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...

( c ) PRESUMPTION.—Individuals who present themselves for covered services from a participating provider shall be presumed to be eligible for benefits under this Act, but shall complete an application for benefits in order to receive a United States National Health Insurance Card and have payment made for such benefits.

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:
(1) Primary care and prevention.
(2) Inpatient care.
(3) Outpatient care.
(4) Emergency care.
(5) Prescription drugs.
(6) Durable medical equipment.
(7) Long term care.
(8) Mental health services.
(9) The full scope of dental services (other than cosmetic dentistry).
(10) Substance abuse treatment services.
(11) Chiropractic services.
(12) Basic vision care and vision correction (other than laser vision correction for cosmetic purposes).
(13) Hearing services, including coverage of hearing aids.

( b ) PORTABILITY.—Such benefits are available through any licensed health care clinician anywhere in the United States that is legally qualified to provide the benefits.

( c ) NO COST-SHARING.—No deductibles, copayments, coinsurance, or other cost-sharing shall be imposed with respect to covered benefits.

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.

SEC. 104. PROHIBITION AGAINST DUPLICATING COVERAGE.
(a) IN GENERAL.—It is unlawful for a private health insurer to sell health insurance coverage that duplicates the benefits provided under this Act.
( b ) CONSTRUCTION.—Nothing in this Act shall be construed as prohibiting the sale of health insurance coverage for any additional benefits not covered by this Act, such as for cosmetic surgery or other services and items that are not medically necessary.

(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).
( B ) Salaried positions in institutions receiving global budgets under paragraph (3).
( C ) Salaried positions within group practices or non-profit health maintenance organizations receiving capitation payments under paragraph (4).

(F) NO BALANCE BILLING.—Licensed health care clinicians who accept any payment from the USNHI Program may not bill any patient for any covered service.

( C ) FUNDING.—
(1) IN GENERAL.—There are appropriated to the USNHI 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 small tax on stock and bond transactions.

(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.

Lets kick it off with a link to one popular single payer plan...

H.R.676 United States National Health Insurance Act (or the Expanded and Improved Medicare for All Act)

Some interesting items...



( c ) NO COST-SHARING.—No deductibles, copayments, coinsurance, or other cost-sharing shall be imposed with respect to covered benefit

(F) NO BALANCE BILLING.—Licensed health care clinicians who accept any payment from the USNHI Program may not bill any patient for any covered service.

(a) IN GENERAL.—It is unlawful for a private health insurer to sell health insurance coverage that duplicates the benefits provided under this Act.

© FUNDING.—
(1) IN GENERAL.—There are appropriated to the USNHI 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 small tax on stock and bond transactions.

(1) IN GENERAL.—No institution may be a par24
ticipating provider unless it is a public or not-for
profit institution.

No double-dipping, it appears. If you sign up for USNHI, you can't bill patients for any services that you receive payments from the USNHI Program.

I see very few difficulties in getting around this provision. With medical corporations, etc. the same 'clinician' will not be billing the patient, and so on.[/b]

Pretty much kills that forever, no matter how good the service or benefits.

(1) GUARANTEED ELIGIBILITY. Obama and Biden will require insurance companies to cover pre-existing
conditions so all Americans, regardless of their health status or history, can get comprehensive benefits at fair
and stable premiums.
(2) NEW AFFORDABLE, ACCESSIBLE HEALTH INSURANCE OPTIONS. The Obama-Biden plan will create a
National Health Insurance Exchange to help individuals purchase new affordable health care options if they are
uninsured or want new health insurance. Through the Exchange, any American will have the opportunity to
enroll in the new public plan or an approved private plan, and income-based sliding scale tax credits will be
provided for people and families who need it. Insurers would have to issue every applicant a policy and charge
fair and stable premiums that will not depend upon health status. The Exchange will require that all the plans
offered are at least as generous as the new public plan and meet the same standards for quality and efficiency.
Insurers would be required to justify an above-average premium increase to the Exchange. The Exchange
would evaluate plans and make the differences among the plans, including cost of services, transparent.
The Exchange will have the following features:
􀂾 Comprehensive benefits. The benefit package will be similar to that offered through the Federal
Employees Health Benefits Program (FEHBP), the program through which Members of Congress get
their own health care. Plans will include coverage of all essential medical services, including preventive,
maternity and mental health care.
􀂾 Affordable premiums, co-pays and deductibles. Participants will be charged fair premiums and
minimal co-pays for deductibles for preventive services.
􀂾 Simplified paperwork. The plan will simplify paperwork for providers and will increase savings to the
system overall.
􀂾 Easy enrollment. All Exchange health insurance plans will be simple to enroll in and provide ready
access to coverage.
􀂾 Portability and choice. Participants will be able to move from job to job without changing or
jeopardizing their health care coverage.
􀂾 Quality and efficiency. Participating hospitals and providers that participate in the new public plan will
be required to collect and report data to ensure that standards for health care quality, health information
technology and administration are being met.
(3) TAX CREDITS FOR FAMILIES AND SMALL BUSINESSES. Barack Obama and Joe Biden understand that too
many families that do not qualify for public health programs like Medicaid and SCHIP have trouble finding
affordable health insurance. They know from talking to small business owners across the nation that the
skyrocketing cost of healthcare poses a serious competitive threat to America’s small businesses. The Obama-
Biden health care plan will provide tax credits to all individuals who need it for their premiums. They will also
create a new Small Business Health Tax Credit to provide small businesses with a refundable tax credit of up to
50 percent on premiums paid by small businesses on behalf of their employees. To be eligible for the credit,
small businesses will have to offer a quality health plan to all of their employees and cover a meaningful share
of the cost of employee health premiums.
(4) EMPLOYER CONTRIBUTION. Large employers that do not offer meaningful coverage or make a meaningful
contribution to the cost of quality health coverage for their employees will be required to contribute a
percentage of payroll toward the costs of the national plan. Small businesses will be exempt from this
requirement.

