NHI Topicality Neg

NHI Must Have Ten FeaturesNHI incorporates ten featuresHaslett 13

David, professor emeritus of philosophy at the University of Delaware. He has written a number of articles in ethics, social and political philosophy, and philosophy of law, as well as several books, including Capitalism with Morality. “National Health Insurance Reconsidered.” Health Affairs blog, February 15, 2013, http://healthaffairs.org/blog/2013/02/15/national-health-insurance-reconsidered/

What shall be argued here is that national health insurance achieves every one of these goals, but only in a form much like that outlined below, incorporating ten features .

The Ten Features

1. Universality . National health insurance is to cover every citizen, and cover each for life. It is to replace Medicare, Medicaid, SCHIP, and every other program that is part of the excessively complex, overly expensive, inadequate patchwork of government health care programs that exists today.

2. Comprehensiveness. National health insurance is to be comprehensive . Except for purely elective procedures, such as fertility treatments and most cosmetic surgery, it is to cover all proven health care, including medical tests, hospital stays, rehabilitation treatments, and medications. And there are to be no restrictions, either direct or indirect, upon the freedom of doctors to prescribe whatever proven health care they consider appropriate. What qualifies as ‘proven’ health care — proven, as opposed to clearly experimental, bogus, or harmful — is to be determined by an independent panel of distinguished doctors. Their decisions are to be based not upon cost considerations, but upon medical considerations only.

3. Free Choice of Doctors. National health insurance is to place no restrictions upon the freedom of people to choose their doctors and other health care providers themselves .

4. Large Co-payments. For effective free-market price competition among health care providers, it is necessary for people to be prudent, thoroughly cost-conscious health care shoppers. But for people to have sufficient incentive to be cost conscious, they must bear much of their health care costs directly, rather than indirectly through insurance premiums. Therefore — except for crucial preventative care, such as periodic physicals, prenatal care, and immunizations, which is to be provided at no charge — national health insurance is to require co-payments of 50 percent for all health care. Large co-payments reduce, considerably, the tax dollars that otherwise would be needed for financing national health insurance. And they place more of the burden of financing it upon those consuming more of its services, which is as it should be. And most important, large co-payments provide people with sufficient incentive to be genuinely prudent, cost-conscious health care shoppers.

5. A Yearly Cap. A national insurance agency, the NIA, is to be established for reimbursing health care providers and collecting co-payments . Health care providers are to supply the NIA with the information necessary for reimbursing them. From this information, the NIA is, for each household, to determine the total amount of co-payments the household has accumulated during the year, and send the household an itemized list. But how much of this total the household ends up actually paying is to be to be capped at 25 percent of the household’s income that year above poverty guidelines. The rest need never be paid. Call this the ‘yearly’ cap. Since a household’s yearly cap cannot be determined until its income for the year has been determined, how much of its total accumulated co-payments it must actually pay cannot be conclusively determined until the year is over. After the year is over, the amount owed is to be paid either all at once, or in equal installments over a period as long as ten years, at a fair rate of interest.

6. A Long-term Cap. To help alleviate family financial hardships from long-term medical conditions — from, that is, illnesses or injuries that require expensive treatment over a number of years — co-payments related specifically to a long-term condition are to be capped as soon as the total already paid reaches 50 percent of the average above-poverty-line household income for the years in which the payments were made. Call this the ‘long-term’ cap. The percent of co-payments a household pays toward reaching its yearly cap for any given year that also counts toward reaching its long-term cap for any given condition is to equal whatever percent of the household’s total medical expenses that year were related to the condition.

7. Free-Market Prices. Health care providers are to be strictly prohibited from ever charging more than they would otherwise charge just because a household’s yearly or long-term cap has been, or is likely to be, exceeded. Other than this, national health insurance is not to place any restrictions upon what providers charge. And, regardless of what they charge, providers that observe the above prohibition are, by government, to be reimbursed in full for any nationally insured care they provide, except for care not subject to the normal constraints of supply and demand. Care not subject to the normal constraints of supply and demand would be (1) preventative care provided free of charge, and (2) extraordinarily expensive care, like heart transplants, care that, by itself, would be costly enough to put a typical household above its yearly or its long-term cap, thereby undermining the incentive to shop prudently. How much providers are to be reimbursed for care not subject to these normal constraints is to be determined by NIA officials in negotiation with a panel of health care providers. The reimbursement limits they set are to be just high enough for assuring that providers choosing not to charge more than these limits will be sufficient in number for no one ever to lack timely access to necessary care solely because of costs. Households that patronize providers that do charge more than these limits are to be wholly responsible for paying the difference themselves.

