A Health Care Glossary for Politically Charged Times

August 14, 2009
GeriPal
All Posts, End-of-Life, Health Policy, Palliative Care

Now that we are in an Orwellian world in which words reflect corporate and politically motivated interests rather than reality, I thought that a glossary might helps many of us navigate the shark ridden waters of health reform.

HOW TO USE THIS TOOL

Whenever one of the target words or phrases is used, simply reply by citing the information included under “reality based term”.

HEALTH CARE GLOSSARY

Politically Motivated Term

Death Panel: This term is used politically to scare us into thinking that if the “Obama” plan passes, Gestapo like panels of physicians will pull the plug on any patient (especially if they are old or disabled) with a poor prognosis.

Reality Based Term

Death Panel: Death panels exist now, but not in Medicare and not at the VA. The only “Death Panels” that exist in the current health care system are in private health insurance plans, where a reviewer might deny a life saving service if it is deemed to be too expensive.

The so called “death panels” that are proposed under the Obama plan are really just a payment reform that would allow physicians to be paid for spending time with families and patients who are struggling to make difficult end of life decisions. I defy you to find A SINGLE PERSON who has not appreciated having a physician spend extra time with them during an episode of serious illness of a loved one.

Politically Motivated Term

Consumer Choice: This term is used politically to scare us into thinking that any type of health care reform will deny us of choice of doctor, drug, or treatment.

Reality Based Term

Consumer Choice: Under our current system, for people who are uninsured or underinsured, consumer choice means the freedom to choose between getting treatment and going bankrupt OR delaying treatment and getting sicker or even dying (and then becoming bankrupt). The Institute of Medicine estimated that 18,000 people die each year related to lack of health insurance (IOM, 2001), a number that is estimated to be even higher today (Dorn, Urban Institute2008). Over half of all bankruptcies are related to medical bills (Himmelstein et al, American Journal of Medicine 2007). For those with insurance, consumer choice often means the choice of which for profit insurance company gets the right to deny your claims.

Politically Motivated Term

Government Run Health Care: This term is used politically to scare us into thinking that any type of health care reform will involve “Government bureaucrats” that will deny us of choice of doctor, drug, or treatment.

Reality Based Term

Government Run Health Care: The VA is an example of government run health care, as is the military health care system. There is no mention anywhere in any of the current health reform proposals of anything like the VA. The “public option” would be an insurance plan that would compete with private insurers, similar to Medicare.

As long as we’re dealing with reality, how do these scary “government plans” compare to private?

The New England Journal of Medicine published a study that compared Veterans Affairs health facilities on 11 measures of quality with fee-for-service Medicare. On all 11 measures, the quality of care in Veterans Affairs facilities proved to be “significantly better”(Arsura et al. NEJM 2003). The Annals of Internal Medicine also published a study that compared veterans health facilities with commercial managed-care systems in their treatment of diabetes patients. In seven out of seven measures of quality, the VA provided better care (Asch et al, Annals of Internal Medicine 2004). Scary, huh? For private insurers, its terrifying!

Here’s another scary statistic for insurers. In a recent study published in Health Affairs, guess what insurance was ranked most highly by enrollees? Medicare! In that study, 67% of elders rated Medicare as excellent or very good, 43% of Medicaid recipients rated their insurance as excellent or very good, and in last place only 21% of those with individual plans rated them as excellent or very good (Davis K et al. Health Affairs, July/August2009).

Politically Motivated Term