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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...)

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( 12 comments — Leave a comment )
lady_branwyn
Jun. 19th, 2011 01:32 am (UTC)
People have run into non-payment issues with these plans. Plus, they aren't insurance plans so they aren't regulated by the government. With no oversight, you would have to hope that honest and competent people are running your plan.
whose business plan is to deny coverage to sick people
As a former employee of the health insurance industry who has also worked on the provider side, I can't let that pass without comment.
What is the basic business model of an insurance company? The policyholders (the insured) pay premiums which form a pool of money which is used to pay the claims of anyone who needs medical care plus related administrative costs. (Vastly simplied but the general idea.) Let's say that $2 million a year in premiums is added to that pool. This year, six policyholders need $500,000 treatments (it can and does happen--for example, a bone marrow transplant). The typical lifetime limit on coverage issued by my former employer was $1 million so assume that all of the claims must be paid. There will be a shortfall of $1 million. Who should make up that shortfall? If the insurance company routinely pays out more than it takes in, it will eventually go out of business. So it's options are 1. charge higher premiums or 2. try to limit who is covered so there will be less risk that people in the plan will need $500,000 worth of care.
It's easy to demonize the insurance industry, but remember that if they can't cover their costs, they will simply go out of business. Maybe the better question is: why does medical care cost so much? Why would any treatments cost half a million dollars? But our politicians don't want to address that issue in any meaningful fashion because they (and the general public) don't want to antagonize the sacred cow that is the medical profession. (Note: I would be the last person to deny that there is waste and abuse within the health insurance industry, but insurers make an easy and convenient scapegoat in the insurance debate.)
celandineb
Jun. 19th, 2011 06:47 pm (UTC)
But a for-profit company - ANY for-profit, insurance or otherwise - has a first obligation to create profit for its shareholders. So there is in fact a legal necessity to create profit, and an easy way for health insurance companies to do that is to limit payouts, with or without reasonable cause.
lady_branwyn
Jun. 19th, 2011 07:58 pm (UTC)
They are between the proverbial rock and a hard place--either raise premiums and lose customers OR try to weasel out of paying legitimate claims (not only bad publicity for the insurance company but also a potential source of lawsuits) OR try to limit who you are willing to insure. None of those are great options.

When I worked in hospital finance, I used to find it amusingly predictable which insurance companies would come up with outrageous reasons to either deny claims or at least delay payment. It was always the same scumbag companies.

Interstingly, my former employer in the insurance industry likes to claim that it is actually a non-profit entity because it is a mutual company which is (at least technically) owned by the policyholders.
marta_bee
Jun. 19th, 2011 07:44 pm (UTC)
You're right, Branywn - picking on the insurance industry is an easy attack. And I do recognize that sometimes hard decisions have to be made - that sometimes we must say "no" for the greater good. What bothers me is the idea that there should be any profit motive involved. Health care shouldn't be a business, and the paying for it certainly shouldn't be a business.

You'd get no argument for me about looking at why costs are so high and fighting systematically to keep them down. I'm all for that and really do wish I could see a way to work toward improving that issue. But I still think I'd have a hard time with the idea that there should be people who have to balance, on top of the already complicated questions of who should get care and who shouldn't, their own quite legitimate interest as a corporation in benefiting their shareholders. It's asking too much of human nature to do all that at once, I think, which is why the paying for medical care should itself be non-profit.
lady_branwyn
Jun. 19th, 2011 08:11 pm (UTC)
I am in favor of a single payor system overseen by the government. I've seen the current system from just about every angle--provider, patient and insurer--and I think that the current system is so dysfunctional that it can't be salvaged. But I can't blame insurers for trying to stay in business when the rising cost of healthcare has left them with an obsolete business model.
You can also see the detrimental effect of the profit motive in the god-awful "direct to patient" advertising by pharmaceutical companies. Patients demand more expensive non-generic drugs because they saw them on TV or they get the impression that drugs are always the best means of treatment when there might be other options. ARgh.
telperion1
Jun. 19th, 2011 10:54 pm (UTC)
I am at times frustrated beyond belief with the organization behind American health care. It's actually a major reason I want to emigrate to somewhere with a single-payer system one of these days; when I deal with insurance frustrations I start fantasizing about the times I have been sick in Germany and the U.K. Which may be flavoring my perceptions of insurances.
lady_branwyn
Jun. 20th, 2011 01:51 am (UTC)
Businessweek magazine had an interesting article about universal health coverage a few years back. It discusses the French system--which you never hear about in our health care debate in the US. The French have a hybrid public/private system where everyone gets a basic level of coverage through the government system, but people can buy supplemental private policies if they wish. It sounds like it works pretty well both in terms of keeping costs down and delivering care to the entire population.
A very close friend lives and works in Japan, and even as an American national, she is included under their universal coverage. She is satisfied with it.
celandineb
Jun. 20th, 2011 01:23 am (UTC)
I am in favor of a single payor system overseen by the government.

Me, too. As Marta says, health care shouldn't be a business. That model is just incompatible with overall good results for the actual patients. Recent reports indicate that despite paying more for health care than any other country, the US just doesn't have very good outcomes overall (e.g. in terms of life expectancy). The reason for that has to be that there's a lot of profit being made (by insurance companies, drug companies, physicians... pretty much every single type of player, if not every single individual or different company). We HAVE to get the possibility of profit out of the equation.
lady_branwyn
Jun. 20th, 2011 01:36 am (UTC)
Agreed about the detrimental influence of profit, though our poor life expectancy is also due to lack of exercise and overeating. When I was in grad school, a Spanish classmate told me how surprised he was that Americans were never outside! Why weren't people strolling around their neighborhoods in the evening after work? Why did restaurants so rarely have outdoor seating? This was 15 years ago, but it was a bit of an eye-opener for me to hear an outsider's perspective on our lifestyle. This Spaniard thought that our way of life was uttterly wretched, lol. We worked too hard and long and didn't enjoy what we had. (Sort of OT, but it is part of the problem.)
spacellama
Jun. 20th, 2011 06:07 pm (UTC)
Recent reports indicate that despite paying more for health care than any other country, the US just doesn't have very good outcomes overall (e.g. in terms of life expectancy). The reason for that has to be that there's a lot of profit being made

I don't see the logical causal (A therefore B) relationship here. Couldn't there be lots of reasons why the American health care situation is inefficient?
celandineb
Jun. 20th, 2011 06:16 pm (UTC)
If health care spending is very high in the US, and yet US health is poor, that strongly suggests that the money spent on health is misspent (i.e. to profits for insurance companies, drug companies, etc., rather than for care that is effective). It does not preclude the possibility that there are *also* other factors, such as lack of exercise, poor nutrition, and so on. This is not an either-or situation.
foxrafer
Jun. 30th, 2011 07:00 pm (UTC)
Our health care system is so messed up, but this option definitely has a whole lot of "do not want" clauses.
( 12 comments — Leave a comment )

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