Building A Cathedral and Health Reform Consequences

Mankind was never so happily inspired as when it made a cathedral.

Robert Louise Stevenson, 1850-1894

We have to pass the bill so that we can find out what it is in it.

Nancy Pelosi, Speaker of the House, March 9, 2010

In nature there are neither rewards nor punishment – there are consequences.

Robert Ingersoll, 1833-1899, Some Reasons Why

When I think of U.S. efforts to build a health system and its mounting adverse consequences. the story of the three stone cutters and the cathedral comes to mind.

A traveler comes upon three individuals working with stone. The traveler approaches the first worker and asks, "What are you doing?" The worker replies, "I am a stone cutter, and I am cutting stones." The second worker explains, "I am a stone cutter, and I am cutting stones to earn money to support my family." When asked the same question, the third worker says, "I am a stone cutter, and I AM BUILDING A CATHEDRAL!"

Three men - all working at the same site, performing the same task - had three very different perspectives of what they were working toward.

All of us – Democrats, Republicans, Independents – want to build a Cathedral called an equitable health system. We simply have different time tables and different approaches.

Democrats are in a hurry to get the Cathedral built. They resort to forcing their Grand Design on others through government fiats, and a host of new agencies, regulations, and rules. Unfortunately, because of their haste, their quickly laid plans are flawed and unforeseen consequences ensue.

Republicans are in no particular hurry. They nsist they can build the Cathedral incrementally from the bottom-up relying on existing artisans, merchants, and professionals.

Independents ask, why don’t you two get together? Rome wasn’t built in a day. Both of you should work together to erect a Cathedral in the center of the City for all to use in sickness and in health.

But the parties cannot agree, and adverse consequences develop. Some of those who would build the Cathedral from their Grand Design fall out of power due to a poor economy. Citizens can no longer afford to provide services. Their opponents cut off their funds, and parishioners who worship at the Cathedral find they can no longer afford alms to give when attending services.

Meanwhile, in the building of the modern Cathedral, known as a health system, an avalanche of bad news begins to bury the master builders.

1. The Principle Group, an Iowa-based company, announces it will drop coverage for 840,000 people because it can no longer afford government mandates.

2. MacDonalds, in a memo to HHS, announces it will be unable to meet requirements to cover 30,000 workers because it has a high employee turnover. It claims it spends more on signing people up and carrying out other administrative duties than the new rules will allow (85% medical care and 15% administrative).

3. The National Retail Federation announces millions of more policies are at risk for the same reason at Home Depot, Disney, Staples, CVS, Walgreens, Blockbuster, and other major retailers.

4. Harvard Pilgrim announces 22,000 New England seniors can’t keep the coverage they have, and like other health plans, it is abandoning the market for its Medicare Advantage members in response to the massive cuts coming to this popular program.

5. A number of insurers announce they plan to stop offering child-only policies because the business model required is unsustainable.

6. AT&T, Caterpillar, John Deere, Verizon and other large employers announce they might have to drop coverage for drug benefits of retirees because of expenses incurred due to the new law.

When building a modern Cathedral, bear in mind the needs and skills of workers, suppliers, and taxpayers. Anticipate consequences of your master plan. Read and reread your plan. You are building a Cathedral on a foundation that has been in place for 70 years for employers and 45 years for Medicare recipients . Keep some rudiments of the foundation intact, or the Cathedral may collapse.