Go For The Gold

Under the Senate's bill, there would be four levels of benefits —

bronze, silver, gold and platinum... while the House bill calls for

three levels of coverage —basic, enhanced and premium.

The New York Times, October 5, 2009

Well, THERE's the problem.

Forget all the discussions about runaway Medicare costs, about needless procedures, about reimbursement rates. Yes, doctors order too many unnecessary tests, and patients are crybabies that won't do the most basic things like lose weight and stop smoking. And insurance companies are slow to recognize alterative treatments that can save lives and money. Juggling and bringing order to all of those factors and a thousand others like them is the reason that the healthcare debate is the most problematic and difficult social discussion we've had since... well... maybe ever.

And it's not like there's any real disagreement that there is a problem. Everybody... Republicans, Democrats, motorcycle enthusiasts, Barry Manilow fans... will concede that while the system works, it is in serious need of a tune-up. It's not like abortion, where there can an honest debate based on fundamental beliefs on both sides. Or conversely like slavery or denying women the right to vote, where it's hard to imagine a time when people could actually muster up an argument justifying either point of view. No, players on both sides agree that action must be taken. It's a difference in method, not intent, that's making us all crazy.

But at present time one of the big sticking points in hammering out a compromise that all (read "all" as in "all Democrats") can live with is the level of coverage that people will be required to have and that insurance companies will be required to offer. As noted in the above excerpt from The New York Times, the Senate and the House have different conceptions. And just as importantly as the actual dollar amounts involved is the names of the plans themselves.

Normally we are quick as a country to embrace new names and their associated rankings. Who among us doesn't know that "super" is bigger than "big," that "grande" trumps "large," that "red" is more of a threat than "orange." If you asked around, most would agree that "black" is better than "platinum." And note that virtually overnight almost the entire country caught on to the Starbucks conceit that when ordering a $2 cup of coffee "tall" really means "small."

It's important because rankings are the stuff by which we decide what we choose and how we live our lives, be it restaurants or movies or the size of a pizza. Sometimes it's relayed as stars, sometimes as forks, other times as colors or precious metals. But whether the designations refer to quality or quantity, we need to be able to compare A to B to C to know what to pick. And if the designations aren't self evident, we don't know which way to turn. I, for one, am thankful my car takes "regular" gas, because unless I looked at the prices I could never remember which was better, "ultra" or "super."

So a major component of any successful reform bill will be not just creating a system that works, but giving names to the parts of that system. Consumers will need an easy, shorthand way to talk about the thousands of rules and regulations that will be enacted. And that means some kind of across the board sizing system that will make it possible to compare apples to apples. Just as clothes come in small, medium and large, we need a simple way to see what size tee shirt to stretch across our individual health care bellies.

In a classic comedy bit called "The 2000 Year Old Man," interviewer Carl Reiner chats with ancient curmudgeon Mel Brooks about his experiences and observations over two millennia. Among other things, Brooks points out that World War II went on longer than it should because we all listened to Churchill and were intent on finding the "Narzis." He shakes his head and laments that if he had only called them by their proper name of "Nazis" we would have found them sooner, and the war would have been over years earlier.

And so it may be with a health care. We think we know the enemy, but we've got to get our terms straight. And unless we can get together and agree that the "enhanced gold ultra" plan should be taxed while all people should have at least "basic blue regular" coverage, we'll never get anywhere.

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Marc Wollin of Bedford wonders why bronze is the lowest Olympic medal there is. His column appears regularly in The Record-Review and The Scarsdale Inquirer.