The president has a sales job to do if he wants the American people to get behind whatever reform emerges from the congressional sausage grinder in the next few days. As part of his pitch, he has been flogging three terms guaranteed to resonate with the public—waste, fraud, and abuse. Who isn’t against waste? Nobody. Who isn’t against fraud? Nobody except those committing it. Who isn’t against abuse? Well, nobody, but what exactly does it mean in the context of health care?
The White House called the president’s initiative “a new effort to crack down on waste and fraud in Medicare, Medicaid, and other government programs through the expanded use of payment recapture audits.” In fact, he signed a presidential memorandum directing all federal agencies and departments to try harder to reclaim the government’s money through the use of these audits. The White House explained that the federal waste of the taxpayers’ money included payments made to the wrong person, for the wrong reasons, in the wrong amounts. And all these wrongs total some $98 billion in lost revenue to the federal treasury. That’s a good chunk that could be used for subsidies to the uninsured—so if the government is to make good on its promise of health insurance for more people, it has to step up its collection efforts.
About the same time the president was educating the public about payment recapture audits, a contributor to a listserv I am on raised a relevant question: Who commits health care fraud, waste, and abuse? Is it mainly the providers or the consumers of health care? Who suffers, and who should be held accountable?
So I thought I would return to the journalist’s own staple—the man-on-the-street interview to see what ordinary people know about health care waste, fraud, and abuse. Would the president score a homer with this one? I stopped by the Union Square Greenmarket in Manhattan and asked customers and sellers what was meant by the terms. Most of the people I talked to struggled to answer my two questions: What do waste, fraud, and abuse mean in the context of health care, and who is responsible for it?
Jeffrey Sanders, age forty-two, said he was “not really sure” what the terms meant, but he was sure it was the government doing the abusing. A twenty-seven year old artist who wouldn’t give his name shook his head and said waste meant waste management and hazardous materials. “I assume it’s the corporations doing it,” he said. “Not necessarily the government. I would hope Obama is talking about that.” Ron Siracusa, fifty-eight, was working at a booth operated by Di Paola Turkey Farms and had a different take. He told me he had been a government employee, and waste was the “excesses of government programs.” Who is responsible for that, I asked? “It’s the politicians,” he said.
One man who was selling pickles wouldn’t give his name or his age and admitted he didn’t know much about health care. He didn’t have insurance but thought the perpetrators of waste, fraud, and abuse were the government and insurance companies. That’s hardly surprising, given how that industry has won the Villain of the Year Award.
A flower seller from Long Island didn’t want to give his name either, but he had plenty to say. Fraud is self-explanatory, he said. “You’re lying and taking money for the wrong reasons. Money spent on health care is not wasteful. Everyone should have the same health care as the politicians. I am sure the abuse is all the way up the chain. Have you looked at a hospital bill? You get charged $30 for a box of Kleenex.”
The flower seller suggested that it was hopeless to try asking elected leaders much about anything substantive. “They are trying to pass a bill. Who knows what’s in it?” He continued: “Congressmen come through the market all the time. But ask them a meaningful question, and they’re out of here. I’ve seen it. Weiner and all.” He was referring to New York Rep. Anthony Weiner.
A few people I chatted with were in the ballpark, sort of. Megan Stone, twenty-nine, was working at a booth selling baked goods. She said it was not individuals who were engaging in waste, fraud, and abuse, but “hospitals, CEOS, CFOs who are pushing money around.” She added “Obama is focused more on the people who really cause the problem.”
Tom Toigo, age fifty-three, said he was active in Democratic politics in upstate New York. To him, health care waste meant that doctors are ordering more tests. He, too, said that it was the insurance companies that were causing health care abuse. “Their perspective is how they can make the most money.”
Twenty-three year old Sierra Carrere was selling beans, grains, flour, and polenta. She knew her merchandise as she explained how to use spelt. She also knew a bit about health care. Abuse in health care, she said, was overmedicating children and giving prescriptions to people who don’t need them. Abuse occurred when people can’t get health care.
What does all this mean for the president’s sales job? He needs to put “waste, fraud, and abuse” near the top of pedagogical to-do list. It seems the public needs to understand the terms along with the individual mandate, affordability, age banding and all the other wonky terms the public is fuzzy on. The White House announcement did talk about boosting transparency. The administration is launching an Improper Payment Dashboard, which would let people see the details on improper payments, view error rates, and so on. But first, the WH needs some transparency in language if it is serious about communicating with the public.Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR's healthcare desk, which is part of our United States Project on the coverage of politics and policy. She also blogs for Health News Review. Follow her on Twitter @Trudy_Lieberman.