Thursday, December 5, 2013

No. 12: The Expanded and Improved Medicare For All Act of 2013

On February 13, 2013, U.S. Representative John Conyers (D-MI) introduced H.R. 676, the "Expanded and Improved Medicare For All Act." The bill has 53 cosponsors (all Democrats) in the House of Representatives. On February 22, the bill was referred to the Subcommittee on Indian and Alaska Native Affairs of the Committee on Natural Resources. There has not been any other action on the bill. Here is the bill summary prepared by the Congressional Research Service:
Establishes the Medicare for All Program to provide all individuals residing in the United States and U.S. territories with free health care that includes all medically necessary care, such as primary care and prevention, dietary and nutritional therapies, prescription drugs, emergency care, long-term care, mental health services, dental services, and vision care.
Prohibits an institution from participating unless it is a public or nonprofit institution. Allows nonprofit health maintenance organizations (HMOs) that deliver care in their own facilities to participate.
Gives patients the freedom to choose from participating physicians and institutions.
Prohibits a private health insurer from selling health insurance coverage that duplicates the benefits provided under this Act. Allows such insurers to sell benefits that are not medically necessary, such as cosmetic surgery benefits.
Sets forth methods to pay institutional providers of care and health professionals for services. Prohibits financial incentives between HMOs and physicians based on utilization.
Establishes the Medicare for All Trust Fund to finance the Program with amounts deposited: (1) from existing sources of government revenues for health care, (2) by increasing personal income taxes on the top 5% income earners, (3) by instituting a modest and progressive excise tax on payroll and self-employment income, (4) by instituting a modest tax on unearned income, and (5) by instituting a small tax on stock and bond transactions. Transfers and appropriates to carry out this Act amounts that would have been appropriated for federal public health care programs, including Medicare, Medicaid, and the Children's Health Insurance Program (CHIP).
Requires the Medicare for All Program to give first priority in retraining and job placement and employment transition benefits to individuals whose jobs are eliminated due to reduced administration.
Requires creation of a confidential electronic patient record system.
Establishes a National Board of Universal Quality and Access to provide advice on quality, access, and affordability.
Requires the eventual integration of the Indian Health Service into the Program, and an evaluation of the continued independence of Department of Veterans Affairs (VA) health programs.
A Few Thoughts
During the 40 years of The Insurance Forum, I rarely wrote about the tragic situation of those in our great nation who have no insurance covering the cost of health care and those who have inadequate coverage. A few exceptions were articles contributed by Alan Press in our March 2008, June 2008, October 2009, and December 2009 issues, and my article in the June 2010 issue about the then recently enacted Patient Protection and Affordable Care Act (PPACA).

I have said on occasion that I support the concept of a single-payer system of universal health care. I have not embraced the PPACA, because I think it is a complex compromise that will not solve the problems we face. Also, I am pessimistic about the likelihood of enactment of a single-payer system, such as H.R. 676. Whenever anyone asks me why we do not have universal health care of the type found in every other advanced society in the world, my one-word answer is "Politics."

In my opinion, the enactment of Social Security in 1935 and Medicare in 1965 were the two greatest political achievements of the past century. Each occurred as the result of an extraordinary combination of events. I think it will require a similar combination of events for the U.S. to enact a system of universal health care, which thus far has eluded Presidents Theodore Roosevelt, Harry Truman, and Barack Obama.