No lessons or lectures or clever turns of phrase this evening. It's been a rough day. I've been off for a few weeks now, ever since we got back from my college reunion. That was sort of the end point of a very busy six months, during which I'd been pretty disciplined and focused. The weeks since have been a mess.
When I have smaller projects to do, I'm pretty good about setting schedules and making progress. In their absence, I'm left with the big project. I created a Facebook page for our little experiment here in Middletown, which makes it look like there's "stuff" going on when there isn't - at least not in the traditional understanding of "stuff."
There's a lot happening. We're becoming really good friends with some of the people who live right around us. That is awesome. It's what we came here to do. There's also a hodgepodge of local organizations and causes I've been able to be involved with on some level - people and groups doing good things for our town.
Still there's been little cohesion. I tend to look at things from the big picture. Our place in the world is to participate in the good God is doing around us - to live into "the Kingdom" - this crazy new way of living that Jesus introduced and that continues to emerge. I want to live a lifestyle that exemplifies some of the core foundations of that Kingdom - the dignity and value of all people for their own sake; radical love, compassion, and forgiveness; reconciliation and peace-building. I really do believe we have to get along with one another - not because we really need to do it, although we do, but because the whole of eternity is us, all of us, living together in love. It's an eternity I think we need to practice now.
That beings said, some things are really missing from my life.
I haven't had friends - real, deep, hang out on a regular basis and completely relax around friends - in a long time. I have a lot of people I know pretty well, people I like and whose company I enjoy - good neighbors who are becoming friends more and more each day - but it's difficult to move beyond the superficial to the real in those relationships and I'm terrible at it to begin with. I never know quite how to read a friendship and say what's appropriate at the right times - I also (despite my plethora of pronouncements and opinions) have a pretty dim view of myself as a person. I need affirmation more often than you'd expect and I just don't often feel I have much to offer in terms of friendship that people really want.
I am not all that down on my life. I really believe in why we're here in Middletown. I love my family and I enjoy most of every day. Yes, I am an extreme introvert and I could probably get along just fine holed up in the house all day every day scouring the internet for more and more information (random and otherwise). Technically, I could live a rather contented life that way.
The problem is that Kingdom impulse again. I do have this innate belief that life is more than just contentment, more than just getting by. I firmly believe we're meant for something. Life has purpose.
I've been recognizing lately (and especially today) that all the proper intellectual commitments in the world mean nothing if they're not being lived out amongst friends. It is in the cauldron of relationships that life happens - in the midst of our messiness and insecurities and awkwardness and inadequacies that we really do live out whatever it is we believe.
I am a pastor a minister and so "ministry" is sort of what I'm supposed to do. There are a lot of perspectives on what that means, but usually it entails doing some series of actions for a specific purpose - preaching or praying or serving or singing (usually among friends, but directed towards strangers) for the purpose of making more Christians.
I'll be honest. I'm not really in the mood to talk about God or life with people I'm not friends with. By that I mean the longer I live and the more I think about it, I'm tired of talking about important things with people I barely know. When that happens, the things we know, the opinions we form, the subjects of our conversations become the central element of the relationship, rather than the relationship itself. The way we view and care for one another should be paramount. Watching out for each other, welcoming each other, supporting each other despite our failures and disagreements - that should be the baseline, bedrock foundation of not just relationships, but life itself.
To me that's "ministry." It's really just life: treating the people around you like family. It means making sure your friends know they're your friends, no matter how crazy they turn out to be (and hoping that commitment works both ways).
So, for those who live near me - those people in my life on an almost daily basis - if you're still reading this far into the post, take this as an invitation to be as real as you want to be (or even more real than that). I need people in my life to talk about big things with - life and love and pain and fear and God and depression and whatever - and I'm not always the best at starting conversations.
I'd love to have regular (not necessarily scheduled) time to sit down and talk with people who want to talk about real things, important things. I need that to stay sane. I really do.
I also need people who like playing RISK or Trivial Pursuit or all those other games that take hours to play and normal people despise. And people who are equally excited about the World Cup or the Winter Olympics or any of the other odd sports I happen to like. And just for the record, those don't all have to be the same people.
Above all I need people who will prioritize relationship - see me as me and not a conglomeration of my actions, thoughts, and ideas. I'll do my absolute best to do the same for you.
Wednesday, November 20, 2013
Thursday, November 14, 2013
One Light Still Shines by Marie Monville
Disclaimer: I was given a free copy of this book for the purpose of review. My integrity is not for sale. Those who know me well are aware I would relish the chance to give a bad review in exchange for a free book. If I've failed to do so, it has nothing to do with the source of the material and only with the material itself.
Although she might dislike the characterization, this book is most easily described as the memoir of the wife of the Amish schoolhouse shooting. In reality, it is the compelling narrative of the forced maturation of a young woman in the midst of tragedy. The fact that national attention-capturing tragedy is the catalyst for this transformation is really tangential to the ultimate story, but also the reason it was published in the first place.