I'm thinking this will be mostly a congressional plan, as opposed to whatever Obama ran on.

"Licensed health care clinicians who accept any payment from the USNHI Program may not bill any patient for any covered service."

I think arebuntz sees the "poison pill" in this line correctly. If a medical facility/provider does USNHI work, they then are barred form providing any similar work to any other patient except a USNHI patient. Even if said patient is not claiming under the program but paying by other means. Thus for covered procedure X, a USNHI provider cannot perform said procedure unless it is for a USNHI patient. Once in, you're locked in forever. As either provider or patient. It just isn't "mandatory." pardon me while I break out into uncontrollable laughter.

Oh, and did you notice the "modest and progressive excise tax on payroll and self-employment"? They aren't financing this on the backs of the richest 5% but on everyone making any money. What's "modest" and how "progressive" is it? I recall in a presidential campaign just a little while back "rich" became anything upwards of $50K for a family. To the Sufferers of Potomac Fever words like rich, modest, and progressive are quite malleable in their meanings and highly situational in application.

Even if all of the above are true (which is very likely), I'd still think it's worthy of consideration.

Not only did I grow up with HMO-like 'public-private' (it's a hybrid system in Greece, apparently it follows the Belgium model, for what that's worth) institutions and coverage, but I am actually quite happy with the HMO (Kaiser Permanente) that I now get (free to ME). When I look at how much my employer contributes I can only conclude that my employer has gotten a terrible deal out of the HMOs and PPOs. It could be that the cops and like personnel who are in the pool make it a bit riskier than one would expect given who else is in the pool and our numbers.

"Licensed health care clinicians who accept any payment from the USNHI Program may not bill any patient for any covered service."

I think arebuntz sees the "poison pill" in this line correctly. If a medical facility/provider does USNHI work, they then are barred form providing any similar work to any other patient except a USNHI patient. Even if said patient is not claiming under the program but paying by other means. Thus for covered procedure X, a USNHI provider cannot perform said procedure unless it is for a USNHI patient. Once in, you're locked in forever. As either provider or patient. It just isn't "mandatory." pardon me while I break out into uncontrollable laughter.

I would say this is perhaps the least offensive method to implement an incentive to get everyone into the system. Just making it against the law would be far worse.

For some reason choice is rarely an option when the lefties get together and help everybody. To help 40 million we have to coerce 300 million.

Mutual coercion, mutually agreed upon and mutually imposed MAY have superior effects than individual choice.

My least favorite thing about Obama was his take on healthcare.

What is needed is to just lower the age of Medicare bit by bit until everyone is covered (maybe under 18s first, then 60s, 50s, 40s, 30s, 20s)

That will give the paper pushers time to retrain.

what brand of coersion is that

One freeloader works as well as another. If you think you've found a way to get something for nothing you really haven't.

And the jailer. Buy inyerface an inhaler or go to jail

Executive Summary
Bold, comprehensive health reforms that assure immediate health insurance coverage for all
Americans can be far less expensive than incremental reforms that cover little more than half of
the uninsured. Comprehensive reforms can reduce health spending while also reducing the
federal deficit by targeting those fundamental elements of the system that contribute to
inefficiency and uncontrolled cost growth, such as consumer incentives and excessively complex
administration. Incremental reforms that do not address these core problems will not save enough
to achieve universal coverage without dramatically increasing the federal deficit.

