NOAH - An actually doable fix for American Healthcare

Health
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Introduction
“NOAH” (New Opportunity for American Healthcare) is an initiative which will dramatically improve the effectiveness of American tax dollars spent in healthcare. It is not a program and does not give rise to more bureaucracy, but rather it will reduce tax spending and the control large corporations have on healthcare, while providing Americans more options and better prices for their care.

While it is in line with DOGE, MAHA, and the greater MAGA movement, it is also something every American—left, right, or center—should agree is a great new opportunity for all.

I have provided at the end of this a link to a presentation I developed, where you can read both a more conversational and more technical exploration of this idea.

Background
I have worked behind the scenes in healthcare for nearly a decade and a half. I have seen firsthand the profiteering, waste, and inefficiency that plagues American healthcare. Further I’ve also worked intensively under and with the regulations, programs, and bureacracy that purports to solve these problems, while they, in reality, contribute more to them. This is what led me to develop the NOAH idea.
I am submitting this idea anonymously for two reasons. First, because I still work in healthcare, and because my proposal undermines and exposes the manipulation of healthcare by organizations I work with, I could be potentially fired and blacklisted. Second, I am not looking for credit: I just want American Healthcare to be freer, fairer, faster, and better for all of us.

Policy Summary
NOAH has layers, but it can be understood simply;

Allow Americans the ability to use out-of-pocket healthcare expenses toward their taxes.

The execution requires a bit more detail, (see link below) but, if this idea is put into effect, it will gradually undermine the bureaucrats and special interests groups which have a stranglehold on American Healthcare and funnel billions of tax dollars into their own pockets each year. In addition, it will invalidate the need for much of the regulation and oversight that is also a source of waste in our healthcare systems.

NOAH has many, many other benefits to Americans and to their healthcare providers. Click this link to read the full proposal (about a 5 min read):

https://pdfhost.io/v/.q1YYkR4i_Solving_the_AHC_Crisis

What you can do
If you’re interested in this idea, here’s what you can do:

Vote for this idea and share with your friends and family. Let’s get this great idea in the public conversation!

Follow @HlthcarePatriot on X for updates and share this policy on your social platforms!

Share your support for this idea with President Trump, Vice President Vance, HHS Secretary Kennedy, your local senators and congressional representatives. A quick search online can give you the information you need to write a letter or email to them, and these folks are also on social media platforms too! The more they hear about this idea from different places and connections, the more likely it is to be implemented.

Thank you for your time and consideration. May God bless you, and may He continue to bless the United States!

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I like the idea of everyone spending their money and not OPM other people’s money on their health care. If we shop around and make vendors compete for our business and support we might get much better value!

Help me understand how the tax credit won’t add to the deficit.

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Hi Marcos!

Thanks for engaging! I do cover it a bit more in the presentation that’s linked, but in simple terms, it won’t add to the deficit because it balances the budget better than the current paradigm. Here are the 3 big reasons this works:

  1. Government spending on the health insurance market outpaces the associated tax revenue which would be lost. So you’re cutting tax revenue, yes, but you’re cutting even more tax spending through reduced utilization.
  2. Removing insurance and regulators from the healthcare equation presently and will always make healthcare dramatically more affordable and accessible. These two groups purport to positively affect healthcare access, but, as I explain in the link, always have the opposite effect.
  3. As a result of 2, you have two things that can (and likely will) happen; a greater utilization of healthcare resources, increasing the need for and employment of healthcare professionals (and increased tax revenue from these higher-paying jobs) and due to greater utilization of healthcare resources, a more healthy workforce, which leads to less untaxed downtime and utilization of other tax-funded hardship spending.

Keep in mind too that the average person utilizing NOAH is not going to spend their entire tax liability on healthcare every year.

Let me know if you have follow up questions or want more detail! If you like the idea, I’d appreciate you clicked the vote button and shared! Be well, my friend.

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I did read this and the pdf attachment and it is an interesting concept. I may have missed it or not understood it but what happens if I am injured in January, through no fault of my own, and I end up with a $25,000 bill, and I don’t have the money to pay the bill? Am I suppose to take out a loan, or credit card, to pay the bill and then wait almost a year to get repaid?

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Hi Bob!

Great question, thanks for asking. I do cover that in the technicals after the main section of the PDF, but I can answer here;

In the scenario where you have a $25K bill, you’d notify them that you were uninsured under NOAH, and that you couldn’t pay the full amount (or at all, depending on your situation) at this time, “without impoverishment.”
Your hospital/provider could elect to either waive a portion or all of the bill (this is already plausible for existing tax write-offs that hospitals do today) or if that is not possible, to set you up on a payment plan, and either collect from you directly according to terms you’d work out with them, or they would file (similar to what providers do now) to have gradual repayment from your wages (when you returned to work).
The difference is, instead of how wages are garnished today, eating at the income you live on, your provider would receive money from the federal government, from income tax you are already paying. This would repay your debt gradually, without you ever being “in medical debt.” At tax time, since you’ve already technically been paying your taxes, you have no additional liability.