The first half of the book is "before" - the tragedy and immediate aftermath through the funeral; the second half is "after" - the process of a family's healing and ultimately the formation of a new family as the author, Marie Monville remarries seven months after her husband's death.
The book wisely and realistically does not dwell on the shooter, Charlie Roberts. His actions, taking hostage and eventually killing a number of young Amish girls in 2006, are so discordant from the man his family knew, there really is no point in dwelling on the why. As the mother of three young kids, Monville is more consumed with coping with he loss of a husband and father.
The depth of loss, grief, and forgiveness are poignant and moving. The narrative starts off with big words and verbose descriptions that sound a bit too professional. Maybe Monville writes this way (this well), but the ghostwriter on the front probably indicates otherwise. Still, the prose is pretty genuine and you get over the polish of it pretty quickly.
A ghostwriter provides a mediated reality. While there is a compelling narrative of personal transformation, the book (any book) creates a character. While the character is expressing the author's views, they are expressed through someone else's perspective. This particular book is hyper-focused on a narrative of hope, that God is faithful in all situations. I would personally be interested in some of the other narratives that run through such a compelling story. I wonder what we're missing.
None of that lessens the value and impact of the book, however, which is a truly powerful story of faith and growth. Monville uses a lot of insider language, things that will make sense to Zondervan's largely evangelical audience, but language that will likely put a barrier between the story and readers who may be coming to the book not for a spiritual treatise, but because of her connection to the Amish shooting and who could potentially benefit from its testimony.
While I've never read any Christian Romance novels, I suspect the second half of the book may look pretty similar. The story of her whirlwind second romance is presented believably, but the choice of words is probably not most effective for a broad audience. Throughout the book the prose can be exhaustive and as a pastor, I have some serious questions about the lengths she goes to explain away her husband's tragedy, still, it's a powerfully candid book from a rare and unique perspective. That value is well worth the extra hundred pages for those interested in ways people face and process difficult situations.
Disclosure of Material Connection: I received this book free from the publisher through the BookSneeze.com® book review bloggers program. I was not required to write a positive review. The opinions I have expressed are my own. I am disclosing this in accordance with the Federal Trade Commission’s 16 CFR, Part 255: “Guides Concerning the Use of Endorsements and Testimonials in Advertising.”
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Tuesday, November 12, 2013
Judgment and Justice
I was reading a passage of scripture the other day - one of those places where Jesus talks about judgment - you know, separating the good and the bad at the end of the age. Heaven and Hell stuff, for a lack of some better terms.
These passages often terrify and/or anger people. I'll admit I'm still occasionally scared that I won't measure up to God's sense of justice, which is, I suppose, a cut above being constantly scared, so I've got that going for me, which is nice. We always seem to be our toughest critic. I know I beat myself up for not living up to this ideal I've got planted in my head. Yeah, I'm not as terrible as some people, but I'm pretty pathetic most of the time. Sometimes it's tough to think God's going to see me and think, "this is what I'm looking for."
Of course, when I think like that, I'm substituting my own sense of what God's justice should be for what God's justice actually is. We're scared or angry with the concept of judgment because we just assume God is going to get it wrong. We might not think that consciously, but we're so accustomed to what passes for "justice" in the world around us, we just assume justice is not all that close to just. We've seen how tough it is to apply a strict set of expectations across the board without getting someone unfairly convicted. These experiences really throw off our perception of God.
In the end, though, God is going to get it right. That's what justice means. Just because what appears to be justice in our world is often wrong or corrupt or unfair, does not mean "justice" in general behaves that way. It's a bit of a nebulous concept and there's some measure of circular logic involved: God will get judgment right... why... because God is the kind of person who gets judgment right.
That's just how it work, though, at least in the intellectual exercise of predicting the future. I'm not sure of the details, of course, but I suspect real judgment and real justice are more about relationship than rules and laws. We humans have this innate desire to treat everyone as if we're all the same. The same crimes deserve the same punishments, every kid gets the same education, every person in the same job deserves the same pay. That kind of thing.
We're all different, though. And while we humans may not be able to appreciate the full nuances of our fellow human beings, I suspect God will. In the end, I don't believe anyone will have any problems with where they end up.* People who don't end up in heaven will really not want to be there.
That's not to say hell is an enjoyable place, but I suspect the misery of heaven could be worse than the misery of hell, to the right kind of person anyway.
It's not just paradise vs punishment after all. That stuff comes from popular religion, weak generalizations, and our tendency to make our theology reflect our culture and not the other way around. If you read scripture closely, heaven is not "whatever you love best in the world," it's not a self-indulgent, individualized Utopia. It's just not like that.
