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Belmont Club

All in the Name

August 31st, 2014 - 3:43 pm

“What’s in a name?” Shakespeare asked.  Everything, it may turn out.

The Washington Post describes the efforts of Samaritan Ministries to offer an alternative to Obamacare.  Samaritan is a leading health-care sharing ministry where a group of individuals undertakes to share health costs according to a certain procedure.   The payouts are less defined than insurance, but the bills are typically smaller as well.  But a year ago Reason Magazine warned that such plans could be killed off by Obamacare:

Samaritan may soon become a casualty of new incentives created by Obamacare, which does virtually nothing to reduce third-party payments in delivering health care. When their bills are mostly covered by insurance companies or the government—which may also be heavily subsidizing their premiums as well—patients aren’t discerning shoppers.

Under Obamacare, most Samaritan members will be able to purchase health insurance policies that offer richer benefits for lower prices, thanks to significant taxpayer subsidies. Take, for example, the median Samaritan household, which has three members and an annual income of about $40,000. Under Obamacare, that family will pay around $2,500 dollars a year to buy a middle-of-the-road “silver” plan on the new health care exchanges. Why so cheap? Because taxpayers will pick up two-thirds of the total cost of the insurance premium.

In fact the opposite has happened.

Month-over-month enrollments doubled and tripled throughout the year at Samaritan Ministries—one of the country’s biggest health care sharing ministries, which now has about 113,000 members, 43 percent more than it did a year ago.

Another major program, Medi-Share, reported an average of 500 inquiries a day over the open enrollment period starting in October. Medi-Share saw membership jump to more than 82,000 members nationwide, with a 7 percent increase in March alone.

One reason for their continued growth is Obamacare didn’t turn out to be the steal it was cracked up to be. Networks were narrow. Coverage was refused. Deductibles were high. Premiums started to rise alarmingly.  For minor aches and pains many people opted to go to a walk-in Walmart $40 clinic than see their ‘primary health care physician’ under Obamacare.

So was the “Holy Spirit” coming to the rescue of Samaritan? Or did the “Holy Spirit” come in the guise of the God of Mathematics?  The key lies in a clause everyone who joins Samaritan must sign.  They must forswear ‘debauchery’.

Every year, Gary Duff signs an updated version of these 40-page terms, which detail one way Americans can avoid buying private insurance or paying into the Affordable Care Act.

The deal, made possible by a little-known provision in the health-care law, has one particularly important requirement: The Duff household of nine must abstain from general debauchery.

Samaritan Ministries, a health-care sharing group, will charge its national network to cover the family’s medical bills, but only if they agree to forsake binge-drinking, extramarital sex, illegal drugs and tobacco (with the exception of celebratory, post-birth cigars).

It is here where the God of Mathematics touches down upon the earth. One of the reasons faith-based health care Ministries might work is self-selection. Cynics may scoff at the morality clauses of Samaritan Ministries, but such morality clauses are probably written on the handout your doctor gave you under the heading “lifestyle changes” when your blood pressure turned up too high and the lab came back with alarming cholesterol and sugar counts.

“Now Mr. Jones,” the doctor will say, “you really have to stop drinking and smoking.”

“What about …”

“And I wouldn’t go picking up ladies at the bar any more at your age Mr. Jones.  This is the fourth time I’ve had to prescribe antibiotics this year.”

“Ok doc. I’ll make those lifestyle changes.”

‘Lifestyle changes’ are a synonym for ‘avoiding debauchery’. And if you rename “confession” to “counseling” and “fasting and abstinence” to the Michelle Obama school lunch program what have we missed? One of the reasons why groups like Samaritan tend to work is they require low-risk pools.  Anyone who looks at such groups will probably find alarming evidence of bigotry and discrimination. And they would be right! They predominantly contain a certain type of person.  The map of any self-selected group is never like the map of America.

But insurance companies did exactly the same thing by offering those who didn’t smoke, drink to excess or in general engage in “Christian living” lower premiums. They did it for exactly the same reason. They were a low risk pool so the insurers could charge them less.  Car insurers do that. Home insurers do that.

“Is this your third home to burn down Mr. Jones?”

“I’m afraid your insurance rates have gone up.”

