Discussing All the Options for Health Care

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Interesting piece by Mike Dennison today in the Independent Record, discussing what wasn’t said at the recent Montana Health Care Forum: universal health care:

Instead, we heard lots of talk about solutions that would encourage or require Americans without health insurance to buy private health insurance.
A chief organizer of the forum, Montana Blue Cross/Blue Shield — the state’s largest private health insurance company — says it wasn’t trying to control or guide the content of the forum.
Conference organizers identified speakers they felt had both national and state perspectives on health issues and health reforms, and tried to get them on the agenda, says company spokeswoman Linda McGillen.

Right. Maybe I am a cynic, but I have my doubts that Blue Cross/Blue Shield looked too hard for anyone who advocates universal care, given that their business model depends on incredibly priced insurance. I suspect that the Universal Healthcare Foundation, for instance, would have been interested in attending.

It’s probably not a stretch to say that they would love mandatory insurance, because through either legal pressure on individuals or government subsidies, BCBS would likely reap a huge benefit. Why, I wonder, would we want BCBS to create a huge unmanageable bureaucracy with excessive executive pay beyond the control of voters rather than creating a government-operated system?

And don’t let the media and Republican rhetoric confuse you. Americans want universal health care. It’s unbelievable that Republicans, beholden to business interests and Democrats, afraid of their own shadows, are unwilling to see that.

About the author

Don Pogreba

Don Pogreba is a seventeen-year teacher of English, former debate coach, and loyal, if often sad, fan of the San Diego Padres and Portland Timbers. He spends far too many hours of his life working at school and on his small business, Big Sky Debate.

His work has appeared in Politico and Rewire.

In the past few years, travel has become a priority, whether it's a road trip to some little town in Montana or a museum of culture in Ísafjörður, Iceland.

4 Comments

  • For the first time in the history of America. The life expectancy of today’s children is less than that of their parents. This is catastrophic. And our infant mortality is equal to that of a third world country. Current U.S. adult life expectancy is down from #1 to #42. And dropping fast. These facts are what is known as EXTINCTION! indicators. These are the early signs of the final phase of the EXTINCTION of the American people.

    You have to take the profit motive out of health care delivery. The profit motive does not work with health care. Or any other essential public service like police, and fire. The sooner everyone faces this truth. The sooner you will be able to adopt a real solution to the problem. The days of paying for health care out of pocket are at an end. Just like the mob days of paying for protection out of pocket came to an end.

    HR 676 is the way to go. Single payer Universal National Health Care For All. Medicare for all. Accept no substitutes. The sooner you face this. The sooner you begin to heal the Cancer of private for profit medicine that is destroying this entire society. Other developed countries realized this years ago. It’s a no-brainer now. See sickocure.org

    Money, greed, and the profit motive has just decimated health care in America. And killed, and injured millions needlessly. Just for profit. But that is what large amounts of money, greed, and a lust for power always does. No one is immune from this corrupting power. The smart ones know this. And avoid letting them-self be put in compromising positions. But that is easier said. Than done. And very few succeed.

    Most in the US go into medicine primarily to become wealthy. That is who the medical schools mostly choose. Most of the medical schools faculty are in bed with the drug companies, and others. And like the story of Dr. Faustus. They end up selling their soles. One compromise at a time. Until Lucifer owns them.

    In medicine. Compromised care means. Injury, disability, and death. It’s sad really. But HR 676 can fix this disgrace. Like it has in other developed countries. The only question is. How many more millions will be hurt, injured, and killed. And how many more of your children will die before their time. Before we fix this disgrace of private for profit health care in America.

    I realize there will be a few people that have what they believe is good health care coverage. Who will want to opt out of a single payer system like HR 676. But let me remind you we rank # 37 in quality of health care for all. Down from #1. Never the less. A few opting out is not a problem. As long as all other Americans are automatically covered at birth through life. Unless they choose to opt out of HR 676. The government takes out 1.4% from your paycheck now for Medicare. All they have to do is substitute for HR 676 what they now take out of your paychecks for private health insurance. Remember, we already spend more on health care than any other country in the world. Right Now. We are being ripped off. And raped.

    The SCHIP program is a desperately needed program for Americas children. But with the impending EXTINCTION of Americas children. And their current catastrophic health care condition. SCHIP needs to be extended to cover all of Americas children, immediately. Parents should have no hesitations, or financial worries about seeking medical care for their children. Whenever they have any concerns about their children’s health. Especially in the richest country in the world. I would submit that any President, or politician that fails to do this for the children. Betrays their most solemn oath to protect the American people. Especially when you consider that all other developed countries have done this. And that we are the richest country in the world.

    So get on it America. Get it done. You have been doing great over the past several months. Keep it up. And step it up. You have to force it, and take it. It’s the right fight, and the right thing to do. Now is the time… Take no prisoners.

  • I agree 100% that Universal HealthCare is needed and that single payer is probably the best option. However, I feel HR 676 is a complete bust on this point. I have read the entire bill, not just summaries posted on the net, and have serious problems with some aspects of it. I would be glad to point these errors out if anyone is interested.

  • Ok, well here is my point-by-point breakdown of my problems with HR 676. I do apologize for the length, but wanted to make sure that I also gave the corresponding paragraph of the bill that I discuss.

    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.
    Why not change this 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. Also, who determines what is medically necessary? Some administrator somewhere with no medical background as we have in Medicare/Medicaid now?

    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? By the way, the vast majority of hospitals are non-profit now, and that doesn’t seem to be helping much.

    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. There are procedures done everyday at hospitals now where the reimbursement is actually below the cost to perform the procedure. Where is the provision that reimbursements must be in line with the actual cost of doing the procedure?

    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. I guess this is to make the government takeover of hospitals happen as stated in Sec. 202(a)(c).

    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? This would quickly cause the closing of hospitals across the country. I guess the final intent here is for the government to take over ownership of hospitals, clinics, etc. This seems a rather underhanded way to make that happen.

    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? Oh yeah, I forgot, the government is going to “negotiate” their budget for them.

    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 for 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?

    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? Again, 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? The unemployment insurance system is significantly underfunded now. Where will the additional money needed to implement this come from? I hope the plan is not to take money from the new systems budget to cover this.

    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 no one in any position of power will pay any attention to what we say. 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. Again, I apologize for the length, but wanted to be clear and thorough.

    Marty G., RN

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