I'm not sure exactly what it is like. I'm not someone from one reality can fully appreciate another. Between here and now, something changes. I can make a lot of guesses, but they won't really get us anywhere. Whatever happens, it's going to be what we deserve and we're all going to be ok with that. I imagine, in some form, our future is going to be an extension of our present. That's why it seems pretty imperative to get our present right.
There's a lot of be said about what exactly those options are - heaven, new creation, hell, annihilation, etc - but for the purposes here we're going to say heaven and hell in the classical sense.
These passages often terrify and/or anger people. I'll admit I'm still occasionally scared that I won't measure up to God's sense of justice, which is, I suppose, a cut above being constantly scared, so I've got that going for me, which is nice. We always seem to be our toughest critic. I know I beat myself up for not living up to this ideal I've got planted in my head. Yeah, I'm not as terrible as some people, but I'm pretty pathetic most of the time. Sometimes it's tough to think God's going to see me and think, "this is what I'm looking for."
Of course, when I think like that, I'm substituting my own sense of what God's justice should be for what God's justice actually is. We're scared or angry with the concept of judgment because we just assume God is going to get it wrong. We might not think that consciously, but we're so accustomed to what passes for "justice" in the world around us, we just assume justice is not all that close to just. We've seen how tough it is to apply a strict set of expectations across the board without getting someone unfairly convicted. These experiences really throw off our perception of God.
In the end, though, God is going to get it right. That's what justice means. Just because what appears to be justice in our world is often wrong or corrupt or unfair, does not mean "justice" in general behaves that way. It's a bit of a nebulous concept and there's some measure of circular logic involved: God will get judgment right... why... because God is the kind of person who gets judgment right.
That's just how it work, though, at least in the intellectual exercise of predicting the future. I'm not sure of the details, of course, but I suspect real judgment and real justice are more about relationship than rules and laws. We humans have this innate desire to treat everyone as if we're all the same. The same crimes deserve the same punishments, every kid gets the same education, every person in the same job deserves the same pay. That kind of thing.
We're all different, though. And while we humans may not be able to appreciate the full nuances of our fellow human beings, I suspect God will. In the end, I don't believe anyone will have any problems with where they end up.* People who don't end up in heaven will really not want to be there.
That's not to say hell is an enjoyable place, but I suspect the misery of heaven could be worse than the misery of hell, to the right kind of person anyway.
It's not just paradise vs punishment after all. That stuff comes from popular religion, weak generalizations, and our tendency to make our theology reflect our culture and not the other way around. If you read scripture closely, heaven is not "whatever you love best in the world," it's not a self-indulgent, individualized Utopia. It's just not like that.
I'm not sure exactly what it is like. I'm not someone from one reality can fully appreciate another. Between here and now, something changes. I can make a lot of guesses, but they won't really get us anywhere. Whatever happens, it's going to be what we deserve and we're all going to be ok with that. I imagine, in some form, our future is going to be an extension of our present. That's why it seems pretty imperative to get our present right.
There's a lot of be said about what exactly those options are - heaven, new creation, hell, annihilation, etc - but for the purposes here we're going to say heaven and hell in the classical sense.
Thursday, November 07, 2013
The Wasted Seed
So I've been trying to put some semblance of order back into my life lately (it's gotten a bit discombobulated). Most mornings I've been picking out a few of the Daily Office passages and taking some time to rest and relax before embarking on the business of the day. As a result, you might actually get a few more calm, devotional-type posts here once in a while.
Last week sometime I was reading Jesus' parable of the sower and the seeds. The narrative is of a sower, scattering seed; it falls among rocks, thorns, packed ground, and actual good, tilled soil. When you get towards the end, Jesus explains what it means to those who really want to know.
For most of my life I've been shaped by the evangelical church in the US. It tends to emphasize spiritual success. Make converts, sin less, be good, do better. This particular parable is usually a cautionary tale in the way I've been formed. Most of the seed ends up wasted. Birds come and get it, it withers from weak roots, the weeds choke it out. Don't be like that bad soil. Be the good soil. Grow. Make more Christians. Be fruitful. Produce!
It's sort of depressing, honestly.
Anyway, I sort of had a realization last week. God doesn't waste seed. There may be some theological streams that tell you some people are destined to fail - that God throws seed their direction, but knows nothing will come of it. I just don't believe that. God doesn't waste seed.
I mean, it's not like soil gets to choose where it sits. There's nothing dirt can do to make itself more amenable to growing things. It's just dirt. (Any good Biblical scholars among you will be recognizing the connection here about now, if you have not already. If you still have not - look here - that is all the help you get.)
I'm going to out on a limb here and say most of the people I know, most of the Christians I know, if they're really honest and look at their lives, it's tough to claim they're producing a hundred, sixty, or thirty times what was sown. That's miraculous numbers. If I'm gardening, I would be ecstatic if my crop produced double. That would be a dream come true. As far as biology goes, I think most seeds generally produce what was sown. If you're lucky you get one plant from one seed. Very rarely do you see a hundred plants growing from one seed. I'm not even sure where there would be room for all of them.