Baucus Sees Summer Delivery of Healthcare Reform Bill
By Emily P. Walker, Washington Correspondent, MedPage Today
Published: March 04, 2009
WASHINGTON, March 4 -- Sen. Max Baucus (D-Mont.) laid out an "ambitious" plan to have a bipartisan healthcare reform bill ready to go by June or July, while acknowledging the massive task ahead of him.

"This is the most difficult challenge in my life," he told a group of reporters Tuesday. "It's so complicated," he said.

But despite the complexity of healthcare reform and the difficulty of gaining bipartisan support for the movement, Baucus said he's been encouraged by what he characterized as growing Republican support for a major healthcare bill this year.

Baucus said the costs of his plan would be fully offset, which he hopes will make it more palatable to fiscal conservatives.

"It will not add to the deficit," he said.

Baucus published a white paper in November outlining his goals for healthcare, which are similar to those of President Barack Obama. At the time, he said the plan would cost a significant amount of money up front, but that it was worth the investment.

Wrong on Bankruptcies

Obama said that health care costs cause a bankruptcy every 30 seconds in the U.S.

Obama: And for that same reason, we must also address the crushing cost of health care. This is a cost that now causes a bankruptcy in America every 30 seconds.

Data from the U.S. Courts show about 934,000 personal bankruptcies in the 12-month period ending June 2008. There are about 32 million seconds in a year. So someone filed for bankruptcy roughly every 30 seconds last year. But even a very high estimate, like the Harvard study we looked at last year, would only attribute half of those personal bankruptcies to medical expenses. So that's one health-related bankruptcy every minute at most.

WASHINGTON (AP) - Democrats are seeking a compromise on a bigger government role in insurance coverage as part of President Barack Obama's proposed health care overhaul.

At issue is whether middle-class workers and families should have the option of a government-sponsored plan that would compete with private insurers. Obama and other Democrats support the idea, which Republicans adamantly oppose.

Sen. Charles Schumer, who is working on the issue for the Senate Finance Committee, said Thursday one potential compromise is based on insurance plans that most states already offer their employees. Obama's health secretary nominee, Kansas Gov. Kathleen Sebelius, likes the idea.

Schumer, D-N.Y., said such a plan would avoid expanding a federal program like Medicare and that a private insurer possibly could run it. Sebelius already administers that type of plan in Kansas.

At a Senate hearing, Sebelius noted that more than 30 states "have a public plan side by side with private market plans in our state employee programs." State workers, she said, "have an opportunity to take a look at which is best suited to themselves and their families. And there has been no destruction of the marketplace."

The insurance lobby fears that a federally backed plan could drive companies out of business.

"We are taking a look at the different state employee plans to get a better understanding of how they operate," said Robert Zirkelbach, a spokesman for America's Health Insurance Plans.

GOP lawmakers "are going to need to know what's in the fine print," said Craig Orfield, a spokesman for Sen. Mike Enzi, R-Wyo., a leading lawmaker in the debate.

The issue of a public plan is a major stumbling block in deciding how to rein in health costs and cover the uninsured.

The state employee plans are similar to how big companies insurer their workers. Companies budget each year for health expenses, then hire an insurer to process claims, negotiate rates with doctors and hospitals and cajole employees to follow healthier lifestyles.

In California, the state sponsors three medical network plans for employees and retirees. These plans are offered alongside traditional insurance plans. The state-sponsored plans, administered by Anthem Blue Cross, account for about one-fourth of the 1.3 million people in the state employee health program, said Karen Perkins, a spokeswoman for the California Public Employees Retirement System, known as CalPERS.

The idea of using the state employee plans as a model came last month from two policy experts, Len Nichols and John Bertko.

"We were just trying to avoid nuclear war," said Nichols, director of health policy for the nonpartisan New America Foundation. "We saw advocates of Medicare for all pushing to put the country into Medicare. And we saw the right using that to push the moderates out of engagement in the health reform debate."

In an interview, Schumer said he is looking at Nichols' idea as a possible compromise and is beginning to sound out other Democrats. He said he has some room to maneuver because Obama and many Democrats did not spell out what they mean by a "public" insurance option.

But Schumer said other Democrats insist that option should look like Medicare, in which the government directly sets benefits and payment rates.

Mark McClellan, a health policy expert who ran Medicare under President George W. Bush, said Nichols' proposal was "well meaning," but that the government is much bigger than any state, so the effects of a federally backed plan on the insurance market would be far greater.

