The Essence of ObamaCare:  Morality Versus Workability?

 Look to the essence of the thing, whether it be doctrine, practice, or interpretation.

Marcus Aerulius (121 AD - 180 AD),  Meditations

Indifference to the needs of others is immoral.

Colbert King,  “ObamaCare – A Question of Morality,” Washington Post, November 30, 2013, King writes a regular Saturday column for the Washington Post.  This on is on what black ministers are saying about ObamaCare in the nation’s capitol

It’s more than the website. It’s how the law itself is built from its architecture that’s just not workable.

Paul Ryan (R-Wisconsin),  Congressman and former Republican Vice-Presidential Candidate

Tweet:  Is it a moral obligation of a nation to make health care a right, even if the health system is unworkable under its health law?

Healthcare.gov: It’s the Endgame That Counts

Everything has an end.

Masai Saying

All’s well that ends well.

Proverb

Healthcare.gov was relaunched today.   The front-end of the site looks better. It’s faster. Waiting times are less.  Enrolling is easier.  Glitches have been smoothed over.  

But in everything one must consider the end.  It’s the end-to-end final product that will  counts in the end. The front end looks good.  Now is the time to look at the back end, what going on behind the scenes, and to ask these questions.

·         Has the 5% error rate in information transmitted to insurers been corrected?

·         Has the rate of personal identity theft been reduced  to an acceptable or  fail-safe levels?

·         Have the “orphan patient” problem – those patients who think they’ve signed up but the insurance company is unaware of their enrollment – been addressed?

·         Have people learned yet they won’t be able to keep their doctor or hospital, that neither are in the network of their new plan?

·         Do people know yet that the premiums and deductibles quoted to them are subject to change as insurers scramble to meet two week deadlines?

·         Do people realize that employer-based plans may no longer cover family members, or cover them at exorbitant rates?

·         Are people aware that the IRS, operating out of the White House, is responsible for distributing subsidies,  tracking down non-enrollees, and  enforcing rules of the ObamaCare endgame?

Until these questions are answered,  the end game is far from over.  It may just be beginning.

Tweet:   On December 1,   access and efficiency of the healthcare.gov  website have improved,  but questions about its end results remain in doubt.

The Price and  Burdens of Enforcing Obamacare

Let every nation know, whether it wishes us well or ill, that we shall pay any price, bear any burden, meet any hardship, support any friend, oppose any foe to assure the survival and success of liberty.

Ask not what your country can do for you, but what you can do for your country.

John Fitzgerald Kennedy (1917-1963), Inaugural Address, January 21, 1961

I have always admired President John Kennedy’s eloquence.  

I also admire President Obama as a person. 

But these sentiments do not mean I agree with either President Obama's  or President Kennedy’s social agendas. 

In the case of Obama, the agenda seems to be social equity through income  and health care redistribution. This agenda brings to mind Samuel Johnson’s aphorism,”The road to hell is paved with good intentions.”

The same might be true if President Kennedy’s intentions were to be  applied to health care, one the most complex ecosystems known to man., which would make the price and burdens of enforcing  ObamaCare too high.

I do not believe, we as a nation can:

·         pay any price to cover every citizen for every  health care eventuality when that price is $2.7 trillion, three times the promised estimate;  dramatically increase premiums by an average of 47% on the individual market for those not receiving federal  subsidies;  slow economic growth and produces joblessness; convertsfull-time jobs to part-time jobs;  cost more, reduce choice, and  provide worse coverage.

·         Bear any burden, causing  us and our descendants to pay  off  a $17 trillion national debt, soon to be $20 trillion or more, and in the process imposing an unacceptable tax burden  on the middle class.

·          meet  all the hardships and support all  the needs of every citizen no matter what their individual situation.

·          oppose any foe that that disapproves or your  philosophy of government.

·         Asks everyone what they can do for the country rather than what they  can do for themselves.

There are exceptions for those unable to fend for themselves because of sickness or poverty, but in the main we pride ourselves on being a self-sufficient and self-reliant nation whose strength comes from below rather than being imposed from above.

Tweet:  Price of ObamaCare,  with higher premiums and deductibles  and reduced choices,  may be too great  a burden for the middle class to bear.

My Perspective on Obamacare

You can never understand a person until you understand his point of view.

Harper Lee ( born 1926 ), American novelist and author of  To Kill a Mockingbird

Everybody we do is an opinion not a fact.  Everything we see is a perspective not a truth.

