National Health Insurance: A possible solution.... Part 2

Types of Insurance:
Single Payer Health Care: Some countries implement national health insurance through taxation or by legislation requiring compulsory contributions to a national insurance fund operated by the government from which medical expenses are provided by private entities (doctors and hospitals). This is known in the United States as single-payer health care.

Socialized Medicine: Some countries implement national health insurance through taxation and/or by legislation requiring compulsory contributions to a national insurance fund operated by government, but the money can only be spent on health services commissioned by government. This is referred to by some in the United States as socialized medicine. An example of this is the UK's National Health Service.

Equalization Pool: Some countries implement national health insurance funds which must provide a minimum standard of coverage and are not allowed to discriminate between patients by charging different rates according to age, occupation or previous health status. To protect the interest of both patients and insurance companies, the government establishes an equalization pool to spread risks between the various funds. Thus a fund with predominantly younger, healthier patients pays into the pool, and older, sicker patients may receive from the pool. The government may also contribute to the pool as a form of health care subsidy.
Social Health Insurance: countries are largely funded from contributions by employers and employees to sickness funds. Funds do not come from the government, and neither from direct private payments. This system operates in many European countries such as Germany, Belgium and Ireland. These countries have a social health insurance systems which is characterized by the presence of sickness funds, which can be based on professional, regional, religious, or political affiliation.

Here is a little background on the proposal for NHI
Historical Background:
political efforts:Theodore Roosevelt was the first presidential candidate to call for national health insurance in his 1912 third party bid for president. The only major national health insurance proposal introduced in Congress during this period was a House Joint Resolution submitted in 1916 by a Socialist Congressman Meyer London from New York's East Side. Most of the action was at the state level, with universal coverage initiatives discussed in CA, NY and several other states.

Oppositions: Woodrow Wilson, when became the president in his first inaugural address in 1913 had suggested the federal government should safeguard the nation's health but he never seriously pursued this issue during his presidency as he was preoccupied with other issues in his first term such as World War I. In Wilson’s second term as president there was a congressional initiative hearing even though it was never voted on in the committee.
Several groups who had initially supported national health care reforms began to change their position. Health care reform came late in the Progressive era when a more conservative atmosphere was covering the United States. World War one was also a major reason why national health insurance care reform never gained much momentum. The public's attention was taken by the war. Because national health insurance began in Germany, it was seen as unpatriotic during the war to support the movement. Medical profession, labor organizations and businesses groups because of their self interests clashed in ways prevented reform from becoming a reality.

On the state level between 1915 and 1920, eight states (California, Connecticut, Illinois, Massachusetts, New Jersey, Ohio, Pennsylvania, and Wisconsin) appointed official commissions to investigate health insurance. The "Standard Bill" for health insurance was drafted by the American Association for Labor Legislation in 1915 and introduced in a number of state legislators. In 1919 it was introduced in a bipartisan manner and held strong support from labor groups and civic associations, but no state bill was ever enacted because of growing oppositions. Doctors initially supported the idea of universal coverage at the state level, but ultimately came to the conclusion that government medicine might pose a serious threat to their livelihoods. They were successfully able to organize strong opposition to reform initiatives so that nothing was enacted. Pharmacists opposed the legislation because prescription drugs insurance payments, they feared would destabilize their business. While commercial insurance firms did not offer health insurance during this period, a large part of their business was offering burial insurance to pay funeral costs.

The fact that people generally felt actual health insurance (as opposed to sickness insurance) was unnecessary prior to 1920 also helped to defeat proposals for compulsory, nationalized health insurance in the same period. Although many European nations had adopted some form of compulsory nationalized health insurance by 1920 the proposals sponsored by the American Association for Labor Legislation (AALL) to enact compulsory health insurance in several states were never enacted.

However, later The Social Security Amendments of 1965 created a governmental health insurance program known as Medicare intended primarily for the aged. In 1993 President Bill Clinton introduced a plan for universal health care coverage but a negotiation could not be reached with the opponents in Congress and the bill died.

Single payer as National Health Insurance:
Single payer is one alternative proposed for reforming the U.S. health care system. According to the National Library of Medicine's Medical Subject Heading thesaurus, a Single Payer System is
“An approach to health care financing with only one source of money for paying health care providers. The scope may be national, state-wide, or community based. The payer may be a governmental unit or other entity such as an insurance company. The proposed advantages include administrative simplicity for patients and providers, and resulting significant savings in overhead costs.”

