Health Summit Cheat Sheet
A glossary of health reform words, phrases, and slogans.
Click here for a guide to following the health care reform story online.
On Feb. 25 President Obama will host, from 10 a.m. till 4 p.m., a bipartisan meeting on health care reform at Blair House, across the street from the White House. (A final, updated guest list is here.) The meeting will be televised on C-Span, and it is your patriotic duty to watch it (or at least catch a highlight reel later on). If you do, you'll hear quite a lot of impenetrable jargon; familiar words and phrases used in unfamiliar ways; and obviously coded messages that you may have some difficulty deciphering. To help you understand the proceedings, Slate provides the following cheat sheet—part glossary, part encyclopedia, and part devil's dictionary.
Actuarial value. The percentage of health care costs covered by an insurance plan. For example, a health plan with an actuarial value of 0.80 is one that covers 80 percent of health care costs.
Adverse selection. In health insurance, the tendency of unhealthy policyholders to drive away healthy ones by raising health insurance costs. (See "Death spiral.")
Anthem. Short for Anthem Blue Cross, a unit of WellPoint, which is one of the nation's five biggest for-profit health insurers. Anthem made itself a whipping boy of the Obama administration this month by announcing it would raise its premiums by up to 39 percent. To quiet the ruckus it agreed to postpone the increases by two months. Anthem got spanked in a House hearing Feb. 24.
Antitrust exemption. Insurers enjoy an antitrust exemptionthanks to a 1945 bill sponsored by Sen. Pat McCarran, D-Nev. After the health-insurance lobby trashed the Senate health reform bill, Democrats sought revenge by removing the exemption, and now the White House has endorsed it. The House voted yesterday to repeal it, 406-19. Although insurers oppose this, they aren't terribly worked up about it because the likelihood of antitrust action against insurers is remote. Even most House Republicans voted for repeal in the House.
Baucus, Max. Democratic senator from Montana and chairman of the Senate finance committee. Baucus tried to get bipartisan support for his health reform bill well past the point when it was obvious he wouldn't get it (see "Gang of Six"). In the end the only Republican who voted aye in committee was Sen. Olympia Snowe, who later voted against the bill on the Senate floor.
"Bending the cost curve." The favored health reform catchphrase for slowing the rate of health care spending. Sometimes it refers to private health spending, and sometimes it refers to government health spending. Often the person using the catchphrase isn't sure which he means.
Benefit tiers. The different levels of health benefits to be offered, under health reform, to purchasers through a government-regulated exchange. (See "Exchanges.") In the Senate bill and the Obama proposal, these range from a "Bronze plan" (minimal), to a "Silver plan" (basic), to a "Gold plan" (better), to a "Platinum plan" (best). There is also a catastrophic plan for young people (see "Young invincibles").
Best practices. The health reform bill mandates the collection of national data on which medical procedures have been shown statistically to work best. Eventually, it's assumed, cost savings will be achieved by encouraging doctors to follow these "best practices," but the bill doesn't venture very far into this controversial territory, and there are sound clinical reasons to tread lightly.
Bipartisanship. When used by Republicans, a synonym for "Democratic surrender." When used by Democrats, a synonym for "incorporating into the health reform bill ideas previously favored by Republicans but failing to win Republican votes."
Bishops. The U.S. Conference of Catholic Bishops. It won't support any health reform bill that lacks its favored language on denying unsubsidized abortions to people who purchase private health insurance through a new government-regulated exchange. The Obama proposal lacks that language. (See "Stupak amendment.")
Blue dogs. Conservative Democrats. They either oppose health reform or support it only reluctantly. If health reform fails, it will largely be their fault.
Boehner, John. House Republican leader from Ohio and author of the only official GOP health care plan, which would extend health coverage to only 3 million people (as against 31 million in the Obama proposal).
British model. The socialized health care system in the United Kingdom. Often cited by opponents of health reform, because of its middling track record. Seldom cited by proponents for the same reason.
Brown, Scott. The reason this health care summit is taking place. A Massachusetts Republican, he captured Sen. Ted Kennedy's former seat, denying Democrats a filibuster-proof Senate majority. Brown opposes Obamacare, even though as recently as last summer he seemed to support it, comparing it favorably to the Massachusetts health reform on which it's modeled (which Brown still supports). He is not invited to the Blair House meeting.
