Monthly Archives: November 2013

Medical Part Six

Personal Responsibility verses Group Responsibility
Skimmer Version—Just the main points for those who won’t take the time to read the full article
• In general individuals will not knowingly harm or take from other individuals.
• Persons easily rationalize harming or taking from groups of people when they are in the form of companies, institutions or the government.
• Persons also rationalize harming or taking from individuals as long as they are acting through a group, company, institution or the government and are detached from the person being harmed.
• A little harm done to a lot of persons or major harm done to one person is still the same amount of harm. The detachment felt by the group makes it easier to rationalize.
• Group responsibility means no responsibility. IF EVERYONE IS RESPONSIBLE, THEN NO ONE IS RESPONSIBLE.
• Our current medical system works through groups rather than individuals, especially in the area of billing. There is waste, overcharging and fraud and no one cares because these actions are taken against groups rather than individuals.

The Full Article
Years ago I was driving and I needed to stop for gas. I pulled into a rather large and busy, self-serve, gas station. In those days you could pump your gas first and then go up to the window to pay. So I filled up my tank and walked up toward the window. There was another customer in front of me. He looked into the attendant’s booth. Then he shaded his eyes with his hand to see in better. He turned around, looked at me with a puzzled expression and said, “There’s no one in there”. Then he walked back to his car. I walked up to the window and sure enough, no one was there. I tried to see in the building but there was no sign of an attendant. I walked a little way down the front of the building to see if the attendant was in another section. People behind me were walking up to the window and then back to their cars and driving away. As I made it in front of the garage section I heard a voice yelling for help. I called back. It was the attendant. He said, he had been robbed and locked in the bathroom, but he was alright. He asked me to find the emergency shut-off switch and shut down the pumps. By this time news of the unattended gas station had made its way to the pump islands. People were no longer coming to the window. They were just filling up their tanks and driving away. I found the switch and shut down the pumps.
My guess is that a hand full of people got to work and told the story about the unattended gas station where they filled up for free. I don’t know if the report of the robbery made in on the news or into the newspaper the next day; but my guess is that the same people who were happy at their good fortune to get free gas were horrified that some low-life would rob a gas station at gun point.
How is it that we can condemn someone for robbery and yet justify our own actions of stealing a tank full of gas? You see one action is violent and directed toward an individual. The other is detached, almost unintentional and directed toward a company. Somehow we have little problem rationalizing negative actions against a group or an institution. It is easy to say “Exxon is this huge company. They make tons of money—huge profits. They won’t miss a tank of gas. That’s not going to hurt them.”
Exxon is a company, but that company is made up of thousands of people. Individuals that have families and responsibilities and bills, just like everyone else. What if Exxon took the losses that they experienced that day and said, “Rather than spreading the loss across the whole company, we will deduct it all from one person’s pay check.” Suddenly that gives it a different perspective. For some reason we think it is OK to hurt a lot of people just a little bit, but it is not OK to hurt one person a lot. Funny, it is the same amount of hurt; just one is distributed and one is concentrated.
What about when it is the other way around? Will a group of people combine their efforts to do major harm to an individual and not feel personally responsible? Of course they can and do. This is the basis of a firing squad. One man can execute another, but when he does, he often feels great guilt and personal responsibility. So the solution is to have a firing squad. In this way the execution will be quicker. We don’t have to watch the person suffer. No one bullet or person killed him. The responsibility is distributed among multiple people. It becomes easier for a person to justify or rationalize their action. “I didn’t kill him. I was just following orders. Someone else convicted him; they are responsible for his death.” I am not against executions or firing squads. I am just using it to illustrate in a dramatic way how we rationalize our individual actions when we act in a group.
By this time you should be asking yourself, “What does this have to do with medicine?” It has a lot to do with our current medical system. Notice that we no longer talk about health care in terms of doctors and patients; it is now the “health care industry” or our “medical system”. In Medical Part Four I talked about how medicine has moved from being a ministry to being a business. It has also moved from individuals dealing with each other to, groups, institutions, and companies dealing with each other and with individuals.
Let me give a few examples.
When dealing with a family physician, the exam is done face to face after you talk to the receptionist, filled out paper, been weighed and vital signs taken. When it is all over the billing is between institutions. The doctor’s billing department contacts the insurance company for payment.
