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HR676 which is titled in the bill: ‘‘United States National Health Insurance Act (or the Expanded and Improved Medicare for All Act)" is nothing of the sort. If you read it it turns out that "Improved" means "Transformed out of all recognition". Don't get me wrong, if I was God-Emperor I might mandate tearing down the entire medical care delivery system and starting over with government built and controlled medical facilities and modestly salaried and all optical, dental and long term care delivered for free to everyone who happened to be within the borders of this country at any given time. Then again I was dropped on my head as a baby. What is Kucinich's excuse?
The gory details of what is really in this bill in the Body.
To see why this bill is a pure joke you can start with Sec 211(c): (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.
Stop right there. Does that include all funding for Medicaid, Medicare, the VA, the Indian Health Service, the Public Health Service, the National Institutes for Health, hospital construction funding from HHS, health education via HHS or the Dept of Education? Well on reading it certainly appears so and after a ten year reprieve for the VA and five years for IHS explicitly so for those two. Did any Rep who co-sponsored this think about how a proposal to phase out specialized coverage for combat veterans would play come the mid-terms? Going on:
(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.
How much of an increase? What would 'modest and progressive' look like in numbers? And maybe could we define 'small'? Can the revenue provisions of this bill even by scored? If not it could never have been considered for final.
Okay what would the bill cover? Everything.
102 (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.
Okay the combination of (6) and (13) suggests that glasses come included in (12), which I guess means anyone can buy the most expensive fashion frame and have the total cost covered. Plus there is not a clear line between 'full scope' of dental and 'cosmetic', Is all orthodontia just cosmetic? Of course not. Are incredibly more expensive crowns stronger, more durable and long term have health benefits. Of course. So who makes the call in a specific case here?
And take (7). Under this bill it would appear that all long-term nursing home care is covered, which is a good thing except there are no cost controls at all. Because of the following language:
Sec 102(c) NO COST-SHARING.—No deductibles, copayments, coinsurance, or other cost-sharing shall be imposed with respect to covered benefits.
Nice except that it means that you can't pay for upgrades, no private room in the hospital or nursing home, every facility would have to provide the same level of care to everyone for the same price. Because you can't turn anyone away: Sec 101 (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. and Sec 101 (c) PRESUMPTION.—Individuals who present themselves for covered services from a participating provider shall be presumed to be eligible for benefits under this Act Well surely you could purchase supplementary insurance like Medicare Complete? Well maybe, depending on how the second section of this is interpreted: SEC. 104. PROHIBITION AGAINST DUPLICATING COVERAGE.
(a) INGENERAL.—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. So maybe you could buy coverage for a private room or upgraded cable or a bell and basket for your scooter. But mostly it is one size fits all.
But abolishing the VA after ten years and allowing unlimited free lifetime care to anyone within US borders, i.e. including newly arrived illegals, would not be the most controversial part of this bill, instead that would be the provisions of 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.
(2) CONVERSION OF INVESTOR-OWNED PROVIDERS.—Investor-owned providers of care opting to participate shall be required to convert to not-for-profit status.
(3) COMPENSATION FOR CONVERSION.—The owners of such investor-owned providers shall be compensated for the actual appraised value of converted facilities used in the delivery of care.
(4) FUNDING.—There are authorized to be appropriated from the Treasury such sums as are necessary to compensate investor-owned providers as provided for under paragraph (3).
(5) REQUIREMENTS.—The conversion to a not-for-profit health care system shall take place over a 15-year period, through the sale of U.S. Treasury Bonds. Payment for conversions under paragraph (3) shall not be made for loss of business profits, but may be made only for costs associated with the conversion of real property and equipment While few progressives would regret the elimination of for-profit general hospitals, in this legislation 'provider' implicitly includes every dentist, optometrist, pharmacy, private mental health facility, private substance abuse facility in the country, moreover they have to sell at current appraised value which might or not include such things as Good Will and not only forgo any profits they might have made going forward have to accept payment over 15 years.
There are other equally urnealistic provisions but what I have shown so far shows why this is fundamental a Joke being played on the rest of Congress and people like the FirePups. Taken together this is a proposal for a fully Socialized, fully Nationalized medical system. As written your in store pharmacy would be illegal, as would the Pearle Vision Center at the mall, if they are part of a for-profit organization they cannot sell to anyone covered with national insurance.
This is not Medicare for All, the resulting structure would look nothing like Medicare does today, instead of being able to choose your doctor and facility you will be limited to governmental or non-profit facilities largely staffed by salaried doctors. Or ones working off a government established fee schedule, every practitioner no matter how skilled can only charge for piece work.
Personally I am not afraid of the word socialist or moving way closer to the European Social Welfare system, but I don't know any such system which has gone to the lengths of banning for profit group practices outright or nationalizing the countries pharmacies. If anyone can explain to me, using the actual bill language, why any of my conclusions are off-base, otherwise I can only say people bought into a vast practical joke, that Kucinich could now be openly boasting that if necessary he will single-handedly deny HCR the last vote when he fostered this aspiration as being a serious plan is beyond delusional and close to criminal. Where's Batman when you need him.