This exercise does two things! It addresses an ongoing issue in the US health care system â whether we should have a single payer system â AND it effectively ties up the course into a tidy bundle. To consider NHI, we have to consider the entire âsystemâ, such as it is! Regardless of how you feel about a single payer system, it is good to have the facts that support both sides of the issue. This exercise gives you the opportunity to explore those and have a good discussion with a classmate about them. As we come to the end of HLTH 6010, this project will allow you to consider all the topics we have studied over the term. You will do this by applying them to the hottest topic aroundânational health insurance. Many attempts have been made to spell out how a national health insurance arrangement might look in the United States. Since it is hard to discuss the concepts without a specific plan to talk about, we will use a bill that has been fleshed out enough to be introduced to Congress. In January 2009, John Conyers sponsored HR 676: The United States National Health Insurance Act. We have chosen this plan NOT because it is necessarily advisable or even good. We are using it for this exercise because it provides a framework to see what one potential national plan might look like while allowing us to address many of the issues facing U.S. health care today.
Assignment Details
The local Rotary Club has asked you to write an article for their newsletter about a national health insurance (NHI) plan like the one introduced in HR 676. Youâve roped in your colleague to help. There seems to be a debate among Rotary members about whether NHI would solve our health care problems or create more problems. They want to know both the pros and the cons. In particular, the person who asked you to prepare this has included the following issues that members have raised:
Old people will be denied care so they will die sooner
People will get sicker because they’ll have to wait for care
We’ll be assigned to doctors and hospitals and not be able to choose our own
It inappropriately tries to solve the problem of uninsured people who could get insurance if they just got a job, or who could just get the care they need at the emergency room
This is just socialized medicine
The government will be running health care and making all the decisions.
Structure your article in the following format and subheadings (Introduction, Pros and Cons, and Answers to Rotary Issues):
Brief introduction: You must first assure that they know what NHI might look like in the U.S. and why it is such a hot topic.
Pros and Cons: Then come up with an annotated list of advantages and disadvantages for society if NHI were developed. Rotary has specifically asked for a balanced view and a list of 4 pros and 4 cons. List your pros and cons with substantive support and scholarly or professional sources.
Answers to Rotary Issues (address each issue in a separate paragraph): Be sure to address in a little detail the issue of lack of health care because there are so many different opinions about its causes and its effects on society and the system.
You are asked to analyze this bill by explaining it to a lay audience. Chances are you will find things in the bill that you like and some that you hate. We do not ask you to support or reject it, only to analyze it. You may be adamantly in favor of national health insurance or strongly against it. That doesn’t matter. The best approach to this activity is to deal with each provision of the bill separately so that at the end, someone could go back and pick out the aspects you think have promise and those you think would cause problems.
Please write your report from the perspective of health administrators as you take a careful look at HR 676. You need not spend much time on the macro or national level. We’ll leave that to the economists!
You will need to do some reading to develop your list. Be sure to read at least one source that strongly supports NHI and another that strongly opposes it. You may consult other sources. For this assignment, you may need to cite sources that are not generally considered “professional” since much of the support and criticism comes from political sources. Be sure to note biases and acknowledge opinions that may not be based in fact. Though Rotary would likely not print your sources, be sure to include them in APA format within your assignment.
Answer Only items for Tavi.
Rosanna/Tavi- See my changes and or suggestions below in red. Red next to yellow is suggested alternate text. I will write âsubstantiveâ support of my added pro/cons.
What does NHI look like in the US and why is such a hot topic? I may add a little fluff to the introduction paragraphs.
The United States National Health Care Act, or the Expanded and Improved Medicare for All Act (H.R. 676), is a bill, first introduced in the United States House of Representatives in 2003 with 25 cosponsors by former Representative John Conyers (D-MI). The bill had 49 cosponsors in 2015. As of October 1, 2017, it had 120 cosponsors, which amounts to a majority of the Democratic caucus in the House of Representatives and is the highest level of support the bill has ever received since Conyers began annually introducing the bill in 2003. Under a single-payer system, most medical care would be paid for by the federal government, ending the need for private health insurance and premiums, and probably recasting private insurance companies as providing purely supplemental coverage, to be used when non-essential care is sought (GovTrack.us. 2007).
