Friday, February 22, 2013

Group v. Individual Analysis

I was asked to explain my mathematical model.

Insurance analyzes the health experience of a group over a year. People are dynamic beings. People often move between groups. People will often belong to more than one group at a time. Sometimes people are not in a health group.

Insurance creates a fractured view of individuals.

I believe that health care should be administered to individuals and not groups.

I wish to see health care based on a full life cycle analysis of the individual.

Now, it just so happens that the flow of information in health care follows the flow of money.

This is not surprising. Money is nothing but a piece of information. Money is a tool that humans use to quantify resources. 

In the insurance model, money flows between insurance pools and large health providers.

The fact that the money is flowing through these massive pools creates a fractured view of the individual.

My goal is the change the flow of the money so that it flows through individual accounts held by people.

Imagine for a moment that all of your health spending flowed through a savings account and that this savings account included a document management system that recorded the itemization of each bill.

This account would provide you with extremely valuable information related to your health.

Changing the flow of information would change the focus of all the jobs in the insurance industry. Notably, a claims adjuster is a person who is controlling the flow of resources from a large insurance pool. Changing the flow of resources would change the focus of the job from the needs of the pool to the needs of the individual.

To denote this change, I created a new job description called a "Health Care Advocate." The advocate oversees the flow of resources through an account and helps maintain the documents that flow back from the care providers.

So, if you were a member of the Medical Savings and Loan, all of your health spending would flow through an account in your name and under your control.

To gain perspective on your personal health, you need to know how you fare in regards to others.

Members of the plan allow actuaries access to summary information from their account.  So, from each account I abstract summary information. The summaries are stripped of any personal identifying information.

Since the account is under your control, you will see both the extracted information and the groups that analyze the information.

I take the summaries and merge them together to create composite views.

Clients will periodically have sessions with their advocate in which they compare their personal health experience with the composite views.

The composite views might track pertinent information such as health-effecting lifestyle choices, preventative medicine, diseases, major injuries, catastrophic events, genetic make-up and anything that affects health.

By looking at the composite views, you and your advocate will make projections of your expected expenses. These projections will become a basis for your savings plan.

In my ideal plan, summary information also includes data about your income and savings. The plan would also include data on any unmet health needs in your life. By including summary financial information in the composite views, we will be able to compare people's physical health with their financial health.

Now, if the ratio of your health costs to your financial condition is within the norm, then you are expected to self-fund your care. If your health experience and financial condition is out of whack, you will need additional assistance. (It's this basic)

So, the Medical Savings and Loan has a different mathematical model than insurance. With insurance we place the resources of the group in a pool. Actuaries analyze the experience of a group over a year. Insurance companies use this analysis for speculative plays on the health market.

The Medical Savings and Loan sees each person as a whole being. The program channels all of the health spending through a savings account owned by client.  It creates composite views of the health experience of others. This allows you to make a side-by-side comparison of your personal experience with the experience of others in your community.

I transform all the insurance agents, claims adjusters and medical transcriptionists into a new profession called the "Health Care Advocate." You will periodically work with your advocate to make sure your personal information is correct and to create a projection (based on real world information) of your future health expenses.

The program gives people who can self-fund their care the tools and knowledge needed to achieve this goal. The program also identifies those who cannot self-fund their care.

The composite views identify the people who can self-fund their care. It also identifies the people who cannot.

The composite views will show information about the amount of funds held aside for assistance. The views will also show how the grant money was applied.

The presentation that I've been wanting to have for the last five years simply talks about how these two approaches to funding health care differ.

The goal of the presentation is to build a full business model around this mathematical model. If a group of people met and created a new business model around this mathematical model, then the group of people could march into the political arena and say: "The problem in health care is the overuse of group financing for individual consumption." The solution to health care is not to force everyone into a pool, but to provide an alternative mechanism for funding care.

The Achilles Heel of PPACA is the insurance mandate. The mandate is premised on the false assumption that pooled insurance is the only possible way to fund health care.

The people who engage in this conversation must be brave. Simply considering alternatives to insurance means that you are standing against the most powerful people in our nation.

I live in Utah. I am not LDS. The LDS Church (Harry Reid, Mitt Romney, Karl Rove, Governor Mike Leavitt, Governor Huntsman, and crew) are fully committed to the idea of socializing medicine through health exchange.

Open discourse is not tolerated in the Beehive State.

The people who run this state are vicious. If you so much as question their power, they do everything they can to drive you down.

 I have enough space on my credit card to drive up to 700 miles and get a hotel for two nights.
 For five years I've been staring at a map. This range includes Denver, Cheyenne, Phoenix, Tucson, Las Vegas, Reno, Idaho ... or possibly Southern California.

I think Arizona is the best bet.

The problem is that I cannot force other people into a room. I have absolutely no desire to force anything on anyone. I dislike PPACA because if forces a negative ideology onto this once great nation.

Unfortunately, I'm just stuck here in Salt Lake until I get an invitation from a group with a half dozen or so people who are brave enough to stand against Obama, Romney and other forces of oppression for the good of their fellowman.

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