Wednesday, March 06, 2013

The Church as Lifestyle Maintenance Organization

Back in the 1980's the insurance industry aggresively pushed a scheme called the Health Maintenance Organization (HMO). This was presented to employers and the medical community as a way to lower health care costs by keeping people healthy. People believed this sales pitch, and the HMO business took off. According to a Rand report, "HMO enrollment exploded from 3 million in 1970 to over 80 million in 1999" (p4). Of course, health care costs have not fallen since the introduction of the HMO (p.14), so what went wrong?

As I alluded to in the first sentence, the HMO model was/is a scheme. The primary goal of the scheme is for the insurer to make money. Here is how it works,

1) Identify a population at low risk for utilizing medical services.
2) Convince the employers of that population that their insurance costs will be better managed by this plan.
3) When a covered individual gets seriously ill, count on them eventually losing their job and  winding up on a public health system which will limit the HMO's long term costs (remember the HMO is designed for health maintenance and not illness maintenance).
4) Convince the government to endorse the HMO model (just don't tell them anything about #3).
5) Never bother to define the word "Health."

Do you see the major elements of the scheme? From the get-go, "Health Maintenance" sets an impossible goal.  It was once explained to me as trying to keep perfect health until you suddenly drop dead (the black curve below). That is not what happens for most of us. Most of us can look forward to a gradual loss of "health" often interrupted by sudden deteriorations followed by partial recoveries all the while spending lots of somebody else's money (the red and blue curves).

The scheme of the HMO is to make money off the healthy customers during the flat level of the curve, to take care of short term care, and to shift patients to another payor for long term management once health maintenance is no longer the goal and the downhill slide has begun.

The joke these days is that our government has approved so-called Medicaid and Medicare HMOs despite the fact that much of the target population has one or more chronic illnesses, and many are likely on the negative trajectory side of the curve. These plans have been incentivized by the federal government, and are enrolling patients in great numbers. I have watched their info-mercials while visiting other market areas, and I am impressed with how loving and caring these plans sound. If I were part of the target population, I would be easily taken in by the sales pitch.

What does all this have to do with the Church?

The Church is sometimes referred to as a hospital for sinners. This scheme is the opposite of the HMO scheme. The Church deliberately takes on the sick, and the power of Christ makes people well, or gives them health, and it does so in a way that flips the conventional health/time curve so that it should look like this,

Note that for a few, the path to health is sudden (the black curve), while for most it is characterized by a steady growth despite some ups and down (the red curve), and for some there is a slow and sustained growth in health over time (the blue curve).

How does the Church's scheme work?

1) Identify a population at high risk. This would appear to include everybody.
2) Convince the members of that population that they really are at risk and need this plan.
3) When a covered individual gets seriously ill, nurse them back to health, and don't change the overall plan.
4) Convince the government to keep out of this business.
5) Treat the disease, and actually define ill health as "Sin."

Once again, we see a pattern that is the opposite of the  HMO scheme.

While that may sound like a poor business plan, it has been a very successful one for the past 2,000 years, but for some reason there are a lot of modern churches that don't like this model and they are busy drawing up "Strategic Visions" after they have introduced changes to the classical model. I call this the "LMO" or "Lifestyle Maintenance Organization" church. Here is the scheme:

1) Identify a population at low risk. Once the ideas of Heaven, Hell, and Judgement are taken out of the contract, this population would appear to include everybody.
2) Convince the members of that population that while they are healthy already, your plan can keep them in this state or possibly make them feel even more healthy.
3) When a covered individual gets seriously ill, first counsel them that they are not really ill. If they persist in their delusion, politely explain to them that they would feel more at home in another plan. (remember the LMO is designed for lifestyle maintenance and not for treating the seriously deluded).
4) Convince the government to legitimize things that might cause a person to feel unhealthy.
5) Change what was traditionally considered to be an illness into a sign of good health.

Shouldn't the LMO appeal to more people than the old "church as a hospital for sinners" model? With the LMO an enrollee need not fear the possibility of some God/Man ever suggesting they give up whatever lifestyles they had engaged in prior to joining the LMO. In addition, the LMO promises to help people to maintain their lifestyles, and avoids the use of harsh treatments and bitter medicines such as the humility and repentance prescribed by the traditional Church model.

As more and more churches buy into the LMO plan, look for them to grow as fast as the Episcopal church has over the past 20 years.

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