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SUZANNE VENEZIA
P.O. BOX 295
COLMAR, PENNSYLVANIA 18915-9998
(215) 390-3126 s.venezia@verizon.net
05/19/2014
Sent Through U.S. First Class Express Mail EK 008774151 US and Online at ttp://www.whitehouse.gov/
contact/submit-questions-and-comments
THE WHITE HOUSE
TO THE PRESIDENT OF THE UNITED STATES OF AMERICA
BARACK OBAMA
1600 PENNSYLVANIA AVENUE NW
WASHINGTON, DC 20500
Dear Mr. President,
With regard to my last letter to you in September of 2013, I once again kindly call your attention to the
healthcare issues in the United States which, unfortunately, have not been resolved with the enactment of
the Patient Protection and Affordable Care Act (PPACA).
Your counterparts in other countries - Chancellor Angela Merkel, Prime Minister Stephen Harper,
President Putin, Prime Minister François Hollande, Prime Minister Matteo Renzi, Prime Minister Shinzō
Abe, and Prime Minister David Cameron - have something very important in common with their
constituents, they have access to the same healthcare programs and pay for services as a percentage of
their income. You, Mr. President, and your colleagues, who are being copied on this letter, due to your
public employee status, pay very little for your healthcare and even have additional benefits, like good
dental and vision plans, which many Americans must forego completely.
Congratulations, however. For many years the United States has been successful in implementing a
healthcare program for federal employees; state, county and local governments have also been successful
in providing their employees with good healthcare plans. These are not models to eliminate, but to
expand. Since the remedy provided by PPACA, however, does not meet the standards which have been
afforded to public sector employees for many years, it needs to be changed. I propose a single-payer
program with public support.
Employers have long rallied against employer health plans and yet employer plans are currently an
integral part of PPACA. New legislation has already been enacted for extending the deadlines for

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employers to provide health care plans for their employees. Given the lack of support and
administrative and financial burden, the Department of Health and Human Service (HHS) cannot afford
to dedicate further resources to managing and policing compliancy among employers with regard to
healthcare. Moreover, although employers can also use the HHS Marketplace to purchase employee
plans, this does little to contain costs. Only large employers are capable of negotiating premiums like
those contracted by public agencies, and we have already seen that this type of market contracting can
create market strategies to increase spending for tax purposes whereby compromising the integrity of
healthcare services. New legislation, like the “Cadillac” excise tax , has already been created to remedy
market manipulation. Do we really want new legislation or just a better, simpler program?
With regard to contributions, the single-payer system would also eliminate employer contributions to
employee plans; every employee – public and private, full and part-time – would contribute 12% of their
earned income which would be directly deducted from payroll by the employer and sent to the
employees’ plan in the Marketplace. Marketplace exchanges would be organized on the federal, state
and/or local levels as they are presently envisioned to be created over time.
There would be no ceiling on income. In the plans offered by Blue Cross Blue Shield of Michigan,
healthcare copays are quoted at more than $800/month (for 60 year olds) (http://www.bcbsm.com ).
Considering that the employee cost in the private sector is on average almost 30% of the insurance cost
( http://kff.org/report-section/2013-summary-of-findings - 2013 Employer Health Benefits Survey - Aug
20, 2013), the plan for this $800/month employee contribution could cost over $30,000/year. While
higher incomes would require substantial contributions, unlike the healthcare plans currently offered in
the health care market which include criteria such as an insured’s health and age, and since a quality
healthcare program does not discriminate against the age or the health of an individual whereby making
of these elements a market speculation tool, deductions/subsidies based on age or health criteria would
not be part of the new program I propose.
At the moment, health care access is also based on employment; I live in Pennsylvania and am
unemployed, but not due to my choice. Since Pennsylvania has refused Medicaid expansion, I am not
eligible for any state health insurance plan. Due to my economic situation, I do not meet the penalty
threshold in PPACA1
; this is no gift, however. I cannot afford healthcare plans, and do not qualify for
1
I attempted to enroll in the Marketplace to verify its functionality; unfortunately, I received multiple errors and
got locked out; I contacted the HHS hotline various times and also received recorded telephone messages

