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Cadillac Health Plans – What Does that Really Mean?

by Bradley Miller on October 20, 2009

Here’s another curiosity of mine concerning the impending healthcare reform – do people really understand what they mean when they demand “good coverage” or the “Cadillac” of care plans?

Think about the etymology of that saying: “The Cadillac of . . . . ” In essence that means the cream of the crop – you can visualize a Cadillac vs Chevy and can most likely give me a list a mile long that details the differences and luxuries of the Cadillac.  Or Audi vs VW.  You get the picture.

But what does a “good” healthcare plan look like? Let alone the Cadillac of health plans?  Can you tell me? Sure – choice of doctors means something, but that choice most likely doesn’t make that big of a difference in your care unless you’re really, really sick.  Does a good healthcare plan give you the option of which hospital you can go to? Or how many days you can stay there? In other words, what is your definition of a good health plan and how do we apply that to the federal reforms?

One comment I often get is that a good health plan won’t jack up rates for pre-existing conditions or cut your insurance if you get diagnosed with a disease.  I agree, but to me that seems more like common sense – sort of “don’t be evil.”  I’ll add these more to the “duh” category for now.  If we as a country leave these provisions out, shame on us.

In medical school we spent many hours at a very famous cancer hospital in NYC – the top floor was reserved for VIPs, with wood paneling and a nursing/guard station at the elevators.  Needless to say, most medical students weren’t allowed anywhere close to the floor.  But, by all accounts, the patients on this floor didn’t receive any better care than those patients on other floors.  In fact, often times they were over hospitalized – too much care, which can be bad, too.  And, their cancer survival rate wasn’t any higher than any other floor – money can’t buy life extension.  Aside from security, this floor didn’t seem to add much to care, despite its Cadillac appearance. Is this good care? High quality care?

For now, I simply want to challenge the way we define “quality healthcare.” The next time you hear someone (or yourself) get enraged over healthcare reforms and the quality of care these reforms will bring, I ask you to reflect on what “quality of care” really means.  What does it mean to have the “Cadillac” of healthcare plans? It might not mean what you think. Is it outcome and health based? Or gold plated with valets at the door? Are these mutually exclusive?  My wager is that it’s not as easy to define the true differences as you may initially think.

This goes deeper than just high quality care – how we define quality care will affect all levels of healthcare reform.  My comment here is that we need to better understand what we mean when referring to high quality care and to be more careful in how it plays out in the coming reform.

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