If you belong to an HMO, you go to the office and you may see your doctor or another doctor on the schedule. I had a doctor for about 8 years that I never met. The routine is much the same as seeing a family doctor, but much less personal. You move from line to line and room to room receiving and returning forms until you see the doctor. Once again the billing is handled by institutions and departments.
Hospitals are even worse. Now when you go to a hospital you may be assigned to a team of doctors. So who is really responsible for you? The hospitals have realized that this is a problem. They understand that if everyone is responsible then in reality, no one is responsible. Now they will designate someone on the medical team as the responsible physician. In some cases a hospital will assign a patient advocate. This is an additional person, paid by the hospital, to assist the patient in navigating through all of the complex hospital procedures and personnel. It gives the patient one person that they can deal with and is responsible to see that the patient gets proper care.
The big problem here is:
If I go to my HMO and see a doctor, then later go back and see another doctor, and he sends me to a specialist, who is responsible for my healthcare? The answer is everyone and no one. If I would die the chances are that my primary care physician would never know. He would only see that I was dropped from his list.
What about billing? If the doctor or hospital over bills, who will hold them accountable? I most likely will not check the bill closely. Even if I do, I have little recourse to have it corrected. Besides what do I care? If I have it corrected then I get no benefit. The insurance company is the one that saves money. That will never trickle down to me.
This concept is so obvious. Everyone knows it and experiences it in their daily lives. Are you more careful when spending your own money or someone else’s money? I think most of us, if we are honest, would say we are more careful when spending our own money.
Normally when I buy my lunch I try to average about $5 a meal. On a rare occasion I go on a business trip. They give me an expense account that may allow me to spend up to $25 per meal. I will feel free to spend it all. Why? Because the money comes from a group, a company, not an individual.
My brother, Dave, related to me a personal experience as to how this plays out in the world of medicine. He was without medical insurance but he did have a medical savings account. A situation came up where he needed to have an MRI. He called the place referred by his doctor. They quoted him a price somewhere around $3000. That seemed rather expensive so he decided to shop around. He called another place and received a price of about $1,200. After calling some more places and he found one that would do it for only $800. That was quite a savings. As he was talking to the receptionist, to book the appointment, he related to her his experience calling various places. He told her that he needed a good price because he didn’t have insurance and would be paying for it out of his medical savings account. Her reaction was “Oh I didn’t know you would be paying for this yourself. In that case it is a different price, only $385, we save a lot by not needing to bill an insurance company.”
There was a price range from $3,000 to $385. How can that be? There are really three factors coming into play here. One of them is what she mentioned, billing an insurance company. Many times insurance companies will delay payments as much as 120 days. That means repeated billings, which cost. They will also negotiate the price based on their own rules. Sometimes companies will borrow money from a bank based on accounts payable resulting in more paper work and interest payments. All of this adds up. With a simple cash payment from an individual all of this goes away.
The second factor is that dealing with an individual allows the market economy to function. Dave shopped around for the best price and they know if they want to get Dave’s business they are going to need to provide reasonably good service at the best price. That is not so with our current medical system. Often the patient gets to decide where he will get the best service base on a doctor’s recommendation. Then the insurance company must pay for it. Sometimes the insurance company will set limits on what they will pay or they will negotiate the price after the fact. A related market factor is supply and demand. People will pay more for a product if they have a lot of money available. Dave had limited funds available; whereas the insurance company has very deep pockets.
The final factor, and I think the most significant, is the aspect of dealing with a company rather than an individual. The woman that Dave was dealing with realized that to charge him even the $800 would create a financial hardship for him and she offered him the $400 price. That doesn’t happen when dealing with insurance companies. Rather they are viewed as cold institutions loaded with money. The game of business come into play. Now it is a strategic contest to see how to move as much money as possible from their company to ours. Individuals and the impact on their lives is no longer a factor.
In order to fix our current medical system we need to move the payment system back to the individual as much as is reasonably possible. Medicine happens with individual doctors and surgeons treating individual patients. The payments for such services should happen in the same way. We will explore some ideas on how to make that happen in next week’s article, Medical Part Seven.

