Be very careful what you wish for. The talking heads of your favorite news flavor are buzzing and the key words in the dialogue are disturbing. The political extremes vacillate between fear-baiting concerning a devious plot to stage an irreversible socialist coup and a vehement defense of the social equity necessity of accepting additional levels of centralized mandated enlightened management. What should of course consistently strike a discordant note is the mandatory participation component inherent in this entire spectrum of thought.
Simply as a placeholder, let’s begin with a popular source of memorable and profound quotations: “The problem with socialism is that you eventually run out of other people’s money.”—Margaret Thatcher
Social reform is always about mandatory participation, centralized management control and the commensurate reallocation of funding sources necessary to accomplish laudable egalitarian objectives. There is simply a huge and inevitable fiscal price to pay. Understanding the specific source of the need, the newly formed boundaries of the current and future incursion into our personal freedom inherent in that price is the intellectual exercise absolutely necessary of every caring member of our profession. We must all stop now and think very carefully.
I may be repeating this story but it lies at the heart of every column I have ever written. My grandfather died in 1976. My father was president of Guardsman Life and I was a learning disabilities teacher growing organic vegetables in rural Iowa. We both flew to Houston to help sort things out. My grandmother had arrived from England in the womb in 1898 and somehow had maintained very British mannerisms. She had a reserved and proper no-nonsense demeanor. She however was suffering from COPD. At breakfast with just the three of us, my father had on his best selling shoes and was strongly promoting a nearby condo that had a nurse on staff. Rudy Hagelman was a legendary closer. I was quietly eating my raisin bran and enjoying the show. When dad had exhausted his argument my grandmother set up even straighter and burned into my mind and my future in this profession the following: “Son, the garbage picks up on Tuesdays and Fridays. When the time comes, you may set me out. I will not be leaving this house!”
I will not engage in the national inoculation debate. I do believe science ultimately holds most of those cards. What we should all find disturbing is the consistent drum beat of “mandated social insurance compliance.” Insurance is about personal free will, personal choice and personal responsibility.
My grandmother got it all correct even though it drained her savings and the equity in her home.
The outlines of our brave new world are beginning to crystalize:
- According to a recent survey from LeadingAge, a group of nonprofit providers of aging services: “85 percent of Americans agree that now is the right time to think about building a better aging services system. Eighty-six percent say the government must make a bigger investment in services and care for older Americans.”
- Our President recently gave a speech to promote his pending “social infrastructure” legislation as he left for a global environmental summit in Scotland. The first argument from his lips was the need for expanded health care services at home. Please recognize that the proposed expansion of Medicare and Medicaid for the purpose of enhanced home care services is the majority of healthcare costs embedded in this potentially historic legislation.
- COVID has shifted the conversation permanently from institutional care solutions to care at home.
- The Washington Cares Act may end up being remembered as reminiscent of the emotions and conclusions of the Boston Tea Party. Governmental coercion based on new mandatory employment taxes leading to enhanced bureaucratic management control. We have seen one obvious fact that should not have escaped any of us. If exposed to the real possibility of having to pay for your own care is present, consumers will take action. Was what happened in Washington State coercion or incentive?
- The recent application avalanche in the Pacific Northwest should have reinforced this most basic of all insurance principals. As an example, I can’t help thinking Steve Moses’ thoughts on exposing home equity to long term care costs would solve the long term care insurance conundrum overnight.
The only care I want managed is equity of access.
Other than that I have no opinion on the subject.
