Nylander Healthcare Reform Planning

[Flo]

Yeah, I have been familiarizing myself with Nylands system.

I think the freerider problem could be addressed by using IDs like a drivers license or issuing a health card that is used to identify a person.

I'm not sure though, it's good to think about.

[Flo]

I've started the drafting of the bill. More will come as I move along. feel free to add any contributions and I'll add them in if they're bueno

[Rommy]

As your Vice President, I wish you luck and I am here if you need me o/

[Flo]

the rough draft of the bill is basically finished. it's in the OP

[Ceausescu]

Yeah, I have been familiarizing myself with Nylands system.

I think the freerider problem could be addressed by using IDs like a drivers license or issuing a health card that is used to identify a person.

I'm not sure though, it's good to think about.

Yeah, some sort of identifier is needed. The best option, for situation where IDs are unavailable, is to have some sort of protocol that allows the health system to request that a person be ID-ed by the police.

[Rommy]

Or maybe just a computer system where everyone is inputed for the national record, like name, birthdate, etc. etc. that could be done within the health system instead of relying on Police.

[Sal]

I'm assuming for people born in Nyland you'd have a social security numbering process the same as you do in the US in which people are given a unique number at the time of birth. That should cover pretty much everyone actually born in Nyland, but that comes with its own problems (losing the card which is tiny and made of paper and for some unknown reason is not allowed to be laminated, identity theft, children not born in hospitals/"off the grid" are not registered with the national or local vital records system [whether due to illegality of parents, religious cult, etc.] not ever receiving a card...)

Travelers would be more difficult since the only options seem to be: A.) it's mandatory to purchase traveler's insurance at the time of entrance to Nyland regardless of duration of stay, B.) every traveler to Nyland must obtain a visa regardless of length of stay, and the cost of the visa is adjusted to include for prorated "insurance" (taxes to be paid to the federal government) in addition to the usual administrative fees and etc., or C.) travelers/tourists actually are just free riders and proof of passport at time of being seen is enough to waive the need for any other form of identification.

And then there are people who are there illegally. I don't know what you'd do with them.

[Flo]

Yeah, I'm still trying to figure out what to do about those who aren't legally in the country. I don't think it's politically possible to pass the bill if we allow non-legal freeriders. We're relying on UP votes and I don't think we get them if we do that.

I think work visa people and student visa people should have the cost included in their cost for the visa maybe. Surely not too much, or they won't visit, but enough to at least get something. Tourists and visitors... They should probably be free riders right?

What do you guys think?

Also, re: social security cards. You can always get another one. I have like... three I think. My mom was super paranoid when I was born apparently.

I feel like you would just need to prove nyland citizenship to get your "Medicare ID" but you could prove it a few different ways. You'd probably need a birth certificate as well as a social security card, maybe a drivers license? idk... they kind of overlap. you need a and b to get c so if you have a and c you're good or something like that.

[Seperallis]

Okay, I'm going to force myself to actually sit down and write this, because the alternative is to explain in the chat, and that's dumb.


What is Nyland's healthcare system?

For all intents and purposes, the system of care etc that exists in Nyland is the same as that in the US, in that the burden of cost is placed on the shoulder of the person seeking care. This cost can be paid directly, or the person can buy private for-profit, private non-profit, or state-run (as in, from the states) insurance to help cover the cost of care. Etc etc, I can't be bothered to go into perfect detail about how healthcare is operated in the US, because that's a huge topic.

There are, however, two key and VERY IMPORTANT differences between the way Nyland's federal government handles healthcare, and the way the US gov't handles it:

1) Nyland has a Bismarck-model voucher system
Kind of. As Sal explained, if you are a taxpayer (that is, anyone who files their taxes, regardless of whether they actually owed any tax to the federal government that year), then you are eligible to receive a voucher from the federal government to go towards the purchase of medical-related expenses, including dental care (but not prescription drugs which are inadequately covered by a separate voucher program). Now, this voucher doesn't need to be given to the doctor, it can also be used to purchase insurance (and is probably smart to do so in many cases), or set aside in an HSA for future use. You are not mandated to get insurance, insurers are not mandated to cover you, and you're not even mandated to receive the voucher in the first place (you can decline it if you so choose).

