Health Summit Cheat Sheet
A glossary of health reform words, phrases, and slogans.
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Dartmouth Atlas. A survey of regional differences in health care spending that suggests spending more doesn't correlate with better care. Made famous by Atul Gawande in a much-cited New Yorker article. The Dartmouth Atlas' findings were recently questioned in the New England Journal of Medicine. Click here for Dartmouth's response.
Death spiral. A situation in which a health insurance plan, by drawing a disproportionate percentage of unhealthy customers, drives up costs, causing healthy customers to leave the plan, which in turn drives up costs further. (See "Adverse selection.")
Doctor fix (aka, "Sustainable Growth Formula"). By law, physician fees under Medicare are supposed to be adjusted annually according to a complex formula. In practice, Congress annually overrides the imposition of the formula and lets doctors set their rates a bit higher. Opponents of health reform cite this as evidence that the bill will never achieve its projected Medicare savings. But in fact, Congress has a mostly good recent record when it comes to realizing planned savings in the program.
Doughnut hole. A gap in Medicare's drug coverage for seniors who spend more than $2,700 annually on drugs but less than $6,154. (These amounts change from year to year.) The Obama plan would eliminate it.
Dual eligibles. People who are eligible for drug coverage through both Medicare and Medicaid. When Congress extended Medicare coverage to pharmaceuticals in 2003, it moved elderly people receiving drug coverage through Medicaid into Medicare. That made sense, because Medicare is more generous. But the Medicaid program was allowed to negotiate volume discounts for the drugs it purchases; Medicare (in an outrageous sop to the pharmaceutical industry) is not. Consequently, moving Medicaid beneficiaries into Medicare cost the government a lot of money. Health reform would do almost nothing to fix this.
Elmendorf, Doug. Director of the Congressional Budget Office, a nonpartisan congressional office that's regarded as the official referee of disputes about health reform's cost.
Employer mandate. The requirement that all employers above a certain size must provide all full-time employees with health insurance. The Obama plan would do this indirectly by leveling a financial penalty on businesses with one or more employees who end up receiving a federal subsidy to purchase health insurance on the new government-created insurance exchange.
Timothy Noah is a former Slate staffer. His book about income inequality is The Great Divergence.
Photograph of President Obama by Mark Wilson/Getty Images.