Michael Rozier, S.J. on the Health Care Controversy

From our friend at The Jesuit Post, a thoughtful essay from a young Jesuit who works in public health:

A few years ago I was in Paris in a meeting room that might as well have been an art gallery – certainly no place for a boy from rural Missouri.  I was there because I’d been asked to serve as the English-speaking secretary for a global meeting of the National Bioethics Councils – a nice perk of my work with the World Health Organization’s Ethics team.  The president of a bioethics council in a developing nation and I were speaking before the meeting when he brought up my life as a Jesuit.  He said, “Many more people in my country would be dead if not for the Catholic Church and its commitment to quality care for everyone… and I mean everyone, regardless of who they are or where they’ve come from.  The Church cares for those no one else will.  I just want to say thank you.”


Three months before that conversation in Paris I had presented my thesis in an utterly unremarkable conference room only made distinctive by the incredible cadre of faculty and students of Johns Hopkins School of Public Health who sat before me.  Some in the room knew that I had been working on a new way of setting population-level health goals that focused more on achieving equity.  Everyone in the room knew I was a Jesuit.  As far as I know they were, without exception, supportive of my vocation.  But they did not give me a free pass that afternoon.  One of the first questions I received, from one of the kindest faculty members in the school, was this: “Do you think the fact that you are a visible representative for a Church that many believe treats women unequally in any way impacts your ability to speak on the importance of equity in health?”

Both of these stories describe part of who I am.  The fact of the matter is that I imperfectly straddle two worlds that rarely speak the same language, but are often engaged in the same work.  Both care deeply about the poor.  Both see health as an intrinsic and instrumental good.  Both emphasize personal and public responsibility.  Yet for their all these similarities it is not rare for a situation to arise in which these worlds seem to be talking past one another.  No, that analogy doesn’t quite do justice to the tension I feel – it sometimes feels to me that the Church and the world of public health are standing face-to-face screaming at one another.  And at moments like this, when tensions are really high, they act like scorned lovers who pretend that they really don’t need each other anyway.  And I can do little but watch.

So why do it, you ask?  Aside from my love of drama, I consider it a 21st Century version of Jesuit missionary work.

Let me dive into this thicket with a warning: I am not interested in providing a position.  If you’re looking to score points in a debate then you probably should look elsewhere.  But if you want to engage other people in conversation on a topic as neuralgic as they come these days, then I hope what I offer will be helpful.

Read the rest here.

Tim Reidy


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Michael Barberi
6 years 10 months ago

I was not implying that there are no beneficial features of ObamaCare, such as free contraceptive coverage, no pre-existing provisions, etc. I was referring to total healthcare costs, as in a real and substantial reduction in total cost or a significant reduction in the increase in total costs. There are no signficant provisions of ObamaCare that will address the underlying causes of total healthcare cost increases. With respect to contraceptive coverage, it is a minor cost as a percent of total healthcare costs.  Preventative care is a no-brainer. Of course, it will save money by reducing total healthcare costs, but we are talking about a small incremental reduction in total costs that free contraceptive coverage will generate. It is a drop in the total bucket. More importantly, many plan sponors already cover contraceptive services and many states mandate such coverage.

I agree with you that we must change how healthcare is delivered, administered and funded. However, I am not convinced that ObamaCare is the answer and if it gets fully implemented, I hope I am wrong.

Michael Barberi
6 years 10 months ago
I was a senior partner in a world-wide healthcare consulting firm, responsible for a national practice, professional standards and "ethics".

In my 30 years of experience, every government estimate of major healthcare legistlation was characterized by an over-estimation the savings and an under-estimation of cost. There is nothing in ObamaCare that will curtail the sources of healthcare cost increases as estimated, except further cuts in hospital and physical reimbursements and restrictions on access to care (allocation of care and resources). You cannot cover 40 million people without any healthcare coverage, establish a comprehensive standard of benefits for all, and save money. The fallacy statement is this: "we" are already paying for much of this healthcare through the free care of hospitals, emergency admissions, etc. The truth statement is this: "We" are only paying for the tip of the iceberg of their future utilization when they get comprehensive healthcare coverage.

I am all for national healthcare. However, we are far better off with a graduated strategy and an honest estimate of costs and savings. The first part of ObamaCare was a good first step. However, it is irresponsible that no one in Congress read the bill or understood it. Ditto for much of the Obama administration.

