Comparing Health Security America with HR 676, the Dems' single payer plan

The plans are Health Security America (HSA), and HR 676, cited as the United States National Health Insurance Act (or the Expanded and Improved Medicare for All Act). Health Security America health plan was designed primarily by Dr. Fred Bannister and very specifically described in his book Health Security America: Fixing the health care crisis. The United States National Health Insurance Act was led by Rep. John Conyers, D-MI. Both plans fall under the umbrella of “Medicare for All.”

Both of the “Medicare for All” plans are revolutionary and merit examination. The list below has some of the main points that need to be compared and contrasted, with the aim of ensuring that every American finally gets a fair health plan, unadulterated by the concerns of special interests such as drugs and device manufacturers, hospital and professional associations.

Issues:

(1) Which health plan gives the individual citizen a voice in a decision making process as free of unseen lobbyist influence as possible? Will information on major issues be as available to the individual citizen as it is to the special interests?

(2) Which health plan offers the more accessible, transparent, and above all simple administration?

(3) Which health plan will allow the citizen to make the final decisions on the cost (premiums) and coverage since he or she will pay this bill every month for HSA or yearly in taxes for HR 676?

(4) Which health plan will permit clear accountability (as opposed to vague, resistant bureaucracy)?

(5) Which health plan makes the citizen more cognizant of his or her personal and family health responsibility?

Please read on for a point-by-point comparison of the two plans.

The train leaves the station in November

I was asked to write an op-ed piece for National Underwriter magazine. The piece published this month is behind a firewall, and at any rate, has been edited down to a pale ghost of what I wanted to tell those 50,000 readers in the insurance industry. Below I've posted my original message:

In November the train is leaving the station, and those working in the health care industry, be it insurance, pharmaceuticals, device manufacturers or professional groups had better either leap aside or ride the coach car. Universal single payer health care is an unstoppable express. Will you ride that train?

As a physician involved in administration and in starting up an HMO, I know that people in the health care industry are good people just living by the rules that our democracy prescribes for us to advance our business. The government allows us to redress grievances, and so we all have tried hard as any business to influence legislation to favor our products. This is not wrong in law, nor is it morally or ethically wrong—wouldn't you agree?

Well, get ready for some real change; there is a rumble building. If you adapt, you will do fine. But adapt you must. The results of every polling agency indicate that, after Iraq, the number one concern of the American people is the cost of health care. You all know the numbers by now. A school superintendent whom I know recently heard from his insurance agent and told to expect another "usual" 21% increase in the health policy for next year. Well, this is not a "normal or usual" condition in the minds of people buying this product. If you think it is normal, you'll miss the train.

This November, I predict a Democratic House and, maybe, if our leadership still does not exercise prudence, the Senate will turn Democratic as well. A single payer, universal health plan will be introduced in that Congress. A major sea change, it will not be the usual tweaking of health care, such as we see in the Democratic House Caucus Platform, or the Republican-driven Medicare part D drug plan. Citizens have had it with those piecemeal riggings and are pushing for an engine of real change.

Two types of plans will be introduced.

First, we will see a single payer universal plan that involves only showing a card and getting health care from a provider. The government will add an income tax, most likely around seven percent. It will basically be Medicare for all and will be an extension of the current system. Special interests in the health care field will all insist on and get their input, and, in my
opinion, we all will get poorer care, more expensive care, less available care, and we will probably head for bankruptcy of this system in double time. Drugs will be purchased as per Medicare part D, with little competitive component. Doctors will howl for more money and the American Hospital Association will howl they need an increase of rates. The fifteen percent of our GDP spent on health care will rise—and it is already twice that of other industrialized countries, only for shorter life expectancy—and we will be in even more of a financial mess or—

Second, a single payer universal plan that still involves a card but is not administered or funded by the government will be offered. There is such a proposal already laid out, and it is called Health Security America. Under this system, the government has an extremely circumscribed role: to authorize and fund start-up, and to determine the poverty level and pay the premiums of the indigent to the resulting non-profit health insurance company. We pay for wintertime fuel for the poor so that they don't freeze; the same reasoning will be advanced to health care. The non-profit corporation Health Security America, Inc. will be governed by elected citizens listening to all Americans in a hearing process, then setting premiums and coverage. A significant by-law of this corporation will be the forbiddance of long-term debt.

