I quickly read for the first time H.R.676 the single payer health care bill that has several co-sponsors in Congress- and have several random questions that have popped up in my head and was hoping someone more steeped in the history of the single payer movement can help.
Issue 1: 'Sec. 104: Prohibition against duplicating coverage'
I assume this is the section that makes the private insurance industry obsolete. However, there does not seem any provision that explains where the tens of thousands of people who currently work in the health insurance industry go. I don't give a rat's ass about the top executives, but I do have concerns about the grunt workers, who are just trying to make a living like everyone else in America. Why is there no provision for incorporating at least some of these workers into the new system?
Issue 2: 'Title II: Subtitle B" Funding
I was hoping to find a more simplified, straightforward funding mechanism. Instead, there seems to be a hodge-podge of four different mechanisms including raising income taxes on the wealth, including A) incorporating existing revenue for health care, B) increasing taxes on the top 5% C) a 'modest and progressive excise tax on payroll' and D)Instituting a small tax on stocks and bonds transactions.
B) and D) concern me the most. As for B), with looming budget deficits and the many needs our nation will confront over the next few years, I can easily see this money getting diverted to other uses. Instead, why not synthesize B and C by getting rid of all income limits on the current Medicare tax? In other words, even if you make $5 million per year, you still pay the same percentage of your income toward national health insurance. This perhaps would get rid of the need to put an additional payroll excise tax on employers, which I believe could hurt employment.
I also have concerns about D). While I believe there should be a tax on stocks and bonds transactions, I would think we need that particular tax to fix our broken financial system, and it seems odd to divert it to health care.
Issue 3: 'Section 202: Payment of Providers and Health Care Clinicians'
This section seems to leave the 'fee for service' system intact. Why is fee for service controversial? Answer: It creates incentives for doctors to order unnecessary services in order to increase income. I am sure this system is left intact to garner the support of physicians. But the question I have is as follows: Will doctors continue to order unnecessary procedures and tests even if this bill is passed?
Overall, though, I'd have to say I am suitably impressed with this Bill; its power is in its simplicity. I do want to make sure that laid off health insurance workers are taken care of, that funding is secure, and that the dysfunctions of the current 'fee for service' system can be addressed over the long haul. But on balance, it seems to a layman like me to be very powerful legislation.