Equality

As it is written, "He who gathered much had nothing left over, and he who gathered little had no lack."  2 Cor. 8:15

The Patient Protection and Affordability Act (aka ObamaCare) is one of the largest wealth redistribution acts of recent memory. In short, it seeks to achieve equal access to and equal benefits from the US Health System, for all US citizens. For those with access to the best and latest, we are finding it harder to get timely and convenient appointments, caregivers have less time to give us, rules are being imposed as to when or even if we can get the professional advice we seek, or scans and labs we think we deserve. And we're paying more. For those who live life near the poverty line, our benefits and choices may have expanded, but all amidst a growing concern the delivery system we've created cannot sustain. And the "Equality for all ideology" is being brokered through an ever expanding set of rules imposed by a growing Federal Bureaucracy. Lawmakers seek money and votes for any consideration of concession - while the burden these rules place on citizens and the delivery system slowly implode. The winner, US Government? The looser, US Citizens?

Inherent to any system that aspires to create equality is a sub-system of number counters who ultimately certify, through numbers, if the system is fulfilling the equality objective. And mathematicians even back to Archimedes, in his essay The Sand Reckoner, realized the limits to counting was a function of the size of the universe defined, the then known size of 10 to the 63rd power. Years later another mathematician, Carl Gauss, introduced infinity, simply defined as not finite, and therefore not determinable by counting or measurement. To use math for all that we do, the certainty behind the numbers is within limits. Equality is therefore only achieved within limits. As we constantly adjust the math to new limits, it enables us to begin exploring the universe yet still find our return.

Ideology is a first cousin to theology, but without reference to God.  It is therefore not surprising the concept of equality as written from an ideological perspective has inherent limits when viewed through a theological lens. Let's examine: And Jesus answering said unto them, Render to Caesar the things that are Caesar's, and to God the things that are God's." Mark 12:17. Later, Paul says, "at this present time your abundance being a supply for their need, so that their abundance [the poor person] also may become a supply for your need, that there may be equality." 2 Cor 8:14. Isn't it interesting that the only direct reference in scripture to equality frames the poor and rich as equally needy of one another? In both passages, the focus is on our individual responsibility, poor or rich, set within the present time period (i.e. limit).

When US Citizens elect public policy officials and empower them to function as "equality watchdogs", society is ultimately weakened rather than strengthened. The focus and objective of government is to appease the greed of the electorate through limited, measured, and funded short-term successes.  We effectively take God off the table and render policy making a finite objective that future generations may suffer greatly from and seek to change.  Even more distressing, we redistribute wealth through an ever enlarging labyrinth of channels and the money barely ever benefits the poor.

As we enter another season of elections, remember the problem is we're inviting government policy to usurp individual responsibility and making all accountability to "Caesar". Caesar wins while the citizens hope Caesar will pass on and give man another chance to finally get it right. And the cycle repeats. The only real solution is for mankind to recognize their misdirection, to dismantle the size and scope of government itself, through reconnecting our ideology to our theology.  We each need to rely on the eternal hand of God to manage much of the accountability of man toward one another, through reliance on the infinite wisdom of Him. Without an understanding of equality in the context of infinity, we are left solutions where the wealthy and the poor are never brought together in this world to meet one another directly and for equality to take root. Rather, the public policy brokers take most of the wealth transfer and leave nothing for the poor or the wealthy to mutually benefit. Equality is not achieved and new limits must be set.

I'm confident we've lost our way and God is at work in the hearts and souls of His people.  Most caregivers I've known are answering a call in their own hearts and minds - doing with what they have and the ingenuity they can muster, knowing all will soon need care from others. The work of our policymakers annoy, distract, and demoralize, making others think twice about care-giving. All government policy, social or otherwise, enriches some while disenfranchising others. Let's kick off this election season with a new attitude.  Elect all new representatives who aspire to be humble but prayerful servants of the electorate, who praise and worship God, and who promise to dismantle policy based on it's harm with no promise to substitute new policy in it's place until they share how they've been impassioned by God?  Would this be cool or what?

Few Purchase High Risk Pool Insurance

The establishment of a federally-funded temporary high risk pool is among the components of the Affordable Care Act that were implemented early on. By design, the federally-funded high risk pool provides transitional coverage to 2014 for the currently uninsured with preexisting conditions.  Of course, effective January 1, 2014, the Affordable Care Act prohibits health insurers from basing coverage or pricing decisions on health status, assuming the Act is not repealed. High risk pools exist currently in 35 states.

Illinois identified approximately 1.4 million eligible members for the Illinois Pre-Existing High Risk Pool (IPXP).  The Illinois enrollment experience to date of this federally subsidized program offering good insurance for those who currently don't have it, is only moderate at best.  Currently there are fewer than 5000 members, less than 0.5% of those eligible.  There are four different pricing options from which to choose, and the benefit designs also cover much of the costs related to pharmaceuticals.  The Illinois experience is typical...once prospective members realize they must still pay a premium and additional out-of-pocket costs, they opt to remain uninsured.

