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Type of Solution We Have To Have, O Land of the Free and the Brave
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Executive Summary of The United States National Health Insurance Act (HR676) (PDF),
("Expanded & Improved Medicare For All Bill")
*to be introduced by Cong. John Conyers, 108th Congress
Brief Summary of Legislation
The United States National Health Insurance Act (HR676) establishes a new American national health insurance program by
creating a single payer health care system. The bill would create a publicly financed, privately delivered health care program
that uses the already existing Medicare program by expanding and improving it to all U.S. residents, and all residents living
in U.S. territories. The goal of the legislation is to ensure that all Americans, guaranteed by law, will have access to the
highest quality and cost effective health care services regardless of one's employment, income, or health care status.
With over 42 million uninsured Americans, and another 40 million who are under insured, the time has come to change our
inefficient and costly fragmented health care system. The USNHI program would reduce overall annual health care spending by
over $50 billion in the first year. In addition, because it implements effective methods of cost-control, health spending
is contained over time, ensuring affordable health care to future generations.
In its first year, single-payer will save over $150 billion on paperwork and $50 billion by using rational bulk purchasing
of medications. These savings are more than enough to cover all the uninsured, improve coverage for everyone else, including
medication coverage and long-term care.
Employers who currently provide coverage for their employees pay an average of 8.5% of payroll towards health coverage,
while many employers can't afford to provide coverage at all. Under this Act, all employers will pay a modest 3.3% payroll
tax per employee, while eliminating their payments towards private health plans. The average cost to an employer for an employee
earning $35,000 per year will be reduced to $1,155, less than $100 per month.
95% of families will pay less for health care under national health insurance than they do today. Seniors and younger people
will all have the comprehensive medication coverage they need.
Who is Eligible
Every person living in the United States and the U.S. Territories would receive a United States National Health Insurance
Card and i.d number once they enroll at the appropriate location. Social Security numbers may not be used when assigning i.d
cards. No co-pays or deductibles are permissible under this act.
Benefits/Portability
This program will cover all medically necessary services, including primary care, inpatient care, outpatient care, emergency
care, prescription drugs, durable medical equipment, long term care, mental health services, dentistry, eye care, chiropractic,
and substance abuse treatment. Patients have their choice of physicians, providers, hospitals, clinics, and practices.
Conversion to a Non-Profit Health Care System
Private health insurers shall be prohibited under this act from selling coverage that duplicates the benefits of the USNHI
program. They shall not be prohibited from selling coverage for any additional benefits not covered by this Act; examples
include cosmetic surgery, and other medically unnecessary treatments.
Cost Containment Provisions/ Reimbursement
The National USNHI program will annually set reimbursement rates for physicians, health care providers, and negotiate prescription
drug prices. The national office will provide an annual lump sum allotment to each existing Medicare region, which will then
administer the program. Payment to health care providers include fee for service, and global budgets.
The conversion to a not-for- profit health care system will take place over a 15 year period, through the sale of U.S.
treasury bonds; payment will not be made for loss of business profits, but only for real estate, buildings, and equipment.
Funding & Administration
The United States Congress will establish annual funding outlays for the USNHI Program through an annual entitlement. The
USNHI program will operate under the auspices of the Dept of Health & Human Services, and be administered in the former
Medicare offices. All current expenditures for public health insurance programs such as S-CHIP, Medicaid, and Medicare will
be placed into the USNHI program.
A National USNHI Advisory Board will be established, comprised primarily of health care professionals and representatives
of health advocacy groups.
Proposed Funding For USNHI Program: $1.86 Trillion Per Year
A payroll tax on all employers of 3.3%. Maintain employee and employer Medicare payroll tax of 1.45%. Implement a variety
of mechanisms so that low and middle income families pay a smaller share of their incomes for health care than wealthiest
5% of Americans; i.e, a health income tax on the wealthiest 5% of Americans, a small tax on stock and bond transfers, and
closing corporate tax shelters. A repeal of the Bush tax cut of 2001. For more details, see PNHP's "Financing National Health
Insurance."
*For more information, contact Joel Segal, legislative assistant, Rep. John Conyers, at 202 225-5126, or e- mail at Joel.
Segal@mail.house.gov
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Who's Left Out of Health Care Reform?
 If you're one of the nearly 50 million Americans
who lack health insurance, all the sound and fury of the current congressional debate over health care reform signifies nothing.
The "Patients' Bill of Rights" -- Democratic OR Republican version -- is at best really just an "Insured Patients' Bill of
Rights," for the competing proposals do nothing to expand access to health care for the uninsured. And while the health care
issue is extraordinarily complex, the reason for this gap in legislative coverage can be summed up rather easily: uninsured
Americans don't have a lobby and they don't make campaign contributions.
When asked last week by a CBS News poll, "On the health care system, what is the biggest
problem government should address," the #1 priority voiced by the public was "insuring everyone." Dealing with "HMOs
in general" -- the central focus of the fight in the Senate -- was raised by just 8% of those surveyed. But making sure that
everyone has health insurance means going after powerful moneyed interests that now dominate the health care business, and
by extension, the political debate.
Consider that since 1993, doctors and other health professionals have made almost $94
million in PAC, soft money and individual contributions to federal candidates and parties, nearly 60% to Republicans, according
to the Center for Responsive Politics. Managed care providers gave $10.5 million over that same period. In just the last election
cycle, PAC contributions from health professionals, hospitals, nursing homes, pharmaceutical producers and health service
providers totaled $18.3 million, 56% to Republican candidates. Insurance companies gave another $10.4 million, just over two-thirds
to GOPers.