People who need health care despite unhealthy life styles or sheer poverty can’t be viewed through the framework of insurance, for their risk tables will never work out. Such individuals should get treatment as part of a conscious decision by society to provide welfare.  Thus the drunk who keeps drinking should get a liver transplant if it’s available or a who already has AIDs should receive medicine, or the indigent: not because they are insurable but because society as a whole cares enough to allocate charity or tax money to treat them regardless. But no should imagine they are receiving treatment because they’ve paid an Obamacare premium.

It’s not insurance. It’s a conscious act of public policy charity.  There is nothing wrong with either, but they are not the same.

The fundamental problem with Obamacare is that it delivers welfare through the IRS and the insurance system, making institutions designed to do something different accomplish what they were never meant to do.  It might work of a fashion, but only in the way a Ferrari can be used to pull a plow attachment through a field. Not very well.

Over time the role of affinity groups will tend to increase in a society whose bureaucracy is choking on itself.  Many are beginning to understand that having an Obamacare health card is not the same as getting health care. One Obamacare advocate tried to puzzle out why. Her conclusion: Obamacare is Working But the Health System Isn’t. Her explanation is interesting.

People are going to the ER because they had nowhere else to go.

Some industry experts suggest that ER visits are due to a sudden influx of patients seeking care put off due to not being able to afford a doctor. Many of these patients tried to go to the doctor, however, but there was no appointment available. One major problem with the increase in the number of people who can now afford to go to the doctor is that there just aren’t enough of them to go to. …

The increased number of people with insurance has led to a situation where the ER is the only place to get timely care. I, too, have been forced to go to the emergency room in the middle of the afternoon because my doctor was unable to see me with my great PPO plan and the matter required attention that I couldn’t wait three weeks to deal with. During my wait in the emergency room, which would be hours because they determined I wasn’t dying, I would overhear dozens of patients checking in with the same opening line: My doctor told me to come here.

And that’s why health-sharing plans and other affinity groups will continue to flourish despite — or even because — of Obamacare. Whenever there’s a comparative advantage to self-selection, people will self-select. People have been starting clubs, associations and even political parties for centuries. And churches too. It’s all in the name.


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Top Rated Comments   
I've had a very good plan for decades from the employer I retired from.
1. Years ago, I had some tests that required an overnight stay, and the doc who did them said you're fine, go home. The hospital claimed my GP had to discharge me since he requested the tests. It was the weekend. I stayed another two nights, unmonitored, unmedicated. My doc showed up Monday, I went home. Hospital billed for two extra days, monitoring, medication, chart reading by resident, the works. When I told my insurance company about the scam, the rep told me not to worry, they'd just pay it.
2. Another time, I was in the hospital for six days, semi private room, brought my owm meds to be issued from their pharmacy. Hospital billed for a private room and thousands of dollars for meds that I and my insurance already paid for. I complained, the insurance rep did it again; thanks, but don't worry about it.
The bottom line is we've become a society who doesn't give a damn about the cost of anything as long as I get mine for 'free'.

7 weeks ago
7 weeks ago Link To Comment
Surprise, low risk networks work. I get my insurance, when I own something worth insuring, from USAA. Until recently it was a mutual insurance group that only accepted present and former military officers as members. Now it accepts all military members and their families but they say the risks have not increased. It certainly built an enviable reputation for outstanding customer service and low costs. That was not simply due to country club social snobbery to keep out the riff raff. The fact is that military officers, except when they are doing something interesting on active duty the risks of which are not charged to a private insurer, like fly a jet or refuel a ship or move ammunition, tend to be quiet level headed people who avoid doing stupid stuff. As long as you avoid criminals, drug addicts, single males under 21 who think that no one else ever heard of sex and beer and automobiles, and the women who tend to have children out of wedlock with the above risk pool, most people not facing end of life costs can self insure of be insured at a reasonable cost.

Here are some facts that contradict each other.
Americans are exceptionally generous and charitable. Vastly more so than people in other societies. This has been true for as long as America has existed, and possibly longer. This may have something to do with the Protestant Ethic and the role of "Good Works." Most hospitals and great universities in America were established before the income tax. Charitable giving is far greater in Red County America than in Blue regions. Most charities conservatives donate to provide direct services to a population. Most of the people who work for charitable institutions are personally liberal. Most charities liberals contribute to engage in issue advocacy in which they attempt to mobilize people to pressure the government to spend money and engage in rule making. This means that the employees of charities that conservatives donate to are often themselves liberals eager to see the government become more active in that area. Most liberals despise private charity and react with anger when it is suggested that services can be provided more cheaply flexibly and efficiently by private agencies than by the government. They claim that it is offensive and demeaning to ask the indigent to go to a charity that may question their lifestyle. The image of Scrooge and the Workhouses is routinely used to end the conversation. The same people have no problem with advocates pressuring the government to tell people what to eat drink smoke and what level of expressed sexual interest may be legally liable.
7 weeks ago
7 weeks ago Link To Comment
Perhaps it was an unfortunate term, especially since terms are so important. Recently there was an article about how someone was charged $8,000 to bandage a finger cut. But it's ok, because insurance picked up $6,800 of it. See! The wonders of insurance.