8. Supplemental Health Insurance. Supplemental health insurance to cover amounts charged above reimbursement limits, or to cover experimental treatment, may be bought from private companies. But, to preserve people’s incentives to be prudent health care shoppers, private health insurance is never to cover national health insurance co-payments .

9. Free-Market Entry. There are not to be any restrictions, direct or indirect, upon admissions to medical schools or entry into the medical profession, except as is necessary for quality control.

10. Transparency. To be prudent health care shoppers, people need to have not only sufficient incentive, but also sufficient information, information about what providers charge for each service or treatment. They need information about alternative treatments, side effects, success rates, and probabilities, enough information for well-informed, doctor/patient shared decision making. Sufficient information is to be achieved through carefully conceived transparency regulations.

NHI = Universal Coverage

NHI guarantees universal coverage of all US residentsBodenheimer and Grumbach 16

(Thomas & Kevin. Profs of Family & Community Med, UCSF, Understanding Health Policy: A Clinical Approach, 7th ed, 2016, http://accessmedicine.mhmedical.com/content.aspx?bookid=1790&sectionid=121192308

National health insurance means the guarantee of health insurance for all the nation’s residents—what is commonly referred to as “universal coverage. ” Much of the focus, as well as the political contentiousness, of national health insurance proposals concern how to pay for universal coverage. National health insurance proposals may also address provider payment and cost containment.

AT: Medicare is NHI

Medicare is an alternative to NHI. NHI must provide universal coverage; Medicare doesn’tPatel and Rushefsky 14

Kant and Mark E., emeritus prof and full prof of political science, Missouri State U, Healthcare Politics and Policy in America, 4th edition, 2014, books.google.com, p. 188 (Google play edition)

Medicare is the largest public sector healthcare program in the United States, in terms of both dollars and numbers of people covered. It began as an alternative to national health insurance and remains one of the most popular government programs.

Medicare is effectually topical as NHI at best. It only covers one segment of the populationPatel and Rushefsky 14

Kant and Mark E., emeritus prof and full prof of political science, Missouri State U, Healthcare Politics and Policy in America, 4th edition, 2014, books.google.com, p. 189 (Google play edition).

Medicare would cover a large portion of the population, and virtually all would contribute and benefit. It was, effectively, national health insurance for the elderly and eligible disabled (Reid 2009).

NHI = Single Payer

NHI in intent to define interpretation is single-payerBedard 02

Darlene, International Studies BA, St. John Fisher College, Rochester, NY, “Canadian National Health Insurance Versus United States Private-Pay Health Care: Case Study in Coronary Artery Disease.” May 2002, p. 2.

Several terms are often used interchangeably when discussing health care systems. To avoid any confusion national health insurance, national health system, socialized health insurance and private pay health insurance are defined below for use in this paper.

• National health insurance refers to a single-payer system that provides universal access. Under this system, the government finances health care through general taxes, but the actual care is delivered via private -pay providers.

• A national health system differs from national health insurance in that the government not only finances the insurance program, but also manages the infrastructure of the delivery of medical care . Under this system, the government operates most medical institutions, and health care providers are government employees.

• A socialized health insurance system is different yet; employers and employees finance health care through government-mandated contributions . Private pay providers deliver health care, and private not-for-profit insurance companies are responsible for collecting the contributions and paying physicians and hospital.

• Private Pay Health Insurance is the responsibility of the insured to provide for themselves . Most large United States employers offer some form of partial payment for select health insurance coverage for their employees, but other United States' citizens must pay an insurance company directly for health insurance or go without any health insurance if they are unable to afford payment.

