another note, I'm an American doctor, practicing in Australia and they have national health care here. People can also pay for additional private insurance that basically gets them to surgery faster but not much else. Taxation seems pretty high here in order to pay for it but, from inside the system here, it appears to be working well and could be a great example for the U.S.

Edwards is probably right about the fact that it will require some sort of tax increase to pay for a decent system.

As a doctor, I think the insurance companies in America are a HUGE part of the problem......but I won't get on my soapbox in this thread. Another time maybe.

[Expat Sue]

9. health insurance in Australia

I am also an American living in Australia.

The Australian system is a two-tiered system with everyone covered under single-payer universal health care (Medicare) and the option of buying additional insurance to cover things excluded from Medicare (routine dental care being a big one). The private health insurance option is relatively new in Australia and was brought in by the Howard government I believe.

The major problem with the private system, is that it is heavily subsidized by the government, thus diverting funds out of the public health care system to private insurers. The major tax subsidy is a 30% tax rebate on your annual private health insurance premiums. Individuals that have private health insurance are also exempt from the additional 1% Medicare levy that is charged for people with higher incomes (all Australians pay 1.5% of your income as tax to support Medicare with an additional 1% levied onto high income earners). Another is the fact that individuals that signed up when it was first available were locked into premiums calculated on the age of a 30 year old for life (with the government taking up the slack as these individuals age).

I've been in Australia for 5 years and have seen massive increases in premiums for private health insurance. Also, doctors have started charging more for services to people with private health insurance (which has crept up the cost of services overall and there is now a gap betw what doctors charge and what Medicare reimburses, with people making up the difference as out-of-pocket expenses).

The waste that is now in the system is incredible. For example, maternity care is a big reason that people opt for private health insurance. If you go thru a public hospital, after you deliver you are discharged to the prenatal ward where there are typically 3-4 women/babies to a room. There you will stay for approximately 3 days to receive post-natal care. The private hospitals offer individual rooms. To provide these private rooms in Melbourne, private hospitals typically discharge women to the Sofitel hotel (major swanky hotel), where a private nurse will come and do rounds to check up on the women/babies. I opted to have my child in a public hospital and the care I received, especially in the post-natal ward, was excellent. I am outraged that the diversion of dollars from the public to private sector is paying for post-partum women to kick back in a luxury hotel.

In Australia, the diversion of public funds to prop up private health insurance is gutting Medicare. I have no problem if people want to opt for increased medical insurance benefits. However, they should do so without any tax incentives from the government and it should not be done to undermine the public system.

[Greyhound]

11. Have you looked at, or even heard of HR 676?

It is the http://thomas.loc.gov/cgi-bin/query/F?c110:1:./temp/~c110BzTuMk:e4873:">Conyers Kucinich bill and it has none of the drawbacks and delays that this proposal has.

Since it is only a difference of who pays the bill, it doesn't change the delivery system at all.

It requires minimal changes to the existing bureaucracy, essentially just expands existing capabilities to accommodate the greater numbers of participants.

It doesn't have any participation requirements or additional tax-day calculations or forms.

It doesn't require millions more Americans die while the insurance companies "adjust" for the next 5 years.

I have looked, without any luck, on the Congressman's site for any information as to his position on this bill, or why he thinks it necessary to introduce this watered down alternative.

[flpoljunkie]

12. Link has expired. Below is a summary of Conyers' bill, H.R. 676

H.R.676

Title: To provide for comprehensive health insurance coverage for all United States residents, and for other purposes.
Sponsor: Rep Conyers, John, Jr. (introduced 1/24/2007) Cosponsors (68)
Latest Major Action: 2/2/2007 Referred to House subcommittee. Status: Referred to the Subcommittee on Health.

SUMMARY AS OF:
1/24/2007--Introduced.

United States National Health Insurance Act (or the Expanded and Improved Medicare for All Act) - Establishes the United States National Health Insurance (USNHI) Program (the Program) to provide all individuals residing in the United States and in U.S. territories with free health care that includes all medically necessary care, such as primary care and prevention, prescription drugs, emergency care, and mental health services.

Prohibits an institution from participating in the Program unless it is a public or nonprofit institution. Allows nonprofit health maintenance organizations (HMOs) that actually deliver care in their own facilities to participate in the Program.

Gives patients the freedom to choose from participating physicians and institutions.

Prohibits a private health insurer from selling health insurance coverage that duplicates the benefits provided under this Act. Allows such insurers to sell benefits that are not medically necessary, such as cosmetic surgery benefits.

Sets forth methods to pay hospitals and health professionals for services. Prohibits financial incentives between HMOs and physicians based on utilization.

Establishes the USNHI Trust Fund to finance the Program with amounts deposited: (1) from existing sources of Government revenues for health care; (2) by increasing personal income taxes on the top 5% income earners; (3) by instituting a progressive excise tax on payroll and self-employment income; and (4) by instituting a small tax on stock and bond transactions.


Requires the Program to give first priority in retraining and job placement and unemployment benefits to individuals whose jobs are eliminated due to reduced administration.


Establishes a National Board of Universal Quality and Access to provide advice on quality, access, and affordability.

Provides for the eventual integration of the Indian Health Service into the Program.

[Greyhound]

14. Edit period has expired, thanks for the synopsis. n/t

[Czolgosz]

13. This is a good start. The idea that we can go from our current system to single-payer universal

coverage is simply not realistic (we can't even get an incremental minimum wage bill passed without having to negotiate buy-in from conservative Democrats and moderate Repubs with business tax credits).

