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The debate around health care reform in Washington has for years been hindered by a single question: everyone deserves health care, but how do you pay for it? But as public frustration peaks and millions of people struggle with lack of insurance coverage or medical costs of exploitation, the question is rephrased around a set of different questions. : instead of asking how to pay, we wonder why the world's richest country should not have the best universal health system = for all?
Pramila Jayapal's Medicare For All bill marks the beginning of a long-awaited attempt by lawmakers to address this issue in concrete terms: a massive, one-payer, no-charge health plan covering all people living in the United States and effectively suppressing the current sector of health insurance.
As a continuation of a bill previously introduced by Sen. Bernie Sanders, the 2019 Medicare for All plan envisions a broad, multi-year program to transform federal health plans and private insurance plans into one. complete single payer system. To ensure equal access, the system would "spread the risks and benefits across the company … by eliminating eligibility, registration and coverage gaps", with Extremely ambitious goal of reducing costs at the same time. The plan is designed to ensure not only "coverage", but also real care whenever necessary, including primary care neonatal care, insulin chemotherapy, and so on. Reproductive care, including abortion, would be free (and free of current ideological restrictions). It also includes benchmarks based on civil rights for fairness and protections against discrimination based on race, ethnicity, gender, sexual orientation, disability, immigrant status or economic background. The proposal aims for a full transition to the new system within two years and contrasts sharply with market-based universal coverage schemes that preserve the insurance market. It is even higher than Canada and the United Kingdom, which impose some cost-sharing for recipients.
The bill is a leap into the Washington political stranger, but resonates with the pulse of the general public: studies show that most Americans generally support the idea that health care should be managed by the government and provided free, as a human right.
A granular analysis conducted by the National Initiative for Economic and Social Rights (NESRI) assesses the extent to which the draft law builds on several human rights principles, based on several fundamental principles: universality; equity, which protects against discriminatory or structural barriers to care; transparency and accountability of both government and private providers; and the provision of "meaningful public participation" by customers. The assessment goes beyond public health goals to place the single payer in a wide range of fundamental rights, alongside other social rights and political rights.
NESRI gives the bill a comprehensive note with respect to comprehensive and inclusive coverage, providing equal care to all residents, regardless of immigration status, income or medical history. And all vendors would offer a consistent set of mandatory services, in a seamless infrastructure that allows users to navigate services with seamless and consistent access without arbitrary cost differences or coverage gaps.
To address social and geographic disparities in access, the location and distribution of facilities and providers would be managed by a national primary health care office, channeling resources to remote areas, including rural communities. and underserved. In the institutions, staffing levels, wait times and other standards of care would be managed centrally. The plan also eliminates the discriminatory barriers established in current health care policies, including multi-year waiting periods before immigrants and persons with disabilities benefit from public coverage.
From a worker's point of view, the bill lays out a path forward for balancing the needs of workers and patients during the transition. It offers economic readjustment protections for displaced workers to maintain jobs. But NESRI also points to the need for a broader redesign of the workforce, focused on improving historically disadvantaged and underpaid employment sectors, such as care-giving. home and personal care. Beyond the simple guarantee of job security, all new jobs created in the new system should globally improve minimum wages and offer "reliable schedules, better standards of safety and protection of the right of workers to organize. without being embarrassed by employers ".
Yet the legislation still leaves gaps. NESRI stresses that in the pharmaceutical industry, equitable access and funding of prescription drugs should stimulate "public action in cases where pharmaceutical companies do not meet the needs". This poses the challenge of asking Big Pharma to follow the national health care program, while Preventing drug shortages by "directing public funds for research to treatments for medical problems that receive insufficient attention" and breaking drug monopolies by making the production of generic drugs mandatory.
Of course, the hard part will be finding a way to fund the system sustainably, providing excellent care without sacrificing the costs of decent health care. Think tanks and legislators have implemented several projects, including a major increase in the main income tax, up to 80%, a direct wealth tax and a more progressive payroll structure.
The NESRI report has no exact answer to this question. Ben Palmquist, director of NESRI, says, however, that "ultimately, health care funding depends on what we value as a country and on which Congress is accountable. Do we maintain low tax rates on corporations and the wealthy, and allow pharmaceutical and hospital companies to impose on employers, patients and the public what they want? Or are we treating health care as a human right … and taking concerted policy action to challenge rich interests and win taxes and redistributive policies?
Although many questions remain unanswered around Medicare for All and its implementation, NESRI believes that the conversation can be an opportunity to clarify our understanding of what constitutes a human right. Giving communities, workers and suppliers a voice in the development of the system would be a monumental project, but it may be the only way to deliver the most just and sustainable program. NESRI recommends, for example, that the process incorporate innovative approaches to governance, such as "participatory budgeting practices" – a deliberative structure based on a citizen-led assembly – or incorporating support programs to build a better governance structure. global network of social and medical care.
But the bill itself, of course, is a reflection of a growing call for radical change in the way that country takes care of itself. And no matter what congressional arithmetic tells us about how politicians will vote on this particular proposal today, the health of the people will not wait, and citizens have decided they are ready for a new system.
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