Thursday, January 21, 2010

Health Care Revisited Part 1.

As some of you may know, my "day" job is as a computer programmer for Dell Perot Systems (Perot Systems was purchased by Dell last October). I work in our Health Care area and I work with Health Insurance companies, designing and writing programs for our Claims Payment and Premium Billing system, Xcelys. I've been working in the payer side of health care for 13 years now.

Now when we talk about Health Care Reform, we are not talking about reforming health care in the US. We aren't even talking about reforming how it is delivered. We are talking about how to pay for and ration health care. Now "rationing" is a "bad" word. But as everyone who has taking any courses in economics can tell you, almost everything is rationed one way or another. We ration most things in the US by ability to pay. Not everyone who wants diamonds has them. Only those who have enough money to pay for diamonds have them.

Currently, health care is paid for, primarily, by insurance. The purpose of insurance is risk management. You buy home owners insurance to mitigate the risk of catastrophic loss because of damage to your home. You don't buy home owners insurance to fix a leaky toilet or replace the filters on your air conditioner/heater. We don't buy insurance to pay for someone to cut our grass or even trim our trees. Those things are considered normal costs of owning a home.

One of the problems with health insurance is that we ask too much of it and we are using it for too many things. I submit that there are three types of health care
  1. Primary Care - this is the normal health care that we receive. It is doctors visits for routine physicals and immunizations or when you get the flu or a cold. I don't believe that insurance should cover this type of care. Covering primary care is like asking your car insurance to pay for oil changes or tune ups.
  2. Catastrophic Care - this consists of things that are rare, but expensive when they happen. Examples could be specialized tests or surgery or trips to the emergency room or catastrophic illnesses like cancer. These cannot be planned for on an individual basis
  3. Chronic Care - this consists of chronic diseases such as diabetes or asthma or even some mental illnesses. Maintenance care for these diseases is necessary and relatively inexpensive, but it can grow to be very expensive and, if the maintenance care is not received, the chronic disease will turn into a catastrophic one. Some form of payment sharing should be done by insurance because both parties have a strong interest in avoiding the costs of catastrophic care.

My next post will concern other impacts to the costs of delivering health care such as defensive medicine and legal fees as well as the friction costs of insurance and how we can reduce them.


Phil Snyder

Monday, January 18, 2010

The Confession of St. Peter

Today is the Feast of the Confession of Saint Peter the Apostle. Today, we remember Peter's confession "You are the Christ, the Son of the living God." (Matt 16:16). His answer comes to the most important question we will ever face? "But who do you say that I (Jesus) am?"

To put this in a bit of context, Jesus starts by asking what seems to be a theoretical question: "Who do people say that the Son of Man is?" Jesus is not directly about himself here. He seems to be asking what appears to be some "coffee hour" question. When the Son of Man comes, what are people expecting? The various answers are John the Baptist, Elijah, Jeremiah, or one of the prophets. The people were expecting some form of strong and forceful person as the Son of Man.

After listening to what the people were expecting, Jesus asks, "But who do you say that I am?" This is where Peter, inspired by God, answers.

Now, what did Peter mean by "You are the Christ, the Son of the living God?" Well, I don't think he fully understood what he was saying. I believe that Peter was still thinking in terms of a "traditional" Messiah (Christ) who would throw out the hated Romans, reform the Jewish state and restore the Kingship of David. For evidence of this, simply read the rest of the Gospels and look at how often Peter puts his foot in his mouth. Heck, right after saying this, he goes so far as to contradict Jesus when Jesus says that he will have to die and then be raised on the third day (Matt 16:21-24).

So, who do you say that Jesus is?

The Church answers this question with two words: "Savior" and "Lord."

Jesus is our Savior. Americans don't like to hear that we have a Savior, let alone that we need one. We are the people of the Self Made Man. We are the people that pulled ourselves up by our boot straps. We are the people of John Wayne and Gary Cooper at High Noon. We are the rugged individualist. If Pelagius lived in the 20th or 21st century, he would be an American. But we need a Savior! We cannot save ourselves, no matter how hard we try. Jesus is that Savior. He saves us from the power of sin and death. By submitting to the ultimate that sin could dish out, Jesus defeats sin and death and we participate in that victory through our baptism and our life in Jesus Christ. We need Jesus like we need oxygen or water.

Jesus asks you "Who do you say that I am?" I pray that you answer: "You are my Savior. I need you.?"

Jesus in our Lord. If Americans don't like to hear that we need a savior, we even less like to hear that we need a Lord. After all, we are all little lords in our own homes. It seems that our national motto is "You aren't the boss of me!" (Witness TEC's answers to the Anglican Communion.) If we admit that we can't save ourselves, we also must admit that we cannot make the decisions in our lives that lead to salvation or lead to union with God through Jesus Christ. We need direction. We need someone to help us know what to do, when to do it, and how to do it? We need a Lord. This does not mean that we live an escapist life where we make no decisions. A large part of the Christian life is coming to know God so well that we make the right decisions by habit and by nature. We can only have God's law and will written on our hearts if we let God do that. By our fallen nature, our hearts are inclined away from God. We need a Lord to bring our hearts and our wills back to the state that God desires.