The act would establish a universal single-payer health care system in the United States. 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. National Health Insurance is such a polarizing topic due to the vastly different political ideology between the Republican and Democratic parties. Based on polls in 2019, only 30% of Republicans favored National Health Insurance compared to 83% of Democrats (Kaiser Family Foundation, 2019).
Pros:
1. Access to healthcare for everyone. In general all individuals residing in the U.S, including any territory, of the U.S are covered entitling them to a universal, best quality standard of care. The health insurance benefits cover a myriad of services from Emergency care to prescription drugs. We can elaborate on this?
2. Quality care for everyone- I will discuss regulatory boards and the need for health care institutions to meet established benchmarks, much like CMS does now.
3. Improvements in preventative Care- Others have estimated a long-term savings amounting to 40% of all national health expenditures due to preventative health care. Preventative care can save several hundreds of billions of dollars per year in the U.S. (GovTrack.us. 2007).
4. Reduction in Administrative Costs- System savings as a source of financing by vastly reducing paperwork and administration costs. According to data from the Organisation for Economic Co-operation and Development (OECD) the United States health care system performs poorly in administrative efficiency mainly because of doctors and patients reporting wasting time on billing and insurance claim. The U.S per capita spending from private sources, for instance employer sponsored health insurance coverage is higher than in any other countries (Tikkanen et al, 2020). The national system would be paid for in part through taxes replacing insurance premiums, but also by savings realized through the provision of preventative universal healthcare and the elimination of insurance company overhead and hospital billing costs. An analysis of the bill by Physicians for a National Health Program estimated the immediate savings at $350 billion per year (GovTrack.us. 2007).
Cons: I think any con that we list (despite personal feelings or opinions on this) should be disputed in the issues brought forward by the rotary club.
1. High Costs- Funding would mean increase in taxes. Increase personal income taxes on the top 5 percent income earners and instituting a modest and progressive excise tax on payroll and self-employment income and by instituting a small tax on stock and bond transactions. This will cause resentment in the system
2. Limited choice in providers and health care options- more to come
3. Utilization will skyrocket. Potential for long wait times- More to come and we will also dispute this in one of the paragraphs below.
4. Potential for problems with innovation- The United States has always been a leader in the development of medical technology break throughs in cures and treatment despite the overall health and wellness of our country. With a single payer system and the likelihood that the government provides fee schedules and set rates of reimbursement, companies may feel less obligated to spend dollars on research and development of new technologies.
Old people will be denied care so they will die sooner: Tavi
People will get sicker because they’ll have to wait for care: Tavi
We’ll be assigned to doctors and hospitals and not be able to choose our own:
Currently, most insurance plans, including Medicare, have restrictive networks that limit the physicians you may wish to see (Medicare.gov). When a plan allows you to see an out-of-network provider, they almost never cover the full cost. High premiums are increasingly forcing people into insurance plans with narrow networks. With National Health Insurance you will able to choose your doctors and hospitals. Patients shall have free choice of participating physicians and other clinicians, hospitals, and inpatient care facilities (GovTrack.us. 2007). Benefits such as Primary care, prevention, Emergency care, prescription drugs, long term care, basic vision and hearing services including hearing aids, and other services are all available through any licensed health care clinician anywhere in the U.S that is legally qualified to provide the benefits. Participating clinicianâs must be licensed in their state of practice and meet quality standards for their area of care. No clinician whose license is under suspension or who is under disciplinary action in any state may be a participating provider (GovTrack.us. 2007).
