The Seven Health Care Phrases You Should Never Say Again
Fifty years ago, the late comedian George Carlin once explained the Seven Words You Can Never Say on Television: "You know the ones," he said, "sh*t, pi$$, fu*k..." I'll spare you the rest. But in honor of his famous 1972 album, my new year's resolution is to stop saying certain words and phrases when talking about health care. And I hope you'll join me.
Why? Because words matter. They shape our impressions and our understanding. And when they confuse or mislead, things can go afoul. I can't blame all of America's health care woes on these words, but they sure don't help.
The U.S. Healthcare System – It's not a system. It's a decades-old collection of programs, plans, payers, and providers that are mostly disparate and uncoordinated. No one would actually design what we have.
The U.S. Healthcare System – We provide sick care, not health care. Our medical institutions are designed to address sickness and do relatively little to prevent illness and generate health.
Employer Contribution – Employers LOVE when employees say, "My employer pays my health care premiums." But employers are getting credit for something they don't deserve. We employees EARN our compensation, ALL of it – the salary, benefits, bonuses, vacation, etc. Every dollar an employer contributes for employee health care comes from our compensation. So, let's never say that employers are giving us health care.
Payers – Among those well versed in healthcare-ese, payer means a health insurance company or government healthcare program. But the concept is wrongheaded. Health insurers aren't paying. Those of us who pay health-insurance premiums are the payers. Insurance companies mostly process payments. You pay. They process. Using your money. The same goes for a program like Medicare – the American taxpayer is the real payer, not the government.
High Cost of Health Care – First, let's clarify: cost is the amount of money it takes to produce what you are buying. Price is what you pay. While the prices at many hospital systems are in the stratosphere, the costs to provide care are not. So, it's no surprise that for decades, with all their profits, hospitals have kept health care prices a secret. PatientRightsAdvocate.org, a leader in the fight for our new health care price transparency laws, reports that only 16 percent of hospitals are complying with those laws. As a nation, we spend more than twice what other developed countries spend on health care. It's the high prices of health care – not the underlying costs – that are responsible for what Warren Buffet calls "the tapeworm of the U.S. economy."
Reimbursement – No other industry uses the term reimbursement to refer the payments that generate revenue or profits. Reimbursement is what happens when we buy pizza for the school fair, and the PTA reimburses us. Health care euphemisms such as reimbursement perpetuate the quaint and false notion that providers are simply looking to break-even on the services they altruistically provide. Today, money that goes by the nickname reimbursement generates outsized revenues well in excess of costs for many large hospital systems. In a country where medical debt is a major cause of personal bankruptcy, we need straight talk: health care providers are paid, not reimbursed.
Co-insurance – No other form of insurance has both me and my insurer sharing in the payment of my claims. My insurer, Anthem, has nearly 800 million in net assets per member. Isn't that enough to cover all the risk of my health care costs? If I cause a car accident, my auto insurance policy doesn't pay only an 80 percent co-insurance share of the cost. In fact, state law requires that I have full liability coverage every time I get behind the wheel. It's time we all demand full coverage from health plans.
So, what should we use in place of these words and phrases? First, we need insurance that fully protects us against catastrophes, not 'co-insurance' arrangements that leave us exposed to large amounts we can't afford. And whether it's taxes, salary contributions, premiums, or deductibles – you and I are the payers, nobody else. Second, let's never be tempted to imagine that health care companies are 'reimbursed for their costs.' Like any business, they want to be paid the prices they charge.
Purposeful use of these words will add clarity to the public debate about how we might actually achieve a healthcare system worthy of the name. Failing to do so will leave us stuck in a place where Carlin's Seven Words are all we'll have to describe health care in America.
Jim Jusko is Founder and CEO of FireLight Health LLC, a firm that provides pricing data and analysis on U.S. hospitals. His firm provided independent validation for a recent PatientRightsAdvocate.org report that brought national attention to the need for enforcement of the federal hospital price transparency rules.