Bundled payment. Sending the patient or insurer a single bill for a given procedure rather than sending multiple bills from one or more doctors and the hospital. The goal is to simplify billing and to make a procedure's actual cost more transparent. The health reform bill would create pilot programs aimed at eventually moving taxpayer-funded Medicare and Medicaid toward a bundled payment system.
Cadillac tax. A 40 percent excise tax on family health insurance policies valued above $27,500. The tax is unpopular, especially with unions, and has been watered down repeatedly. Many Washington establishment types, including David Brooks, view this as a terrible moral failure, but that is incorrect. In fact, it's a poorly designed tax based on the mistaken theory that excessive generosity is what makes health insurance expensive.
Cao, Joseph. The only House Republican (he's from Louisiana) to vote in favor of health reform. Cao is now one of a dozen House members threatening to switch their votes from "yea" to "nay" over the abortion issue. He is not invited to the Blair House meeting.
Capitation. Paying doctors a fixed rate per patient rather than paying them for individual medical procedures. (See "Fee for service.")
CHIP (aka, S-CHIP). A state-federal government health insurance program for children. The House bill would eliminate the program and move recipients into the newly established exchanges, but the Senate and President Obama decided to leave well enough alone.
CLASS Act. A little-known provision in the health reform bills, the CLASS Act is a new voluntary and self-financed government health insurance program, spearheaded by the late Sen. Ted Kennedy, that would cover nursing-home and other long-term care.
CMS. The Centers for Medicare and Medicaid Services. Formerly known as HCFA (short for Health Care Financing Administration and pronounced "Hikva," which to me always sounded like the name of Tevye's sixth daughter), these are the folks who run Medicare and Medicaid.
Coburn, Tom. A Republican senator from Oklahoma, he is the meanest and craziest opponent of health care reform. And guess what! He's an M.D.!
Collaborative care. When doctors and hospitals band together, typically to serve low-income or rural patients. The health reform bill would give them some funding.
Community rating. Everybody pays the same for health insurance, regardless of how healthy they are. The health reform bills don't establish pure community rating, but they limit variations in pricing (based mainly on age).
Cost-shifting. A practice in which hospitals overcharge private health insurers to make up for lower fees paid by government health insurance programs like Medicare. It happens, but not nearly as much as opponents of health reform say.
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.
Fee for service. Paying physicians per procedure. This encourages physicians to maximize the number of procedures they perform, not all of which may be medically necessary. Health reform does almost nothing about this problem.
Foster, Richard. The chief actuary of the Centers for Medicare and Medicaid Services. A hero to liberals during the Bush administration because his boss, a political appointee, forbade him to reveal his cost estimate for expanding Medicare coverage to pharmaceuticals, he lately has been a hero to conservatives because he's more skeptical than Elmendorf that Congress can realize its planned Medicare cuts.
Free rider problem. If insurers are compelled to take all comers regardless of pre-existing conditions, that will encourage people not to purchase health insurance until they get sick. This is why all the Democrats' health reform proposals require everyone to purchase health insurance, and provide subsidies to help lower-income people purchase it. Republicans know this problem exists but choose to ignore it. (See "Individual mandate.")
French model. France's health care system, in which doctors, hospitals, and health insurers are all private, though heavily regulated and, in the case of insurers, nonprofit, is generally considered to be of very high quality. Consequently, it is seldom mentioned by opponents of health reform and often mentioned by its supporters.
Gang of Six. Senate finance committee members chosen by chairman Max Baucus to negotiate a bipartisan deal on health reform. They failed, and so Baucus put together his own bill, which cleared the finance committee with only one Republican vote. It was a Gang of Seven until Sen. Orrin Hatch, R-Utah, dropped out.
Gatorade. A special deal secured by Sen. Bill Nelson *, D.-Fla., shielding elderly Floridians already enrolled in the wasteful, privately managed Medicare Advantage program from benefit cuts planned under health reform. This is known as "grandfathering," and Gatorade is a rare instance in which it's done on behalf of actual grandfathers.
Grayson, Alan. A slightly unhingedDemocratic Florida representative who took to the House floor to recite the names of people in Republican congressional districts who died because they lacked health insurance. The GOP was not amused. He isn't invited to the Blair House meeting.
