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.