Medical Part Five

Personal Responsibility, Family, Friends and the Church
There is a hierarchy of care in the Bible.
First Level
The first level of responsibility falls on the individual. We are each responsible for our own behavior before God and each other. 2 Thessalonians says that each person is responsible to provide for his own needs.
2 Thessalonians 3:10 (NKJV)
For even when we were with you, we commanded you this: If anyone will not work, neither shall he eat.
Second Level
The second level of responsibility falls to the family. If a person is not able to take care of himself then his family is to step up and assist him. In this way the family unit is strengthened.
1 Timothy 5:8 (NKJV)
But if anyone does not provide for his own, and especially for those of his household, he has denied the faith and is worse than an unbeliever.
Third Level
The third level goes to individuals in the community. Note that I said individuals. Each person has a responsibility before God to pay alms. That is giving to the poor not giving to institutions that give to the poor. God wants us to be personally involved and aware of the needy around us. The book of Ruth is a great example of this system performing at its best. Old Testament Law required that individuals leave a portion of their harvest for the poor.
Leviticus 23:22 (NKJV)
When you reap the harvest of your land, you shall not wholly reap the corners of your field when you reap, nor shall you gather any gleaning from your harvest. You shall leave them for the poor and for the stranger: I am the LORD your God.’”
Old Testament Law also taught that individuals were to freely loan to the poor without charging interest. Giving of alms was an expected common practice of all Jews.
Deuteronomy 15 (NKJV)
7 “If there is among you a poor man of your brethren, within any of the gates in your land which the LORD your God is giving you, you shall not harden your heart nor shut your hand from your poor brother, 8 but you shall open your hand wide to him and willingly lend him sufficient for his need, whatever he needs.
Forth Level
The forth level of care falls quickly behind the third. The forth level is the church. In the Old Testament one reason for the Tithe was so that there would be food in God’s house. Some of that food was for the Levites, but it appears it was also for the needy and for national emergencies.
Malachi 3:10 (NKJV)
10 Bring all the tithes into the storehouse,
That there may be food in My house,
And try Me now in this,”
Says the LORD of hosts,
“If I will not open for you the windows of heaven
And pour out for you such blessing
That there will not be room enough to receive it.
Part of the Tithe was not to be sent to the Temple in Jerusalem, instead it was to be stored locally for the Levite, widow, fatherless and stranger.
Deuteronomy 14:28-29 (NKJV)
28 “At the end of every third year you shall bring out the tithe of your produce of that year and store it up within your gates. 29 And the Levite, because he has no portion nor inheritance with you, and the stranger and the fatherless and the widow who are within your gates, may come and eat and be satisfied, that the LORD your God may bless you in all the work of your hand which you do.
In the New Testament, one of the first issues faced by the early Church was the daily feeding of widows. Overseers were established to make sure the food distribution was equitable (see Acts Chapter 6).
Fifth Level
The fifth level of care comes from the Government. I have searched the scriptures looking for some place where God commanded the king or the Government to feed or take care of the needs of the poor. I was unable to find any (If you have found one I would love to see it). The role of the Government is to provide justice for the poor. The Government is to prevent people from cheating, abusing or taking advantage of the poor. The Government should create an environment where the poor are safe and protected and allowed fair opportunity.
The system that God set up started with the area of greatest care, personal reward and accountability and then work out from there. No one cares about a person more than himself. Next in line would be his immediate family. They have the most to gain or lose regarding an individual in the family. Friends in the community would be next. Then the Church and finally the Government.
Also note that as you move down the hierarchy you move from obligation to charity, mercy and grace. Charity, mercy and grace are attributes of individuals not institutions.
By this time you should be asking, “What does this have to do with healthcare?” Well who cares about your healthcare more than you? No one! You have the most to gain or lose by being healthy. It would follow that you should take the greatest responsibility for your personal healthcare, both in terms of caring for our bodies and paying for medical care. Once a person realizes that their lifestyle is damaging them and they will pay both by poor health and by high personal, out of pocket, medical bills, they become highly motivated to correct their unhealthy lifestyle. Personal responsibility produces better behavior.
The same goes for their family. If a person becomes seriously ill it impacts the whole family. If the family is responsible for the persons health care and expenses they are highly motivated to encourage healthy living. Knowing that you may need your family in a medical emergency forces you to attempt to be on good relations with them. The Biblical structure works to strengthen the family unit.
A person’s friends are also impacted, but not nearly as much as the family. The same could be said of the Church. You will also want to maintain your friendships and your Church relationships because you may need their help in times of need. This strengthens friendships, communities and Churches. All of these work to build up and encourage the individual.
Government has the least personal influence on an individual, it has the least to gain or lose.
Our current medical system is exactly the opposite of God’s design. In our system we don’t take personal responsibility for our health care and our healthcare expenses. Instead we pool our resources through a disinterested third party, insurance companies, hospitals, or the Government. This method leads to the lowest level of accountability. It creates the greatest opportunity for abuse and fraud. Worst of all it undermines personal responsibility, family unity and the position of the Church.
This is a strong statement, but I believe that Satan has been working quietly, behind the seines, for decades within our insurance and healthcare system to get us to this point. His goal is to undermine these three foundational aspects of our society: personal responsibility, family unity and the Church.