D. Basic Security
The General Welfare: A Legislative Agenda for a Better American Future
"We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defense, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America."
"All persons born or naturalized in the United States, and subject to the jurisdiction thereof, are citizens of the United States and of the State wherein they reside."
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Basic Security: Making risk-taking possible.
Capitalist societies work best when people can take risks in the hope of improving their lot and others'. But risk-taking requires a safety net. For the wealthy, we have very effective safety nets: corporate law limited liability and the priority of secured lending. Taken together, these rules allow wealthy investors to determine exactly how much money they wish to put at risk in an enterprise, while protecting the rest of their assets. The wealthy, that is, are never held fully responsible for the consequences of their decisions and are always free to start over again.
For the middle class, however, our safety nets lag behind the other advanced countries. Middle class people need the freedom to be able to leave their jobs without putting their family's health and financial security at risk. Regardless of whether they are would-be entrepreneurs or the backbone of the economy, middle class citizens need to know that they will have good schools for their children, that they will be able to afford housing, medical care and retirement. We need, therefore, (1) a solvent and successful educational system, from preschool to university, funded on a fair basis; (2) retirement and medical care plans that are not dependent on the largess of particular employers and that allow entrepreneurial individuals to leave jobs without putting their children at risk; (3) basic support for families raising children; (4) protections against credit ratings and other records that prevent individuals from overcoming their past.
In a decent society, no one is left to starve and those who are not able to work are cared for by those who can. It is a primary social responsibility to ensure that no child goes without enough income for proper food, clothing, shelter and education. Accordingly, we need (1) a basic support system for parents of young children, (2) an educational systems that serves all children regardless of their parents' economic abilities, (3) basic income for those unable to work for whatever reason.
The Family Protection Act.
The legal guardian of every child below the age of 18 shall receive a monthly payment of $500 for the first such child, $250 for the second such child, $150 for the third such child, and $100 for each additional child. These amounts shall increase with inflation. In the case of children with multiple legal guardians, each guardian shall receive a proportional share of the payment according to the respective guardians' responsibility or as a family court shall decree, but the amount of the payment shall be based on the number of children of that guardian.
Every parent of a new born child shall be entitled to nine months leave from their employment commencing at birth. Each parent shall receive a parental leave payment from SSI-D at the rate that would be paid in the event of established disability. No employer shall fire or otherwise discriminate against parents who take advantage of this provision. Adoptive parents shall be entitled to leave based on the age of their child.
The Medicare/VA For All Act.
In the richest country in the world, medical care should be a basic right for all. Moreover, employees and individual entrepreneurs should be free to move from job to job without worrying about losing medical coverage for pre-existing conditions. Business and industry should be able to compete with foreign-based production on a fair basis -- without having to pay for medical expenses that in other leading capitalist countries are not business expenses.
Building on two highly successful systems already in place, this Act would allow every American to benefit from national health insurance through Medicare, or a national health service through the VA. For adults, it would be entirely permissive -- so that if the private insurance or medical care sector can compete by providing better services, it will be free to do so. However, to prevent free riding that would undermine the system for all of us, every citizen must have some form of medical coverage.
Medicare and the VA are far cheaper and more efficient than the existing private sector insurance plans. So this plan should immediately reduce the proportion of GNP being spent on medical care. Moreover, a universal system should automatically reduce some of the expensive and inappropriate use of our emergency rooms for primary care. Once a national system is in place, further measures will be needed to restrain future growth of costs -- beginning with incentives to increase the use (and compensation) of primary care physicians.
Every American citizen or permanent resident below the age of 18 shall be enrolled in Medicare. His or her parent or legal guardian shall be billed the same fees as a senior citizen Medicare recipient who has enrolled in the cheapest available Medicare coverage.
Every American citizen or permanent resident between the age of 18 and 64 (or the then current age of regular Medicare eligibility) shall be offered the opportunity to enroll in Medicare or the Veteran's Administration medical care system. Each individual may choose either system but not both. Fees shall be the same as for regular (senior citizen) Medicare recipients or veterans, respectively.