As for the contraceptive compromise, just wait. It will manifest itself in either 2 ways: the insurance companies will pass on the cost to everyone; or this compromise will be challenged in court and found either unconstitutional or in violation of another law.
Rick Fueyo
6 years 10 months ago
Very nice piece of non-soundbite reasoning in the Jesuit tradition. Thank you for sharing. 

Though the author does not admit to legal training, much of his suggestion regarding a necessary burden echoes legal reasoning, and I mean that as a compliment.
Marie Rehbein
6 years 10 months ago
I have read the entire article, which covers the contraception controversy from almost every angle. 

It asks the question "Can we agree that the revised mandate compromises religious liberty?" and then goes on to explain that there is a degree of compromise that is at issue.

However, not all agree that the revised mandate compromises religious liberty.  I don't agree.  I don't think the revision compromises religious liberty in any way, and I don't think religious liberty was compromised before the revision. 

I think it is a more than reasonable accomodation to have the insurer deal directly with employee despite the fact that the employer pays the money to the insurance company.  I think this because I view the money paid to the insurer by the employer as the employee's compensation.  Thus, even before, when the insurer did not deal directly with the employee, it was never an impingement on the religious liberty of the Catholic Church affiliated employer that contraception was included among the many things that are covered without copays under the Affordable Health Care Act.

Perhaps, someone would argue that it is an imposition upon an individual's religious freedom to have temptation to sin provided by one's own compensation.  Therefore, dealing directly with the individual would seem to be the appropriate solution.  However, it would not surprise me if the cost of insurance without contraceptive coverage were higher than with it given how insurer's determine costs and risks.

The only impression I have as to the Catholic Church position is that it wishes to use employee compensation as a teaching opportunity in order to convey to all its employees, including non-Catholic ones, its belief that it is mortally sinful to use artificial contraception.  Given that, my sense is that the government is being enlisted by the Catholic Church into imposing Catholic teaching onto citizens who are protected from this by that clause of the First Amendment that protects citizens from government imposition of religion upon them.  In other words, the government should not be making any exceptions for any employers who employ people out of the general populace.

I don't think I am alone in my perspective.  However, I am willing to pat the bishops on the head because we all know they're weird about that birth control thing.  That is how I think most people view this for now.  But if the bishops become more acitivist about getting their way, the backlash will actually bring about the thing they claim they are experiencing.

ed gleason
6 years 10 months ago
50% of employees are now 'kicking in' on their employers health policy. And growing...They already kick in for spouses and children to age 26.
Jim McCrea
6 years 10 months ago
''The only impression I have as to the Catholic Church position is that it wishes to use employee compensation as a teaching opportunity in order to convey to all its employees, including non-Catholic ones, its belief that it is mortally sinful to use artificial contraception.''

Marie, that is the position of the non-elected, non-representative, self-selected few men who have gone out on a limb to impose their theology in the secular world.  Yesterday's Super Tuesday showed that women (among whom are obviously not a few Catholic woman) abandoned support for the episcopal shills (Santorum and The Newt) and, most likely holding their nose at the time, went for Romney is significant numbers for hims to take Ohio away from the leading shill, Santorum.

As time goes on, more and more voters will be ''uncomfortable with an overt exercise of political muscle by the hierarchy.'' (America, 3/5/2012 - ''Policy, not Liberty''). 

Further on in that article is found this:  ''The campaign also risks ignoring two fundamental principles of Catholic political theology. Official Catholic rights theory proposes that people should be willing to adjust their rights claims to one another. It also assigns to government the responsibility to coordinate contending rights and interests for the sake of the common good. The campaign fails to acknowledge that in the present instance, claims of religious liberty may collide with the right to health care, or that the religious rights of other denominations are in tension with those of Catholics. But as Pope Benedict XVI wrote in “Deus Caritas Est,” the church does not seek to “impose on those who do not share the faith ways of thinking and modes of conduct proper to the faith.” Furthermore, the campaign fails to admit that the administration’s Feb. 10 solution, though it can be improved, fundamentally did what Catholic social teaching expects government to do—coordinate contending rights for the good of all.''

That truth that makes one free is not always comfortable for those who want to control the truth.
Joshua DeCuir
6 years 10 months ago
Just as a threshold question, has the actual text of the so-called "revised" mandate (i.e. the accomodation) been published in the Federal Register yet?  If not, then isn't it premature to conclude that it does, indeed, satisfy the moral requirements?

