SOLVING THE AMERICAN HEALTHCARE CRISIS 1 What is the Crisis and what has been tried? The American Healthcare System is fraught with issues, notably; • Overpriced services • Excessive administration • Ine ffi cient care delivery • A primarily reactive (vs. proactive) approach • Large corporations and special interests control the System Attempted solutions have included; • Heavy regulation • Price- fi xing • Excessive government spending and constant legislation These can’t end the crisis because they don’t address the underlying problem. 2 Minimum medical education to become: | | | | | | | | | | | | | | A Doctor At least a decade What is the underlying problem? The private health insurance and government health administration markets are a multi-TRILLION dollar industry. Many leading businesses are not actually providing healthcare but are responsible for the allegedly necessary administration of healthcare by providers. An Admin None Provider - A doctor, hospital, or other medical care person or facility. 3 What is the underlying problem? Insurers and administration contractors are healthcare middlemen that: • Add complexity, cost, and ine ffi ciency to healthcare, AND bene fi t from it • Utilize regulation, price- fi xing, and government involvement to maintain market control and position • Make Billions from American insurance premiums and taxpayer dollars, which doesn’t go directly to improving Americans’ health • Allegedly reduce risk of medical debt, and facilitate care for Americans • Often cost Americans more and always limit healthcare options more than purchasing care directly • Allegedly ensure revenue fl ow for providers • Often interrupt payment to providers and always complicate the payment process. Think about it: Does a deal or supply chain ever get better by adding more middlemen? 4 The Solution is Simple How it NOAH works: 1. Americans designate on their W-4 as self-pay for healthcare , i.e. not buying or renewing a commercial health insurance. 2. Healthcare billed to, and paid by the consumer , directly with providers. 3. At tax time, Americans use paid healthcare expenses to reduce their tax bill and receive refunds to cover not-yet-paid expenses ✓ O ff er Americans the opportunity to self-manage their own care while minimizing their risk WT: New Opportunity for American Healthcare (NOAH) 5 NOAH will make American Healthcare freer, fairer, and faster! Benefits NOAH has a myriad of bene fi ts, including; ✓ More care options for Americans ✓ Managed risk of medical debt without added cost ✓ Fewer upfront costs for healthy Americans ✓ A tax break for all, and protection for the most vulnerable in our country. ✓ Incentivizes preventative care ✓ Greater e ffi ciency in care (more patients can be treated) ✓ Reduces much of the documentation and billing burden for providers ✓ More reliable, less complicated payment for providers (lets doctors be doctors instead of billers!) ✓ Increased cost transparency ✓ Increased competition among providers and health insurers, (improved a ff ordability and care) ✓ Increased compliance to No Surprises Act ✓ Less federal spending required for healthcare funding and administration ✓ Utilizes existing regulations and care supply chain more e ff ectively ✓ No interruption to current insurance system or Americans who might still prefer insurance (no fallout!) ✓ Reduction of power and control by healthcare corporations and contractors ✓ Takes money out of healthcare politics and special interests 6 Steps to Execute the Solution 1. Pass an executive order to put into e ff ect the bare essentials of NOAH (below), to improve adoption time and public support. A. Allow Americans to credit healthcare expenses toward their federal income tax dues, when designated as self-pay, even if they don’t fi le an itemized income tax return. B. Inform providers that, in order for NOAH Americans to utilize self-pay healthcare, all billed fees must be published and available beforehand. Providers are not permitted to bill these Americans, or discriminate against them, otherwise. 2. Work with Congress to develop legislation to immortalize plan. 3. Let the free market work to improve transparency, and increase competition, e ff ectiveness, and a ff ordability for the American Healthcare System. 7 End of Main Presentation Q & A 8 Proposed Technical Details of Legislation • Eligible self-pay healthcare services (“Services”) are refunded to self-pay designated Americans (“Persons”, “they”, “their”) as part of their tax refund, upon fi ling of their income tax return. • Services include all Medicare-recognized health services (e.g. preventative, emergency, acute, institutional, surgical, primary, specialty, ancillary, prescription, non-experimental/ investigational, etc.) performed by an individual, facility, or organization that is quali fi ed to perform such services under applicable federal, state, and local laws (“Provider”). • To be eligible to fi le , a Person must inform the IRS prior to a tax year, of their intent to fi le as Self-Pay for the coming year and to not utilize a commercial health insurance plan or Medicare Part C or D plan that year. Should a Person sign up for one of these plans, fi le as EXEMPT on a W-4, or otherwise withhold less than would otherwise be required of them under normal tax law that year, that Person forfeits all bene fi ts of the the Self-Pay designation for that year. • To fi le and receive the described bene fi ts , a Person must keep record of these Services and their associated expenses and submit a sum total of expenses paid that year, and the sum of amounts outstanding, as of the time of fi ling. Additionally, a Person must retain