Friday, August 14, 2009

A Health Care Glossary for Politically Charged Times

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

Socialized medicine: See government run health care, above.

Reality based Term

Socialized medicine: No such thing exists in reality.

12 comments:

Eric Widera said...

Unfortunately, it looks like from multiple sources that the Senate Finance Committee will be excluding the counseling to plan for end of life provision from the "bipartisan" health care bill. It is a shame that a provision that encourages doctors to spend time with their patients is used for such nefarious means.

Eric Widera said...

Oh those death panels. I am speechless after reading this quote from the veteran Iowa senator, Charles E. Grassley.

“There is some fear because in the House bill, there is counseling for end-of-life, and from that standpoint, you have every right to fear. You shouldn't have counseling at the end of life. You ought to have counseling 20 years before you're going to die. You ought to plan these things out. And I don't have any problem with things like living wills. But they ought to be done within the family.”

elderlaw said...

This death panel thing makes me so seethingly angry. Obviously, anyone would appreciate the opportunity to discuss end of life care (either one's own or that of a loved one) with a doctor. Even Chuck Grassley, though surely his such conversation would be fully covered by the Congressional health insurance plan. The thing is, neither he nor any others objecting to the Obama plan really care about end of life counseling or paying for it. What they care about is that they could use the word DEATH while complaining about the bill, thus easily riling the public ire. This is Karl Rove-ish genius slight of hand, using the health of the American public as a pawn in a strictly political game.

Dan Matlock said...

Perhaps we have done ourselves a disservice by using phrases such as "end-of-life" care. We need to adopt some of the rhetorical brilliance used by our opponents and come up with an equally powerful buzz phrase that captures the benefits of PC (I have no idea what this would be but we need it). What about "values driven supportive care" instead of "end-of-life care"? To achieve reimbursement for values driven supportive care, you have to document a discussion of the patient's values and you have to address their symptoms.

Nate Goldstein said...

A well written post Bree! Thanks.

What I am particularly amazed (and by amazed I mean DISTURBED) about is how two words can set back a movement that has made such progress over the past decade. The chasm between the politics of health care and what people actually need from their clinicians gets wider every day.

Alex Smith said...

I agree with Dan that the term "end-of-life" was what sunk this proposal. I've seen Sean Morrison talk eloquently about this issue on a number of occasions -- by tying palliative care too closely to the "d" word, we've lost funders and supporters who are in reality aligned with our mission. "values driven supportive care" is a good descriptive term, but maybe doesn't have enough panache. Maybe "palliative care" has enough cachet to work, without the pejorative connotations that "end-of-life" care has accrued. Expecting that we can change the culture of our death denying society is unrealistic. We need to figure out how to work with what we have.

Alex Smith said...

For those hoping to do something about this mess -- nice piece in Huffingtonpost here:

Five Things You Can Do About Healthcare, In Ascending Order of Difficulty and Commitment

Helen Chen said...

What a great post, Bree! Even people I think are well educated have asked me what I think about the "death panels" in healthcare reform. It is unfortunate that misinformation repeated over and over develops the patina of truth. Sadly, PC does have a PR problem.

Why aren't more people talking about health care as a civil rights issue? While arguably a problematic metaphor, for better or worse, primary and secondary education in this country are run on a "public plan". Those with resources who are dissatisfied still have the right to enter the marketplace using their own funds. In other countries, children whose families cannot afford school fees go without. Isn't free public school education akin to 'gasp' socialism? Isn't it time we had equality (and, I would hope improved quality) in health care too?

Eric Widera said...

I agree with Dan. Mention the word death (or end-of-life) and you are already behind the 8 ball. A good example is the politifal spinning of estate taxes as death taxes. It is a morally questionable tactic but very effective. It’s also something health care professionals are not good at. So what I have decided to do is to create a "spin-o-matic" on geripal . What you do is enter a phrase into the spin-o-matic. After a click of the mouse out pops the proper political re-phrasing.

For instance - I put "We should incentivize end-of-life counseling" into the spin-o-matic this morning. Out popped the following:

"I'm no Washington insider but just a small town doc, but I'm fed up with big business insurance folks and government bureaucrats making decisions about my health care. It's time we take control of our health care decisions by giving you and your trusted doctor time to make medical decisions based on your values."

ken covinsky said...

I totally agree with Dan. I wonder if both palliative care and geriatrics could use more of Eric's spin-o-matic.

I've often wondered if palliative care talks too much about death. It's not that we shouldn't accept the mortality of all living things---but isn't palliative care really about life? Isn't the belief that all days of life have meaning---even the last days- a statement about the sanctity of life?

Palliative care and Geriatrics are the disciplines that care for patients that are often forgotten--including patients who can't be cured of their disease, but who have lost none of their value as human beings and deserve care that improves the quality of their lives. Palliative Care and Geriatrics are the ultimate life-affirming disciplines of medicine.

Sunday Night Basketball Group said...

I also appreciated Bree's post and have started to ponder how to get this type of message beyond the liberal blog-o-sphere. In my view, the push for health care reform thus far has failed to remind the general public about why health care reform is important and how it will address some of their "lived experience" concerns with the current system. I think we need to stop directly reacting to the voices against reform and remind people why reform will help them and others that they know and come up with a better phrase then "the public option" b/c it doesn't seem to be helping to generate reform momementum...

Alex Smith said...

Bill Moyer's take on the health care debate, and the need for Obama to stop playing nice. Worth watching.