Marcus Aurelius (121 AD -180 AD), Mediations, a book on how  to lead a life of duty and service while achieving equanimity and minimizing conflicts

Today ObamaCare with its promises  healthcare.gov “improvement.” moved out of the shadows of theory  into the real world as it seeks to convince the world  that its website and its policies will  level the health care  playing fields between the have’s and the have-not’s.   The trouble is that every promise is a fudge, a hedge, or a prayer, How well ObamaCare will succeed depends on one’s perspective.

In my E-book , Understanding Obamacare, due out January 2014,  I try  to present a balanced perspective. 

Not so successfully, I fear.   I sent out copies of the manuscript to colleagues for perspective and a blurb. 

One of these colleagues,  William Fore, MD,  who has had a distinguished career as internist specializing in diabetes,  a medical group leader at Johns Hopkins, an inspector  for the Joint Commission,  and a physician who treats the uninsured and underinsured in a “free clinic “ in North Carolina,  called yesterday  to point out differences in our points of view.

Bill hovers on the left of center while I dangle on the right.  

In reading my manuscript,  Bill  found two gaping deficiencies  - One, lack of any substantial discussion in my book on the plight  of  America’s uninsured, who now number about 50 million. 

Two, a failure to address or praise Obama’s effort  to  cover those with pre-existing conditions.  

Bill is right, and I plan to right these deficiencies (right is not the right word, but it will do for now) either by adding either a corrective paragraph in the preface to the manuscript or discussing these problems in a subsequent book on the twin rollout disasters.

Meanwhile,  I harbor these concerns over ObamaCare:

One, the flawed, avoidable healthcare.gov website, in response to which only 50,000 have enrolled and paid their first premium,

Two,  the 5 million people  insurers have dropped from their existing plans in order to comply with ObamaCare standards, which are too broad, too unrelealtic, and too expensive.

From my perspective what disturbs me about these developments are:  

One, the Obama administration’s incompetence in failing to anticipate or to prepare for the website crash when it was repeatedly forewarned what might happen by its own IT experts.

Two,  the failure to see the faulty   trade-offs  between insuring  50 million of the uninsured while  uninsuring 5 million of the insured, which may grow to 80 million to 100 million if employers stick to the letter of the law, which flatly states that all future plans must include ten essential benefits.

Three, and more fundamentally,  Obama’s lack of understanding of the essence of American culture.  We are not an imperialistic nation bent on keeping the have-nots down.  We are not a socialistic society intent on pushing the rich down while raising the poor up.  We are a freedom-seeking capitalist country bent on  elevating  rich and poor by allowing them to exploit their dreams and opportunities in the belief that a rising tide raises all boats.

From Bill’s perspective,  something must be done to provide care for the uninsured and underinsured,   even though this “something” may be disruptive for the medical industrial complex and for the rest of us. On the othr hand,   Bill feels it  is only fair and moral  for insurers the business community, and American society  in general to bite the profit bullet by covering those with pre-existing illnesses,  over which most patients have no control, and for specialists to forego some or income and devote more of their time to caring for the disenfranchised.

It comes down to this:  One man’s meat is another man’s poison.  One man’s tradeoffs are another man’s turnoffs.  The important thing it to appreciate the other man’s perspective.

As the late great Steve Jobs (1955-2011), the Apple of  the Internet’s Eye, eloquently put it, “A lot of  people haven’t had very diverse experiences.  So they don’t have enough dots to connect, and they end up without a broad experience on the problem, The broader one’s understanding of the human experience, the better design  we will have.”

Tweet: One’s experience shapes one’s perspective. One may be partly right or partly wrong when  one  fails to connect the dots.

Thank God It’s Friday, Not Saturday

I thank God for not making me a computer scientist.

Daniel Bernstein (born 1971), American mathematician, cryptologist

You may like Friday because it’s the last day of the work week.

You may like Friday it precedes the weekend.

You may like to celebrate Friday by eating out at a  “Thank God, It’s Friday” restaurant.

As a retailer, you may choose to call it “Black Friday”, the day you finally turn a profit.

If you’re one of these people, you may think of Friday as “Good Friday,” a day in which you have something to cheer about.

Two Exceptions

But this year, there may be  two exceptions to the Cheerful Good Friday Club.  For these people, Good Friday may become Black Saturday.

