Category Archives: Healthcare Thursday

So this Individual Mandate I keep hearing about….?

This is an occasional post covering healthcare systems in the US.

The debate over healthcare reform rages.  A little over a year ago the Patient Protection and Affordable Care Act was signed into law by President Obama.  Since then, much of the fight over implementing the new law has centered on the so-called “individual mandate” provision of the law. What is it? Why the debate? And how does it affect you? Class is in session.

What is the individual mandate?
The individual mandate states that starting in 2014 every American must have health insurance. If you currently do not have insurance, you will be required to purchase a minimal coverage plan or pay penalties.  Think of this like the law requiring liability coverage if you operate a motor vehicle.

Individuals making up to 400% of the federal poverty level (currently the federal poverty level is $11,800 for individuals and $24,000 for a family of four) will receive monetary help to buy coverage.  The less you make the more help you’ll receive.

So, what’s the point?
The idea for the individual mandate is to provide insurance companies with additional customers to offset the insurance rule changes the law set forth. These rule changes include: Insurance companies can no longer, not accept someone for pre-existing conditions, drop patients for getting sick, and set lifetime limits on benefits they will pay.

The Debate…
All those in favor say aye
Supporters say the only way insurance companies would agree to the new regulations would be to increase their risk pool. Meaning they needed more healthy paying customers to offset their increased losses from the new rules. Requiring all citizens to purchase insurance is intended to provide these new customers.

Those opposed…
The primary argument against the individual mandate is the federal government cannot require citizens to buy a privately offered product or service. Opponents are worried if the federal government makes this requirement, it will open up a Pandora’s box of other requirements. This is the crux of the lawsuits contending the individual mandate is not constitutional.

(In the case of the auto insurance requirement, individuals can opt out of the law by simply not operating a car.)

As you can imagine, there are multiple other arguments regarding the overall scope of the law and how the individual mandate affects its stated goals. However, I believe the arguments listed above are an accurate reflection of the primary issues being contended.

How it affects you.
Theoretically, if you already have employer based insurance the individual mandate will not effect you. In fact, the new rules on insurance companies will help. Unfortunately, things rarely work out exactly according to theory. Over time, the total effect of the individual mandate is unclear.

If you don’t currently have insurance, the individual mandate will require you to purchase minimal coverage or face penalties.

I hope this post allowed you to at least have a better understanding of what all the arguing is about. (And it didn’t bore you too much.)

For more information on the healthcare law check out this website.  To hear more opinions on the implications of the law try these blogs. One from the right, and one from the left.

Finding the “Truth” in Health Advice.

Eat like our Paleolithic ancestors, meat, meat , meat!  Red meat will kill you!  Eat carbs, they’re fat free! Carbs make you fat!  Vitamins improve health!  Vitamins are a waste of money! Do cardio first!  Do cardio last! Alcohol is terrible for you!  Wine protects from heart disease!  I’ve gone cross-eyed….

These days when it comes to health, especially diet, there are so many confusing messages it’s hard to make sense of what is good advice.   Why isn’t there consensus on this stuff by now? How can health opinions be so polar opposite?  I thought health was a SCIENCE!    

Yes, health is in essence a science.  But oftentimes, science can be much like religion and politics.  Very smart people have steadfast beliefs that color their view of the world.  One doesn’t have to look any farther than the debate on global warming to see how different viewpoints can come to radically different conclusions from the same set of scientific data.

Add the innumerable variables related to an individual’s health and we’ve got ourselves a raging debate.  Differences in gender, age, genetics, race, culture, social preferences, emotional tendencies, physiology, experiences, education, etc, (going a little cross-eyed again…) affect how we perceive, challenge, learn about, and manage our health.  It’s a wonder there is any consensus at all.

Of course, the vast majorities of opinions on health and diet are based on science.  So what is the truth?  What ARE the right answers?  I’ll weigh in with my opinions throughout the blog.  As you’ll discover, I tend to believe the “truth” is somewhere in the middle. 

You must discover your own “truth”.  To do this you must educate yourself and trust your instincts.  This blog will help you with the former.  The latter is up to you.

Incidentally, after I decided on this topic for today’s post I read a wonderful article by Deepak Chopra on the differences between professional and public opinions on health. Check it out here.

Healthcare and Business: Like Peanut Butter and Pickles

For the first Healthcare Thursday I’m going to keep it simple.  Healthcare is excruciatingly complex, but today I want to boil it down to an odd analogy.

I have a unique perspective having been trained in both healthcare and business.  From my perspective, healthcare and business go together like peanut butter and pickles.

Stay with me here. The goal of healthcare (at least as far as most in the field are concerned) is treating patients. Making them better or more comfortable.  It’s a noble goal, and the siren song to which all healthcare professionals respond.

In business, the goal is quite different.  The primary goal of business is to maximize profits.  This is taught in business school.  Without a doubt, there are businesses with altruistic goals. They may sacrifice some profit for the social good.  And, of course, there are non-profit businesses. But, without exception, a shareholder owned firm in the United States has one goal: maximize profits.

Here’s where we hit trouble.  Now we have goals that, although not completely at odds, mix in a manner that may not be all that appealing.  Hence, healthcare and business go together like peanut butter and pickles.

I’m sure there’s people who LOVE peanut butter and pickle sandwiches. (Didn’t Elvis? Or was that peanut butter and bananas?)  Likewise, some healthcare organizations blend together the moral goals of healthcare with the profit goals of business quite well.  Most, though, find the mix a little odd or confusing.

Essentially, this is the crux of the healthcare argument.  Where do we find that right mix of peanut butter and pickles to highlight the best of each, and maybe even complement each other? 

If all we care about is peanut butter (healthcare), everyone will get every treatment they want for free, but we may bankrupt the country.  If we choose just pickles (business), only those that can afford treatments will get them, and we’ll have millions of people suffering needlessly.

What’s the right mix? 

Of course, this is an over simplified analogy.  There are a dizzying number of interwoven issues that effect how peanut butter and pickles taste together.  (Chunky or creamy? Dill or half-sour? Between bread or dipped?)  

But understanding the competing, yet potentially complimentary, goals of healthcare and business gives a base to decifer the debate that rages over healthcare policy in the United States.

Perhaps someday Americans will like nothing more than the comfort food we simply call, PB&P.