Make sure to check out this op-ed in today’s New York Times. The author, John Cougan, is a lawyer for the public commission in Rhode Island that oversees the health care industry. He argues that a huge problem that contributes to the confusion, denial of care, and legal hassle that surround the health care industry is the wording of the contracts themselves.
He begins with a case, for instance, in which a man was denied care and was told that the insurance company was in the process of reviewing the wording of his contract to determine whether a procedure ought to be covered. Translation: the wording was vague and confusing even to the people who wrote the thing. He then quotes several examples of poorly worded, extremely obtuse language found in actual contracts, and discusses how those passages ought to be written to be clear and unambiguous to any modestly educated person literate in standard American English.
Now, I’m not sure if the particular law that he proposes, which is based on grade-level equivalency, is a good idea. But the general idea is right on. Insurance contracts are written with the intention of obscuring the details. This gives the insurance companies flexibility to deny care later on, but it also increases the administrative costs inherent in the system (both parties have to hire lawyers to read and understand the contracts, the ambiguous language leads to increased calls from confused customers), it increases the litigation in the system (as the ambiguity cuts both ways in the language and leads to lawsuits from those denied care), and it’s just a fundamentally unfair practice. Leaving intentional ambiguity in the contracts is also the exact kind of practice that makes sense from the perspective of an insurer trying to protect it’s bottom line, but drives up the health costs of society as a whole.
Contracts that normally literate people can read and understand. An amazing, revolutionary idea. And one that could save society millions of dollars a year.
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