NHI = Financing of Health Care, Not Nationalization of the Industry

Nationalization of health care providers goes beyond NHIWallace 80

Helen M., Chief of the Child Health Studies Branch of the Children's Bureau, Washington, D.C., “National Health Insurance and Child Health Care,” Journal of Public Health Policy, vol. 1, no 2, June, p. 150

“The terms national health insurance and national health service are often used synonymously, but in fact they have different meanings. National health insurance means the collection and distribution to providers to defray the expenditures for health care. National health service means the system of delivery of care to recipients: the planning, provision, and evaluation of health services (e.g., medical, dental, ambulatory, drugs, appliances); and responsibility for recruitment, education, training, and deployment of health personnel. National health insurance is essentially a bill-paying activity, but it can potentially affect the content and the emphasis of services and patient care.”

National health insurance is distinct from national health service (NHS)Slee 01

Vergil. N., emeritus fellow of the Estes Park Institute and founder of the Commission on Professional and Hospital Activities. Slee’s Health Care Terms, 4th edition, 2001, as cited in National health services, From Library of Congress Subject Headings, http://id.loc.gov/authorities/subjects/sh85083180.html

national health service: an approach to health care reform in which the government actually owns the hospitals and employs the physicians thereby becoming the provider of health service. This is distinguished from national health insurance, in which the government is the sole payer but not the provider . Sometimes called nationalized health service.)

Cummings 03

Nicholas A., Entrepreneur of Psychology: The Collected Papers of Nicholas A.Cummings, 2003. books.google.com, pp. 67-68.National Health Insurance Versus National Healthcare :

Although national health insurance and national health care are often used interchangeably , it is important to point out that they are essentially two distinct national health schemes. National health insurance conceives of health services delivered within a variety of public and private institutions and financed by the Social Security system or by a method similar to the Social Security system (i.e., employer/ employee contributions ). Within national health care, on the other hand, the government would own all of the delivery systems in a manner similar

to Veterans Administration medical service delivery . Some leadership within the Department of Health , Education , and Welfare and organized labor share a distrust of the private sector and favor national health care. The opposite is true within the majority of the Congress and certainly within the health insurance industry , which inherently resists government interference.

National health insurance is a model distinguished from national health service, social insurance, and private voluntary health insuranceAnderson & Maxwell 04Gerald F. and Stephanie L., “Health Policy in International Perspective,” Encyclopedia of Bioethics, http://www.encyclopedia.com/science/encyclopedias-almanacs-transcripts-and-maps/health-policy-international-perspective.

The four generic models are national health service, national health insurance, social insurance, and private voluntary health insurance .

NATIONAL HEALTH SERVICE. National health service systems usually collect revenues from general taxation, mandate the use of public facilities, and have limited cost sharing. As a result, countries with national health service generally offer the greatest equality in access to care and employ the most progressive financing methods. However, some critics have expressed concern that national health services may be relatively inefficient and unresponsive to individuals' healthcare service preferences (Enthoven).

The United Kingdom's National Health Service (NHS) is the archetypal example of this model. Since its creation in 1948, the guiding principal of the NHS has been equity—equal access to healthcare services for all inhabitants. The NHS offers a comprehensive array of government-provided services, a national benefits package, and is financed by general tax revenues. During the early 1990's, the concerns about inefficiencies and customer service led to introducing some market incentives and development of a system of competition within the NHS (Enthoven). However, subsequent reforms initiated by the Labor government largely abolished the quasi-market and emphasized the idea of collaboration with a return to strong elements of command and control (Le Grand).

NATIONAL HEALTH-INSURANCE PROGRAM. National health-insurance systems usually generate revenues from general taxation, have private providers and facilities, allow the government to set payment rates for healthcare providers, and may have limited cost sharing. The major difference between national health insurance and national health service is the ownership of the facilities.

The Canadian health system is an example of a national health-insurance system. Revenues are generated from general taxation, the government sets payment rates for the providers who participate in the system, and there is no cost sharing. Healthcare professionals must choose between participating in the national health-insurance system and opting out of the system entirely to work in the privately financed sector (Flood and Archibald).

SOCIAL INSURANCE. In social insurance systems, revenues are generated from payroll taxes, the private sector provides health insurance, private facilities are common, and the government

sometimes sets payment rates for providers. Although insurance is compulsory, and thus accessible to all, the scope of healthcare benefits may vary by plan.

Social insurance, the first type of health insurance to be developed, was introduced in Germany by Otto van Bismarck [1815–1898] in 1883. Germany has continued to use the social insurance system, and several European nations and other countries like Japan and Korea have modified the basic social insurance model to meet their own needs (Glaser, Powell and Anesaki, Anderson).