The insurance industry will have much more influence in the first scenario. But if you choose it, you will limp along in an extension of the current failed system. I urge you to consider the second option and invest in the greatest good for the greatest number, not just for your company. In the end, taking the long view will strengthen your business and strengthen America.

Implementing the second option will alter your game plans, but in a controlled, and more importantly, sustainable way, involving a health care policy that does not widen the budget deficit, does provide high quality care, and will cost clients at least 50 percent less than a typical premium does today. The insurance companies will sell the policy at a low mark-up and provide add-ons for those who want more than the basic policy agreed on by all citizens. I urge you to read about it the plan’s manual, Health Security America: Fixing the health care crisis.

Riding in the Pullman car is no longer feasible. The insurance industry, the drug industry, professional groups and others will all have a berth, but of course any such change will be a bit uncomfortable. You must use your hard common sense in choosing what to do.


Fred Bannister, M.D.
Chetek, Wisconsin
6/2/2006

Health Security America on WPR

Dr. Bannister talked to Ben Merens on WisconsinPublic Radio 6/5/06

Hear the streaming audio archive.

(Download the latest version of Real Player)

Dr. Bannister on WPR's Ben Merens' show, June 5

Hear Dr. Bannister Monday, June
5th

from 5–6 p.m. on Ben
Merens' show

on Wisconsin Public Radio

If you missed the show, be sure to check the audio
archives

For those in western Wisconsin, Ben Merens' show aris just as WHWC broadcasts West Side, its own local program. But WHWC listeners can still hear the web cast or check Ben Merens' audio archives.

Adventures at Daily Kos

The ideas in Health Security America got a rousing welcome from the massive audience at the world's largest political blogging community, DailyKos, in what one front pager called a "terrific series." Click on the links to see the originals at Daily Kos.

1. Retired M.D. & HMO administrator speaks out introduces myself and
   the health care reform plan
   
2. Health Security America: Kicking the donkey explains the need for independent administration of the new single payer plan, and why Democrats have gotten nothing done in 30 years
   
3. Health Security America: People-powered health care introduces
   the blueprint of HSA's independent administration
   
4. Breaking the special interest hammerlock on health care outlines
   the "8 inviolable rules" to free up competition.
   
5. Health Security America: Howard unbound In which I use my M.D.
   colleague's example to show how HSA will trim expenditures in physician
   and clinical services
   
6. Cutting health insurance premiums by optimizing hospital use talks
   about stopping the excesses of inter-hospital competition
   
7. What patients can do to lower health insurance premiums details
   some of the things a patient can do to help constrain costs
   

Health Security America Compared to the Massachusetts Health Reform Bill

The Massachusetts Health Reform Bill has received much acclaim for being the start of an era of affordable, universal health insurance for all residents. All in the state house and the executive branch worked hard and there are three major provisions to come out of it. Some of these you will recognize are in the US House Dems' platform.

1. Expansion of Medicaid.
2. Subsidies to help pay for private insurance to low-income individuals.
3. Forcing those making more than three times the poverty level to buy insurance or pay a fine.

Yes, if you are an employer and have more than 10 employees and fail to provide health insurance to your employees you will be fined no more than $295 to subsidize care. In addition, hospitals won rate increases.

Drs. Himmelstein and Woodlander of Physicians for a National Health Program recently issued a press release. Follow the link and you will get an understanding of the implications of this plan from experts. An excerpt:

The legislation promises that the uninsured will be offered comprehensive, affordable private health plans. But that's like promising chocolate chip cookies with no fat, sugar or calories. The only way to get cheaper plans is to strip down the coverage, boost copayments, deductibles, uncovered services etc.

