race, sex, age, national origin, income, marital sta-
tus, sexual orientation, religion, political belief, place 
of residence, employment status, or previous health 
status, comprehensive health care services delivered 
by salaried health workers and emphasizing the pro-
motion and maintenance of health as well as the 
treatment of illness. 
(2) To establish representative and democratic 
governance of the Service. 
(3) To provide health workers in the Service 
with fair and reasonable compensation, secure em-
ployment, opportunities for full and equal participa-
tion in the governance of health facilities, and oppor-
tunities for advancement without regard to race, sex, 
age, national origin, sexual orientation, religion, or 
political belief. 
(4) To increase the availability and continuity 
of health care by linking local health care facilities 
to hospitals and specialized care facilities. 
(5) To overcome present disparities in health 
and access to health care resources, especially for 
currently underserved innercity and rural popu-
lations, minority groups, prisoners, and occupational 
groups, by redistributing health care resources to 
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underserved populations, and by enhancing public 
health and preventive health services. 
(6) To finance the Service through progressive 
taxation of individuals and employer contributions, 
and to distribute these revenues on a capitation 
basis, supplemented by allocations to meet special 
health care needs. 
SEC. 4. DEFINITIONS. 
For the purposes of this Act, unless the context im-
plies otherwise: 
(1) 
HEALTH
CARE
FACILITY.—The 
term 
‘‘health care facility’’ means an administrative unit 
composed of specified staff, equipment, and premises 
and established by a health board as an appropriate 
unit of organization for the delivery of specified 
health care or supplemental services under this Act. 
(2) HEALTH
WORKER.—The term ‘‘health 
worker’’ includes— 
(A) any employee of the Service; and 
(B) any individual who for remuneration 
delivers, administers any program in, provides 
supporting services for, teaches the subject 
matter of, or performs research in, health care 
services. 
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(3) INDIRECT PROVIDER OF HEALTH CARE.— 
The term ‘‘indirect provider of health care’’ means 
an individual who— 
(A) receives (either directly or through his 
or her spouse) more than 1⁄10 of his or her 
gross annual income from any one or combina-
tion of— 
(i) fees or other compensation for pro-
vision of, research into, or instruction in, 
the provision of health care, 
(ii) entities engaged in the provision 
of health care or in such research or in-
struction, 
(iii) producing or supplying drugs, 
medical equipment, or other articles for in-
dividuals or entities for use in the provi-
sion of or in research into or instruction in 
the provision of health care, or 
(iv) entities engaged in producing 
drugs, medical equipment, or such other 
articles; 
(B) holds a fiduciary position with, or has 
a fiduciary interest in, any entity described in 
clause (ii) or (iv) of subparagraph (A); or 
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(C) is engaged in issuing any policy or con-
tract of individual or group health insurance or 
hospital or medical service benefits. 
(4) NATIONAL
HEALTH
BOARD.—The term 
‘‘National Health Board’’ means the National 
Health Board of the Service. 
(5) SERVICE.—The term ‘‘Service’’ means the 
United States Health Service established in section 
101. 
(6) SERVICE-RELATED TERMS.— 
(A) HEALTH CARE SERVICES.—The term 
‘‘health care services’’ means the services de-
scribed in paragraphs (1) through (5) of section 
213(a). 
(B) SUPPLEMENTAL SERVICES.—The term 
‘‘supplemental services’’ means the services de-
scribed in paragraphs (1), (2), and (3) of sec-
tion 213(b). 
(7) USER.—The term ‘‘user’’ means an indi-
vidual who is eligible under section 211 to receive 
health care services from the Service under this Act. 
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TITLE I—ESTABLISHMENT AND 
OPERATION OF THE UNITED 
STATES HEALTH SERVICE 
SEC. 101. ESTABLISHMENT OF THE SERVICE. 
(a) IN GENERAL.—There is established, as an inde-
pendent establishment of the executive branch of the 
United States, the United States Health Service. 
(b) AUTHORITY.— 
(1) NATIONAL HEALTH BOARD.—The authority 
of the Service shall be exercised by the National 
Health Board and, in accordance with this Act and 
guidelines established by such Board, by local and 
regional authorities affiliated with the Board. 