"At this point, I don't know many Republicans who are confident a public option could work without making it look like another private sector choice," said McClellan. "And then what would be the point?"

Former Health and Human Services nominee Tom Daschle has said he would remain involved in the push for health care reform — and it’s becoming clearer how he might do it.

Daschle, who withdrew from consideration in February amid tax problems, is rejoining a bipartisan effort with other prominent political leaders to propose a comprehensive health care fix, according to a source familiar with the process.

And by May, Daschle, former Sen. Robert Dole (R-Kan.) and former Sen. Howard Baker (R-Tenn.) are expected to present a package of ideas as founders of the Bipartisan Policy Center. Former Sen. George Mitchell (D-Maine) is also part of the effort, but his new job as Middle East envoy has diverted his attention.

Daschle had stepped out of the process, which began in 2007, when President Barack Obama nominated him to the Cabinet.

Dole told two Senate committees this week that a proposal is forthcoming.

Two top-tier health policy experts are assisting the group of four leaders: Chris Jennings, who worked in the Clinton White House, and Mark B. McClellan, who worked in the Bush administration.

The End of Private Health Insurance
When government 'competes,' guess who always wins?

Above every other health-care goal, Democrats this year want to institute a "public option" -- an insurance program financed by taxpayers, managed by government and open to everyone, much like Medicare. This new middle-class entitlement is the most important debate in Congress this year, because it really is the last stand for anything resembling private health insurance.

This public option will supposedly "compete" with private alternatives. As President Obama likes to put it, those who are happy with the insurance they have now can keep it -- and if they happen to prefer the government offering, well, gee whiz, that's the free market at work. The reality is far different. Not only will the new program become the default coverage for the uninsured, but Democrats intend to game the system to precipitate -- or if need be, coerce -- an exodus to government from private insurance. Soon enough, that will be the only "option" left.

A public program won't compete in a way that any normal business would recognize. As an entitlement, Congress's creation will enjoy potentially unlimited access to the Treasury, without incurring the risks or hedging against losses that private carriers do. As people gravitate to "free" or heavily subsidized care, the inevitably explosive costs will be covered in part with increased outlays to keep premiums artificially low or even offer extra benefits. Lacking such taxpayer cash, private insurance rates will escalate.

Much like Medicare, overall spending in the public option will be controlled over time by paying less for medical services, drugs and technology. With its monopsony purchasing power, below-market fees will be dictated on a take-it-or-leave-it basis -- an offer hospitals and physicians won't be able to refuse. Medicare's current reimbursement policies pay hospitals only 71% of private rates, and doctors 81%, according to the Lewin Group.
[Review & Outlook]

In a recent analysis, Lewin estimates that enrollment in the public option will reach 131 million people if it is open to everyone and pays Medicare rates. Fully 119 million people will shift out of -- or lose -- private coverage. Everything depends on the payment levels that Congress adopts, as well as the size of the eligible pool. But even if a public option available to all takes the highly improbable step of paying at some midpoint between private and Medicare rates, nearly 68 million people will still be crowded out of private insurance. The nearby table summarizes Lewin's eye-popping findings.

This public option would be the most radical change in the way American health care is financed -- and thus provided -- in at least 44 years, and maybe ever. About 170 million people currently have private insurance, which is already pressured by the price controls of Medicare and Medicaid. A significant share of government underpayments are simply transferred to the private sector, adding tens of billions of dollars every year to consumer health bills.

A 2006 study in the journal Health Affairs concludes that around 17 cents of every dollar in relative reductions in Medicare payments to private hospitals are shifted onto private patients -- and that such cost-shifting accounts for fully 12.3% of the total increase in private payer prices between 1997 and 2001.

This share would be far higher were government payment rates not limited to the elderly and the poor but imposed over the entire system. This will only hasten the flight to government. Meanwhile, employers small and large will have every incentive to dump their plans and transfer their workers to the public rolls. The result will inevitably be a cascade of failures or withdrawals from the market by commercial insurers, with the public option as the only option for the diaspora.

Congress will finish the job with regulatory changes. Under the aegis of a level playing field, all private plans will be forced to offer benefit packages similar to those in the public option. They will also be required to accept all comers, regardless of pre-existing conditions, and also be forced to offer similar rates to all enrollees, ending the ability to manage risk through underwriting. Any private plan will essentially become a public utility where government decides what products it must offer and how much it can charge.

Democrats couldn't be clearer on this point. House baron Pete Stark -- who thought HillaryCare was too moderate and has long favored Medicare for all -- said at a recent hearing that currently "We have no mechanism to directly push the private sector to do delivery system reform and address rising costs." But the public option, he added, would force private insurers to "modernize," which seems to be his term for industrial policy.