But the money to pay the $6.8 K came from somewhere; that somewhere was the premium others paid or the subsidy from the government. Ultimately, $8K bandages are unaffordable. But hospitals don't charge according to a cost-plus scheme, but according to negotiated prices with the insurer.

The parties in the sales transaction are not the patient and the provider. They're the insurer and the provider.

The single-health care people claim the way to reduce costs is to fix it so there's only one insurance company, or single payer. But it turns out this leads to bigger hospitals and hospital monopolies are the single greatest cause of high prices.

Avik Roy argued that the problem isn't the way health care is paid for. It's the way it is sold. Hospitals have monopolies because sick people can't be transported very far. By controlling licensing and bed capacity, regulators are the prime cause of hospital monopolies.

The reason $40 Walmart treatments are possible is that in the case of minor ailments, treatment monopolies are far harder to create. You might not be able to travel far to have a heart attack treated, but you can drive the extra 10 miles if you can get your finger bandaged for $40 rather than $8,000.

Competition is possible in noncritical medical emergencies. In urgent situations, not so much. Where compeitition can arise it cuts costs drastically. That is probably where the gains will come from. Being able to pick and chose modes depending on the severity of your condition. Obamacare is trending the other way. They want you to meet all your health needs in the network, which means in the monopoly.
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7 weeks ago
7 weeks ago Link To Comment
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One thing not mentioned in the article is that the Samaritan Ministries also require a letter from one's pastor saying that one attends church a certain number of times per month. Or at least it did when I looked at it. So not only do you have to promise to live properly, you have to prove you're a church going Christian.
7 weeks ago
7 weeks ago Link To Comment
Off-topic:

I made a comment several days ago that I hoped the Filipino officer in charge had the cojones to inspire his troops to a "no surrender" policy. Well, this looks GOOD on General Catapang and the Philippines Army!

"Filipino force defied UN commander in Golan crisis"

http://www.timesofisrael.com/filipino-force-defied-un-commander-in-golan-crisis/

Of course, the other question is now that Islamic rebels ( al-Qaida-affiliated Nusra Front) owns the strategic Golan Heights that Israel ONLY gave up under the condition that the U.N. maintain control of it, how does Israel respond to that new military threat. I would think that Israel needs to retake the Golan, immediately.
7 weeks ago
7 weeks ago Link To Comment
Israel has the bulk of the Golan, this is a kind of DMZ between the Golan and Syria.
7 weeks ago
7 weeks ago Link To Comment
So you mean it's up for grabs?
7 weeks ago
7 weeks ago Link To Comment
There you go again, expecting us to support our side fighting to win.
7 weeks ago
7 weeks ago Link To Comment
OT but of interest I believe. The Filipino troops on the Golan DMZ refused an UN commander's order to surrender to jihadists.

http://thisainthell.us/blog/?p=54902
Filipino peacekeepers defied orders from UN
7 weeks ago
7 weeks ago Link To Comment
Just so everyone will know, the UNDOF commander who ordered the Filipino troops [and presumably the Fijians too] to surrender is Lieutenant General Iqbal Singh Singha of India. If the Fijians bodies are found in a slit trench like pretty much everybody else who has surrendered to the jihadis; their blood is on his hands.