Thanks again for the question, and please feel free to ask follow up ones! If you are willing, I’d really appreciate you voting for the idea, and sharing, if you feel comfortable. Be well, friend!

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Seems like a good idea til it isn’t. First you already have this. What you don’t have is transparency in provider pricing or uniformity in payment resolution. This will most likely cost patients more. Insurers have preferred pricing to your benefit…you dont. If an MRI is billed at 1000 the insurer will pay +/- $400. I promise you any cash price might be less than $1000 it will certainly be MORE than $400. If you have a $30k hospital bill and a 10k deductible the insurer will settle your bill for +/- $12,000, You will pay 10k and the insurer will settle the balance for $8k. It is billing arbitrage which should be illegal. There are better ways to address this but as I said you already have a tax advantaged method to do what you suggest,

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Hi David,

I do really appreciate you taking the time to provide feedback but, respectfully, I must disagree with some of your assertions. I am speaking from (and will demonstrate for you) a great deal of experience with insurer pricing and process. That said, if you will allow me the space, I’ll gladly answer your points;

  • You said, “you already have this” and there is a “tax advantaged method to do what you suggest,” but there is no system like NOAH in existence. Cash pay presently presents a significant risk of medical debt, with no tax advantage. Further, no anti-extortionary pricing and transparency measures have been effective to-date, as they would be under NOAH, because they were created by Washington bureaucrats in the pocket of insurers, whereas NOAH returns healthcare to the free market.
  • You mention that you don’t have transparency in provider pricing, and that is correct currently, but that is built in to NOAH. Currently, there is the “No Surprises” Act to which the healthcare industry has been largely non-compliant, because there are no significant penalties or interruptions to business, whereas part of the proposed legislation for NOAH requires all providers to post cash pricing and fees publicly, upfront, or NOAH patients are not required to pay their bills.
  • I understand you may believe insurance pricing will be cheaper, and that certainly is what insurers spend many millions of dollars to say, but it’s simply not true. I have worked with insurers professionally for many years and I assure you that no provider is taking less from an insurer than cash. Insurers are very costly to work with, and cost providers far more to administer care than cash patients, in the form of; credentialing, authorizations, documentation, billing, denials, audits, and recoupments. Having worked with a wide range of providers and care settings, I can assure you that most negotiate higher rates than the prevailing Medicare or Medicaid rate, if not at least the rate itself, and the CMS rate is no volume discount.
    The hospitals that do publish their rates in compliance with the “No Surprises” Act, demonstrate this:

Los Alamitos Medical Center quotes average cost for a CT scan is $2,400 out-of-pocket for an insured patient, whereas it’s $250 cash.

Advent Health averages over ten grand in insurance copays for, non-surgical labor & delivery, but it is less than three total to a cash patient.

Bouldre Center quotes ACL surgery as costing $20,000 to insurance carriers, but $8,200 cash pay patients.

You might have in your mind some “free” doctor visits or low-copay exams or tests, but this doesn’t even take into account the thousands of dollars in premiums that patients pre-pay to insurance, or the billions insurers receive in subsidies from taxpayers, that they use to offer these services.

  • You mention bills. This is a distinction insurers contrived and another way insurers obscure the truth. There is a massive difference between bills and actual pricing—ask any provider: they never get paid what they bill insurers.
    Providers are essentially required by their insurance contracts to have inflated “usual & customary” billed charges: their insurance contracts’ terms pay according to “lesser of” language, like “lesser of [rate] or 40% of billed charges.”
    This means that, if the insurer negotiates a doctor visit to be paid to a provider at $100, but the provider doesn’t bill at least $250 for the service, the provider won’t be paid the full hundred. This means the insurer can say, “look, you paid a $20 copay on the service that would have cost you $250.”
    You see that as “settling the balance,” when in reality it’s a fabrication and lie that ignores the premium and tax money that your insurer already got from you, which well exceeds the $250 anyway. Instead, you could pay your doctor the $100 (or possibly less) he or she would gladly take as a simple cash transaction, and you’ll save much more in total.
    The reason you can’t easily do this today is because many insurers (including the largest ones) write gag orders into their contracts, that prohibit doctors from telling you what cash pricing is, if they know you have their insurance. I agree with you though, this should be illegal, and NOAH would supersede all of this for those that opt-in.

Be well, David, and thanks again for your thoughts, even if I don’t agree with all of them. If I’ve changed your perspective on this, I’d really appreciate it if you voted for NOAH and shared with others, but I wish you well in any event.

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Aren’t medical expenses already tax deductible? Also, as you admit in your responses, don’t hospitals already charge less when the customer has no insurance?

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Hi Ashley,

Thanks for the questions!

Medical expenses are currently only deductible if they exceed 7.5% of your Adjusted Gross Income (AGI). For example, if your AGI is $50,000, you can deduct medical expenses that exceed $3,750. Everything up to that though, you have no tax relief. Further, you have to itemize your taxes to utilize this perk, so really, you have to have at least 15K in medical expenses that year to have it even out if you’re a single filer, or 30K if you’re filing jointly, inclusive of other itemizations. Most medical expenses are not going to meet that threshold and so that’s not really a viable option for most Americans. NOAH offers reduction of tax liability without the need to waive the standard deduction.

