THE DOUBLESPEAK OF HEALTH REFORM: WHEN COST CONTROL MEANS COST SHIFTING by Celia Wcislo

The increasing cost of providing care to the uninsured is making health industry and health reform insiders nervous. Some suggest that they want to “control costs” by increasing insurance costs for the working poor. For them, cost shifting to the backs of the working poor and uninsured may give them more control, but it certainly does not constitute cutting the cost of health reform. Here are two current examples of Connector doublespeak on cost containment vs. cost shifting:

Example #1: There are more uninsured than the Romney Administration projected. There are more people signing up for CommCare than expected. We might have a cost problem because of this. So, as the Connector Board is preparing to bargain with the insurance plans that are covering this population, we are being asked to prepare for a fight of “cost containment”. Last month, at the Board meeting, hidden in a slide show were bullets that mentioned the possibility of higher premiums, co-pays or cuts in benefits. While expecting people to pay higher premiums or limiting some benefits is controlling costs for the state (who strongly subsidizes CommCare), it is also shifting costs to consumers who sign up for CommCare. The cost problem of an increased number of uninsured cannot just be shifted onto those least able to pay.

Example #2: Everyone agrees that in today’s medicine, prescription drugs are an essential part of treatment for many diseases.

That is why the Connector has voted to include drug coverage as part of every health plan in the Commonwealth. In turn, the business community is rightfully worried about the cost of this benefit.

Last month, when the Connector debated alternative “cost effective” plans for drugs, the debate wasn’t really about cost control. We all agreed that encouraging generic drug use is more cost effective, and can save a lot of money. What we disagreed on was how high the deductible should be, and what drugs should be covered before the deductible. Translation: How much of the cost were we willing to shift to consumers who need to use brand drugs? If we ask the consumer to pay a higher deductible, the employer will pay less for the benefit. This is another example of cost shifting being talked about as if it was cost control.

The language we use can cloud a problem, or mislead the public. Industry and government leaders should not use doublespeak, in the style of the novel 1984, to fool consumers in 2007. We need to speak the truth and not build a false Ministry of Cost Control when what is being promoted is a new Ministry of Cost Shifting.

Let’s tell the truth. If we have a cost problem, let’s figure out how to reign in costs. But we need to all be part of that solution (providers, insurers, government, business, and the consumer), and not continue to shift the costs to each other.

Celia Wcislo is a member of the Connector board
and Assistant Division Director, 1199 SEIU