National Health Insurance

If there were a national insurance, the complaints would just get louder. It would never be enough, people would not stop complaining about the rationed care they recieve. The nurses would take the brunt of the anger.

I may be a pessimist, but people in a universal coverage system would still buy private insurance and opt out out of universal medicaid-thus creating a two tiered system depending on who can afford it.

STRUCTURE OF THE NHP

We have previously described the design of the NHP in some detail.7, 8 It would create a single insurer in each state, locally controlled but subject to stringent national standards. States could experiment with the precise structure of the single insurer. Some may place it within a government agency, while others may choose a commission elected by the citizens or appointed by provider and consumer interests.

Everyone would be fully insured for all medically necessary services including prescription drugs and long-term care. Private insurance duplicating NHP coverage would be proscribed, as would patient copayments and deductibles. Physicians and hospitals would not bill patients directly for covered services. Hospitals, nursing homes, and clinics would receive a global budget to cover operating expenses, annually negotiated with the state health plan - based on past expenditures, previous financial and clinical performance, projected changes in cost and use, and proposed new and innovative programs. Itemized patient-specific hospital bills would become an extinct species. No part of the operating budget could be diverted for hospital expansion, profit, marketing, or major capital acquisitions. Capital expenditures approved by a local planning process would be funded through appropriations distinct from operating budgets.

Fee-for-service practitioners would submit all claims to the state health plan. Physician representatives (probably state medical societies) and state plans would negotiate a fee schedule for physician services. The effort and expense of billing would be trivial: stamp the patient's NHP card on a billing form, check a diagnosis and procedure code, send in all bills once a week, and receive full payment for virtually all services - with an extra payment for any bill not paid within 30 days. Gone would be the massive accounts receivables and the elaborate billing apparatus that now beleaguer private physicians. Alternatively, physicians could elect to work on a salaried basis for globally budgeted hospitals or clinics, or in health maintenance organizations capitated for all nonhospital services.

http://www.pnhp.org/publications/liberal_benefits_conservative_spending.php

first, i would tell the government (senate, congress, president and all of his "folks" , lobbist,supream court , that they are getting thier 2 week notice. they need to train replacements because we have to let them go. they have been loyal for the most part, however, they come to work disheveled, they do not problem solve well, they are disorganized and have managed to complicate even the most simple task.therefor we will need to let them go. as far as a reference, it will depend upon the job for wich they will be applying for . if it includes leadership, i can't give them a good refer. then, i would find a big trash can for all the red tape, and have a policy that is call kiss (keep it simple stupid). the funding would come from the 6 months of free time the congress gets, that they don't actually work. but seriously folks, i have no idea. but, i do feel it may help to get the lawers to lay off. soooo much money is spent trying to prevent rediculous law suits. if we didn't have to hire companies to tell us how much we suck (ie: pres-gainy) and jcho and the various other regulatory agencies that cost big time money, we many actually have money to help americans. we could stop paying for medical care of those that are not american citizens. ( don't go off on me , my family are all imagrants, they came in the 50's and they did not get a thing ! payed for.) they were checked for disease, had a us sponsor and had so much time to become a functioning us citizen before they could be shipped back., )they didn't get off of an air craft and walk into a hospital for free care before they went to a 2 bed room apartment filled with 17 people. ,and then send their kids to school expecting some one to give them special classes because they don't speak english. i would also make sure big companies are spreading the wealth down ward. those that make min. wadge would have insurance, may mean ceo's may not make 1 million a year but oh, well ...sucks to be them.

I've been studying universal health care since the middle 70's. I've looked at the U.K. system, the German system, the French system, as well as the health care systems of Cuba and Red China.

In fact, I visited China, back in the 80's, as part of a three week nurse's only tour. In China they had a program called the 'barefoot doctor's program.' Their level of education was on par with a U.S. paramedic or military combat medic. They treated villagers and their families. They provided basic care, well baby, peds, immunizations, suturing lacerations, providing minor surgery, broken bones.

Germany has had an extensive health care system, with extensive benefits, including a three month time off, with pay, post delivery. And they offer spa services as well. And their system has been in existence since Bismark.

England's system has been in existence for a number of years, as well. And while they do have some long waiting periods for some services, my interaction with several of their citizens has taught me, they prefer their system over ours.

What would I do. I would prefer that everyone be treated equally, regardless of income. Availability of services would be based on need rather then income. If physicians wanted to maintain a private practice, they would have to pay the system very high fees for the privilege, each year. And funding would come from employers, even those claiming to have corporate headquarters outside of this country. Of course, it is wishful thinking on my part. The health care industry is too deeply entrenched in our system.

Woody:balloons:

If there were a national insurance, the complaints would just get louder. It would never be enough, people would not stop complaining about the rationed care they recieve. The nurses would take the brunt of the anger.

I may be a pessimist, but people in a universal coverage system would still buy private insurance and opt out out of universal medicaid-thus creating a two tiered system depending on who can afford it.

it all depends how the system is contructed and whether is the 'opt out' tier did exist as you seem to assume it would

if you look at the NHS the main arguement used to be about waits for elective procedures - primarily because of systems design issues and not looking at supply and demand ... there were aspects of missing the bigger picture which in part was down to politicians - 'forgetting' that peopel waiting for procedures cost more than getting the procedures expedited if they are off work and /or require other assistance ....

'opting out' in an interestign concept it relies on a parallel system for every single aspect of the healthcare system ... and that MEANS everything

I just don't want my health coverage tied to my employment. And I don't want to have to guess and bet on what my possible future health problems might be as I pick and choose what kind of insurance coverage I can afford to purchase. And if I'm wrong - oh well - too bad, you lose!

It would seem that chronic conditions would ultimately have to be covered by a social plan since no matter how well one plans (insurance, savings, health lifestyle, etc), if they end up being dependent upon full-time help, most would eventually run out of their own funds and need to be supported in some way.