Health Care 2020

[James D. Tippett]

Health care 2020


To view the debate surrounding health care it is useful to project the future, ala Alvin Toffler. Health care in 2020 will be viewed as a carefully manipulated plan, so global in its impact that no one envisioned the scope or the speed with which the control was implemented. Looking back we will realize how crafty politicians found it so simple to assemble all the discrete pieces, Bill by Bill to lock in their Socialist vision. Once done, it became an intertwined network of such a pervasive nature that it could never be undone.

Health care legislation passed easily through the partisan House in late 2010 despite the unrelenting objections of constitutional patriots, who as if enabled with psychic ability, foresaw the devastation on the horizon. Many citizens still were unclear on the impact or who to trust and with so many citizens out of work, the promise of affordable health care quelled their objections and dulled the forecast of devastating impacts. Once passed however it quickly became evident, much like a fly into the spider web, that it was about much more than a humanitarian effort.

In the beginning it appeared benign enough, those who had health care, kept it, and those who did not got signed into the Social Health Insurance Trust and required to pay a modest premium. The plan was modeled off the State run Workers’ Compensation systems already in place that had proven somewhat effective at providing affordable coverage for companies. This no frill system also provided the mandatory coverage for companies that had been denied by commercial insurance carriers due to the inherent or perceived risk of their business. It was a proven model, which despite its flaws, was effective at providing medical and lost wage coverage to injured workers and liability protections for employers.

Now confident of public support, or non conflict, Congress also provided a solution to the immigration problem in one fell swoop with the passage of another masterfully planned Bill. This Legislation called the Citizen Responsibility Acceptance Plan provides the parents of children born in the United States with the same citizenship as their children, i.e. American. It was viewed by many as just a matter of time; after all once the child turns 21 they can sponsor their parents to become citizens anyway. It was also viewed as inhumane to subject Hispanic women to the tumultuous incursion under the border fences; it just was not healthy for the mother or the baby, and we all know it is imperative to provide a loving caring family for all American children.

The undeniable benefit is that these individuals were now United States Citizens, taxpaying United States Citizens. But perhaps the ultimate political gain was that these individuals were now registered voters, who would continue to vote for the one who promised them the greatest bounty from the public treasury. Business also found benefit in this as they now had an ever growing pool of legal affordable labor, which drove lower wages allowing them to be more competitive in foreign markets.

Shortly after the passage of health care legislation, it was discovered that a last minute addition to the Bill mandated newborn health screening; Politicians who had been bombarded by parents of children with afflictions, pleading to make testing for all children mandatory, felt compelled to listen to their constituents . Indeed, many children were afforded treatment options at early ages to lessen the impact of their genetic malformations. An added benefit by some views was that these tests also showed promise as being predictors of predisposition to other health and mental afflictions. These afflictions, such as heart disease, cancer, depression, obesity and even halitosis had been ravaging our health care system for years. Multiple benefits were also gained in that to concoct an accurate picture of the child’s genetic composition the parents also were “screened”. How wonderful to have this advanced knowledge of our individual futures. The ability to know whether or not to save for retirement or your child’s education was wonderful and enhanced the life of many who now knew that they had better have fun while they can. Doctors rejoiced in that legal action could no longer be pursued against their negligence for missing a birth defect.

Then as if by coincidence, Bills mandating a national system of easily accessible and searchable electronic health care records, touted as the great cost and life saver by the medical community, passed quickly. Databases strained as they started filling up within the government. How wonderful to have these people segmented in databases, drawn from the hard drives of medical providers holding previously confidential medical records. The public hardly noticed this transition as it was suppressed in the media due to the potential national security implementations, as the U.S. Military was now solidly engaged in North Korea. Besides, the information was going to the Government so confidentiality did not seem like such a big deal, and they already had our social security number anyway, right? Medical providers readily transferred the data, a prerequisite to apply for the numerous government healthcare funding and grants. There was little incentive for not sharing this information and the threat of audit and fines for non compliance were well known.

Commercial health insurance companies, pressured to lower costs to remain competitive, lobbied Congress to allow them access to the National database. Bolstered by the large campaign contributions which seemed virtually unlimited once the Supreme Court struck down the restrictions, Congressional members did not see this as that onerous of a request once the check cleared. After all, it would enhance the insurance companies’ ability to provide more efficient and cost effective care. Oh, and save lives.

With this new found stream of information, commercial health insurance company actuaries went to work. They began evaluating the “status” of the employee’s that their Policy Holders employed. Small businesses and sole proprietors, now one of the largest segments of the economy, were also of particular interest as they were less likely to have employee wellness programs or sufficient hiring or safety practices. They found the data from the new born screening and immigration databases to be of particular benefit and the most comprehensive source of predictive modeling data. Of course, the individual employee would need to authorize and sign a release to allow access to these records. Pressured by their insurance companies with the promise of premium savings, employers made these releases a condition of employment.