It inappropriately tries to solve the problem of uninsured people who could get insurance if they just got a job, or who could just get the care they need at the emergency room: Tom Plut
This is just socialized medicine: Tom Plut
The government will be running health care and making all the decisions: Tom Plut
References
âH.R. 676 â 110th Congress: United States National Health Insurance Act (or the Expanded and Improved Medicare for All Act).â www.GovTrack.us. 2007. February 28, 2023 https://www.govtrack.us/congress/bills/110/hr676
Kaiser Family Foundation (2019). An overview of Medicare. https://www.kff.org/medicare/issue-breif/an-overview-of-medicare/
Tikkanen, R., Abrams, M., U.S. health care from a global perspective, 2019: higher spending. worse outcomes. Commonwealth Fund. Jan. 2020. https://doi.org/10.26099/7avv-fc29.Rosanna/Tavi- See my changes and or suggestions below in red. Red next to yellow is suggested alternate text. I will write âsubstantiveâ support of my added pro/cons.
What does NHI look like in the US and why is such a hot topic? I may add a little fluff to the introduction paragraphs.
The United States National Health Care Act, or the Expanded and Improved Medicare for All Act (H.R. 676), is a bill, first introduced in the United States House of Representatives in 2003 with 25 cosponsors by former Representative John Conyers (D-MI). The bill had 49 cosponsors in 2015. As of October 1, 2017, it had 120 cosponsors, which amounts to a majority of the Democratic caucus in the House of Representatives and is the highest level of support the bill has ever received since Conyers began annually introducing the bill in 2003. Under a single-payer system, most medical care would be paid for by the federal government, ending the need for private health insurance and premiums, and probably recasting private insurance companies as providing purely supplemental coverage, to be used when non-essential care is sought (GovTrack.us. 2007).
The act would establish a universal single-payer health care system in the United States. 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. National Health Insurance is such a polarizing topic due to the vastly different political ideology between the Republican and Democratic parties. Based on polls in 2019, only 30% of Republicans favored National Health Insurance compared to 83% of Democrats (Kaiser Family Foundation, 2019).
Pros:
1. Access to healthcare for everyone. In general all individuals residing in the U.S, including any territory, of the U.S are covered entitling them to a universal, best quality standard of care. The health insurance benefits cover a myriad of services from Emergency care to prescription drugs. We can elaborate on this?
2. Quality care for everyone- I will discuss regulatory boards and the need for health care institutions to meet established benchmarks, much like CMS does now.
3. Improvements in preventative Care- Others have estimated a long-term savings amounting to 40% of all national health expenditures due to preventative health care. Preventative care can save several hundreds of billions of dollars per year in the U.S. (GovTrack.us. 2007).
4. Reduction in Administrative Costs- System savings as a source of financing by vastly reducing paperwork and administration costs. According to data from the Organisation for Economic Co-operation and Development (OECD) the United States health care system performs poorly in administrative efficiency mainly because of doctors and patients reporting wasting time on billing and insurance claim. The U.S per capita spending from private sources, for instance employer sponsored health insurance coverage is higher than in any other countries (Tikkanen et al, 2020). The national system would be paid for in part through taxes replacing insurance premiums, but also by savings realized through the provision of preventative universal healthcare and the elimination of insurance company overhead and hospital billing costs. An analysis of the bill by Physicians for a National Health Program estimated the immediate savings at $350 billion per year (GovTrack.us. 2007).
Cons: I think any con that we list (despite personal feelings or opinions on this) should be disputed in the issues brought forward by the rotary club.
1. High Costs- Funding would mean increase in taxes. Increase personal income taxes on the top 5 percent income earners and instituting a modest and progressive excise tax on payroll and self-employment income and by instituting a small tax on stock and bond transactions. This will cause resentment in the system
2. Limited choice in providers and health care options- more to come
3. Utilization will skyrocket. Potential for long wait times- More to come and we will also dispute this in one of the paragraphs below.
4. Potential for problems with innovation- The United States has always been a leader in the development of medical technology break throughs in cures and treatment despite the overall health and wellness of our country. With a single payer system and the likelihood that the government provides fee schedules and set rates of reimbursement, companies may feel less obligated to spend dollars on research and development of new technologies.