Hence, the requirement that most of the uninsured purchase coverage will either require them to pay money they don't have, or buy nearly worthless stripped down policies that represent coverage in name only.

Third, the legislation will do nothing to contain the skyrocketing costs of care in Massachusetts—already the highest in the world. Indeed, it gives new infusions of cash to hospitals and private insurers.

How does Health Security America compare with the Massachusetts Plan?
First, after reading comments from the link above, the handiwork of self-protective special interests in the Massachusetts plan is plainly visible, and hospitals and insurance companies top the list. They have succeeded in rigging the game for their own security, and this is why citizens will have to govern their own plan—a major part of the Health Security America design. Citizen participation effectively neutralizes the powerful corporate interests.

Insurance companies will help distribute the plan, but at a markup determined by citizens themselves. Hospitals will be governed in the end by citizens' approval and will essentially become true non-profit entities. Citizens will determine the premiums and the coverage. Citizens will determine what is ethical by the use of their vote in the governing process. It will be a national plan—the same all over the US. Yes, all insured will get the same care not only those who can afford it.

Congress does have a role; it will set up the non-profit quasi-corporation run by citizens to govern and accomplish these things I listed. And Congress will have to adopt the 8 inviolable rules demanded by Health Security America and see they are in the by-laws. Since Congress will not ultimately have to take this out of its budget (Health Security America will pay its own way), citizens should be able to press Congress to get the ball rolling. I hope so, and I think most people are desperate for change, too, but the fight will be long and the special interest will fight hard. Those drug companies, health care combines and professional associations will operate on the premise that you, the citizen, is not smart enough to effect this positive change, but you are. Just work hard and we can get it done.

It is a single payer plan in that any entity taking Health Security America funds must follow its rules, and it will be an affordable, broad-based plan, with potentially 295 million clients. It will be virtually impossible for a hospital or a clinic to survive without most of the people, so there will be a single payer plan by default.

I expect marked reductions in premiums ( as high as 50% or more) cost by virtue of the governance procedures and the fee schedules set by Health Security America.

How do we call Health Security America a universal plan? Here is how:
Citizens will have to insist that when congress sets up the Health Security America plan that it set the poverty level, and if a person states that he or she can not afford the premium, then he or she goes to the government office that offers health care relief (It is safe to assume that this will be the Medicaid office) and presents the information documenting his inability to pay-- this office will then pay his premium. There now is only one person not included and I'm not worried about him or about to levy a fine. He is the citizen who declines to sign up. It is voluntary to sign up for Health Security America. Yes, you are responsible to do this. If you don't, you're on your own. If you run up medical bills, you will be required to pay just as you would if you didn't pay a mortage, car payment or child support. I don't think this is too much responsibility to ask of citizens.

If you need more background consider our book Health Security America:Fixing the health care crisis. It is a non-profit effort to get the information out on the Health Security America Health Plan. Go to http://www.healthsecurityamerica.com/ to view excerpts and help us promote this plan by getting a book and informing yourself.

Thank You,
FRED BANNISTER, M.D

Inaugural post

I am beginning this blog to comment on items as they present themselves in the media dealing with our now defunct health care distribution system. Having authored a solution to the health care crisis naming it "The Health Security America Health Plan", I plan on addressing these issues as they would be affected if, indeed, the "Health Security America Health Plan" were the law of the land. I welcome any comments. There are three mandates to the health plan and they are:

1.Health insurance from birth to death will be available without regard to current health.

2. There will be free health insurance for all kids until they reach 19 years of age.

3. This health insurance plan will be paid for by the participants and be governed by them.

No, this is not just three statements of need to be done items. These are three statements that will come about after a roadmap to get this accomplished is followed as outlined in a book "Health Security America: Fixing the health care crisis" This will be the "bible" to a health-secure America. Take a look at http://www.healthsecurityamerica.com The answers are there.
FRED BANNISTER, M.D.