The American healthcare system is sick. It's bleeding dollars and losing patients. As many as 18,000 people in the U.S. die needlessly every year because they don't get the care they need or they get it too late. Most estimates report 44-50 million people in the U.S. have no health insurance while another 50 million are under-insured. That's 1/3 of our entire population, many of whom wait until it's an emergency before they seek medical attention. The result is less preventive care and more, high cost, ER care. In fact, the U.S. pays nearly twice as much per person as other industrialized nations who cover everyone. Yet we only rank 37th in system performance.

The U.S. Spends
Twice the Money on Health;
Ranks 37th in Quality
(Source:  World Health Org)

At the same time, the cost of insurance continues to rise - up 7.7% in 2006 - contributing to the 66% increase we've experienced in a 6 year period. That's 3 times more than worker's earnings rose during the same 6 years. And those same workers are being asked to pay a higher percentage of the premiums, higher deductibles, and higher co-pays.

The Cost of Health insurance
Increased 66%
from 2001-2006

Businesses are being hurt just as badly. High health insurance costs are squeezing profits and limiting our ability to compete, especially in a global marketplace. And in the end, American consumers and taxpayers absorb those costs. The U.S. government has been debating solutions to these problems for nearly 2 decades. In the Republican party, John McCain would “increase the variety and affordability of insurance coverage.” Governor Huckabee favors Health Savings Accounts and also wants to make health insurance more portable and tax deductible. As Governor of Massachusetts, Mitt Romney helped implement a form of universal coverage that made health insurance mandatory, just like car insurance. This general approach is also favored by Democrats Hillary Clinton and Barack Obama. Clinton offers subsidies to those who cannot afford the mandated insurance. Obama wants to reduce premiums but not mandate purchases for adults. John Edwards wants to open Medicare to everyone at a lower cost than traditional insurance, which would eventually drive insurance companies out of the healthcare business. Independent candidate Ralph Nader wants to eliminate health insurance altogether and implement a single-payer, government-run system that's typical in industrialized countries throughout the world. This is also the solution and the bill Rep. Dennis Kucinich and “Sicko” movie Producer/Director Michael Moore endorse. Is it the right Rx for America?

The Bill

The United States National Health Insurance Act (AKA the Expanded and Improved Medicare For All Act) would eliminate health insurance as we know it and replace it with a “universal, best quality standard of care for all individuals residing in the U.S. including any territory.”

In addition to medical care, it also covers dental, vision, hearing, mental health and long term care - with an emphasis on home and community-based approaches. All these services will become available to everyone at no cost. In fact, deductibles, co-pays and co-insurance would be outlawed. It would also be illegal for any insurance company to sell you coverage for these kinds of costs, although they could cover treatments not deemed medically necessary such as cosmetic surgery or in vitro fertilization.

People will fill out a 2-page form and receive a National Health Insurance card. But even if you don't have a card, you are presumed to be eligible. And you can visit any participating doctor, clinic or hospital that you like.

For a clinic or hospital to be a participating provider, it must be a public or not-for-profit organization. Investor-owned, for-profit institutions have to convert and can basically be bought out by the U.S. government over a period of 15 years. HMOs that are already non-profit and have their own employees can participate.

All hospitals, physicians and clinicians must be licensed and/or accredited by their States. Doctors and other licensed medical professionals can choose to be paid a salary or charge a fee for service based on “current prevailing fees.” Again, those fees will be paid by the U.S. government not the patient.

Institutions like hospitals will work on an annual “global budget” that they can allocate as they see fit. There is also a separate capital expenditures budget that can only be used for major equipment purchases or the construction or renovation of healthcare buildings. In all cases, electronic record-keeping is mandated.

Prescription drugs and medical supplies and equipment are also free to all patients. The program will negotiate prices with the pharmaceutical companies, a practice which is now forbidden.

The whole program would be administered by a Director appointed by the Secretary of Health and Human Services. This Director would then appoint regional Directors and Directors for Long-Term Care, Mental Health and Quality Control. Each State will also have a Director appointed by its governor. A newly established National Board of Universal Quality and Access will provide oversight. The 15 members of this board include healthcare experts who are appointed by the President and approved by the Senate.

To fund everything, we will establish the U.S. National Health Insurance Trust Fund given “amounts sufficient to carry out this act.” The money will come from 4 different sources:

All current federal government expenditures on healthcare including Medicare, Medicaid and S-CHIP, (but not Veteran's Affairs and Indian Health programs.)

An increase in the income taxes of the top 5% of earners.

An excise tax on businesses, employees and self-employed individuals (akin to the existing Medicare Tax).

A small tax on stock and bond transactions.

Conyers estimates this program will require $1.19 trillion more in government expenditures per year. This takes into account savings of $387 billion realized through reduced paperwork, minimized administration and bulk purchasing. If enacted, this bill would take effect on the 1st of January following its passage.

“McCain, Obama and Clinton - are against single payer health insurance, full Medicare for all. I'm for it as well as millions of Americans and 59% of physicians.”
Ralph Nader (Indy)
Presidential Candidate

“If I were starting from scratch then a single-payer system would probably make sense. But we've got all these legacy systems in place … so we may need a system that's not so disruptive.”
Barack Obama (D-IL)
Presidential Candidate

“Before you decide to sign on to that kind of a program, go to Canada, or go to European countries that have government-run health care systems. My friends, they don't work, they're inefficient, and they end up in a two-tiered system”
John McCain (R-AZ)
Presidential Candidate

“We've come up with something that's much closer to Republican ideals: reform the market to make the health insurance marketplace work better. Insist on personal responsibility instead of government responsibility.”
Mitt Romney (R, MA)
X  Gov. + Pres. Candidate