A Single payer system would provide universal coverage with at least the same quality and lower costs. The term single payer is sometimes used in the U.S. to distinguish systems paid from a single (governmental) source with other systems of health care in which the government has a higher degree of control including administering hospitals and employing doctors and staff, though logically these too are single payer systems. When the term single payer is used in this way, doctor’s practices and hospitals may remain private and negotiate with the government for fees.

The United States, Canada and Australia have single payer health insurance programs named Medicare; however, Australia's program provides universal health insurance, while U.S. Medicare is only for senior citizens. Government is increasingly involved in U.S. health care spending, paying about 45 percent of the $2.2 trillion the nation spent on medical care in 2004.

The Veterans Administration is a single payer system and provides excellent quality. In a peer reviewed paper published in the Annals of Internal Medicine, researchers of the RAND Corp. reported that the quality of care received by Veterans Administration patients scored significantly higher overall than did comparable metrics for patients in the rest of the U.S. health system.

Obama Vs McCain Healthcare Reforms in a nutshell

With Presidential elections less than sixty days away here is an overview of both the candidates Health reforms for Americans. Both have their Pros and cons, whoever wins have to fix the 1.6 trillion dollar industry.
OBAMA
Affordable national plan based on Congress's own insurance, available to small businesses and individuals without coverage.
Create national regulator to ensure that private insurance plans are fairly priced and available to all. Medicaid and existing employer plans untouched.
Pay for it by levying a payroll tax on any employer not providing insurance; subsidize some small businesses and exempt the smallest businesses and startups.
Universal coverage mandate for children only.

McCAIN
Make health insurance portable from job to job across state lines; work with states to create guaranteed-access plans.
Offer families without coverage through jobs a $5,000 tax credit ($2,500 for individuals) toward the cost of private insurance.
No universal coverage mandate.

BOTH CANDIDATES
Propose a variety of cost-cutting schemes, such as re importation of generic drugs, investing in information technology to drive efficiency, and medical-liability tort reform.

Remembering 9/11

9/11, a day which will never be forgotten. A day which bought the World's most developed country and superpower on it's knees for a moment. A day which will be remembered by many lovers, wives, sons, husbands and mothers who lost their loved ones. 9/11 will be remembered as a day when many firefighters, volunteers, policemen and United 93 hero's sacrificed their lives for strangers.
This day also holds a very special significance in my life. This was my first day in United States of America. This is the day I will never forget for the rest of my life. I will always remember, what I and people around me had gone through. I can never forget this day as it changed the world around me forever. Although it has been seven long years, the scenes of 9/11 are still fresh in my mind as if it was just yesterday. The day still sends chills down my spine. The horrifying scenes of smoke and bodies still make me depressed.Whenever I look back and remember 9/11 I tremble remembering those images I had witnessed and the world around me which changed forever. And this was reality and not the "land of dreams" making 9/11 the first day and the worst day in US and the most memorable day ever in my life.

National Health Insurance a possible solution to US healthcare crisis

Health care spending continues to rise at the fastest rate in our history. In 2007, total national health expenditures were expected to rise 6.9 percent which is two times the rate of inflation. The total spending was $2.3 trillion in 2007, or $7600 per person. Total health care spending represented 16 percent of the GDP.U.S. Health care spending is expected to increase at similar levels for the next decade reaching $4.2 trillion in 2016, or 20 percent of GDP. The annual premium for an employer health plan covering a family of four averaged nearly $12,100. The annual premium for single coverage averaged over $4,400.

Despite this expenditure, the current U.S. system fails to provide universal health coverage. Nearly 47 million Americans or about 16 percent of the population lacked health insurance in 2006.The lack of universal coverage contributes to another flaw in the current U.S. health care. In dimensions of performance, it under performs relative to other industrialized countries. In a 2007 comparison by the Commonwealth Fund of health care in the U.S. with that of Germany, Britain, Australia, New Zealand, and Canada, the U.S. ranked last on measures of quality, access, efficiency, equity, and outcomes.

Policy experts agree that our health care system is puzzled with inefficiencies, excessive administrative expenses, inflated prices, poor management, inappropriate care, waste and fraud. These problems significantly increase the cost of medical care and health insurance for employers and workers and affect families.

To overcome such high costs some policy makers and political representatives have proposed National Health Insurance as a possible solution. National Health Insurance is a government operated or publicly funded system of insurance that provides financial benefits and medical services to persons in need of a treatment or disabled by sickness or accident. Typically, most health care costs are met by the population via compulsory health insurance or taxation, or a combination of both. National health insurance systems are found in many countries, particularly in Europe. In the United States health insurance has been provided by private enterprise on a voluntary basis.

