Health Insurance Premium Versus Healthcare Cost

Healthcare-1
Author: Michael Dewar
Dwelling Place Cleansing

Introduction
This short article is my observation based upon 28 years of interaction with healthcare as the provider of services in a multi-service medical center and hospital setting. I am taking the position that—to truly have affordable healthcare that is sustainable for the American people, five issues must be considered: premium cost, healthcare cost, provider profitability, the marketplace, and physician malpractice cost.

The preceding categories are like five moving parts of the same engine. Or, better yet, think of juggling five balls. The normal way of juggling is: while some balls are going up, others are coming down. But healthcare is a different animal, all five balls must go up and come down at the same time, and must be caught with only two hands. There is always an odd ball to be caught, and the odd ball could be any of the five on each throw. If all balls are not caught, it throws off the entire juggling process. Let’s look at these five balls.

Insurance Premium 

Some people are making the mistake in thinking that if insurance premium falls to the level of consumer affordability that automatically brings down the cost of healthcare, but that is not true. In fact, premium cost coming down could have the reverse effect. It could cause healthcare cost to go up, because there are four other balls putting pressure on the system. When premium falls, the insurance company takes in less money but must continue make payouts as heretofore. That puts pressure on the insurance company to move some things around to make up for lost revenue. In many cases that results in higher deductible and higher copays and reduction in services. These adjustments may not appear dramatic to create alarm up front, but they will become noticeable after a while when you are locked into the system.

For political reasons, government policy makers are greatly focused on lowering premiums because this gives the appearance of affordability in the sight of voters. Plus, it is easier to explain to them, because they are not looking at the other four moving balls. Chances are—they are looking at the odd ball.

Healthcare Cost

There are three categories of people who are quickly affected by the healthcare cost: the insurance people, the provider of services, and the consumer of services. When I speak of healthcare cost, I am speaking of all the services associated with one health crisis or event. Let’s say, Mary fell at home and fractured her right knee. She is rushed by ambulance to the hospital, x-ray reveals she needs a replacement knee. She needs a skilled orthopedic surgeon for the surgery, then three weeks of acute rehabilitation. Upon discharge to home, she needs home care: a visiting nurse, physical therapy, home health aide, and equipment (a walker and cane).

Now, the insurance that Mary has, must be and excellent, top of the line policy to pay for this quality care from ambulance to the last person and service that puts her back on her feet. Chances are her deductible and copay are going to be burdensome, depending on her financial situation. Any home care service over three weeks will have to be paid out-of-pocket, unless she has Medicaid. If she has Medicaid, she is fully covered for the service (at least in NYC), but the quality may not be as good. She will get by, but some service providers do not take Medicaid because of the pittance paid for service. So, right away one can see how quality care is skewed to those that have the best policy (cost more) or those that can private hire extra services.

Provider Profitability

Now, the cost scenarios used in this section is pure fiction, there is nothing like this going on in American healthcare. It is reasonable to say, all the professionals, para-professionals and agencies associated with the care of Mary want to provide services, not at a loss, but at a reasonable profit. Less say, the orthopedic surgeon charges $20,000 for the knee surgery. A good quality, American made prosthetic knee may cost $2,500 depending on type. Some may say that’s a lot of money. But where can you get an orthopedic surgeon at bargain price? And would you prefer a $200 prosthetic knee manufactured in a third world country? Even if you could find one at that price, no orthopedic surgeon would risk his or her reputation using it on a patient.

Or, less say the insurance company will only pay the orthopedic surgeon $5,000 for the surgery and if he or she used cost-effective prosthetic from outside the United States and perform 10 surgeries for the month, $2,000 bonus per surgery will be paid. Now, if this were true, the temptation would be high to compromise on quality to cut cost in favor of the insurance company. And who would know if quality were compromised unless something serious went wrong. The point is—profitability is not a dirty word, and it does not always signal greed. Good healthcare is costly, a fact we already know. But we must still ask the question, what is reasonable profitability? Should there be a reasonable, flat fee for replacement knees from NY to LA?

 The Marketplace

Some people say, like everything else, let market competition regulate the cost. From the preceding paragraph, you begin to see that healthcare is a different animal. Leaving it to be regulated by the marketplace is what brought us to the current crisis. When healthcare is left to the competition of the marketplace to lower costs, on the surface it appears that cost is lower, but below the surface quality is often compromised and fraud becomes wide-spread. Sooner or later, like the housing market the whole system comes crashing down at the expense of the consumer and taxpayer.

How then shall we live as far as healthcare is concerned? I don’t think there is any magic bullet. But a single payer system with incentives for doctors and strict oversight, may be the way to go. We may have to take piece of what works from all the healthcare systems around the world and make it work for the American people. At the same time, the profession of medicine must remain attractive for the brightest students from around the world, less we dumb down medicine to a second-rate profession. We cannot afford to lose our leading edge in healthcare. In the United States, it is easier to spend money on weapons of war than healthcare. The mother of all bombs is rumored to cost $314 million. Yes, one bomb!