Subotai Bahadur
7 weeks ago
7 weeks ago Link To Comment
No doubt India will now step up and supply troops to make up for the shortfall.
7 weeks ago
7 weeks ago Link To Comment
This guy's ordered a lot more surrenders and stand-downs, and has a lot more blood on his hands than Lieutenant General Iqbal Singh Singha:

https://www.google.com/#q=ex+cia+agent+calls+obama+muslim+extremist

former CIA agent is pleading with Americans to open their eyes to the infiltration of epic proportions in our White House

http://www.wnd.com/2014/08/cia-expert-obama-switchedsides-in-war-on-terror/#XOmOEEEe76HLP2MQ.99
7 weeks ago
7 weeks ago Link To Comment
"While there has been a sudden chorus of politicians and military experts calling for the immediate elimination of the terrorist army after it beheaded American journalist James Foley last week, Lopez believes the U.S. should have an overall strategy in place before fully re-engaging in the Mideast militarily.

"Any military action would be further complicated, she told WND, if it were not clear which side the U.S. is on, either in the short term or in the overall war on terror."

And that, as Walter would say, is the way it is.

7 weeks ago
7 weeks ago Link To Comment
Again, it is time to start a new, tear it all down to the founding documents, build upon them from what we know works and avoid what is folly. And above all shoot the Progressives where ever their dark and deceiving souls appear!
7 weeks ago
7 weeks ago Link To Comment
Why tear it all down? There are more than a few states that are managing themselves just fine, and many more that would be without federal intervention and siphoning off capital just to waste it on silly government programs. What is needed is resurgence of state sovereignty. If the blue states choose poorly they should live with their choices, just like Detroit.
7 weeks ago
7 weeks ago Link To Comment
"Again, it is time to start a new, tear it all down to the founding documents"
---
Any additions would have to be as sparse and readable as the originals.
...in our Dream World
7 weeks ago
7 weeks ago Link To Comment
I was admitted to a hospital in San Jose, CA Friday PM. The ER cubby that I was in for the 1.5 hours it took to be admitted was directly across from the intake desk. As I lie there in pain, I couldn't help but hear the merry intake administrator ask one person after another whether they had 1) insurance 2) an SSN 3) identification 4) an email address 5) a phone contact number. During that time I heard only a single person proffer their insurance card. Out of perhaps 30-35 transactions. I gave the nurse my credit card and had the sardonic thought that since they had found a "live one," they were going to ring up my tab. I was honestly shocked at how few of others matriculating through the ER that night could provide the fundamental data points around which virtually every free market and governmental institution works. I'd heard the stories, of course, but experiencing it first hand--in the heart of ultra rich Silicon Valley--was sobering. I realize this anecdotal evidence, but it sure seems like we have a massive problem on our hands.
7 weeks ago
7 weeks ago Link To Comment
... and I hope you are feeling much better now!
7 weeks ago
7 weeks ago Link To Comment
Thanks, laproscopic surgery on Thursday. They're going in through the belly button, removing a few inches of colon, and reconnecting. Medical technology is an honest-to-God marvel. Hope we don't ruin it.
7 weeks ago
7 weeks ago Link To Comment
These are people who know how to milk the system. Odds are most of them have resources and just come in playing the "No hablo" game. Could have a new Escalade out in the valet parking for all you know.

I watched a little Mexican (?) woman going through the game at a grocery store, the clerk obviously having been through this a thousand times before. It's not welfare cadillacs at the grocery store - but I suppose it comes close in the ER, given the putative cost of everything.
7 weeks ago
7 weeks ago Link To Comment
Neptun's comment about EMTALA nails the inflection point. I have argued with leftist policy wonks willing to lie vehemently that cost-shifting is not allowed under the law. I guess they missed the point of King Canute's demo on the beach.

Henry Kaiser's adaptation to FDR's wage controls started modern health insurance. Medicare and then Medicaid spread the moral hazard. But it was EMTALA that destroyed our healthcare system. The "urgency" behind EMTALA's passage was patient dumping.

I once did some work for a developer that builds and manages commercial properties. I was incidentally exposed to the fact that the company contracts with private security firms with predominantly minority uniformed workforces because minority faces behind the badges dulls "social justice" opposition to policing vagrants and troublemakers at their properties.

The punchline? While a senator's wife, our current FLOTUS held a high salary VP job with the University of Chicago Medical Center as the patient-dumping minority face standing in the hospital door to keep indigents out. I am sure she made Bull Connor proud.
7 weeks ago
7 weeks ago Link To Comment
[W]e have no government armed with power capable of contending with human passions unbridled by morality and religion. . . . Our constitution was made only for a moral and religious people. It is wholly inadequate to the government of any other.

(Source: John Adams, The Works of John Adams, Second President of the United States, Charles Francis Adams, editor (Boston: Little, Brown, and Co. 1854), Vol. IX, p. 229, October 11, 1798.)

