Monday, January 30, 2006

How Headlines Work

I've always thought that the people who write headlines have one of the greatest jobs imaginable. This is one place in a newspaper where creativity is acceptable. The purpose of the headline is to grab the reader so that the affixed article is read, so with a little discipline and a lot of imagination, the headline writer gets to let loose with his or her creative genius. A prime example of a good headline writer who scored is from an editorial in today's Washington Post. I mean, who could resist a headline that boldly asks The Next Policy Bungle?. I know I sure couldn't.

PRESIDENT BUSH'S State of the Union speech tomorrow night looks set to address health care. Mr. Bush is choosing a ripe topic: The United States spends almost twice as large a share of its economy on health as other rich countries do, yet it still has lower life expectancy and 46 million uninsured people. Some of his team's thinking is good but not entirely new. For example, both Medicare and private insurers are beginning to reward doctors and hospitals that score well on measures of quality and cost-effectiveness. Other administration ideas are good if done the right way, such as caps on doctors' liability. But the president's team is also enthusiastic about the trend toward out-of-pocket payments, which it sees as a way of driving down health costs. Its enthusiasm is misguided.

The theory behind out-of-pocket payments is that patients who pay their bills themselves will shop carefully. This is likely to hold true some of the time but not most of it. Most consumers aren't equipped to distinguish between good medical service and bad; the results of poor service show up only after they've paid for it. A minority of motivated consumers may do the research necessary to judge whether a doctor's advice is sound, but even this minority can't be expected to start poring over medical journals when they are hit by a medical emergency -- and emergencies account for a large chunk of health spending.
[Emphasis added]

"Out-of-Pocket Payments" is an other term for "deductibles" as used in auto insurance claims. The insured pays for the front end costs up to a certain limit, at which time the insurer steps in, at least for a certain percentage of the claim. Some insurance companies set up a system of co-payments instead, with the insured paying a set figure for each office visit, each diagnostic test, each hospitalization. The co-payment system is what Congress is going to set into place within the Medicaid program.

The problem with both is that sometimes there is neither the time nor the money to intelligently deal with the self-financing (even at a partial level)of one's health care, even if the insured sincerely wants to. For most Americans, cash is tight these days, so that non-emergency conditions (hypertension, diabetes) are often disasterously ignored until they reach the emergency stage, even if they are employed and if their employers provide health insurance. Such a plan doesn't come close to dealing with those 45 million who are not insured at all and who do not qualify for Medicaid (where they would still have to come up cash under the new Congressional plan).

The regime's approach reminds me of the MediCare Prescription Plan.

The headline writer for this editorial certainly nailed it.


Blogger Thersites said...

Then there are those of us who don't live in big cities. We don't have too many options. If we're hit with a medical emergency, we go to the nearest hospital, whether it's great or it stinks.

5:22 AM  
Anonymous Interrobang said...

Healthcare just isn't a "consumer" experience. It's not like you can really say, "Well, I think I'll choose the cholecystectomy over the quadruple bypass." This framing of healthcare as something where "consumers" have to "shop wisely" needs to be counteracted quickly and effectively.

6:03 AM  
Blogger Elmo said...

I would have went with "Throw another turd on the shit pile!"

11:59 AM  

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