No person shall be required to enroll in either program and no enrollee shall be required to use the program for particular health care. However, to ensure that medical care is available when needed and paid for in a responsible fashion, every American citizen or permanent resident between the age of 18 and 64 (or the then current age of regular Medicare eligibility) must be enrolled in Medicare, Medicaid, the VA system or a private medical insurance plan or medical care system providing similar coverage.
In any year in which the unemployment rate is above 5%, funding for this Medicare-For-All/VA program shall be from general revenues or deficit spending.
In any year in which the unemployment rate is below 5%, one half of the proceeds of the Estate Tax shall be directed to this Medicare-For-All/VA program. Any additional funding needed shall come 50% from an income tax surcharge on the top 1% of all income tax payers and 25% from an increase in the Medicare tax and 25% from the general budget of the Pentagon.
The Health Care Improvement Information Act.
Comparative studies have shown that more expensive medical care is rarely synonymous with more effective medical care. Unfortunately, the private market as current structured provides strong incentives for more care, but only weak incentives for better care. Consumers have only limited ability to influence the care they receive, since the primary drivers are medical education, professional self-government, and fee-for-service pay, private insurers, patent monopolies creating monopoly rents and for-profit hospitals driven by markets to expand utilization.
However, consumers and well-intentioned professionals could have more influence with more information and sometimes for-profit actors will find lower costs profitable. Accordingly, we need an better system for collecting, analyzing and disseminating information. In the event the we decide to re-professionalize medical care, fund research by means other than patents or restructure the medical insurance industry with better incentives, the improved information will be even more valuable.
The NIH shall create an agency to research and publicize the most cost effective ways of improving health care outcomes. It shall create reporting protocols to collect all necessary and useful data from all medical care providers and insurers, including but not limited to Medicare and the Veterans Administration and any hospital, insurer or medical provider receiving Federal funds. These shall include, but not be limited to, protocols for investigation of and reporting of all iatrogenic incidents and all insurer denials of care.
The NIH shall issue an annual report stating the percentage of each provider and insurer's net income that is devoted to processing or contesting payments, to administrative overhead, to executive (non-medical) pay, and to profits. The report shall also identify the most and least effective health care providers, both in absolute and cost-adjusted terms.
The NIH shall create and disseminate information about medical and financial best practices on an ongoing basis.
Every medical insurance provider shall be required to provide full and accurate information to the NIH and to consumers at the time of sale, comparing the services it provides and the fees it charges to Medicare and explaining the differences. Any consumer, or group of consumers, injured by false or misleading information may bring an action for damages.
The NIH shall examine the medical education system and propose such changes as are desirable to optimize the number and fields of primary care doctors and specialists produced.
Honest Medical Billing Act.
Current medical billing is extraordinarily difficult to understand and often deceptive, leading to widespread market failure. Billing rates bear no relation to actual charges, while consumers with the least bargaining power are often required to pay more than those with insurance.
The medical industry's standard practice of charging the highest rates to those least able to afford them is discriminatory and unfair, resembling the practices of nineteenth century railroads rather than honest market pricing.
Patients should be entitled to the same rates regardless of their financial status.
Moreover, ordinary common law principles apply to medical contracts and courts should enforce them -- if doctors choose to charge in quasi-contract, they should be held to the principles of quasi-contract, not allowed to simply make up any number they like. If doctors believe that insurance companies have misstated the reasonable and customary charge, they should be allowed to contest such determinations directly with the insurance company; the insured patient has no interest and should be excused from this dispute.
Finally, insurance companies should be consistent in their charges; they should not be permitted to pay a provider one amount and then calculate the patient's co-pay using a different number altogether.
I. Standard Medical Bills and Insurance Forms
The FDA is hereby directed to create a standard medical insurance reimbursement form. All medical insurance carriers shall accept this form on paper and electronically. On a patient's request, any medical service provider shall submit the standard form to any insurance carrier without regard to whether or not the service provider has a contract with such insurer.