PRIVATE VOLUNTARY HEALTH INSURANCE. In the private voluntary health insurance system revenues are generated by a variety of sources including premiums, payroll taxes, and general taxation, private facilities are the norm, the government may or may not set provider payment rates, and coinsurance is common (Maxwell, Storeygard and Moon). This system is likely to have the greatest disparity in access to healthcare services, since access is based upon ability to pay. In addition, it is common for a proportion of the population to be uninsured. In theory, this system should be more efficient than government-run health systems, because free-market competition should result in greater efficiency (Enthoven and Kronick). However, it is believed by many that free-market principles, such as a free flow of product information and price sensitivity among consumers, do not fully apply to the healthcare sector, and consequently competition and greater efficiency do not always occur (Rice et al.). The United States and many low and middle-income countries use a system of voluntary private health insurance.

National health insurance uses private sector providersNiles 16

Nancy J., Basics of the U.S. Health Care System, books.google.com, p. 411

National health insurance: An insurance program funded by the government through general taxes, although the delivery of care is by private providers . It is a legally enforced scheme of health insurance that insures a national population against the costs of health care.

NHI Must Provide Comprehensive Health Care

NHI is financing and government administration to provide comprehensive health careMosby’s Medical Dictionary 09

(Mosby's Medical Dictionary, 9th ed.) http://medical-dictionary.thefreedictionary.com/national+health +insurance)

National Health Insurance: a health insurance program in many countries other than the United States that is financed by taxes and administered by the government to provide comprehensive health care that is accessible to all citizens of that nation.

Almgren 12

(Gunnar, Professor and Faculty Research Associate in the School of Social Work, University of Washington, Health Care Politics, Policy and Services: A Social Justice Analysis, 2d. ed. 2012, Glossary, p. 386)

National Health Insurance. In classic form, national health insurance entails universal coverage for a comprehensive array of health care services, financed through a tax-based public health insurance fund.

NHI benefit package listBodenheimer and Grumbach 16

(Thomas & Kevin. Profs of Family & Community Med, UCSF, Understanding Health Policy: A Clinical Approach, 7th ed, 2016, Kindle Edition, Kindle Locations 5751-5753).

An important feature of any health plan is its benefit package. Most national health insurance proposals cover hospital care, physician visits, laboratory, x-rays, physical and occupational therapy, inpatient pharmacy, and other services usually emphasizing acute care .

NHI Excludes Out-of-Pocket Funding for Health Care

NHI replaces out-of-pocket funding for health careBodenheimer and Grumbach 16

(Thomas & Kevin. Profs of Family & Community Med, UCSF, Understanding Health Policy: A Clinical Approach, 7th ed, 2016, Kindle Edition, Kindle Locations 5495-5499).

National health insurance involves the replacement of out-of-pocket payments by one, or a mixture, of the other three financing modes. Under government-financed national health insurance plans, funds are collected by a government or quasigovernmental fund, which in turn pays hospitals, physicians, health maintenance organizations (HMOs), and other health care providers. Under private individual or employment-based national health insurance , funds are collected by private insurance companies, which then pay providers of care.

NHI Requires Mandatory Participation

NHI is compulsoryBodenheimer and Grumbach 16

(Thomas & Kevin. Profs of Family & Community Med, UCSF, Understanding Health Policy: A Clinical Approach, 7th ed, 2016, Kindle Edition, Kindle Locations 5520-5522).

Key to the financing of national health insurance was its compulsory nature; mandatory payments were to be made on behalf of every eligible person, ensuring sufficient funds to pay for people who fell sick .

Voluntary health insurance is mutually exclusive with NHIAlmgren 12

(Gunnar, Professor and Faculty Research Associate in the School of Social Work, University of Washington, Health Care Politics, Policy and Services: A Social Justice Analysis, 2d. ed. 2012, Glossary, p. 389).

Voluntary Health Insurance. Health insurance plans that are funded from purchasers that include individuals, private and public employers, employment industry purchasing cooperatives, beneficent societies, and labor unions. The term “voluntary” refers to the voluntary nature of participation in the insurance plan, in contrast to the compulsory nature of a tax-based public health insurance fund (see national health insurance ).

