Saving American Health Care and paying for itThe Rick Wagner bill

By a family doctor

Are you happy with the health insurance that your employer provides you?

What did it NOT pay for?

What was your out of pocket cost last year?

Do you even have health insurance?

Are you an employer who can’t afford to insure yourself or your employees?

Employers pay for health insurance for most Americans but the employees are the ones who get sick

Most CEOS and benefit managers have no idea what their plan actually covers until they get sick

As a practicing family doctor, I have seen this every day for the last 24 years

There is a disconnect here, what can we do about it?

Rick Wagner is a patient of mine who had rectal bleeding begin two years ago. I suggested that he see a gastroenterologist for colonoscopy to find out why

Because of the recession, his business was going broke and he couldn’t afford health insurance, so he made the financially responsible decision to not do something he couldn’t pay for

When I saw him last year, and asked him what the colonoscopy showed, he told me he never had it. I told him again that he needed colonoscopy

His wife Lori talked him into the procedure soon thereafter, but by then, his colon cancer had spread to his liver and had become more difficult to treat

When I found this out, I started to write a plan that made sense to me, that would help provide health insurance to people like Rick so they no longer have to sacrifice their health to seek the health care that they need to save their lives

Here is my plan

All adults, employed, unemployed or retired get a health insurance subsidy from the Federal Government

They use the subsidy to sign up, on line, for whichever health insurance plan they want.

The amount of the subsidy is based only on their age, sex and where they live

o The premium can only consider their age, sex, where they live, their weight, and if they smoke.

o No other underwriting occurs, and everyone is covered, with no exclusions or higher rates for preexisting conditions

If they don’t chose a plan, the subsidy is used to pay for the lowest cost basic plan that is offered in their area

If they don’t like the plan, they can switch to a different plan with 30 days notice

The subsidy is set around the expected price of the lowest cost basic plan offered in their area.

If they want a plan that covers optional features, like all medications covered, not just the cost of the cheapest one in the class, they pay a higher premium

The rate is based on their weight and if they smoke?

That doesn’t seem fair, smoking is an addiction, and most people who are overweight have a hard time losing weight!

That may be true, but they do cost more to insure.

Their health insurance subsidy would not reflect the entire increased cost to insure them, but they would save money with lower insurance costs if they can quit smoking or lose weight.

Where does the money for this subsidy come from?

Employers no longer send premiums directly to health insurance carriers

Instead, 90% of the premiums they used to pay goes into a national health care “treasure chest”, the other 10% that they would have spent on premiums should instead be…

spent on something to stimulate the economy and help end the recession, like higher wages, hiring more workers, or cutting prices to make their products more competitive

Employers who do that will get another 10% reduction in the amount that they have to contribute the next year, those who don’t use the savings to raise wages, hire more workers, or cut prices will pay the same cost each year

There will also need to a be a small increase in the Medicare tax that all employees have withheld from their paychecks.

In addition, for the first time all other income, such as capital gains and other investment income and Social Security benefits will be taxed at the same rate.

• The guy at McDonald’s making $8 per hour and their CEO making $20 million per year pay the same rate, the politicians can decide who to exempt to make it possible to enact this into law.

So how does this save me money?

Because you are currently paying for a lot of your health care out of pocket even if you have health.

When the Medicare tax rate goes up, what you have to pay can’t exceed the total of your Medicare tax was plus what you paid out of pocket last year.

Additionally health maintenance costs that you used to have to pay a share of, like flu shots and colonoscopies will no longer have a copayment.

Everyone will pay a share of all their other health care expenses up to an annual maximum, based on their income, but …..

They can pay off their copayment by volunteering for public service, like reading to kids at school or picking up trash along the highway or planting flowers in a park, activities needed, requested, and approved by local governments.

The hospitals and clinics that they owe copayment to can bill the Federal government for the co-pays waived this way.

Or they can write them off and then publicize how much they are contributing to local volunteerism by indirectly paying for it.

•The balance of the cost of the subsidies will be paid for by the Federal government as a part of a more meaningful stimulus package then we have been seeing so far and …

•By payments from the Medicare trust fund until it is depleted, Medicare beneficiaries would he exempt from their Social Security and investment income taxed until the amount they paid in has been used to pay for their subsidies

•There will be no more separate Medicare or Medical Assistance plans, all those beneficiaries will use their subsidies to buy their health insurance like everyone else.

•Many of the employees from those plans could work for health insurance companies helping people select their new health insurance plans. A few would still be necessary to figure out what subsidies everyone gets and what plan they select or are assigned to.

•Ending Medicare and MA would make buying health insurance cheaper

Right now, providers have to write off 50% of the charges to Medicare patients and up to 90% of some of the costs for services to Medical Assistance patients, leading to higher overall health prices, which means higher premiums for you because of the cost shifting to you.

•The VA program will continue, veterans will receive a smaller subsidy for health insurance for those benefits that they need that can’t be provided at a VA hospital or clinic.

So won’t this cost a lot of money If all these people who never had good health insurance coverage get it now?

