Sunday, April 14, 2013

Health Reform and the English Language
As soon as certain topics are raised, the concrete melts into the abstract.
Politics and the English Language (1946)
All animals are equal, but some are more equal than others.
Animal Farm ( 1945)
George Orwell (1903-1950)
Last night, on the Mike Hukabee show, three Obamacare panelists complained about the “one-size-fits-all” approach to health reform. They stressed  this approach dramatically raises health care costs for all Americans.

As I watched, I thought immediately of George Orwell’s classic essay “Politics and the English Language.” In his essay, Orwell notes that vague abstract terms  often replace critical thinking.  
I was reminded of the story of the husband and wife watching their children play in the newly laid concrete in front of their home.  The children’s play infuriated the husband.  The wife commented, “ But, Dear, I thought you loved children!”  “I do,” he replied, “ but in the abstract, not in the concrete.”
Health reform progressives  describe the “one-size-fits-all”  notion in these abstract terms – “comprehensive,”  “essential benefits,” “community rating,” and “standardized.” 
With this language,  they imply that once you apply the same standards to all members of society you achieve some kind of utopian nirvana.  Ideally,  I suppose, you should  redistribute health benefits equally and fairly to everyone.  

In the abstract, this is a wondrous idea. 

Unfortunately,  as Orwell, a committed socialist,  noted,  “All animals are equal, but some are more equal than others.”  This holds true in the most advanced social welfare states.  Those with money and political influence the care they want,  even if it involves travelling to capitalistic America to get it. 
The Affordable Care Act, (sections1302) lists “essential benefits” as,
·         Ambulatory patient services

·         Emergency services

·         Hospitalization

·         Maternity and newborn care

·         Mental health and substance use disorder services, including behavioral health treatment

·         Prescription drugs

·         Rehabilitative and habilitative services and devices

·         Laboratory services

·         Preventive and wellness services and chronic disease management

·         Pediatric services, including oral and vision care.

This is the doctrine of “essentialism,” namely, that all health care services are essential to society and should be available to all regardless of individual abilities, skills, need, education, or economic status.   Essentialism ignores merit, risk, and economic growth.   These factors apparently deserve no special rewards.  Presumably, when government homogenizes humankind into one lump, all will be well, and the nation's level of health will be elevated. 

Community rating”, also called guaranteed issue,  as opposed to risk rating,  is defined as,

 A concept usually associated with health insurance, which requires health insurance providers to offer health insurance policies within a given territory at the same price to all persons without medical underwriting, regardless of their health status. Pure community rating prohibits insurance rate variations based on demographic characteristics such as age or gender, whereas adjusted or modified community rating allows insurance rate variations based on demographic characteristics such as age or gender.

If only you could“standardize” care for all, all the better. 

Every American, in more prosaic language, should have equal access to comprehensive care, regardless of  age, health, pre-existing illness, geographic location, insurance coverage, or citizenship status.  

  • If you are young and healthy,  you should pay the same as the old and sick, even if you cost society nothing in the short run.  In the long run,  you will become old and sick.  
  • If you are poor, the government should subsidize you to raise you to the level of more affluent citizens.   
  • If you are in  a small business,  you must pay for comprehensive coverage of your young healthy employees as  you would for a more mature and older work force.  

Charity for all, and all eggs in one basket. are the goals of progressives,  as  long at government is directing the effort and  the "rich" are paying their "fair share."  

No doubt these are noble goals.   The problem is, of course, that even an affluent society like America cannot afford “Gold,” “Platinum,” and “Cadillac” plans for all and still provide services that allow for personal freedom and choice that fits the needs of individual segments of the population.

In America, the land of capitalism, individualism, meritocarcy, entrepreneuralialismm diversity, and regional variation,  one-size-fits-all does not  fit all and raises the cost for all.

The ideological abstract does not translate into concrete realities.  Simplicity is not so simple, and the abstract is not the concrete.

Tweet:   Abstract health reform terms such  “comprehensive,” “essential benefits,” “community rating,” and “standarization," have ennormous cost implications.



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