All this money and the lobbying that goes along with it has the effect of completely
clogging the legislative arteries, blocking any consideration of fundamental solutions to the health care crisis. Each
special interest group has subsidies it wants supported and privileges protected. Not surprisingly, a great deal of health-related
money flows to the leadership of both parties.
PACs and individual donors connected to the insurance industry and the health professionals
sector are respectively the #1 and #3 sources of all the money Senate Majority Leader Trent Lott (R-MS) has raised since 1993.
They are the #2 and #4 sources of all the money Majority Whip Don Nickles (R-OK) has raised.
On the Democratic side of the aisle, health professionals and the insurance industry are
the #3 and #5 backers of Minority Leader Tom Daschle (D-SD) since 1993. And they are #6 and #9 among Senator Edward Kennedy's
sources of campaign funds, with the hospital/nursing home sector helping out at #10.
The same pattern shows up in the 1997-98 data for the House leadership. Health professionals
and the insurance industry are Speaker Dennis Hastert's top two sources of contributions, with the pharmaceutical sector coming
in at #7 and hospitals and nursing homes at #9. And Minority Leader Richard Gephardt (D-MO) is hardly different, with PAC
and individual contributions from health professionals his #2 source of funds and insurers #7.
It's as if Congress is a private hospital that only treats paying patients, instead
of a public institution open to all.
OUCH! #27, published 7/20/99 by Public Campaign. For more info about Public Campaign
or to subscribe to Ouch!, visit www.publicampaign.org or write to info@publicampaign.org. This bulletin may be reposted to newsgroups as long as it is printed in its entirety.
And then I read an article in the February 2004 Natural History by Director of the Earth Institute
at Columbia University and Special Advisor to UN Secretary-General Kofi Annan on the Millenium Development Goals and I realized
how excited I would be that our President seems to get it about world health, if he only got it about American health and
I had an income of $30,000 a year to raise my two children on instead of $9,000.
The article is called "Why Must the Poor be Sick?" It's a review of a book by Paul Farmer called
Pathologies of Power:Health, Human Rights, and the New War on the Poor.
It says Farmer has saved countless destitute patients lives in Haiti, Peru, and Russia, and has
shown that effective health services, even complex medical regimens, can be put in place in impoverished communiities."His
accomplishments have forcefully undercut the flimsy excuses that the rich countries have routinely offered for their inaction,
as millions of people die unnecessarily each year in poor countries...farmer has 3 themes..that the poor are not the victims
of their sins but of their circumstances,; instead of sitting in judgement on the sick and dying, rich countries should be
helping to save them. 2. The poor can be successfully treated and cured of disease, even in the most unlikely and impoverished
circumstances. 3, the human rights community should be defending the rights of the poor to health, for without the right to
health, all other human rights are likely to proove empty. Nothing, farmer argues, b except practical, physical resources--in
ample supply throughout the rich world--is keeping the poor world from undergoing a revolution in health.
"Farmer's moral stance is grounded in what the liberation theology movement calls a " preferential
option for the poor", a principle of Roman catholic social teaching that enjoins the rich to offer dignity and material support
to the poor...
But he goes on to suggest..structural violence is the key barrier to escape from poverty. In essence,
he occassionally comes close to espousing a neo-Marxist theory, according to which extremem poverty persists mainly because
of exploitation by the rich and powerful. (That the rich become steadily richer and the poor steadily poorer) is not true--"Haiti
aside--the Haitian experience does not shed much light on the massive reduction of poverty in Asia in the past quarter century,
particularly in China and India. ..or even the Dominican Republic....
contrary to the steroetypes prevalent within the bureaucraceis of rich countries and international
development agencies, the destitute adn vulnerable patients that farmer comes into contact with are smart, resourceful, and
absolutely intent on staying alive. They adhere even to complicated drug regimens,...Farmer's genius was to treat his HIV/AIDS
and MDR-TB patients without asking permission from the official aid agencies. They would surely have said no. (using donated
drugs and pilfered supplies) Farmer and his colleague Jim Kim of the Harvard medical School demonstrated clinical efficacy
in treating those 2 diseases and that drug prices could be sharply reduced through aggressive negotiations.
As their successes have become apparant, Farmer, Kim, and their colleagues have increasingly focused
on persuading policy makers to make a bold commitment to improved health among the world's poor. Hence, the third theme--that
human rights are indivisible--that so-called social and economic rights must accompany civil and political rights. Making
such a shift of emphasis would be a sea of change for a community that has traditionally been organized around the defense
of civil and political rights alone.
'''"Again and again he shows that when poor people are abandoned to their economic fate, merely
defending their civil rights will not keep them alive--muc less give them a chance for a dignified and prosperous life....the
rich have an obligation to the poor, to help the poor stay alive in the face of structural impediments of lethal dimensions..."
And here I am, all for this , all against it an hour ago. Not understanding. I still think America
should give dignity and health care to its own and then to others too but not to others while people like me go around without
dental and our ears so swollen from dental caries they are llike donkey ears....
And so it is with other situations in our lives. Those who want to be successful must help their
neighbors, friends, relatives be successful. Those who choose to live well must help others live well, for the value of a
life is measured by the lives it touches. And those who choose to be happy must help others find happiness, for the welfare
of each is bound up with the welfare of all.Incidently, the only U.S. Presidential candidate I heard talking like this is
Dennis Kucinich.
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