fidesquaerens (marta_bee) wrote,

in the 'the more things change' category...

I just stumbled across a rather interesting account of something called health care sharing ministries. (No, I don't regularly read the Sacramento Bee; I found the link through the Pew Forum, which among other things aggregates news about religion in America.)

The basic idea is that you pay a certain fee every month and then once you meet a deductible the group will reimburse you for any health care costs you incur. At first glance it's pretty similar to most health insurance programs, but (at least on paper) the actual company is nonprofit. There doesn't seem to be any cost-matching done by employees, which at least in theory many full-time employees in America are supposed to have; the full cost is paid by the individuals. There also aren't in-network vs. out-of-network concerns, referrals, and the like. Nor (if the article I read can be trusted) are there limits on coverage. You pay a fairly high deductible, but everything after that seems to be covered. It claims to be based on a Biblical concept I actually have been really drawn to myself: "Carry each other's burdens, and in this way you will fulfill the laws of Christ." (Gal. 6:2)

All of which seems really good. A major improvement in terms of simplicity and simply treating people decently than my own insurance; so much so that my first impulse on reading this was "Where do I find out more, because maybe I should sign up." It struck me that they got a fundamental principle: that everyone gets sick, and it's wrong to let people suffer because their illness exceeds their ability to pay, especially if they were doing their due diligence to pay for medical costs (either individually or collectively).

And they may get that (up to a point). But there are some pretty serious problems, too. Rather than paying a copay and having your doctor bill an insurance company, you're paying the full bill upfront and then getting reimbursed after a certain amount. That may mean for some low or middle class families you simply cannot afford to go to the doctor when you're sick, cutting down on preventative care; though that could probably be covered through the right kind of family budgeting. (Perhaps putting the reimbursements into a special personal savings account and drawing out to cover medical costs.)

Also, the "sharing fee" is flat. A lawyer or banker would pay the same sharing fee as a night janitor. That seems to fly in the face of Biblical teachings like the widow's mites, but never mind; it's also bad public policy and does nothing to address the problem of insuring the poor. On a related question of cost controls, this kind of program is completely powerless to combat widespread problems in health care, like having too many doctors of one kind and not enough of another. They don't have any interaction with the health care providers at all, actually.

So it's imperfect. Novel attempts are allowed their faults, and this is at least an attempt to make sure people who need it can afford to see a doctor. I can respect that. Actually, what struck me is how similar it is to a public option. Everyone who opts in pays their share, and then anyone who has expenses over a certain threshold gets the help they need. It's also very bureaucratic: rather than having a private company's bureaucracy decide what care you're entitled to, it's decided to a certain degree by the priorities of those partaking in the system (through the democratic process for the public option, through annual votes of the network in these sharing networks).

But there's a huge difference, really. These private networks are way more controlling of your personal life than we would ever put up with from the government. Poking around one such group's regulations, I see:

  • you must accept certain theological principles
  • you must attend church regularly - certified by said church
  • don't use tobacco or illegal drugs
  • abstain from alcohol, either totally or at least avoid drunkenness
  • practice "good health measures in accordance with the principle that your body is the temple of the Holy Spirit" (which is, really, scarily vague)
  • not have any sexual contact outside of "traditional Biblical marriage"

As an aside, that last point made me laugh. I know what they're talking about, of course, but imagine some Jew who tried to join but declared she wasn't sure if she was eligible because her husband was Arab Iranian; the Bible seems to go on much more about how the Jews are not to marry "the people of the land" than it does about the evils of homosexuality...

There are also practical problems with how they enforce that ethos. For example, if you can show you got AIDS through a transfusion, that's fine; but not if your traditional Biblical spouse was carrying the virus from before you were married? Etc.

If the government tried to put anything like this into practice - say, mandatory monthly citizenship classes, no high-sugar sodas or fried foods, and no sex before a state-recognized marriage - we would be up in arms. Tell me, where is the hysteria we once faced over those mythical death panels?

(Yes, I know there's a real difference between these kinds of groups and public options because you have to sign up for these. But I'm afraid that at the rate our country's health-coverage approach is going, it may be the only real choice. Most people my age know you can't depend on job-provided health care; it's getting too expensive, even if there is a job available that provides good health benefits. I'm not crazy about having to choose between a patchwork of private groups like this or a corporation whose business plan is to deny coverage to sick people, to be honest...)
Tags: political
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