Currently, the system is very behind in its payouts and, should it be kept, will need updating in its payout amounts to meet modern demands. The idea of the system was to preserve the free market while still alleviating some of the the burden of healthcare costs. Currently, the voucher program gives:
- $4,000 per adult per household if they earn up to a taxable income of $14,000
- $2,000 per adult per household if they earn a taxable income between $14,00 and $100,000, though the benefit slowly diminishes on a linear basis starting at a taxable income of $50,000 until it reaches 0$ at $100,000 income. (does that make sense? I worded it poorly, but surely Flo understands)
- $1,000 per child per household if they earn up to a taxable income of $100,000; this is constant and does not diminish like the above vousher for adults.

Any unused or unclaimed amounts from the voucher system for any single year goes into a collective pool of funds, which get distributed to healthcare facilities to cover costs that those facilities would otherwise have to eat, such as paying for an emergency visit from someone who simply can't afford it, etc etc. This measure was probably added in the early Karlsson days.

Speaking of the history of the system, it's actually probably very similar to the fight for Medicare, except history played out differently; to win Lberalist votes, whatever PCP president decided to institute a voucher based system instead of a Medicare-like system. Except for the amount given, the system hasn't changed much since except to expand the definition of what a "qualified expense" might be.

2) Nyland has no Medicaid/Medicare system
Tied to the voucher program, and just as it says. Yes, some of the Medicaid/Medicare function is performed by the voucher system, which is inherently built around delivering aid to people based on need, with the neediest getting the largest benefit. While those benefits can cover a lot of preventive care, the system has its own issues, which will be covered later.

But for now, just these two alone create an entirely different climate around the healthcare debate than it does in the US. Hugely so. Medicare/Medicaid pays LOTS of money to states to provide care for a huge range of things, such as pediatric care for the poor, care for old people, billions of dollars for school nurses...the amount of money that gets sent to the states by Medicare/Medicaid is as staggering in amount as it is in what it gets used for.

The voucher system, though currently funded to about $590 Billion, just doesn't quite do the same.


What are the failures of Nyland's healthcare system?

The most glaring at the moment are two problems: rising costs that are already exorbitant, and the fact that tens of millions simply don't have access to the system.

The first problem, high costs, isn't so much a direct failure of the current system as it is the failure of the government to expand said system or supplement it with some other additional system. The cost problem is a huge and complex web of cause creating effects and those effects in turn providing a feedback loop to the causes and yadda yadda you have a huge mess on your hands; I will not go into how the problem can reasonably be fixed, I'll just leave you with what Sal said earlier.

The second problem, though, is a very direct consequence of the voucher system. As stated, only those who file taxes and have a reportable income receive the voucher. If for whatever reason at all you do not file those taxes or do not have an income, you do not receive care. The largest and most obvious victim of this (aside from DIRTY STINKING ILLEGALS) is Nyland's homeless and jobless, who receive nothing. Anyone who isn't included as a taxpayer, or isn't a member of a taxpaying household, gets nothing. While this isn't a problem for people who can afford it one way or another, this is still very similar to the problem the US has in that people who can't afford access to care don't get the kind of cheap care (preventive or otherwise) to solve problems before they become life threatening (or worse) and cost hundreds of times more to remedy.

Well...actually...I guess the US already has that problem...

It has other consequences and problems too, I'm sure, but I'm too lazy and tired - and my will to keep typing has faded too far - for me to go into super deep detail about it all.

Is that all? Did I miss anything? I know I did. I'd also intended to also preach about how Kohout's plan was a wide-reaching plan that would have addressed a ton of problems at once, using a large expansion to the current voucher system that finally covers prescription costs, institutes price controls on patented drugs and procedures while establishing the foundations of further controls, mandates insurance cover people with conditions, allows the government to negotiate payments...but all you sillies want a plan that addresses only one issue of a sprawling mess of a problem, so whatever.

[Flo]

Is that all? Did I miss anything? I know I did. I'd also intended to also preach about how Kohout's plan was a wide-reaching plan that would have addressed a ton of problems at once, using a large expansion to the current voucher system that finally covers prescription costs, institutes price controls on patented drugs and procedures while establishing the foundations of further controls, mandates insurance cover people with conditions, allows the government to negotiate payments...but all you sillies want a plan that addresses only one issue of a sprawling mess of a problem, so whatever.

should have passed it then o/

for real though, thanks for the information. seems like an interesting system nyland has.