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subsidies due to my unemployed status. Although local subsidized clinics provide PAPS and
mammograms and other health services to low-income persons upon presentation of documentation
attesting to income, funding to these clinics is precarious; last year funding was suspended, and I had to
wait to months make an appointment for routine tests.
The need for a better health care standard more closely aligned with the plans available to federal
employees can be readily identified through the effective comparison of the public and private plans. For
federal workers in Michigan (http://www.opm.gov/healthcare-insurance/healthcare/plan-
information/plan-codes/2014/brochures/73-015.pdf), the co-pays are half of those of the “silver” plans
offered by Michigan providers to the private sector. Likewise, diagnostic services, i.e. labwork, x-rays,
and MRIs are covered in public plans while in plans to private sector employees, some of these services
(like MRIs) can cost more than $200 after deductible payment. Hospitalization costs also vary greatly.
In sum, federal employee plans far outweigh private sector plans on every level - costs are lower and
services are better.
With a 12% contribution, therefore, all employees would have access to a quality standard healthcare
plan. All plans would be individual plans, and all persons, including the unemployed and children, would
be provided with free enrollment in the same standard healthcare plan. In this foreseeable reality (and
not utopia), current plans like the high deductible health plans (HDHPs) would cease to exist.
As shown in Table A which follows, the 12% contribution from all of those who work will provide for
substantial healthcare funding. In my experiences in living abroad, I know of no one who voluntarily
opted not to work since free access to healthcare was guaranteed without employment. Lately, I have
often heard these arguments in the media; they are solely the thoughtless considerations of privileged
people who have never experienced destitution.
SOME NUMBERS FOR THE PROPOSED NEW PROGRAM
The Table which follows provides an outline of the program’s budget costs and funding. It is a simple
table for a simple program – or at least a program that guarantees a quality healthcare standard for the
entire population.
instructing me to call again, I did so a number of times, but just received the same recorded message to call again.

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TABLE A - CALCULATION OF HEALTHCARE CONTRIBUTIONS BASED ON RECENT
PUBLIC/PRIVATE PAYROLL AND PUBLIC/PRIVATE HEALTHCARE PLAN DATA
New Program
Public Sector
Total Premium
$11,642
New Program
Private Sector
Total Premium
$11,642
Current
Public Sector -
Average
Total Premium
$11,642
Current
Private Sector
Average Total
Premium
$10,621
New Program
Public Sector - Average Annual
Salary $47,924
12% Employee Contribution on
Income
$5,751 $2,463
New Program
Private Sector - Average Annual
Salary $47,528
12% Employee Contribution on
Income
$5,703 $2,824
New Program
Public Sector Contribution for
Public Employees
$5,891
New Program Public Contribution
for Private Employees
$5,939
Current Public Sector
Contribution
$9,179
Current Private Sector Employer
Contribution
$7,797
Public Sector Savings with New Plan : $9,179 - $5,891 = $3,288 x 22,000,000 (employees) = $72,336,000,000*
New Public Costs for Private Sector Employees for New Program :
133,627,000 x $5,939 = $ 793,610,753,000
=================
Funding:
- Deduction of Current Federal Medicaid Spending $ 416,800,000,000
- Deduction of State Medicaid Spending (nonfederal) $ 191,454,904,000
- Savings from Public Sector $ 72,336,000,000*
- Savings from removal of employer participation in Healthcare management with regard
to tax legislation and tax administration and operations $ 50,000,000
==================
$ 112,969,848,000

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The Public sector data in Table A is from the 2012 Census of Governments: Employment
Summary Report released in 03/06/2014 (http://www2.census.gov/govs/apes/2012_summary_
report.pdf ). The Public sector data represents the average annual payrolls of all non-military federal,
state, and local employees (part-time and full-time).
The Private sector data in Table A is from the Quarterly Census of Employment and Wages -
QCEW Industry Tables (http://www.bls.gov/cew/), and the wage represents the total average wage in all
private industry in the U.S. taken in the Third Quarter of 2013. Although the Public and Private wage
references derive from different years, for the purposes of calculating healthcare costs for the new
program proposed herein, this different reference year has negligible importance.
The healthcare costs in the Private and Public sectors and the employee contributions in Table A are
averages taken from the U.S. Department of Health and Human Services, Agency for Healthcare
Research and Quality, Premiums and Employee Contributions for Employer-Sponsored Health Insurance:
Private versus Public Sector, 2012, published in April of 2014
(http://meps.ahrq.gov/mepsweb/data_files/publications/st435/stat435.pdf).
According to the 2012 Census of Governments: Employment Summary Report released in 03/06/2014,
all Public sector (non-military) employees (part-time and full-time) numbered 22,000,000. Private
civilian employment numbered 155,627,000 in March of 2014 (A-1. Employment status of the civilian
population by sex and age; http://www.bls.gov/news.release/empsit.t01.htm). Total US population at the
time of the writing of this report numbered 318,892,103 (U.S. and World Population Clock
http://www.census.gov/popclock/). Therefore, the total workforce (Private and Public sectors) amounted
to 177,627,000 or approximately 55% of the total population.
With regard to the calculation in Table A for Private Sector employees, the Public Sector workforce of
22,000,000 was subtracted from the total workforce of 155,627,000 for a Private Sector workforce of
133,627,000. Since, therefore, the new healthcare system proposed herein is based on universal coverage
(including children and the unemployed), and since approximately 45% of the population is not part of
the workforce, the healthcare plan annual cost selected for this report is the plan for “Single+1” at
$11,642 (Public sector average cost found at
http://meps.ahrq.gov/mepsweb/data_files/publications/

