Buyer Beware or Unaware?

One of those nagging little facts I retain for no particular reason is a phrase I learned in my high school economics class my senior year – caveat emptor. A Latin phrase which means let the buyer beware. The basic concept is that in any given transaction, the one handing over money for goods or services should beware to the best of their ability they are not being taken advantage of. This could be in purchasing a faulty product or not studying the terms of service carefully (a common problem these days when Terms and Conditions of products can be very lengthy and very small print!). If you aren’t careful about how you buy, you might be taken advantage of. Don’t simply trust blindly.

It’s an important concept, as it presumes the buyer is capable of being wary. That they have the requisite skills and understanding to make decisions regarding who they give their money to and in exchange for what. It was a fundamental, undergirding principle of our country for a long time, though I’m not so sure it is any longer.

Of course the buyer can’t possibly know everything. Laws have been created and passed to give buyers protections. Did that new big-screen TV not work out of the box like promised? The seller or the manufacturer or your credit card company – and likely all three – provide you with some level of protection from the reality that despite best intentions and through no deliberate attempt to defraud, goods and services don’t function the way they should.

That’s a far cry from assuming consumers are too stupid to know what they’re doing. But more and more, the assumption seems to be that consumers shouldn’t be held at all responsible for the decisions they make, and that experts should take that responsibility for them.

One example of this is in the field of health care and insurance. Since costs for health care and healthcare insurance continue to skyrocket (perhaps because the system is faulty?!?), and because more and more health insurance companies are covering procedures that are elective in nature and passing the costs on to others (gender change surgeries, abortions, etc.), it’s an important arena for consumers to be aware in. Sometimes it’s simply a matter of taking whatever your employer provides. Other times, you have options or choices, either through your employer or because you are self-employed. Even with your employer, there are usually various options and plans to select from a given provider, and so the consumer is still required to beware what they are purchasing or paying for is really what they want and need.

For seven years now my family has been a member of a health sharing ministry. This decision was made because of concerns of the changes in health insurance in terms of what they decided they would cover (and therefore what we would be helping to pay for), particularly in terms of abortions. We did our research, I talked with at least one person who had been a member for years already, and we read and reread the fine print. Samaritan Ministries did a good job then and now of clearly stating what we were and were not getting and what was and was not covered. We understood not everything was covered, and we understood that our membership and ability to submit needs for coverage was based on a shared set of Christian principles in terms of how we live our lives.

Had our health situations changed substantially (we’re all basically healthy), this might not have been a good option or an option we needed to leave behind. But we’ve so far not ever regretted the decision to move to Samaritan Ministries, and we genuinely feel good, knowing we are helping other Christians in their needs.

But, caveat emptor. And so when I saw this article pop up in a news feed the other day warning against such programs, I naturally read it. After all, regardless of how I feel about something, I want to be well informed.

Firstly, the article is primarily politically motivated, in opposition to a move by the Internal Revenue Service (IRS) to allow health sharing ministries to be considered a form of health insurance and therefore allowing participants to potentially claim their expenses as deductions on their taxes. The article perceived this as an attack on Obamacare (the Affordable Care Act) since it could entice more people to leave traditional health insurance plans and participate in health sharing ministries instead. This would reduce the number of healthy people paying into insurance plans and drive up insurance costs. The goal of the author is to protect the costs of those participating in health insurance plans, rather than to honestly evaluate whether there might be viable alternatives to such plans that could – using market forces – pause or reverse some of the spiraling costs of health care and health insurance. The author’s irritation that health sharing ministries are less expensive than many health insurance plans is palpable.

One particular critique is that health sharing ministries aren’t as comprehensive in their coverage. This is very true. There are many things our membership with Samaritan Ministries don’t cover. This is part of the appeal for us, in some ways, as we don’t want to be funding abortions if we can help it. In other ways, it does serve as a reinforcement to pay attention to our membership and potential needs. If we developed a health condition not covered by our membership, we’d need to evaluate whether we could remain members or not. Likewise, when I’ve been asked by others about our experience, I’ve emphasized that while it works for us, it may not work for everyone and they need to pay attention very carefully to the fine print.

Also as our needs have changed, I’ve been proactive in asking questions of Samaritan. When our oldest son left home for an internship a few weeks ago, I needed to ensure he was still considered part of our family plan, or else we’d need to help him get his own individual plan with Samaritan (or a different insurance plan if he decided to go that route). In all such communications Samaritan has been clear and forthright and prompt. Sometimes less coverage is exactly what you want, because you know you aren’t ever going to need some of the things that aren’t covered.

