An interesting linguistic anomaly is the idiomatic expression. Idioms are defined as a group of words whose definition — when taken together — is quite different than the meaning of the individual words themselves. We may refer to someone as "feather-brained" or "hopping mad." Though there are neither feathers nor hopping involved, we gain a more colorful understanding of someone who is not too smart or who is really ticked off.
Such is the case with the phrase "The chickens are coming home to roost." There are no chickens involved, of course. We use this idiomatic expression to indicate that today we are experiencing the consequences of earlier decisions. In some sense, this phrase seems to have become a set of bookends for health care in the United States.
Many of the most important medical innovations and techniques used today have been invented or pioneered in this country. For years, those achievements attracted the most forward-thinking researchers and medical pioneers, all seeking to expand the future based on the promise of the present. The free market system worked well; it rewarded risk takers and penalized ideas that didn't work. Universities vied for the top talent by encouraging research and innovation. They created research centers that served a dual purpose: to raise the bar on today's innovations and to mentor tomorrow's scientists.
In 2003, U.S. research and development expenditures were estimated at $95 billion. In 2006, fueled by this capital investment, the United States led the world in medical innovation, whether measured in terms of revenue or the sheer number of drugs and devices introduced. The United States represented three-fourths of the world's biotech revenues and 82% of the R&D spending in biotechnology. While none of us care for the high cost of patent drugs, those dollars helped this country maintain a position as a leader in medical advances.
Hospitals and famous clinics, such as Mayo, Cleveland and others, built world-class reputations on the tide of all of that innovation and invention. Even today, in a world where medical tourism usually connotes Americans going abroad, foreigners seek out care in our country. Earlier this year, the administration approved a visit by Yemeni president Ali Abdullah Saleh, so he could receive medical treatment here. Saleh had suffered serious injuries in a June attack on his palace in the country's capital of Sanaa.
This practice is not confined to world leaders. According to a 2008 report by McKinsey & Co., 60,000 to 85,000 medical tourists traveled to the United States for in-patient medical care. There is enough demand for such services that Kinsey notes that several major medical centers and teaching hospitals have patient centers in other countries to serve patients who want treatment in the United States.
Yet today, there are chickens of another variety coming home to roost. In February, the Catholic Church was broadsided by the administration's dictum that all manner of reproductive services must be provided by employers under PPACA. The church was adamant that this was an intrusion on one of its core principals as well as a violation of the First Amendment to the U.S. Constitution, which prohibits the government from impeding the free exercise of religion.
At the time of this writing, the administration's tortuously nuanced "accommodation" (these services will be made available through the insurance company rather than through the employer directly) is being viewed by many in the religious community as a distinction without a difference. It also neglects to account for the many larger, self-insured plans where the insurance company or third-party administrator merely processes claims that are directly funded by the employer.
White House Chief of Staff Jack Lew, appearing on "Fox News Sunday" on Feb. 12, said, "I think what the president announced on Friday is a balanced approach that meets the concerns raised both in terms of access to health care and in terms of protecting religious liberties. And, you know, we think that's the right approach."