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st435/stat435.pdf). Since this cost effectively refers to the healthcare coverage for two people, its use
guarantees universal coverage with only 55% of the population effectively employed.
Although the Public sector average cost is approximately $1,000 greater than the Private sector option
($10,621), it was selected due to better standards of services and also to make “comfortable” projections
with higher premiums rather than with lower ones. However, the higher average premium cost for
single coverage ($6,278) was not selected (and multiplied by 2), since it is reasonable to assume that the
premium price of $11,642 for coverage of this magnitude can be successfully negotiated. Population and
employment are very important factors in this program, and contribution based on income provides
greater program stability than flat-fee rates.
The Medicaid deduction amount of $416,800,000 in Table A was taken from the National Health
Expenditure Projections 2012-2022 (http://www.cms.gov/Research-Statistics-Data-and-
Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/downloads/proj2012.pdf).
The State Medicaid deduction amount of $191,454,904 in Table A was reported by the National
Association of State Budget Officers State Expenditure Report
(http://www.nasbo.org/sites/default/files/State%20Expenditure%20Report%20%28Fiscal%202011-
2013%20Data%29.pdf)
AN UNDERFUNDED PROGRAM ?
Instead of being a national institution of nonprofit profile, healthcare in the United States is an
enormous, power-wielding industry. Our health costs in this country with regard to per capita spending
and percentage of gross domestic product are the highest in the world. While it can be argued that quality
healthcare and valued services increase costs, limiting to some extent, therefore, the negative inferences
from high per-capita spending, the OECD Health Data Report from 2013
(http://www.oecd.org/unitedstates/Briefing-Note-USA-2013.pdf) makes some important considerations:
In most countries, health spending is largely financed out of taxes or social security contributions,
with private insurance or ‘out-of-pocket’ payments playing a significant but secondary role. The
United States together with Mexico and Chile are the only OECD countries where less than 50%
of health spending is publicly financed. The public share of health expenditure in the United
States was 47.8% in 2011, much lower than the OECD average of 72.2%.

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However, the overall level of health spending in the United States is so high that public (i.e.
government) spending on health per capita is still greater than in all other OECD countries,
except Norway and the Netherlands. Public spending on health in the United States has been
growing more rapidly than private spending since 1990, largely due to expansions in coverage.
With this proposal, the public share of health expenditure would be little more than 50% - still an
incredibly low rate compared to those in other countries.
The budget of any program, however, must be balanced and to that end, in order to transform healthcare
from a for-profit industry into a national service institution, this new program proposes that all healthcare
providers who intend to continue to serve this publically funded program convert their businesses into
nonprofit entities. This would be a requirement for those businesses who wish to be included as
providers in the United States healthcare system.
This transformation would certainly improve the integrity of healthcare and reduce costs, and I am
certain that its effects would be seen within a three-to-five-year period whereby balancing the program
budget.
There are many important collateral implications in removing employer responsibility in employee
healthcare, the most important being the creation of a required appointment for serious dialogue about
raising the minimum wage and therefore, the standard of living for many people in this country. For
“serious dialogue”, one would intend congressional initiative and follow-through. A review of current
employer tax liability and accountability would be another required appointment as a consequence of the
program proposed herein.
This proposed program also involves job creation on the federal, state and local levels for managing
employee health plans.2
Aside from strengthening the overall economy and increasing social
engagement, the creation of new jobs will decrease premium costs, since these are calculated on a near-
double basis for each employee.
2
The 2015 Budget for the Department of Health and Human Resources also foresees public employment
expansion to meet with the needs of healthcare expansion (http://www.hhs.gov/budget/fy2015/fy-2015-budget-
in-brief.pdf.)