NHI Must Be National in Scope

NHI needs to cover the whole nationKooijman 99

Jaap, instructor, Faculty of Humanities, U of Amsterdam, --and the Pursuit of National Health, The Incremental Strategy Toward National Health Insurance in the United States of America, 1999, p. 102. Books.google.com

Moreover, [I.S.] Falk feared that any compromise on the scope of national health insurance would undermine the most important objective. “ National health insurance is national because it undertakes to draw on the economic resources of the whole nation in order to meet the health needs of people everywhere whether they live in rich or poor areas, and whether they are urban or rural .”

Knowledge@Wharton 11

Wharton School of Business, University of Pennsylvania, High School Glossary Project, February 28, http://kwhs.wharton.upenn.edu/term/national-health-insurance/

National health insurance is health insurance provided to an entire nation. In Canada, everyone is covered by national health insurance from birth, rather than receiving insurance from their parents or employers until they turn 65, as we do in the US.

NHI in US inherency depends on national-level decisions about paymentLieberthal 16

Robert D., Professor of Public Health, U of Tennessee, Knoxville, What is Health Insurance (Good) For? 2016, p. 256

Most national health insurance systems and single payer systems perform a financial intermediation role in defining what is healthcare and what the system pays for, and does not pay for. In part, this is a pragmatic aspect of public financing of healthcare, since it would be impossible for a governmental plan to pay for “everything” and still remain solvent. Instead, all social health insurance programs make public choices. The main difference between the U.S. and non-U.S. systems is that national health insurance and national healthcare systems make decisions on a national basis rather than on the basis of particular plans, populations, or employers, as occurs in the United States .

Alternatives to NHI

Expanding public health services to lower-income population would be an alternative to NHIKooijman 99

Jaap, instructor, Faculty of Humanities, U of Amsterdam, --and the Pursuit of National Health, The Incremental Strategy Toward National Health Insurance in the United States of America, 1999, p. 46. Books.google.com (Google Play ebook).

However, the most challenging of all alternative proposals to Sydenstricker and Falk’s [1935] national health insurance plan was the “coordinated plan to achieve health security” introduced by surgeon general Thomas Parran. Instead of national health insurance , he suggested, the existing public health services could be expanded to provide medical care to the lower-income population . Measures for the extension of maternal and infant care had already been included in the economic security bill. To extend these measures even further would only be a little step.

NHI alternatives either retain private payment or don’t cover everyoneMatusiak 04

(Dr. Matthew M, Director, Public Health Laboratories Marion County Health Department Indianapolis, A National Health Insurance System/Program: A Review Of US History And Current Debate, The Internet Journal of Healthcare Administration. 2004 Volume 3 Number 2., https://webcache.googleusercontent.com/search?q=cache:bNi0B8hDAkIJ:https://print.ispub.com/api/0/ispub-article/7628, p. 5

Alternatives Suggested to the National Health Insurance The mounting health care insurance and health care disparity crisis has created several alternatives to a National Health Insurance proposal. Critics state that “all [these proposals] share one critical liability: because they would retain the role of private insurers, they would perpetuate administrative waste, making universal coverage unaffordable” (1, p. 803).

Contribution Schemes and other Mechanisms to Increase Patients' Price Sensitivity

This proposal places a cap on the employers' premium contribution at a specified fixed amount. This would cause employers to look for low cost options in health care insurance and health care treatment. Identified problems would be that the increasing cost of health insurance would be re-directed from the employer to the employee. Additionally, lower-income workers would need to choose between a higher priced insurance plan and other personal expenses or a lower-priced health insurance plan with little or no benefit to the employee (1).

Tax Subsidies

This proposal would offer tax credits to low and middle income families that purchase private health insurance. Identified problems would be the amount of tax credit given and the rise in

the cost of health insurance. The current proposal has an annual credit of $3,000.00 per family under President Bush's Plan. This amount falls far short of the annual amount of adequate health insurance paid in the United States (1).

Expansion Medicaid and other Public Program

These proposals would expand the eligibility requirement for public programs. One obvious problem would be that these programs are already considered to “offer second-class coverage” (1, p. 803) to enrollees. Another identified problem is that the payment by Medicaid and other public programs are slow. This may cause financial difficulties for health care providers if the number of enrollees is high (1). This already has been realized in some of the public hospital closures recently in the United States.