Gruber, Jonathan. An eminent MIT health economist, Gruber's reputation as a disinterested health reform referee was compromised in January when Politico revealed that he'd received $297,600 the previous June from the Health and Human Services department to assess various health reform proposals.
Health cooperatives. The Obama plan's and the Senate's lame nonprofit substitute for the "public option" government health insurance program included in the House bill. Obamacare would appropriate $6 billion to help create them. Probably not worth the trouble.
Health Insurance Rate Authority. A new body that President Obama proposes creating within the Health and Human Services Department to block excessive private health insurance rate hikes.
High-risk pools. You take a whole bunch of people who can't get health insurance elsewhere, because they're too unhealthy, and you get them to share the risk, with the government chipping in, too. The health reform bill proposes this as a stopgap until the exchanges are operational. Republicans propose this as the whole solution. Unsurprisingly, high-risk pools have astronomical premiums. (See "Adverse selection.")
"If you like your coverage, you can keep it." Obama's campaign promise, and a key distorting imperative in health care reform. As Obama himself has pointed out, you can't keep it if your boss takes it away, as bosses are increasingly doing because of out-of-control costs.
Ignani, Karen. President of America's Health Insurance Plans, the health insurers' lobby. The Obama administration is scapegoating health insurers partly because they're the one major health insurance industry that actively opposes the health care reform bill.
Independent Payment Advisory Board. A panel created in the Senate bill and the Obama proposal to find cuts in Medicare.
Individual market (see also "Nongroup market"). Health insurance that isn't obtained through an employer or other group. This is where the worst abuses are, and it's the focus of most health reform provisions.
Individual mandate. A provision in all the Democratic health reform bills requiring everyone to have health insurance or pay a tax penalty. Under the Obama proposal, if you don't have it you pay $695 per year (up to a maximum of $2,085) or 2.5 percent of your household income—whichever is greater.
Individual responsibility (aka, wellness program). The various versions of the health reform bill offer financial incentives to employers to discount health insurance for people with healthy habits. Gun owners lobbied successfully to insert language stating that not owning a gun cannot be deemed a healthy habit.
Intellectually dishonest. Hifalutin' term for "hypocritical." Seldom used by actual intellectuals, but often tossed around by politicians.
(There is no health reform jargon that begins with "J.")
Kennedy, Ted. It is literally true that "this wouldn't be happening if Ted Kennedy were still around." His death occasioned the loss of the Democrats' 60-vote filibuster-proof majority, putting health reform in peril. It was, of course, the great cause of his life, yet his name has not been invoked all that much by either side.
Lieberman, Joe. OnetimeDemocratic nominee for vice president, he is now an Independent. He killed the public option, he killed the Medicare buy-in, and he damn near killed health care reform itself. Senate Majority Leader Harry Reid probably wouldn't mind killing him. He is not invited to the Blair House meeting.
Lifetime cap. Health insurers impose lifetime spending caps on policyholders. Health reform eliminates them.
Louisiana Purchase. In modern usage, a special deal on Medicaid spending for Louisiana that secured Democratic Sen. Mary Landrieu's vote for health reform.
Malpractice reform. The rallying cry of Republican opponents of Obamacare. It's true that the Democrats, hemmed in by their dependence on campaign contributions from trial lawyers, have been reluctant to include much relief from malpractice suits in the health reform bill. It's also true that premiums for malpractice insurance aren't a major driver of health care costs. But malpractice lawsuits drive doctors crazy and probably cause them to practice defensive (i.e. unnecessary) medicine, which imposes costs of its own.
Massachusetts Connector. The precursor of health reform's insurance exchanges under the pioneering Massachusetts health reform that Republicans are loath to call Romneycare because they don't want to admit a leading conservative GOP presidential contender created Obamacare's blueprint.
McCaughey, Betsy. Former lieutenant governor of New York and health policy wonk who played a major role in sinking Hillarycare in 1994 and is trying to do the same for Obamacare. Famously sloppy with facts but still published with some regularity on the Wall Street Journal editorial page.
McConnell, Mitch. Senate Republican leader. He has not put forth any health reform bill, preferring not to pretend he wants any bill at all.
Medical loss ratio. The percentage of the premium dollar that health insurers, under health care reform, are required to spend on health care. In the Obama plan and the Senate bill, it's 85 percent for large group policies and 80 percent for nongroup individual policies.
Medicaid. A state-federal program providing health insurance to the indigent. To be expanded significantly under health care reform.
