Comments on HR 676
A noble attempt and I am almost for it. I am 100% for a Medicare based single party payer delivering universal health coverage. There are many benefits available from this bill and they are listed elsewhere. I will focus on the problems.
You cannot establish a "global regional budget"- and "cover all medical services"- as envisioned. Utilization will skyrocket. To stay under budget, payments would have to be reduced, becoming progressively more unfair toward the end of each fiscal year.
Everyone needs to pay a monthly premium, scalable to income. Having a premium assigned will allow ownership of the plan and will supply a lever that can be used to prod individuals into a healthier lifestyle. For example, if someone continually fails to control certain risks, as with smoking or hypertension, they could be assessed a few dollars more each month. They would be reminded of their need to improve each time they received their premium statement. Small sums added would be sufficient to make people think.
Everyone needs a per incidence co-pay. It does not have to be much. I was working an outlying emergency room one night and a mother brought in her oldest child for "cold symptoms". She then signed the other 5 children in "just to be checked." Don't think for an instant that over utilization will not be a problem under HR 676 as written.
Drug costs could be controlled by paying a flat rate for a given class of drugs. If a different drug was desired we would still pay that set amount toward the new drug and the patient would pay the difference. Patients would pressure the providers for the lowest priced options and drug companies would feel pressure to keep their drugs within an affordable range. Negotiating with the drug companies, as envisioned, would leave the system open to fraud and favoritism.
Tapping into the "top 5%"- of income earners is not always tapping into people with disposable income. Many people live at the edge of their income as it is. All people need to pay a scalable fair share. We need to avoid building resentment for the system.
If you require all people to be covered under a universal plan and require all providers to accept the plan, you do not have to mandate anything to private insurance companies. There will not be a market for their product.
Too much of a "Mandate"- will simply breed resentment. It would be better to just make the product indispensable.