The words we use affect what we can think, and, from time to time, I’ve tried to resist use of terms that seemed to be designed to put fences around thought.
One example is the term “health reform,” when applied to a specific policy, program or proposal.
Most of us would say we want to reform the U.S. health care system in ways that would make care better and more efficient. But, in reality, one interest group’s “health reform bill” is usually going to be another group’s health system change poison.
So, when I’ve had a chance, I’ve tried to avoid referring to the bills that created the Patient Protection and Affordable Care Act of 2010 (PPACA), or PPACA’s ancestors, siblings or nieces and nephews, as “health reform bills.”
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For similar reasons, I’ve always tried to avoid using the term “consumer-directed health plan” (CDHP), or anything like it, outside of direct quotes or proper names. To me, it’s seemed as if the term CDHP has referred directly to efforts to put patients in charge of personal health accounts. Whether those patients would really be directing their own health care would depend on what the patients were like and what their coverage was like. So, I’ve always tried to use the term “personal health account-based program,” not CDHP.
Today, I was looking at e-mails from companies talking about how great they are at promoting “patient engagement” and patient “consumerism”: Making consumers better health care shoppers.
Right. Because we can see from the PPACA public health exchange experiment how wonderful consumers are at choosing standardized health plans from a fairly small menu of health plans without live-human help. Uh, wait: Consumers aren’t wonderful at that!
But maybe consumers are better at shopping for high-quality, cost-effective diabetes care from a directory that gives 100 endocrinologists’ names, addresses, languages spoken, and star-based quality ratings. Because we’re all born knowing how to shop for endocrinologists, right? And however that star rating system works, it surely encompasses everything anyone really needs to know about a board-certified endocrinologist, right?
Uh, maybe not.
On the one hand: The idea that patients should take charge of helping to hold down the cost of their care seems to me to be absolutely correct.