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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 Jr., D-MI. The bill had 88 cosponsors as of October 7, 2009.

The act calls for the creation of a universal single-payer health care system in the United Statesmarker, the rough equivalent of Canada's Medicare and the United Kingdommarker's National Health Service. All medically-necessary medical care decided between doctor and patient would be paid for automatically and directly by the Government of the United States, ending the need for private insurance for such care, and probably recasting private insurance companies as supplemental coverage, to be used when non-essential care is sought.

The national system would be paid for through taxes, which would replace insurance premiums. Advocates of single-payer healthcare, such as economist Paul Krugman, have argued that by eliminating insurance company administrative overhead, healthcare costs would be reduced sufficiently to cover the uninsured. One study estimated U.S. private insurer administrative costs at 30% of total healthcare costs, versus 17% for the single-payer Canadian system.

The bill was first introduced in 2003, when it had 25 cosponsors, and has been reintroduced in each Congress since. H.R. 676 was expected to be be debated and voted upon by the House in September 2009, but October 2009 is now more likely. It will be considered as an alternative to Affordable Health Care for America Act, H.R. 3962.

Elements of the bill

The summary of the National Health Care Act includes the following elements, among others:

  1. Expands the Medicare program to provide all individuals residing in the United States and U.S. territories with free health care that includes all medically necessary care, such as primary care and prevention, prescription drugs, emergency care, long-term care, mental health services, dental services, and vision care.
  2. 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. Private insurance would be replaced via the Medicare expansion.
  3. Gives patients the freedom to choose from participating physicians and institutions.
  4. Prohibits a private health insurer from selling health insurance coverage that duplicates the benefits provided under this Act. Allows such insurers to sell benefits that are not medically necessary, such as cosmetic surgery benefits.
  5. Sets forth methods to pay institutional providers of care and health professionals for services. Prohibits financial incentives between HMOs and physicians based on utilization.
  6. 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.
  7. Establishes a program to assist individuals whose jobs are eliminated (e.g., within insurance companies) due to the simplified single-payer administrative process.
  8. Requires creation of a confidential electronic patient record system.
  9. Establishes a National Board of Universal Quality and Access to provide advice on quality, access, and affordability.
  10. 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.
  11. The bill covers treatments on or after the first day of the year that begins one full year after passage (January 1, 2011 if the bill is passed in 2009). Compensation continues for 15 years to owners of converting for-profit providers for reasonable financial losses.

The elements of this bill include: water, fire, earth, air.AVATAR THE LAST AIRBENDER ROCKS!!Hence I Be Eating Tea Horribly Yellow.


H.R. 676, though introduced in 2003, initially received attention with the June 2007 release of the Michael Moore documentary Sicko, which focuses on the status of health care in the United States, the only developed country without universal health care. The DVD edition of the film includes a segment (Sicko Goes To Washington) promoting the bill.

In 2009 the bill was reintroduced and renamed from the United States National Health Insurance Act to the United States National Care Act, a reflection of the fact that the bill provides health care instead of providing health insurance. Health care was a major part of Barack Obama's campaign promises, and while he admitted that only a single payer system would provide universal coverage, the plan favored by Obama would be to increase insurance coverage instead. However, town hall remarks by Obama have included support for a single payer system. In 2007, about 46 million Americans were without health insurance, but increasing insurance would still not provide coverage for the approximately one third of those who actually qualify for Medicare and Medicaid but are unable or unwilling to apply.


The bill proposes an expansion of the popular Medicare program to the non-elderly to provide universal coverage and allows individuals to select their own doctors. The bill would create a single-payer system, with Medicare replacing the 1,300 private insurance companies currently involved, which would reduce net costs between $100 and $250 billion annually, based on estimates. The savings relates to the approximately one-third of healthcare expenses which are spent on administrative overhead rather than medical service delivery.

H.R. 676 represents a significant expansion of government, essentially replacing a large part of the private health insurance industry via an expansion of the Medicare program. Conservatives historically have argued against the expansion of government programs, offering significant resistance to the current and prior healthcare reform efforts, and the bill would raise taxes for higher-income individuals. On July 30, 2009, Rep. Anthony Weiner offered Republicans an opportunity to oppose government-run health care programs by putting forth an amendment that would eliminate Medicare. Every single Republican representative (and every Democrat) on the House Energy and Commerce committee voted to continue Medicare.

Opinion polling

Polling is varied when pollsters ask Americans whether or not they support a single payer system or some type of "medicare for all" plan.

In November 2009, Ipsos found that just 22% of Americans support a "Creation of a single payer system in which the government controls the entire healthcare insurance system, while 72% opposed. In August 2009, Rasmussen Reports found that just 32% of Americans support a single payer system, while 57% are against it. In July 2009, Kaiser found that 55% supported "a national health plan in which all Americans would get their insurance through an expanded, universal form of Medicare-for all." In the same month, Time Magazine found that 49% supported "a national single-payer plan similar to Medicare for all, in which the government would provide healthcare insurance to all Americans." In October 2003, a Washington Post poll found that 62% supported "a universal health insurance program, in which everyone is covered under a program like Medicare that's run by the government and financed by taxpayers."

A poll of practicing physícians in Massachusetts published by the American Medical Association (AMA) found that 55.7% of AMA members and 66.8% of non-members preferred "single payer" as a basis for reform over the other alternatives offered of "managed care" and "fee for service". Overall support for single payer was 63.5% compared to 25.8% for fee for service and 10.7% for managed care.

Medical tourism

Since the act covers all "residents," a section was added requiring the Secretary of HHS to create a rule addressing the possibility of medical tourism (Section 101(e)).

See also


  1. Krugman-NYT-One Nation, Uninsured-June 2005
  2. Research Report-Harvard & Canadian Institute for Health Information-Costs of Healthcare Administration in the U.S. and Canada 2003
  4. United States National Health Care Act - Summary
  5. Insuring America's Health: Principles and Recommendations, Institute of Medicine at the National Academies of Science.
  6. The Case For Single Payer, Universal Health Care For The United States, John R. Battista, M.D. and Justine McCabe, Ph.D.
  7. American Health Care
  8. Towards Universal Health Care
  9. Universal Health Plan is Endorsed The Boston Globe August 13, 2003
  10. Town Hall Meeting on Health Care
  11. More Americans Have No Health Insurance retrieved 21 September 2009
  12. The Harris Poll 2009
  13. Summary of the Bill
  14. The New Republic-Conservatism is Dead-Tanenhaus-February 2009
  15. Summary of the Bill

External links

  •  – Information on the act from the Library of Congress Database
  • Congressman John Conyers, Jr., sponsor of the bill, official U.S. House website
  • - A grassroots effort to inform the public about H.R. 676

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