Under this model, the annual political warfare over Medicare payment policies would be imported to what is left of the private sector. Once government takes over the majority of U.S. health-care liabilities, it can either provide every service at huge and growing cost, or it can ration services. People who need an MRI or hip replacement or whatever will face waiting lines. Medical innovation will be at the mercy of the price controls hashed out in Washington.

Proponents of a public option point to the Federal Employees Health Benefits Program to dismiss such criticism, but that program is offered only to a discrete population. Mr. Obama's proposal would be open to everyone and necessitate a huge permanent increase in government spending as a share of the economy. Medicare and Medicaid alone account for 4% of GDP today and will rise to 9% by 2035, according to the Congressional Budget Office. CBO estimates that individual and corporate income tax rates would have to rise by about 90% to finance the projected increase in spending through 2050 -- without the new middle-class entitlement.

Proponents will say we are exaggerating, but the consequences we describe are inevitable when government bulldozes into a market. Democrats want to sell their "public option" as a modest and affordable reform that won't affect anyone's private insurance. It isn't true. Republicans, especially those in the Senate who want to cut a deal on health care, should understand that a public option is the beginning of the end of private health insurance.

Proponents will say we are exaggerating

National Survey Finds Numerous Problems Facing Primary Care Doctors, Predicts Escalating Shortage Ahead


November 18, 2008

BOSTON–A survey released today by The Physicians’ Foundation depicts widespread frustration and concern among primary care physicians nationwide, which could lead to a dramatic decrease in practicing doctors in the near future. The survey examined the causes behind the doctors’ dissatisfaction, the state of their practices and the future of care. The resulting findings show the possibility of significantly decreased access for Americans in the years ahead, as many doctors are forced to reduce the number of patients they see or quit the practice of medicine outright.

An overwhelming majority – 78 percent – of physicians believe that there is an existing shortage of primary care doctors in the United States today. Additionally, nearly half of them – 49 percent, or more than 150,000 practicing doctors– say that over the next three years they plan to reduce the number of patients they see or stop practicing entirely.

“Going into this project we generally knew about the shortage of physicians; what we didn’t know is how much worse it could get over the next few years,” said Lou Goodman, PhD, President, The Physicians’ Foundation. “The bottom line is that the person you’ve known as your family doctor could be getting ready to disappear – and there might not be a replacement.”

The Physicians’ Foundation believes the future of primary care could have a significant impact on the American healthcare debate.

“At a time when the new Administration and new Congress are talking about ways to expand access to healthcare, the harsh reality is that there might not be enough doctors to handle the increased number of people who might want to see them if they get health insurance,” said Walker Ray, MD, Vice President, The Physicians’ Foundation. “It’s as if we’re talking about expanding access to higher education without having enough professors to handle the influx of students. It’s basic supply and demand.”

The reported reasons for the widespread frustration among physicians include increased time dealing with non-clinical paperwork, difficulty receiving reimbursement and burdensome government regulations. Physicians say these issues keep them from the most satisfying aspect of their job: patient relationships.

“Tens of thousands of primary care doctors face the same problems as millions of ordinary citizens: frustrations in dealing with HMOs and government red tape,” said Sandra Johnson, Board Member, The Physicians’ Foundation. “The thing we heard over and over again from the physicians was that they’re unhappy they can’t spend more time with their patients, which is why they went into primary care in the first place.”

Don't be so modest, wsj. Everyone will say you're exaggerating. It's called propaganda. Be frank about it.

eliminating private health care insurance is a primary goal for them...

Don't be so modest, wsj. Everyone will say you're exaggerating. It's called propaganda. Be frank about it.

Supposedly that is what will save enough to cover everyone. Badly, but we have to make sacrifices. Like grandma.

It's their (our) duty... perhaps we can learn from the indigenous peoples of North America and when our time has come just wander off into the forest... circle of life and all that...

Single Payer/Medicare for All advocates would not deny that they are exaggerating, eliminating private health care insurance is a primary goal for them...

Other than NK and Cuba, which country has eliminated private health care insurance?

Not as supplements but basic policy, quite a few, in all but a few cases and soon to be dwindling to none, the US for the Medicare Population...

Folks covered by Medicare Part A and Part B still get supplemental health insurance policies and a small number of them choose to go into Medicare Advantage. The vast majority stay in fee for service Medicare Part A and Part B.

Countries with single payer basic policies that cover everyone (or nearly so) may still allow supplemental policies for additional coverage but not for basic coverage.