Also, yes, hospitals charge less when you’re cash-pay, but currently, if you have no insurance and a 30K medical bill, you’re paying that AND income taxes. NOAH would allow you to use your medical expenses toward your tax liability, and further, would improve the rate that providers actually collect on cash debts, because they can receive payment directly from the government for debts without garnishing the patient’s wages.

Thanks again for looking into this! Let me know if you have further questions. Be well!

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Mr. Patriot, As I see it you currently have 3 tax advantaged ways to pay for healhcare; Health Savings Accounts; Deductible Medical Expense over 7.5% AGI; Employee premiums are tax deductible via ss125. Additionally many hospital systems offer ‘charity care’ to cover out of pocket expenses which few people avail themselves of.f
NOAH may be of benefit to a handful of people with MONEY. If it were as simple as paying cash there qould be lesser reason for ‘premium’. Even the most basic of expenses are beyond the means of many Americans on an ongoing basis and anything greater than that = financial disaster.
Hospitals will not put themselves at risk for direct billing beyond co-pays and in any event the cash price will never be less than the insurer price. 35% of direct bills are never paid. Insurers always pay. Drs. and other providers are in the getting paid business not the billing business. They are always paid 90 days after the fact by law. That is what makes insurance work. Money in money out. General reserves are usually 12 weeks (25%) claims paying ability.
There isn’t any transparency or competion for that matter in provider pricing. I have never seen an add for $100 Dr. visits. But there could be.

It would be far easier to make NOAH an integral part of everyday practice. All out-of-pocket expenses tax deducible and a provider choice of cash or insurance with a visible difference, Sort of like GoodRx. Insurance will usually win out because the co-pay will always be less than the cash price.

We can disagree without issue but can’t give you my vote. As a designer of single payer corporate systems I agree it is a noble idea but I suggest you attack it from a different perspective that is simple and tidy. Best wishes…

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David,

I was still completely befuddled as to where your positions are coming from until I read your last line. You’re a “designer of single payer corporate systems”: of course you don’t like NOAH—it would further demonstrate that Americans have better options than Medicare for All. NOAH is a free-market approach to healthcare; you’re diametrically-opposed, having a monopolistic approach to healthcare (which is also unconstitutional, BTW).

Your accusation that NOAH benefits people with money couldn’t be further from reality, but is actually true of the three proposed tax-advantages. Poor and unprivileged people can’t use them;

  • HSAs are only good if you have the extra MONEY to store away: most Americans are living paycheck to paycheck right now.
  • 7.5% AGI is a minimum of $15K-$30K of your own MONEY spent on healthcare and other itemizable deductions in a single year order for it to make sense (vs. standard deduction, as I already explained in a previous comment.) I make twice the average American salary and I’ve never reached that number, not even once. Most Americans don’t spend that much every year, or even make enough money to spend that every year (they’d go into debt if they had to) which is why this is not a viable option and why so few people use it.
  • 125 Plans are only available employees of employers that offer them, which is usually white-collar jobs (not that there’s anything wrong with them, I’m a white-collar worker myself). So unless your employer does, this isn’t even an option for you.

Even if these were great options, NOAH doesn’t prevent anyone from using them. NOAH is just adding another option, not removing the others. If NOAH is bad, no one would use it and no harm would be done, but monopolies don’t want real competition.

While I’ve answered your other criticisms already and you’ve already tipped your hand that you have a vested ideological interest in seeing NOAH not come to light, I’ll end my replies to you with this;

I’ve worked intimately with all parts of the care continuum for many years, as a care partner, mind you, not as an ally to insurers. I can assure you that there’s widespread support from doctors and hospitals to reduce insurance’s part in healthcare. They all LOVE cash patients, even if they’re by payment plan. There is way less billing involved and way less bad debt from cash patients than from insurers, I’ve seen the books and I know the billing mechanics of both, intimately, from my profession. On top of that, there’s no audits or recoup periods from cash patients. It’s better for everyone, all that is needed is the government to ACTUALLY cut healthcare users breaks, not to fund the money machine is managed care.

You are welcome to continue to assert that it would mean financial ruin and higher prices for people, but a) I’ve lived otherwise, b) so have many others I’ve consulted for, and c) I have already demonstrated, with data sources, that such is not true, and d) there’s heaps more data to that end, easily discoverable by web search or AI chat.

There is a reason why American health insurance companies are the wealthiest companies in healthcare, despite Americans having worse health outcomes than other developed countries and paying more for care. There’s also a reason why people choose to come to America for healthcare and pay CASH when they have “free” healthcare in Canada and European countries.

American doctors and healthcare providers are the answer to the American Healthcare System’s ills, not another program and definitely not a single payor system. Insurers and government only need to get out of the way of them, to make it easier for people to work with their providers as directly as possible.