People will think twice about frivolous health care use, like seeing a doctor the first day of a cold, or asking for an MRI the day after a sprained ankle if they always have to pay for a small copayment or work it off in volunteer service

Patients will also be selecting their own health insurance, most for the first time, which should make them more aware of what everything costs them, and how they can change that with different behavior, providers or health insurance

The premiums for insurance will be lower than they would be right now because hospital and clinics no longer have to have higher rates to pay for those people who never pay their bills

The premiums will also be lower because there will no longer be cost shifting from Medicare, which currently pays about 50 cents on the dollar and may be paying even less soon, and Medical Assistance, which pays as little as 10 cents on the dollar

So won’t this cost a lot of money If all these people who never had good health insurance coverage get it now?

Not if service is delivered at the right times;

1) When a disease can be prevented, like a stroke, before it happens, with better blood pressure control, when it is less expensive 2) In the office, and not the ER or hospital, where it is more expensive

3) By a well trained primary care provider whenever possible, because the same care costs less if they provide it, rather than a specialist, especially when multiple problems are present

By forgiving all med school debt for anyone who goes into and stays in primary care, higher paid specialists can pay off their debt quickly, we can’t

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4) When it is needed, because of what we have learned from unbiased clinical trials and well designed practice guidelines, and not because we are constantly under the threat of malpractice suits by a patient with a bad outcome

By exempting physicians from malpractice liability if a bad outcome occurs when a physician doesn’t do a test the patients asks for which guidelines have shown should not be done routinely

5) At the right time, not after the deductible is meet, because there will be no deductibles

-in my experience, deductibles cause patients to not get needed

preventive care before they area meet. Once they are meet, patients go in for everything before the next plan year starts because now its paid for, they encourage wasteful expense then

6) Early in an illness when medications are more effective, by making sure that “orphan drugs” that would normally not be profitable enough for pharmaceutical companies to develop

-The absence of the appropriate drug makes treatment of illness more expensive because less appropriate, more expensive treatments need to be used instead of later

-The pharmaceutical companies may see windfall profits if millions of Americans can afford their drugs for the first time These companies can afford an assessment used to pay for research and development of orphan drugs and to keep their cost down

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So won’t this cost a lot of money If all these people who never had good health insurance coverage get it now?

It still might, so …

There would be a limit on the price of all medical care, and the cost of all supplies sold to health care providers, those prices can’t rise faster than the overall inflation rate

o In this economy, getting guaranteed no worse than cost of living price increases is a great deal!

The only exception is medical specialists, their reimbursement formulas, usually based on how many patients they see, is frozen until their salaries and those of primary care doctors are again similar, which will take decades at the present rate.

They were last similar in the 1940s before hospital based care and the salaries of those who provided it improved because they had better coverage in the early health insurance plans

But won’t the insurance companies make out like bandits if everyone can buy their own health insurance?

o The bottom line is that the health insurance industry, with their legions of lobbyists and the huge amounts of campaign contributions that they make to both parties can sink any health care they don’t like, they sank the Clinton plan in the 1990s

o However, with my plan, if they accept the government subsidies given to patients to buy insurance, their books have to be transparent

o If they make huge profits in an area this year, the subsidies are obviously too high, and they will be “dialed down” next year

o Most plans won’t charge much more for a premiums than the subsidy pays for, so their profits should drop to more reasonable levels

You don’t like my plan?

So you’ve got a better plan, huh?

Can your plan…..?

Stimulate the economy, make American goods more competitive overseas and help end the recession?

Give patients a choice in their health insurance and how expensive a plan they want?

Eliminate raising premiums or denying insurance for preexisting conditions?

Guarantee Americans they won’t pay more than last year in health insurance and out of pocket costs

Hold down the cost of health care and slow the rate of increase in cost

Encourage more volunteerism in this country

Help ensure that there enough primary care doctors and doctors in underserved areas?

Accomplish this with a smaller Medicare program rather than creating a brand new program

Allow all present health insurance carriers and health care organizations to continue to exist while preventing excessive profit

Is this plan any worse than the status quo?

Who are the winners?

Employees who have no control over their health insurance now

Those with no health insuranceThose with no primary care doctorsDoctors going in to primary care with

huge debtEmployees of companies who export their

goodsPeople who live in underserved areasPeople with insurance who can’t afford

their copayments

Who are the losers?

Foreign companies that we compete against

Surgeons and specialists in areas that aren’t underserved

Malpractice attorneysOwners of health care supplier used

to high profitsThe very wealth and those with big

retirement investment portfolios that don’t get taxed now

There is enough money being spent on health care in the US to have the best health care in the world, but we don’t, too many people now get too little share of it

Everyone will find something in this plan they don’t like, but overall, it has a better chance of saving our health care system than anything else I have seen

There is a lot of pain out there when it comes to health care, the pain should be shared more evenly too

If you agree with what I have said, forward a copy of those file to anyone you know you who has an interest in saving our health are system, and send a copy to your Congressman and Senator. I will have a Facebook page, “Saving American Health Care and Paying for it”, let me know what you think.

Hopefully it will “go viral”

Bill Benn