Nylander Healthcare Reform Planning

[Flo]

If you guys don't remember, waaay back when I had first controlled the President of Nyland (Christoffer Harrow lol) I had this topic: http://forums.eternityrpc.com/topic/11157933/1/ about the tax reform I had planned to implement. It didn't get as much traffic as I would have liked but in the end did pass, quite successfully actually.

This topic is intended to perform a similar function. One of the chief goals I have selected for this term is healthcare reform. I am confident of the legislatures ability to pass critical healthcare reform that can provide cheap, high-quality, healthcare options for ALL Nylanders.

The overall goal for this healthcare reform is to establish a Single-Payer system in Nyland. Yes, I said the naughty word. Give me time to explain myself before you bring about the criticism that may or may not be true and accurate.

~~~

These are the primary problems with healthcare, as we know it in Nyland today. (I typically adapted stuff from the US as much as I could, and tried to adapt it to Nyland where possible)

Cost

This is the biggie. Healthcare is expensive, almost prohibitively so. The high cost of healthcare keeps people from making the choice to participate in preventative health services, visiting their doctor, dentist, etc. and on the more extreme end, seeking treatment for conditions they know they have. If they do make the choice to get treatment, they often get buried in debts they likely cannot pay. The only way out of this debt (besides obviously paying it off) is through costly bankruptcy or the effective relinquishing of their retirement savings (it does happen). Naturally, if you ask any rando on the street if they think healthcare should be more affordable, they will surely agree.

Insurance

While it is true that Nyland helps to cover costs by providing taxpayers with stipends, it should be known that the insurance system does little to help keep costs down. Insurance is one of the rare business models that benefits when its customers don't use what they paid for, so to speak. Some may argue that insurance provides peace of mind, but if I get injured, I'm not looking for peace of mind, I'm looking for them to pay my bill (that I've been indirectly paying for the whole time).  By removing this from the healthcare equation (for the most part) we can remove the interest in raising prices at all (by removing the profit motive from the equation). Some will certainly balk at the idea of removing profit motive, since there is a school of thought that has the understanding that profit motive is the surest way of making progress (which is not totally unfounded) but in the end, we're not talking about hamburgers or automobiles, we're talking about peoples lives. While the profit motive will be removed from the company perspective, surely there will be individual profit motive for those in the industry, such as doctors, etc. because they'll still get paid well for their services. Be advised that there would still be private insurance, it would just not be used for mandatory procedures, so no one would be making a profit from my heart transplant, so to speak.

Unnecessary Care

Many of the criticisms for a single-payer system refer to long waits and difficult access, but these could not be further from the truth, in terms of mandatory procedures. As Sal has said below, mandatory procedures would be easy to access and waits wouldn't be that long, but non-mandatory procedures would certainly have waits. Under the current system (as it is in the US) there is still priority for mandatory services, but there is a large priority for other elective services as well that drive costs up. By isolating those elective services we can ensure that access to mandatory services get the priority they need. (if you would like, you can research some of the ways unnecessary care drives up healthcare costs. it's pretty substantial.)

Access

The chief reason for changing to this new system is access. Simply put, access to cheap and subsidized healthcare is limited at the moment to taxpayers only. There are whole sections of the population who simply don't have that access. If healthcare is believed to be a universal right in Nyland it should indeed be a universal right to all in Nyland.

~~~~

Code:

The Healthcare Reform for All Act of 1585 (HRA85)
Assembly Bill 1585.077
Drafted by: Angelica Parker-Olsen (NCDA), Kraig Parker (MCN), Hannah Koch (UP) Submitted by: Erik van Holkiet (MCN) Submit Date: (Date submitted to be heard on the floor. (answer this)) Hearing Date: (Date the bill was heard on the floor. (leave blank)) Revision Date: (Latest revision date of the bill. (leave blank)) Summary: The Healthcare Reform for All Act of 1585 seeks to reform Nylands healthcare system to establish a new single-payer system. The bill will establish a single government social insurance program called Medicare that will provide healthcare insurance for all in Nyland. This program will be funded by the establishment of a mostly flat payroll tax on all Nyland personal income. This bill is intended to address the rising costs in healthcare by removing the profit-motive from the system. By ensuring the primary healthcare provider, Medicare, is not operating for profit, costs across Nyland can be cut to the benefit of Nylander citizens. Section 1: Medicare I) The government will establish a single governmental social insurance program. This program shall be called Medicare. II) Medicare will be the primary provider for all Nylander healthcare services. III) Medicare will be a non-profit organization, funded by the government. IV) Non-Medicare providers will still be allowed to exist, and can be used alongside Medicare. Section 2: What Coverage is Provided I) All medical procedures will be covered by Medicare. II) For non-elective medical procedures, Medicare will pay for the entirety of the cost (minus a minimal co-pay) III) For non-cosmetic elective medical procedures, Medicare will pay for most of the costs, but not all. (coverage rates depend on the given procedure, naturally) IV) For cosmetic elective medical procedures, Medicare will pay for some costs, but not all. (coverage rates depend on the given procedure, and why they are being undertaken) V) In the event that the individual is unable to pay for their procedure up-front (considering elective procedures), Medicare will pay for the procedure and offer free financing options to the individual in question. VI) The definitions of non-elective, non-cosmetic elective, and cosmetic elective, will be decided by the Department of Health and must be approved by the Legislature. Section 3: Who Recieves Coverage I) Any person in Nyland with a valid Medicare ID will be covered by Medicare. II) A Medicare ID will be provided to all citizens of Nyland III) Temporary Medicare IDs will also be provided to those non-citizens who are permitted to stay in Nyland legally a) These temporary Medicare IDs will be provided for the duration of their stay in Nyland, but will have to be renewed once per year for the duration of their stay Section 4: The Medicare Tax I) Medicare shall be funded by a flat payroll tax that shall be called "the Medicare Tax" II) Medicare Tax shall be applied to all Nylander personal income III) Medicare Tax will be taken from each paycheck, rather than at the end of the year. IV) Medicare tax shall start at 10% a) Half (5%) shall be paid by individuals, while the other half (5%) shall be paid by employers V) Nylanders with incomes less than $25,000 (or otherwise in the 0% tax bracket) can apply for a credit equal to half of their Medicare Tax payments over the year.

