Sunday, January 6, 2013

I Know There is No Hope, But My Heart Keeps Saying There Is

I admit. I am depressed out of my gourd.

I spent four years and all my personal resources trying to find someone who is brave enough to discuss real free market health care reform. (Buying insurance across state lines or adding an HSA to high deductible insurance is not reform).

The opportunity to repeal ObamaCare is gone and lost forever.

But there is a little optimist deep in my heart that keeps urging me onward.

A group willing to discuss free market health care reform could change things.

I guess I need to explain why I still see hope.

As it happens, I was a math major in College. I was deeply interested in the foundations of math and logic and held the dream of becoming a high school math teacher. My long term goal was to write a high school level calculus book.

At the time, the Education Department at the University of Utah was using school choice as a litmus test for qualification for teaching in the state. I was pro-school choice and was filtered out. The story is funny. I was required to write an essay against school choice. My essay wasn't just for choice, I advocated that teachers owned the school and ended my essay with the words "Workers of the world untie!"

The professor was livid. She circled the word "untie," and wrote "UNITE." She showed the essay to other members of the department and I received Fs in three classes that quarter for one play on words.

So, I ended up doing what math majors do. I started working in insurance. Specifically, I worked for a state run insurance company.

I saw that insurance was doing to health care what progressives had done to education. My job was to write computer programs for analyzing claims. My programs needed to let actuaries and auditors drill down to the details of each policyholders claims history. So, I spent a lot of time with auditors and discovered that there were numerous cases in which people died because their insurance company let them down.

I also discovered the hidden secret of state run health care.

The secret is that the politically powerful always get better care than the disenfranchised.

Progressives wax philosophic about equality, but the politically powerful will always get more than the disenfranchised.

Having spent my academic career studying the foundations of math and logic, it was abundantly clear to me that the insurance paradigm was structurally flawed.

The fact that anyone is willing to work in that horrific industry boggles my mind. Where's the decency?

The fact that anyone in good conscious could work in insurance makes me weep for my species.

As I studied the data, I could see thousands of people trapped in insurance policies that were systematically undermining both their health and their community.

I could not in good conscious accept checks from an insurance company; so I left and set myself to the task of reverse-engineering and insurance pool along free market principles.

The question in the forefront of my mind has been: How do you break an insurance pool into individual accounts.

I collected my thoughts and gave the process the working name: "The Medical Savings and Loan." 

Having created the Medical Savings and Loan, I approached health care and asked how would a data driven health system evolve in a free market.

My program could either be built from scratch or it could be created by re-engineering an insurance pool.

In a third experiment I asked: What would I do if I were made the Health Care Czar?

I can talk for hours about the effects the creation of the Medical Savings and Loan would have on social policy.

For example, we, as a society, want to care for the poor. What happens if a person who has no insurance has a medical emergency or needs primary care?

Right now the person shows up at the emergency room. The hospital pays the bill and charges the expenses to others.

From a social policy, the Medical Savings and Loan works as follows: We would give anyone needing care a loan. The second that you accept the loan, you are thrown into a structured savings system and given career guidance to minimize the burden you place on society.

There is money for people who need care. They would decide if they want to take out a big loan for the emergency room, or take out a smaller loan and visit a clinic.

As you see, health care is a multidimensional topic. A robust health care solution must make sense from multiple perspectives.

I built my program from an individual perspective of care, but it also looks beautiful from a social perspectives.

In my presentation I actually look at health care from multiple perspectives. I look at care from the individual perspective, from the doctor's perspective and a social service perspective.

I spend a great deal of time discussing funding care from an economic stand point.

For example, insurance creates an artificial concentration of wealth. When we put our health care resources into a common pool, the people who control the pool become wealthy and the policyholders diminish. Creating an alternative to insurance would actually do more to bridge the gap between rich and poor than Obama's hefty tax plan.

Insurance plays a role in our nation's debt crisis. Traditionally people saved for their health care. Insurance replaces savings with a pay-as-you-go scheme. Restoring the concept of self-funded care would do more to alleviate our nation's debt crisis than the current wrangling over the debt ceiling.

My goal has been to create a mathematical model for self-funded care that could be implemented as a business plan.

I love to talk about how the Medical Savings and Loan could be implemented as a network of businesses.

But I can also present the ideas as a collection of principles.

For example, one of my foundational principles is: "Those who can self fund their care should."

Isn't that a beautiful and concise principle?

The natural corollary of the first principle is that people who cannot self-fund their care need assistance.


Are people so dense that they cannot fathom that a principle has a corollary?

We can express the idea clearly in Set Theory.

The set of people who can self-fund care is distinct from those who cannot.

The group of people who can self-fund care is different from the group of people who cannot.

