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A step towards "universal health care" run by the government?


title: to amend the internal revenue code of 1986 to impose an excise tax on certain medical care providers that fail to provide a minimum level of charity medical care, and for other purposes.

sponsor: rep thomas, william m. [ca-22] (introduced 12/8/2006) cosponsors (none)

latest major action: 12/8/2006 referred to house committee. status: referred to the house committee on ways and means.

search results - thomas (library of congress)::

the text of the bill has not been published yet, but this looks like one more step towards universal health care. what do you think?

Antikigirl, ASN, RN

Specializes in Education, Acute, Med/Surg, Tele, etc. Has 13 years experience.

Wow...do other businesses have to also provide minimal charity work also or get excise taxed? Does my grocery store HAVE to provide groceries for a year for a poor family? Does Walgreens HAVE to provide free medications to patients with low incomes? Does my gas station HAVE to provide free gas for charity? Does Petco HAVE to provide animal food to a poor dog or cat? I could go on...but I think you get the point!

I mean this sounds like a witch hunt because we chose professions to HELP others as is??? What says that because we took on in the healthcare profession that we HAVE to be charitable? I choose to be charitable, and so does my community hospital when we have the money (because most of our moneys go directly into people that can't pay as is!!!!!). I guess I don't see it as a universal healthcare system as much as targeting a profession...a profession that has taken ENOUGH hits as is...and that is going to shoot them in the foot!!! What signal is that sending to future healthcare professionals (or us in it now?)...that you HAVE to be charitable and loose your rights to be paid for what you do...you are a drone to the masses and you better pitch in or else...welcome to healthcare! Oh man!

Does the retired nurse providing care in her home for a couple elderly patients have to provide charity work when that is their only means of income? Does the private practice doc in a rural community have to fire their nurse because they have to take on a charity patient and can't afford the RN? Does the ambulance company have to provide taxi service to the poor free of charge, possibly missing a serious emergency? All because we HAVE to obey the rules of forced charity???

Bad idea...very bad idea! Charity is a choice..and looses all meaning when forced!

outcomesfirst, BSN, RN

Specializes in Research, ED, Critical Care. Has 28 years experience.

Universal health care is a must; but I would need to read this bill first to see if it is a step toward it - It sounds exactly like Triage 34 points out - as an unfair tax. That said - one of the problems with our current system is the profit demands....Charity should not be an issue

Universal health care is a must;

You think that state or federal agencies should take the place of private insurers?

IMO, except for national defense, minting money, building highways and running police forces, there isn't anything the government can do better than the free market.

Why don't they just call it what it is? Universal is just a nice way to say "socialist" healthcare. I didn't realize we were now living in Russia. If you want to see what a bad idea socialist healthcare is, go look at Canada's system. People waiting months and months for urgent surgeries. Poor quality doctors, etc.

Tha bottom line is - why should people who earn a paycheck have to pay for healthcare for the people who don't?

This bill sounds like they're trying to mandate that healthcare providers must put in a certain number of hours a week/month/year or they will have to pay a penalty (tax in their lingo).

That's absolutely outrageous. When you mandate volunteers they aren't volunteers anymore.

I know our facility asks us as individual nurses to write down and submit to them the things we do within our communities on our own time that pretain to community service. Things like working at a free public B.P. clinic, taking swabs for a national tissue registry, providing public health screenings, bringing mobile screening units to the area, assisting with a Red Cross Blood drive......

I'm certain that these hours are then counted toward the facility's "charitable" community giving.

Is this what we're talking about?


Title: To amend the Internal Revenue Code of 1986 to impose an excise tax on certain medical care providers that fail to provide a minimum level of charity medical care, and for other purposes."

I think that without the full text of the proposal, it's really impossible to draw any real conclusion. For example...

.. What are "certain medical care providers" defined as? I know that as it stands now, certain not-for-profit organizations are required to provide charitable care for a defined percentage of cases in order to maintain their tax-exempt status. If you read the above statement, it would seem that the legislation is targeted at defining what amounts to a penalty to those providers that fail to meet the required number of charitable cases.

.. what is meant by "for other purposes"?

.. how is "charity medical care" defined in this case?

So, at first blush anyways, I'd say the proposed legislation is more of a "big stick" to wield at providers who claim tax exemption but fail to meet the defined parameters to gain that exemption. Which seems reasonable, to me at least. I also don't think that this has anything to do with the establishment of "socialized medicine". But, like I said, without the full text of the proposed bill, and an indepth knowledge of this particular portion of the tax code, I could be wrong.