Regardless, I'm not that soil. The one that gets the good seed. That's not me. I have a sneaking suspicion it's not you either. The seeds on the rocky soil, the path, and among the weeds, the wasted seed - that's me. That's my kind of soil.
I'm the seed that gets stolen away. The seed so distracted by my own junk, I fail to see hurting people around me. My seed is careless and thoughtless and obtuse a lot of the time. I fold under persecution and I give up when things get too tough. My seed is filled often times with doubt that any seed, any soil is really good deep down. Sometimes I'm not sure anything will ever grow anywhere at all. My seed is envious of everything that looks better, smarter, easier, more successful than me.
I live my life among the wasted seed.
But God doesn't waste seed. If it's falling in my direction, it's doing so for a purpose. I feel a bit daft for seeing this parable as bad news. The only people for whom Jesus has bad news are the ones who are already convinced they're the good soil. The bad soil is still getting seed - and getting a lot of it. The sower keeps sowing where there's little chance of growth.
If there's one thing I know about the Kingdom of God, it's that things in the Kingdom don't quite work the way they seem to work in the rest of the world. That term itself is loaded, but essentially the Kingdom of God refers to those places where things work as God desires them to work, where justice is done, peace reigns, and people are loved and respected not for what they do, but just because they're people. The Kingdom of God is a place where love wins.
In this rambling parable of an analogy, the seed is the Kingdom. We may not always see it breaking through all the time - it only hits the good soil once in a while - but it keeps coming. And instead of the bad soil corrupting the seed, keeping it from becoming all it can be, well the Kingdom seed works the other way around. The seed makes the soil better.
Yes, there are times when I fail, when I forget and reject and refuse to follow the Kingdom way of love. There are times when the world beats me down. Or my lack of discipline holds me back. Or the demons in my life rear their ugly heads. But those seeds I waste, they're not the only seeds I'm going to get. The love keeps coming. The Kingdom continues to break through. And, believe it or not, those seeds are changing me. Very likely - no, absolutely, the Kingdom is coming in me in ways I just can't see. I suspect it will continue to do so, so long as I still care enough to worry about it.
You see, God doesn't waste seed. There's nothing the soil can do to make itself better. It's just dirt. It's the sower who comes along and works the ground and spreads the seed. It is love that makes something beautiful out of our lives.
Last week sometime I was reading Jesus' parable of the sower and the seeds. The narrative is of a sower, scattering seed; it falls among rocks, thorns, packed ground, and actual good, tilled soil. When you get towards the end, Jesus explains what it means to those who really want to know.
For most of my life I've been shaped by the evangelical church in the US. It tends to emphasize spiritual success. Make converts, sin less, be good, do better. This particular parable is usually a cautionary tale in the way I've been formed. Most of the seed ends up wasted. Birds come and get it, it withers from weak roots, the weeds choke it out. Don't be like that bad soil. Be the good soil. Grow. Make more Christians. Be fruitful. Produce!
It's sort of depressing, honestly.
Anyway, I sort of had a realization last week. God doesn't waste seed. There may be some theological streams that tell you some people are destined to fail - that God throws seed their direction, but knows nothing will come of it. I just don't believe that. God doesn't waste seed.
I mean, it's not like soil gets to choose where it sits. There's nothing dirt can do to make itself more amenable to growing things. It's just dirt. (Any good Biblical scholars among you will be recognizing the connection here about now, if you have not already. If you still have not - look here - that is all the help you get.)
I'm going to out on a limb here and say most of the people I know, most of the Christians I know, if they're really honest and look at their lives, it's tough to claim they're producing a hundred, sixty, or thirty times what was sown. That's miraculous numbers. If I'm gardening, I would be ecstatic if my crop produced double. That would be a dream come true. As far as biology goes, I think most seeds generally produce what was sown. If you're lucky you get one plant from one seed. Very rarely do you see a hundred plants growing from one seed. I'm not even sure where there would be room for all of them.
Regardless, I'm not that soil. The one that gets the good seed. That's not me. I have a sneaking suspicion it's not you either. The seeds on the rocky soil, the path, and among the weeds, the wasted seed - that's me. That's my kind of soil.
I'm the seed that gets stolen away. The seed so distracted by my own junk, I fail to see hurting people around me. My seed is careless and thoughtless and obtuse a lot of the time. I fold under persecution and I give up when things get too tough. My seed is filled often times with doubt that any seed, any soil is really good deep down. Sometimes I'm not sure anything will ever grow anywhere at all. My seed is envious of everything that looks better, smarter, easier, more successful than me.
I live my life among the wasted seed.
