At least one hundred and eight Democratic Congressional representatives have co-sponsored HR 676, introduced by Representative John Conyers Jr. of Michigan.
Although we are currently watching a nightmare unfold, perhaps it is time to leave that reality for a bit and take a fantastical tour through HR 676, to see what national Universal Health Care might look like.
The bill uses straightforward language, so we'll do a lot of quoting from it directly...
Ready?
We'll start at the beginning, with its simple declaration:
All individuals residing in the United States (including any territory of the United States) are covered under the Medicare For All Program entitling them to a universal, best quality standard of care.Q. So what does 'covered' mean? The health care benefits under this Act cover all medically necessary services, including at least the following:
- Primary care and prevention. - Approved dietary and nutritional therapies. - Inpatient care. - Outpatient care. - Emergency care. - Prescription drugs. - Durable medical equipment. - Long-term care. - Palliative care. - Mental health services. - The full scope of dental services... - Substance abuse treatment services. - Chiropractic services, not including electrical stimulation. - Basic vision care and vision correction - Hearing services, including coverage of hearing aids. - Podiatric care.
Q. What does it cost a patient?
No deductibles, copayments, coinsurance, or other cost-sharing shall be imposed with respect to covered benefits.Q. Who will you be able to see?
Patients shall have free choice of participating physicians and other clinicians, hospitals, and inpatient care facilities.Q. What kinds of entities would be allowed to provide health care services?
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.Interestingly, For-profits can convert to non-profits, and if they do their owners will be justly compensated over a fifteen year period.
Q. How can health care providing entities receive payment? Here it gets a bit complicated:
The Medicare For All Program...
...shall pay each institutional provider of care, including hospitals, nursing homes, community or migrant health centers... or pre-paid group practices, a monthly lump sum to cover all operating expenses under a global budget.
The Program shall pay physicians, dentists... nurse practitioners, nurse midwives, physicians' assistants, and other advanced practice clinicians... by the following payment methods: - Fee for service, or - Salaries, in institutions being paid lump sums as above, or - Salaries, in non-profit health maintaenance organizations.
Q. How do fee-for-service doctors et al get paid?
...under this Act physicians shall submit bills to the regional director on a simple form, or via computer. Interest shall be paid to providers who are not reimbursed within 30 days of submission.Q. How do organizations and other health care providing individuals get paid?
The Director shall create a uniform computerized electronic billing system, including those areas of the United States where electronic billing is not yet established...Q. How's the whole thing work?
To carry out this Act there are established on an annual basis... - an operating budget - a capital expenditures budget - reimbursement levels for providers - a health professional education budget, including amounts for the continued funding of resident physician training programs.The capital expenditures budget shall be used for funds needed for: - the construction or renovation of health facilities; and - for major equipment purchases.
Q. How will reimbursement fees be set?
The Program shall negotiate a simplified fee schedule that is fair and optimal with representatives of physicians and other clinicians, after close consultation with the National Board... and regional and State directors......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.
Q. THE BIGGIE: WHERE IS THE MONEY GOING TO COME FROM?
There are appropriated to the Medicare For All Trust Fund amounts sufficient to carry out this Act from the following sources: (A) Existing sources of Federal Government revenues for health care. (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. (D) Instituting a modest tax on unearned income. (E) Instituting a small tax on stock and bond transactions.
So lots of revenue sources, each one relatively small, adding up to the whole enchilada. This seems pretty reasonable. Sure, there would be fights over the exact percentages and amounts from each source - what do you expect? The key thing to remember is that we're (as in all of us) are already paying for all the medical services in the US. It's not like we're building an interstate highway system from scratch and need a new source of revenue to create it. All that's happening is shifting who is paying and how.
Q. What happens to Medicare, Medicaid and the Children's Health Insurance Program?
...there are hereby transferred and appropriated to carry out this Act, amounts from the Treasury equivalent to the amounts the Secretary estimates would have been appropriated and expended for Federal public health care programs, including... the Medicare program... the Medicaid program... [and] the Children's Health Insurance Program...Q. What happens to Veterans' Care?
This Act provides for health programs of the Department of Veterans’ Affairs to initially remain independent for the 10-year period… After such 10-year period, the Congress shall reevaluate whether such programs shall remain independent or be integrated into the Medicare For All Program.Q. Who's running the show?
this Act shall be administered by the Secretary through a Director appointed by the Secretary.There is also a National Board with 15 members appointed by the President, with certain slots reserved for health care experts and providers.
Q. Who's realy running the show? I.e., how and where does all the administrivia happen?
The Secretary shall establish and maintain Medicare For All regional offices for the purpose of distributing funds to providers of care. Whenever possible, the Secretary should incorporate pre-existing Medicare infrastructure for this purpose.Q. What happens to all the people who lose their jobs because there is so much less red tape and no vast bureaucracy for denial of services?
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 two years of Medicare For All employment transition benefits with each year's benefit equal to salary earned during the last 12 months of employment, but shall not exceed $100,000 per year.
As expensive as this may be, it's a) probably necessary and b) it's a capped, limited time expenditure.
So that's a basic guided tour. You can read the whole bill yourself, as it contains a fair amount more that I either skipped over or abbreviated significantly. It's only about seventeen pages, with neither fine print nor lack of whitespace.
Oh yeah, one last question.
Q. What's the effect:
-- Universal health care for all residents of the United States, -- and perhaps just as importantly:
PEACE OF MIND FOR EVERYONE - THOSE WHO GET SICK, KNOWING THEIR ILLNESS WON'T BANKRUPT THEIR FAMILY; - AND THOSE WHO AREN'T SICK, KNOWING THAT IF THEY DO GET SICK THEY WILL BE TAKEN CARE OF REGARDLESS OF THEIR STATUS, WEALTH LEVEL or ANYTHING ELSE.
How much is that worth?