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The United States National Health Care Act, or the Expanded and Improved Medicare for All Act (), is a bill introduced in the United States House of Representatives by Representative John Conyers (D-MI).〔("House Reps Introduce Medicare-for-All Bill" ) ''Becker's Hospital Review'', Feb. 14, 2013〕 The bill had 49 cosponsors in 2015. The act would establish a universal single-payer health care system in the United States, the rough equivalent of Canada's Medicare, the United Kingdom's National Health Service, and Taiwan's Bureau of National Health Insurance, among other examples. Under a single-payer system, all medical care would be paid for by the Government of the United States, ending the need for private health insurance and premiums, and probably recasting private insurance companies as providing purely supplemental coverage, to be used when non-essential care is sought. The national system would be paid for in part through taxes replacing insurance premiums, but also by savings realized through the provision of preventative universal healthcare and the elimination of insurance company overhead and hospital billing costs. An analysis of the bill by Physicians for a National Health Program estimated the immediate savings at $350 billion per year.〔Physicians for a National Health Program (2008) ("Single Payer System Cost?" ) ''PNHP.org''〕 Others have estimated a long-term savings amounting to 40% of all national health expenditures due to preventative health care. Preventative care can save several hundreds of billions of dollars per year in the U.S., because for example cancer patients are more likely to be diagnosed at Stage I where curative treatment is typically a few outpatient visits, instead of at Stage III or later in an emergency room where treatment can involve years of hospitalization and is often terminal. Recent enactments of single-payer systems within individual states, such as in Vermont in 2011, may serve as living models supporting federal single-payer coverage.〔("State-Based Single-Payer Health Care — A Solution for the United States?" ) ''New England Journal of Medicine'' 364;13:1188-90, March 31, 2011〕 The bill was first introduced in 2003, when it had 25 cosponsors, and has been reintroduced in each Congress since. During the 2009 health care debates over the bill that became the Patient Protection and Affordable Care Act, H.R. 676 was expected to be debated and voted upon by the House in September 2009, but was never debated.〔(【引用サイトリンク】title=H.R. 676: United States National Health Care Act or the Expanded and Improved Medicare for All Act (Govtrack.us) )〕 Advocates who remained staunchly for single-payer health care as the ultimate vote and passage of the America's Affordable Health Choices Act of 2009 loomed tried to present HR 676 as a viable alternative to the Affordable Health Care for America Act (H.R. 3962), but were ignored, and in some cases arrested by police during various nationwide debate events, and the bill never received significant public support. ==Elements of the bill== The summary of the National Health Care Act includes the following elements, among others:〔(【引用サイトリンク】title=United States National Health Care Act – Summary )〕 #Expands the Medicare program to provide all individuals residing in the United States and U.S. territories with free (i.e. tax-funded) health care that includes all medically necessary care. This would include primary care and prevention, prescription drugs, emergency care, long-term care, mental health services, dental services, and vision care. #Prohibits an institution from participating ''unless it is a public or nonprofit institution''. Allows nonprofit health maintenance organizations (HMOs) that deliver care ''in their own facilities'' to participate. On the whole, private insurances would be replaced with the new nationalized system for all basic, major care. #Gives patients the freedom to choose from participating physicians and institutions—which, given the coverage of the new national system, would be any institution or clinic in the United States receiving any degree of public funding (i.e. the vast majority). #Prohibits a private health insurer from selling health insurance coverage that duplicates the benefits provided under this Act. Allows the private insurers to sell benefits that are not medically necessary, such as cosmetic surgery benefits. #Sets forth methods to pay institutional providers of care and health professionals for services. Prohibits financial incentives between HMOs and physicians based on utilization. #Establishes the USNHC Trust Fund to finance the Program with amounts deposited: (1) from existing sources of government revenues for health care; (2) by increasing personal income taxes on the top 5% of income earners; (3) by instituting a progressive excise tax on payroll and self-employment income; and (4) by instituting a small tax on stock and bond transactions. Transfers and appropriates amounts that would have been appropriated for federal public health care programs, including Medicare, Medicaid, and the State Children's Health Insurance Program. These taxes would be paid instead of insurance premiums, as the government (instead of private insurance companies) would be paying for the care under this single-payer system. #Establishes a program to assist individuals whose jobs are eliminated (e.g., within insurance companies) due to the simplified single-payer administrative process. #Requires creation of a confidential electronic patient record system. #Establishes a National Board of Universal Quality and Access to provide advice on quality, access, and affordability. #Provides for: (1) the eventual integration of the Indian Health Service into the Program; and (2) evaluation of the continued independence of Department of Veterans Affairs (VA) health programs. #The bill covers treatments on or after the first day of the year that begins one full year after passage (January 1, if the bill is passed in 2014). Compensation continues for 15 years to owners of converting for-profit providers for reasonable financial losses. 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「United States National Health Care Act」の詳細全文を読む スポンサード リンク
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