But God doesn't waste seed. If it's falling in my direction, it's doing so for a purpose. I feel a bit daft for seeing this parable as bad news. The only people for whom Jesus has bad news are the ones who are already convinced they're the good soil. The bad soil is still getting seed - and getting a lot of it. The sower keeps sowing where there's little chance of growth.
If there's one thing I know about the Kingdom of God, it's that things in the Kingdom don't quite work the way they seem to work in the rest of the world. That term itself is loaded, but essentially the Kingdom of God refers to those places where things work as God desires them to work, where justice is done, peace reigns, and people are loved and respected not for what they do, but just because they're people. The Kingdom of God is a place where love wins.
In this rambling parable of an analogy, the seed is the Kingdom. We may not always see it breaking through all the time - it only hits the good soil once in a while - but it keeps coming. And instead of the bad soil corrupting the seed, keeping it from becoming all it can be, well the Kingdom seed works the other way around. The seed makes the soil better.
Yes, there are times when I fail, when I forget and reject and refuse to follow the Kingdom way of love. There are times when the world beats me down. Or my lack of discipline holds me back. Or the demons in my life rear their ugly heads. But those seeds I waste, they're not the only seeds I'm going to get. The love keeps coming. The Kingdom continues to break through. And, believe it or not, those seeds are changing me. Very likely - no, absolutely, the Kingdom is coming in me in ways I just can't see. I suspect it will continue to do so, so long as I still care enough to worry about it.
You see, God doesn't waste seed. There's nothing the soil can do to make itself better. It's just dirt. It's the sower who comes along and works the ground and spreads the seed. It is love that makes something beautiful out of our lives.
Tuesday, November 05, 2013
Obamacare?
(Um... I'm allowed to use this picture, right? Seeing as how I have no strong feelings for or against the President? I think it's a funny picture and I appreciate the satire, whether intended or not. I promise.)
So, as I've said many times, I'm no fan or opponent of this particular law. Like any piece of legislation (especially one that never went through a conference committee) it's a jumbled mess. What I am in favor of is the idea that everyone deserves health care at least as good as I expect for my family.
All along I assumed this plan was going to be intentionally unwieldy so that eventually there would be no real political choice but moving to a single payer system. A single payer system has proven, time and again, to be the single most effective, cost efficient means of providing health care around the world.
It is also decidedly unAmerican, especially if you cling to the traditional definition of American, which may or may not come sans its initial 'A.'
Since this whole debate began and I've had a chance to read up on it heavily, I've come to realize that there are likely any number of unique, original systems by which the US can keep its love of choice and competition, yet also provide quality basic care to everyone.
TIME Magazine devoted an entire issue to one such option - having the government 'negotiate' prices the way they do with medicare, but allowing insurance companies to compete for business (essentially competing for lowest overhead). This story proves, contrary to popular perception, that Medicare is both the most effective and efficient delivery system in the US (largely due to the volume of care it provides) and that doctors, as much as they complain about medicare patients and threaten to stop seeing them, almost never do (I believe 97% of doctors accept medicare).
There are other options, but their elucidation is for another time and place - since the Affordable Care Act (ACA, Obamacare) doesn't actually address healthcare directly, but only provides insurance.
We can get the problems out of the way up top. First is that whole insurance business. The ACA essentially directs an extra 50 some odd million people into an industry where their presence will do little, if anything to stop the disproportionate rise in costs. Yes, volume will keep costs lower for a time, but the underlying problem of cost inflation remains. Unless the actual cost of care is addressed, it's still kicking the can down the road.
Second, the notion that the government has any say over what plans are offered and which doctors accept which insurance is bunk and sort of mean spirited. Technically, when the President said you can keep your doctor, he was telling the truth. What he didn't mention was that your doctor might not want to keep you. I'm sure its nothing personal, but... you know... these things happen. Likely they have issues with your insurance company, which is not all that difficult to understand. In any event, the President doesn't make decisions for your doctor and he shouldn't have implied he could.
The notion that everyone can keep their plan was also pretty close to an outright lie. The ACA does grandfather in any plan in existence when the law passed. Technically, anyone could keep their plan. However, insurance companies are free to remove plans and make people switch. They do it all the time, law or no law. In this case, moving people to more expensive plans with greater coverage (even if often it costs people less, due to subsidies) makes them more money - and we all know how insurance companies make decisions; it's not about what's best for the customer, but what's best for the bottom line. (That's the main reason I'm in favor of a non-profit health system; it's not perfect, but at least my health isn't taking a back seat to money).
Still, even if the government didn't expect all those grandfathered plans to be dropped right away, for about 3 million people, there is and was a 100% absolute inevitability of having to switch plans - if not this year, then next. The ACA includes a minimum coverage requirement, and the whole idea of "grandfathering" anything means you expect it to eventually go away. They could have been more up front about these realities, but then, of course, there was a chance the bill wouldn't pass. I haven't read the fine print in one of those termination letters, but I imagine the insurance companies aren't going out of their way to vindicate the President and take blame on themselves either.