I can't help but chuckle when Marie writes above:

"The only impression I have as to the Catholic Church position is that it wishes to use employee compensation as a teaching opportunity in order to convey to all its employees, including non-Catholic ones, its belief that it is mortally sinful to use artificial contraception."

I mean, how dare they try to be a light in the world, a salt, a leaven...how dare they!
Marie Rehbein
6 years 10 months ago
Josh, I'm glad you got a chuckle out of my characterization of the Church taking an opportunity for a teaching moment.  We all know this opposition is part of the effort to (in the words of Mike Huckabee) "repeal Obamacare".  The bishops are tools in this effort, and they wanted to make the people in the pews tools also.

Question:  Why would anyone want to repeal the following?:

"The Affordable Care Act ensures Americans have access to quality, affordable health insurance. To achieve this goal, the law ensures health plans offered in the individual and small group markets, both inside and outside of the Affordable Insurance Exchanges (Exchanges), offer a comprehensive package of items and services, known as “essential health benefits.” Essential health benefits must include items and services within at least the following 10 categories:
1. Ambulatory patient services
2. Emergency services
3. Hospitalization
4. Maternity and newborn care
5. Mental health and substance use disorder services, including behavioral health treatment
6. Prescription drugs
7. Rehabilitative and habilitative services and devices
8. Laboratory services
9. Preventive and wellness services and chronic disease management, and
10. Pediatric services, including oral and vision care.
"Cost sharing (including copayments, co-insurance, and deductibles) reduces the likelihood that preventive services will be used.... The Affordable Care Act – the health insurance reform legislation passed by Congress and signed into law by President Obama on March 23, 2010 – helps make prevention affordable and accessible for all Americans by requiring health plans to cover recommended preventive services without cost sharing."
Answer:  Because it was proposed and passed into law by Democrats.

Singling out contraceptives from all the types of prescriptions that will be covered, even when these are used for many medical problems and not contraception, is not something the bishops are likely to think of on their own.  You can be sure that someone who does not understand much beyond creating political controversy was was paid to come up with the idea that the Catholic Church was in danger of losing its religious freedom.
J Cosgrove
6 years 10 months ago
I tried to comment on the Jesuit site but it requires that one have accounts with certain orgainizations so I sent Father Rozier a comment by email.  Here is what I sent him.

his is an excellent article but rather than just praise the process here, let me make two comments:

First, the basic problem in this debate may be being ignored and it was mentioned right up front.  Namely this phrase, ''health goals that focused more on achieving equity.''  That may be the basic problem, how is the word equity or equal being used.  Generally in those occasions in history where equity is imposed, it is done with force or shall we use the word ''mandate.''  In fact the very first word on this page about this topic is ''mandated.''  So far in the health care debate we have two very important mandates discussed, first, we are mandated to buy health insurance and now employers are mandated to provide contraception. Human beings resist mandates and thankfully that is how God made us. There are no incentives except the withholding of punishment.  In other words the incentives are negative.

Second, the economic pie is not fixed and should not be looked on as something to be divvied up in some way.  It sometimes grows and sometimes contracts and to our great fortune it has grown unbelievingly in the last 200 years.  But that was not always the case nor is it the case in a lot of the world today.  Similarly, health care should not be looked on as some fixed pie to be divvied up equally.  We must let inequality prevail within some limits because that is how the pie grows and delivers more to those on the lower end.

Now I know that this will rub a lot of people the wrong way but one of the premises of this article is that we should look at what others are suggesting and try to understand their point of view.
Marie Rehbein
6 years 10 months ago
JR, I appreciate your comments.  I, too, do not like mandates in principle.  However, I look at the value of what is mandated before I decide whether to stand on principle or compromise.

One example of something that I don't think is fair, but that is mandated, is the Medicare tax.  First, it falls more heavily on the least compensated employees, because it is a flat tax.

Second, it provides the same amount of coverage for people who have more than enough wealth to provide for their own medical expenditures as it provides for those who cannot afford medical care at all, even though the burden of contribution was greater on the poorer person during his working life.