If we could go from our current system to single-payer universal coverage in one step, wouldn't Rep. Conyers's H.R.676 have more support? I love the bill and what I love most about Kucinich's candidacy is his tireless advocacy for this plan.

So do we give up because the best plan on the table (H.R. 676) is legislatively D.O.A.? Hell no! We must find a plan that lowers the insurmountable hurdles which are preventing us from passing H.R. 676. This plan does just that (and John Edwards's health care plan does, too).

We all know that the Medicare model is substantially more efficient because it cuts the blood-sucking private medical insurance ticks out of the process. Yet we also know from Hillary's failed efforts at expanding health care coverage in the early '90s that the private medical insurance ticks will spend a PR fortune to saturate the media with "you lose the doctor of your choice" propaganda (which is bullshit, but it has proven to be effective bullshit).

This model would not deprive anyone of the choice of doctors, and yet it would provide for universal coverage (since coverage is both universal and mandatory, I think the program should include a tax credit set at the amount of the publicly run insurance program's premiums and applied so that the private or public insurance premiums are off set by that tax credit for those whose income is taxed at a rate where they would fully benefit from such a credit and the government run program should be provided as a cost-free entitlement for those who would not benefit from such credit).

The government program would compete side-by-side with the blood-sucking private medical insurance ticks. The built-in inefficiency of the blood-sucking private medical insurance would require those private insurers to stop the price gouging or would doom them to competitive failure in the marketplace. This would ultimately evolve into a single payer system as inefficient private systems failed to compete with the more efficient governmental program, and we would accomplish this intimate goal of single payer universal coverage without ever depriving anyone of "the doctor of your choice" because anyone who bought into the bullshit could continue to subsidize their blood-sucking tick out of their own pocket until that fetid industry collapses under its own weight.

[Cleita]

16. Well, it hasn't collapsed under its own weight and

it won't as long as we keep feeding the beast. Single-payer universal health care, based on the model proposed by the Physicians for a National Health Plan http://www.pnhp.org was passed in the legislature of California, the sixth largest economy in the world, but was vetoed by our muscle-headed governor, Arnold, a person who has received large donation from the health insurance and PHARMA industries. A petition was circulated to reintroduce the bill.

It was signeded by a majority of Californians and it's presently going through the legislature again. If Arnold vetoes it a second time, he is clearly acting against the will of the people of California who are overwhelmingly in favor of it.

If the privatized health insurance industry isn't cut out, it won't work because it will place a burden either on the taxpayer, the business communities, or the working class person who will have to pay for a bloated system that doesn't deliver the health care access it should.

[Czolgosz]

17. That's my point. If you can't pass it in California, we can't pass it nationally or in any red state

I am 100% for single-payer universal health care, and I prefer the model proposed by Physicians for a National Health Plan. But that is not going to pass nationwide (and hasn't been passed into the law of any state, either). Do we give up because we cannot pass the best legislative solution? I don't think so.

I'm also 100% against the death penalty. Can I get capital punishment abolished? Not in the current political climate. Do I give up? No. I fight to get laws requiring DNA evidence, I fight to get moratoriums where there is some consensus for moratoriums, I fight for individual death row habeas corpus fights. Is there any question in my mind that a complete ban is a thousand times better than laws requiring DNA evidence, moratoriums, and individual death row habeas corpus fights? Hell yes! But I will not abandon the fight just because I cannot win with one knockout punch.

We need universal health care. If we can't get a single-payer system as advocated by Physicians for a National Health Plan and many other similar organizations, we need to get the best we result that is politically achievable and the, next session, go back and either get single-payer or the next closest step toward single payer, and go back again the nest session and do the very best we can.

I see the plans which gradually move to universal care with a choice between private insurance and what amounts to expanded Medicare as a step in the right direction. I'd rather fly all the way across the room in a single bound, but if I can't, I will not refuse to take a step toward my ultimate goal.

[Cleita]

18. It will get passed in California. The people are overwhelmingly

in favor of it and the only obstacle is Arnold. If he doesn't move out of the way, there will be petitions to recall him, I'll bet. It can't happen soon enough for me.

[Czolgosz]

20. From your lips to God's ears. . . (or at least from your keyboard to God's email account)

[ProudDad]

22. Read our lips - we DID pass it

and the schwarzenfucker vetoed it.

Now the aaaaarnold has proposed an uninsured criminalization plan -- if you can't afford insurance you're criminalized and fined.

SB840 will pass again this year. If the CNA and its allies get mobilized again (and they will) the groppensteroidenfuhrer might just have to sign it this year.

on edit: IF he doesn't, it will probably be on the ballot as an initiative next year and we'll fuckin' pass it then...

[Czolgosz]

23. In the body, I said "passed into law" but I couldn't fit that whole phrase into the subject box.

There is all sorts of stuff we can pass in congress in in the great state legislatures of our blue states, but with the Chimperor and the Gropenator wielding veto stamps, it doesn't pass into law and leaves too many people without health care.

[ProudDad]

26. Alas, so true n/t

[ProudDad]

21. The biggest problem I see

is that for many (most) folks it retains a health insurance system that's seems somewhat tied to employment.

As someone who has retired from work, living on Soc Security but too young for Medicare -- I'm FUCKED. If any medical emergency happens to me in the next 2+ years, I'm wiped out.

This plan may help me but probably not as much as a real single-payer health care system where EVERYONE and every business contributes a progressive amount to the pool according to their ability to contribute.

[Cleita]

24. Amen, you've got that. A single payer universal plan would

cover everyone regardless of age, employment or medical history.