HR 676, introduced by Rep. John Conyers Jr, is known as the United States National Health Insurance Act – or an expansion of Medicare. Of course it’s controversial, since it’s advocating a form of universal health care with significant government controls, which tends to ruffle feathers in any form it takes. I found an article written by a pediatric ICU nurse who presents a very well thought out dissection of the bill, with lots of good points to consider. His perspective is from the hospital front lines, and as such it carries a good amount of weight. I like his contention that the entire US health care system needs an overhaul, not just patchwork fixes here and there, and he’s done an excellent job of taking apart the bill line by line and addressing the underlying issues. My view comes from the health insurance/admin side of things, and is admittedly skewed towards seeing some sort of national health care system as the fairest way to provide such basic necessity to all Americans.
I agree that medical benefits – other than emergency care – should be limited to people legally residing in the US.
I also agree that there should be some sort of financial penalty for treating an emergency room as if it were a doctor’s office. ER services should be reserved for people who are truly sick, and should not be used as a 24 hour primary care office. I’ve written about this issue in the past, and I believe that we need more urgent care facilities attached to hospitals, where people can go when they need care but it’s not an emergency. I also think that people overuse health care in general, not just emergency services. So I disagree with HR676 when it comes to the lack of copays and deductibles. I think that copays and deductibles should be waived in emergency situations for low income patients. But with no financial outlay at all, people may be more likely to seek medical care when none is actually needed – afterall, it’s “free” so why not use it? I think that some degree of cost for services is necessary to keep overutilitzation at bay.
Sec 103 of the bill maintains that health care providers on the national health care system must be non-profit. I strongly agree with this position. I know that profit and capitalism work wonders for our economy. But there are some areas – and I think health care is absolutely one of them – where profit shouldn’t be a motive. It creates an inherent conflict of interest that shouldn’t be part of a health care environment. The only goal should be providing affordable health care for everyone. Profit for shareholders should not come into play with something as necessary as health care. That’s not to say that hospitals should become charity units. The providers should make a good salary and hospitals should not have to struggle to raise funds – but shareholder profits on pharmaceuticals, medical supplies, and hospitals seem unethical to me.
With regards to payment for services, HR676 would set national standards for reimbursement (much like Medicare). PICU Traveller points out that this could end up with a scenario where the reimbursed amount is less than it costs to provide the service. True, under our current system, where health care is a very expensive game. But how is it possible for other countries to provide health care that has better outcomes than we do, for a fraction of the cost? What we see as the “cost” of health care actually includes an awful lot of profit, and a huge amount of medical malpractice expenses. If both of these aspects of our health care system were removed or significantly curtailed, we might find that the basic cost of providing health care is a lot lower than we think it is.
Sec 205 of HR676 details the coverage of prescription drugs, including efforts to keep costs down by encouraging the use of generics and lower priced drugs instead of their pricier alternatives. I would really like to see more in this section regarding regulations on the pharmaceutical industry. I am firmly in favor of a ban on pharmaceutical advertising in the media. There’s a reason we don’t have cigarettes advertised on TV – the same should be true of prescription meds. I think that the pharmaceutical industry should be non-profit, with research money coming from tax dollars instead of investors. And I think that the pharmaceutical industry should be limited in terms of how they market their products to doctors. Presenting information is fine, but presenting that information over a $400 dinner or a trip to Jamaica is not fine. If HR676 included these sorts of provisions, we’d be on the right track to lowering the cost of prescription medications. But with the lobby power that big pharma has in Washington, I suppose such provisions would be a death sentence for the whole bill, so maybe it’s best if they’re not included. Sad, but true.
Sec 303 deals with the re-employment of admin workers in the current health care system who would be out of a job with the admin streamlining proposed in HR676. This is the first time I’ve seen this issue addressed – obviously a more efficient admin process would involve fewer workers, and it’s good to see that the writers of the bill have taken this into consideration. My view is that if profits were curtailed for shareholders – who are not actually working in the health care industry – maybe fewer jobs in the industry would need to be eliminated in order to control costs. But one way or another, whether the solutions are perfect yet or not, I’m glad to see that the representatives who wrote this bill are looking at the issue of job loss and attempting to find ways to help those affected.
I agree with PICU that it’s tough for individual voices to be heard in the healthcare reform process. Some stares are making an effort at reform – including Colorado – but it’s going to take unified, nationwide changes to really fix our health care system. Unfortunately there is a long line of deep-pocketed special interest groups who are deeply invested in maintaining the status quo. But with more people becoming uninsured every day, sooner or later their collective voices will be loud enough for Washington to hear.