Malpractice Coverage

One of the basic reason doctors’ services should not be had at a bargain price from some, and a greedy price from others is the unbelievable high cost of malpractice insurance. Two professions collide in malpractice: the medical and the legal. There are greedy lawyers and there are greedy doctors, but I am not too quick to fault them. The consumer falls in the middle. The right of the consumer must be protected; therefore, settlements must be fair and equitable. Outrageous law suits often driven by greed must be discouraged. Someone needs to rethink the convergence of interests and come up with affordable coverage and reasonable and equitable payouts. Perhaps, a government subsidized malpractice insurance, if not already in existence.

If doctors are poorly paid on the one hand, and greedily paid on the other, and malpractice insurance has gone through the roof, then we are forced to maintain the status quo or come up with a more balanced system that works for all the players, except the greed. We have the skills to do it, but I am not sure we have the will as yet.

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ABSOLUTE POWER?

king
Some in the media are claiming that the President of the United States has “Absolute Power.”  This concept is a carry-over of medieval “divine rights of kings.” Back then, kings of the secular state believed they were appointed by God to rule over all of life including the church. When Papal Rome ruled, they adopted the same concept for a while, exercising authority over kings.

The constitution does not give the President absolute power, or unquestioned authority, not even on immigration matters. I think they are confusing “absolute power” with “exclusive authority.”  The President has exclusive authority on immigration policy matters, but policy must conform to the constitution. The constitution comes closest to absolute power. But not totally absolute, because the constitution can be changed by the people. We the people are vested with absolute power under God. I say, under God, because He is the only one with true absolute power, thus the words, one nation under God.

Author: Michael Dewar
Executive Director/Dwelling Place Cleansing 
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What Do We Mean When We Say We Believe?

The Power of Beliefalaska-eagle-caufgt-fish

Author: Michael Dewar
Executive Director/Dwelling Place Cleansing

The word “believe” could be a very tricky word; lately, it is creating a lot of confusion for some in the public square, government, and the media. So, I decided to take a look at it with the following three use of the word believe:

Hi John, are you going to the concert this Saturday? John gives his answer, “I believe so.” Regardless of his facial expression, this colloquial use of the word expresses uncertainty. John is not quite sure that he will attend the Saturday concert. If he had a strong sense of certainty, he would have used others words like, most definitely! Or, without question!

I believe in Jesus and He forgave me of my sins. Here believe presupposes three things: Knowledge about Jesus, accent or agreement that He is able to forgive, and appropriation (that is personally accepting Him as Savior, so He could do the forgiving). To do all this a person must accept the historical fact of His Virgin Birth, His death, and His resurrection. Upon these foundational truths rooted in factual, historical evidence, people say–you are a believer.

I believe five million undocumented persons voted illegally in the recent election. In this context believe is a notion in my head that has to be substantiated by quantifiable, factual evidence outside of my head. Let me illustrate with the following experience:

I did one year internship (Social Work) in a major psychiatric hospital in Queens, New York. On the first day, I was told to present my credentials to the resident psychiatrist; he supposed to be somewhere on the ward. The first man I saw with a white coat and a stethoscope around his neck I presumed to be the doctor. As I was getting ready to talk to him, a nurse came out and said, “Not him! He is a patient.” He just believes he is a doctor. Later, another patient told we with much conviction that she was the Virgin Mary. She believed that she was. The fact is, the man was not a doctor and the woman was neither Mary or a virgin (she had children). Even faith requires evidence (Heb. 11:1).

We cannot take what is in a person’s head as truth unless we have factual, historical data that is quantifiable. It does not matter whose head the belief finds residence in. I am beginning to think that a psychiatric evaluation should be part of the requirement to run for public office.

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MAKE 2017 A YEAR OF PEACE AND CELEBRATION

Lifestyles

Michael Dewar, author
Director/Dwelling Place Cleansing 

A Time to Celebrate

The wise King Solomon reminds us that there is a time and a season for everything, and we have the power to bring that season about (Eccl. 3:1-8). Christmas and the New Year are times of peace and joyful celebration. Christmas is the season when the Creator of the Universe clothed Himself in a human body as the Prince of peace, and pitched His tent among us as our Savior and Lord (John 1:14). According to Luke (2:8-20), His first crib was the feeding trough in a manger. That’s certainly not the red carpet welcome.

Most of us would prefer being born at the downtown Cosmopolitan Hospital, rather than a manger under the curious gaze of sheep and donkeys. These animals were no doubt wondering, what in the world was going on! The manger is a birthplace we would rather keep quiet about. Middle school and high school friends could be mighty cruel had they gotten wind of it. Our little secret would be all over social media. But in spite of such lowly birth, the baby grew up to change the world and divide history into BC and AD.

We may not be proud of our grand entrance into this world, but we are not to be blamed for that, nor should we allow it to rob us of the joys of life. Perhaps, our parents did the best with the cards they were dealt, so don’t be too quick to fault them either. The manger story tells us we can overcome the circumstances of our birth and make good of  life.