the records for normal IRS audit-eligible periods. • Services must be paid directly, at conclusion of service, by the recipient, whenever that Person has the means to do so without impoverishment (i.e. immediate impact to a Person’s fi nancial wellbeing or ability to meet their needs and existing liabilities), and must agree to a payment plan if one is o ff ered by the provider. A Person must certify in writing at conclusion of service to the provider if they cannot be pay without impoverishment, and must pay for the service in piecemeal or whole, as soon as they are able to do so without impoverishment. This is to prevent the delay of payment to providers, and to prevent abuse by Persons. Current laws still apply: as is the law today, a provider is still permitted to refuse service if a Person refuses to pay for previous non- emergency care provided, and emergency care cannot be denied to anyone. • A Person may not be refunded a positive balance from their return. The point of this legislation is only to reduce a Person’s tax burden in view of healthcare debts, after all other tax credits and liability deductions, up to the point that a Person might have no tax burden. • Providers must publish fees prior to service, which may not change more than once per quarter, and must be immediately available upon request, including service coding (CPT, HCPCS, etc.) quantity of measure (each, per diem, per foot) and service description. Providers may not lawfully bill any party, including Persons for an unpublished fee. This will provide the transparency and compliance to the No Surprises Act necessary to ensure free market competition. • Providers must issue Persons an invoice of Services performed and an itemized, printed receipt, upon any payment in part or whole, for those services in an indelible medium (e.g. printed paper, not heat-transfer receipt). • Providers must retain records of all costs associated with care provision , by code, or they may not claim them in subsequent deposition for auditing purposes. • Providers who do not follow these rules may not charge or bill a Person and may not discriminate against Persons, with regard to how that Provider would service Americans using other methods of healthcare payment. • For areas of doubt or dispute , the text of this legislation should be interpreted fi rst in the best interest of the applicable Person(s), then in the best interest of the applicable Provider(s), before any interest of the government. • 9 Possible objections Persons can abuse NOAH for unnecessary medical services! Persons can use NOAH as a tax shelter! NOAH makes doctor’s jobs harder! Lower federal tax revenue! Disrupts the insurance market! No. With the provision for services to follow Medicare guidance, medical necessity is required for services. Performing medically unnecessary services is still governed by FWA laws and can strip Providers of their credentials. This would actually add tax fraud to the criminality of such an act. No, Persons are only recovering money that they spent on healthcare at tax time. And are not receiving money they spent, only o ff setting their tax burden. Any scheme to do more than that is, and would still be, illegal. On the contrary, Providers already have an easier time serving self-pay patients, easier billing for them, and a smaller amount of unrecognized revenue from them. You’ll have a hard time fi nding a Provider to complain about getting paid cash! Yes, however, the amount saved in spending on administration and peripheral areas, for both Federal and State entities, would represent a substantial net improvement. Less revenue, but drastically less cost for multiple government programs and entities. As the key problem in the American Healthcare System, disruption is necessary, but this option provides organic, not contrived challenge, for smooth transitions as this Solution garners more use. The real thing being lost here is fi scal waste in the System —money spent that doesn’t actually improve health—and only those who pro fi t by that waste will be impacted. NOAH is a free-market challenge for insurers, freeing Americans to entertain more options, and reap the bene fi ts of lower prices from greater competition. If insurers remain competitive, there is nothing to fear. 10 Sources and Additional Reading Slide Slide Slide Slide 1) https://pmc.ncbi.nlm.nih.gov/articles/PMC6390800/ https://www.bmj.com/content/383/bmj.p2340 https://www.theatlantic.com/business/archive/2013/03/why-is-american-health-care-so-ridiculously- expensive/274425/ https://www.pgpf.org/article/why-are-americans-paying-more-for-healthcare/ https://www.americanprogress.org/article/excess-administrative-costs-burden-u-s-health-care-system/ https://www.mckinsey.com/industries/healthcare/our-insights/administrative-simpli fi cation-how-to- save-a-quarter-trillion-dollars-in-us-healthcare https://www.commonwealthfund.org/publications/issue-briefs/2023/oct/high-us-health-care-spending- where-is-it-all-going https://www.gao.gov/products/gao-25-107194 https://companiesmarketcap.com/healthcare/largest-healthcare-companies-by-market-cap/ #google_vignette https://disfold.com/united-states/sector/healthcare/companies/ https://x.com/i/grok/share/poJQeEkbij0zK5SQSWSzFnT4c 2) https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data/ nhe-fact-sheet https://www.grandviewresearch.com/industry-analysis/healthcare-insurance-market https://www.mordorintelligence.com/industry-reports/united-states-health-and-medical-insurance- market 3) See previous and https://x.com/i/grok/share/NEYgUOLGBRhtpwmDr0gqOmqwP 4) See previous and https://x.com/i/grok/share/K8QRzmNdpeuR7G2UpAIXlCFc2 11 12