These exceptions are: ObamaCare  officials  and their High Tech followers .  You  two are responsible for  healthcare.gov’s  second launch.  This second launch   follows  the aborted October 1aunch pad crash.

·          As a administration  official, you like to announce  bad news on Friday. Why? Because people tend to forget  bad news over the weekend.  By Monday, all is either forgiven or forgotten.  But this year, you have no choice because of your self-imposed Saturday,  December 1 deadline. 

On Satruday,  you said things were going to   get “better,” 80% better, better enough to accommodate 50,000 users all at once. You picked Saturday as the magical Witching Day when everything was going to go smoothly  for all of  those logging in to pick a health plan.

 

The first Witching Day was Tuesday,  October 1. Then times were different.   That was before  5 million health plan cancellations. These cancellations  now outnumber the 50,000 officially enrolled by 10:1. This time the stake are higher.  It’s Make or Break Time for ObamaCare.  You’re  in the Public Opinion Crosshairs.

·         But maybe not.  You can always move the goalposts. You can always delay tje mandate for small business by a year.   You can always extend the sign-up period.  You can always lower expectations  by saying you didn’t really mean what you said the first time.  And you can always blame somebody else –  the health plans, Republicans,  even  your very own computer team.  Its members include those digital nerds,  those pernicious programmers, those guys and gals who wrote those millions of lines of unconnected code.   They may have seen those glitches coming, but they should have warned you  louder and harder. It’s their fault. They should have told you  everything that could go wrong would go wrong.   They should  have known a technical drop-dead date was not the same as a political drop-dead date.

But they didn't  under your political pressure to deliver  on your October 1 promise.  That’s ancient history now.  This year,  history comes on Saturday.

TGIF (Thank God, It’s Friday), not MGIF (My God, It’s Saturday).   You still  have  another day to untangle the Web you   weaved when you deceived yourselves and the public.

Tweet:  This Friday  isn’t TGIF (Thank God, It’s Friday),  it’s TGINS (Thank God, It’s Not Saturday)

Quote of Day: Cleanin' Up Mess No Bed of Roses

Gabriel:  What about cleanin’ up de whole mess and sta’ tin’ up all over  ag’in  wid some new kind of animal?

God:  An’ admit I’m licked?  Even bein’ Gawd ain’t a bed of roses.

Marcus Cook Connelly (1890-1980), American playwright, key member of Algonquin Round Table, and Pulitzer Prize Winner of Pulitzer Prize for Drama in 1930

Attitude and Gratitude: I am Proud to be an American Physician

Attitude is a little thing that makes a big difference.
Winston Churchill

This Thanksgiving day I’m feeling bad about the direction the health system seems to be headed

·         Health plan cancellations are running 10:1 over people signing up on health exchanges,

·         Physician surveys  indicate less than half of doctors plan to accept patients from health exchanges.

·         Some of our finest health institutions,  like the Mayo Clinic, are being excluded from the exchanges because their services cost more than average.

·         The small business mandate has been delayed for one year, adding to the uncertainty over ObamaCare.

It’s enough to put one in a bad mood, But as my Episcopal Priest son once told me, “Dad when you’re feeling bad, make yourself a gratitude list.

My Gratitude List

I am grateful I live in a country where,

• People can disagree disagreeably about the health reform law, but without riots, strikes, or violence.

• Voters can feel free to express their opinions about the health reform law – Only 38% approve of it while 59% disapprove.

• The Gallup poll indicates 82% of people are satisfied with their health care. That's not 100%, but it is impressive.

• Few citizens choose to go abroad to seek better care.

• Every citizen who goes to an emergency room will be treated no matter what his or her financial circumstances.

• No matter where you live in the U.S., most citizens still have quick or immediate access to the best medicine and technologies has to offer without government oversight, second guessing, or rationing. This is not true in most other countries.

• We provide such exceptional care that kings and potentates come here for treatment (The King of Saudi Arabia is now at Cornell to get a herniated disc fixed), and doctors come here from around the world to learn, to train, to practice, and to benefit from our research.

• We listen to the voices of the people when the majority protest a sweeping health reform law they fear will cost them their current coverage and access to doctors.

• We cover 110 million of our 310 million citizens through costly Medicare and Medicaid programs and pay for ½ of all health care costs, an expense per capita above that of other nations.

• Our political system allows us to engage in a lengthy, sometimes acrimonious debate, on what is the right thing to do in the long run to provide the best care for most of the people most of the time.

