America is dying: Language is key

The healthcare debate frequently takes the forefront of partisan politics, but there are many reasons why language like “Obamacare” and “Trumpcare” is problematic. Associating presidential administrations with entire healthcare systems creates bias and misinformation. According to a report by the New York Timesone-third of Americans do not know that Obamacare and the Affordable Care Act are the same. Of course people would be confused, and it’s naive to think otherwise. This begs the question: How much does the general public really know about the healthcare that they use?

As a disclaimer, this piece is not to shame Americans about their “lack of knowledge,” but rather to unveil a system that is so messy and labyrinthine that even myself, a student majoring in community health, struggles to reconcile its complexity. It’s an interesting concept to think about: You, as a consumer, purchase your health insurance plan. So, by virtue, you should be able to access your schedule of benefits (a list of all the services that are covered under your plan along with pricing) pretty easily. After all, you own it.

So, I tried it. I went out to actively find my schedule of benefits. I perused the internet, made phone calls, visited the website and asked my parents for help. After two entire weeks, I got my hands on it. I obtained three files — all in different locations on the internet — that explained each aspect of my health coverage: a 17-page schedule of benefits, a 77-page provider manual and a 72-page prescription drug formulary. In each of these documents were words like “deductible,” “copayment,” “coinsurance” and “pre-authorization.” According to The Washington Post, only 14 percent of all participants in a survey answered all four questions regarding “the most basic insurance features” correctly (deductible, copay, coinsurance and maximum out-of-pocket). These words are not self-explanatory, so how exactly can we expect average Americans to effectively use a system that’s impossible for everyone to understand?

In every field, the language we use is important. In healthcare, it’s not just important, it’s essential. If only 11 percent of people can correctly estimate the cost of a four-day hospital visit (I was unable to accurately estimate the price using my schedule of benefits), we simply cannot expect patients to have value-based interactions with the healthcare sector. An important tenant of public health is “health literacy,” which is one’s ability to effectively understand and use health-related information. A goal of public health professionals is to promote health literacy, particularly among vulnerable, underserved populations; however, just based on the little experiment I did, that dream is a bit lofty.

Being vague is not the answer when it comes to public health, and this goes beyond just health insurance. We need to reevaluate how we distribute health-related information to patients in every sector of the workforce including food labels, consent forms, warning labels and online health information. It took five minutes of me scrolling aimlessly through my documents to learn a really important lesson: Language is key, and we need to simplify it.


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