(2) EMINENT DOMAIN AUTHORITY.—The Serv-
ice shall have the authority, under the power of emi-
nent domain, to acquire by condemnation under ju-
dicial process real estate for the Service for public 
purposes whenever it is necessary or advantageous 
to do so. 
(c) ADMINISTRATION.—The Board shall implement 
administrative measures as necessary to assure the equi-
table distribution and allocation of health care resources 
and services. 
(d) ACCOUNTABILITY AND CONTROL.—The Board 
shall establish mechanisms to assure accountable, rep-
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resentative and democratic governance of the Service and 
of health care facilities by health care users and workers, 
with limits on conflicts of interest as described in this Act. 
SEC. 102. APPOINTMENT OF THE NATIONAL HEALTH 
BOARD. 
The President shall, no later than 30 days after the 
date of the enactment of this Act, appoint 21 individ-
uals— 
(1) who are 18 years of age or older; 
(2) who are concerned about the health care 
problems of the Nation; 
(3) who approximate the Nation’s population by 
race, sex, income, language, and region of residence, 
and approximate the percentage of rural and fron-
tier populations; and 
(4) no more than seven of whom are or have 
been health workers, indirect providers of health 
care, or members of the immediate family of such 
workers or indirect providers within 24 months of 
the date of such nomination, to serve as members of 
the National Health Board of the Service. 
SEC. 103. POWERS AND DUTIES OF THE NATIONAL HEALTH 
BOARD. 
The National Health Board shall— 
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(1) establish the boundaries of health care de-
livery regions, in accordance with section 107; 
(2) establish procedures for creating local and 
regional authorities within each health care delivery 
region, to oversee and administer the delivery of 
health services, pursuant to section 104, and other 
provisions of this Act in their respective regions and 
local areas; 
(3) carry out such duties of the National 
Health Board as it deems necessary and consistent 
with the timetable given under this Act and the pur-
poses of the Service; and 
(4) provide for the recording of minutes of each 
of its meetings, and shall make such records avail-
able to the public for inspection and copying. 
SEC. 104. REPRESENTATION IN LOCAL AND REGIONAL AU-
THORITIES. 
The governing bodies of the local and regional au-
thorities created pursuant to section 103(b) shall consist 
of representatives of users resident in their local area or 
region and representatives of health workers employed by 
the Service in their local area or region. Representatives 
of such users shall comprise the majority of such rep-
resentatives and representatives of such health workers 
shall comprise a minority. 
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SEC. 105. PUBLIC ACCOUNTABILITY AND FINANCIAL DIS-
CLOSURE. 
(a) PROHIBITION OF CONFLICTS OF INTEREST.— 
(1) IN GENERAL.—Individuals with direct or in-
direct conflicts of interest shall not serve on health 
boards or authorities. Subject to paragraph (2), such 
conflicts may consist of ownership of, employment 
in, or other financial affiliation with any industry in 
a position to profit or otherwise benefit from the ac-
tivities of the health board. 
(2) EXCEPTION.—Paragraph (1) shall not 
apply to employment as a health worker by the Serv-
ice as specified in this Act. 
(b) DISCLOSURE.—Candidates for health boards or 
authorities shall fully disclose any such potential conflicts 
of interest, and if elected or appointed shall sever any af-
filiations that could result in a conflict. 
SEC. 106. INSPECTOR GENERAL FOR HEALTH SERVICES. 
Within the United States Health Service there shall 
be an Office of the Inspector General for Health Services, 
to be headed by an Inspector General for Health Services, 
that shall have authority to ensure the effective operation 
of the services pursuant to this Act and to investigate and 
pursue any grievances against the National Health Board 
or its local authorities. The Inspector General shall have 
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the same authority as an Inspector General has under the 
Inspector General Act of 1978. 
SEC. 107. ESTABLISHMENT OF HEALTH CARE DELIVERY RE-
GIONS. 
(a) ESTABLISHMENT OF HEALTH CARE DELIVERY 
REGIONS.—No later than 6 months after the appointment 
of members of the National Health Board, such Board 
shall establish, in accordance with this section, health care 
delivery regions throughout the United States. 