National Health Insurance at political level:
In Congress, Rep. John Conyers has introduced The United States National Health Insurance Act (HR 676). As of January 2008, HR 676 has 88 co sponsors. It was first introduced, with 25 cosponsors in 2003 and since been reintroduced each session. The act calls for the creation of a universal single payer health care system in the United States, in which the government would provide every resident health insurance free of charge. In order to eliminate unequal treatment between richer and poorer Americans the Act would also prohibit private insurers from covering any treatment or procedure already covered by the Act. The bill is currently in the House Energy and Commerce's Subcommittee on Health. The bill has drawn significant attention beginning in July 2007 because of the release of the Michael Moore documentary Sicko which focuses on the status of health care in the United States.

National health insurance is a priority issue among the presidential candidates for the elections in 2008. Hilary Clinton whose first attempt at a health care overhaul failed 13 years ago, suggests that that she would mandate coverage for 47 million uninsured Americans, provides tax credits for Americans who cannot afford insurance, offer more choices for coverage, end discrimination based on pre-existing conditions and expands Medicaid and the State Children's Health Insurance Program. Obama on the other hand suggests that all children will have health insurance and it will be paid for by rolling back President Bush's tax cuts for households earning over $250,000. Republican candidate John McCain is for free-market, consumer-based system he has pledged affordable health care for every American he says universal health care is possible without a tax increase. Whatever, their plan is the current system needs a fix before the projected health share of GDP crosses 20 percent by 2017.

National Health Insurance at State Level:
Inspired by the increasing number of uninsured Americans, the declining number of employ¬ers offering insurance to their employees and the lack of federal action, states are leading the way in health care reform. States are using market based initiatives, Medicaid and SCHIP expansions, and public-private partnership to increase access and affordability of insurance. Massachusetts is implementing a universal health care system by mandating that residents purchase health insurance .The City of San Francisco is also undertaking a universal health care system for uninsured residents. California, Maine, Vermont and Hawaii are also considering or seeking to implement universal or close to universal systems. Recently, a California State Senate committee voted on a bipartisan basis against a plan to help establish a $14 billion fund to subsidize medical insurance for 5 million uninsured Californians.

Possible Funding Models:
U.S could adopt a mixed model of funding. General taxation revenue is the primary source of funding, but in many countries it is supplemented by charge to the individual and/or an employer or with the option of private payments (either direct or via optional insurance) for services beyond that covered by the public system.
Another solution is a mix of public and private contributions. The majority of universal health care systems are funded primarily by tax revenue (e.g. Portugal). Some nations, such as France and Japan employ a multi payer system in which health care is funded by private and public contributions.

A distinction possibly can be made between municipal and national healthcare funding. For example, one model is that the bulk of the healthcare is funded by the municipality, specialty healthcare is provided and possibly funded by a larger entity, such as a municipal co-operation board or the state, and the medications are paid by a state agency.

Compulsory insurance could be enforced to cover up costs. This is usually enforced via legislation. Sometimes there may be a choice of several funds providing a basic service or sometimes just a single fund.

A risk compensation pool to equalize the risks between funds can be used. A fund with a predominantly healthy, younger population has to pay into a compensation pool and a fund with an older and predominantly less healthy population would receive funds from the pool. In this way, sickness funds compete on price and there is no advantage to eliminate people with higher risks because they are compensated for by means of risk-adjusted capitation payments. Funds are not allowed to pick and choose their policyholders or deny coverage, but then mainly compete on price and service. In some countries the basic coverage level is set by the government and cannot be modified.

Opponents of government mandates or programs for universal health care argue that people should be free to opt out of health insurance and that government programs would require higher taxes, increase utilization, and reduce health care quality. Opponents also claim that the absence of a market mechanism may slow innovation in treatment and research.

Possible Solutions:
National health care costs would be lower than the current US system due to lower administrative costs. By lowering these administrative costs the United States would have the ability to provide universal health care, without managed care, increase benefits and still save money.

The US denies access to health care based on the ability to pay. Under a universal health care system all would access care. There would be no lines as in other industrialized countries due to the oversupply in our providers and infrastructure, and the willingness/ability of the United States to spend more on health care than other industrialized nations.

National health care administered by a state public health system would be much more democratic and much less intrusive than our current system. Consumers and providers would have a voice in determining benefits, rates and taxes. Problems with free choice, confidentiality and medical decision making would be resolved.

For profit, managed care cannot solve the US health care problems because health care is not a commodity that people shop for, and quality of care must always be compromised when the motivating factor for corporations is to save money through denial of care and decreasing provider costs. In addition managed care has introduced problems of patient confidentiality and disrupted the continuity of care through having limited provider networks.