Employer Mandates

These proposals would mandate that all employers pay for health insurance for their employees. This would include a mandate that employers pay all or a major part of the premium. The identified problems would be the effect on the economy and small businesses. The businesses in the United States would begin to lower wages or increase prices to compensate for this mandate. Thus, the problem has not been solved. The employee would not have the ability to pay for the health insurance because of personal expenses versus the cost of insurance (1).

NHI Topicality Aff

NHI Need Not Be Universal Coverage

NHI need not cover the entire population. Germany proves.Maarse et al. 13

Hans, chair in health care policy analysis in the Faculty of Health Sciences of the University of Maastricht. “Bismarck’s Unfinished Business in Western Europe.” In Scaling Up Affordable Health Insurance: Staying the Course, World Bank Report, ed. Alexander S. Preker, et al., p. 337, https://openknowledge.worldbank.org/handle/10986/13836

A single national health insurance model does not exist. Hence, countries differ in the extent to which each of these basic characteristics is fulfilled. For instance, a national health insurance scheme may cover a substantial part of the population, but not all, as in Germany and, until 2006, in the Netherlands . Similarly, government involvement may be very strong (e.g., in France) or less strong (e.g., in Germany).

Medicare is NHI and not universal coverage. Best interpretation is US-specific because of USFG in the topic.Wray 12

Dr. Almon, Jr., University President and Political Science Professor, Cyberland U of North America, “The American System of Government: Politics & Government in the U.S.A. Part One,” http://www.proconservative.net/CUNAPolSci201PartOneB2.shtml, 2012

In the U.S.A., national health insurance, in the form of Medicare, is nearly 35 years old , having been established under 1965 amendments to the Social Security Act of 1935. National health insurance in other English-speaking societies and in the West European countries began earlier and is universal in coverage .

Medicare, the American version of national health insurance, is not universal in coverage; its coverage is limited to particular categories of persons specified by law . Under Medicare, acute-care coverage (hospital care, skilled nursing facility care, hospice care, and some aspects of home health care) is provided for (1) Social Security and Railroad Retirement beneficiaries, on reaching the age of 65 years, (2) some disabled persons under 65 years of age (those entitled to receive Social Security and Railroad Retirement disability benefits for a period of 24 months), and (3) persons suffering from end-stage renal disease (permanent kidney failure treated with dialysis or a transplant).

NHI Administration Can Be Private

Private health insurance companies or employer can administer NHIBodenheimer and Grumbach 16

(Thomas & Kevin. Profs of Family & Community Med, UCSF, Understanding Health Policy: A Clinical Approach, 7th ed, 2016, http://accessmedicine.mhmedical.com/content.aspx?bookid=1790&sectionid=121192308

Under government-financed national health insurance plans, funds are collected by a government or quasigovernmental fund, which in turn pays hospitals, physicians, health maintenance organizations (HMOs), and other health care providers. Under private individual or employment-based national health insurance, funds are collected by private insurance companies, which then pay providers of care.

German example proves NHI can have multiple payersLieberthal 16

Robert D., Professor of Public Health, U of Tennessee, Knoxville, What is Health Insurance (Good) For? 2016, pp. 194-195

In Germany, a number of health insurance mandates enacted for different groups in the 20th century expanded sickness funds dating to the 19th century to include the entire population (Bump 2015). Germany’s model is a “national health insurance” model, where insurance is compulsory but is provided by a number of organizations . In the German system, the size of public groups is large, since there are a relatively small number of public, competing “sickness funds” that cover most of the population (131 as of 2014), a form of outsourcing by the government within the German system (Elias et al. 2014).

NHI Administration Can Be Local (Not Federal Government)

Canada example support this interpretationLieberthal 16

Robert D., Professor of Public Health, U of Tennessee, Knoxville, What is Health Insurance (Good) For? 2016, p. 195

Canada implemented a national health insurance program as a single payer in 1966, expanding a program that began in the province of Saskatchewan in 1961 (Hutchison et al. 2001). Providers are often privately or self-employed, but are paid by a single public insurance system. As a result, Canada has essentially thirteen public funds related to the number of counting provinces and territories in the country, in a sense a form of outsourcing by the federal government to local governments in Canada (Elias et al. 2014).