(b) REQUIREMENTS FOR DELIVERY REGIONS.—Each 
health care delivery region shall meet the following re-
quirements: 
(1) The region shall be a contiguous geographic 
area appropriate for the effective governance, plan-
ning, and delivery of all health care and supple-
mental services under this Act for residents of the 
region. 
(2) The region shall have a population of not 
less than 500,000 and of not more than 3,000,000 
individuals, except that— 
(A) the population of a region may be 
more than 3,000,000 if the region includes a 
standard metropolitan statistical area (as deter-
mined by the Office of Management and Budg-
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et) with a population of more than 3,000,000; 
and 
(B) the population of a region may be less 
than 500,000 if the National Health Board de-
termines that this is necessary to facilitate the 
delivery of health care and supplemental serv-
ices or the effective governance of the health 
program within such region. 
A region under subparagraph (B) may be a sparsely 
populated frontier area which consists of a very 
large or multi-state geographic area. 
(3) The boundaries of each region shall take 
into account— 
(A) any economic or geographic barrier to 
the receipt of health care and supplemental 
services in nonmetropolitan areas, and 
(B) the differences in needs between non-
metropolitan and metropolitan areas in the 
planning, development, and delivery of health 
care and supplemental services. 
(c) MODIFICATION OF BOUNDARIES.—The National 
Health Board shall review the boundaries of regions no 
later than 2 years after each decennial national census, 
or upon receipt of and at such other times as it deems 
necessary, and may modify the boundary of any region 
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in which there has been a substantial shift of population 
justifying such modification or if such modification would 
better carry out the purposes of this Act, and if such modi-
fication is approved in a referendum of residents in an 
area whose regional identification would be changed by 
making such modification. 
(d) PROCESS.—At least 60 days prior to the estab-
lishment of the boundaries of any region, or modification 
of the boundaries, the National Health Board shall col-
laborate with its regional authorities to provide for— 
(1) notice in the area which would be affected 
by the establishment of such boundaries of the 
boundaries proposed to be established, and of the 
date, time, and location of the public hearing on 
such establishment as provided in paragraph (2); 
and 
(2) a public hearing at which individuals can 
speak or present written statements relating to the 
establishment of such boundaries. 
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TITLE II—DELIVERY OF HEALTH 
CARE 
AND 
SUPPLEMENTAL 
SERVICES 
Subtitle A—Patients’ Rights in 
Health Care Delivery 
SEC. 201. BASIC HEALTH RIGHTS. 
The Service, in its delivery of health care services to 
users, shall ensure that every such individual is given the 
following basic health rights: 
(1) The right to receive high quality health care 
and supplemental services from any facility within 
the Service capable of providing such services with-
out charge and without discrimination on account of 
race, sex, age, religion, language, income, marital 
status, sexual orientation, dress, or previous health 
status. 
(2) The right to humane, respectful, dignified, 
and comforting health care, and to the reduction of 
pain and distressful symptoms. 
(3) The right to have all medically necessary or 
appropriate health services delivered in a convenient 
and timely manner. Any decision to deny or post-
pone such necessary or appropriate care shall be 
made only on the basis of temporary and reasonable 
limitations in the availability of service personnel 
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and physical facilities. Users shall have the oppor-
tunity for timely and effective appeal of any decision 
to deny or postpone care. 
(4) The right to choose the health workers who 
shall be responsible for, and the health facilities in 
which to receive, the individual’s health care serv-
ices. 
(5) The right of access to all information, in-
cluding the individual’s health records and the med-
ical dictionary produced under section 433(b), which 
promotes an understanding of health. 
(6) The right to have all health care informa-
tion, reports, and educational materials translated 
into the individual’s primary language. 
(7) The right to receive, prior to the delivery of 
any health care service, a careful, prompt, and intel-
ligible— 
(A) explanation of the indications, diag-
noses, benefits, side effects, and risks involved 
in the delivery of such service, and a description 
of all medically necessary or appropriate alter-
natives to such service (including no treatment); 
(B) answer to any question relating to 
such health care service; and 
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(C) explanation of one’s health rights de-
scribed in this subtitle, and the right to have 
such health care service delivered only with the 
individual’s prior, voluntary, written consent. 
