• Obama didn’t say nothing on health care

    Here’s the key passage from the State of the Union transcript:

    On Medicare, I’m prepared to enact reforms that will achieve the same amount of health care savings by the beginning of the next decade as the reforms proposed by the bipartisan Simpson-Bowles commission.

    Which means, according to Wikipedia,

    $341 billion in federal health care savings by reforming the Sustainable Growth Rate for Medicare, repeals the CLASS Act (which has already happened), increase Medicare cost sharing, reform health-care tort, change provider payments, increase drug rebates and establishes a long-term budget for total federal health-care spending after 2020 to GDP + 1 percent.

    The details in the full report (PDF) include many sensible directions for further reform. Notes:

    • The SGR savings estimate is now lower.
    • Obama has long advocated for more regulatory intervention of pharmaceutical prices.
    • The Independent Payment Advisory Board (IPAB) or the HHS Secretary if the IPAB is not staffed is charged with keeping Medicare growth under GDP + 1 percent. Last year, Obama wanted to tighten that to GDP + 0.5 percent. Simpson-Bowles would expand the IPAB’s scope to all federal health care.
    • All in all, this is not nothing. Obama said something on health care. He just said it very efficiently.
    • Of course there are political issues. There are always political issues.
    • I do not like Wikipedia’s hyphenation of “health care.”


    • House style for many publications is healthcare now, especially in the UK, regardless of the artificial and unnecessary distinctions between a system or adjective (healthcare) and the process of care or noun (health care). A hyphen as you say is the worst of all worlds.

      • I’m amazed by your comment, Marc, and by Steve Laniel’s. Though you both disagree on the hyphen issue, you both seem to think the spelling changes depending on whether health care/healthcare/health-care is an adjective or a noun. Maybe I’ve been living under a grammatical rock (totally possible!) but this is news to me. Are you aware of a fuller discussion of this?

        • Austin – I didn’t just refer to noun/adjective but also a system (the healthcare industry; the business of healthcare) and giving care (we provided him with the best health care).

          There’s lots of discussion about this on the web and there seems to be a preference for now in the US to keep health care as separate words at least in the second sense.

          In the UK, healthcare in whatever sense is one word in the style guides of NICE (National Institute of Health and Clinical Evidence) and Guardian newspaper and others, but not in some others – eg
          the Economist has health care as a noun and health-care as an adjective. The UK Telegraph also has health care.

          I would say that perhaps more forward-thinking outlets are going for healthcare…

          And here’s a note from the Chicago Manual of Style:

          ‘Finally, I would bet that instances of “health care” in print in one form or another must have grown exponentially in the last fifty years. And whenever a compound becomes common currency, there’s a chance it will evolve to become one word. American Heritage seems to recognize this.’


    • I don’t mean to be William Safire or anything, but “health-care” is appropriate when (and only when) it’s modifying something else. So “health-care tort” is fine, as is “health-care crisis”, but “Billy had no access to health care” requires no dash.

    • Hi Austin. The “health care” noun versus “health-care” as an adjective thing boils down to the phrase “compound modifier”. https://en.wikipedia.org/wiki/Compound_modifier

      For that matter, “compound modifier” is an example: “He researches compound modifiers” versus “Steve Laniel wrote a pedantic post about the compound-modifier problem.”