We can see that the 14th Amendment is being used to trump the First Amendment. Before long, a lawsuit will be filed against groups like this and a Federal judge will rule that they are discriminatory. We already see it happening as the full weight of the "law and state" are being brought to bear against small business owners who decline on religious grounds to participate in same sex wedding events.
7 weeks ago
7 weeks ago Link To Comment
SPAIN ORDERS CUSTODY FOR PARENTS OF ILL UK BOY

LONDON (AP) -- The grandmother of a 5-year-old British boy with a severe brain tumor accused U.K. authorities on Monday of cruelty for seeking an arrest warrant and pursuing the family abroad after his parents removed him from a British hospital against medical advice.

In Britain, proton beam therapy is currently only available in the country to treat certain patients with cancer in their eyes. Other countries, including the U.S., Switzerland and Japan, also use proton beam therapy to treat cancers of the spinal cord, brain, prostate, lung and those that affect children.

Britain's health department announced in 2011 it will build two treatment centers to make proton beam therapy available in London and Manchester from 2018. Until those facilities open, Britain will pay for patients eligible for the therapy to go to the U.S. and Switzerland for treatment.

It wasn't immediately clear why health care officials didn't make this option available to Aysha.

http://hosted.ap.org/dynamic/stories/E/EU_BRITAIN_BOY_BRAIN_TUMOR?SITE=AP&SECTION=HOME&TEMPLATE=DEFAULT&CTIME=2014-09-01-06-43-12
7 weeks ago
7 weeks ago Link To Comment
Two words:
Power and Control
7 weeks ago
7 weeks ago Link To Comment
Going to the ER is not free. If you have income/assets the hospital can come after those to get reimbursed.
7 weeks ago
7 weeks ago Link To Comment
And, if you don't have income/assets, then who pays?
7 weeks ago
7 weeks ago Link To Comment
Earlier in American History, communities built and operated their own "community hospitals." Doctors – diagnosticians, surgeons, internists, obstetricians, whatever specialists were in good standing – were allowed "privileges" to admit and treat patients they would have examined at their offices at various locations in the surrounding communities. Those physicians paid fees to the Hospital from the fees they charged their patients, and of course there were accommodations made for the indigent and poor.

When I was about 10 years old, every week I took a bus to the downtown square in the small farming community where we lived, and sit in the waiting room of my violin teacher's studio. There were always magazines to read. "Look" and "Life" magazine had lots of pictures and not too much text, but they dealt with serious "grown up" matters. This was about the time that Kidney Dialysis Machines were first being made available to communities, and one magazine had a multipage spread about the committees that towns around the country had been obliged to create to decide which kidney patients would get the treatment, and which would NOT.

The committees were made up of librarians, police, fire fighters, teachers, housewives, and other suchlike representatives of "normal" folks. These people accepted the responsibility of choosing who would live, who would die, reviewing the candidates applications and diagnoses. Since the new Kidney Dialysis technology was astronomically expensive, even large cities could only afford one machine and the trained staff needed to operate it. This meant that only a fraction of all patients with failed kidneys could possibly be kept alive.

Now it seems our culture is no longer capable of dealing with such decisions. Insurance companies and medical institutions do have criteria to determine which patients will be placed on lists to receive transplants, and behavior is considered. Active alcoholics who cannot refrain from drinking, for instance, are generally excluded as candidates for liver transplant. But Political Correctness makes it impossible for our culture to even ASK certain groups about their personal behavior, even though certain deadly diseases continue to spread by behaviors and decisions subject to individual choices.

There is a set of attitudes that have crystallized in our culture that see to be steering us to suicide: If something BAD happens, (a) it has to be someone else's fault; (b) SOMEONE has to pay ME for anything BAD that happens, and it doesn't even matter if it's the person responsible, since (c) anyone or any institution that has money can ONLY have accumulated it by CHEATING us victims out of moneys that rightfully should have been OURS.

"It could have been mine... It SHOULD have been mine... GIVE IT TO ME!"

.
7 weeks ago
7 weeks ago Link To Comment
Oooops.

"attitudes... in our culture that see to be steering us..."

Should read:

"attitudes... in our culture that seeM to be steering us..."

Again, I grovel with abject embarrassment for not catching that...
7 weeks ago
7 weeks ago Link To Comment
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