Medical inflation. The rate of inflation in medicine. Much greater than the general rate of inflation.
Medicare. A federal program providing health insurance to the elderly.
Medicare Advantage. A 2003 experiment allowing private management of Medicare. The theory was that it would be cheaper than government-managed Medicare. The opposite proved to be true, and private companies ended up lavishing extra benefits on customers at taxpayers' expense. These will be pared back under health care reform.
Medicare buy-in. A proposal briefly offered by Senate Majority Leader Harry Reid allowing people too young to be eligible for Medicare to purchase health insurance through the program. Shot down by Sen. Joe Lieberman.
Medicare Part A. The hospital-insurance part of Medicare.
Medicare Part B. The doctor-insurance part of Medicare.
Medicare Part C. See "Medicare Advantage."
Medicare Part D. The drug-insurance part of Medicare.
Medicare surtax. Under the Obama plan, a surtax of 0.9 percent would be added to the existing 1.45 percent Medicare tax for families with income above $250,000. It would also add a corresponding 2.9 percent tax on investments for families in the same income bracket.
Moral hazard. In health reform, the idea that if I give you health insurance you'll go to the doctor too much. Undermined by the reality that if I don't give you health insurance you won't go to the doctor enough, with the result that you'll get sicker and your medical treatment will become very expensive.
Nelson, Ben. Dithering final Senate Democrat to come out in favor of health care reform. Pleasant surprise: He is not invited to the Blair House meeting.
Nuclear option (constitutional option). A way to get around the Senate rule that says you can't change the rules governing filibusters unless you have 67 votes, which is more than you need to filibuster. The vice president declares that Senate rules cannot be imposed from one Congress to another (each one runs two years), and then calls for a simple majority vote to change the rules, invoking usual parliamentary practice and the U.S. Constitution. Sen. Harry Reid won't go near it, alas. The Republicans seriously considered using the nuclear option five years ago to end judicial filibusters, and the Republican Policy Committe produced a document (still online!) saying the option was perfectly legitimate. Now that they're in the minority, they say the nuclear option is a thing of the devil.
"One size fits all." Republican characterization of Obamacare. It isn't true. Obamacare imposes minimum benefits on four or five different levels of private health coverage within the exchanges. (See "Benefit tiers.") It imposes almost no new requirements on employment-based insurance offered outside the exchanges.
Orszag, Peter. The White House budget director and a major evangelist for health reform as deficit reduction, which may have been the wrong approach.
Pelosi, Nancy. House speaker.Rumored to be somewhat disaffected by Obama's leadership style.
Pre-existing condition. Any health problem you know about the day you sign your health insurance policy. It doesn't have to be big to screw you out of coverage. All Democratic versions of health reform would prevent insurers from excluding anyone based on a pre-existing condition.
Premium credits. Subsidies enabling lower-income people to purchase health insurance through the exchanges. They are offered in the form of a refundable tax credit.
Primary care. A visit to your general practitioner or internist.
Providers. Hospitals and doctors.
Public option. A government health insurance program established under the House health reform bill to compete with private health insurers in the exchanges. It's absent from the Senate bill and the Obama proposal. There is some movement to put the public option into a reconciliation bill, but Sen. Jay Rockefeller, one of the public option's strongest supporters, is dubious that can be done without wrecking health reform's chances of passage.
(There is no health reform jargon that begins with "Q.")
Rationing. Scare term used by Republicans to oppose health reform. In fact, the bill imposes no direct rationing at all. Indirect rationing is imposed by the market all the time through the pricing of health insurance and denial of benefits.
Reconciliation. A legislative procedure, permitted on bills thataffect the federal budget, allowing a bill to pass the Senate with a simple 51-vote majority—no filibusters allowed. The White House has signaled its interest in trying to pass health reform this way. The Web site Open Left is keeping a whip count of senators who favor reconciliation. Republicans pretend this is unprecedented for social legislation, but they did it with welfare reform. The GOP and Fox News have propagandistically labeled reconciliation a "nuclear option," but the nuclear option is actually something different. (See "Nuclear option.")
Reinsurance. Insurance for insurers. Another favored Republican solution to the health care crisis.
Rescission. You get really sick. Your insurer then combs through your paperwork to see if you made some minor error in filling out your policy. If you did, they cancel your policy. It's medieval. Even Republicans want to end this.