Insurance industry with some change in government mandates has the expertise to make universal health insurance possible by simply redesigning some insurance products and better utilizing the dollars we already have available. For example, every employer in this country is required by law to purchase workers' compensation. Most employers offer health insurance to some degree. However, job-related sickness or injury must be covered by workers' compensation. Off-the-job sickness or injury must be covered by health insurance. This has the employer paying out of two different pockets for one common end health insurance. By mandating universal health insurance and shifting the part of the workers' compensation premium that covers health issues to universal health insurance, these premium dollars will be better utilized.

Federal government along with state and local government in partnership and on a mandatory basis provide National health insurance by adopting as single type or a mix and match of multiple types of healthcare funding models and provide health coverage for all including the uninsured.

Another possible solution instead of providing NHI is enacting a standard health insurance deduction, expanding health savings accounts and deregulating insurance markets that could truly expand coverage, improve quality and make care more affordable

In establishing universal health care the best remedy for countries health care crises is not increasing government power, but increasing patient power instead. Affordable, high quality health cares a right of all Americans irrespective of age, race, income and residency differences in our society Any National payer system should have these two characteristics:
1) A defined set of benefits guaranteed to all citizens; and,
2) A global budget to pay for the health services provided (the fixed total amount of money that will be spent for one year on a given set of benefits offered to the entire population).

Health care Card In India for the poor

Rashtriya Swasthya Bima Yojana which was formally launched on the 1st of October last year to help provide smart card based cashless health insurance cover up to Rs.30,000 or $700 to the Below poverty Line or BPL families in the next five years under the Health Insurance Scheme. An estimated six crore BPL workers in all 600 districts in the country at one lakh workers per district would be covered for 120 district per year starting from this financial year. The Central Government has already issued Guidelines and a Draft Tender Document has been prepared and sent to all the States.
This is how it works, total sum insured would be Rs. 30,000/- per family, per annum, on a family floater basis. It would operate through cashless transactions and would cover hospitalization expenses, taking care of most of the illnesses with as least exclusions as possible. An initial allocation of Rs.250 crore has been made in the budget 2008-09. The Centre would contribute 75% of the annual premium whereas the States would be contributing the remaining 25%.
The use of smart card will make this project totally cashless and provide interoperability to facilitate use by migrant labor and use of IT applications for the poorest of the poor make this scheme unique in nature. The Scheme would use both public and private service providers for delivering the insurance package. It would also seek the contribution of Rs.30, by way of Registration fee, from the BPL beneficiary with a view to inculcating a sense of ownership in them. Fifteen States (Delhi, Rajasthan, Gujarat, Haryana, Bihar, Uttrakhand, Kerala, Punjab, Chhattisgarh, Jharkhand, Uttar Pradesh, Tamilnadu, Karnataka, Maharashtra and West Bengal) have been approved. States of Orissa and Himachal Pradesh are likely to start very soon. All States, except the States in the North-East and J&K, have formally communicated their participation in this program. The Enrolment software has, by and large, stabilized but the real challenge would be the operation of Transaction software which will be used in the hospitals. The specifications for Transaction Software have been approved and released. A Certification System has also been put in place. A couple of Service Providers have submitted the software for certification.

The card is works at both public and private hospitals that have pre-enrolled in the program. The card system functions like a health savings accounts with s consumer-driven incentives to manage costs wisely. The program launched in April has already drawn 1.5 million enrollees. The government hopes 60 million more will join buy the 1st anniversary of the program.

The challenges are many; the back-end data base management which would ultimately make the scheme paperless can lead to fraud and insecurity. This is a long term exercise which will take a few months. If a person is not present in his home state he is not eligible he has to return to his home state to qualify. Not all private practices and hospitals will be willing to allocate discount rate for such a system and until now there are just few enrollees. This type of card should not lead to the market distortions that occurred in the United States after Medicaid and Medicare came into existence. Another challenge is that it only covers medication to a certain extent which would eat a large chunk of money. This is a good move by the government to help the underprivileged yet deserving population, we have to wait and watch how far this scheme is successful. While the use of the card is limited to care at hospitals, it still goes a long way to reduce the chance that medical debt will financially crush already-impoverished families. And with one-third of the world's poor living within its borders, India is right to address its health care challenge the budget provides for Rs.10 billion for the Aam Admi Bima Yojana that provides insurance cover to poor households. This will cover 10 million poor households in addition to the 10 million likely to be covered by Sep 30 this year.