Healthcare 2020

James D. Tippett

To view the debate surrounding health care it is useful to project the future, ala
Alvin Toffler. Healthcare in 2020 will be viewed as a carefully manipulated plan, so
global in its impact that no one envisioned the scope or the speed with which the
control was implemented. Looking back we will realize how crafty politicians found it
so simple to assemble all the discrete pieces, Bill by Bill to lock in their Socialist
vision. Once done, it became an intertwined network of such a pervasive nature
that it could never be undone.

Healthcare legislation passed easily through the partisan House in late 2010
despite the unrelenting objections of constitutional patriots, who as if enabled with
psychic ability, foresaw the devastation on the horizon. Many citizens still were
unclear on the impact or who to trust and with so many citizens out of work, the
promise of affordable healthcare quelled their objections and dulled the forecast of
devastating impacts. Once passed however it quickly became evident, much like a
fly into the spider web, that it was about much more than a humanitarian effort.

In the beginning it appeared benign enough, those who had health care, kept it,
and those who did not got signed into the Social Health Insurance Trust and
required to pay a modest premium. The plan was modeled off the State run
Workers’ Compensation systems already in place that had proven somewhat
effective at providing affordable coverage for companies. This no frill system also
provided the mandatory coverage for companies that had been denied by
commercial insurance carriers due to the inherent or perceived risk of their
business. It was a proven model, which despite its flaws, was effective at providing
medical and lost wage coverage to injured workers and liability protections for
employers.

Now confident of public support, or non conflict, Congress also provided a solution
to the immigration problem in one fell swoop with the passage of another
masterfully planned Bill. This Legislation called the Citizen Responsibility
Acceptance Plan provides the parents of children born in the United States with the
same citizenship as their children, i.e. American. It was viewed by many as just a
matter of time; after all once the child turns 21 they can sponsor their parents to
become citizens anyway. It was also viewed as inhumane to subject Hispanic
women to the tumultuous incursion under the border fences; it just was not healthy
for the mother or the baby, and we all know it is imperative to provide a loving
caring family for all American children. The undeniable benefit is that these
individuals were now United States Citizens, taxpaying United States Citizens. But
perhaps the ultimate political gain was that these individuals were now registered
voters, who would continue to vote for the one who promised them the greatest

James D. Tippett jdt@tipsonxl.com 9.13.2009

bounty from the public treasury. Business also found benefit in this as they now had
an ever growing pool of legal affordable labor, which drove lower wages allowing
them to be more competitive in foreign markets.

Shortly after the passage of healthcare legislation, it was discovered that a last
minute addition to the Bill mandated newborn health screening; Politicians who had
been bombarded by parents of children with afflictions, pleading to make testing for
all children mandatory, felt compelled to listen to their constituents . Indeed, many
children were afforded treatment options at early ages to lessen the impact of their
genetic malformations. An added benefit by some views was that these tests also
showed promise as being predictors of predisposition to other health and mental
afflictions. These afflictions, such as heart disease, cancer, depression, obesity and
even halitosis had been ravaging our health care system for years. Multiple
benefits were also gained in that to concoct an accurate picture of the child’s
genetic composition the parents also were “screened”. How wonderful to have this
advanced knowledge of our individual futures. The ability to know whether or not to
save for retirement or your child’s education was wonderful and enhanced the life of
many who now knew that they had better have fun while they can. Doctors rejoiced
in that legal action could no longer be pursued against their negligence for missing
a birth defect.

Then as if by coincidence, Bills mandating a national system of easily accessible

and searchable electronic health care records, touted as the great cost and life
saver by the medical community, passed quickly. Databases strained as they
started filling up within the government. How wonderful to have these people
segmented in databases, drawn from the hard drives of medical providers holding
previously confidential medical records. The public hardly noticed this transition as
it was suppressed in the media due to the potential national security
implementations, as the U.S. Military was now solidly engaged in North Korea.
Besides, the information was going to the Government so confidentiality did not
seem like such a big deal, and they already had our social security number anyway,
right? Medical providers readily transferred the data, a prerequisite to apply for the
numerous government healthcare funding and grants. There was little incentive for
not sharing this information and the threat of audit and fines for non compliance
were well known.

Commercial health insurance companies, pressured to lower costs to remain

competitive, lobbied Congress to allow them access to the National database.
Bolstered by the large campaign contributions which seemed virtually unlimited
once the Supreme Court struck down the restrictions, Congressional members did
not see this as that onerous of a request once the check cleared. After all, it would
enhance the insurance companies’ ability to provide more efficient and cost
effective care. Oh, and save lives.

James D. Tippett jdt@tipsonxl.com 9.13.2009

 With this new found stream of information, commercial health insurance company
actuaries went to work. They began evaluating the “status” of the employee’s that
their Policy Holders employed. Small businesses and sole proprietors, now one of
the largest segments of the economy, were also of particular interest as they were
less likely to have employee wellness programs or sufficient hiring or safety
practices. They found the data from the new born screening and immigration
databases to be of particular benefit and the most comprehensive source of
predictive modeling data. Of course, the individual employee would need to
authorize and sign a release to allow access to these records. Pressured by their
insurance companies with the promise of premium savings, employers made these
releases a condition of employment.