[Jamzor the Jaxxor]

single payer? dirty nylander commie scum

[Seperallis]

Just to help you, the main key difference between US and Nyland is that Nyland doesn't have Medicare or Medicaid. It has a Bismarck-esque voucher program where direct funds are given to people/families for medical care, and can use it to pay for the care directly, put it in an HSA, use it to pay for private insurance, etc etc.

I can answer whatever questions you have, though the process will most likely involve me turning to Sal and asking logistical questions of healthcare and whatnot.

[Rommy]

So we should just ask Sal then >:T?

[Sal]

I mean, you can ask me things. It doesn't mean I'll have a good answer for everything, but I'll probably have an answer.

[Seperallis]

So we should just ask Sal then >:T?

No. Ask me. I'm important. >:U

[Rommy]

So we should just ask Sal then >:T?

No. Ask me. I'm important. >:U

In the context of Nyland, what was the evolution of Nylandic healthcare? It is facing similar high-prices as in the US of A? Is the healthcare lobby as big? Whats the average cost of healthcare per capita? How could single-payer impact a regular doctor, as in visit times, patient overload? Why am I asking these questions? Will medical research be brought down due to single-payer, or could the Feds make up for the large of market level capitalism towards it?

[Seperallis]

So we should just ask Sal then >:T?

No. Ask me. I'm important. >:U

In the context of Nyland, what was the evolution of Nylandic healthcare? It is facing similar high-prices as in the US of A? Is the healthcare lobby as big? Whats the average cost of healthcare per capita? How could single-payer impact a regular doctor, as in visit times, patient overload? Why am I asking these questions? Will medical research be brought down due to single-payer, or could the Feds make up for the large of market level capitalism towards it?

Yes.

[Flo]

single payer? dirty nylander commie scum

YOU SAID YOU LIKED IT I HAVE PROOF

Just to help you, the main key difference between US and Nyland is that Nyland doesn't have Medicare or Medicaid. It has a Bismarck-esque voucher program where direct funds are given to people/families for medical care, and can use it to pay for the care directly, put it in an HSA, use it to pay for private insurance, etc etc.

I can answer whatever questions you have, though the process will most likely involve me turning to Sal and asking logistical questions of healthcare and whatnot.

If there isn't medicare or Medicaid in Nyland I think this is an easier sell, personally.

So we should just ask Sal then >:T?

No. Ask me. I'm important. >:U

In the context of Nyland, what was the evolution of Nylandic healthcare? It is facing similar high-prices as in the US of A? Is the healthcare lobby as big? Whats the average cost of healthcare per capita? How could single-payer impact a regular doctor, as in visit times, patient overload? Why am I asking these questions? Will medical research be brought down due to single-payer, or could the Feds make up for the large of market level capitalism towards it?

I'll try to answer these questions:

In the context of Nyland, what was the evolution of Nylandic healthcare? ~~ we'd need to decide this. idk

It is facing similar high-prices as in the US of A? ~~ healthcare is expensive period, the only difference is in the US we pay for a lot of stuff out of pocket, through insurance premiums or deductibles.

Is the healthcare lobby as big? ~~ lobbys are big players, and healthcare is a large sector of the economy, typically. This could be good or bad. In the US, physicians often support single payer, while big pharma and insurance companies typically oppose it, because it would mean the end of their ability to gouge prices, in the case of big pharma, and would remove their relative monopoly on healthcare provision, in the case of insurance companies. I don't feel particularly bad for either, if I had to be honest.