Nevertheless, I do not object to the Medicare program, nor to the various things it covers, even though some of those things might be hormonal contraceptives (since we know they are not just for contracepting) or erectile dysfunction medications (even though couples past their childbearing years do not need medical help for the purpose procreating - erectile dysfunction is God's way of saying don't do it).
Michael Barberi
6 years 10 months ago
The real issues are the following:

1. The definition of a religious institution: The Obama administration has defined a religious institution that would have an religious exemption from the contraceptive mandate. This definition is universal. It applies to all organizations. Obama makes the case, rightly or wrongly, that Catholic Universities, Hospitals, etc, that employ both Catholic and non-Catholic employees and are not formally owned, controlled and managed by the Church, are not exempt from the contraceptive mandate (the formal definition is likely more complex). If the definition is changed, then is must be universally applied. Would an institution owned by another Church (Jewish, Prostestian, Scientology) be allowed to exclude certain medical benefits based on their religious beliefs? Or would this only apply to preventative coverage, as defined by the government? Is Obama's defintion of a religious institution constitutional?

2. The Obama Comprise: If the government mandates the insurance company, and not the Catholic institution, to offer free contraceptive coverage to their employees (and not charge the Catholilc institution for such cost), "who is offering such coverage"? If not the Catholic institution, how is this an intrusion on their religious liberty? Can the government legally mandate the insurance company to do this, without due process?

3. Cooperation with Evil: If a Catholic institution is not offering free contraception coverage, because Obama is giving them a special so-called exemption, and the insurance company is making the free offer of coverage, then to what extent is the Catholic institution cooperating with evil? If 98% of Catholics have not received the doctrine of contraception, is the Church cooperating with evil when it does nothing about the "silent pulpit"?  The pulpits are silent in reminding Catholics that unless they confess contraception as a sin and receive absolution, receiving the Eucharist is a sacrilege. Nor do bishops make this clear in any weekly, monthly or annual Catholic bulletin. Is the Church cooperating with evil by an act of omission. If a Catholic institution uses the concept of "cooperating with evil" as one of the reasons for a religious exemption, is this not contradictory?
Michael Barberi
6 years 10 months ago

The issue of "the tip of the iceberg" is as follows: people who do not have healthcare coverage often seek care in the emergency room of a hospital when something serious is involved. However, this is dramatically different from people who have comprehensive coverage. They seek all forms of healthcare from many providers when they have any type of illness or injury, regardless of severity. Thus, if you compare the utilization of healthcare between these two groups, the cost is significantly and dramatically different.

Consider this: prescription drugs were always a part of every major medical plan. Then prescription drugs were carved-out of medical plans and set up under their own managed pharmacy benefit plan. A person was given a "prescription drug card" that they could use in pharmacies to get drugs for a small copay, and they could use mail order for maintanence drugs. Initially, many of these pharmacy benefit providers said, costs would be reduced. What happened? No one understood that utilization of drugs in a major medical plan, with a $200 annual deductible and the fact that people had to submit a paper claim from to the insurance company for reimbursement was dramatically different from having a "prescription drug card" where they could get a drug a point of purchase. The utilization of drugs in the card plan was dramatically more than the utilization of drugs in the major medical plan. This increase in utilization offest the discount on the drugs. Thus, costs increased. The solution was to totally redesign the card and mail order plan. The copays had to be significantly increased, generics had to be mandatory, and a realistic incentive provided to use mail order.

Value is a function of price, quality and access. If every provider followed "best practices" and did not manipulate the system, the quality of healthcare would reduce the oveall cost of healthcare because we would be eliminating much unnecessary follow up care, poor diagnosis and treatment, and fraud and abuse. This is a highly complex subject but suffice it to say that there is nothing I know of in ObamaCare that will significantly improve quality. Lower prices and access to care can reduce costs, but no one wants to reduce access.

Setting up a system where there is competition between providers for access to patients have always been a good theory, but few realistic systems have proved to be the standard for a national healthcare plan. Healthcare costs can be contained, and the rate of increased reduced. However, if you are going to cover 40 million people that do not have a plan now, you better have a program that will work. So far, I don't know that ObamaCare is the answer.

I hope this was helpful.
Michael Barberi
6 years 10 months ago

I forgot to respond to your last impotant remark. Indeed, a court could uphold the Obama compromise on free contraceptive coverage. I did not say a court would not. However, insurance companies will definitely pass on these costs to their clients.

The fallacy is this: contraceptive coverage may reduce overall medical costs; but so do many other products and services. If contraceptive coverage is mandated to be "free" based on this premise, why not other services?