Specializes in Emergency. Has 2 years experience.

If you want to see what a bad idea socialist healthcare is, go look at Canada's system. People waiting months and months for urgent surgeries. Poor quality doctors, etc.

Ouch! I'm from Canada, and while I do admit our health care system needs much work, I would disagree that it is a "bad idea" to provide health care to all. Yes, it does take far too long to get urgent surgeries....I agree, and that is something that is being worked on right now, but people who need surgeries do get them whether they can afford them or not. I have never heard of someone refusing to seek needed care because of the cost to do so, or prolonging/self-treating b/c of the cost of a drs/er visit, or losing their house b/c of no insurance, etc.

Yes, Canada does not have a perfect system, but neither does the USA. One thing I remember hearing that I really liked was that Vermont had universal health care for children. At least, I think it was Vermont.... Now, wouldn't that be a good idea???


Specializes in ER, OPEN HEART RECOVERY. Has 5 years experience.

Sounds like another excuse for the federal government to take MORE of my money. Really inspires me to work harder.

kenny b

Specializes in none yet, but I'm VERY excited!.

Ouch! I'm from Canada, and while I do admit our health care system needs much work, I would disagree that it is a "bad idea" to provide health care to all.

I've always been facinated by the differences between socialized medicine and a system driven by captialism. Maybe you'll allow me to pick your brain for the purpose of greater mutual understanding.

Since the US system is regulated, it is hard to know what a truly capitalistic system would look like. I think the primary concern with socialized medicine is that people will over-use it. Do you see this much in Canada?

Other concerns include the idea that the govt. could never (by its very nature) be nearly as efficient as free-enterprise. This makes the whole thing cost more.

Finally, there is a major concern that when the taxpayers provide anything, the incentive for people to provide for themselves evaporates (in many, but not all cases).

I know that a Capitalistic system has concerns as well, (like the profit motive's tendency to negatively affect medical decisions). These are somewhat (but not completely) alleviated by the natural selection inherent in the competative environment.

I've always wanted to talk to a Canadian about these things and I'm presenting these ideas without the intent to give offense at all. Just curious what an "insider" thinks about these things.

My sister used to work for an organization called Intestinal Disease Foundation - offered information, etc. for, well, intestinal diseases. She used to get calls from people in Canada for information. She has been told by these Canadians that they can only see specialists, i.e., a gastroenterologist (sp?) once a year.

This bill is just another Bandaid fix - it doesn't solve the real problem and move us any closer to a better health care system. We are basically paying for universal health care and not getting it. When a Provider (Hospital, Clinic, Doctor) has to provide a certain amount of charity work for the uninsured or underprivileged - those costs get passed on to the people who are insured and do pay for their health care. We all pay for the charity care!

The system could be much more efficient and save us millions of dollars. A single-payer system, such as Canada's, is the way to go.

Canada's Health Care Lauded by One Who Knows

by Sol Littman

Ever since my wife and I chose to leave Canada and settle in Tucson, we have been amazed and angered by the distortions and misrepresentations in the American media of Canada's government-funded, one-payer medical system. Among them is the recent op-ed article in the Arizona Daily Star by Dr. Jane M. Orient.

For most of my adult life, I worked as a journalist in Canada and took full advantage of Canada's health-care system. My wife, daughter and grandchildren were free to choose their own primary doctors and specialists. Service was consistently kindly, prompt and concerned. If something serious was suspected, we were tested, X-rayed and examined in a matter of days. Our physicians were highly trained and the hospital facilities modem and pleasant.

Thirty years ago, I had my gall bladder removed and had to spend three or four days in hospital. When I was discharged, I was presented with the bill-a total of $5.50 for the use of the television set in my semi-private room. The Ontario Hospital Insurance Plan paid the rest.

It is important for Americans to know that people in Canada tend to live a couple of years longer than their U.S. counterparts and that Canada's infant mortality rate is lower. This is attributed to the fact that everyone-young, old, working or unemployed-is covered for basic hospital and medical care in Canada without co-insurance or deductibles. This is in contrast to the United States, where there are more uninsured people (over 40 million) than Canadian inhabitants.

American critics of Canada's health care are quick to cite the fact that there are lengthy waiting lists for non-emergency medical procedures. It is also true that there is considerable overcrowding in some hospitals, but this is due to the fact that emergencies are treated immediately even if it means a lineup of gurneys in the hospital corridor-a situation I have found exists in American emergency wards as well.

The Canadian system does not rely on private insurance companies. The system is run by 10 provinces and two territories. They pay the bills and set the rules. Medicare, which services the American elderly, is the closest approximation to the Canadian one-payer system, but there are important differences.

