Implementation Day!

As this posts, on the day of the rollout of the Affordable Care Act, a.k.a. Obamacare, we have the makings of high political theater. As with the implementation of most things (federal laws included), Wagnerian music fills the background of what proves to be a change that will likely fail to live up to apocalyptic expectations. Ditto the government “shutdown.” Nor are we ushering in a new era of universal health and wellness, with songs of praise to the federal bureaucracy breaking out.

I have little of substance to add to what Jon Holmund said in his excellent blog post last week. All I will do is add some reflections from my own vantage point.

Much is written about the trend toward part-time hires and diminishment of hours for existing employees in businesses, which include an eclectic mix from Home Depot to Trader Joe’s to Forever 21. United Parcel Service (UPS) will curtail family benefits. This was all, by some accounts, unexpected among the planners of the legislation. By other accounts, it was part of a conspiratorial plan to make the law unworkable and (Wagnerian music cue here…) force an even more Draconian plan on a stodgy America toward a Canadian/European model. Again, good theater, but I have worked with people that are crafting legislation that they consider essential; they expect all good things will come from it, not that it will be a speed bump on the road to something really good. The president didn’t want to attach his name to a law that would be quickly supplanted because of its inadequacies.

My veterinary practice is small potatoes. I am nowhere close to the fifty-employee threshold that is ostensibly impacted by the new law (see Trader Joe’s, et al. above). So why am I hiring a new receptionist, one who will replace a full-time employee that had health care benefits, one that will work a 28-hour week? It saddens me to do it, because I thoroughly appreciate the fact that my business (like other kinds of medical practices) has traditionally cared for staff that don’t make outstanding wages and that feels some sense of ministry to patients and staff alike. I am just too worried to hire another full-time staff member.

My unscientific talks with other “safe” small businesses (under fifty employees) finds that we all fear what happens if things go terribly wrong—if young, healthy people ignore the mandate to buy health insurance (and thereby subsidize the sick and old). What if these people just pay the penalty (or “tax” as the Supreme Court has determined it) or otherwise feel that a government that sometimes seems incapable of much that would be deemed “competent” will never “find them” to force enrollment in one of the healthcare exchanges? A quick fib on a 1040EZ may be enough to keep Uncle Sam at bay.

If this happens, the premiums we pay, the ones small businesses will face, could be awful. This potentially means eliminating insurance for our staff, people who are struggling to get by as it is, and that is a grievous thing. Will it happen? No-one knows. But fear of the unknown, fear of promises from political figures that have themselves fallen into disrepute, urges caution. I am hopeful that all fears are proven too great, that small businesses, including my practice, will find that it is of little real consequence and that we can go back to hiring full-time employees and letting them join health insurance plans. It’s my Pollyannaish side.

Ironically, I think there may be little appetite to delay the onset of Obamacare, even among its critics in the world of business. Perhaps citizens of the United States feel like we’re on a 9-foot cliff waiting to jump into a cold lake below. We could stand there longer and fear the result a little more, or we could just jump in and then deal with what we will then know. Sink or swim, just don’t keep us hanging. Another year of waiting is hardly something to cheer.

Over the weekend I did a 37-mile bike tour (with my energetic 10-year old son) that offered several things for me to process. One of the things I like about cycling is the way it slows things down. Certainly it lets me face my own mortality—there are parts of me that hurt that I hadn’t expected. But it also makes a rider look at each house we pass, each farm and orchard and lake cottage, and think about those who live inside. Sometimes the people look back, and then the narrative in your mind has faces to connect with it. I thought of my staff, present and future, and I thought of what would happen to my body that is aging (perhaps faster after my ride!) and is now facing the loss of the insurance that my wife’s employer has felt the need to give up in January (one I understand all too well). What do I expect will come of us, and them?

This ride took us past small towns with tiny homes and rural areas with aging mobile homes, past elaborate horse farms and Lake Michigan “cottages” that were worth millions. What happens to the inhabitants of each when cancer strikes? Do I really want a system where the former are denied care and the latter can circumvent the system to get it? Where does my family fit? My sense of distributive justice is stymied by the sense that fallen humanity can’t have it all, and that the gulf between the haves and have-nots has, if anything, been heightened in recent years.

But cycling also helps me face my own idolatry. I can easily ride 100 miles when studying a route on my computer screen. Hills, pedals, knees and rough pavement humble me to reality. And I can fear the consequences of health care policy that could kill me, kill my family, kill my business, pull the safety net out from under me, take away the care I “deserve” as much as the rich weekenders on the Lake Michigan beaches.

And then I have lost trust in a God that I have promised to trust with everything, who has given me a life of which I am only a weak steward. I fear jumping into a cold lake from which I will ultimately be rescued, no matter what, and yet my anxiety ignores my rescuer. Yes, I am to be dedicated to justice and wholeness among human beings while I am on Earth. But I am not to be so lost in the process that I cannot recognize who is in charge, if I am swept up in the drama and fail to appreciate in whose hands my healthcare ultimately lies.

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