The other fallacy is this: insurance plans for large employers, is a cost plus arrangement. Claims cost are a direct pass through to the plan sponsor (the employer, Catholic institution, government sponsor, etc). If claims costs are reduced, the insurance companies do not benefit, only the plan sponsor. Thus, mandating free contraceptive coverage for large plan sponsors where the insurance company cannot pass on the costs of contraceptive coverage is absurd. The claims cost savings on overall healthcare costs, as a result of contraceptive coverage, are already passed on to the plan sponsor, while the claims cost of contraceptive coverage is paid by the insurance company!!!! What this means is that the insurance company must absorb the cost of contraceptive coverage, with no offset in terms of the reduction in overall healthcare costs. It accures to the plan sponsor. Further, it is almost impossible to determine what costs were reduced by contraceptive coverage and demand that the plan sponsor send back these so-called savings to the insurance company. If insurance companies cannot win in court, they will find a way to pass on these costs through higher administration fees.

The Obama compromise is seriously flawed. I repeat my earlier blog where I defined what the real problems are.
Marie Rehbein
6 years 10 months ago

I would like to zero in on this statement you make "The utilization of drugs in the card plan was dramatically more than the utilization of drugs in the major medical plan."  Was this really an issue of utilitzation or was the insurer able to escape having to pay for the prescription when it was too cumbersome for the insured to file a claim?  I think a lot of what has led to the development of The Affordable Health Care Act was insurer's making the insured's lives intentionally difficult in order to avoid paying legitimate claims.

Before I posted my earlier question to you, I had composed a long post about the original intent of health insurance and its transformation over time.  I thought it was too long, but I will try to convey the same in less space.

Insurance, generally, is intended to protect assets from unpredictable occurrances.  If health insurance were like this (and it may have been intended to be at first), it would only kick in when medical expenses reach a predetermined level, and then it would reimburse to a stated limit. (i.e. with a house, it's frequently replacement cost, with a car, it's depreciated value, with term life, it's the benefit amount.)  One pays these other insurances on a yearly basis and rarely makes a claim.

Health insurance, though, cannot work the same way that other insurance works because illness and injuries are frequent and recurring. Unlike with other insurance, the insurer cannot grow the money in order to cover claims and still show a profit, because it goes out the door almost as soon as it comes in.  How much the insurer charges over the actual cost of paying claims and running the business in order to have funds to invest or hold in reserve may be something the government knows, but the public doesn't - at least I don't.

I think we are seeing a change in the function of the health insurer from an insurance provider to a clearinghouse for medical payments.  Getting costs down or slowing the rate of increase is not really the aim.  The aim is for all citizens to get good healthcare.  This might cost more, but so long as the increased cost is not due to providers and insurers gaming the system, there is no reason to insist that these costs should be lower.
ed gleason
6 years 10 months ago
[left off]
and won't it be moot when 100% of workers eventually kick in.. in two years the complaint will be history.
C Walter Mattingly
6 years 10 months ago
Marie (#9), 
Perhaps because the Affordable Care Act is not affordable?
Maybe that's why the name never stuck. The public quickly realized the projected numbers were bogus, the phase in of the plan carefully structured to avoid the public being cognizent of its real costs until after the next election. Before Obamacare cost increase estimates in 2014 of slightly over 6% are now projected at over 9%. That, and the president's violation of his word to put the healthcare debate in the sunshine for all to become informed and debate, instead drawing it up behind closed doors and passing it under reconciliation against the will of the American public, may indicate why it is Obamacare, not Americare, because it was all crafted behind closed doors, out of view of the people, and contrary to the will of the majority.
My opinion would be to revisit what Obama promised but ignored: reopen the issue, put it before the American public. It may indeed be that this or something similar is the best plan or at least the preferred one; it may be the bipartisan plan of Weyden Ryan. And importantly, it may be one the American public can afford. And in any case, it would be one the public had the opportunity to know and support, not one which needed to be passed before we could know what was in it.
Let's execute government in the sunshine, rather than merely promise it and then provide the old behind closed doors substitute. It could benefit us all.
Marie Rehbein
6 years 10 months ago

If it were the case that our elected leaders would work together in good faith to find a good, consumer-oriented health care solution, it would not be necessary for things to be done in secret.  The biggest problem, the one that led to having it passed under reconciliation, was not that it was against the will of the American people, but that it was against the will of the Republican machine.