Old people will be denied care so they will die sooner: Tavi
People will get sicker because they’ll have to wait for care: Tavi
We’ll be assigned to doctors and hospitals and not be able to choose our own:
Currently, most insurance plans, including Medicare, have restrictive networks that limit the physicians you may wish to see (Medicare.gov). When a plan allows you to see an out-of-network provider, they almost never cover the full cost. High premiums are increasingly forcing people into insurance plans with narrow networks. With National Health Insurance you will able to choose your doctors and hospitals. Patients shall have free choice of participating physicians and other clinicians, hospitals, and inpatient care facilities (GovTrack.us. 2007). Benefits such as Primary care, prevention, Emergency care, prescription drugs, long term care, basic vision and hearing services including hearing aids, and other services are all available through any licensed health care clinician anywhere in the U.S that is legally qualified to provide the benefits. Participating clinicianâs must be licensed in their state of practice and meet quality standards for their area of care. No clinician whose license is under suspension or who is under disciplinary action in any state may be a participating provider (GovTrack.us. 2007).
It inappropriately tries to solve the problem of uninsured people who could get insurance if they just got a job, or who could just get the care they need at the emergency room: Tom Plut
This is just socialized medicine: Tom Plut
The government will be running health care and making all the decisions: Tom Plut
References
âH.R. 676 â 110th Congress: United States National Health Insurance Act (or the Expanded and Improved Medicare for All Act).â www.GovTrack.us. 2007. February 28, 2023 https://www.govtrack.us/congress/bills/110/hr676
Kaiser Family Foundation (2019). An overview of Medicare. https://www.kff.org/medicare/issue-breif/an-overview-of-medicare/
Tikkanen, R., Abrams, M., U.S. health care from a global perspective, 2019: higher spending. worse outcomes. Commonwealth Fund. Jan. 2020. https://doi.org/10.26099/7avv-fc29.
Reading-
Chapter 13, Health Policy
Chapter 14, The Future of Health Care Services Delivery
Blum, J.D. (2006). Efficiencies in health care regulation: Observations near and far. Annals of Health Law, 15(2): 309â319.
Schimmel, N. (2012). Regulating U.S. health care. New York Times. Retrieved from http://www.nytimes.com/2012/09/18/opinion/regulating-us-health-care.html (Note: If you like, you can easily find the post to which Schimmel refers and that focuses primarily on k-12 education but mentions health care).
Plein, L. C. (2014). An uncertain federalism: the states and the Affordable Care Act. Journal Of Health And Human Services Administration, 3(350).
Costello, M.M. (2017). Regulating Pharmaceutical Pricing: Why is Europe More Aggressive than the US? The Journal of International Management Studies. 12(1): 42-46 http://www.jimsjournal.org/7%20Michael%20M.%20Costello.pdf
Kaiser Family Foundation. (2020). Public opinion on single-payer, national health plans, and expanding access to Medicare coverage. Retrieved from https://www.kff.org/slideshow/public-opinion-on-single-payer-national-health-plans-and-expanding-access-to-medicare-coverage/
Garfield, R., Orgera, K., & Damico, A. (2019). The Uninsured and the ACA: A Primer â Key facts about health insurance and the uninsured amidst changes to the Affordable Care Act. Kaiser Family Foundation. Retrieved from https://www.kff.org/uninsured/report/the-uninsured-and-the-aca-a-primer-key-facts-about-health-insurance-and-the-uninsured-amidst-changes-to-the-affordable-care-act/
Stoltzfus Jost, T. (2017). The morality of health care reform: Liberal and conservative views and the space between them. The Hastings Center Report, 47(6), 9-13. doi:10.1002/hast.774
Govtrack.us. (2007). HR 676 (110th): The United States National Health Insurance Act. Retrieved from http://www.govtrack.us/congress/bills/110/hr676
This exercise does two things! It addresses an ongoing issue in the US health ca
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