• As a country, we believe in individualism and choice, in government care as well as private care, in the independence of physicians to choose their specialty, where they want to live, and to provide care they think is best for patients based on individual human judgment rather than bureaucratic rules .

• We are a society that prides itself in our generosity to help others around the world , in our innovations that make us the Internet crossroads of health information of the world, the fountainhead of many advanced medical technologies- in genomics, cancer therapy, life-saving and life-style restoring procedures, our imaging technologies; and in vibrant entrepreneurialism in multiple health care spheres, a spin-off of free markets in a capitalistic society.

Tweet: I am proud to be an American physician, living in America, land of the free and home of those seeking health care choice.

Smoked Turkey and Foggy Mirrors

Smoke and mirrors is a metaphor for a deceptive, fraudulent or insubstantial explanation or description. The origin of the phrase comes from The Wonderful Wizard of Oz while describing the titular wizard's usage of smoke and mirrors to deceive the general populace.

Wikipedia

Astonish me in the morning.

Tyrone Guthrie(1900-1971), Theatrical Director, to his actors after a particularly bad rehearsal

Thanksgiving Day  - This morning I was astonished  when I read in the New York Times that the Obama administration is advising Americans not to visit healthcare.gov.

The first paragraph of the piece reads:

“White House officials , fearful that the federal health care website may be overwhelmed  this weekend, have urged their allies to hold back enrollment efforts so the insurance marketplace does not collapse under the crunch of new users.

What Crunch?

 Thus far  Americans by the millions have avoided the health site. Less than 2% .have signed on and paid a premium ,  When it reaches self-imposed deadline, Saturday, December 1, ObamaCare will be  90,000 to 100,000enrollees behind schedule in meeting its goal of 7 million enrollees by March 2014.   It’s worse for the young and healthy,  Precious few have signed on, far short of the pace needed to reach 2.3 million by March 2014.  Hispanics are staying away, partly for lack of a functional Spanish healthcare.gov website.

Mixed Messages

I am astonished by the mixed messages emanating from the White House (WH(.

·         The WH has cancelled its big health care marketing campaign set for December, fearing the campaign might increase too demand so much the  site will crash..  It fears failure so much it has its crash helmets on. 

·         The  WH  is sending out messages telling parents durint Thanksgiving  to persuade their adult children  to enroll  on the exchanges. 

·         Kathleen Sibelius is urging  people to go immediately  to healthcare.gov to sign up,

·         Jeffrey Zients, who heads the repair effort,  say the site can handle 50,000 simultaneous users, but not 250,000 if pent-up demand explodes. 

·         As the WH simultaneously   damps down and revs  demand for enrollment, it says will  focus on people who lost their policies and people who started but did not complete applications on the website. 

·         And if things were not confusing enough,  today the WH aanounced it will delay the sign-up for one  year for small businesses who want to go online to get insurance though the federal website.

The President’s Agenda

What is the President’s agenda – to expand the reach of healthcare.gov or to suppress it until the website is fixed? He can’t hve it both ways.

President Obama had best act quickly. The  American people are rapidly losing confidence in the capacity and ability of government to act decisively and  competently.   

Obama, the political wizard,  should step out from behind his  magic curtain to tell us candidly what is going on. Until then, soke and mirror will crate  confusion and uncertaint and impede progress on all fronts.

 It ‘s  time the administration got its act together The halhtcare.gov dress rehearsal has not gone well, and the crystalline chandeliers are breaking up and falling upon the audience. 

Maybe events will fall in Obama’s favor.  Today he took two positive steps .  He apologized  for healthcare.gov turkey and pardoned  the White House turkey.

Tweet:    The Obama administration is sending out mixed signals about the status and capacity of healthcare.gov.

Healthcare.Gov. No Espanol

It isn’t just the English-language federal website that is weighing on the success of the health law. Consumers still can’t enroll for insurance on CuidadoDeSalud.gov, the U.S. government’s Spanish language website.