In the United States, the government pays the bills but private insurance companies that are more wasteful than the government run the system. In addition, some of our American health-care dollars go to make the insurance companies rich and play no role in actual health care.

The waiting times for some procedures are longer in Canada than in the United States, but this problem is being actively tackled by the government in the wake of a Canada Supreme Court decision that "access to a waiting list is not access to health care." However, the decision did not abolish the one-payer system-in fact, it reinforced it by giving the Quebec government, which was the chief object of the lawsuit, 12 months to remedy the situation.

As a result, Quebec is working hard to catch up with the rest of Canada. The average wait for a hip replacement has been reduced to four to five weeks, and knee replacements usually take six to seven weeks. This may still be too long, but if you happen to be one of the 40 million uninsured Americans, you might have to wait forever.

Why have my wife and I chosen to spend our retirement years in Tucson? We did, in fact, worry about leaving behind our Canadian health care, but climate, the availability of year-round golf and relatively good health persuaded us to take the chance.

We have found medical services in Tucson excellent, but expensive and complicated. We don't like being at the mercy of an HMO and have yet to decipher the ins and outs of the new drug plan. We continue to long for the simplicity and efficiency of Canada's single-payer system.

augigi, CNS

Specializes in Critical Care, Cardiothoracics, VADs. Has 10 years experience.

I agree with the above post's quoted article - I'm in Australia and it's all very simple with universal healthcare (although the government "encourages" people to take out additional private health cover by way of an additional medicare tax if you don't). I am completely baffled by the HMO/PPO/copay/deductible system!

outcomesfirst, BSN, RN

Specializes in Research, ED, Critical Care. Has 28 years experience.

you think that state or federal agencies should take the place of private insurers?

imo, except for national defense, minting money, building highways and running police forces, there isn't anything the government can do better than the free market.

the empirical data is there. u.s. citizens spent $5,267 per capita for health care in 2002—53 percent more than any other country (gerard f. anderson, peter s. hussey, bianca k. frogner and hugh r. waters, 2005). health spending equaled 14.6 percent of u.s. gdp in 2002. only two other countries, switzerland and germany, spent more than 10 percent of their gdp on health care. international data on quality that exist—life expectancy and infant mortality statistics—place the united states in the bottom quartile of industrialized countries. population surveys have shown that the extra spending is probably not buying better experiences with the health care system, with the exception of shorter waits for non-urgent surgery. (peter s. hussey, gerard f. anderson, robin osborn, colin feek, vivienne mclaughlin, john millar, and arnold epstein 2004) the united states pays much higher prices than other countries for pharmaceuticals, hospital stays, and physician visits – these costs are all ultimately paid for by the tax payer through the cost shifting system developed to - wait for it – pay for care of the uninsured. an unexpected benefit of employer based insurance (a wwii incentive) and medicare (an initiative to help the elderly and the economy) was that health care organizations and physicians now had steady, guaranteed streams of income – and we were off to the races. incomes soared, individuals interested (venture capitalists) in profits began to invest in health care, and being a physician was becoming seriously profitable. universal health care in the us is long overdue to hard working people, basic human decency requires we provide it. using revenues to provide care, rather than a source of income is the imperative now and for the future of the united states. there is nothing wrong with profits or making money –just not at the expense of lives. what we need is basic system that immunizes every child; that anyone who needs an antibiotic gets one; that unclogs ers, that ensures a car accident does not wipe out a middle class family financially and so on. yes, choices will have to be made – do we build a new plastic surgery center or a new primary care office? do we keep patients on ventilators for 2 months, or do we accept terminal illness? hard, but necessary decisions - irrespective of payor source. health care for the masses must become what is necessary – education, prevention and treatment, not what is desired and not as a source of profits. as a nation and as individuals we must find other sources of individual revenue and wealth building. we must support healthcare education for all professions – money must stop being an obstacle to a career as a nurse, physician, or researcher and greed must not be a motivator to enter health professions. if that means an individual must wait 4 weeks for knee surgery – so be it. of course the government must run this program – our ‘government’ is why we live in the greatest country on earth.

again, i am not sure what this new hr bill is and cannot make a decision about it with out the facts, but surely the available data tells us we must do something. change is incremental, perhaps this will be a first step.

In nursing these days, we hear so much about 'evidence based' research, etc, ad nauseum. Anyone care to refute the cold hard facts that our Healthcare system is not delivering the goods? It's expensive and inefficient, giving a false sense of personal autonomy that Americans so cherish.

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