Part of the uninsured problem in America is simply a matter of personal choice to go bare. The law prohibits providers of emergency services from with-holding life sustaining care, so everyone needing urgent care can get it.  The costs associated with uninsured care are passed to those who can pay, including the taxpayer.  We all know other examples of deadbeats in our lives and it is indeed rare that government regulations are very effective as a remedy.  Left to our own creative ways, however, we will deal with deadbeats in all sorts of ways hopefully still in keeping with legal, moral and ethical standards. Peer-to-peer confrontation and holding one another accountable where accountability is appropriate (i.e. moral), is usually more effective than enacting more law.

Whether or not the Supreme Court upholds the individual mandate, there will be many who simply will not buy the insurance nor pay the penalty/tax. The Pre-Existing Uninsured High Risk Insurance Products are showing us what is to come.  While some of the public policy intent behind the Patient Protection and Affordable Care Act is to provide us a better system of care, the failure to follow solid free market economic principles will result in a cost-prohibitive outcome.  

Supreme Court Arguments Make Us Think

The Supreme Court arguments this week should be reviewed by all of us interested in thinking through reasoned solutions to the rightful role insurance products should play in our society. I won't even attempt to summarize what is done so much better elsewhere. Rather, I will simply remind us that insurance is not and never has been an appropriate vehicle for social reform.

The economic problem of health care cost in the US emerged from a complex interplay of market forces and the desire of politicians to leverage those forces for political gain. Mr. Obama may have gone over the top for a political power grab but he is just one of a long line of politicians to take advantage of this sector of the economy for personal objectives.

Health insurance is designed to help individuals avoid bankruptcy in the event of personal high cost events. It is not a product suitable to cover the costs of everyday needs and wants of a society. While insurance pools the resources of many to cover the catastrophic costs of a few, it is not an appropriate tool for achieving what some envision as the ultimate tool of social justice.

We will reign in health cost in the US by having government play a much smaller role in regulating the industry, getting government out of paying for so much of the services, and allowing employers to more easily make affordable contributions to benefit pools while employees pay the difference. By connecting the individual buyer directly with the seller, we will reduce the skyrocketing costs of largely discretionary services. While easily conceptualized, this is a tough pill to swallow and politicians, many market players, and many consumers won't like the personal economic impact. This is precisely why the formula will work but also the reason behind the resistance. But by making insurance the tool of social reform, more of us are appeased in the short run while we ultimately loose our economic strength and freedom as a Nation. I hope and pray the Supreme Court decision helps us all rethink our real priorities as a Nation.

Affordable Care Will Be the Goal for Most

Over the past few weeks we have begun to see coverage mandates that will make up the benefit designs on Health Exchanges in 2014.  This week, HHS adopted the IOM non-evidence based recommendations to include all forms of contraception as a preventive benefit, "free" of any out-of-pocket copays or deductibles.  Whether or not we even believe appropriate as a "preventive benefit", generic birth control pills are rather inexpensive, the branded products are not.  Yet, after August 1, 2012, all will be covered at no individual cost.  This is a wonderful opportunity for Pharma to accelerate their advertising of branded pills and raise the cost of this benefit for all responsible for paying premiums. For taxpayers who will subsidize the purchase of health insurance for some, and for the rest of us who purchase our plans without subsidy, the price of our insurance premiums just went up for all.

Universal coverage for disease prevention where no out-of-pocket costs are expected makes sense where there is good evidence the intervention will help the individual and the larger public.  Childhood immunization is the classic example as the intervention clearly effective at disease prevention as well as the spread of disease in the population.  It is much less clear whether cholesterol screening, diabetes screening, etc. should be "free" of individual responsibilty to pay a portion at the time of service.  But it is truely a stretch to say that society should foot the bill for all forms of pregnancy prevention, a condition that is hardly even considered a disease.  Using the underlying arguments in favor of such coverage, we could argue virtually everything we contemplate in health care prevents something.  Don't we contemplate an appendectomy to prevent a ruptured appendix and possible death?

For health care to remain affordable for all, benefits must primarily target the financial assistance necessary for an individual and family to weather a catastrophic event.  Secondarily, it is appropriate for benefits to support the use of preventive services that benefit both the individual and society at large.  Some of these preventive benefits may deserve consideration of no out-of-pocket costs but most should arguably require some responsibility from the individual. 

When President Obama argued for administrative simplification of health care, this was a code word for social reform and the same benefits for all, at a cost supported by society. It is important for all of us to think carefully about the benefit mandates that we will hear more and more about over the ensuing weeks.  Nothing is free and the question is when and how should individuals take responsibility for their own health costs?  In general, universal mandates increase the cost for us all, ultimately making health care unaffordable.