Single Payer = NHISingle-payer is government-financed NHIBodenheimer and Grumbach 16

(Thomas & Kevin. Profs of Family & Community Med, UCSF, Understanding Health Policy: A Clinical Approach, 7th ed, 2016, Kindle Locations 5586-5591, Kindle Edition)

In 1989, Physicians for a National Health Program offered a new government-financed national health insurance proposal. The plan came to be known as the “single-payer” program, because it would establish a single government fund within each state to pay hospitals, physicians, and other health care providers, replacing the multipayer system of private insurance companies (Himmelstein & Woolhandler, 1989). Several versions of the single-payer plan were introduced into Congress in the 1990s, each bringing the entire population together into one health care financing system, merging the social insurance and public assistance approaches.

Single-payer NHI covers medically needed servicesHealth Care for All NC 17

501(c)3 organization and a state chapter of Physicians for a National Health Program. https://www.healthcareforallnc.org/faq/

Single-payer national health insurance is a system in which a single public or quasi-public agency organizes health financing, but delivery of care remains largely private. Under a single-payer system, all Americans would be covered for all medically necessary services, including: doctor, hospital, preventive, long-term care, mental health, reproductive health care, dental, vision, prescription drug and medical supply costs. Patients would regain free choice of doctor and hospital, and doctors would regain autonomy over patient care.

Medicare for All = NHIMedicare for All is NHIFirestone 12

Dr. Joseph M., Managing Director, CEO of the Knowledge Management Consortium International (KMCI). He has taught Political Science at the Graduate and Undergraduate Levels, and has a BA from Cornell University in Government, and MA and Ph.D. degrees in Comparative Politics and International Relations from Michigan State University, Naked Capitalism blog, October 21, http://www.nakedcapitalism.com/2012/10/neoliberalism-kills-part-one.html

Medicare for All is National Health Insurance without National Health Service . It is not equivalent to the UKs NHS as you can see by comparing Canada or Taiwan to the UK.

European precedent proves Medicare and Medicaid become national health insuranceBodenheimer and Grumbach 16

(Thomas & Kevin. Profs of Family & Community Med, UCSF, Understanding Health Policy: A Clinical Approach, 7th ed, 2016, Kindle Locations 5570-5572, Kindle Edition)

Many people believed that Medicare and Medicaid were a first step toward universal health insurance. European nations started their national health insurance programs by covering a portion of the population and later extending coverage to more people. Medicare and Medicaid seemed to fit that tradition .

Catastrophic [Major Risk] Insurance Can Be NHI

Catastrophic national health insurance is distinct from general national health insuranceLaumann and Knoke 87

Edward O. and David, George Herbert Mead Distinguished Service Professor of Sociology at the University of Chicago & professor of sociology at the University of Minnesota. The Organizational State: Social Choice in National Policy Domains, 1987, p. 91, books.google.com

Attempts were made to improve the competitiveness of the health care system, including relaxation of the requirements for federal assistance to HMOs. Suggestions for general, as well as catastrophic, national health insurance continued to be debated. By 1979 this issue had become one of the major points of confrontation between Carter and presidential contender Edward Kennedy .

Catastrophic national health insurance is an alternative to general national health insurance. Bahamian example.Hartnell 17

Neil, Bahamas Tribune 242 business editor, “Minnis Makes Fiscal Responsibility Pledge.” Tribune242.com, January 5, http://www.tribune242.com/news/2017/jan/05/minnis-makes-fiscal-responsibility-pledge/

He also implied that an FNM government under his leadership would chart a different course on healthcare reform to the Government’s proposed National Health Insurance (NHI) initiative, promising to end ‘cook outs’ by introducing a Catastrophic Health Insurance Plan to finance care for life-threatening diseases. “Our focus will be on the substantial upgrade of the health infrastructure and delivery of services,” Dr Minnis said. “We will introduce a Catastrophic National Health Insurance Plan that will adequately address your chronic heart diseases, cancer and organ transplants, so as to relieve you of the worries that can devastate families both emotionally and financially .”

Catastrophic national health insurance has been part of the NHI debate for yearsPauly et al 91

Mark, economist, Wharton School of Business, U of Pennsylvania, “A Plan for ‘Responsible Health Insurance,’” Health Affairs, vol 10, no. 1, 5-25, p. 25 note 1

The notion that ideal national health insurance should take the form of income-related catastrophic coverage has been advocated by health economists for twenty years . See M. Feldstein, “A New Approach to National Health Insurance,” The Public Interest (Spring 1971):

93–105; and M. Pauly, An Analysis of National Health Insurance Proposals (Washington, D.C.: American Enterprise Institute, 1971).