(8) The right to refuse the initial or continuing 
delivery of any health care service whenever such re-
fusal does not directly endanger the public health or, 
in accordance with State law, the health of the indi-
vidual if the individual is dangerous to himself or 
herself. 
(9) The right to have all individually identifi-
able information and documents treated confiden-
tially and not disclosed (except for statistical pur-
poses and for the control of communicable diseases, 
drug abuse, and child abuse) without the individual’s 
prior, voluntary, and written consent. 
(10) The right of access at all times to individ-
uals or groups for counseling, health information, 
and assistance on health matters, including access to 
user advocates who shall— 
(A) assist users in choosing the most ap-
propriate sites from which to receive health 
services and the most appropriate health work-
ers from whom to receive such services; 
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(B) provide counseling and assistance to 
users in filing complaints; and 
(C) investigate instances of poor quality 
services or improper treatment of users and 
bring such instances to the attention of the ap-
plicable authority. 
(11) The right to be accompanied and visited at 
any time by a friend, relative, or independent advo-
cate of the individual’s choosing, and the right to 
have routine services, such as feeding, bathing, 
dressing, and bedding changes, performed by a 
friend or relative, if the individual so chooses. 
(12) The right, in the event of terminal illness, 
to die with a maximum degree of dignity, to be pro-
vided all necessary symptom relief, to be provided 
(and for the individual’s family to be provided) coun-
seling and comfort, and to be allowed (if desired) to 
die at home. 
(13) The right of access to a complaint and 
grievance system and to legal assistance to enforce 
these rights. 
SEC. 202. RIGHT TO PAID LEAVE TO RECEIVE HEALTH 
CARE SERVICES. 
(a) AMENDMENT
TO
FAIR
LABOR
STANDARDS 
ACT.—The Fair Labor Standards Act of 1938 is amended 
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by inserting after section 7 (29 U.S.C. 207) the following 
new section: 
‘‘MINIMUM HEALTH LEAVE COMPENSATION 
‘‘SEC. 7A. Each employee of any employer who in any 
workweek is engaged in commerce or in the production 
of goods for commerce, or is employed in an enterprise 
engaged in commerce or in the production of goods for 
commerce, shall be entitled to receive from the employer, 
for each 35 hours he is employed by the employer (not 
counting more than 35 hours in any workweek), com-
pensation for one hour of employment at the regular rate 
at which the employee is employed (as that term is used 
in section 7 of this Act) for an hour— 
‘‘(1) during the period of 52 weeks beginning 
with the workweek with which the entitlement is 
earned, and 
‘‘(2) during which the employee is unable to 
work because of the need for the employee (or a de-
pendent of that employee) to receive necessary 
health care services.’’. 
(b) CONFORMING AMENDMENTS.—The Fair Labor 
Standards Act of 1938 is further amended— 
(1) in section 3(o), by striking ‘‘sections 6 and 
7’’ and inserting ‘‘sections 6, 7, and 7A’’; 
(2) in section 13— 
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(A) in subsection (a) before paragraph (1), 
by striking ‘‘and 7’’ and inserting ‘‘, 7, and 
7A’’; 
(B) in subsection (a)(3), by striking ‘‘sec-
tions 6 and 7’’ and inserting ‘‘sections 6, 7, and 
7A’’; and 
(C) in subsections (d) and (f), by inserting 
‘‘7A,’’ after ‘‘7,’’ each place it appears; 
(3) in section 14(d), by striking ‘‘6 and 7’’ and 
inserting ‘‘6, 7, and 7A’’; 
(4) in section 15(a), by striking ‘‘section 6 or 
section 7’’ and inserting ‘‘section 6, 7, or 7A’’; 
(5) in section 16— 
(A) in subsection (b), by striking ‘‘section 
6 or section 7’’ and inserting ‘‘section 6, 7, or 
7A’’; 
(B) in subsection (b), by striking ‘‘or their 
unpaid overtime compensation’’ and inserting 
‘‘their unpaid overtime compensation, or their 
unpaid health leave compensation’’; 
(C) in subsection (b), by inserting ‘‘or of 
unpaid 
health 
leave 
compensation’’ 
after 
‘‘amount of unpaid overtime compensation’’; 
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