It's a messy system.
It's easy enough to argue that people on these cheap, bare-cones plans were either taking a huge risk or throwing money away on policies that would have bankrupted them anyway if they had a medical emergency - but the truth is, they weren't told anything clearly up front and this comes as a surprise to most simply because no one was willing to name the hard truth openly and honestly. That is not fair.
Now to provide a little context:
150 million Americans have insurance provided by an employer of some kind, about 50% of the population. An additional 100 million are on either medicare (for those over 65) or medicaid (for those with very little money). There are about 45 million people with no insurance at all, which leaves roughly (and these are very rough numbers) about 15-20 million people buying insurance individually.
It is this last cohort who is really the focus of the ACA. This number may grow a small amount with some very small businesses ending health coverage as a benefit (although businesses with less than 25 employees can get pretty generous tax credits - 35% the first year, 50% afterwards - for continuing to offer coverage). The vast majority of Americans will see no change.
For those 15-20 million people, though, things will get a little dicey. The fact that 45 million other people without insurance may now have access to it, while important in the grand scheme of things, is no comfort to those undergoing upheaval.
In the end, older people (those in the few years before medicare eligibility) are going to come out pretty solid in the process. The ACA limits their premium costs to three times those of healthy 26 year olds (that's way less than most of these people are paying now). The cost for those 26 year olds will be going up. However, most of them have never had insurance anyway, so they don't realize they could have been getting it cheaper all along. The people (and especially families) in the middle, will likely be paying more.
The subsidies will help in some areas (families making under $25,000 a year likely won't pay anything at all), and help less in others (target expenses as a percentage of income are not fixed rules, so some people are just going to be exceptions and pay above 9.5% of their income).
In the end, more people will be covered for more things - and the speculation about outcomes (both positive and negative) is really just speculation until things begin to hash themselves out. I'd imagine 2015 is really when we can start to take stock of what's right and wrong with the ACA.
Yes, people will complain about health coverage. Some might even wish for their previous plan. Although, I think it's a near-universal maxim: "If you're happy with your health insurance, you're probably not using it very much."
The cost side of things is still perilous. As I said, I've been pretty skeptical that this plan was even intended to work out fiscally, let alone could meet projections. There are problems - like states with only one or two insurers entering the marketplace and large insurers avoiding them altogether - but initial premiums are coming in, on average, 16% below what even the White House predicted in selling the bill. That gives me pause to at least see where things are going.
There's also a real possibility for improvement. Assuming some section of the GOP embraces pragmatism in the next couple years, there might be space for reform - to eliminate the obvious problems (like 80 year old single men having pregnancy coverage)* and address future issues (like the aforementioned cost issues).
As for my personal views, well, here is a comment I posted on a friend's Facebook status during the gov't shutdown. I think that sums it up pretty well:
Two final thoughts:
The failure of the ACA website is embarrassing and shameful. Even for those who can separate the law from its implementation, it is a disaster. The Medicare Part D prescription drug plan rolled out during the second Bush administration is a nearly identical system. Yes, there is a difference between a system run and accessed by gov't and insurance company employees exclusively (as in Part D) from one accessed by the public (the ACA), but not enough difference that you can't learn from past mistakes. You've pretty much lost the argument forever with those people who don't trust the government to "manage healthcare." Even though there's really no management of healthcare involved in the ACA, you have to admit, screwing up a website does not bode well for the future - maybe you can get away with it in 1998, but not in 2013.
Lastly, to those small business owners who are stopping health coverage and NOT giving employees the money you've been spending on their healthcare to help offset their new coverage:
(I'm just clenching my jaw and shaking my head; I really have no idea what to say to you people. For shame! There may be every reason to stop offering coverage, using it as an excuse to cut labor costs is downright cold-hearted.)
To sum it all up: I'm glad more people are getting coverage. I am sorry some people are overwhelmed by the changes. I hope they improve this over time. My family is blessed to pay very little for very good insurance, but I'd gladly pay more if it meant other people could have better care.
*I get the outrage at mandatory pregnancy coverage. For a while I was on an individual plan that was very cheap precisely because I didn't need pregnancy coverage - my plan was about a fourth the cost of a similar one for females. This mandate was clearly a way to keep government costs down. By including everyone in the burden of paying for pregnancies, the costs are spread equally to everyone - those getting the subsidies and those not, but the women most likely to get pregnant are disproportionately getting subsidies, so this move saves the government money.
I've also wondered why my staunchly pro-life evangelical friends are so upset by this. Covering everyone for pregnancy means that there will be fewer abortions. That's just cold, hard facts. Any woman who had cost as a consideration will no longer have that consideration. I consider it good news - and something I'm willing to pay extra to support.
