The president was right – healthcare is complicated There are lots of reasons, but a big one is language. What something is called can add to or lessen understanding. Sometimes it can be deceptive, giving the impression of a more acceptable definition than the truth. It rarely works for long, but a lot of harm can happen in the meantime. When it’s revealed, it undermines trust for the future.
The most recent example is the Office of Health Strategy’s project to cap healthcare costs, mislabeled as a much less scary “benchmark.”
Managed care is a classic example that spread quickly across Connecticut’s healthcare landscape in the 1990s. The name implies, and promises were made, that insurers would save money by coordinating care, ensuring we would get the care we needed when we needed it. The reality was that managed care plans denied necessary care, reduced payments to providers, and boosted payer profits. When the truth came out, the backlash led to state legislation in 1997 and 1999 with expansive controls on managed care plans.
Other examples include consumer-directed care, which shifts more costs onto consumers; Accountable Care Organizations, large unregulated, unaccountable health systems that are rewarded if they reduce healthcare costs; value-based purchasing, which is mostly about saving money; and short term plans, or more accurately, skimpy insurance plans. In the insurance world, the uninsured are “free riders,” which is offensive on many levels; medical “losses” are what insurers have to pay providers from our premiums for care that is delivered; and “adverse selection” is cherry-picking the most lucrative patients.
Connecticut’s many relentless proponents of capitation, a failed model that pays a set amount per person per month for healthcare, have used many deceptive terms to reinstate the failed, but profitable, model. Deceptive terms include “population-based payment,” which sounds like public health but is the opposite; “modernization,” which is ironic since capitation failed in the 1990s; “global budgets,” which is closer to the truth; and “bundles” or “shared savings,” which are entirely different payment models. None of their attempts to swap out the truth for a pseudonym have worked. We’re on to them.
Connecticut Medicaid has saved $2.25 billion since we ditched capitated managed care plans in 2012.
The latest term to be misused is OHS’ Cost Cap plan labelled as a “benchmark.” According to Merriam-Webster’s Dictionary, a benchmark is “something that serves as a standard by which others may be measured or judged, a stock whose performance is a benchmark against which other stocks can be measured, a point of reference from which measurements may be made, or a standardized problem or test that serves as a basis for evaluation or comparison (as of computer system performance).” A reference for measurement. That sounds as if OHS will be measuring healthcare costs and comparing to other costs or states or what-have-you.
What OHS plans is to cap healthcare cost growth at a level they’ve chosen based on economic metrics never meant for setting limits. According to Webster’s, a cap is “an upper limit (as on expenditures : CEILING.” OHS plans to enforce this cap through confidential negotiations with over-spending providers and industries, without public input or transparency, to develop a confidential plan to cut those costs.
This is directly analogous to Connecticut’s state budget spending cap. If costs exceed a cap based on economic metrics never meant for setting limits, cuts have to be made. The difference is that those cuts are public, arrived at in a public process voted on by elected representatives that answer directly to voters.
If anyone tries to sell you on an idea that sounds too good to be true, be very very wary and don’t trust the labels they give it.
Ellen Andrews, PhD, is the executive director of the CT Health Policy Project. Follow her on Twitter @CTHealthNotes.
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