PNHP Plan Principles

1. 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

2. PNHP Plan • Eligibility & Coverage • Hospital Payment • Payment for Physicians and Outpatient Care • Long-Term Care • Medications and Supplies • Capital spending, Health planning, Profit • Funding

3. 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

4. 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

5. 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)

6. 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

7. 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

8. 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

9. 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

10. 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.)

11. 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.