How could single-payer impact a regular doctor, as in visit times, patient overload? ~~ This is not NHS, so the single doctor would operate the same way they always did. Rather than being paid by an insurance company (or my pocket) they get their money from a government fund (the single payer). This is similar to medicare, if you're curious, except medicare is only available to old people or disabled people (which is why single payer is often called "medicare for all" in the US). Patient wait times and overload... I think the arguments for that are grossly overstated by those who either haven't done their research or simply want to oppose the idea for political purpose. There would have to be rules put into place for the use of emergency services and what constitutes an emergency, maybe. But I really don't think these problems are as big a deal as people like to pretend, unless you're trying to get non-life threatening services.

Why am I asking these questions? ~~ FIIK

Will medical research be brought down due to single-payer, or could the Feds make up for the large of market level capitalism towards it? ~~ This is an interesting question, but I want to make it clear this is not NHS. The government is not running healthcare, it's simply paying for it, using moneys from the tax payer. Medical research is expensive, indeed, and I'm not yet sure how big pharma would react to this. For one, they could have more buyers, since people could more readily afford prescription drugs. But on another, maybe the profit motive is out of the equation now. It's kind of sick how profit motivates the creation of life-saving drugs, isn't it? Regardless, I would have to think about this one and how it could be addressed. I'm not inclined to believe the free market always does the right thing in this respect.

[Sal]

In the context of Nyland, what was the evolution of Nylandic healthcare? It is facing similar high-prices as in the US of A? Is the healthcare lobby as big? Whats the average cost of healthcare per capita? How could single-payer impact a regular doctor, as in visit times, patient overload? Why am I asking these questions? Will medical research be brought down due to single-payer, or could the Feds make up for the large of market level capitalism towards it?

A note on the bold part.

Regarding cost of healthcare per capita, it will most likely be driven down overall. I don't know what the starting point is, but if the government is the single payer, it has the right (like an insurance company does) to decide what procedures it will and won't pay for, which keeps costs down. That's basically its entire mechanism to keep things cheap. Like Flo mentioned, emergency services are generally going to remain easy to access and covered under the government, but "optional" procedures probably won't be (keep in mind that an "optional" procedure is not always aesthetic like a nose job; the quality of life can be greatly improved by a certain procedure and it still may not be covered - think knee replacements, excess skin reduction surgery after losing lots of weight, LASIK, fertility treatments... Also keep in mind that the longer you wait with certain things, the worse that non-life threatening condition may become, and the more expensive the treatment will be when a patient ultimately gets seen.) It's these sorts of optional procedures that you're going to see the longest wait times for (although excessive wait times are the result of many factors, including the poor coordination of various sectors of the healthcare industry - acute/emergent care vs. specialized practices vs. long term care and hospice, etc.)


I'm thinking one of the big issues you'll have with this system is the "free rider" conundrum. With the Bismarck model, what Nyland currently has, you get a voucher only if you've paid your taxes. That doesn't mean that you can't go to the doctor if you haven't paid your taxes, because hospitals and clinics are privately operated, but you'll be paying the total amount out of pocket. With the NHI model that's being proposed, doctors are paid out of a pool of tax money, meaning nothing's tied to the individual. Illegal immigrants, the destitute, medical tourists, etc. can tap from this pool for services (think Americans border-hopping to Canada for cheap organ replacements or something) which, philanthropically speaking, is great, but the more this occurs, the more often you have money coming out but not going back in, and the more covered services may/will eventually be limited (or tax hikes, whatever).


To put the change in the simplest terms, you need to keep in mind the three parties involved in the system Nyland is moving from and the one it's moving to: Patients, Doctors, and Government.

Currently: Patients pay their taxes; Government gives taxpaying Patients vouchers/set amount of money; Patients give vouchers to Doctors for whatever they want (or use it to buy supplemental insurance from private companies, or to put in a health savings account, etc.)

Proposed: Patients pay their taxes; Government uses tax money to pay Doctors directly whenever Patients visit, taxpayer or not.

We're not moving from America to UK with this proposal; we'd be moving from Japan to Canada.


Personally, I don't know that this proposed change is going to dramatically impact the cost of healthcare if that's your overall aim. In my opinion (take it with a grain of salt as healthcare economics wasn't my concentration with my MPH), price caps is the way you need to go if the main issue is doctors making their costs really steep/different from hospital to hospital. Through a combination of real-world codes that we have that can basically identify every single aspect of a patient, a hospital, a drug, a procedure, etc. - for reference, look up LOINC, SNOMED, and ICD-10 codes - you can put a price on literally anything done in any medical institution. Use these to create a menu of prices that remains constant throughout the country, possibly adjusting for cost of living by region or something, and set the prices, and I'd see more impacts happening to costs.


It's good to keep in mind that all systems have pros and cons, and it all probably balances out somewhere along the way (except whatever the US is doing, because we have the most exorbitant healthcare spending with worse outcomes than several other modernized nations).