Defining the problem down…

The federal Republican alternative budget proposal that came out earlier this week was widely panned for lack of substance. In fact, for not having any numbers whatsoever.

Christopher Beam at Slate took at look at the words in the proposal, and noticed the signficant use of “universal” access to health care in the document.

But what does it mean? As he points out, President Bush used to say that everybody had “access” through the emergency room–which is not really the case. (Hospitals only have to stabilize a patient, and they are free to bill you, oftentimes multiple times what insurers pay.) If you reduce the size of the problem, then your solution can be similarly small.

When talking the issue through with him, I was reminded about how the term “access” can be used as a low bar or a high bar. When some talk about “access” to care, they simply mean making sure a clinic is available in the county; or that a tax credit is available; rather than the provision of comprehensive health coverage which will provide financial security.

But lots of consumer and public health advocates actually take “access” to be a higher standard than simply coverage. We believe that coverage is crucial, but do providers take it? (CHCF’s Mark Smith argues that Medi-Cal coverage is not access but simply a “license to hunt” for a willing provider, given that many doctors don’t take the coverage.) Is access limited by significant cost-sharing? By an inadequate network of providers? By the lack of interpretation services so the patient can actually talk to their doctor?

Language matters, and sometimes we need to be specific about what we advocate, given the different definition of “universal” and “access.”

But Beam’s main point is one that we should take to heart. “Universal access” is something so popular that politicians of all stripes now embrace the term, even when trying to define it in different ways.

Health Access California promotes quality, affordable health care for all Californians.
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