Risk adjustment. A redistributive scheme in which insurers with sicker patients receive funds from insurers with less-sick patients. The health reform bills require the health and human services department to establish a risk adjustment process for the exchanges.
Rockefeller, Jay. Democratic West Virginia senator and the conscience of health reform. No one in Congress has more consistently talked sense on the issue. He wasn't invited initially to the Blair House meeting, but later was added to the list.
Romney, Mitt. Former Massachusetts governor and future presidential candidate, he created Obamacare's forerunner at the state level and is terrified that conservative GOP primary voters will notice.
Ryan, Paul. Republican House member from Wisconsin and ranking member of the House budget committee. Ryan has proposed eliminating Medicare and replacing it with a voucher system. This endears him to President Obama, who can use him to argue that the GOP, for all its hollering about health reform's cuts to Medicare, would like to pull the plug on it altogether.
Sebelius, Kathleen. Health and human services secretary. Her role in health reform has been largely invisible. Maybe she's just discreet.
Single-payer. A form of health insurance in which the government becomes the insurer. Canada's system is single-payer.
Smith, Adam. Bard of capitalism, exalter of markets. You wouldn't want to go to his primary care physician.
Socialized medicine. A form of health insurance in which the government provides not only the insurance but also the doctors and hospitals. Britain has this sytem. So does Spain and Italy.
Stupak amendment. The House provision in health care reform effectively blocking health insurers who offer coverage for abortion from participating in the exchanges. Rejected by the Senate, it's the only abortion language supported by the U.S. Conference of Catholic Bishops. (See "Bishops.") It probably can't be included in a reconciliation bill because it has no impact on federal spending. That makes it a huge obstacle to passing health reform.
Tauzin, Billy. Departing president of the Pharmaceutical Manufacturers of America, he cut a deal with the Obama White House limiting drug companies' exposure in health reform. Great deal for him, lousy one for the country.
"That dog won't hunt." Fake down-home expression meaning "No." Often used by Washington politicians, but seldom used by those with authentic rural roots.
Three-legged stool. In health reform, a phrase describing the mutual dependence of an individual mandate, a ban on exclusion based on pre-existing conditions, and subsidies to purchase health insurance. (See "Individual mandate" and "Preexisting conditions.")
Trigger. In the health-reform debate, a proposal by Sen. Olympia Snowe, R.-Me., to create a "public option" government-insurance program in the event that private insurers failed to extend coverage and lower costs in the new exchanges. The proposal never won over opponents of a public option. U
Trigger. In the health-reform debate, a proposal by Sen. Olympia Snowe, R.-Me., to create a "public option" government-insurance program in the event that private insurers failed to extend coverage and lower costs in the new exchanges. The proposal never won over opponents of a public option.
Universal health care. Health insurance for everybody. Health reform won't achieve that, but the Obama plan would extend coverage to 31 million of the 45 million uninsured.
Verification. To purchase private health insurance on the exchanges, even unsubsidized private health insurance, you have to verify that you aren't an illegal immigrant. Denying private health insurance to illegal immigrants will drive up the cost of health care, or taxes, or both.
Wyden, Ron. Democratic senator from Oregon, he's the darling of Washington policy wonks because of his proposal to eliminate the current tax exclusion for health insurance and replace it with vouchers. The plan was less than ideal. But Wyden subsequently became an evangelist for opening up the exchanges to as many people as possible, which was a very good thing to do. He wasn't invited initially to the Blair House meeting, but later was added to the list.
(There is no health reform jargon that begins with "X.")
Young invincible. Young people who don't purchase health insurance because they're in rude good health. The Senate plan and the Obama plan create a special category of health insurance just for them to be sold within the exchange. This kind of undermines the principle that the pool should be as large and diverse as possible.
(There is no health reform jargon that begins with "Z.")
2013. The year that health exchanges are up and running in the House bill.
2014. The year that health exchanges are up and running in the Senate bill and the Obama plan.
37. Where the U.S. places in the World Health Organization's international ranking of health systems.
Correction, Feb. 25, 2010: An earlier version of this column referred to Bill Nelson as "Ben" Nelson. Ben Nelson is an altogether different senator, a Democrat from Nebraska. (Return to the corrected sentence.)
E-mail Timothy Noah at firstname.lastname@example.org.
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.