The insurance form, and each medical bill sent to any patient, shall clearly state the date of service, the service performed including the standard medical code, and the fee.
II. "Most Favored Nation" Fair Pricing Clause
No medical provider shall bill any uninsured patient any fee higher than the lowest fee that such provider has contractually agreed to accept, or ordinarily accepts, from
any public or private insurer,
self-insured employer,
Blue Cross plan or
Medicare,
unless the bill clearly states in bold letters
(1) that the fee is higher than the fee charged to insured patients and
(2) the dollar amount of the lowest fee charged to insured patients, and
(3) the difference between the fee charged and the lowest fee charged to insured patients.
Any bill issued in violation of this provision shall be unenforceable and the patient shall not be liable for any charge for the billed service.
Any patient who is billed in violation of this provision and pays the amount billed or any part of it may sue for a refund plus a penalty of 50% or reasonable attorney's fees. The statute of limitations shall be the statute of limitations for contract actions, commencing at the time of payment of the bill.
III. Quasi-Contract Suits for Fair Value Only
In any lawsuit by a medical service provider or assignee for payment for medical services rendered, medical service charges shall be deemed charges in quasi-contract for fair value of services rendered. Provided however, that this provision shall not apply if the medical service provider proves that the patient contracted to pay a higher amount after being fully informed, in advance of the service, of the exact charge that would be billed and the difference, if any, between that charge and the charge that would be accepted as "reasonable and customary" for the service by the largest local insurer or an insurer of the patient's choice.
The burden of proof to prove the fair value of services rendered shall be on the service provider.
In the ordinary course, fair value shall be the lower of the reasonable and customary charge for such services or the lowest fee such provider accepts for such services from non-charity cases.
In exceptional cases, however, the court may depart from these standards for good cause shown.
Insurance company standards for "reasonable and customary" shall be admissible as expert witness opinion evidence of "reasonable and customary" charges.
The amount billed in the contested instance is not evidence of the fair value of services rendered, provided however that in no event shall a court award the service provider more than the amount billed.
Any patient who is billed more than the legally enforceable amount for medical services and pays such bill may sue for a refund plus a penalty of 50% or reasonable attorney's fees. The statute of limitations shall be the statute of limitations for contract actions, commencing at the time of payment of the bill.
IV. Medical Provider's Right & Obligation to Dispute Insurance Company Determinations
If a medical service provider bills an insured patient for medical services and the insured patient (or the patient's insurance company) pays the "reasonable and customary" charge as determined by the patient's insurance company, plus any applicable CO-pay or deductible, the provider shall have no further remedy or claim against such patient. However, the medical service provider shall be fully subrogated to such patient's claim against the insurance company for breach of contract due to incorrect determination of "reasonable and customary" and may proceed against the insurance company in the patient's shoes to recover under the insurance contract and for any related damages.
Any medical service provider or association of such providers may commence a declaratory action against any insurance company or companies to correct determinations of "reasonable and customary" fees. Such actions may be commenced in advance of, during, or after any actual dispute over an actual submitted bill.
V. Honesty in Insurance Co-pays
Any insurance contract providing for a CO-pay amount calculated as a percentage of the service charge shall apply the percentage to the "allowable" or "reasonable and customary" charge, whichever is lower. In no event shall an insurance company calculate any charge for a deductible, CO-pay, or patient's responsibility as a percentage of a billed amount the insurance company would not pay.
The Save Our Schools Economic Recovery Act.
The American system of school financing is a national disgrace and a clear violation of the principles of equal citizenship. Students in different areas receive different degrees of funding depending largely on whether their neighbors are wealthy or their local government subdivision has a solid tax base. As a consequence, some districts are able to finance education easily while others are not, and local government, land use and other aspects of American life are seriously distorted as individual parents seek to use a dysfunctional system to advantage their children or avoid paying for the education of the next generation. Instead of pressing for better schools for all, those parents who are able seek solutions for their own children, while children whose parents are less aware of the issues or have fewer options simply suffer the consequences. All Americans suffer as a result, as our country becomes increasingly unequal and because our ability to maintain a competitive, successful, growing economy depends on the quality of our primary and secondary education.
