Tuesday, July 22, 2008

The Age of a Child

As someone who is both a consumer of healthcare, and employed by the industry I'm very interested in the future of our healthcare system, and the ongoing debate about how to reform it. How can you get better healthcare to everyone at a price that's affordable to consumers and our government?

I know I'm in the minority here, but sometimes I find myself irritated with the media for presenting such an incomplete description of the problems with our system. I'm not here to defend insurance companies, but I will say that our nation's healthcare crisis isn't something that was single-handedly created by insurers. I believe that lawyers, providers, consumers, and even "advocates" have a hand in exacerbating our problems.

So you know why I'm interested in healthcare, but what's my point? Well, I've made a few observations about some of our public policy and I have a theory I'd like to test on you. (Yes, I realize this boring editorial may scare off my few precious readers, but I'm gonna go for it anyway.)

Well here's my theory: The way we currently define a "child" is costly. By creating a consistent definition, there could be cost-savings and other benefits.

Wow .... that's a mighty deep thought for first thing on a Tuesday morning, eh??

Indulge me, pretty please, for a moment while I share a few observations:
  • Driving age -- 16 (set by the states, but I think this is pretty much the standard)
  • Legal age to join the military -- 18 (or 17 with parental consent)
  • Legal age to drink -- 21 (again, set by states, but 21 is the norm)
  • Age considered a "child" for statutory rape -- 17
  • Age at which an individual can file for emancipation from parents -- 16
  • Age considered a "child" for the purpose of establishing Medicaid benefit packages and requirements for child services -- 21
  • Age to vote - 18
I could go on, but I think I've made a point that the way we define a "child" is all over the place. And in some cases it looks like we tend to pick an age that is most favorable to the child .... from a child's point of view. Not necessarily what is best for the person as a whole or the rest of society.

Let's give you a car at 16, but we'll consider you a "child" for another 5 years for the purposes of your entitlements in the health and welfare system.

Then there's the age old debate -- you can go fight and die for our country at 17/18, but you can't legally drink a beer until you're 21. Doesn't favor the "child", but doesn't exactly make sense either.

What does this have to do with reforming our healthcare system? Well, what made me want to write about this was a review of one presidential candidate's views on healthcare, and what he would do to reform our system. (And I'm neither endorsing nor taking a pot shot at either candidate.) Someone is proposing mandated coverage for "children " up to the age of 25.

25 !?!?!?! Holy camoly? There's a new one!!! When I saw the number 25, I kinda flipped out. (in my head, of course. I don't do real back-flips anymore.)

Has anyone thought about the impact of picking a number like 25 ... say, over a number like 21 or 23 or 16 or any other number? Based on my experience in working with public health programs, I can tell you that "children" are entitled to just about any service they want or need, and there is hardly a limit. The public health and welfare system is like a big ole endless pu pu platter for anyone defined as a child.

Now, before you start thinking I'm some kind of monster who doesn't like kids, or you think I derive a sadistic pleasure from denying and limiting healthcare services, I can assure you that's not the case. However, I do take my responsibility as a steward of the public tax dollar very seriously. It pisses me off to see waste, not to mention fraud or abuse. It also pisses me off to know there are 50M people in this country who don't get any healthcare at all unless they have some threat to life or limb that sends them to the emergency room. Pretty shitty healthcare, eh?
Anyway, benefit packages for the demographic known as "children" -- however you define it -- are vast and virtually unlimited in government-funded programs. "Vast" and "unlimited" are not something that I consider responsible stewardship no matter how old a person is.

Sure, in an ideal world everyone could get unlimited benefits. Everthing you want, and as much as you want of it. Like the free ice cream truck at the company picnic! Yay, wouldn't that be nice?

Unfortunately, the ice cream truck can only hold so much ice cream. So if some pig decides to take 10 ice creams, even though they can only eat 2 ...that means the truck is going to run out sooner and some people probably won't get any ice cream at all. And just because you can eat 2 doesn't mean you should get 2. If you're an adult, someone will likely point out that there's a limit of one per person and you should put back the extra. But if you're a "child", I bet nobody would say anything about going over your allowed amount -- even though it still meant that some other person didn't get any ice cream at all. Is that how things should work? In my book, no. I'm the ice cream steward that would tell the kid to put back his extra ice cream and everybody would think I'm a big ole meanie for telling the kid "no."

Enough of the ice cream analogy, you get my point: the bucket of money available to pay for benefits isn't endless, so we need things like defined benefit packages, limits, authorizations, etc to help make sure that the services being used are really necessary. It's certainly not a perfect system, but it's better than nothing. Everyone can't have everything when there isn't enough money to pay for it.

Except children. Our laws are structured to give the vast and limitless to "children." I believe litigation over the years has virtually eroded whatever boundaries may have existed -- but that's a whole 'nuther subject. By expanding the definition of "child" to age 25, it expands the vast and limitless to a whole new segment of the population. I can't even fathom what the increased cost of healthcare would be just by tacking 4 years onto the current definition of a child.

If we're going to arbitrarily create yet another definition of the age of a child, I wonder if we'll also .....

..... raise the drinking age to 25 since everybody younger is still a child? (How many livers would be spared? How many bars would have to close?)
.... pull the kids under 25 out of the military? (How secure would our nation be then??)
.... get every kiddie under 25 off the road? (Hey, it would reduce fuel consumption and pollution problems, not to mention our roads would be a safer place? Wouldn't it lessen overall car insurance premiums too?)

Personally, I think 25 is too old for someone to be considered a child. I mean, you're just not a kid anymore when you're 25. Yeah, you may be a 20something still going to high school proms, or maybe you're on your 7th year of college. You're just not a child at age 25, and you certainly shouldn't be entitled to the legal benefits afforded to "children." How in the world can someone know when it's time to accept and learn adult responsibility if the age is so blurred? I hope we're not creating a society of Peter Pans.

If I ruled the country, I'd legally define a "child" as under 18. Then, any law (state or federal) that pertains to a child would have to apply my definition. I'd also create some exceptions because, let's face it ... the world ain't black and white, it's lots of colors and shades of grey. Example of an exception: a person who goes on to college and remains a dependent of their parents could have an expanded definition for certain programs (like healthcare) until they turn 21, or maybe even 22.

After that, grow up. You're on your own!

Ok, that's the end. Am interested to hear your thoughts .... if anyone made it this far.


Los said...

Lawyers have certainly driven up the cost of health care with all of the lawsuits (some just, many unjust) against medical practitioners and hospitals ... I'll focus more on them .... basically, because at age 36, I should still be considered a child.

Oh, and the drug companies ... again, ridiculous.

SGM said...

G, you're dead on. A child is 18 or under. 25! For heaven's sake! Much to my dismay, the entitlements will never end - but dang! we don't have to expand them do we?
I got no more to give to anyone else