Simply put, we can fix America’s Healthcare system in two steps. 1st step, eliminate the fraud! 2nd step, create an American Wellness Act that pays Americans to stay healthy! Done deal! System fixed!

Ok, so you are thinking what fraud are we talking about and why in the world should the US Government PAY people to stay healthy?

The fraud is rampant. Out of control. Extends to virtually every aspect of our healthcare system and I could write an entire book on the cases I have worked on for consumers. Obamacare was a complete disaster. However, our healthcare before the Affordable Care Act was adopted, was not much better.

Let’s take a look at our healthcare prior to the Covid-19 pandemic.

It’s a $3 trillion sector of our economy, representing an 18% share of the United States’ GDP. Our drug spend alone per family is over $1000.00 per year. If it wasn’t for the efforts of the Trump Administration to demand transparency with the cost of drugs, and allow Americans to seek alternatives, we would always remain at the top of the list in the world as the country paying the most per-capita.

America is a country born and raised on free open markets, competitive pricing and entrepreneurial spirit. We should treat our purchasing of healthcare “medical services” like we do our fast food restaurant purchases. We’ve got Arbys, Jack in the Box, McDonalds, Wendys and many more. Every week there is another special going on and a new offer to bundle that McSandwich with Fries and a ice cold drink for only $6.99. Why do all these fast food restaurants offer such amazing deals? Two reasons, to beat out their competition, and to sell their inventory for cash that clears their bank in 24 hours at most. Fast food restaurants maintain a pretty stable profit margin at 6%-9%, with McDonalds as high as 20%.

So I bet you are laughing a bit over my comparison of Healthcare with Fast Food. Let me somber the mood here for a minute. If Fast Food restaurants were run like our healthcare in America, that $6.99 sandwich deal would cost you $47.04. And, if you wanted it faster by using the drive through window, it could be as much as $100.00. Same sandwich, same ingredients, same employee making the sandwich, the only difference being you would have the fast food restaurant send a bill to your house, your office, your employer or some other third party to pay for it. That’s the difference.

Let me give you a real life example, which I have many of them.

I recently underwent an extensive physical exam at my doctor’s office in order to prepare me for a more aggressive exercise program. As part of the exam, one of the tests had to be performed by a medical facility outside of the doctor’s office. The Doctor wrote up a referral and the charge for the test was $79.00, which I was to pay for in cash (credit card) on the day I took the test. When I arrived at the medical facility there were a handful of other patients waiting and I checked in, filled out all the normal forms including insurance information, gave the referral from my Doctor, confirmed the cost at $79.00 and took a seat. Within the hour, I had my tests run and was checking out. The receptionist told me their credit card system was down and so they would contact me later to take the payment.

About 30 days later I got a bill in the mail. It did not make any sense since it was for lab test work that appeared to have been submitted to the listed insurance company and this bill was for the unpaid (remaining) balance of $532.00. And they were offering me three easy ways to pay. 🙂 Really!

I called them up, they asked me how I would like to take care of the $532.00 balance on the account and I explained to them the process through which I came to use their facilities and how I had been told the cost to me was $79.00. The woman in the billing department replied, “Oh, you were not submitting this to your insurance company, you were going to pay cash! OK, I will have the adjustment made to the statement and reduce it to the $79.00 cash (credit card) payment.”

Folks, this was not a one time event for me. I have experienced this three times over the past 7 years, where I discovered I could get the same medical services, on a cash basis, for a fraction of the cost of it going through my insurance. Hello….. one of the primary reasons our healthcare costs in America run roughly twice as much per capita than other developed nations, is this. And excuse me for being so blunt, this is fraud in my opinion. The $79.00 charge for the 5 minute test they ran, had the same technician, same equipment and same results as the $532.00 charge they sent me because it was coded for payment by an insurance company.

The American Wellness Act is proposed legislation for the US Government to provide financial incentive to consumers for their validated efforts to get healthy and remain healthy.
The American Wellness Act is proposed legislation for the US Government to provide financial incentive to consumers for their validated efforts to get healthy and remain healthy.

As I stated above, the list of abuses to our healthcare system are rampant and we can stop them.

As I have witnessed so many areas of over billing, wrongful charges and collection efforts by hospitals, Doctors and medical facilities in the healthcare industry, and I have read about the efforts to correct things for over a decade and yet nothing seems to get better, I have started work on proposed legislation.

I have called the legislation, the American Wellness Act, (AWA) to help counter the skyrocketing costs of our healthcare and more importantly, save lives.

The legislation, the AWA, would serve as a catalyst for a healthier America. It would simply be a flat predetermined amount, tax credit, that every American would receive each year, based upon their filing of a form for an earned credit with the IRS. If the form is completed and the information validated through third party documentation, a $7,500.00 check would be sent to the taxpayer. (Note: The $7,500 is my estimate of the needed amount)

The consumer “taxpayer” would be responsible for living a balanced life style, improving their health and fitness, through proper adjustment of their nutrition, physical and mental activities. A physical exam would be required with a qualified Doctor, to sign off on the progress being made each year by the consumer. The $7,500 would be used by the consumer for things such as a gym membership, at home exercise equipment, a bike, organic foods, counseling, coaching, training, and nutritional supplements that are a part of their fitness and wellness program.

The end result over the next decade of the Act being in place would mean a far more healthier American population. Significant reduction in prescription drug usage, a reduction is age related illnesses such as cancer, heart disease, diabetes and other illnesses that are escalated through lack of proper nutrition and exercise. The AWA could in fact reduce the demand on hospitals and other emergency medical services while at the same time increase the production and support for our local farmer’s markets and other related wellness marketplace providers.

How would the government pay for the $7,500 for each of those that follow the plan and stay on the program each year? Simple… pay now or pay later! The amount the US government pays out each year is roughly $1.2 trillion, with $644 billion going to Medicare, $427 billion to Children’s healthcare and $80 billion to veterans. The reason for this massive cost to the federal government, the US taxpayers, is due to the state of our wellness in America. Currently the obesity rate of adults in America is at an all time high of 42.4 percent. That’s 139 million adults in America that either need to make a change in their lifestyle, or will end up “paying later” for the lack of their attention to their nutrition, fitness and overall health now.

The American Wellness Act can also have two other significant benefits to America almost immediately. Healthier people are not as negatively affected by Covid-19. Obesity, and its affect on our health and immune system, leads to higher risk levels with Covid-19, along with other viruses and diseases. Secondly would be the positive economic stimulus affect to wellness providers, gyms, fitness trainers, doctors, labs, local farmers, counselors, and other health and wellness professionals that would immediately see an increase in their incomes.

I am moving forward thie month with these efforts for the American Wellness Act and your support by communicating your interest to your congressional representatives is needed. Visit us, join us, online here.

Wayne Warrington Consumer Advocate, Fraud, Insurance, Wellness

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