A Powerpoint presentation of a plan written by a family doctor

1. Saving American Health Care
and paying for it
The Rick Wagner bill
By a family doctor

2. 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?

3. 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?

4. 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

5. 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

6. 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

7. 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!

8. 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.

9. 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

10. 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.

11. 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 …..

12.  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.

13. •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.

14. •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.

15. 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

16. 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

17. Continued
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

18. Continued
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

19. 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

20. 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

21. 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

22.  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?

23. Who are the winners?
 Employees who have no control over
their health insurance now
 Those with no health insurance
 Those with no primary care doctors
 Doctors going in to primary care with
huge debt
 Employees of companies who export
their goods
 People who live in underserved areas
 People with insurance who can’t afford
their copayments

24. Who are the losers?
 Foreign companies that we compete
against
 Surgeons and specialists in areas that
aren’t underserved
 Malpractice attorneys
 Owners of health care supplier used to
high profits
 The very wealth and those with big
retirement investment portfolios that
don’t get taxed now

25.  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