I happen to like that preventive care will now be covered by insurance, given how much money I have given over the decades to insurance companies and then having found myself paying out of pocket anyway for most of my medical care - the big exception being maternity care, though.  If all care had been provided the way maternity care was, I would be happy, and I have a sense that The Affordable Health Care Act will finally provide for this.

Projected costs are estimates, of course, but projections have to go beyond the year 2014 for me to feel that there is a judgment to be made for or against the program.  Perhaps, in 2015 costs without the program would rise again 6% while with the program they would stabilize.  I most definitely do not want this Act repealed before we see it in action.  I think efforts to repeal it are completely politically motivated and indifferent to the well-being of the citizens.
Dan Hannula
6 years 10 months ago
Not bad-and the typical Jesuit thinking that educated a farm-boy like me many years ago.  However, it is less about the contraception controvery and more about civic virtue-an important value we have lost in the public square of late.

If you read the writings of the Founders, especially the Federalist Papers, you will see that civic virtue dominate their thoughts?  They learned that in order to re-invent the republic, Americans had to be a self-governing people.  We had to change from being “subjects” to being “citizens.”  A radical new form of government required a radical new kind of person committed to exercising civic virtue.   

Alexis de Tocqueville called civic virtue “habits of the heart.” In short, it is tolerance, mutual respect, willingness to debate and compromise, and above all, belief and respect for the rule of law, even when you lose.

James Madison feared that the seeds of failure were “sown in the nature of man.”  Modern history also gives plausibility to Madison’s fear.  The French soon followed us in republic building.  Their attempt, sadly, ended in disaster.  Civic virtue proved inadequate there to prevent a frenzied intolerance, which led to tyranny, then to terror, and then to a well-worn guillotine.
Americans will weather this storm if we keep our civic virtue.  And, the Bishops need to take it down a notch-They really aren't persduasive at acting like victims right now.
Amy Ho-Ohn
6 years 10 months ago
" ... the Affordable Care Act is not affordable?"

What is unaffordable? How much is too much money to pay for life and health? If the life of a pre-implanted zygote is believed to be worth however much danger, pain, exhaustion, disability and stigma it may cost its mother to bring it to term, shouldn't the life of that same human being be worth as much money as the ACA will cost when he's an adult?

The ACA was not passed in the dark. The entire country has been debating for thirty years how to provide health insurance to citizens who can't afford to buy it. The ACA wasn't anybody's favorite solution, but it was passed in accordance with the legitimate legislative procedures of Congress. If the laws of a country are eternally subject to being capriciously overthrown whenever there is a change of governing majority, no lasting inter-generational contract is possible.

The ACA is not unworkable. We have a version of it in Massachusetts. It is expensive, complicated, bureaucratic and confusing, but it works. The lame have motorized wheelchairs, the blind have Braille medication labels, the asthmatic get those breathing-tube thingies, the diabetic get dialysis and the cancerous get chemotherapy. It may not be the kingdom of heaven, but it's a heck of a lot better than it used to be.     
Marie Rehbein
6 years 10 months ago

Thank you for explaining your expertise.  The more one knows, the more one knows what one doesn't know.

There is no way for medical providers to compete with one another on the basis of good value for the money.   This, I think, is why the cost of health care keeps rising, and you are right that this is not addressed by any system to date.  Doctors charge what they charge because they can, and people who need care just have to get it and pay for it even when it doesn't help them get better.

It also may be that that health care costs have risen because of the bureaucracy of billing and payments rather than because of people seeking treatment.  We recently got a health savings account and have found that some providers are willing to charge less because they get paid on the spot and don't have to bother with the insurer.

I don't understand what you mean by "'We' are only paying for the tip of the iceberg of their future utilization when they get comprehensive healthcare coverage."  Do you mean that you think emergency rooms and hospitals will be getting more customers because more people have insurance and that preventive services and less expensive delivery systems will not sufficiently reduce the use of the expensive emergency rooms and hospitals?  Do you think that medical providers have an incentive to provide more care to more people for more money as a result of healthcare reform?  Do you think some sick people are currently out of the system and will swarm the new system when it is implemented and that this will set a new, higher rate for seeking medical services that will not subside once they have been treated? 

When people talk about the health care costs vs GDP, they are looking at what employers pay toward health insurance compared to their business earnings.  If this cost were removed from the employer, would this even be a statistic?  If all insurance were directly paid by the individual could this still be figured against the GDP?  Is this really a valid way to assess the value of health care reform, or is it more proper to see how well illness is prevented and health is restored in order to determine the value?

