| The Single Payer bill furthest along in the legislative process belongs to the state of Pennsylvania, where the House bill was resubmitted last week, with 36 co-sponsors. You can read the whole bill here. (Don't worry, it's only 27 pages) Basically: The plan shall provide health care coverage for all citizens of this Commonwealth and for certain eligible visitors. The agency shall work simultaneously to control health care costs, achieve measurable improvement in health care outcomes, promote a culture of health awareness and develop an integrated health care database to support health care planning and quality assurance.
I'll answer in detail after the jump, but this is NOT socialized medicine. Here is what would be covered: Covered services. (a) Benefits package.--The board shall establish a single health benefits package within the plan that shall include, but
not be limited to, all of the following: (1) All medically necessary inpatient and outpatient are and treatment, both primary and secondary.
(2) Emergency services.
(3) Emergency and other medically necessary transport to covered health services.
(4) Rehabilitation services, including speech, occupational, physical and massage therapy.
(5) Inpatient and outpatient mental health services and substance abuse treatment.
(6) Hospice care.
(7) Prescription drugs and prescribed medical nutrition.
(8) Vision care, aids and equipment.
(9) Hearing care, hearing aids and equipment.
(10) Diagnostic medical tests, including laboratory tests and imaging procedures.
(11) Medical supplies and prescribed medical equipment.
(12) Immunizations, preventive care, health maintenance care and screening.
(13) Dental care.
(14) Home health care services.
(15) Chiropractic and massage therapy.
(16) Complementary and alternative modalities that have been shown by the National Institute of Health's Division of Complementary and Alternative Medicine to be safe and effective for possible inclusion as covered benefits.
(17) Long-term care for those unable to care for themselves independently and including assisted and skilled care. (b) Exclusions for preexisting conditions.--The plan shall not exclude or limit coverage due to preexisting conditions. (c) Copayments, deductibles, etc.--Beneficiaries of the plan are not subject to copayments, deductibles, point-of-service
charges or any other fee or charge for a service within the package and shall not be directly billed nor balance billed by
participating providers for covered benefits provided to the beneficiary. Where a beneficiary has directly paid for
nonemergency services of a nonparticipating provider, the beneficiary may submit a claim for reimbursement from the plan for the amount the plan would have paid a participating provider for the same service. Where emergency services are rendered by a nonparticipating provider, the beneficiary shall receive reimbursement of the full amount paid to such nonparticipating provider not to exceed 125% of the amount the plan would have paid a participating provider for the same service.
You will NEVER see a more comprehensive plan. The funding system involves taxes. There, I've said it. OOOOH - the third rail!!!!! Pause. Breathe. Good, lightening has not struck. You say the word "taxes" and people seem to implode and lose their minds. What they forget, especially in this case, is that other costs offset the taxes. For example, pretend that you are currently employed, with a spouse and two kids. You receive health insurance through your job. The annual premium is $12,500 (which is about the median, depending on whose numbers you believe, the range of everything I've seen is about $11,600 to $15,500). You pay 20% of the premium, or, $2,500 annually. You earn $50,000/year. The tax would be 3% - that would be $1,500. Thus, you'd pay less in taxes than your current premium, plus, no deductibles or co-pays. On the employer side, your employer is now paying $10,000 for your premiums (actually a little less because of the tax exclusion) or 20% of your pay. The tax to your employer would be 10% or $5,000, HALF of what it is paying now. I know your question: why does it cost so much less and provide more? Answer after the jump. |
Let's say you break your leg. You go to the emergency room, where they x-ray your leg, operate because it is a compound fracture and you need a pin, set your leg, keep you in the hospital for two days, and then send you home with instructions for follow-up care. Billing would come, separately, from the ER, the docs, the radiologists, the hospital, the pharmacy, etc. Currently the goal of your insurance company is to find a way to pay out less for your treatment than it earned from premiums. Therefore, there are costs associated with processing the bill, denying parts of it, reviewing it, and finally paying for part of it, leaving the rest to you. This process can easily add hundreds of dollars to a claim. For a complicated claim, it can add thousands of dollars. Those administrative costs disappear with Single Payer. In addition, due to the implementation of electronic records and, most likely, bundling, the costs from the providers decrease and there is less of a bill to pay. Further, since there is no longer a private insurer with "the deal" there are no ancillary costs associated with making-up the costs not accorded the insurer with "the deal". Thus, overall costs and specific costs reduce in real terms. ______ Finally: Is this socialized medicine? No. Socialized medicine means that the government both pays for and provides health care. Under Single Payer, services are still provided privately. The only difference to the provider is to which address the bill is sent. And also that the bills will be paid without argument, re-submission, or court time.
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