The New York Times last week ran an op-ed entitled, Plain English is the Best Policy, by John Aloysius Cogan Jr., the executive counsel for the Rhode Island Office of the Health Insurance Commissioner, drawing attention to a serious problem with our health care system:
"Every week my office hears from Rhode Islanders who don't understand their insurance coverage and can't get their claims paid," wrote Mr. Cogan. "A cancer patient named Kevin, for example, couldn't figure out why his insurance company had denied his claim for chemotherapy charges. His policy seemed to cover the treatment, but its incomprehensible mishmash of cross-referenced definitions, schedules, exclusions and riders made it hard to tell. When my office pressed company officials to explain the denial, we were told that they were still sorting through the policy; they believed Kevin's claim was not covered, but they needed more time to figure it out. Even the insurance company had trouble understanding its own contract."
"It is hard to believe," Mr. Cogan lamented, "that very many of the 200 million Americans who have private health insurance understand their own coverage."
Here's where I have some news for Mr. Cogan: The 200 million Americans he is referring to don't understand their own coverage because they don't buy their own coverage. Their employers do. Hence, they don't read their coverage, don't know what's in it, and don't really care - till they fall sick and need to use it. One way to fix the problem would be to change the federal tax code so that instead of employers getting a tax deduction for buying individuals insurance, individuals get a tax deduction for buying their own insurance. That'll give them an incentive to read and understand what's in their policies before they sign up. Which, in turn, will give insurance companies an incentive to write these policies in "plan english," just as they do auto, home, life and a myriad other policies that they market to individuals instead of corporate bureaucrats.
But what is Mr. Cogan's solution? He notes that his office's analysis of policies in Rhode Island found that most are written at a college to graduate-school reading level. But the average Rhode Islander reads at an eighth-grade level. So - presto - starting next year, Mr. Cogan boasts, "we have decided to require that all policies in our state be written at that (8th grade) level."
First of all, it seems to me -- and I could be wrong -- that if an average Rhode Islander reads at the 8th grade level, then his main problem is not lack of well-written insuance policies. It is lack of good schools.
But what I am wondering is how will Rhode Island enforce this mandate? Will it have 8th graders read the insurance policies and take a comprehension exam? But then how will it know that the 8th grader reading the insurance policy actually reads at the 8th grade level? Perhaps it will have to mandate SAT exams for all 8th graders? But how will it know that the SAT exam is really measuring what 8th graders ought to be reading at the 8th grade level? Maybe it will have to mandate that the test makers making the exam take an exam first showing that they know what 8th graders should be reading at 8th grade level.
You catch my drift.....
But here's a thought: If Rhode Island can require insurance policies to be understandable to 8th graders, can't we require the same of any health care legislation that Congress passes? I don't know what such a law would look like. But I know that it damn well wouldn't be 1,000-plus pages long. And that would be an improvement right there.