So, as I've said many times, I'm no fan or opponent of this particular law. Like any piece of legislation (especially one that never went through a conference committee) it's a jumbled mess. What I am in favor of is the idea that everyone deserves health care at least as good as I expect for my family.
All along I assumed this plan was going to be intentionally unwieldy so that eventually there would be no real political choice but moving to a single payer system. A single payer system has proven, time and again, to be the single most effective, cost efficient means of providing health care around the world.
It is also decidedly unAmerican, especially if you cling to the traditional definition of American, which may or may not come sans its initial 'A.'
Since this whole debate began and I've had a chance to read up on it heavily, I've come to realize that there are likely any number of unique, original systems by which the US can keep its love of choice and competition, yet also provide quality basic care to everyone.
TIME Magazine devoted an entire issue to one such option - having the government 'negotiate' prices the way they do with medicare, but allowing insurance companies to compete for business (essentially competing for lowest overhead). This story proves, contrary to popular perception, that Medicare is both the most effective and efficient delivery system in the US (largely due to the volume of care it provides) and that doctors, as much as they complain about medicare patients and threaten to stop seeing them, almost never do (I believe 97% of doctors accept medicare).
There are other options, but their elucidation is for another time and place - since the Affordable Care Act (ACA, Obamacare) doesn't actually address healthcare directly, but only provides insurance.
We can get the problems out of the way up top. First is that whole insurance business. The ACA essentially directs an extra 50 some odd million people into an industry where their presence will do little, if anything to stop the disproportionate rise in costs. Yes, volume will keep costs lower for a time, but the underlying problem of cost inflation remains. Unless the actual cost of care is addressed, it's still kicking the can down the road.
Second, the notion that the government has any say over what plans are offered and which doctors accept which insurance is bunk and sort of mean spirited. Technically, when the President said you can keep your doctor, he was telling the truth. What he didn't mention was that your doctor might not want to keep you. I'm sure its nothing personal, but... you know... these things happen. Likely they have issues with your insurance company, which is not all that difficult to understand. In any event, the President doesn't make decisions for your doctor and he shouldn't have implied he could.
The notion that everyone can keep their plan was also pretty close to an outright lie. The ACA does grandfather in any plan in existence when the law passed. Technically, anyone could keep their plan. However, insurance companies are free to remove plans and make people switch. They do it all the time, law or no law. In this case, moving people to more expensive plans with greater coverage (even if often it costs people less, due to subsidies) makes them more money - and we all know how insurance companies make decisions; it's not about what's best for the customer, but what's best for the bottom line. (That's the main reason I'm in favor of a non-profit health system; it's not perfect, but at least my health isn't taking a back seat to money).
Still, even if the government didn't expect all those grandfathered plans to be dropped right away, for about 3 million people, there is and was a 100% absolute inevitability of having to switch plans - if not this year, then next. The ACA includes a minimum coverage requirement, and the whole idea of "grandfathering" anything means you expect it to eventually go away. They could have been more up front about these realities, but then, of course, there was a chance the bill wouldn't pass. I haven't read the fine print in one of those termination letters, but I imagine the insurance companies aren't going out of their way to vindicate the President and take blame on themselves either.
It's a messy system.
It's easy enough to argue that people on these cheap, bare-cones plans were either taking a huge risk or throwing money away on policies that would have bankrupted them anyway if they had a medical emergency - but the truth is, they weren't told anything clearly up front and this comes as a surprise to most simply because no one was willing to name the hard truth openly and honestly. That is not fair.
Now to provide a little context:
150 million Americans have insurance provided by an employer of some kind, about 50% of the population. An additional 100 million are on either medicare (for those over 65) or medicaid (for those with very little money). There are about 45 million people with no insurance at all, which leaves roughly (and these are very rough numbers) about 15-20 million people buying insurance individually.
It is this last cohort who is really the focus of the ACA. This number may grow a small amount with some very small businesses ending health coverage as a benefit (although businesses with less than 25 employees can get pretty generous tax credits - 35% the first year, 50% afterwards - for continuing to offer coverage). The vast majority of Americans will see no change.
For those 15-20 million people, though, things will get a little dicey. The fact that 45 million other people without insurance may now have access to it, while important in the grand scheme of things, is no comfort to those undergoing upheaval.
In the end, older people (those in the few years before medicare eligibility) are going to come out pretty solid in the process. The ACA limits their premium costs to three times those of healthy 26 year olds (that's way less than most of these people are paying now). The cost for those 26 year olds will be going up. However, most of them have never had insurance anyway, so they don't realize they could have been getting it cheaper all along. The people (and especially families) in the middle, will likely be paying more.