Yes, this means that someone with a pre-existing condition who opts for a health sharing ministry could end up with some substantial bills they need to pay on their own. That’s why they need to read the fine print very carefully. Yes, someone could simply see the lower monthly share amount and decide it was best to switch out of traditional health insurance to save some money on a monthly basis, and because they ignored the principle of caveat emptor, they could end up hurting themselves financially when things they assumed would be covered aren’t covered. This isn’t because the health sharing ministry is being dishonest or attempting to defraud people. Rather, it’s because health sharing ministries by default and design cover fewer things than traditional health insurance does. That’s not bad (at least it doesn’t have to be) but it does require paying attention to details.

Not that this keeps people from insulting health sharing ministries and, by extension, those who find them valuable.

The Los Angeles Times ran a rather bitter column on the topic of the proposed IRS changes. “Healthcare experts” are invoked nebulously as disapproving of health sharing ministries because of “substandard coverage”, ignoring the fact some such health sharing ministries are intentionally providing less coverage for certain things deemed necessary and essential by experts, such as abortions and elective surgeries for gender reassignment.

I’ll assume the columns assertions that sometimes these plans are marketed in less than honest ways might sometimes happen. Frankly, I don’t see many advertisements for these plans out there, but still, I’m sure it could conceivably happen. That doesn’t mean the plan or ministry itself is dishonest. Unless of course they’re deliberately misleading people, in which case they should be held accountable as any provider of goods or services should be – and not simply because they’re health sharing ministries.

Nineteen state attorney generals think the proposed IRS changes are illegal because of a lack of analysis of the outcomes, and because it could be damaging to existing health insurance markets. Why is it that we are guarding against potential competition in this market? Oh yeah, that’s right. Because this is a government mandated and controlled market to some extent now, and the government apparently didn’t consider the possibility of competition messing up the amazing numbers it used to convince our lawmakers to approve it. Gee. I guess we should just stick with the status quo despite there being potentially good alternatives that give the power and decision making back to the people rather than the government.

Because people apparently aren’t capable of being wary or informed in their decision making. So let’s just eliminate options for them. Much simpler. Very American. Not.

The author asserts that my health sharing ministry is offering me junk, and I’m stupid enough to buy it. While that’s always potentially true (even of insurance companies) my experience thus far is that this is not the case. To assert otherwise in such broad brushstrokes displays the very type of willful or unavoidable ignorance the author is accusing me of possessing and seeks to protect me from.

Unfortunate.

The New York Times weighed in as well with an emotional piece about a young boy with a tragic illness. The implication in the article is that this poor family is going to be ruined because they are members of a health sharing ministry instead of an insurance company. The article has multiple compelling photos of the young boy in various stages of health, and essentially paints the picture this family is being left out to dry by their health sharing ministry – Samaritan Ministries, the same one we use.

But nowhere is that specified in the article.

Instead, the severity of the boy’s situation and treatment and the likely costs of such treatment will likely exceed the cap on per incident issues. Ignoring the fact that Samaritan negotiates with healthcare providers for reduced charges because they will be paid via cash rather than having to jump through insurance hoops hoping for reimbursement. And despite the specific fact – mentioned but lost in the shuffle in the article – that Samaritan has a program specifically to help in such extreme situations. The boy’s family hasn’t been cheated or misled or anything, and there’s no certainty yet the bills will exceed the incident cap, or that Samaritan won’t cover up to the cap, and that there may not be additional funds to help them.

But just the possibility that there could be a problem is enough to justify the attack article. Despite the fact the father defends Samaritan in terms of previous issues they’ve submitted for coverage. Still not good enough.

So, after reading these various articles, I come back to to what my high school economics teacher, Mr. Conway, taught me. Caveat emptor. Know what you’re doing to the best of your ability. But also recognize you can’t know everything, and nothing is guaranteed. The authors of these various articles all give the common impression that health insurance coverage is guaranteed, yet I’m sure we all know someone who was told their coverage wouldn’t be as extensive as they were led to believe, or who were denied coverage for a particular issue.

The New York Times article mocks the company’s exhortation for members to trust in God. But that’s just what it’s members do. Not simply a claim of Christian faith is required for membership but also reasonably verifiable evidence of regular church attendance. Members do trust God, and that’s part of the point of Samaritan Ministries – is faith not simply as a pleasant sounding mantra but something that guides the decisions we make and the money we spend and how we spend it.

I pray these authors never run up against the unpleasant truth that health insurance is not a guarantee of financial safety and security. And I pray they might reconsider whether deliberately opting for programs that don’t cover everything is the same thing as receiving “substandard” care, and whether the potential for misunderstanding is the same as duplicity.

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