This Act maintains the American tradition of decentralized local control over schools, but ameliorates the worst aspects of local financing. As a side benefit, it also creates a small counter-cyclical buffer to our current system of school financing.
The Congress hereby allocates funds to each local school board, to be determined as follows.
One half of the total proceeds of the Estate Tax shall be distributed to school districts in proportion to the number of children served by each such district.
Each school district shall receive an additional grant in the amount of $50,000 x the number of children served x a percentage equal to the percentage of fair market value assessed and collected in real estate taxes for the benefit of the school district, but not more than $2000 per child or less than $500 per child.
Funds allocated pursuant to this Act shall be a grant to be used in the discretion of the local school board unless the state legislature shall direct otherwise.
The Copyright Limitation and Monopoly Distortion Reduction Act
Whereas, copyright is a government-granted monopoly power allowing publishers and other copyright holders to extract monopoly profits, and
Whereas such monopolies are warranted for limited times to promote the publication of interesting, beautiful, useful and entertaining materials, and to reward the creators and publishers of such material, and
Whereas most knowledge is cumulative and common, created in reliance and dependence on the work of others and, in turn, contributing to that common enterprise,
Whereas the original US copyright act provided for a monopoly term of 14 years, renewable once, after which knowledge would return to the public domain,
Whereas one person's use of knowledge created by another does not diminish the creator's knowledge and is more likely to increase than decrease the latter's ability to increase the fund of human knowledge,
Whereas excessively long copyright privileges interfere with the progress of the arts and sciences, economic growth and human cultural development, distort markets, create dysfunctional incentives for publishers to concentrate on finding potential "blockbusters" instead of a wide range of material, interfere with the ability of researchers and artists to use the common fund of knowledge and culture, and create incentives for monopoly rent seeking by excessive litigation and other means, now therefore:
Copyrights shall expire after 30 years or the death of a human creator who is also the copyright holder, whichever is later. In the case of a collective or corporate creator or copyright holder, copyright shall expire after 30 years.
The Social Security Improvement Act
A secure retirement is one of the basic protections that every middle-class family needs. The more secure the retirement, the more risks people will be able to take during their working career. Accordingly, this Act proposes to increase both the security and size of social security retirements.
The cap on FICA tax is hereby repealed.
Social security benefits for all persons who retire after 2015 shall be increased by an additional 5% percentage of their base income above the amount provided under current law.
Bankruptcy Correction and Equal Justice Act.
In the last round of bankruptcy law reform, financial interests successfully lobbied to create new and unfair burdens on individual borrowers that do not apply to business borrowers. Our capitalist system requires that lenders take responsibility for the loans that they make and suffer the consequences if they make imprudent loans. A major function of lenders is to restrain over-optimistic consumers who may not have realistic views of the economic value of expensive vocational training or other education, or their ability to pay for homes and other consumption. Lenders should be required to bear the costs of their errors so that they do not have an incentive to press inappropriate debt on unsophisticated borrowers. Conversely, citizens who have suffered unexpected set-backs -- inability to find a job using their education, loss of job, illness or other personal tragedies that make it impossible to pay home mortgage loans -- must be able to move on with a fresh start. For this reason, the Act restores ordinary bankruptcy rules to consumer loans.
The special provision barring discharge of student loans is repealed. A bankruptcy court may discharge student loans on the same terms and pursuant to the same rules as other unsecured loans
The special provision barring "cramdowns" of home mortgage loans is repealed. A bankruptcy court may re-form or discharge a loan secured by a home mortgage on the same terms as other secured loans.
The special provisions limiting discharge of credit card and other consumer debt are repealed. Consumers are entitled to discharge and bankruptcy relief on terms no worse than businesses.