The subsidies will help in some areas (families making under $25,000 a year likely won't pay anything at all), and help less in others (target expenses as a percentage of income are not fixed rules, so some people are just going to be exceptions and pay above 9.5% of their income).
In the end, more people will be covered for more things - and the speculation about outcomes (both positive and negative) is really just speculation until things begin to hash themselves out. I'd imagine 2015 is really when we can start to take stock of what's right and wrong with the ACA.
Yes, people will complain about health coverage. Some might even wish for their previous plan. Although, I think it's a near-universal maxim: "If you're happy with your health insurance, you're probably not using it very much."
The cost side of things is still perilous. As I said, I've been pretty skeptical that this plan was even intended to work out fiscally, let alone could meet projections. There are problems - like states with only one or two insurers entering the marketplace and large insurers avoiding them altogether - but initial premiums are coming in, on average, 16% below what even the White House predicted in selling the bill. That gives me pause to at least see where things are going.
There's also a real possibility for improvement. Assuming some section of the GOP embraces pragmatism in the next couple years, there might be space for reform - to eliminate the obvious problems (like 80 year old single men having pregnancy coverage)* and address future issues (like the aforementioned cost issues).
As for my personal views, well, here is a comment I posted on a friend's Facebook status during the gov't shutdown. I think that sums it up pretty well:
First, I don't support Obamacare, necessarily. I don't think it's effective or efficient, but I'd prefer moving forward and fixing it, rather that starting over. Already, we're seeing the cost on insurance for people on these exchanges much lower than even the Democrats predicted (16% lower, on average). A lot of my neighbors are getting heath insurance for the first time. There're a lot of problems, for sure, but we won't really know what they are until it's implemented. Second, Congress isn't exempted, like everyone else who has insurance provided by their employers, they don't have to change anything because of it - my family and I fall into the same boat. This is a sneaky trick of the tongue opponents are using to make them seem hypocritical. In fact, no one whose employer covers health care (something like 50% of households in the country) is impacted by this (unless their employer stops providing health care altogether). Now, employers stopping health care altogether is why they've delayed implementation for some. I think that's cowardly and wrong. Some huge corporations have made this work already; I'm not sure why the others can't - mostly it's just greed. Home Depot is moving most of their workers to 29 hours a week so they'll never have to comply. This is one of the problems with the law - there's not really a good way to balance public and private funding of healthcare, especially for low-wage workers. Essentially handing free business to insurance companies, which is the foundation of the ACA, is a terrible idea, in my estimation; I'd frankly love to see alternatives proposed, yet the GOP leadership (definitely separate from the GOP itself) refuses to do anything, but look backward. Moderate Republicans in the House have worked on bills that could get majority support (with the help of Moderate Democrats), but Boehner and company won't let them come to the floor because the Conservative wing of the party dominates. They're preventing compromise by making demands the majority of the Congress doesn't agree with. I think the GOP has a really unique place to play in making healthcare work in this country, but the members who really care about improving things are being drowned out by obstructionists.
Two final thoughts:
The failure of the ACA website is embarrassing and shameful. Even for those who can separate the law from its implementation, it is a disaster. The Medicare Part D prescription drug plan rolled out during the second Bush administration is a nearly identical system. Yes, there is a difference between a system run and accessed by gov't and insurance company employees exclusively (as in Part D) from one accessed by the public (the ACA), but not enough difference that you can't learn from past mistakes. You've pretty much lost the argument forever with those people who don't trust the government to "manage healthcare." Even though there's really no management of healthcare involved in the ACA, you have to admit, screwing up a website does not bode well for the future - maybe you can get away with it in 1998, but not in 2013.
Lastly, to those small business owners who are stopping health coverage and NOT giving employees the money you've been spending on their healthcare to help offset their new coverage:
(I'm just clenching my jaw and shaking my head; I really have no idea what to say to you people. For shame! There may be every reason to stop offering coverage, using it as an excuse to cut labor costs is downright cold-hearted.)
To sum it all up: I'm glad more people are getting coverage. I am sorry some people are overwhelmed by the changes. I hope they improve this over time. My family is blessed to pay very little for very good insurance, but I'd gladly pay more if it meant other people could have better care.
*I get the outrage at mandatory pregnancy coverage. For a while I was on an individual plan that was very cheap precisely because I didn't need pregnancy coverage - my plan was about a fourth the cost of a similar one for females. This mandate was clearly a way to keep government costs down. By including everyone in the burden of paying for pregnancies, the costs are spread equally to everyone - those getting the subsidies and those not, but the women most likely to get pregnant are disproportionately getting subsidies, so this move saves the government money.
I've also wondered why my staunchly pro-life evangelical friends are so upset by this. Covering everyone for pregnancy means that there will be fewer abortions. That's just cold, hard facts. Any woman who had cost as a consideration will no longer have that consideration. I consider it good news - and something I'm willing to pay extra to support.
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