“Son, there's not much left of the carcass … you can stop beating that horse now.”

In a continuing back-and-forth exchange [1], the Director of the Citizens Alliance for National Health Insurance [2] piped in, saying, “For those of you with an interest in having a viable national health insurance system in the US in our lifetime, please visit www.HR676.org [3].”

I checked out the Citizens Alliance for National Health Insurance [4] website and while the site answers a bunch of questions like “Why haven't I heard of this bill before?” and “Do we really want our health care system to be controlled by government bureaucrats?” while urging people to sign up, it does not, however, present the actual text of H.R. 676, nor links to the actual text of H.R. 676. Yes, it does link to the official website for H.R. 676 [5], but the official website for H.R. 676 [6] (run by Congressman John Conyers, Jr. (D) [7]) doesn't have the actual text to the bill, nor a link to the actual text.

It's a weird omission from both sites, don't you think?

And it's not like it's not online (H.R. 676 [109th]: Expanded and Improved Medicare for All Act) [8] or difficult to find online [9].

Okay, so I went the extra step to find the actual text to H.R. 676 [10] and after reading it, I have quite a few questions that the Citizens Alliance for National Health Insurance [11] haven't answered. For instance:

(a) In General—All individuals residing in the United States (including any territory of the United States) are covered under the USNHI (United States National Health Insurance) Program entitling them to a universal, best quality standard of care. Each such individual shall receive a card with a unique number in the mail. An individual's social security number shall not be used for purposes of registration under this section.

“H.R. 676 [109th]: Expanded and Improved Medicare for All Act [12]”

Since the bill states “individuals residing in the United States” and not “citizens of the United States,” am I to infer that this also covers aliens? Both legal and illegal? I don't have a problem with covering legal aliens residing in the United States, but I do have a serious problem with my taxes going to pay for the health care of a large number of illegal aliens who don't even pay taxes!

Taxes? Did I say taxes?

National health insurance will simply require participating members to pay a similar monthly health insurance premium, perhaps in the form of a tax (but it's still the same thing as a premium no matter what you call it**)

**Whatever they call it—It's very important to keep in mind that this is NOT an ADDITIONAL tax but a REPLACEMENT for current private health premiums.

“Citizens Alliance for National Health Insurance [13]”

Sorry, premiums, which brings up another point—is this voluntary? If it is, I'll buy the Citizens Alliance for National Health Insurance argument that it's a “premium,” not a “tax.” But if this is involuntary, you can play all the language semantic games you want, it becomes a tax! (or outright theft as some would say [14]) The bill doesn't say one way or the other, although Conyer's financing figures [15] show it as a payroll tax of 3.3% on both employer and employee.

Which brings up another question—as someone who is self-employed, are my taxes going up 6.6%? (In case you are unaware, those who are self- employed pay 7½% Social Security tax as an employee, and 7½% (the so called “Self-employment Tax”) as employer! Again, it's not answered in the text, nor on the official website [16].

(2) FEE FOR SERVICE—

(A) IN GENERAL—The Program shall negotiate **a simplified fee schedule that is fair with representatives of physicians** and other clinicians, after close consultation with the National Board of Universal Quality and Access and regional and State directors. Initially, the current prevailing fees or reimbursement would be the basis for the fee negotiation for all professional services covered under this Act.

(B) CONSIDERATIONS—In establishing such schedule, the Director shall **take into consideration regional differences in reimbursement, but strive for a uniform national standard**.

(C) STATE PHYSICIAN PRACTICE REVIEW BOARDS—The State director for each State, in consultation with representatives of the physician community of that State, shall establish and appoint a physician practice review board to assure quality, cost effectiveness, and fair reimbursements for physician delivered services.

(D) FINAL GUIDELINES—The regional directors shall be responsible for promulgating final guidelines to all providers.

(E) BILLING—Under this Act physicians shall submit bills to the regional director on a simple form, or via computer. Interest shall be paid to providers whose bills are not paid within 30 days of submission.

(F) NO BALANCE BILLING—Licensed health care clinicians who accept any payment from the USNHI Program may not bill any patient for any covered service.

(G) UNIFORM COMPUTER ELECTRONIC BILLING SYSTEM—The Director shall make a good faith effort to create a uniform computerized electronic billing system, including in those areas of the United States where electronic billing is not yet established.

(3) SALARIES WITHIN INSTITUTIONS RECEIVING GLOBAL BUDGETS—

(A) IN GENERAL—In the case of an institution, such as a hospital, health center, group practice, community and migrant health center, or a home care agency that elects to be paid a monthly global budget for the delivery of health care as well as for education and prevention programs, physicians employed by such institutions shall be reimbursed through a salary included as part of such a budget.

(B) SALARY RANGES—**Salary ranges for health care providers shall be determined in the same way as fee schedules under paragraph (2)**.

“H.R. 676 [109th]: Expanded and Improved Medicare for All Act [17]” (emphasis added)

How is this not nationalizing the health care system? As a doctor (not that I am one, but I'm asking as if I were one) how does this benefit me? Does my malpractice insurance go down? Is it eliminated? Am I still allowed to practice privately the same treatments that this bill covers? If so, am I allowed to charge less than the Federal mandated charges? More?

(a) In General—It is unlawful for a private health insurer to sell health insurance coverage that duplicates the benefits provided under this Act.

“H.R. 676 [109th]: Expanded and Improved Medicare for All Act [18]”

As an insurance company, what about our existing policies when (if) this goes into effect? Do we still provide coverage under the existing policy? If no, do those portions of the policy become null and void? And does the insured get part (or all) of their premium back?

(c) Intent—Sums appropriated pursuant to subsection (b) shall be paid for—

(1) by vastly reducing paperwork;

(2) by requiring a rational bulk procurement of medications;

(3) from existing sources of Federal government revenues for health care;

(4) by increasing personal income taxes on the top 5 percent income earners;

(5) by instituting a modest payroll tax; and

(6) by instituting a small tax on stock and bond transactions.

“H.R. 676 [109th]: Expanded and Improved Medicare for All Act [19]”

How odd, even the text of the bill uses the word “tax” instead of “premium.” It looks like a tax to me. And how do I know that the “modest payroll tax” won't balloon into an “unmodest payroll tax?” Amendment XVI of the Constitution [20] passed because the income tax was guaranteed to be a 1–7% [21], but that was quickly modified [22].

As it stands right now, there're too many questions for me to be comfortable with this bill ever being passed.

[1] http://corsair2.livejournal.com/220452.html

[2] http://www.hr676.org/

[3] http://www.hr676.org/

[4] http://www.hr676.org/

[5] http://www.house.gov/conyers/news_hr676.htm

[6] http://www.house.gov/conyers/news_hr676.htm

[7] http://www.house.gov/conyers/

[8] http://www.govtrack.us/congress/billtext.xpd?bill=h109-676

[9] http://clusty.com/search?query=H.R.+676

[10] http://www.govtrack.us/congress/billtext.xpd?bill=h109

[11] http://www.hr676.org/