Amy Schatz, “Spanish-Language Health Site Delayed, “ Wall Street Journal, November 26, 2013

Oh well, another day, another delay.   But what the heck.  The delay only postpones decision-making enrollments of 53 million Hispanics.  What the heck.  Hispanics  are only 16% of the U.S. population.  What the heck. Hispanics are,  by far, the fastest growing minority group and a crucial constituent of the Democratic Party’s base.  What the heck.  The Hispanics are the most likely to be uninsured, according to the U.S. Census Bureau.   What the heck. Administration officials estimate 10.2 million of the 53 million could qualify for coverage under the health law.  But what the heck.  Spanish-speaking citizens can always call Spanish-speaking call center employees with the assistance of Spanish-speaking assisters.  If you’re strictly Spanish-speaking, you can always enroll elsewhere, even if no healthsite Espanol.

Tweet: The Spanish healthcare.gov website,  CuidadpDeSalud.gov has been delayed until the U.S. government can fix healthcare.gov.

Can Three 20 Year Old Entrepreneurs Working Three Nights  For Nothing Save Healthcare.Gov, Which Took Three Years and $634 million to Build?

Skewered through and through with office pens, and bound head and foot with red tape.

Charles Dickens (1812-1870),   David Copperfield

ObamaCare is a hugely complicated approach to addressing problems in health care that have simpler solutions.

Gordon Crovitz “ObamaCare’s Serious Complications, “ Wall Street Journal, October 12. 2013

Can three 20 year olds  – George Kalogeropoulus, Ning Liang , and Michael Wasser- working in San Francisco for 3 nights on a website called healthsherpa.com  save healthgov.com save healthcare.gov from itself by replacing it with a simpler website? 

Is the website of the three, which has now been visited by hundreds of thousands  seeking answers that could not find on healthcar.gov,  a breakthrough that could  salvage  a bureaucratic, red-tape bound, muscle-bound,  federal website from its overly complicated rules for doing things? 

Could  healthcare.sherpa replace healthcare.gov, as intimated by Fox News?

Can you just go to healthsherpa.com, type in your zip code to see if your state qualifies for help, enter your income,  family size,  pick your plan, and follow a few simple instructions, and Voila!  In a few moments, find out how much an exchange plan would cost and how it compares to your current plan?

The answer seems to be, Yes it can. But , and it’s a Big If  , say the  big guys,  the government website developers, healthsherpa.com does not replace healthcare.gov.   It does not allow users to purchase insurance, verify citizenship, estimate tax breaks or subsidies.

As H.L, Menckem (1880-1956) said,  “For every complicated problem, there is a simple solution,  and it’s wrong.”

Actually,  the healthsherpa.com solution is not wrong,  it is incomplete.  It is a start. It is just a fragment of a larger solution.   It helps consumers find an answer to those burning questions, “How much is this government plan going to cost?”  “ Should I  pay the penalty of $95? Should I wait until the smoke clears  over healthcare.gov  mess?” Or, conversely, “Maybe I ought to enroll.  This looks like a good deal.”

Healthsherpa raises some fundamental issues.

Maybe healthcare.gov  suffers from inelastic thinking, from an bureaucratic mindset cultivated and developed by excessive time spent on government projects.   Maybe healthcare.gov is hidebound by too many government rules and regulations. 

Maybe a simpler approach  can help achieve the “fix” healthcare.gov so badly needs.

Tweet:   Three young coders in San Francisco have developed a website,  healthsherpa.com, that helps consumers find rates of health exchange plans.

Sources

1.       Healthsherpa.com Does What ObamaCare Can’t – Provides Rate Information, Washington Times, November 14

2.      Why Healthsherpa.Com Is Not A Replacement for Healthcare.gov,  e-plurubusunum.com, November 11

3.      Healthsherpa Helps Thousands Get Insurance Quotes, NPR, November 13

4.      Fix’s Misleading Healthcare.gov Cpmparison Disputed by Actual Web Developers,  Mediamatters.org, November 18

5.      Trio of Young Coders Build Website in Days, CNN, November 11

Is IRS Up To Job of Enforcing ObamaCare?

·         “ObamaCare + IRS = Perfect Storm,  Forbes, 11/7/13

·         “For Beleagured IRS. A Crucial Test Still Awaits After Troubled Roll-Out of Health Care Law,”Washington Post, 11/25/13

·         “Health Care ObamaCare Lawsuits, “ New York Daily News, 11/24/13

·         “IRS Crucial Test in ObamaCare,”  HispanicBusiness.com, 11/24. 13

Recent Headlines on Subject of ObamaCare and IRS

Questions, Questions, Questions

Is the IRS up to the  job of tracking and tracking down millions of miscreants who either don’t buy health insurance or who don’t cough up the $95 penalty for not doing so?

