March 9, 2012

Ki Tisa: Individual health insurance mandate and patient registration?

Filed under: Judaism, Software Blog — marcstober @ 10:29 am

For the past five years of my career I’ve worked on a patient registration system. It keeps track of millions of people for both clinical care and insurance reimbursement. So, when I started to practice my Torah reading for this week’s Ruach Shabbat Family Service (please come!), I couldn’t help thinking it sounded familiar:

When you take a headcount of the Israelites, to register them, for each man give a soul-payment to God to register them, that they will not get a plague by being registered. Those on the registry will give a half-shekel… (Exodus 30:12-13, my translation)

As Jews, we believe that every word in the Torah has meaning. (It better, since I have to basically memorize the cantillation of the reading! :)) I found a few things interesting.

The reason for donation is to avoid a plague. Today, spirituality complements modern medicine, but ancients really believed religious acts could cure physical illness–pre-modern religious leaders were sometimes even keepers of herbal remedies, etc. This sounds a lot like health insurance.

They are only asked for a half shekel. “Half” here has always meant to me that people are not asked to pay their share. There are other campaigns (such as to build the Temple, that we read a few weeks ago) where some give less and some give more, but the half shekel is the same for everyone. Thus, there is value to being a taxpayer even if you take more than you pay in. In modern terms, yes, liberals, some people need public assistance, and yes, conservatives, everyone should be responsible for paying something.

A more subtle point I notice from my IT experience is the focus on individual registrations rather than a count, which are not the same. In a small group, you know each person as an individual and you can count them. In a simple business, you can ignore people’s uniqueness–treat them “as a number,” as we say–because you only care about the totals. Treating each person as a valuable, unique individual and scaling that up to a population of thousands or millions is hard. Often, the techniques for counting totals are at odds with the techniques for counting individuals. In a database, it’s technically easy to retrieve one record or count all records if your data set is small. But, when you have millions of records, you need specialized, separate techniques for “transactional” and “analytic” processing.

Taking this to a higher level, I think perhaps the core Judeo-Christian value (not that Jews and Christians have exactly the sample values) is the value of the individual. It’s interesting that in English we can say that each person “counts,” and yet means, davka, that we are not simply counting them, but recognizing individuality. In healthcare, although we could probably do more with population-based measures, we tend to treat each case as individual. In the synagogue, although we worry about membership numbers, each person gets a chance to go the bimah as a bar mitzvah because we treat each person as an individual.