Celebrate Life

Life is a gift to celebrate, even if all you can afford is one cupcake and a mini candle. It is your attitude that the divine looks at. Trust me, celebration of life is better than being bitter and angry. Celebration not only generates endorphin in your body, making you feel better, it will turn things around beyond your wildest dream. It is the kind of thing heaven takes notice of and rewards.

Every people group on earth has at least one event that they celebrate each year. In ancient Israel, the Jews had seven feasts they celebrated each year; just about all seven feasts were divinely appointed. They were directed to celebrate joyfully before the Lord. That says, a lot about God. He is not this mean, sad, bearded, old man who is read to get you for stepping out of line. He likes a good party! May be that’s why the first miracle Jesus did was at a wedding feast, where he turned water into wine and kept the celebration going (John 2:1-11). He was fun to be around. Religious folks didn’t care much for Him and the feeling was mutual. They thought He celebrated too much, that He hang out with the wrong crowd. They called Him a glutton and a wine lover.

In spite of what the Jews have suffered throughout their history, they still celebrate most of the ancient feasts today. They take time for meaningful celebration. They work hard, they celebrate before God, and they prosper. Rather than hating them, perhaps, there is something other people groups can learn from them. And don’t forget that Mary and Joseph were Jewish, and the Son that was born in a manger grew up to become the Master Teacher, a rabbi.

Add A New Celebration

Beyond work for peace, I want to invite you to do something different at your house with your family in 2017.  Add a new celebration to your calendar. Lets call it, my dwelling place anniversary celebration. Do it and watch things turn around for you and your family for the better. Conduct this celebration anytime in 2017 but before December. My reasons and instructions for this new celebration is in the book, Dwelling Place Spiritual Cleansing. Get it here or Amazon or Barns and Noble.

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A BREACH OF SECURITY

“Except the LORD keeps the city, the watchman wakes but in vain.” – Psalm 127:1

twin-towers

Every tragedy has a spiritual side to it, 9/11 is no exception. It was a breach of security in the most powerful nation on earth.  Supersonic F-15 fighter-jets were scrambled, but in vain. The towers fell, lives were lost, and lessons learned, I hope. The tragedies that took place on that fateful day were pure evil, yet much good happened on that day. The heroic actions of first responders, firefighter, police officer, EMS workers, and ordinary people helping each other in extraordinary ways. Amidst unspeakable evil, our better angels pushed us beyond the call duty to be our brother’s keeper, which in fact is our spiritual duty of “love thy neighbor.”

There are two kinds of spirituality that hold sway in this world: one finds its origin in personified good (God), and the other most often springs out of personified evil. This is true but simplistic, for it does not fully explain the mystery of evil. Some things are evil, but they serve as instruments to bring about the good. This does not mean perpetrator (s) go unpunished. Let me illustrate this point.

Joseph’s eleven brothers were wickedly jealous of him and his dream of leadership over them. They got rid of him by selling him into slavery. They brought his bloody coat home to convince their parents that a ravenous wild beast devoured their son. They had their parents believing the lie for twenty plus years. That’s evil! But God used that act of cruelty to fast track Joseph to Prime Minister over Egypt.

In the end, Joseph saved all Egypt and his own family, including his rascal brothers, from death by starvation. He told them, “You intended to harm me but God intended it for good” (Gen.50:20). Yes, 9/11 was evil with human faces; they intended to harm us, and the nation was a sitting duck in the face of this security breach. Powerful but helpless.

Our schools, our shopping malls, and even our churches have already suffered a breach of security. In as-much-as some families have already suffered home invasion, our homes are still the last security frontier, and we need divine help to keep it safe. Every family should make their stand here. But remember, there are many evils making its assault on home and family: the high divorce rate, drugs and alcohol addiction, pornography, economic deprivation, foreclosure, flood and fire. The threat of evil to home and family is from within as well as from without. Every one of us is capable of being the very agent of evil that destroy our own home and family.

By now you must sense that I am not just talking about life insurance, firearms, and electronic home security, to name a few. These conventional security measures are important, but they can give you a false sense of security. I am talking about a level of security that many people are just too quick to dismiss. But I want to emphasize that there is a spiritual side to all security breach and that includes any assault upon home and family. Even if the assault is foreclosure, wild-fire, or flood, it can be avoided, but only with advanced preparation.

Rabbi Jesus once contrasted the security He provides to that provided by personified evil with these words: “The thief [Satan] comes only to steal and kill and destroy; I [Jesus] have come that they may have life, and have it to the full” (John 10:10).

Personified evil is Satan. Note that he is call a “thief” who not only wants to steal from you. He wants to kill and destroy you. He wants to take your health, your family, your money, your self-worth and your life on top of it all. He watches for your unguarded hour to move in on you for the kill. But there is someone much stronger than your enemy who wants you to have life and live it to the full. He is the best home and family security for evil cannot breach where He camps out. But you have to intentionally activate this security protection at your house. I have written a book to help you do just that. Get your paperback copy today.

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