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MEDICARE CONSIDERATIONS
Medicare spending has long been a major concern also due to an increasingly aging population and high
unemployment even before the enactment of PPACA which in part proposed to reduce Medicare costs
over time; however, after the enactment of PPACA, in order to address financial trends for a better
budget, and specifically with regard to Medicare, the Additional Medicare Tax and the Unearned Income
Medicare Contribution surtax, as added by PPACA, were enacted.
The trends, however, in the last decade regarding health care benefits for retirees foretold of an
increasing reliance by the Private sector on Medicare options for retirees:
Very few private-sector employers currently offer retiree health benefits, and the number offering them has
been declining. In 2010, 17.7 percent of workers were employed at establishments that offered health
coverage to early retirees, down from 28.9 percent in 1997.
 Between 1997 and 2010, the percentage of non-working retirees over age 65 with retiree health
benefits fell from 20 percent to 16 percent.
 Because employers are under no obligation to provide retiree health benefits, except to current retirees
who can prove that they were promised a specific benefit, and because (unlike defined benefit pension
plans) employers are not under any obligation to pre-fund retiree health benefits, it is likely that
employers will continue to make changes to those programs, espec
research found little impact of reductions in coverage on retirees, but that may be because initial
changes employers made to retiree health benefits affected future retirees as opposed to then-current
retirees. Over time, more and more retirees have “aged into” those program changes, resulting in the
greater impact found in more recent studies.
 While many employers have dropped retiree health benefits, especially for future retirees, most that
have continued to offer retiree health benefits have made changes in the benefit package they offer:
raising premiums that retirees are required to pay, tightening eligibility, limiting or reducing benefits,
or some combination of these increasing retiree contributions.
( Employment-Based Retiree Health Benefits: Trends in Access and Coverage, 1997‒2010, published in
October 2012 by by Paul Fronstin, Ph.D., and Nevin Adams, J.D., Employee Benefit Research Institute
(http://www.ebri.org/pdf/briefspdf/EBRI_IB_10-2012_No377_RetHlth.pdf))
In fact, since the employer surveys which Towers Watson publishes are those of a for-profit company
who provides services of financial and risk management to many large companies, including Fortune
500 companies who carefully guard their public image, the current responses from employers about
retirement benefits to employees are especially insightful:
Financial support continues to erode for retiree medical benefits … Employer subsidies for retiree medical
coverage have declined sharply over the last two decades, especially for pre-Medicare-eligible retirees. The
cost of pre-65 coverage has risen far faster than costs for active employees. Significantly, nearly two-thirds
of companies that offer access to an employer-sponsored plan today say they are likely to eliminate those
programs in the next few years and steer their pre-Medicare retiree population to the public exchanges.
Two-thirds of companies believe that private exchanges will offer a viable alternative to employer-
sponsored coverage for active employees as early as 2015. Towers Watson/NBGH 2013/2014 Employer
Survey on Purchasing Value in Health Care issued in May of 2014 (http://www.towerswatson.com/)

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* * *
Mine is not a “sour grapes” proposal due to my unemployed status. I specifically included details
in this letter of my personal situation because I know that my plight is shared by many others. I
have had the opportunity to live in another country, Italy, where the standard of living for all
community members was certainly better than what I have witnessed in this country. Mine is a
contribution to make things better.
We have seen the increasing erosion of public education in this country also with the
introduction of vouchers and charter schools providing tax-payer monies to people who often
have no experience in education whatsoever; these schools are practically “off the radar” with
regard to accountability.
While we cannot afford to allow PPACA to fail, since it is an important achievement given the
current trends to limit the role of government in safeguarding and guaranteeing important social
programs, we must move to modify the Act, based on this proposed program in this initial
phase of PPACA’s enactment.
I thank you for your valuable time and attention.
Sincerely,
Suzanne Venezia
Copied to : - Office of the Governor Of Pennsylvania Tom Corbett
- Robert P. Casey, Jr., U .S. Senator
- Allyson Y. Schwartz, Representative 13th
Congressional District of Pennsylvania