So far as the contraceptive coverage is concerned, the cost of providing it should be less than the cost of maternity care and new baby care, especially if there are the kind of complications that people who use contraception tend to anticipate and which motivates them to contracept. Finally, there is a possiblity, too, that the compromise will be challenged in court and upheld.

Michael Barberi
6 years 10 months ago

Your comments are valuable, but they are also ignorant of the health insurance industry. Ever since health insurance became a staple as part to an employee's compensation, paper claim forms were not norm. Technology was not available for electronic processing of medical claims. The exception was pharmacy claims as they were part of a separate electronic reimbursement system. There was no fraud on ill intent on the part of health insurers to deny legitimate medical claims. save for a few horror stories. For the most part, insurers are ethical and responsible corporations.

The utilization in card plans were dramatically different from the utilization in major medical plans because of the so-called "shoebox effect". This means that most people would put their Rx receipts in a so-called shoebox until year end, then file a paper claim. The result was missing receipts and the inconvenience of the paper claim form. As technology caugth flight and Rx benefits were carved-out of medical plans, this had both negative and positive effects. The negative was only temporary, in that the transition from a medical claim system to a card system under-estimated the increase in utilization. This was eventually solved by plan design.

The cost that an insurer charges for administering a medical plan, for very large employers, is less than 10% of the total cost. Claims cost represent 80-90% of total costs, based on the type of plan, the type of funding (e.g. self-funded) and the size of the plan, in terms of covered lives.

The insurance industry is not perfect and there are many horror stories. However, they are also very mis-represented as the evil one.

Lastly, slowing the cost increase in health plan will always be a major priority of any plan sponsor or insurer. However, quality of care is equally important and the key to solving our nation's healthcare crisis.

I hope this helps.
Marie Rehbein
6 years 10 months ago
Thank you Michael.  I am willing to allow that the shoebox was to blame for claims not being paid.  However, the increase in payments with an easier to use system is not an indictment of the system.  It merely means that prior to the implementation of the system, insurers were not experiencing costs that they legitimately would have an obligation to pay if claims had been filed.  It's not really the same as saying medical costs increase.  It means that some medical costs were not taken into account when figuring how much money is spent on healthcare, prior to the implementation of the system.

If anyone is still reading this article and comments, the following is an interesting article:

Michael Barberi
6 years 10 months ago

You missed my point again. I will take the blame for it as my remarks may not have been complete.

The cost Ireferred to is the cost to the plan sponsor...a government, an employer, a Catholic institution. MY POINT: in making forecasts of healthcare costs, actuaries must factor into their calculations reasonable assumptions based on experience. Based on 30 years of experience with government forecasts of healthcare costs, the CBO, in estimating the cost of ObamsCare, over-estimated savings and under-estimated costs. The Rx shoebox example was only an example of unrealistic under-estimation of utilization when a plan sponsor moved form a major medical plan to a separate prescription drug card plan. It was the "unrealistic estimation of the shoebox effect" that I used as an example of an "unrealistic assumption" when I was talking about the unrealistic forecast of the healthcare costs and savings of ObamaCare.

I hope this is clearer explanation.
Marie Rehbein
6 years 10 months ago

It is clearer.  However, you say that there is nothing in the Affordable Care Act that will save money, but the major difference between this and the old way of doing insurance is that preventive care will be encouraged by making it look like it's free in that it will cost nothing above the price of insurance.

If people are in better health, they won't get cancer from smoking.  They won't have strokes from being overweight.  They won't wait until an infection is raging and requires hospitalization to be treated.  If you are a complete mercenary, you might look at these as self-limiting in health care expenses, because they so often lead to death, thereby eliminating the health care cost, but that would be evil. 

The idea behind eliminating copays is just the opposite of the idea behind instituting them.  Instituting them was supposed to reduce demand on insurance, so that people didn't take every little thing to the doctor.  Eliminating them is supposed to get people to take little things to the doctor so they don't become big things.

If more people access the system, this is good.  If that causes more money to spent on health care, this is not necessarily a bad thing.  Medical products, often made in the US, are products to be sold.  Medical care is a service in a service based economy.  Thinking beyond the concerns of the employer or the insurer is necessary to assess the benefits of this new system.

If the Congressional Budget Office has miscalculated on this, perhaps you could point out specific things it has failed to take into account, but to say they did this wrong because they have missed things in the past is not sufficient.


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