Jesus asks you "Who do you say that I am?" I pray that you will answer: "You are my Lord. I will follow you."

Jesus is our Savior and our Lord. He saves us from sin and death and leads us to know the Will of God and provides us direction in our lives to know God's will and the strength (through Grace) to do it.

Phil Snyder

Tuesday, January 12, 2010

J. I. Packer and Catechesis

I had a wonderful "Godincidence" (a "coincidence" that can be attributed to God) this weekend. Dr. J. I. Packer (the author of Knowing God and other books) came to town for the Bishop Stanton lecture. Normally this takes place in November, but this was how the schedule worked out.

Anyway, Dr. Packer's latest crusade is for improved catechesis - instruction in the faith. This is something that the Episcopal Church has done poorly for several decades. We seem to operate under the notion that everyone is already a Christian and they don't need instruction. This is something that I feel very strongly about. We don't seem to care about Christian Education - particularly for adults! We operate as if the Catechism class is where you "graduate" and you don't have to be in Sunday School any more.

Now one of my duties at St. James is to teach our Catechsism class every year. I normally do a combined youth and adult class and I refuse to talk down to the young people. The class is about 1/2 lecture and 1/2 small group discussion - with adults and kids sitting in the same groups.

The "Godincidence" is that my Catechism class started last Sunday (Jan 10th) - the day after Dr. Packer's lecture!

Anyway, here is what we cover in the class
1. Who is God - the Father
2. Who is God - Jesus, the Son
3. Who is God - the Holy Spirt and the Trinity
4. Who are we?
5. What is our goal? (To live a life filled with and powered by God's Grace)
6. Where do we live the life of Grace? - The Church
7. How do we live the life of Grace? - by Faith.
8. What is this faith? The Baptismal Covenant
9. What is this faith? The Nicene Creed
10. How do we grow in faith and grace? - Prayer
11. How do we grow in faith and grace? - Study
12. How do we grow in faith and grace? - Ministry
13. How do we grow in faith and grace? - Sacraments
14. What obstacles can we expect in our life? Sin (and overcoming obstacles)
15. Sin and Virtue (APESLAG, and FHL Time For Prune Juice)
16. How is the Parish and Church structured?

Anyway, that is my basic outline. I will be teaching the class from now until Trinity Sunday when our Bishop will come to confirm.

Please pray for me and for the class.

Phil Snyder

Thursday, January 07, 2010

Perception and Reality

One of the phrases I loathe in today's business and social world is "Perception is Reality." Today, Matt Kennedy published a story on Stand Firm about the definition of "faithfulness" and it brought this problem to mind.

One of the tenents of post-modernism is that every person has their own meaning for words and, so, the only thing that really matters is what the reader or listener understand the meaning to be - that the author's intent should not be attended to or it should be secondary to the listener's/reader's understanding. The first part of that statement is true. We all have, because of our experiences, our own shading on the meanings of words - particularly words with religious significant such as "faithfulness." However, the second statement - that the author's intent should be seconded to one's understanding does not follow. The author's intent and meaning should be what drives the conversation, not the reader's understanding.

I believe that this is a problem that comes up from "perception is reality" thinking. It is true that we act on our own perception of reality. But that does not mean that our perception is reality. Reality is reality and our perception is always faulty.

In religious terms, the difference between Reality and our perception is commonly called "sin." If I perceive that marital faithfullness is not broken unless I have sexual intercourse outside of marriage and I then have several female friends where we perform oral sex on each other, then I do not perceive that I have sinned, but I still have sinned. My perception did not match reality. Even if my wife agrees with me, I still have sinned. I submit that the majority of our sins are committed because we truly do not and cannot perceive reality. But we still sin.

So, how do we come to perceive reality more truly? Some submit that this is a problem of knowledge. We simply need to be instructed in what the right is and then we will do it. Some submit that this is a problem of our nature and we should just accept that we are all just human and we should support and bless those who are being faithful to their perceived reality.

I say that it is a matter of our will and not our minds. Our wills are so twisted that we cannot know reality - even when we are educated about it. Our will reject reality in favor of our perception. The way to solve this is not just education (although education can be a part of it). We need to have our wills destroyed and remade. This is the process of sanctification or theosis. This is the process of developing our conscience (with knowledge) and submission of our wills to God's will. So, how do we know God's will? Well, as individuals it is very hard to know God's will. God's voice sounds an aweful lot like our own when we are by ourselves. We have to listen to what God has said in the past (Scripture and Tradition) and listen to what the Church says now (Reason).

The second answer (just accept that we are sinful and then bless people when they are being true to their perception) denies that there really is sin. It makes Jesus' sacrifice on the cross meaningless and empties the Resurrection of its power. We cannot bless sinful behavior - no matter how well meaning the behavior is.

Perception is not reality. Reality is reality. We need to pray and study and submit so that we can see reality more clearly. Changing our perception to match Reality is not so much a problem of the mind. It is a problem of the will. We need "to die daily to sin" so that we can perceive reality.

Phil Snyder