Can the IRS distribute those trillions of dollars of subsidies to those millions of the uninsured  and people with incomes low enough to qualify?

Can the IRS deal effectively with millions of Spanish-speaking  peoples (16% of Americans) who may not speak or read enough English to understand ObamaCare?

Can the 15,000 new IRS agents needed for the job of carrying out the 47 new tasks required to enforce ObamaCare,  including  distributing  trillions of dollars in subsidies and penalizing those who do not comply with the law?

Can the IRS perform its new duties when the health law specifically forbids the IRS from using its customary collection tools- liens, fines, foreclosures, criminal prosecution, and garnished wages?

Can the IRS do these things in light of its tarnished reputation for its partisanship in denying tax-exempt status to the Tea Party and other conservative organizations?

Can the IRS run this operation out of the White House which is suffering  an all time low  reputation for credibility and competence?

Can the IRS function efficiently and effectively if healthcare.gov is not up to speed, remains full of glitches,  or is vulnerable to identity and personal security hacking?

Can the IRS cope with dozens of lawsuits now underway challenging the various provisions of the individual and employer mandates?

Can the IRS enforce section 1441 which imposes a 3.8% tax on the net income and investments of taxpayers, estates, and trusts?

What level of enforcement is needed to nudge taxpayers into being cmpliant?

Will the $95 penalty rising to $695 in subsequent years be enough? 

Just asking.

Tweet: The IRS faces the huge, unenviable, unknowable, and perhaps undoable  task of enforcing 47 new tasks stemming from the ObamaCare Law.

 

 

 

Consequences of Ten “Essential Benefits”

What's essential for one person may be tangential or inconsequential for others.

One Man's Interpretation of  "Essential Benefits" Clause in Health Reform Law

Let me explain in a roundabout fashion where I am coming from:  In other languages, one of them a dead language,  "One for all, all for one" sounds like this.

Unus pro omnibus, omnes pro uno.  Latin

Un pour tous, tous pro uno.   French

Uno para todos, todos para uno.  Spanish

Obamanese

In Obamanese,  It sounds more like this:

One set of essential benefits for all,  all essential benefits in one standard plan,  or no "substandard "health plan for you.

“One for all, all for one,” and its French equivalent,  was the rallying cry for the Three Musketeers.

Now experts  say U.S health plans, under the ObamaCare law,   must contain ten “essential benefits “to qualify for health exchanges, for health plan members to receive federal subsidies, and for employers to legally offer any health plan. 

It's one plan for all, in the form of  its bronze, silver, gold, or platinum equivalent, and all for one, or needless to add, none for all.

The Ten Essential Benefits

What are these ten essential benefits?

The Affordable Care Act, (sections1302) lists “essential benefits” as,

A 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.

     What Doesn't Matter

Whether you want to receive this “benefits, is not a matter of whether, you are:

·         young or healthy

·         of sound mind and

·         do not take prescription drugs

·          Have any need for laboratory have no need for maternity, newborn care, or pediatric services

·         you are single,  and do not have a child who needs dental care, or eye glasses

·         You do not want to seek preventative, substance abuse, behavioral health treatment, wellness, chronic disease management, or rehab or habiliative (whatever that is).

What Matters

 What matters is that we are all in this thing called life and health and citizenship together.  It’s all for one, one for all, that’s what counts.

But now, experts at the American Institute and the Manhattan Institute are telling us that as many as 80 million to 100 million Americans may lose their employer-provided health insurance by 2015 because existing plans do not contain these benefits.  No matter that routinely including these benefits drives up costs on average by 41% in the individual markets (Manhattan Institute).

Middle class Americans who do not qualify are aghast and angry that routine inclusion of ten essential benefits for services they do not seek or want, is causing them to lose plans they chose and drives up health premiums and deductible to unaffordable levels in a health law ironically title “The Patient Protection and Affordability Act.”

How Could This Be?
 

How could this be?    It’s really quite simple.  Their plans do not meet federal standards.   Ergo, their plans are “substandard.”

This state of affairs stems from 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.

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 is the goals of progressive, as long at government is directing the effort and the "rich" are paying their "fair shar

No doubt this is a  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, meritocracy, entrepreneurialism diversity, and regional variation, one-size-fits-all does not fit all and  will  raises the cost for many.

Tweet: Health reform doctrines such “comprehensive essential benefits,” have enormous cost and cultural consequences.