Our social policy is founded on the absurd notion that these two distinct groups of people must be shoved into the same program.

 If we started with the principle that those who can self fund their care should and recorded all health expenses, then we will discover those who cannot.

It's that simple.

Insurance, in contrast, is a complex and ugly bastard. We put all of our health resources in a common pool and reduce everyone in our society to dependency then have shrill political battles as the wolves in the halls of power tear about the common pool.

There are other principles. For example, I believe strongly that people own their own body. Since people own their body's they should own the resources needed to care for their body.

Please ask yourself this question. What is the name given to people who don't own their body? If someone else owns your body, then you are a _ _ _ _ _?!

Another foundational principle is that since people own their bodies, they (not the insurance company) should own the data related to the care of the body.

I can express the Medical Savings and Loan as a mathematical model or as a collection of principles.

In my opinion this is good system design.

We can build the model from the principles or abstract out the principles from the model.

Since health care is a data intensive program, I personally believe the best path to free market health care reform is to start with an existing insurance pool and reverse engineering it along free market principles.

Let's say we had good data from an insurance pool. The first thing we would do is figure out how many people in the pool could self fund their care and how much money was needed by the people who could not self fund their care.
We would then set aside more than enough money to care for the people in need in a grant program.

Now let's look at the people who care self fund their care. It turns out that health expenses are unpredictable. People's health savings will not match up perfectly with their health needs.

So, my program would look at the data to see how often and when people who can self fund their care need additional assistance.

The data driven program would create a loan reserve to cover the expenses.

I want to have a huge loan reserve that is multiple times the expected amount of the loans. So, in my program the medical savings accounts own the loan reserves.

So, while the principles are easy to discuss, the implementation of the program would involved continuous detailed analysis of health care data.

For that matter. One of the founding principles of the Medical Savings and Loan is: "We live in the information age. In the information age, our health care should be information driven."

The program has a mathematical model. It has a business model. It has well defined principles and is data driven.

To make this model work, there would need to be a group of dedicated professionals who will spend their careers recording and analyzing health care data. I called this core group of people "Health Care Advocates."

These people already exist in the insurance paradigm. The insurance industry is filled with people who collect and analyze data. The difference between insurance agents and healthcare advocates is that the insurance agent works for the insurance company while the advocate works directly with people.

This is simply a slight change of focus.

The reason I still have hope is my belief that if a group of people physically met in a room to talk about free market health care reform, we could create figure out how to apply the ideas from the Medical Savings and Loan and figure out how to apply them to the Health Exchanges.

As I mention at the beginning of this post. PPACA is a cynical piece of legislation. The idea is to wrap the insurance industry in a bureaucratic nightmare called a Health Exchange.

Progressives believe that the Health Exchanges would cause a systemic collapses of the insurance industry and it would then form into a shell for socialized medicine.

Insurance is mathematically unstable. The exchanges will collapse. However, if patriots were together to talk about free market health care. There is an outside chance that a group could create a structure so that the Health Exchanges collapsed into a free market structure.

My brain tells me that I should give up hope. But my heart keeps screaming that if a group of people were brave enough to discuss free market health care, that group could make a difference.

The future of America looks dark. It looks like our experiment in free society as come to an end and the the forces of socialism are so strong that there is no longer any hope of retaining freedom.

But the freedom movement has yet to try the radical approach of actually looking at health care data and discussing free market health care reform.

There is a possibility that if the defenders of freedom stopped talking about who is the most "severely conservative" and spoke about the issue of health care, that we could find a path out of this dispairing system of increased statism and diminished freedom.

I am stuck in the Soviet Socialist Republic of Utah. If only I could find a group of people willing to invest the time and resources to stand up for liberty, my heart tells me that group could make a difference.

Because Conservatives are useless sticks in the mud, we lost the opportunity to repeal ObamaCare.

However, if a small number of free thinking people in the freedom movement got together they could form a structure that would be in place to take over health care when the Health Exchanges fail.

I began by pointing out that the health exchanges in ObamaCare were designed to fail. Progessives see the exchanges as a step in the progression to socialism.

However, it is possible for a group of patriots to engineer a design such that the exchanges fail into a free market structure.

All that it takes is a group of people who are willing to sit down and do the hard work of analyzing health care data.

I am not doing this for the money. I do this because I love the American experiment in self rule.

The people who are brave enough to work on developing an alternative to insurance might make money.

The best path to restoring America is not a book, it is not a political candidate, it is not a shrill talk radio show. The path to restoring America is to create an organization dedicate 100% to exploring self-funded alternatives to insurance.

If that group existed, then when opportunities arose, it could make a difference.

The only way to start a real group is for a small number of people to physically meet in a room and talk.

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