Catastrophic national health insurance would cover “major risks”Seidman 78

Laurence S., Chaplin Tyler Professor in the Department of Economics, University of Delaware in Newark, Policy Analysis, vol 4, no 1, Winter, 123-127, abstract, https://www.ncbi.nlm.nih.gov/labs/articles/10306456/

A central purpose of proposed "major-risk" ("catastrophic") national health insurance would be to provide an incentive to economize by requiring most households to pay, out of pocket, at least a fraction of the cost of all medical care they use.

NHI Need Not Deliver Comprehensive Health Care

Universal coverage need not be equal quality careFuchs 76

Victor R., Stanford U econ professor, “From Bismarck to Woodcock,” Journal of Law & Economics, August, p.349

“The U.S. already has implicit national health insurance . Some of the observed behavior would seem less irrational if we assume that the U.S. already has implicit national health insurance, especially for catastrophic illness. If it is true that most uninsured people who need care can get it one way or another--through government hospitals, philanthropy, or bad debts--then it may be rational for people to buy only shallow coverage, or indeed, not to buy any insurance at all. To suggest that there is implicit insurance in the United States covering nearly everyone is not at all to suggest that there is equal access to equal quality care .”

NHI covers basic health careBodenheimer and Grumbach 16

(Thomas & Kevin. Profs of Family & Community Med, UCSF, Understanding Health Policy: A Clinical Approach, 7th ed, 2016, Kindle Locations 5482-5484, Kindle Edition)

For more than 100 years, reformers in the United States argued for the passage of a national health insurance program, a government guarantee that every person is covered for basic health care. Finally in 2010, the United States took a major, though incomplete, step forward toward universal health insurance.

NHI Can Include Private Health Insurance

NHI does not exclude private health insuranceHealth Insurance Benefits.com 17

U.S. Health insurance company corporate information website, http://www.healthinsurancebenefits.com/what-is-national-health-care/

Commonly referred to as statutory health insurance by government regulatory, a national health insurance scheme is designed to me a legally enforced manner of ensuring that the entire population receives health care . It is meant to insure the population against any costs typically associated with medical care. The way that the program is funded can vary from nation to nation, depending on the particular type of program that is implemented. Some rely on the public sector to administer health care, others focus on the private sector, while still others combine the two in one way or another.

It is important to note that national health insurance does not necessarily mean that the entire health care system is run by the government, nor does the government have to finance it in its entirety. The scheme is usually set up and established via some type of federal legislation, often taking the shape of an entire reform of the existing system. Two of the more commonly cited examples are the Medicare system in Australia and the National Health Service in the United Kingdom.

Under both of these systems, general taxes paid within the country go to fund the system. These taxes are not optional, even though individuals are free to choose and pay for a private health insurance carrier if they so desire. Under both systems, however, the majority of the citizenry has chosen to join the national health insurance scheme since they are already paying for it.

AT: Must Define NHI According to Another Country’s System

Each country’s NHI system is different. Aff ground requires flexibility for best US policy.Health Insurance Benefits.com 17

U.S. Health insurance company corporate information website, http://www.healthinsurancebenefits.com/what-is-national-health-care/

Over the years, different countries have implemented their own versions of national health insurance. Each program differs in terms of how they are funded and how heath care services are actually provided to the population.

Canada, for example, has implemented a funding mechanism where the payments to the system are made by the government from money collected via tax revenue. France, on the hand, also has a system of mandatory contributions to the national health insurance scheme, but the collection itself is actually administered by several non-profit organizations that have been established just for that purpose.

Some countries have implemented an alternative approach to funding, where individuals are required to contribute to one of a series of competing insurance funds. These funds are required to provide a minimum level of coverage to each individual, and no discrimination is permitted on the basis of age, occupation, or prior health conditions.

In order to protect both patients and insurance providers, the government will create a system of equality designed to spread the risk out among the various insurance funds.

The following countries currently have some system of national health insurance in place:

AustraliaBelgiumGermanyGhanaColombiaJapanFranceSouth KoreaSwitzerlandTaiwanNigeriaCanadaGermanyPhilippinesUnited Kingdom