Sophisticated computer software scanned the databases continually, at first

identifying only an organizations cumulative risk exposure that allowed for more
accurate annual premium determinations, and the formation of more competitive
quotes. Soon the benefit of an even more detailed analysis became evident.
Insurance companies found that if they utilized a Sequential Contributor Review and
Evaluation Workup, they could calculate precise premiums to be more reflective of
exposures presented by any individual within the target group, and adjust
premiums accordingly. Employers rebelled against this as they felt they had no
control over an employee’s personal habits or their genetic predisposition.
Insurance companies were unyielding and only provided two options. First, the
company could find coverage through the Social Health Insurance Trust or exclude
selected employees from coverage, and direct them to the Social Health Insurance
Trust.

Companies were reluctant to sign in to the Social Health Insurance Trust as it was
difficult to attract top talent with this coverage option, as liposuction and cosmetic
surgery were seldom covered. In addition, expenses related to the numerous
government mandates, administrative tasks and reporting requirements actually
outweighed the premium savings gained when companies left the commercial
insurance companies. Excluding certain employees with negative medical
indicators, such as high blood pressure, obesity or a history of psychological
counseling, gained ground as a realistic solution. Additionally, companies found
that if they also excluded those employees showing a genetic predisposition to any
number of ailments they could further lower their expenses. This is not viewed as
draconian since the employees are simply rolled into the Social Health Insurance
Trust as mandated under a Friday afternoon Congressional session that passed this
amendment to the legislation.

Once the employees are in the Social Health Insurance Trust, they find that there
are numerous resources available to them. The government completes its own
Sequential Contributor Review and Evaluation Workup for each individual entering
the Trust. Given that this coverage is now funded by the public, the Government
has implemented an oversight administration that is responsible for overseeing the

James D. Tippett jdt@tipsonxl.com 9.13.2009

Social Health Insurance Trust centers and in setting the requirements for the
individual care plans under which individuals will be bound. This is wonderful in that
an obese person can be placed on an exercise and diet regimen to reduce their
weight, their health risk and thus reduce the cost exposure to the Social Trust.
Similarly an individual’s alcohol consumption, participation in at risk hobbies, and
even driving habits can be monitored to reduce the risk exposure to the Social
Trust.

Congress touts the success of the program in reducing obesity and the death rate.
New legislation is introduced and passed that extends the program to include
people with genetic predispositions under the Care Plan Requirement. The software
again hums through the databases driven by these new search criteria. Lists print
flagging individuals with potential predispositions, family histories and other
perceived mutations. These individuals are also bound under the Care Plan
Requirement and prescribed precautionary pharmaceuticals, counseling and
periodic monitoring.

It soon becomes evident that compliance with the stipulations in an individual’s

care plan is difficult to monitor. So to, requiring regular monitoring visits to the
Social Health Insurance Trust centers is costly to the system. Something must be
done. In response Congress enacts the Community Health Issuance Program
whereby an individual pays an additional premium, through payroll deduction, to
account for the higher risk they bring to the Social Health Insurance Trust.
Participants can take advantage of the automated monitoring provision of the
Community Health Issuance Program by having a small RF monitoring device
implanted painlessly behind their ear, resulting in lower premiums. It’s a wonderful
world.

By the year 2030 the problems are insidious. The Social Health Insurance Trust,
burdened by a pool of medically dependant citizens and a diminished tax base is
starting to crumble. Companies have stopped hiring individuals flagged as risks in
the national databases, thereby adding them to the public tax burden. A system of
health credits is instituted whereby unemployed individuals are allocated a set
number of transferable credits calculated by risk and other factors such as
adherence to their Care Plans. To decrease the stress to these individuals, Care
Plans are amended to include medications to reduce anxiety. Individuals
unemployed for more than three months are automatically enrolled in the
Community Health Issuance Program and fitted with the comfortable monitoring
devices. Criminal law is modified to include penalties for non compliance.

James D. Tippett jdt@tipsonxl.com 9.13.2009

 Fortunately, genetic engineering is showing promise and newlyweds are offered
premium credits to seek genetic counseling before having children. End of life
counseling has indeed produced the intended result saving billions in unnecessary
treatments. Start of life counseling is added to the legislation that mandates start of
life counseling when genetic defects or predispositions are found in newborns.
Parents are encouraged to consider the quality of life and added costs that must be
bore given the increased premium rates, or additional health credits needed to
offset the increased exposure to the social system. With birth defects in children
plummeting, and similar statistical results being seen across the medical care
continuum, the program is celebrated as a success.

You decide – Fact or Fiction – If nothing more, a cautionary tale

James D. Tippett jdt@tipsonxl.com 9.13.2009