PNHP Plan Principles

• Access to comprehensive health care is a human right

• The right to chose and change one’s physician is fundamental

• Pursuit of corporate profit and personal fortune have no place in caregiving

• In a democracy, the public should set health policies and budgets

PNHP Plan

• Eligibility & Coverage• Hospital Payment• Payment for Physicians and Outpatient Care

• Long-Term Care• Medications and Supplies• Capital spending, Health planning, Profit

• Funding

Eligibility & Coverage

• Single plan , everyone in, nobody out covers all medically necessary services

• Long-term care, mental health, dental, drugs & supplies

• No co-payments or deductibles

• Portable

Hospital Payment

• Monthly lump sum for operating expenses

• No operating expenses used for expansion, profit, marketing, major capital purchases

• Capital expenditures from NHI fund based on community need

• For-profit hospitals converted to not-for-profit

Payment for Physicians and Outpatient Care

Three payment options:

• Fee-for-service (eg Polyclinic, Dr. X)

• Salaries within institutions receiving global budgets (eg Swedish)

• Salaries within capitated groups (eg GHC)

Long-Term Care

• Cover disabled of all ages

• Home and nursing home care

• Local public agency coordinates, global budgets

• For-profit NH & agencies converted to NFP

• Training, support, finances for family caregivers

Medications and Supplies

• Cover all medically necessary prescription drugs and medical supplies based on national formulary

• Expert panel establishes & updates formulary

• Negotiated drug & equipment prices

Capital spending, Health planning, Profit

• NHP budget funds construction of health facilities and purchase of expensive equipment

• Regional health planning boards allocate capital funds

• Compensation for owners of investor owned facilities and equipment

Funding

• NHP pays for all medically necessary health services, with total expenditures set at same proportion of GDP as year prior to NHP

• Public money now routed through private insurers, employer contribution, plus income & payroll taxes

• Mix of taxes used to raise funds is a matter of tax policy separate from organization of health care

Similarities between HR 676 and HR 1200

• Universal coverage- “everyone in, no one out”

• Portability (state to state and job to job)

• Choice of providers• Mechanisms for quality control and cost control

• Comprehensive benefit package (inpatient, outpatient, emergency, preventive, mental health, substance abuse, prescription drugs, long term care, dental, etc.)

Differences between HR 676 and HR 1200

• HR 676: National program, administered pricing • Payment predetermined on average provider cost.

• “Efficient” providers expected to make money while inefficient providers would lose.

• Makes "for profit" healthcare illegal.

• HR 1200: State-based program, national standards• Federal govt. collects taxes, distributes to States based on risk-adjusted percentage of population.

• Federal Board establishes required benefits package.

• Each State develops a program conforming to national guidelines, regulations, and required covered services.