Sophisticated computer software scanned the databases continually, at first identifying only an organizations cumulative risk exposure that allowed for more accurate annual premium determinations, and the formation of more competitive quotes. Soon the benefit of an even more detailed analysis became evident. Insurance companies found that if they utilized a Sequential Contributor Review and Evaluation Workup, they could calculate precise premiums to be more reflective of exposures presented by any individual within the target group, and adjust premiums accordingly. Employers rebelled against this as they felt they had no control over an employee’s personal habits or their genetic predisposition. Insurance companies were unyielding and only provided two options. First, the company could find coverage through the Social Health Insurance Trust or exclude selected employees from coverage, and direct them to the Social Health Insurance Trust.

Companies were reluctant to sign in to the Social Health Insurance Trust as it was difficult to attract top talent with this coverage option, as liposuction and cosmetic surgery were seldom covered. In addition, expenses related to the numerous government mandates, administrative tasks and reporting requirements actually outweighed the premium savings gained when companies left the commercial insurance companies. Excluding certain employees with negative medical indicators, such as high blood pressure, obesity or a history of psychological counseling, gained ground as a realistic solution.
Additionally, companies found that if they also excluded those employees showing a genetic predisposition to any number of ailments they could further lower their expenses. This is not viewed as draconian since the employees are simply rolled into the Social Health Insurance Trust as mandated under a Friday afternoon Congressional session that passed this amendment to the legislation.

Once the employees are in the Social Health Insurance Trust, they find that there are numerous resources available to them. The government completes its own Sequential Contributor Review and Evaluation Workup for each individual entering the Trust. Given that this coverage is now funded by the public, the Government has implemented an oversight administration that is responsible for overseeing the Social Health Insurance Trust centers and in setting the requirements for the individual care plans under which individuals will be bound. This is wonderful in that an obese person can be placed on an exercise and diet regimen to reduce their weight, their health risk and thus reduce the cost exposure to the Social Trust. Similarly an individual’s alcohol consumption, participation in at risk hobbies, and even driving habits can be monitored to reduce the risk exposure to the Social Trust.

Congress touts the success of the program in reducing obesity and the death rate. New legislation is introduced and passed that extends the program to include people with genetic predispositions under the Care Plan Requirement. The software again hums through the databases driven by these new search criteria. Lists print flagging individuals with potential predispositions, family histories and other perceived mutations. These individuals are also bound under the Care Plan Requirement and prescribed precautionary pharmaceuticals, counseling and periodic monitoring.

It soon becomes evident that compliance with the stipulations in an individual’s care plan is difficult to monitor. So to, requiring regular monitoring visits to the Social Health Insurance Trust centers is costly to the system. Something must be done. In response Congress enacts the Community Health Issuance Program whereby an individual pays an additional premium, through payroll deduction, to account for the higher risk they bring to the Social Health Insurance Trust. Participants can take advantage of the automated monitoring provision of the Community Health Issuance Program by having a small RF monitoring device implanted painlessly behind their ear, resulting in lower premiums. It’s a wonderful world.


By the year 2030 the problems are insidious. The Social Health Insurance Trust, burdened by a pool of medically dependant citizens and a diminished tax base is starting to crumble. Companies have stopped hiring individuals flagged as risks in the national databases, thereby adding them to the public tax burden. A system of health credits is instituted whereby unemployed individuals are allocated a set number of transferable credits calculated by risk and other factors such as adherence to their Care Plans. To decrease the stress to these individuals, Care Plans are amended to include medications to reduce anxiety. Individuals unemployed for more than three months are automatically enrolled in the Community Health Issuance Program and fitted with the comfortable monitoring devices. Criminal law is modified to include penalties for non compliance.

Fortunately, genetic engineering is showing promise and newlyweds are offered premium credits to seek genetic counseling before having children. End of life counseling has indeed produced the intended result saving billions in unnecessary treatments. Start of life counseling is added to the legislation that mandates start of life counseling when genetic defects or predispositions are found in newborns. Parents are encouraged to consider the quality of life and added costs that must be bore given the increased premium rates, or additional health credits needed to offset the increased exposure to the social system. With birth defects in children plummeting, and similar statistical results being seen across the medical care continuum, the program is celebrated as a success.

You decide – Fact or Fiction – If nothing more, a cautionary tale

Note: This was first written in September. In just one month much has come true. The Bill in congress includes a provision to tie insurance premiums to overall health, as determined by a required physical. There will be penalties, fines for not having insurance, insurance that will cost $8,000 to $10,000 per year.(if you make over $88K) Time will tell what will ultimately happen if someone does not pay their health insurance bill. Nor has anyone, to my knowledge, defined what you would get for your money, but I am sure the insurance companies will have some say in setting the plan. Given that there is little in the Bill to stop frivolous lawsuits or cap damages, these exposures will have to be covered in the insurance costs. You will have no choice, you must have this insurance, you or someone else must pay for it, and once that happens you will be subject to any provisions under the plan that may be added in the future. Once it is passed, there is no turning back.

The Cynic
http://imokyouarenot.blogspot.com/